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Rauch, Alexandra (2017): Physical activity in people with spinal cord injury in Switzerland. Dissertation, LMU München: Medizinische Fakultät
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Abstract

Spinal cord injury (SCI) is a devastating health condition by leading to the deterioration or loss of a number of functions depending on an intact spinal cord and consequently to limitations and restrictions in a variety of activities and domains of participation. Due to the decrease of physical capacity, people with SCI have increased risks to develop secondary conditions, which again possibly contribute to premature death. Accordingly, people with SCI still have a shorter life expectancy compared to the general population. Among the leading causes of death in SCI are cardiovascular diseases for which physical inactivity represents a significant risk factor. In general, physical activity (PA) can improve both mental and physical health in people with SCI. People participating in sport or other PAs show lower levels of mental disorders. Furthermore, regular leisure time PA and specific exercises can improve fitness and reduce the risks for secondary conditions. However, to achieve physical health benefits recommendations on PA suggest regular specific endurance and muscle strengthening training with a defined minimum of intensity and duration. In a number of studies in different countries it could be shown that PA levels are ra-ther low, in particular for some subgroups. Since it is likely that PA behavior depends on the culture and context in which people are living, PA levels may vary in different countries. As-sociates and determinants with PA levels have been investigated and identified mainly environmental factors to associate with participation in PAs. However, a comprehensive understanding of the associations with PA rarely exists yet due to the lack of a comprehensive model explaining PA in people with SCI. For the development and implementation of programs to promote PA country specific information is essential to target the programs to the specific needs of the SCI population. For Switzerland, no data on PA levels and according associations with PA levels for people with SCI exist to date. The general objective of this doctoral thesis is to describe PA levels and their associates in people with SCI in Switzerland for the first time. Specifically, it aims to describe LTPA (sport and exercise) levels and the achievement of recommendations on PA in the Swiss SCI population and to identify associations with PA levels by applying comprehensive models. The results should provide stakeholders responsible for the development of programs promoting PA in people with SCI in Switzerland with relevant information. The first study aimed to describe the frequency of participation in sport (PiS) and to identify correlates for PiS in persons with SCI in Switzerland. It could be shown that about 60% of the study sample (n=505) participated in sport at least once a week. However, PiS decreased significantly from the time before the onset of SCI to the time of the survey (P<.001). Sport levels were significantly lower in women than men for the time of the survey (P<.001), whereas no difference was observed before onset of SCI (P=.446). Persons with tetraplegia participated significantly less often in sport than persons with paraplegia (P<.001). Lesion level, active membership in a club, frequency of PiS before the onset of SCI, and the subjective evaluation of the importance of sport correlate with PiS. When controlling for gender differences, only the subjective importance of sport for persons with SCI determines PiS, particularly among women. The objective of the second study was to describe physical activity (PA) levels by considering distinct types and intensities and the achievement of the World Health Organization (WHO) recommendations on PA in persons with SCI and to investigate associated factors. In this study it could be shown that participants (n=485) carried out PA a total of 6.0 hours/week (median) whereas most time was spent to carry out PAs with only light intensity (median 2.2 hours/week). 18.6% were physically inactive, 50.3% carried out muscle-strengthening exercis-es, and 48.9% fulfilled the WHO recommendations. Furthermore, it was found that women, people aged 71+, and people with complete tetraplegia had significantly lower odds of fulfilling the WHO recommendations than participants in the respective reference category (men, ages 17-30, incomplete paraplegia). The third study aimed to explore associations with PA levels by applying a comprehensive model based on the ICF framework. The specific aim was to identify those aspects that potentially explain being physically active and the achievement of the WHO recommendations on PA (ACH-WHO-REC) in people with SCI. This study showed that higher levels of social support and self-efficacy significantly increased the odds of being physically active. For ACH-WHO-REC, the use of an intermittent catheter increased, whereas being dependent in self-care mobility and coping with emotions by focusing on and venting of emotions decreased the respective odds. Furthermore, experiencing hindrances due to accessibility is associated with increased odds for ACH-WHO-REC. For both PA outcomes, older age decreased, but being a manual wheelchair user increased the odds to achieve the outcome.