Assessing Changes in Fear of Movement in Patients attending Cardiac Rehabilitation: Responsiveness of the TSK-NL Heart Questionnaire.

OBJECTIVES: The primary objective was to determine the responsiveness of the Dutch version of the 13-item Tampa Scale for Kinesiophobia for cardiac patients (TSK-NL Heart). The secondary objective was to assess changes in kinesiophobia during cardiac rehabilitation. METHODS: Kinesiophobia was measured pre- and post-cardiac rehabilitation using the TSK-NL Heart questionnaire in 109 cardiac patients (61 years; 76% men). The effect size of kinesiophobia score changes was calculated for the full population. A measure that is responsive to change should produce higher effects sizes in patients in whom kinesiophobia improves. Therefore, effect sizes were also calculated for patients who did or did not improve on selected external measures. For this step, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were completed as external measures in a subsample of 58 patients. RESULTS: The effect size of the TSK-NL Heart for the full study population was small (0.29). In line with the study hypothesis the effect size was higher (moderate) for patients with improved CAQ (0.52) and HADS scores (0.54). Prevalence of high kinesiophobia levels decreased from 40% pre-cardiac rehabilitation to 26% post-cardiac rehabilitation (p = 0.004). CONCLUSION: The TSK-NL Heart has moderate responsiveness and can be used to measure changes in kinesiophobia. Improvements in kinesiophobia were observed during cardiac rehabilitation. Nevertheless, high levels of kinesiophobia were still highly prevalent post-cardiac rehabilitation.

Sedentary behavior: Different types of operationalization influence outcome measures.

INTRODUCTION: Sedentary behavior (SB) influences health status independently of physical activity. The formal definition of SB is: "any waking behavior characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture". However, measuring SB mostly does not include both the intensity and postural component. The aim of this study was to quantify the effect of type of operationalization of SB on total sedentary time and the pattern of SB. METHODS: 53 healthy subjects were measured 24h with a multi-sensor activity monitor that provides a valid one-second detection of body postures and movements and a calculated intensity measure. The SB outcome measures were: total sedentary time; number of sedentary bouts; mean bout length; fragmentation; and W-index. All outcomes were calculated for three types of operationalization of SB: 1) waking time in lying and sitting posture and below the sedentary intensity threshold (<0.016g comparable with Actigraph <150 counts, COMBI); 2) waking time in lying and sitting posture (POST); 3) waking time below the sedentary intensity threshold (<0.016g, INT). Outcome measures based on these three operationalizations were compared with repeated measures ANOVA. RESULTS: Total sedentary time was significantly different (p<0.001) between all three conditions: 505.8 (113.85)min (COMBI), 593.2 (112.09)min (POST), and 565.5 (108.54)min (INT). Significant differences were also found for other outcome measures. CONCLUSION: Our study shows that type of operationalization significantly affects SB outcome measures. Therefore, if SB is defined according to the formal definition, measurements must include both the intensity and postural component.

Sensitivity and reproducibility of accelerometry and heart rate in physical strain assessment during prosthetic gait.

Accelerometry and heart rate (HR) are frequently used indicators of physical strain during normal daily life. The present study focused on the sensitivity and reproducibility of accelerometry (body motility, the intensity of body movement measured with accelerometry) and HR (percentage maximal heart rate reserve, %HRR(max)) in the assessment of physical strain during walking in persons with a lower leg amputation, using persons without an amputation as reference. Ten patients with an amputation of the leg and ten comparison subjects performed, at an interval of 1 month, the same walking protocol three times. Subjects walked at a preferred speed and at fixed speeds. At their preferred walking speed, speed (0.63 vs 1.31 m s(-1), P=0.001), body motility [0.53 vs 0.91 (arbitrary unit), P=0.001] and %HRR(max) (42.5 vs 27.6, P=0.02) differed between the amputation group and the comparison group. At fixed walking speeds, only %HRR(max) differed between groups ( P

Body fat, fitness and level of everyday physical activity in adolescents and young adults with meningomyelocele.

OBJECTIVE: Data on body fat and fitness in adolescents and young adults with meningomyelocele are scarce. The aim of this study was to assess body fat and fitness in this patient group. In addition, we explored whether the level of everyday physical activity is related to body fat and fitness. SUBJECTS AND METHODS: Body fat (skinfold thickness), fitness (VO2peak), and everyday physical activity (Activity Monitor, based on accelerometry) were measured in 14 patients with meningomyelocele (8 men, 6 women; age range 14-26 years). RESULTS: Peak VO2 was 20-30% lower than reference values and 4 patients were obese. Level of everyday activity was related to fitness (rs = 0.65, p = 0.01) but not to body fat. CONCLUSION: Young patients with meningomyelocele are at risk for developing obesity and have a distinctly subnormal fitness. Level of everyday physical activity is related to fitness in this patient group.