Luc H. van der Woude

Physical activity for people with a disability: a conceptual model

The promotion of a physically active lifestyle has become an important issue in health policy in first-world countries. A physically active lifestyle is accompanied by several fitness and health benefits. Individuals with a disability can particularly benefit from an active lifestyle: not only does it reduce the risk for secondary health problems, but all levels of functioning can be influenced positively.The objective of this article is to propose a conceptual model that describes the relationships between physical activity behaviour, its determinants and functioning of people with a disability. The literature was systematically searched for articles considering physical activity and disability, and models relating both topics were looked for in particular. No models were found relating physical activity behaviour, its determinants and functioning in people with a disability. Consequently, a new model, the Physical Activity for people with a Disability (PAD) model, was constructed based on existing models of disability and models of determinants of physical activity behaviour. The starting point was the new WHO Model of Functioning and Disability, part of the International Classification of Functioning, Disability and Health (ICF), which describes the multidimensional aspects of functioning and disability. Physical activity behaviour and its determinants were integrated into the ICF model. The factors determining physical activity were based mainly on those used in the Attitude, Social influence and self-Efficacy (ASE) model. The proposed model can be used as a theoretical framework for future interventions and research on physical activity promotion in the population of people with a disability. The model currently forms the theoretical basis for a large physical activity promotion trial in ten Dutch rehabilitation centres.

Contractile properties and fatigue of quadriceps muscles in multiple sclerosis.

Functional characteristics of electrically stimulated quadriceps muscles of patients with multiple sclerosis (MS) were determined to investigate whether adaptations in muscle properties contribute to the higher fatigability of these patients. The estimated maximal isometric force generating capacity of MS patients was only 11.2% (P < 0.05) lower than control subjects. However, the patients were only able to voluntarily exert 75 ± 22% (n = 12) of their maximal capacity, against 94 ± 6% (n = 7) for the control subjects. There were no differences in muscle speed, suggesting that muscle fiber distribution was not different in the MS patients due to reduced muscle usage. During a series of repeated contractions, greater decrements occurred in isometric force and in maximal rate of force rise in the MS patients (by 31.3 ± 10.3% and 50.1 ± 10.0%, respectively; n = 13) than control subjects (23.8 ± 6.6% and 39.0 ± 8.1%, n = 15), suggesting a lower oxidative capacity. The results indicate that increasing the mass of their muscles by training may help to reduce the excessive muscle fatigue of MS patients.

Mechanical loading of the low back and shoulders during pushing and pulling activities

The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the initial and sustained exerted forces and the mechanical load on the low back and shoulders. Detailed biomechanical models of the low back and shoulder joint were used to estimate mechanical loading. Using generalized estimating equations (GEE) the effects were quantified for exerted push/pull forces, net moments at the low back and shoulders, compressive and shear forces at the low back, and compressive forces at the glenohumeral joint. The results of this study appeared to be useful to estimate ergonomics consequences of interventions in the working constraints during pushing and pulling. Cart weight as well as handle height had a considerable effect on the mechanical load and it is recommended to maintain low cart weights and to push or pull at shoulder height. Initial and sustained exerted forces were not highly correlated with the mechanical load at the low back and shoulders within the studied range of the exerted forces.

Coronary heart disease risk indicators, aerobic power, and physical activity in men with spinal cord injuries

OBJECTIVE To compare the lipid and (apo-)lipoprotein profile and blood pressure of men with long-standing spinal cord injuries (SCI) to those of an age-matched able-bodied (AB) population, and to assess the most important determinants of this profile and blood pressure. DESIGN A cross-sectional study of persons with chronic SCI residing in the community. SETTING Tests were performed in a university research laboratory. SUBJECTS Thirty-seven men (age 37.4 +/- 12.0 yrs) with longstanding (14.7 +/- 8.6 yrs) SCI ranging from level C4/5 to L5 volunteered to participate. Comparisons were made with published data from 3,498 AB men, age 20 to 59 yrs, from the same country. MAIN OUTCOME MEASURES Lipid and lipoprotein profile (total cholesterol [TC], high-, low-, and very low-density lipoprotein cholesterol [HDL-C, LDL-C and VLDL-C, respectively], and triglycerides [TG]), as well as aerobic power, activity level, anthropometric variables, and blood pressure. Multiple regression analyses assessed the most important determinants of the lipid and blood pressure profile. RESULTS None of the lipid variables were related to the lesion level. TC, HDL-C, and TC/HDL-C were not significantly different from the AB population. The most important determinants of TC, LDL-C, and the ratios TC/HDL and HDL-C/LDL-C were age, smoking behavior, and activity level. Aerobic power was not an important determinant of any lipid or (apo-)lipoprotein or blood pressure. CONCLUSION Men with long-standing SCI do not appear to have an essentially different coronary heart disease risk profile compared with AB persons. Modifiable risk factors such as activity level, smoking, alcohol consumption, body mass index, and adipose tissue were more important than lesion level and aerobic power in the determination of the lipid and lipoprotein profile, suggesting several potential interventions.

Successfully improving physical activity behavior after rehabilitation.

Purpose. To determine the effects of the physical activity promotion programs Rehabilitation & Sports (R&S) and Active after Rehabilitation (AaR) on sport and daily physical activity 1 year after in- or outpatient rehabilitation. Design. Subjects in intervention rehabilitation centers were randomized into a group receiving R&S only (n = 315) and a group receiving R&S and AaR (n = 284). Subjects in six control centers (n = 603) received usual care. Setting. Ten Dutch rehabilitation centers. Subjects. Subjects consisted of 1202 rehabilitation patients. Most frequent diagnoses were stroke, neurological disorders, and back disorders. Intervention. Both the sport stimulation program (R&S) and the daily physical activity promotion program (AaR) consisted of personalized tailored counseling. Measures. Two sport outcomes and two daily physical activity outcomes were assessed with questionnaires at baseline and 1 year after rehabilitation. Analysis. Multilevel analyses comparing both intervention groups to the control group. Results. The R&S program showed no significant effects. Intention-to-treat analyses in the R&S + AaR group showed borderline significant improvements in one sport (odds ratio [OR] = 1.66, p = .02) and both physical activity outcomes (OR = 1.68, p = .01 and regression coefficient = 10.78, p = .05). On-treatment analyses in the R&S + AaR group showed similar but stronger effects. Conclusions. The combination of the R&S and AaR programs improved physical activity behavior and sport participation 1 year after in- or outpatient rehabilitation. The R&S program alone did not have any effects.

Changes and Determinants of Life Satisfaction After Spinal Cord Injury: A Cohort Study in The Netherlands

OBJECTIVE To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation. DESIGN A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured. SETTING Eight rehabilitation centers in The Netherlands. PARTICIPANTS Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Life Satisfaction Questionnaire. RESULTS Mean satisfaction with life +/- SD as a whole was 5.3+/-0 before SCI and 4.3+/-1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (beta=.31, P<.05), pain (beta=.19, P<.05), and secondary impairments (beta=.22, P<.05). CONCLUSIONS Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.

Recovery of life satisfaction in persons with spinal cord injury during inpatient rehabilitation.

van Koppenhagen CF, Post MW, van der Woude LH, de Groot S, de Witte LP, van Asbeck FW, van den Heuvel W, Lindeman E: Recovery of life satisfaction in persons with spinal cord injury during inpatient rehabilitation. Objective: To determine the course of life satisfaction of persons with spinal cord injury and its determinants during inpatient rehabilitation and up to 1 yr after discharge. Design: Prospective cohort study of 222 persons with spinal cord injury. Measurements at the start of active rehabilitation, after 3 mos, at discharge, and 1 yr after discharge. Questions about current life satisfaction and current life satisfaction compared with life satisfaction before spinal cord injury were asked and analyzed, and the sum score Life Satisfaction Total of these questions was analyzed using a multilevel regression analysis. Person and injury characteristics and secondary impairments at each measurement were analyzed as possible determinants of the Life Satisfaction Total score. Results: Estimated Life Satisfaction Total scores improved from 5.3 (SE, 0.16) at the start of active rehabilitation up to 6.5 (0.17) at discharge and remained stable (6.5; 0.16) during the first year after discharge. Significant determinants of a positive course of life satisfaction were less pain, fewer secondary impairments, and better functional status. Conclusions: Life satisfaction already improves during inpatient rehabilitation. Functional status, pain, and secondary impairments must be treated adequately in multidisciplinary rehabilitation.

Prospective Analysis of Lipid Profiles in Persons With a Spinal Cord Injury During and 1 Year After Inpatient Rehabilitation

OBJECTIVES To investigate the course of lipid profiles during and 1 year after inpatient rehabilitation of persons with spinal cord injury, and to determine which personal, lesion, and lifestyle characteristics influence the changes in lipid profiles over time and among subjects. DESIGN Multilevel regression analysis of measurement points during and after rehabilitation. SETTING Eight rehabilitation centers in The Netherlands. PARTICIPANTS People with complete and incomplete paraplegia and tetraplegia (N=180). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and the TC/HDL ratio. RESULTS We found a significant decrease in TG and TC/HDL during inpatient rehabilitation and a significant increase in HDL during and after inpatient rehabilitation. TC and LDL, however, showed unfavorable increases after clinical discharge. The changes in HDL and LDL over time differed between lesion groups. An increase in the body mass index (BMI) led to an unfavorable change in all lipid profiles. Older participants showed higher TC, LDL, and HDL concentrations. Women and participants who consumed some alcohol, or who were more active 1 year after discharge, had more favorable HDL levels. CONCLUSIONS Lipid profiles improved during inpatient rehabilitation but deteriorated somewhat after clinical discharge. Controlling ones BMI seems important in diminishing the risk for unfavorable lipid profiles.

Underlying Mechanisms of Improving Physical Activity Behavior after Rehabilitation

Background: Regular physical activity is beneficial for the health and functioning of people with a disability. Effective components of successful physical activity promotion interventions should be identified and disseminated. Purpose: To study the underlying mechanisms of the combined sport stimulation program “Rehabilitation & Sports” (R&S) and daily physical activity promotion program “Active after Rehabilitation” (AaR). Method: Subjects in four rehabilitation centers received R&S + AaR (n = 284). Subjects in six control centers (n = 603) received usual care. Physical activity and its determinants were assessed with questionnaires at seven weeks before and nine weeks and one year after rehabilitation. Results: Variables that were determinants of the intervention-induced improvement in physical activity behavior at both follow-up measurements were attitude, the perceived benefits “improved health and reduced risk of disease,” “better feeling about oneself,” and “ improved fitness,” and the barrier “limited environmental possibilities.” The percentage change in the intervention coefficient caused by these determinants ranged from –35.3% to –16.3% and from –28.4% to –11.3% at nine weeks and one year after rehabilitation, respectively. Conclusion: Personalized tailored counseling interventions can improve physical activity behavior in people with a disability by targeting both personal and environmental determinants of physical activity behavior.

Work Technique in Relation to Years of Experience among Parcel Delivery Drivers

Goal of this study was to examine whether experienced parcel delivery drivers use a different work technique while loading their truck than their inexperienced colleagues. The results showed that experienced workers significantly spent more time for unofficial breaks during work compared with their inexperienced colleagues. No significant differences were reported for other work technique variables such as use of ergonomic devices and trunk posture.