Self-reported leisure time physical activity: a useful assessment tool in everyday health care.

BACKGROUND: The individual physical activity level is an independent risk factor for cardiovascular disease and death, as well as a possible target for improving health outcome. However, today's widely adopted risk score charts, typically do not include the level of physical activity. There is a need for a simple risk assessment tool, which includes a reliable assessment of the level of physical activity. The aim of this study was therefore, to analyse the association between the self-reported levels of physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS) question, and cardiovascular risk factors, specifically focusing on the group of individuals with the lowest level of self-reported PA. METHODS: We used cross sectional data from the Intergene study, a random sample of inhabitants from the western part of Sweden, totalling 3588 (1685 men and 1903 women, mean age 52 and 51). Metabolic measurements, including serum-cholesterol, serum-triglycerides, fasting plasma-glucose, waist circumference, blood pressure and resting heart rate, as well as smoking and self-reported stress were related to the self-reported physical activity level, according to the modernized version of the SGPALS 4-level scale. RESULTS: There was a strong negative association between the self-reported physical activity level, and smoking, weight, waist circumference, resting heart rate, as well as to the levels of fasting plasma-glucose, serum-triglycerides, low-density lipoproteins (LDL), and self-reported stress and a positive association with the levels of high-density lipoproteins (HDL). The individuals reporting the lowest level of PA (SGPALS, level 1) had the highest odds-ratios (OR) for having pre-defined levels of abnormal risk factors, such as being overweight (men OR 2.19, 95% CI: 1.51-3.19; women OR 2.57, 95 % CI: 1.78-3.73), having an increased waist circumference (men OR 3.76, 95 % CI: 2.61-5.43; women OR 2.91, 95% CI: 1.94-4.35) and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98), compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above. CONCLUSION: The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.

Invited commentary on "Level of evidence in four selected rehabilitation journals".

Level of evidence has been studied in 4 selected rehabilitation journals in the article by Kocak, Unver, and Karatosun. However, other journals within the rehabilitation field would also have been relevant to study to get a more comprehensive analysis. Examples of such journals are mentioned in this commentary. The limitations of the traditional impact factor are discussed, and the use of a 5-year impact factor is suggested. The categorization of journals used and the lack of definitions of the categories are criticized. The importance of publishing more randomized controlled trials and systematic reviews in rehabilitation is supported.

Long-term risk of stroke and myocardial infarction in middle-aged men with a hypertensive response to exercise: a 44-year follow-up study.

INTRODUCTION: Data on the prognostic value of hypertensive response to exercise in cardiovascular disease are limited. The aim was to determine whether SBP reactions during exercise have any prognostic value in relation to the long-term risk of stroke and myocardial infarction (MI). PATIENTS AND METHODS: A representative cohort of men from Gothenburg, Sweden, born in 1913, who performed a maximum exercise test at age 54 years, (n = 604), was followed-up for a maximum of 44 years with regard to stroke and MI. RESULTS: Among the 604 men, the mean resting and maximum SBP was 141.5 (SD 18.8) and 212.1 (SD 24.6) mmHg, respectively. For maximum SBP, the risk of stroke increased by 34% (hazard ratio 1.34, 95% confidence interval 1.11-1.61) per 1-SD increase, while no risk increase was observed for MI. The highest risk of stroke among blood pressure groups was observed among men with a resting SBP of at least 140 mmHg and a maximum SBP of at least 210 mmHg with an hazard ratio of 2.09 (95% confidence interval 1.29-3.40), compared with men with a resting SBP of less than 140 mmHg and a maximum SBP of less than 210 mmHg, independent of smoking, blood glucose, cholesterol and BMI. CONCLUSION: Among middle-aged men with high resting and maximum blood pressure during maximum exercise workload, an increased risk of stroke was observed but not for MI. Further studies with larger sample sizes are needed to investigate the underlying mechanisms of the increased risk of stroke among individuals with hypertensive response to exercise.

Publishing in physical and rehabilitation medicine.

This paper presents the panel discussion from the "Meet the Editor" symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2007. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the USA, despite the fact that journals currently published in these regions are distributed worldwide.

Publishing in physical and rehabilitation medicine.

This paper presents the panel discussion from the 'Meet the Editor' symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2007. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the USA, despite the fact that journals currently published in these regions are distributed worldwide.

Walking habits in elderly widows.

Walking habits were studied in 3 groups of elderly widows. The average walking time per week was calculated from interviews or questionnaires. There was in a small studied group a tendency for walking time to be lower at 3 and 12 months after loss than at 4 or 5 years. An increased odds ratio was demonstrated in larger groups of widows for walking less than 120 minutes per week in those who "did not feel healthy," or who had "musculoskeletal health problems," or "cardiovascular health problems." Widows from a population-based study also showed increased odds ratio for not walking as long with "lack of friends" and "not being active in associations." This was not found in married women from the population study. Our results indicate that newly bereaved women may reduce their physical activity, and that the change in exercise habits may be associated with reduced perception of being healthy and a decreased social network.

Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women.

OBJECTIVE: To investigate whether greater cardiovascular fitness in midlife is associated with decreased dementia risk in women followed up for 44 years. METHODS: A population-based sample of 1,462 women 38 to 60 years of age was examined in 1968. Of these, a systematic subsample comprising 191 women completed a stepwise-increased maximal ergometer cycling test to evaluate cardiovascular fitness. Subsequent examinations of dementia incidence were done in 1974, 1980, 1992, 2000, 2005, and 2009. Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012. Cox regressions were performed with adjustment for socioeconomic, lifestyle, and medical confounders. RESULTS: Compared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval [CI] 0.03-0.54) among those with high fitness and 1.41 (95% CI 0.72-2.79) among those with low fitness. High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness. CONCLUSIONS: Among Swedish women, a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important.

Organizing human functioning and rehabilitation research into distinct scientific fields. Part I: Developing a comprehensive structure from the cell to society.

There is a need to organize rehabilitation and related research into distinct scientific fields in order to overcome the current limitations of rehabilitation research. Based on the general distinction in basic, applied and professional sciences applicable to research in general, and the rehabilitation relevant distinction between the comprehensive perspective based on WHO's integrative model of human functioning (ICF) and the partial perspective focusing on the biomedical aspects of functioning, it is possible to identify 5 distinct scientific fields of human functioning and rehabilitation research. These are the emerging human functioning sciences and integrative rehabilitation sciences from the comprehensive perspective, the established biosciences and biomedical rehabilitation sciences and engineering from the partial perspective, and the professional rehabilitation sciences at the cutting edge of research and practice. The human functioning sciences aim to understand human functioning and to identify targets for comprehensive interventions, with the goal of contributing to the minimization of the experience of disability in the population. The biosciences in rehabilitation aim to explain body injury and repair and to identify targets for biomedical interventions. The integrative rehabilitation sciences design and study comprehensive assessments and interventions that integrate biomedical, personal factor and environmental approaches suited to optimize people's performance. The biomedical rehabilitation sciences and engineering study diagnostic measures and interventions suitable to minimize impairment, including symptom control, and to optimize people's capacity. The professional rehabilitation sciences study how to provide best care with the goal of enabling people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction with the environment. The organization of human functioning and rehabilitation research into the 5 distinct scientific fields facilitates the development of academic training programs and career building as well as the development of research structures dedicated to human functioning and rehabilitation research.

Organizing human functioning and rehabilitation research into distinct scientific fields. Part II: Conceptual descriptions and domains for research.

Human functioning and rehabilitation research can be organized into 5 distinct scientific fields. The objective of this paper is to provide conceptual descriptions and to outline selected research domains for 4 of the 5 distinct scientific fields. A conceptual description of the biosciences in rehabilitation and the presentation of respective research domains are beyond the scope of this paper. The research domains of the human functioning sciences can be identified and described according to the generic research process, which involves theory building and observation. The according domains include theory and models of human functioning, classification and measurement of functioning, functioning epidemiology and functioning impact assessment. The research domains of the integrative rehabilitation sciences can be identified and described by drawing on the public health approach. They include rehabilitation services research, rehabilitation intervention research and rehabilitation administration and management. There are many conceivable research domains within the realms of the biomedical rehabilitation sciences and engineering. They are often defined in relation to an organ system or in relation to an intervention approach. The research domains of the professional rehabilitation sciences are well established and include professional standards and guidelines for the provision of best care, rehabilitation quality management, scientific education and training of professionals in rehabilitation, and development and evaluation of the rehabilitation team.

Developing "Human Functioning and Rehabilitation Research" from the comprehensive perspective.

With the International Classification of Functioning, Disability and Health (ICF) the World Health Organization (WHO) has prepared the ground for a comprehensive understanding of Human Functioning and Rehabilitation Research, integrating the biomedical perspective on impairment with the social model of disability. This poses a number of old and new challenges regarding the enhancement of adequate research capacity. Here we will summarize approaches to address these challenges with respect to 3 areas: the organization of Human Functioning and Rehabilitation Research into distinct scientific fields, the development of suitable academic training programmes and the building of university centres and collaboration networks.

Disability in a 4-year follow-up study of people with post-polio syndrome.

OBJECTIVE: To evaluate changes over time in a clinically based cohort of individuals with post-polio syndrome. DESIGN: A prospective longitudinal study. SUBJECTS: A total of 106 individuals with poliomyelitis sequelae were included in the study. They were self-referred or had been referred to the post-polio clinic. After 4 years subjects were called for a follow-up and underwent the same measurements as at the initial assessment. METHODS: The following measurements were conducted at both the initial assessment, and the follow-up: questionnaires including Nottingham Health Profile, muscle strength and walking speed. RESULTS: Minor changes in disability during a 4-year period were shown. A significant reduction in muscle strength was only seen for 60 degrees flexion in the left leg and for right and left dorsal flexion. No change could be seen in the total Nottingham Health Profile score. CONCLUSION: The minor changes in disability found in this study are an indication that we still do not know which subjects are at risk for deterioration. It is difficult to say whether the small changes over time shown in this study are associated with support from the polio clinic or are an expression of the natural history of the syndrome. However, it is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity.

Diaphragmatic function in advanced Duchenne muscular dystrophy.

The aim of this study was to assess diaphragm electrical activation and diaphragm strength in patients with advanced Duchenne muscular dystrophy during resting conditions. Eight patients with advanced Duchenne muscular dystrophy (age of 25 +/- 2 years) were studied during tidal breathing, maximal inspiratory capacity, maximal sniff inhalations, and magnetic stimulation of the phrenic nerves. Six patients were prescribed home mechanical ventilation (five non-invasive and one tracheotomy). Transdiaphragmatic pressure and diaphragm electrical activation were measured using an esophageal catheter. During tidal breathing (tidal volume 198 +/- 83 ml, breathing frequency 25 +/- 7), inspiratory diaphragm electrical activation was clearly detectable in seven out of eight patients and was 12 +/- 7 times above the noise level, and represented 45 +/- 19% of the maximum diaphragm electrical activation. Mean inspiratory transdiaphragmatic pressure during tidal breathing was 1.5 +/- 1.2 cmH2O, and during maximal sniff was 7.6 +/- 3.6 cmH2O. Twitch transdiaphragmatic pressure deflections could not be detected. This study shows that despite near complete loss of diaphragm strength in advanced Duchenne muscular dystrophy, diaphragm electrical activation measured with an esophageal electrode array remains clearly detectable in all but one patient.

Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up.

BACKGROUND: Low aerobic capacity has been associated with increased mortality in short-term studies. The aim of this study was to evaluate the predictive power of aerobic capacity for mortality in middle-aged men during 45-years of follow-up. DESIGN: The study design was a population-based prospective cohort study. METHODS: A representative sample from Gothenburg of men born in 1913 was followed from 50-99 years of age, with periodic medical examinations and data from the National Hospital Discharge and Cause of Death registers. At 54 years of age, 792 men performed an ergometer exercise test, with 656 (83%) performing the maximum exercise test. RESULTS: In Cox regression analysis, low predicted peak oxygen uptake ([Formula: see text]), smoking, high serum cholesterol and high mean arterial blood pressure at rest were significantly associated with mortality. In multivariable analysis, an association was found between predicted [Formula: see text] tertiles and mortality, independent of established risk factors. Hazard ratios were 0.79 (95% confidence interval (CI) 0.71-0.89; p < 0.0001) for predicted [Formula: see text], 1.01 (1.002-1.02; p < 0.01) for mean arterial blood pressure, 1.13 (1.04-1.22; p < 0.005) for cholesterol, and 1.58 (1.34-1.85; p < 0.0001) for smoking. The variable impact (Wald's χ(2)) of predicted [Formula: see text] tertiles (15.3) on mortality was secondary only to smoking (31.4). The risk associated with low predicted [Formula: see text] was evident throughout four decades of follow-up. CONCLUSION: In this representative population sample of middle-aged men, low aerobic capacity was associated with increased mortality rates, independent of traditional risk factors, including smoking, blood pressure and serum cholesterol, during more than 40 years of follow-up.

Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis.

OBJECTIVE: To analyse cross-cultural validity of the Functional Independence Measure (FIM) in patients with stroke using the Rasch model. SETTINGS: Thirty-one rehabilitation facilities within 6 different countries in Europe. PARTICIPANTS: A total of 2546 in-patients at admission, median age 63 years. METHODS: Data from the FIM were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively. RESULTS: Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed. CONCLUSION: Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples.

[Adapted exercise important after stroke. Acute and long-term effects of different training programs]. / Anpassad motion viktig efter stroke. Akuta och långsiktiga effekter av olika träningsprogram.

Following stroke, persons experience deficits in motor control, reduced muscle strength, disuse atrophy, reduced cardiovascular fitness and elevated energy expenditure during locomotion. Recent exercise studies with few subjects, report beneficial outcomes after strength and low intensity aerobic exercise training. Progressive strength and aerobic exercise programmes from 3 to 6 months produced gains in functional recovery and health-related functional status such as motor function, peak isokinetic torque, balance, endurance, peak aerobic capacity and overall fitness without exacerbating spasticity. Increased access to community-based physical activity programmes is recommended to prevent deconditioning and to improve health related quality of life in persons after stroke. Well-functioning rehabilitation from acute care, through special rehabilitation units to community-based physical activity programmes is important.

Activity limitations in personal, domestic and vocational tasks: a study of adults with inborn and early acquired mobility disorders.

PURPOSE: To compare activity limitations at the workplace with those in the home situation. SUBJECTS AND METHODS: Sixty-nine subjects, 22-49 years of age, with inborn or early acquired mobility disorders and with experience of vocational employment were studied. They were interviewed to assess their level of dependence according to the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) and in 22 vocation-related items. Rasch analysis was perfomed in order to assess the relative difficulty of the items. In the vocational items the subjects rated perceived difficulty on a 4-level scale. Satisfaction in one general and six domain-specific areas was rated on a 6-level scale. RESULTS: Forty-six per cent of the subjects were dependent in one or several FIM items, 90% in IAM items and 38% in the vocation-related items. In 15 of these items great difficulty was reported by few subjects. Collapsing the 7-category scale for dependence to four categories gave the best Rasch model. Most of the IAM items were the hardest to manage without assistance. FIM social-cognitive and cognitive vocation-related items were the easiest items. Most subjects were satisfied in the general and domain-specific areas. CONCLUSIONS: Activities related to household tasks and transportation demonstrated the highest level of dependence, whereas it was easier to acquire independence in most vocation-related tasks.