Automatically tailored exercise app training is feasible, usable, and safe for people with paraplegia: a parallel mixed methods pilot study

Mobile exercise apps for people with paraplegia that offer accessible and customized exercise programs have the potential to promote fitness and health in this population. However, there is a lack of suitable exercise apps that do not require the support of healthcare professionals for exercise progression. The ParaGym app was designed to automatically tailor and progress the training intervention using an algorithm. This study aimed to assess the feasibility and safety of the exercise program, as well as the usability of the app to determine whether the app should be further developed.

Twenty-three participants with chronic paraplegia (mean age 48 ± 13 years, 15/8 male/female) performed three app-delivered exercise sessions per week over six weeks. A mixed-methods approach was used to comprehensively assess feasibility, usability, and safety based on semi-structured interviews, exercise diaries, adherence and retention rates, the System Usability Scale (SUS), and reported adverse and severe adverse events. Interviews were analyzed using structured qualitative content analysis.

Interview themes comprised satisfaction, adherence and motivation, training sessions and exercises, technical functionality, ease of use, and perceived safety. Participants expressed overall satisfaction with the app, as affirmed by the intention to continue use, an adherence rate of 70%, and a retention rate of 88%. Exercises were overall suitable and feasible, supported by easily understood videos and descriptions. Areas for improvement included frequent transitions between wheelchair and floor exercises and insufficient time to change positions during timed exercises. The mean SUS score was 84 ± 11, indicating good usability. This was confirmed during interview sessions. No adverse events occurred, and participants reported feeling safe during the training.

The app-delivered exercise sessions were overall feasible, and the app was easy to use. Further development is indicated and should prioritize practical considerations, such as grouping floor exercises, integrating additional safety considerations, and providing features for the user to further personalize the program. A future marketable and publicly available version for wheelchair users of all fitness levels can make a valuable contribution to low-threshold leisure opportunities.

German Clinical Trials Register (DRKS00030370), October 25, 2022.