Promoting Physical Activity in People Who Have a Long-Standing Spinal Cord Injury

The main objective of the study described in this thesis was to examine the effectiveness of a 16-week self-management intervention –called HABITS- in changing the level of physical activity of people who have lived with a spinal cord injury for a long time. We also examined whether the self-management intervention contributed to an improvement in the level of exercise behaviour of the participants and whether it resulted in an improvement in their self-management skills. We have performed a randomized controlled trial. This study showed no diffences between the intervention (HABITS) and the control group. In addition, the study tested the validity of a newly developed device for appropriately measuring the physical activity of the participants; this was based on an activity monitor that measured their self-propelled wheelchair driving. This study showed high validity results. The main research of this thesis was based on a theoretical model of the relationship between self-management skills and physical activity. This model was based on two behavioural change theories: the transtheoretical model of behavioural change and the theory of planned behaviour. A further aspect of the study, therefore, was to investigate the relationship between self-efficacy and physical activity, testing the hypothesis that, among people with a long-standing spinal cord injury, those who have a higher level of self-efficacy level have higher activity levels. We have confirmed this hypotheses

The Activ8 activity monitor: Validation of posture and movement classification

Introduction: To set up and guide interventions with the aim to increase physical activity and lower sedentary behavior valid monitoring of physical behavior is essential. The aim of this study was to evaluate the validity of the single-uni

Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial

Background. Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. Objective. The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. Methods. This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. Results. Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes (P ≥.05). Conclusions. A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude

Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury:The HABITS Randomized Clinical Trial

BACKGROUND: Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. OBJECTIVE: The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. METHODS: This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. RESULTS: Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes ( P ≥ .05). CONCLUSIONS: A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude

Wheelchair-specific fitness of persons with a long-term spinal cord injury: Cross-sectional study on effects of time since injury and physical activity level

Purpose: To study the impact of time since injury (TSI) and physical activity (PA) on fitness of persons with spinal cord injury (SCI). Method: Cross-sectional study. Persons with SCI (N = 158) in three TSI strata: 10-19, 20-29 and ≥30 years after SCI and divided in an active and inactive group. Fitness [peak power output (POpeak) and peak oxygen uptake (VO2peak)] was assessed. Results: In persons with tetraplegia, no significant relationship was found between TSI and fitness after controlling for confounders, while a higher activity level was related to a higher POpeak in this group. Active people with tetraplegia also showed less decline in POpeak with an increase in TSI compared to inactive people. In persons with paraplegia, after controlling for confounders, it was shown that TSI had a negative effect on POpeak, while PA was not significantly associated with fitness in people with paraplegia. Conclusions: In people with paraplegia, fitness was significantly lower in those with a longer TSI. Persons with a long TSI might need more attention to remain fit and PA might be an important element in that respect as shown by the results of the group with a tetraplegia.Implications for RehabilitationWheelchair-specific fitness seems to diminish over time after paraplegia.An active lifestyle is related to wheelchair-specific fitness in persons with tetraplegia.Prevention of long-term deconditioning is very important