Isotemporal Substitution of Sedentary Behavior by Different Physical Activity Intensities on Pain and Disability of Patients With Chronic Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: To investigate the association of isotemporal substitution modeling (ISM) of time spent in sedentary activities with physical activity in different intensities on pain and disability of patients with chronic low back pain (LBP). DESIGN: Observational and cross-sectional study. Device-measured physical activity levels were assessed using an actigraph. Pain intensity was measured using the 11-point numeric rating scale, and disability was measured using the Roland Morris Disability Questionnaire. The ISM was used to estimate the theoretical substitution association of reallocating time from 1 exposure variable to an equal amount of time in another exposure variable while holding total activity time constant. SETTINGS: Outpatient physical therapy clinic. PARTICIPANTS: This study included data from 358 patients (N=358) with chronic LBP aged between 18 and 60 years. MAIN OUTCOME MEASURES: Pain and disability. RESULTS: Our results suggest that replacing 60 minutes of sedentary behavior with 60 minutes of vigorous activity in a week is significantly associated with a decrease in pain (ß=-1.67; 95% confidence interval [CI], -3.18 to -0.15). Additionally, replacing 60 minutes of light physical activity (ß=-1.67; 95% CI, -3.18 to -0.16) or moderate activity (ß=-1.67; 95% CI, -3.21 to -0.13) with the same amount of time of vigorous activity per week may also favorable reductions in pain. For the analysis of disability, no significant associations (P>.05) for disability in any of the isotemporal models were found. CONCLUSIONS: Our results showed that replacing 60 minutes of sedentary behavior with equal amounts of vigorous activity per week was associated with reductions in pain intensity. Similarly, replacing a light or moderate activities with vigorous activity was also associated with reductions in pain intensity. Finally, no significant associations were observed between time spent in sedentary activities with physical activity in different intensities for disability.

Cross-cultural adaptation and reliability of the Functional Gait Assessment in older Brazilian adults.

BACKGROUND: The Functional Gait Assessment (FGA) is a standardized instrument for assessing postural stability during various walking tasks. It was developed to increase the reliability and to decrease the potential ceiling effect observed with the Dynamic Gait Index (DGI). OBJECTIVE: To translate and cross-culturally adapt the FGA into Portuguese-Brazilian, and to evaluate its reliability in community-dwelling Brazilian older adults. METHODS: The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. The pre-final version was applied to a sample of 55 older adults of both sexes living independently in the community. For the assessment of reliability (i.e. inter- and intra-rater reliability, standard error of measurement (SEM), and internal consistency), 70 older adults aged 60-87 years were evaluated. RESULTS: There was a conceptual equivalence between the original and the translated versions. All FGA items that used measurements in inches and feet were modified to use matching values in centimeters to reflect the measurement unit used in Brazil. The FGA-Brazil showed excellent inter- and intra-rater reliability (ICC2,1 > 0.90), low SEM (ranging from 1.03 to 1.52), and good internal consistency (Cronbach's alpha = 0.858). CONCLUSION: The FGA-Brazil is a semantically and linguistically valid and reliable instrument to assess walking balance among community-dwelling older adults.

Construct and criterion validity of the functional gait assessment-Brazil in community-dwelling older adults.

BACKGROUND: The functional gait assessment (FGA) is a reliable instrument to evaluate walking balance in the Brazilian older population. However, other measurement properties need investigation. OBJECTIVE: To determine the construct and criterion validity of the FGA-Brazil and its ceiling and floor effects. METHODS: Sociodemographic, clinical, and anthropometric data were collected from 126 older adults. Participants completed the Mini-mental state examination followed by the FGA-Brazil, Berg balance scale (BBS), gait speed, and the Falls Efficacy Scale-International. Six months later, the participants were interviewed by telephone about their fall history. Exploratory factor analysis was used to determine the structural validity. We also determined the construct validity of the FGA-Brazil, using hypothesis testing, by investigating the differences between groups using the Mann-Whitney U test. Criterion validity was determined using the Spearman correlation between the FGA-Brazil and the other balance and gait measures, and using the Receiver Operator Characteristic curve. RESULTS: Participants' mean age was 69.3 ±â€¯7.4 years, and 84 (69.4%) were female. Factor analysis resulted in two factors explaining 53.3% of the total variance. Moderate and high significant correlations were found between the FGA-Brazil and gait speed (r = 0.65) and BBS (r = 0.80). A significant difference in the FGA-Brazil median score between older adults with low and high concern about falls was observed. The cutoff score recommended for predicting falls was 22 or less. No ceiling and floor effects were observed. CONCLUSION: We recommend the FGA-Brazil to determine the risk of falls in community-dwelling older adults.