PhD defence H. (Hedwig) Kooijmans

People who have lived with a spinal cord injury over a long period generally tend to be physical inactive. Previous research has shown that people who suffer a spinal cord injury become less physically active, and that their level of physical activity continues to decrease. Their activity levels are especially low compared to the general population and it is even lower than that of people with other chronic conditions. Conversely, a physically active lifestyle can improve the health of people with a spinal cord injury; for example, physical activity reduces the risk of cardiovascular disease, prevents secondary health disorders and increases physical fitness, as well as improving the individual’s quality of life. Previous research has shown that behavioural change to develop a healthier, more active lifestyle requires more than just information about the benefits of physical activity or physical fitness training. There have been indications that a self-management intervention would be an effective way to improve physical activity levels. Such an intervention would combine the provision of information with active learning strategies and behavioural change techniques to increase the individual’s self-management skills. These skills facilitate behavioural change so that the individual develops and maintains a more active physical lifestyle. Examples of self-management skills related to physical activity are: Self-efficacy, the confidence in being able to exercise more; Attitude, the pros and cons the individual feels about physical activity; Social Support, the support for becoming more physically active received by the individual from his or her environment; and Proactive Coping, the development of strategies by the individual in advance to solve potential problems that may restrict him or her from becoming more physically active. 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 public defence will take place at the Prof. Andries Queridoroom, 3rd floor Education Center, Erasmus MC. The ceremony will begin exactly at 13.30 hrs. In light of the solemn nature of the ceremony, we recommend that you do not take children under the age of 6 to the first part of the ceremony.