Tele-exercise in individuals with spinal cord injury: a systematic review.

Background: The coronavirus disease 2019 (COVID-19) pandemic has seen the emergence of tele-exercise as a mean of remotely providing physical activity. This is particularly crucial given that individuals with spinal cord injury (SCI), often engage in lower levels of physical activity due to barriers such as transportation issues and financial limitations. Given the potential the tele-exercise for individuals with SCI, this study aims to characterize research on tele-exercise interventions in this population focusing on the approach (synchronous, asynchronous, or hybrid), platform, intervention details, duration, adherence, outcomes, and improvements. Methods: A review was conducted using the Embase, Scopus, and PubMed databases, adhering to the PRISMA reporting checklist. Studies on "tele-exercise" and "teleexercise", without specifying SCI in the search terms were screened. Inclusion criteria were limited to English-language articles published up to April 2024. Articles in poster or editorial format and grey literature were excluded. The decision was made to exclude gray literature and focus solely on studies published in peer-reviewed scientific journals. Two reviewers (B.L.R. and R.R.G.C.) independently screened the titles and abstracts of the initially retrieved articles, and then discussed them to ensure agreement. Results: The review identified twelve articles (seven studies with intervention, three studies as projects, one study as cross-sectional analysis and 1 study as theorical framework). Most studies (58.3%) employed synchronous tele-exercise interventions, with Zoom software being the most prevalent platform (41.7%). Interventions primarily focused on muscle strength (75.0%) and aerobic training (75.0%), with a median duration of 8.0 weeks. The mean (standard deviation) adherence was 67.3% (18.7), with variations observed between sex and approaches (synchronous, asynchronous, or hybrid). The most commonly assessed outcomes included physical activity levels (58.3%), adherence (33.3%), pain (25.0%), and physical activity behavior (25.0%). Significant improvements were noted in health status, physical capacity, and tele-exercise implementation. Conclusions: Tele-exercise interventions, predominantly utilizing synchronous methods and emphasizing muscle strength and aerobic training, are effective and feasible for individuals with SCI. These interventions contribute to improved health outcomes and increased exercise adherence, establishing them as a viable option for promoting physical activity among individuals with SCI. However, the results should be interpreted with caution as the quality of the studies was not considered in this review.