Psychosocial Factors of Physical Activity among People with Disabilities: Prospective Cohort Study

Purpose/objective: This study aimed to 1) explore the associations between psychosocial factors and physical activity behavior in people with physical disabilities and/or chronic diseases, both between and within persons over time; and 2) examine whether these associations differ for people initiating and people maintaining physical activity behavior.Research methods/design: Data of 1256 adults with physical disabilities and/or chronic diseases enrolled in the prospective cohort study Rehabilitation, Sports and Active lifestyle (ReSpAct) were analyzed. Self-reported physical activity and four main psychosocial factors (i.e. self-efficacy, attitude, motivation, social support) were measured with questionnaires 3-6 weeks before discharge (T0) and 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. Hybrid multilevel regression models (corrected for age, sex, education level, diagnosis, counseling support) were used.Results: Multivariable significant between-subject associations were found for self-efficacy (β=.094 17 95%CI .035 – .153) and intrinsic motivation (β=.114 95%CI .036 – .192). Multivariable significant within-subject associations were found for identified regulation (β=-.038 95%CI -.072 – -.005) and intrinsic motivation (β=.049 95%CI .016 – .082). Effect modification of initiating or maintaining physical activity was found for the between-subject association of attitude (p=.035). No significant associations were found for social support, amotivation, external regulation and introjected regulation.Conclusion/implications: This study is the first that explored the between- and within-subject associations between psychosocial factors and physical activity over time in a large cohort of adults with physical disabilities and/or chronic diseases. The findings indicate the importance of intrinsic motivation, identified regulation and self-efficacy in initiating and maintaining physical activity behavior

RehabMove 2018: Stimulating physical activity in hard-to-reach physically disabled people; systematic development of a community-based intervention

PURPOSE: Physically disabled people participate less in physical activity (PA) than healthy people. Most existing PA interventions are rehabilitation- or school based, limiting their reach. The current study aims to develop a community-based intervention for stimulating PA in hard-to-reach physically disabled people. METHODS: Intervention Mapping (6 steps) was used for systematically developing a PA intervention. Health related quality of life (HRQoL) of physically disabled people was measured using the RAND-36. Requirements on an intervention were investigated using qualitative research among experts and physically disabled people. RESULTS: HRQoL was poorer in physically disabled people compared to healthy people (step 1). Since experts expressed no need for a new intervention, the existing intervention “Activity coach” (Dutch: Beweegcoach) was adapted to the requirements of experts and the target population. Within the adapted intervention, “Activity coach+”, participants will be reached by a network of intermediate organizations. Participants will have a physical assessment by physiotherapists, and will be individually guided to organized or non-organized activities by an activity coach. Participants will monitor and set goals for daily PA using an activity tracker. Participants will be coached one year (step 4). Activity coaches were trained and network meetings were organized to support adoption and implementation (step 5). Activity coach+ is implemented in community March 2017, and will be evaluated using a mixed-method design. PA will be objectively monitored, and health effects will be evaluated using questionnaires and physical assessments after 0, 2, 4, 6 and 12 months. Experiences with the intervention will be determined using qualitative research (step 6). CONCLUSION: Activity Coach+ included a community-based intervention for stimulating both organized and non-organized PA in hard-to-reach physically disabled people, and is currently under evaluation

RehabMove 2018: Effectiveness and feasibility of Activity Coach+; a physical activity intervention in hard-to-reach physically disabled people

PURPOSE: Physically disabled participate less in physical activity (PA) compared to healthy people. Existing PA interventions are mainly performed in rehabilitation-, school- or primary healthcare settings, limiting their reach. Systematic development applying Intervention Mapping resulted in the community-based intervention Activity Coach+, aiming to stimulate both organized and non-organized PA in hard-to-reach physically disabled people. The purpose of this study was to test effectiveness and feasibility of Activity Coach+. METHODS: Activity Coach+ was implemented in community, and evaluated using a longitudinal study including measurements at baseline, and after 2, 4, 6 and 12 months. PA behavior was measured using the Activ8 accelerometer and the adapted SQUASH questionnaire. Body mass index (BMI), waist circumference, systolic blood pressure, hand grip force, 10 meter walk test, 6 minute walk test and Berg Balance Scale were measured to assess health changes. Bio psychosocial health was assessed using the RAND-36, Exercise Self-Efficacy Scale, Fatigue Severity Scale and IMPACT-S questionnaire. Data was analyzed using non-parametric Friedman tests. RESULTS: Currently, results of the first four months after implementation of Activity Coach+ are present. During the first four months, 29 hard-to-reach physically disabled people participated in Activity Coach+, of whom two dropped out. PA behavior did not change within the first four months. BMI (p=.004), 10 meter walk test (p=.001), 6 minute walk test (p=.020), dynamic balance (p=.014) and vitality (RAND-36) (p=.049) increased over time after implementation of Activity Coach+. A relevant trend was found for the increase of hand grip force (p=.055). CONCLUSION: Activity Coach+ was found feasible in a community setting. First indications for effectiveness of Activity Coach+ in hard-to-reach physically disabled people were provided. Long-term effectiveness of Activity Coach+ will be presented at the conference

Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care: Protocol of the Physicians Implement Exercise = Medicine (PIE=M) Development and Implementation Project.

Contains fulltext : 229883.pdf (publisher's version ) (Open Access)BACKGROUND: The prescription of physical activity (PA) in clinical care has been advocated worldwide. This "exercise is medicine" (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. OBJECTIVE: This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. METHODS: PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. RESULTS: This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. CONCLUSIONS: The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients' health, while minimizing the burden on clinicians