Modifiable Physical Factors That Influence Physical Function for People Receiving Peritoneal Dialysis.

Introduction: People receiving peritoneal dialysis experience physical function decline, impairing their ability to complete everyday activities, leading to poorer quality of life. Physical factors, including cardiorespiratory fitness, muscle strength, physical activity, and sedentary behavior are associated with physical function. However, little is known about this relationship, or temporal changes of these factors in this cohort. This study aimed to explore modifiable physical factors that are associated with physical function, identify which factor has the strongest influence, and explore temporal changes. Methods: Adults receiving peritoneal dialysis underwent objective and self-reported physical function, cardiorespiratory fitness, muscle strength, physical activity and sedentary behavior assessments 3 times over a 12-month observation period (at baseline, 6 months, and 12 months). Results: Eighty-two participants underwent assessments. All modifiable physical factors were predominantly moderate to strongly associated with physical function at baseline. Cardiorespiratory fitness had the strongest and most consistent influence with every meter conferring a 0.08-unit (P < 0.01) and 0.01-unit (P < 0.05) increase in self-report and objective physical function score, respectively. Temporal changes were observed for modifiable physical factors with significant mean changes in cardiorespiratory fitness (-9.8%), quadricep strength (-5%), moderate-to-vigorous (-25.9%) and total (-16.2%) physical activity, and sedentary behavior (+7.1%). Conclusion: The results of this study indicate that cardiorespiratory fitness could be routinely monitored to detect risk of physical function decline and targeted through intervention to enhance physical function for people receiving peritoneal dialysis. Nevertheless, all factors should be considered when designing interventions to mitigate temporal changes and induce the numerous health benefits offered by being physically active.

Ecological Momentary Assessment to Explore Fatigue, Mood, and Physical Activity Levels in People Receiving Peritoneal Dialysis.

Introduction: Fatigue is a frequent and debilitating symptom that contributes to poor quality of life for people receiving peritoneal dialysis. Ecological momentary assessment using mobile technology (mEMA) is a novel survey technique that can collect symptom data in real-time and has not been trialed in a peritoneal dialysis cohort. The study aimed to explore real-time fluctuations and associations between fatigue, mood, and physical activity using mEMA. Methods: Adults receiving peritoneal dialysis completed fatigue and mood scales, via a mobile application (app), 5 times daily for 7 days and, concurrently wore an accelerometer. A feasibility questionnaire was completed on the eighth day. Results: Forty-eight adults completed the study. Within-day fatigue fluctuations were observed with severity lowest during mid-morning to early afternoon and peaking at bedtime. Associations between fatigue and mood were observed with a 1-unit change in mood score conferring a 5.2-unit change in fatigue (P < 0.01). Higher volume of physical activity was associated with lower fatigue and enhanced mood. Overall adherence to the app-based surveys was 73% with most participants reporting mobile phones and the mEMA app being easy to use. Conclusion: People receiving peritoneal dialysis experience within day and day-to-day fluctuations in fatigue that appear highly variable. Higher fatigue severity was associated with poorer mood and lower physical activity levels with future studies required to explore if physical activity-based interventions could be a potential strategy for the management of these symptoms. Furthermore, mEMA, and mobile phones, were feasible to capture symptom data with potential to be employed in future research or, as part of improved care.

Characteristics and Frequency of Physical Activity and Exercise-Related Side Effects in People Receiving Peritoneal Dialysis.

OBJECTIVE: People receiving peritoneal dialysis may receive health benefits from physical activity or exercise. However, on-going uncertainty and fear regarding safety may result in this population missing out on the health benefits of participation. The aim of this study was to explore the characteristics and frequency of physical activity and/or exercise-related side effects (e.g., symptoms such as pain or shortness of breath) and negative health events (e.g., stroke or hyper/hypoglycemia) experienced by people receiving peritoneal dialysis. METHODS: An international online survey involving adults receiving peritoneal dialysis was conducted with questions related to nature, occurrence, and impact of side effects and/or negative health events experienced during or soon after participation in physical activity or exercise. RESULTS: Fifty-two people completed the survey reporting 151 side effects that were related to physical activity and exercise and 67 that were possibly related. Fatigue (58% of respondents), muscle/joint soreness or pain (54%), and dizziness (43%) were the most frequently reported side-effect types. The majority occurred occasionally (58% of all side effects), if not rarely (24%) and participation in on-going physical activity or exercise was typically prevented only occasionally (39%) or not at all (31%). Side effects were mainly self-managed (54% of all side effects) or did not require treatment (19%) and had low (38%) or no effect (30%) on ability to do daily activities. CONCLUSIONS: People receiving peritoneal dialysis generally experience side effects that can be considered a normal response to physical activity or exercise engagement. Furthermore, the risk of serious or peritoneal dialysis-specific side effects as a result of physical activity or exercise appears to be low. The results add to the emerging evidence suggesting physical activity and exercise appear to be safe for people receiving peritoneal dialysis.

Exercise or physical activity-related adverse events in people receiving peritoneal dialysis: A systematic review.

People receiving peritoneal dialysis (PD) may benefit from participation in exercise or physical activity. However, exercise therapy for people receiving PD is not typically included in routine care, in part, due to ongoing uncertainties about risk. The aim of this review was to systematically collate and explore data on adverse events experienced by people receiving PD while undertaking an exercise or physical activity intervention. Searches yielded 25 exercise or physical activity intervention studies involving people receiving PD. Of these 25 studies, 17 studies provided adverse event data and were included in the final review. No serious adverse events (e.g. death, hospitalisation) were found attributable to the intervention. From 50 reported adverse events during the intervention period, 32 were attributable to the exercise or physical activity intervention with most being musculoskeletal (e.g. muscle/joint pain, etc.) followed by fatigue. Most events were mild to moderate in severity and resolved by exercise programme modification, education, rest or medication. The results from this review did not uncover signals of harm for people receiving PD who engage in exercise with risk of adverse events appearing to be low, however, improved adverse events reporting and further interventional studies are required before robust guidelines can be produced.

Ecological momentary assessment to explore fatigue, mood and physical activity levels in people receiving peritoneal dialysis: A study protocol.

INTRODUCTION: Fatigue is a frequent and debilitating symptom for people with end-stage kidney disease (ESKD) receiving dialysis. Ecological momentary assessment (EMA) allows real-time data capture of day-to-day and diurnal variations. EMA has been used to study haemodialysis-related fatigue but not in people receiving peritoneal dialysis who are unique in their physical, environmental and logistical characteristics. The aim of this study is to explore the real-time associations between fatigue and mood (EMA mobile application) and objective physical activity levels (accelerometry) in people with EKSD receiving peritoneal dialysis. METHOD: A 7-day intensive longitudinal study will be conducted. People receiving peritoneal dialysis within South Australia will be invited to participate. Five times throughout the day, participants will be prompted to answer 18 questions relating to fatigue (Visual Analogue Scale to Evaluate Fatigue Severity) and a single question for mood (Visual Analogue Mood Scale). Participants will continuously wear a GENEActiv accelerometer to capture physical activity levels during the 7-day period. At the completion of the data collection, participants will answer questions to evaluate the feasibility and acceptability of using EMA. DISCUSSION: This study will be the first to explore the real-time relationships between fatigue, mood and physical activity in people with ESKD receiving peritoneal dialysis. Understanding the fluctuations people experience and the relationships between mood and physical activity and fatigue will inform clinical management and well-being intervention development.

Validity and Reliability of Hand-Held Dynamometry for Abdominal Flexion Muscular Assessment.

CONTEXT: Abdominal musculature underpins core stability, which can allow for optimal performance in many activities of daily living (eg, walking and rising from a chair). Therefore, assessment of the abdominal muscles poses as an important consideration for clinicians in order to identify people at risk of injury or functional decline. OBJECTIVE: This study aimed to build on the limited amount of knowledge surrounding abdominal muscle strength assessments by investigating the validity and reliability of hand-held dynamometry (HHD) for the assessment of isometric abdominal flexion strength. STUDY DESIGN AND PARTICIPANTS: Comparative analysis for validity and test-retest reliability was employed on a cohort of apparently healthy individuals. HHD was compared with the criterion, isokinetic dynamometry, through an isometric contraction of trunk flexion on both instruments. Hand-held dynamometry assessments only were performed on a subsequent day for reliability analysis. The peak values for all assessments were recorded. RESULTS: A total of 35 participants were recruited from the University of South Australia and the general public. Comparative analysis between the HHD and isokinetic dynamometer showed good agreement (intraclass correlation coefficients = .82), with the Bland-Altman plots confirming no proportional bias. Reliability analysis for the HHD reported good consistency (intraclass correlation coefficients = .87). CONCLUSION: HHD together with the participant setup (supine, trunk flexed, and supported at 25° with the legs horizontal and remaining unfixed) is a valid and reliable tool to assess isometric abdominal flexion strength.

Modifiable Physical Factors Associated With Physical Functioning for Patients Receiving Dialysis: A Systematic Review.

BACKGROUND: Patients receiving dialysis have reduced physical function, which is associated with unfavorable clinical outcomes and decreased quality of life. The authors aimed to identify and explore modifiable physical factors associated with physical function for patients receiving dialysis. METHODS: Searches were performed in MEDLINE, Embase, Ovid Emcare, and The Cochrane Library in October 2018. Etiological studies involving dialysis populations that report association or predictive statistics between a modifiable physical factor and physical function were eligible for inclusion. Predictor variables were (1) modifiable via exercise and (2) considered an impairment in the International Classification of Functioning, Disability and Health. RESULTS: Of 5384 titles screened, 23 studies were included. Thirteen studies focused on physical activity levels and muscle strength and the relationship with physical function while 2 studies investigated sedentary behavior. Twenty-one studies focused on hemodialysis populations. Studies related to physical activity levels displayed a moderately strong relationship with physical function, whereas muscle strength displayed a predominantly weak to moderate relationship. CONCLUSIONS: Physical activity levels, sedentary behavior levels, and muscle strength are related to physical function status for patients receiving dialysis. There is a need for robust longitudinal data to confirm the results of this investigation and for more focus on populations receiving peritoneal dialysis.

Patterns and correlates of time use and energy expenditure in older Australian workers: A descriptive study.

BACKGROUND: How people use their time has health implications, but use of time may be influenced by factors such as age, sex, education and health. OBJECTIVE: This study aimed to provide detailed information on the daily activity patterns of older working people. STUDY DESIGN: 139 older Australian adults (aged 50-79 years) undertook comprehensive interviews on their use of time. This paper presents a cross-sectional analysis of the baseline findings from a longitudinal study. MAIN OUTCOME MEASURES: Use of time was measured using the Multimedia Activity Recall for Children and Adults (MARCA), administered via computer-assisted phone interview. Activity patterns were described, and compared on the basis of sex, education and health status. RESULTS: The main activities undertaken were sleep (mean 466min/day), work (mean 233min/day) and chores (mean 160min/day), with little time spent on physical activity (mean 13min/day). Women spent more time doing chores (p<0.001) while men spent more time on vigorous activities (p<0.001). Participants with "fair" health spent less time on inside chores (p=0.05) and grooming (p=0.02) than healthier participants. CONCLUSIONS: Healthy lifestyle interventions for older workers should aim to increase physical activity levels by targeting specific activities, depending on sex and health status.

Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review.

Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPERO (registration number CRD42014010155). Level of Evidence Therapy, level 2a. J Orthop Sports Phys Ther 2016;46(6):431-442. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6449.

A systematic review of methods to predict maximal oxygen uptake from submaximal, open circuit spirometry in healthy adults.

OBJECTIVES: This systematic review aimed to (i) report the accuracy of submaximal exercise-based predictive equations that incorporate oxygen uptake (measured via open circuit spirometry) to predict maximal oxygen uptake (VO2max) and (ii) provide a critical reflection of the data to inform health professionals and researchers when selecting a prediction equation. DESIGN: Systematic review. METHODS: A systematic search of MEDLINE, EMBASE (via OvidSP), CINAHL, SPORTDiscus (via EBSCO Host) and Scopus databases was undertaken in February 2013. Studies were required to report data on healthy participants aged 18-65y. Following tabulation of extracted data, a narrative synthesis was conducted. RESULTS: From a total of 7597 articles screened, 19 studies were included, from which a total of 43 prediction equations were extracted. No significant difference was reported between the measured and predicted VO2max in 28 equations. Pearson's correlation coefficient between the predicted and measured VO2max ranged from r=0.92 to r=0.57. The variables most commonly used in predictive equations were heart rate (n=19) and rating of perceived exertion (n=24). CONCLUSIONS: Overall, submaximal exercise-based equations using open circuit spirometry to predict VO2max are moderately to highly accurate. The heart rate and rating of perceived exertion methods of predicting VO2max were of similar accuracy. Important factors to consider when selecting a predictive equation include: the level of exertion required; participant medical conditions or medications; the validation population; mode of ergometry; time and resources available for familiarisation trials; and the level of bias of the study from which equations are derived.

The elasticity of time: associations between physical activity and use of time in adolescents.

The way an individual uses one's time can greatly affect his or her health. The purpose of this article was to examine the cross-sectional cross-elasticity relationships for use of time domains in a sample of Australian adolescents. This study analyzed 24-hour recall time use data collected using the Multimedia Activity Recall for Children and Adults (N = 2,200). Using simple linear regression, the authors calculated the difference in time devoted to a reference activity (i.e., screen time, sleep, or social) given 1 hour extra in the time devoted to a criterion activity (i.e., physical activity). The most elastic activities were screen time and school-related time. Every additional hour committed to physical activity was associated with 32 minutes less screen time. This relationship was more pronounced in obese adolescents (-56 minutes screen time) compared with normal (-31 minutes) and overweight (-27 minutes) adolescents. Promising behavior patterns exist, with screen time appearing as a highly elastic behavior.

All the stereotypes confirmed: differences in how Australian boys and girls use their time.

BACKGROUND: To influence adolescent health, a greater understanding of time use and covariates such as gender is required. PURPOSE: To explore gender-specific time use patterns in Australian adolescents using high-resolution time use data. METHOD: This study analyzed 24-hour recall time use data collected as part of the 2007 Australian National Children's Nutrition and Physical Activity Survey (n = 2,200). Univariate analyses to determine gender differences in time use were conducted. RESULTS: Boys spent more (p < .0001) time participating in screen-based (17.7 % vs. 14.2% daily time) and physical activities (10.7% vs. 9.2%). Girls spent more (p < .0001) time being social (4.7% vs. 3.4% daily time), studying (2.0% vs. 1.7%), and doing household chores (4.7% vs. 3.4%). CONCLUSIONS: There are gender-specific differences in time use behavior among Australian adolescents. The results reinforce existing time use gender-based stereotypes. Implications. The gender-specific time use behaviors offer intervention design possibilities.

Obese adolescents are less active than their normal-weight peers, but wherein lies the difference?

BACKGROUND: Obese adolescents achieve less moderate to vigorous physical activity (MVPA) than normal-weight adolescents, but the nature and extent of the deficit is unclear. This study aimed to describe differences in MVPA across weight status categories by domain of activity (sport, play, and active transport) and specific activity-sets (e.g. team sports, playground games, and chores) using minutes of activity, estimated intensity, and estimated energy expenditure as metrics of MVPA. METHOD: Anthropometric, use-of-time, and pedometer data were collected on a random sample of 2,200 Australian children aged 9-16 years. Minutes of activity, intensity metabolic equivalents of tasks (METs), and energy expenditure (MET.min) within each domain were estimated using an energy cost compendium. RESULTS: Obese adolescents reported 174 MET.min/d lower MVPA energy expenditure than normal-weight peers (p < .0001), more than accounting for the entire difference in total daily energy expenditure (154 MET.min/d). Of this difference, 121 MET.min/d was associated with lower sports participation (p < .0001) and 45 MET.min/d with less free play (p = .03). There were no differences in minutes of active transport or in reported activity intensity across weight status categories in sport, free play, or active transport. The differences in MVPA participation between obese and normal-weight adolescents were largely because of different levels of participation in team sports, cycling, partner sports (boys), and dancing (girls). CONCLUSION: More than two-thirds of the difference in energy expenditure between obese and normal-weight Australian adolescents was because of lower participation in sport. Strategies for engaging obese adolescents in sport may help to redress deficits in energy expenditure.