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1.
Clin Interv Aging ; 14: 1503-1514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31686795

RESUMO

Introduction: We compared Nordic walking training (NW) to a multicomponent training (MCT) program of an equivalent intensity, in older adults. Our main hypothesis was that MCT would result in larger effects on cognitive processes than NW. Methods: Thirty-nine healthy older adults, divided into two groups (NW and MCT), took part in the study (17 males, 22 females, mean age =70.8±0.8 years). They were tested for cardiovascular fitness, motor fitness and cognitive performance during the two weeks preceding and following the 12-week training session (3 times/week), respectively. For both the NW and MCT interventions, the training sessions were supervised by a trainer. Heart rate of participants was monitored during the sessions and then used to make training loads as similar as possible between the two groups (TRaining IMPulse method). Results: Results showed that training resulted in better performance for cardiovascular and motor fitness tests. Among these tests, only two revealed a significant difference between the two groups. The NW group progressed more than the MCT group in the 30 Seconds Chair Stand test, while in the One Leg Stance test, the MCT group progressed more. For the cognitive assessment, a significant effect of training was found for executive functions, spatial memory score, and information processing speed response time, with no differences between the two groups. Conclusion: The study confirmed that physical exercise has a positive impact on cognitive processes with no advantage of MCT intervention over NW training. A possible reason is that NW intervention not only improved cardiovascular capacities, but also motor fitness, including coordination capacities.


Assuntos
Transtornos Cognitivos/terapia , Terapia por Exercício/métodos , Caminhada/normas , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Função Executiva/fisiologia , Terapia por Exercício/estatística & dados numéricos , Feminino , Frequência Cardíaca , Humanos , Masculino , Aptidão Física , Caminhada/fisiologia
2.
BMC Geriatr ; 19(1): 20, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674278

RESUMO

BACKGROUND: Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. METHODS: A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen's kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. RESULTS: Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). CONCLUSIONS: The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00005591 ). Registered 2 February 2015.


Assuntos
Disfunção Cognitiva/diagnóstico , Serviços de Saúde para Idosos/normas , Limitação da Mobilidade , Velocidade de Caminhada/fisiologia , Caminhada/fisiologia , Caminhada/normas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/psicologia , Estudos Transversais , Feminino , Serviços de Saúde para Idosos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/normas , Admissão do Paciente/tendências , Modalidades de Fisioterapia/normas , Modalidades de Fisioterapia/tendências , Equilíbrio Postural/fisiologia , Reprodutibilidade dos Testes
3.
PLoS One ; 13(10): e0205792, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30321226

RESUMO

The 6-minute walking test (6MWT) is a simple assessment tool to evaluate exercise capacity. The result of the test is the distance that a subject can walk at a constant and normal pace within 6 minutes (6MWD) and reflects the aerobic/fitness performance related to walking function. Use of 6MWT has been relevant to assess exercise tolerance either in healthy children or in patients with, heart, lung and metabolic diseases. Our aim was to find 6MWT reference values in healthy Italian children. The 6MWT was performed in 5614 children aged 6-11 years recruited from primary Italian schools. Age related reference percentiles of the covered distance were gender-modeled. A linear and quadratic regression model was used to predict 6MWT performance. Males walked longer distances than females, respectively 598.8±83.9 m vs 592.1±77.6 m (p = 0.0016). According to the regression analysis, 6MWD was positively related to age, gender and height, while it was negatively related to body weight [(6MWD = -160.16 + 93.35× age (years) -4.05× age2 (years) +7.34× gender (m) +2.12× weight (kg) -2.50× height (cm)]. Reference values were established for the 6MWT in healthy children. The age related 6MWD percentiles provided a useful tool in the assessment of capacity in 6-11 year children, in fact they may be helpful to evaluate the effect of a given treatment or rehabilitation program and represent a feasible measure as to prevention within the primary school context. It was found a substantial difference from other countries for 6mwd values. In our study, factors such as age, weight and height were relevant for the prediction of 6MWD, similarly to other studies. Therefore, these variables should be taken into account in context of exercise performance.


Assuntos
Caminhada , Fatores Etários , Criança , Estudos Transversais , Teste de Esforço/normas , Feminino , Humanos , Itália , Masculino , Aptidão Física , Valores de Referência , Fatores Sexuais , Caminhada/fisiologia , Caminhada/normas , Caminhada/estatística & dados numéricos
4.
BMC Musculoskelet Disord ; 19(1): 224, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021639

RESUMO

BACKGROUND: The gait pattern varies within the population and between patient groups with different musculoskeletal diseases. It also varies over time due to various reasons. Three-dimensional gait analysis (3DGA) is frequently used to measure these changes, but the precision of this methodology may vary. METHODS: We primarily aimed to study the repeatability of hip motion measurements in patients with unilateral osteoarthritis (OA), patients with unilateral total hip arthroplasty (THA) and healthy controls. A secondary aim was to delineate any differences in hip motion during walking between these groups. Ten males and 10 females in each group were recruited. All patients underwent gait assessments using 3DGA recorded by 2 examiners. Data was analysed with comparison of variance and linear regression. RESULTS: The variability of the extension-flexion recordings was smallest in healthy controls (SD < 7.7°), increased in patients with THA (SD < 11.1°) and was most pronounced in the OA patients (SD < 12.2°). The degree of hip extension-flexion turned out to be the variable that most effectively could separate the controls from the 2 patient groups and the patient groups from each other. One to 2 years after THA the gait pattern was improved but still differed comparing a group of THA from a group of healthy controls. CONCLUSIONS: Patients with hip osteoarthritis showed the poorest repeatability between gait recordings collected by different examiners, as compared to patients operated with a THA and healthy controls. The walking pattern after THA still differed from healthy controls 1-2 years after the operation.


Assuntos
Artroplastia de Quadril/normas , Análise da Marcha/normas , Marcha/fisiologia , Prótese de Quadril/normas , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Estudos Transversais , Feminino , Análise da Marcha/métodos , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Caminhada/fisiologia , Caminhada/normas
5.
Int J Health Geogr ; 17(1): 17, 2018 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-29871687

RESUMO

BACKGROUND: Identifying elements of one's environment-observable and unobservable-that contribute to chronic stress including the perception of comfort and discomfort associated with different settings, presents many methodological and analytical challenges. However, it also presents an opportunity to engage the public in collecting and analyzing their own geospatial and biometric data to increase community member understanding of their local environments and activate potential environmental improvements. In this first-generation project, we developed a methodology to integrate geospatial technology with biometric sensing within a previously developed, evidence-based "citizen science" protocol, called "Our Voice." Participants used a smartphone/tablet-based application, called the Discovery Tool (DT), to collect photos and audio narratives about elements of the built environment that contributed to or detracted from their well-being. A wrist-worn sensor (Empatica E4) was used to collect time-stamped data, including 3-axis accelerometry, skin temperature, blood volume pressure, heart rate, heartbeat inter-beat interval, and electrodermal activity (EDA). Open-source R packages were employed to automatically organize, clean, geocode, and visualize the biometric data. RESULTS: In total, 14 adults (8 women, 6 men) were successfully recruited to participate in the investigation. Participants recorded 174 images and 124 audio files with the DT. Among captured images with a participant-determined positive or negative rating (n = 131), over half were positive (58.8%, n = 77). Within-participant positive/negative rating ratios were similar, with most participants rating 53.0% of their images as positive (SD 21.4%). Significant spatial clusters of positive and negative photos were identified using the Getis-Ord Gi* local statistic, and significant associations between participant EDA and distance to DT photos, and street and land use characteristics were also observed with linear mixed models. Interactive data maps allowed participants to (1) reflect on data collected during the neighborhood walk, (2) see how EDA levels changed over the course of the walk in relation to objective neighborhood features (using basemap and DT app photos), and (3) compare their data to other participants along the same route. CONCLUSIONS: Participants identified a variety of social and environmental features that contributed to or detracted from their well-being. This initial investigation sets the stage for further research combining qualitative and quantitative data capture and interpretation to identify objective and perceived elements of the built environment influence our embodied experience in different settings. It provides a systematic process for simultaneously collecting multiple kinds of data, and lays a foundation for future statistical and spatial analyses in addition to more in-depth interpretation of how these responses vary within and between individuals.


Assuntos
Biometria/métodos , Ambiente Construído/normas , Planejamento Ambiental/normas , Nível de Saúde , Características de Residência , Estresse Psicológico/epidemiologia , Acelerometria/métodos , Acelerometria/normas , Acelerometria/tendências , Adulto , Ambiente Construído/tendências , Planejamento Ambiental/tendências , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Meio Social , Estresse Psicológico/psicologia , Caminhada/psicologia , Caminhada/normas
6.
J Pediatr Rehabil Med ; 11(1): 23-30, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29630560

RESUMO

PURPOSE: To examine the relationship between clinic-based walking capacity measures and community-based walking activity in ambulatory children with cerebral palsy (CP). METHODS: A secondary analysis of a cross-sectional cohort was employed at tertiary care children's hospital; n= 128, ages 2-9 years, Gross Motor Function Classification System (GMFCS) I-III. Walking capacity was captured with 1- and 6-minute walk tests (1MWT, 6MWT), Gross Motor Function Measure-walk/run/jump score (GMFM-E), and Activity Scale for Kids performance version (ASKp-30). Walking activity performance in the community was quantified by StepWatch (SW). RESULTS: Moderate correlations were documented for 6MWT to SW outputs of walking level, moderate high intensity, 60-minute peak and peak activity index (r= 0.55-0.58, p< 0.01). GMFM-E correlated with all SW outputs (r= 0.55-0.69, p< 0.01) except 1-minute peak walking rate. Per regression modeling, GMFM-E was associated with walking level and intensity (p< 0.02) and 6MWT related to high intensity walking (p< 0.4, R=2 0.28-0.48). CONCLUSION: 6MWT and GMFM-E have the strongest associations with level, amount and intensity of walking in daily life. Results suggest that the 6MWT and GMFM-E can be employed to estimate community walking activity in ambulatory children with CP. Future studies should focus on environmental and personal factors that influence community walking performance.


Assuntos
Paralisia Cerebral/reabilitação , Caminhada/normas , Atividades Cotidianas , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino
7.
Intensive Crit Care Nurs ; 45: 11-17, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29396165

RESUMO

OBJECTIVES: To determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes. DESIGN/METHODS: Prospective, longitudinal, comparative study using three time points (pre-, immediate post-intervention and 12-month post-intervention sustainability). Analyses included comparative statistics and multivariable modelling. Data were collected by clinical nurses, from administrative databases. Psychological health data were collected using a valid, reliable tool. SETTING: Patients treated in a 22-bed Neurological Intensive Care Unit of a quaternary-care medical centre. OUTCOME MEASURES: Highest mobility level, length of stay, mortality, discharge disposition, quality metrics and psychological profile including depression, anxiety, and hostility. RESULTS: Amongst 260 pre-intervention, 377 post-implementation, and 480 twelve-month post-implementation patients (N = 1117) walking increased post-implementation and was sustained at the eight-month assessment, p < .001. After multivariable adjustment, unit and hospital length of stay and psychological distress were reduced compared to the pre-early mobility programmes (all p < .001). There were no differences in discharge disposition (i.e., home vs skilled nursing facility), mortality or quality metrics. CONCLUSION: Ongoing implementation of an early mobility programme in a neurological intensive care environment led to sustained improvement in patients' level of mobility, length of unit and hospital stay, depression, anxiety and hostility levels.


Assuntos
Enfermeiras e Enfermeiros/tendências , Avaliação de Resultados da Assistência ao Paciente , Avaliação de Programas e Projetos de Saúde/métodos , Caminhada/tendências , APACHE , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Enfermagem em Neurociência/métodos , Enfermagem em Neurociência/tendências , Razão de Chances , Estudos Prospectivos , Caminhada/normas
8.
Arthritis Care Res (Hoboken) ; 70(7): 1005-1011, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29045051

RESUMO

OBJECTIVE: Evidence of physical function difficulties, such as difficulty rising from a chair, may limit daily walking for people with knee osteoarthritis (OA). The purpose of this study was to identify minimum performance thresholds on clinical tests of physical function predictive to walking ≥6,000 steps/day. This benchmark is known to discriminate people with knee OA who develop functional limitation over time from those who do not. METHODS: Using data from the Osteoarthritis Initiative, we quantified daily walking as average steps/day from an accelerometer (Actigraph GT1M) worn for ≥10 hours/day over 1 week. Physical function was quantified using 3 performance-based clinical tests: 5 times sit-to-stand test, walking speed (tested over 20 meters), and 400-meter walk test. To identify minimum performance thresholds for daily walking, we calculated physical function values corresponding to high specificity (80-95%) to predict walking ≥6,000 steps/day. RESULTS: Among 1,925 participants (mean ± SD age 65.1 ± 9.1 years, mean ± SD body mass index 28.4 ± 4.8 kg/m2 , and 55% female) with valid accelerometer data, 54.9% walked ≥6,000 steps/day. High specificity thresholds of physical function for walking ≥6,000 steps/day ranged 11.4-14.0 seconds on the 5 times sit-to-stand test, 1.13-1.26 meters/second for walking speed, or 315-349 seconds on the 400-meter walk test. CONCLUSION: Not meeting these minimum performance thresholds on clinical tests of physical function may indicate inadequate physical ability to walk ≥6,000 steps/day for people with knee OA. Rehabilitation may be indicated to address underlying impairments limiting physical function.


Assuntos
Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Desempenho Físico Funcional , Teste de Caminhada/métodos , Caminhada/fisiologia , Caminhada/normas , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Valor Preditivo dos Testes , Estudos Prospectivos
9.
Int J Health Geogr ; 16(1): 27, 2017 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-28778205

RESUMO

BACKGROUND: An online version of the Microscale Audit of Pedestrian Streetscapes (Abbreviated) tool was adapted to virtually audit built environment features supportive of physical activity. The current study assessed inter-rater reliability of MAPS Online between in-person raters and online raters unfamiliar with the regions. METHODS: In-person and online audits were conducted for a total of 120 quarter-mile routes (60 per site) in Phoenix, AZ and San Diego, CA. Routes in each city included 40 residential origins stratified by walkability and SES, and 20 commercial centers. In-person audits were conducted by raters residing in their region. Online audits were conducted by raters in the alternate location using Google Maps (Aerial and Street View) images. The MAPS Abbreviated Online tool consisted of four sections: overall route, street segments, crossings and cul-de-sacs. Items within each section were grouped into subscales, and inter-rater reliability (ICCs) was assessed for subscales at multiple levels of aggregation. RESULTS: Online and in-person audits showed excellent agreement for overall positive microscale (ICC = 0.86, 95% CI [0.80, 0.90]) and grand scores (ICC = 0.93, 95% CI [0.89, 0.95]). Substantial to near-perfect agreement was found for 21 of 30 (70%) subscales, valence, and subsection scores, with ICCs ranging from 0.62, 95% CI [0.50, 0.72] to 0.95, 95% CI [0.93, 0.97]. Lowest agreement was found for the aesthetics and social characteristics scores, with ICCs ranging from 0.07, 95% CI [-0.12, 0.24] to 0.27, 95% CI [0.10, 0.43]. CONCLUSIONS: Results support use of the MAPS Abbreviated Online tool to reliably assess microscale neighborhood features that support physical activity and may be used by raters residing in different geographic regions and unfamiliar with the audit areas.


Assuntos
Cidades , Planejamento Ambiental/normas , Internet/normas , Pedestres , Características de Residência , Caminhada/normas , Arizona , California , Humanos , Reprodutibilidade dos Testes
10.
J Appl Physiol (1985) ; 123(5): 1288-1302, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28729390

RESUMO

The metabolic energy that human walking requires can vary by more than 10-fold, depending on the speed, surface gradient, and load carried. Although the mechanical factors determining economy are generally considered to be numerous and complex, we tested a minimum mechanics hypothesis that only three variables are needed for broad, accurate prediction: speed, surface grade, and total gravitational load. We first measured steady-state rates of oxygen uptake in 20 healthy adult subjects during unloaded treadmill trials from 0.4 to 1.6 m/s on six gradients: -6, -3, 0, 3, 6, and 9°. Next, we tested a second set of 20 subjects under three torso-loading conditions (no-load, +18, and +31% body weight) at speeds from 0.6 to 1.4 m/s on the same six gradients. Metabolic rates spanned a 14-fold range from supine rest to the greatest single-trial walking mean (3.1 ± 0.1 to 43.3 ± 0.5 ml O2·kg-body-1·min-1, respectively). As theorized, the walking portion (V̇o2-walk = V̇o2-gross - V̇o2-supine-rest) of the body's gross metabolic rate increased in direct proportion to load and largely in accordance with support force requirements across both speed and grade. Consequently, a single minimum-mechanics equation was derived from the data of 10 unloaded-condition subjects to predict the pooled mass-specific economy (V̇o2-gross, ml O2·kg-body + load-1·min-1) of all the remaining loaded and unloaded trials combined (n = 1,412 trials from 90 speed/grade/load conditions). The accuracy of prediction achieved (r2 = 0.99, SEE = 1.06 ml O2·kg-1·min-1) leads us to conclude that human walking economy is predictably determined by the minimum mechanical requirements present across a broad range of conditions.NEW & NOTEWORTHY Introduced is a "minimum mechanics" model that predicts human walking economy across a broad range of conditions from only three variables: speed, surface grade, and body-plus-load mass. The derivation/validation data set includes steady-state loaded and unloaded walking trials (n = 3,414) that span a fourfold range of walking speeds on each of six different surface gradients (-6 to +9°). The accuracy of our minimum mechanics model (r2 = 0.99; SEE = 1.06 ml O2·kg-1·min-1) appreciably exceeds that of currently used standards.


Assuntos
Teste de Esforço/métodos , Gravitação , Velocidade de Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto , Fenômenos Biomecânicos/fisiologia , Teste de Esforço/normas , Feminino , Previsões , Humanos , Masculino , Caminhada/fisiologia , Caminhada/normas
11.
J Neurol Sci ; 379: 77-80, 2017 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-28716284

RESUMO

BACKGROUND: In persons with MS (PwMS), the Expanded Disability Status Scale (EDSS) is used to monitor disability progression. Scores between 4.0 and 7.0 are determined by maximum walking distance. Self-estimation of this value is often employed in clinic settings. OBJECTIVE: To examine the accuracy with which PwMS estimate their walking distance, and observe subsequent changes to the EDSS. METHODS: This prospective cohort study recruited PwMS with previously recorded EDSS of 3.5-7.0. Participants estimated their maximum walking distance and then walked as far as they could along a pre-specified course. Each distance was converted to an EDSS score, the "estimated EDSS" and the "actual EDSS". Chi-Square analysis was used to compare EDSS scores. Logistic regression was used to determine predictors of inaccurate estimations. RESULTS: Of the 66 PwMS in this study, 43.9% had a difference in the actual EDSS compared to the estimated EDSS. Median estimated EDSS was 4.75 (range 3.0-7.0); after walking assessment, median actual EDSS was 5.0 (range 3.0-7.0), which represented a significant difference [X2 (df 64, N=66)=206.9; p<0.001]. Actual EDSS decreased in 9 PwMS (13.6%) and increased in 20 PwMS (30.3%). Logistic regression did not find any demographic/disease characteristic to be predictive of this discrepancy. CONCLUSION: Some PwMS do not accurately estimate maximum walking distance; only 56.1% of PwMS accurately estimated their actual EDSS.


Assuntos
Avaliação da Deficiência , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/fisiopatologia , Autorrelato/normas , Teste de Caminhada/normas , Caminhada/normas , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Teste de Caminhada/métodos , Caminhada/fisiologia
12.
Spine J ; 17(2): 211-217, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27592193

RESUMO

BACKGROUND CONTEXT: The timed 30-m walking test (30MWT) is used in clinical practice and in research to objectively quantify gait impairment. The psychometric properties of 30MWT have not yet been rigorously evaluated. PURPOSE: This study aimed to determine test-retest reliability, divergent and convergent validity, and responsiveness to change of the 30MWT in patients with degenerative cervical myelopathy (DCM). STUDY DESIGN/SETTING: A retrospective observational study was carried out. PATIENT SAMPLE: The sample consisted of patients with symptomatic DCM enrolled in the AOSpine North America or AOSpine International cervical spondylotic myelopathy studies at 26 sites. OUTCOME MEASURES: Modified Japanese Orthopaedic Association scale (mJOA), Nurick scale, 30MWT, Neck Disability Index (NDI), and Short-Form-36 (SF-36v2) physical component score (PCS) and mental component score (MCS) were the outcome measures. METHODS: Data from two prospective multicenter cohort myelopathy studies were merged. Each patient was evaluated at baseline and 6 months postoperatively. RESULTS: Of 757 total patients, 682 (90.09%) attempted to perform the 30MWT at baseline. Of these 682 patients, 602 (88.12%) performed the 30MWT at baseline. One patient was excluded, leaving601 in the analysis. At baseline, 81 of 682 (11.88%) patients were unable to perform the test, and their mJOA, NDI, and SF-36v2 PCS scores were lower compared with those who performed the test at baseline. In patients who performed the 30MWT at baseline, there was very high correlation among the three baseline 30MWT measurements (r=0.9569-0.9919). The 30MWT demonstrated good convergent and divergent validity. It was moderately correlated with the Nurick (r=0.4932), mJOA (r=-0.4424), and SF-36v2 PCS (r=-0.3537) (convergent validity) and poorly correlated with the NDI (r=0.2107) and SF-36v2 MCS (r=-0.1984) (divergent validity). Overall, the 30MWT was not responsive to change (standardized response mean [SRM]=0.30). However, for patients who had a baseline time above the median value of 29 seconds, the SRM was 0.45. CONCLUSIONS: The 30MWT shows high test-retest reliability and good divergent and convergent validity. It is responsive to change only in patients with more severe myelopathy. The 30MWT is a simple, quick, and affordable test, and should be used as an ancillary test to evaluate gait parameters in patients with DCM.


Assuntos
Exame Físico/métodos , Doenças da Medula Espinal/diagnóstico , Espondilose/diagnóstico , Caminhada/normas , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico/normas , Estudos Prospectivos , Psicometria/métodos , Psicometria/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Doenças da Medula Espinal/psicologia , Espondilose/psicologia
13.
Prev Med ; 95S: S120-S125, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27364934

RESUMO

Nearly one-third of adults report no leisure-time physical activity (LTPA). Governmental and authoritative bodies recognize the role that community design through zoning code changes can play in enabling LTPA. This study examined the association between zoning and no adult LTPA in the U.S. This study was conducted between 2012 and 2016, with analyses occurring in 2015-2016. Zoning codes effective as of 2010 were compiled for jurisdictions located in the 495 most populous U.S. counties and were evaluated for pedestrian-oriented code reform zoning, 11 active living-oriented provisions (e.g., sidewalks, bike-pedestrian connectivity, mixed use, bike lanes) and a summated zoning scale (max=12). Individual-level LTPA data were obtained from the 2012 CDC Behavioral Risk Factor Surveillance System (BRFSS). County-aggregated, population-weighted zoning variables were constructed for linking to BRFSS. Log-log multivariate regressions (N=147,517 adults), controlling for individual and county characteristics and with robust standard errors clustered on county, were conducted to examine associations between zoning and no LTPA. Relative risks (RR) compared predicted lack of LTPA at 0% and 100% county-level population exposure to each zoning predictor. Zoning code reforms were associated with a 13% lower probability of no LTPA (RR: 0.87, 95% CI: 0.82-0.92). Except for crosswalks, all zoning provisions were associated with an 11-16% lower probability of no LTPA. Having all 12 zoning provisions was associated with a 22% lower probability of no LTPA (RR: 0.78, 95% CI: 0.72-0.83). The results suggest that active living-oriented zoning is a policy lever available to communities seeking to reduce rates of no LTPA.


Assuntos
Planejamento de Cidades/normas , Planejamento Ambiental/normas , Exercício Físico , Atividades de Lazer , Saúde Pública/normas , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Índice de Massa Corporal , Planejamento de Cidades/estatística & dados numéricos , Planejamento Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos , Caminhada/normas , Caminhada/estatística & dados numéricos , Adulto Jovem
14.
Spine J ; 17(1): 26-33, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27793759

RESUMO

BACKGROUND: Research suggests that people with lumbar spinal stenosis (LSS) would benefit from increased physical activity. Yet, to date, we do not have disease-specific activity guidelines for LSS, and the nature of free-living physical activity (performance) in LSS remains unknown. LSS care providers could endorse the 2008 United States Physical Activity Guidelines; however, we do not know if this is realistic. The goal of the present study was to determine the proportion of individuals with LSS meeting the 2008 Guidelines. A secondary goal was to better understand the nature of physical performance in this population. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: People from the Lumbar Spinal Stenosis Accelerometry Database, all of whom have both radiographic and clinical LSS and are seeking various treatments for their symptoms. OUTCOME MEASURES: Seven-day accelerometry (functional outcome) and demographics (self-reported). METHODS: For the present study, we analyzed only baseline data that were obtained before any new treatments. Patients with at least 4 valid days of baseline accelerometry data were included. We determined the proportion of individuals with LSS meeting the 2008 US Physical Activity Guidelines of at least 150 minutes of moderate-vigorous (MV) physical activity per week in bouts of 10 minutes or more. We also used the novel Physical Performance analysis designed by our group to determine time spent in varying intensities of activity. There are no conflicts of interest to disclose. RESULTS: We analyzed data from 75 individuals with a mean age of 68 (SD 9), 37% of whom were male. Three people (4%) were considered Meeting Guidelines (at least 150 MV minutes/week), and 56 (75%) were considered Inactive with not even 1 MV minute/week. With the 10-minute bout requirement removed, 10 of 75 (13%) achieved the 150-minute threshold. The average time spent in sedentary activity was 82%, and of time spent in nonsedentary activity, 99.6% was in the light activity range. CONCLUSIONS: In conclusion, the present study confirms that people with symptomatic LSS, neurogenic claudication, walking limitations, and LSS-related disability are extremely sedentary and are not meeting guidelines for physical activity. There is an urgent need for interventions aimed at reducing sedentary behavior and increasing the overall level of physical activity in LSS, not only to improve function but also to prevent diseases of inactivity. The present study suggests that reducing sedentary time, increasing time spent in light intensity activity, and increasing time spent in higher intensities of light activity may be appropriate as initial goals for exercise interventions in people with symptomatic LSS and neurogenic claudication, transitioning to moderate activity when appropriate. Results of the present study also demonstrate the importance of employing disease-specific measures for assessment of performance in LSS, and highlight the potential value of these methods for developing targeted and realistic goals for physical activity. Physical activity goals could be personalized using objective assessment of performance with accelerometry. The present study is one step toward a personalized medicine approach for people with LSS, focusing on increasing physical function.


Assuntos
Guias de Prática Clínica como Assunto , Estenose Espinal/reabilitação , Caminhada/normas , Idoso , Terapia por Exercício/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/terapia
15.
J Public Health (Oxf) ; 39(2): e19-e26, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-27412174

RESUMO

Background: This study examined the effect of different intensities of physical activity and the recommendations of the World Health Organization (WHO) on the subjective well-being (SWB) of adults in two age groups (18-64; 65+). Methods: Cross-sectional survey data from 28 European countries were used for the analysis (n = 21 008). Participation intensity was measured with the number of days and minutes of light (walking), moderate and vigorous activity. Another three dummy variables reflected how the WHO guidelines were met. Two-stage least square models were estimated with life satisfaction (measuring SWB) as the dependent variable. Results: For 18- to 64-year-olds, walking (minutes and days/week) and vigorous activity (minutes/week) significantly added to SWB, while moderate activity (minutes/week) had a negative effect. Individuals in both age groups meeting the guidelines only for moderate activity and those meeting the guidelines for both moderate and vigorous activity or using a combination of both reported significantly higher well-being levels compared with those not meeting the guidelines. Conclusions: Physical activity recommendations aiming at improving individuals' mental health should reconsider the inclusion of light-intensity activity, the interchangeability of moderate and vigorous activity, and the fact that more physical activity does not lead to better outcomes for all intensities and age groups.


Assuntos
Exercício Físico/fisiologia , Atividade Motora/fisiologia , Saúde Pública/normas , Caminhada/normas , Adulto , Idoso , Estudos Transversais , Europa (Continente) , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Organização Mundial da Saúde
17.
NeuroRehabilitation ; 38(1): 7-14, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26889793

RESUMO

BACKGROUND: The Expanded Disability Status Scale (EDSS) is a well-established clinical measure to assess disability in multiple sclerosis (MS). Gait dysfunction is primarily considered for scoring only above EDSS 3.5. However, the changes in functional systems in below EDSS 3.5 may result gait disturbances. OBJECTIVE: To determine the distinctive ability of the EDSS 2.0 in terms of walking impairment as well as fatigue, depression, and quality of life in persons with MS with mild disability. METHODS: All participants underwent the neurological examination for generating an EDSS score and completed the measures of walking performance, as well as other measures of fatigue, depression, and quality of life. The participants were divided into two groups according to the EDSS scores (i.e. EDSS <2.0 and 2.0-3.5). RESULTS: Participants with EDSS 2.0-3.5 had significantly worse walking performance, as well as fatigue, depression, and quality of life levels than the participants with EDSS <2.0 (p <  0.05). The EDSS significantly correlated with the measures of walking performance, as well as other measures of fatigue, depression, and quality of life. CONCLUSIONS: The EDSS 2.0 has a distinctive ability in terms of walking impairment as well as fatigue, depression, and quality of life.


Assuntos
Pessoas com Deficiência , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/epidemiologia , Esclerose Múltipla/diagnóstico , Exame Neurológico/estatística & dados numéricos , Caminhada/normas , Adulto , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Pessoas com Deficiência/psicologia , Fadiga/diagnóstico , Fadiga/epidemiologia , Fadiga/fisiopatologia , Feminino , Transtornos Neurológicos da Marcha/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Exame Neurológico/psicologia , Qualidade de Vida/psicologia , Caminhada/fisiologia
18.
Neurology ; 86(5): 442-5, 2016 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-26740680

RESUMO

OBJECTIVE: This methodologic study investigates if the 2-minute walk test (2MWT) can be a valid alternative to the 6-minute walk test (6MWT) to describe walking capability in patients with neuromuscular diseases. METHODS: Patients (n = 115) with different neuromuscular diseases were invited to participate on 2 test days, each consisting of 1 2MWT and 1 6MWT separated by a minimum 30-minute period of rest. The order of the walk tests was randomly assigned via sealed envelopes. A group of 38 healthy controls completed 1 6MWT. RESULTS: The mean walking distance for the 2MWT was 142.8 meters and for the 6MWT 405.3 meters. The distance walked in the 2MWT was highly correlated to the distance walked in the 6MWT (r = 0.99, p < 0.001). There was a significant decrease in walking speed from the first to last minute in the 6MWT, both among patients and healthy controls, which was not evident in the 2MWT. Results were consistent across diagnoses and levels of disease severity. CONCLUSION: The 2MWT is a potential alternative to the 6MWT to describe walking capability among patients with neuromuscular diseases during clinical trials.


Assuntos
Teste de Esforço/métodos , Teste de Esforço/normas , Doenças Neuromusculares/diagnóstico , Caminhada/fisiologia , Caminhada/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Doenças Neuromusculares/fisiopatologia , Fatores de Tempo , Adulto Jovem
19.
Appl Ergon ; 52: 309-16, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26360223

RESUMO

Walkway codes and standards are often created through consensus by committees based on a number of factors, including historical precedence, common practice, cost, and empirical data. The authors maintain that in the formulation of codes and standards that impact pedestrian safety, the results of pertinent scientific research should be given significant weight. This article examines many elements of common walkway codes and standards related to changes in level, stairways, stair handrails, and slip resistance. It identifies which portions are based on or supported by empirical data; and which could benefit from additional scientific research. This article identifies areas in which additional research, codes, and standards may be beneficial to enhance pedestrian safety.


Assuntos
Códigos de Obras/normas , Planejamento Ambiental/normas , Caminhada/normas , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Códigos de Obras/métodos , Feminino , Humanos , Masculino , Segurança/normas
20.
Ann Ig ; 27(4): 678-87, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26241112

RESUMO

AIM: To design an easy method to evaluate the walkability of an urban neighborhood, in order to support Public Administrations in the decision making related to urban health policy and local development. METHODS: The tool, called the Walking Suitability Index of the territory (T-WSI), has been further developed by our team. T-WSI is applied to each street of an environmental area. It includes 12 indicators subdivided into 4 categories: practicability, safety, urbanity, pleasurableness. Data collected in each street are inserted in an algoritm to perform weighted sums and to aggregate the indicators and the categories, up to compute the final index. To validate T-WSI an experimental study was carried out in two environmental areas of Rome: "San Saba" and "Sacco Pastore". RESULTS: The average index is: 58.6 for the neighborhood "San Saba" and for 55.1 for "Sacco Pastore. Both results detected gaps in the design for pedestrian use of public spaces. Among the analysed categories, Safety showed the worst results in both neighborhoods, mainly for the lack of "protection from vehicle speed". CONCLUSIONS: The developed tool is easy to use, inexpensive, sensible and reproducible, offering a good basis for urban health policy decisions. The relevance of the tool stands on the survey methodology, based on the direct and objective observation of the context.


Assuntos
Planejamento Ambiental , Segurança , Saúde da População Urbana , População Urbana , Caminhada , Planejamento Ambiental/normas , Inquéritos Epidemiológicos , Humanos , Reprodutibilidade dos Testes , Características de Residência , Roma , Segurança/normas , Fatores Socioeconômicos , Inquéritos e Questionários , Saúde da População Urbana/normas , Caminhada/normas
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