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Met dit onderzoek werd de relatie tussen verschillende karakteristieken van beweeg gedrag en determinanten van gezondheid, en tussen verschillende karakteristieken van beweeggedrag onderling, verkend bij mensen met een lichamelijke beperking of chronische ziekte. Inzicht in deze relaties kan bijdragen aan fundamentele kennis over de onderliggende mechanismen van beweeggedrag en gezondheid. Hierdoor wordt het mogelijk gerichtere beweegadviezen te geven op basis van de verschillende karakteristieken van beweeggedrag, met als doel gezondheid te bevorderen.

De Nederlandse overheid heeft de ambitie om burgers in 2020 de beschikking te geven over een persoonlijke gezondheidsomgeving (PGO). Met deze digitale toepassing wordt het mogelijk om gegevens van verschillende zorginstellingen en zelf verzamelde informatie over gezondheid op één plek te verzamelen, in te zien, aan te vullen en te delen. De burger bepaalt met wie welke informatie wordt gedeeld. Een PGO is daarmee een wezenlijk andere toepassing dan een elektronisch patiëntendossier of portaal van een afzonderlijke instelling. Een PGO heeft een levenslang karakter. Op landelijk niveau wordt gekeken naar standaarden om kwaliteit en gegevensbescherming te garanderen (MedMij afsprakenstelsel).

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.

Study Design Cross-sectional study.Objectives To describe experienced sitting-related health and stability problems among persons with paraplegia (PP) or tetraplegia (TP) and to investigate associations with personal, lesion and wheelchair characteristics as well as satisfaction with sitting posture.Setting Dutch community.Methods A self-report questionnaire on seating was developed and completed by wheelchair-users living with Spinal Cord Injury (SCI) for >= 10 years (N= 264). Sitting-related problems and satisfaction with sitting posture were compared between participants with PP and TP using Chi-square and t-tests. Logistic regression analyses were performed to investigate associated characteristics.Results Reported sitting-related problems comprised: sitting to be tiring (regularly to always) (33%), sitting to be painful (28%), pressure ulcers in the last three months (29%), instability while sitting (8%) and instability during reaching (33%). Except for instability during reaching, no differences in occurrence of sitting-problems were found between lesion-group. Persons with TP were more dissatisfied with their sitting posture than persons with PP: 51% vs 36% (p = 0.022) and 51% and 47% respectively thought their sitting posture could be improved (p = 0 .670) . 'Experienced lack of support in the wheelchair' was associated with most sitting-problems. Pain and instability were associated with dissatisfaction with sitting posture.Conclusion Sitting-related problems and dissatisfaction with sitting posture were frequently reported by persons with long-standing SCI. Sitting problems appeared to associate with lacking support in the wheelchair/seating. A comprehensive feedback from the wheelchair user and a stability check (reach task), as part of the wheelchair/seating-user fitting, may contribute to prevention of sitting-related problems.

Study design: Cross-sectional surveyObjectives: To describe computer and Internet use (other than for work or study) among people with long-standing spinal cord injury (SCI), examine associations between demographic and lesion characteristics and Internet use, and examine associations between Internet use and mental health, participation, and life satisfaction.Setting: Community, The NetherlandsMethods: Participants were 265 individuals living with SCI for at least 10 years, who were 18-35 at the onset of SCI, aged 28-65 at the time of the study and wheelchair-user. Scales for General and Health-related Internet use were developed.Results: Nearly all (97.7%) participants had Internet access and 98.4% of those used it daily or weekly. Of those with tetraplegia, 47.4% had assistive devices for computer use. General Internet use, such as following news and online banking, was very frequent. Websites with information on general health or accessibility were typically visited a few times a year. Three-quarters never visited websites of other individuals with SCI or foreign websites with information on SCI. General Internet use was associated with male gender, younger age, and higher education. Participants with tetraplegia scored higher on Health-related Internet use compared to participants with paraplegia. Health-related Internet use was associated with worse participation, but not with the other psychosocial variables.Conclusion: Internet has become part of daily life of people with SCI in the Netherlands. However, only one association between Internet use and indicators of psychosocial functioning was found. Possible underuse of adaptive devices and of SCI-specific websites warrant further investigation.

A short maximal steep ramp test (SRT, 25 W/10 s) has been proposed to guide exercise interventions in type 2 diabetes, but requires validation. This study aims to (a) determine the relationship between W-max and (V) over dotO(2)peak reached during SRT and the standard ramp test (RT); (b) obtain test-retest reliability; and (c) document electrocardiogram (ECG) abnormalities during SRT. Type 2 diabetes patients (35 men, 26 women) performed a cycle ergometer-based RT (women 1.2; men 1.8 W/6 s) and SRT on separate days. A random subgroup (n = 42) repeated the SRT. ECG, heart rate, and (V) over dotO(2) were monitored. W-max during RT: 193 +/- 63 (men) and 106 +/- 33 W (women). W-max during SRT: 193 +/- 63 (men) and 188 +/- 55 W (women). The relationship between RT and SRT was described by men RT (V) over dotO(2)peak (mL/min) = 152 + 7.67 x W-max SRT1 (r: 0.859); women RT (V) over dotO(2)peak (mL/min) = 603 + 4.75 x W-max SRT1 (r: 0.771); intraclass correlation coefficients between first (SRT1) and second SRT W-max (SRT2) were men 0.951 [ 95% confidence interval (CI) 0.899-0.977] and women 0.908 (95% CI 0.727-0.971). No adverse events were noted during any of the exercise tests. This validation study indicates that the SRT is a low-risk, accurate, and reliable test to estimate maximal aerobic capacity during the RT to design exercise interventions in type 2 diabetes patients.

Rehabilitation treatment may be improved by objective analysis of activities of daily living. For this reason, the feasibility of distinguishing several static and dynamic activities (standing, sitting, lying, walking, ascending stairs, descending stairs, cycling) using a small set of two or three uniaxial accelerometers mounted on the body was investigated. The accelerometer signals can be measured with a portable data acquisition system, which potentially makes it possible to perform online detection of static and dynamic activities in the home environment. However, the procedures described in this paper have yet to be evaluated in the home environment. Experiments were conducted on ten healthy subjects, with accelerometers mounted on several positions and orientations on the body, performing static and dynamic activities according to a fixed protocol. Specifically, accelerometers on the sternum and thigh were evaluated. These accelerometers were oriented in the sagittal plane, perpendicular to the long axis of the segment (tangential), or along this axis (radial). First, discrimination between the static or dynamic character of activities was investigated. This appeared to be feasible using an rms-detector applied on the signal of one sensor tangentially mounted on the thigh. Second, the distinction between static activities was investigated. Standing, sitting, lying supine, on a side and prone could be distinguished by observing the static signals of two accelerometers, one mounted tangentially on the thigh, and the second mounted radially on the sternum. Third, the distinction between the cyclical dynamic activities walking, stair ascent, stair descent and cycling was investigated. The discriminating potentials of several features of the accelerometer signals were assessed: the mean value, the standard deviation, the cycle time and the morphology. Signal morphology was expressed by the maximal cross-correlation coefficients with template signals for the different dynamic activities. The mean signal values and signal morphology of accelerometers mounted tangentially on the thigh and the sternum appeared to contribute to the discrimination of dynamic activities with varying detection performances. The standard deviation of the signal and the cycle time were primarily related to the speed of the dynamic activities, and did not contribute to the discrimination of the activities. Therefore, discrimination of dynamic activities on the basis of the combined evaluation of the mean signal value and signal morphology is proposed.