title: Personal and environmental factors to consider when aiming to improve participation in physical activity in children with Spina Bifida: a qualitative study.
abstract: BACKGROUND
  Youth with spina bifida (SB) are less fit and active than other groups with childhood disability. While recent studies have shown benefits of exercise training, the increased fitness levels do not sustain or lead to increased levels of physical activity (PA) in these children. Therefore, it seems important to explore which factors are associated with participation in PA (or lack of) in youth with SB. The objective of this study is to describe both personal and environmental factors that are important for participation in physical activity as experienced by these children and their parents, in order to better develop intervention strategies to improve participation in PA in youth with SB.
  
  
  METHODS
  Eleven semi-structured interviews with parents of children with SB aged 4-7 years, nine focus groups with youth with SB (n = 33, age 8-18 years) and eight focus groups with their parents (n = 31) were conducted, recorded and transcribed verbatim. Two independent researchers analyzed the data. Central themes for physical activity were constructed, using the model for Physical Activity for Persons with a Disability (PAD model) as a background scheme.
  
  
  RESULTS
  Data showed that youth with SB encountered both personal and environmental factors associated with participation in PA on all levels of the PAD model. Bowel and bladder care, competence in skills, sufficient fitness, medical events and self-efficacy were important personal factors. Environmental factors that were associated with physical activity included the contact with and support from other people, the use of assistive devices for mobility and care, adequate information regarding possibilities for adapted sports and accessibility of playgrounds and sports facilities.
  
  
  CONCLUSIONS
  Our findings suggest that a variety of both personal and environmental factors were either positively or negatively associated with participation in PA. An individual approach, assessing possibilities rather than overcoming barriers within and surrounding the child may be a good starting point when setting up intervention programs to improve participation in PA. Therefore, assessment of both personal and environmental factors associated with physical activity should be standard care within multidisciplinary intervention programs aimed to encourage healthy active lifestyles in youth with SB.
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, 101, 3584, CJ, Utrecht, The Netherlands. Manon.bloemen@hu.nl.|Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands. Manon.bloemen@hu.nl.
authors.forename: Manon A T
authors.initials: MA
authors.lastname: Bloemen
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583TM, Utrecht, The Netherlands. o.verschuren@dehoogstraat.nl.
authors.forename: Olaf
authors.initials: O
authors.lastname: Verschuren
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, 101, 3584, CJ, Utrecht, The Netherlands. claudiavanmechelen@hotmail.com.
authors.forename: Claudia
authors.initials: C
authors.lastname: van Mechelen
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, 101, 3584, CJ, Utrecht, The Netherlands. hanneke.borst@student.hu.nl.
authors.forename: Hanneke E
authors.initials: HE
authors.lastname: Borst
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, 101, 3584, CJ, Utrecht, The Netherlands. arina_deleeuw@hotmail.com.
authors.forename: Arina J
authors.initials: AJ
authors.lastname: de Leeuw
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, 101, 3584, CJ, Utrecht, The Netherlands. mars_ha@hotmail.com.
authors.forename: Marsha
authors.initials: M
authors.lastname: van der Hoef
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, 101, 3584, CJ, Utrecht, The Netherlands. Janke.degroot@hu.nl.|Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands. Janke.degroot@hu.nl.
authors.forename: Janke F
authors.initials: JF
authors.lastname: de Groot
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities; D015444:Exercise / Q000502:physiology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010290:Parents; D016135:Spinal Dysraphism / Q000503:physiopathology*