The others delivered educational content via the Web and provided participants with weekly phone calls or email by a study staff member. Another study delivered a single 60 min Web-based program to provide transfer training. Yet, a handful of internet-based studies have been conducted over the last 3 years that have provided participants with SCI 8 to 12 weeks of website access that included physical therapy education, taught self-management strategies to increase frequency of intermittent catheterization, reduced depressive symptoms, and reduced pain. Despite increased use among people with SCI, there has been substantially less use of the internet to connect with people with SCI. Furthermore, the internet has successfully been used to promote physical activity.

The internet is increasingly used to deliver relatively low-cost health behavior change programs to populations with chronic health problems such as diabetes, cancer, and asthma. Thus, the internet offers a potentially promising platform to connect with individuals living with SCI who face transportation barriers and reside in communities with fewer accessible physical activity options.

Although people with SCI report lower rates of internet access, 2 studies published in the last decade indicate that 65% to 70% people have computer access, and most of these individuals (63%-92%) use the internet. Nearly three-quarters (73%) of Americans have home broadband access, and 37% of Americans report using smartphones as their primary means of accessing the internet. The internet has dramatically transformed how we conduct our daily lives, and according to the Pew Research Center, nearly 9 in 10 adults reported accessing the internet in 2018. The Potential of Internet Use for Intervention Given pervasive transportation difficulties facing people with SCI, the internet may offer a feasible and promising approach to help bridge the transportation barrier in delivering interventions that promote health for people with SCI. Transportation continues to be a leading barrier to participation for people with SCI across various health-related lifestyle changes, including physical activity. Vissers et al and Levins et al reported that people with SCI described both environmental barriers such as inaccessible buildings, lack of available programs, and societal attitudes as well as personal factors that were barriers such as physical and mental health problems and concerns about body image.

Although several studies have examined barriers to physical activity that people with SCI face, people living with SCI encounter lack of access to timely and quality health information (eg, SCI-related medical issues and regarding fitness or health promotion) and have fewer opportunities to engage in community-based physical activity than those without a disability. Nevertheless, evidence is limited regarding effective approaches to promote regular participation in physical activity for people living with chronic SCI. Furthermore, the consortium strongly recommends that people with SCI do at least 150 min of physical activity each week beginning as soon as possible after acute SCI, in line with national physical activity guidelines for all Americans. Lifestyle intervention is recommended as the first line of treatment to reduce CMD risk, with a focus on nutrition (ie, follow a heart-healthy diet) and physical activity. The consortium posits that CMD may be more challenging to treat in those with SCI than the general population and advocates for aggressive prevention. CMD refers to the presence of at least 3 of 6 chronic disease risk factors that include abdominal adiposity, dyslipidemia, hypertension, insulin resistance or glucose intolerance, proinflammatory state, and prothrombotic state. Clinical practice guidelines published by the Consortium for Spinal Cord Medicine recognize that people with spinal cord injury (SCI) face greater risk for cardiometabolic disease (CMD) than the general population.

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