Gaps in the Evidence

Several gaps in the literature were identified in this chapter.  First, more comprehensive population-level data is required to fully understand physical activity participation levels in the SCI population (Wilroy & Knowlden 2016). Existing studies are limited by the challenges in physical activity measurement in this population, inconsistencies in reporting, a focus on aerobic (rather than distinguishing between aerobic and strength-based) activity, and a predominance of studies from high-income countries. Future research advances in physical activity measurement and reporting are needed.

Second, there is a paucity of research describing the factors (i.e., correlates, barriers, facilitators) that influence participation in physical activity among persons with SCI in low- and middle-income countries. A starting point for intervention development in low- and middle-income countries is to explore the multilevel factors influencing participation.  In high-income countries, researchers should move beyond reporting correlates, barriers and facilitators to participation, to incorporate this knowledge into interventions that aim to alleviate barriers and increase physical activity-related psychosocial and behavioural outcomes.

Interventions that aim to increase physical activity participation among persons with SCI have continued to evolve in the past decade. While both informational and behavioural strategies are promising to include in interventions aimed at physical activity-related psychosocial and behavioural outcomes, high-quality experimental designs testing the impact of a given strategy with larger sample sizes are required. Incorporating theory into the design and evaluation of the intervention would offer guidance about the mechanisms of change for these interventions (Best et al. 2017). Given physical activity participation requires sustained effort over time, future intervention research should focus on evaluating the long-term impact of interventions (Best et al. 2017). In addition, authors are encouraged to include more specific and thorough intervention descriptions in publications to allow for replication/future development to build the existing literature base (Tomasone, Flood et al. 2018).

Finally, given the recent upwelling of interest in translating physical activity promotion efforts in the community and clinical settings, more studies that unpack implementation strategies that support intervention uptake and effectiveness on physical activity behaviour are required (Best et al. 2017). This translational research should be done in partnership with stakeholders from the SCI community (e.g., persons with lived experience, community organizations, health care providers) to ensure feasibility and maximal impact on physical activity participation among persons with SCI (Best et al. 2017); the use of SCI-specific principles to guide this collaborative work is encouraged (Gainforth et al. 2021).