Physical fitness and physical activity in fatigued and non-fatigued inflammatory bowel disease patients.

OBJECTIVE: To assess physical fitness and physical activity in inflammatory bowel disease (IBD) patients and whether fatigue is associated with impaired physical fitness and impaired physical activity. MATERIALS AND METHODS: Ten patients with quiescent IBD and fatigue (fatigue group [FG]) based on the Checklist Individual Strength-Fatigue score of ≥35 were matched for age (±5 years) and sex with a non-fatigue group (NFG) with IBD. Physical fitness was measured with a cyclo-ergometric-based maximal exercise test, a submaximal 6-min walk test, and a dynamometer test to quantify the isokinetic muscle strength of the knee extensors and flexors. Level of physical activity was measured with an accelerometer-based activity monitor. RESULTS: The patients in both groups did not differ in regard to medication use, clinical characteristics, and body composition. However, medium-to-large effect sizes for impaired physical fitness (both cardiorespiratory fitness and muscle strength) and physical activity were seen between the patients in the FG and the NFG. Especially, intensity of physical activity was significantly lower in the FG patients compared with the NFG patients (effect size: 1.02; p = 0.037). Similar results were seen when outcomes of the FG and NFG were compared with reference values of the normal population. CONCLUSION: Fatigued IBD patients show an impaired physical fitness and physical activity compared with non-fatigued IBD patients. This gives directions for a physical component in fatigue in IBD patients. Therefore, these new insights into fatigue indicate that these patients might benefit from an exercise program to improve physical fitness and physical activity.

Validation of an activity monitor for children who are partly or completely wheelchair-dependent.

BACKGROUND: Children who are wheelchair-dependent are at risk for developing unfavorable physical behavior; therefore, assessment, monitoring and efforts to improve physical behavior should start early in life. VitaMove is an accelerometer-based activity monitor and can be used to detect and distinguish different categories of physical behavior, including activities performed in a wheelchair and activities using the legs. The purpose of this study was to assess the validity of the VitaMove activity monitor to quantify physical behavior in children who are partly or completely wheelchair-dependent. METHODS: Twelve children with spina bifida (SB) or cerebral palsy (CP) (mean age, 14 ± 4 years) performed a series of wheelchair activities (wheelchair protocol) and, if possible, activities using their legs (n = 5, leg protocol). Activities were performed at their own home or school. In children who were completely wheelchair-dependent, VitaMove monitoring consisted of one accelerometer-based recorder attached to the sternum and one to each wrist. For children who were partly ambulatory, an additional recorder was attached to each thigh. Using video-recordings as a reference, primary the total duration of active behavior, including wheeled activity and leg activity, and secondary agreement, sensitivity and specificity scores were determined. RESULTS: Detection of active behaviour with the VitaMove activity monitor showed absolute percentage errors of 6% for the wheelchair protocol and 10% for the leg protocol. For the wheelchair protocol, the mean agreement was 84%, sensitivity was 80% and specificity was 85%. For the leg protocol, the mean agreement was 83%, sensitivity was 78% and specificity was 90%. Validity scores were lower in severely affected children with CP. CONCLUSIONS: The VitaMove activity monitor is a valid device to quantify physical behavior in children who are partly or completely wheelchair-dependent, except for severely affected children and for bicycling.

The Activ8 activity monitor: Validation of posture and movement classification.

INTRODUCTION: To set up and guide interventions with the aim to increase physical activity and lower sedentary behavior valid monitoring of physical behavior is essential. The aim of this study was to evaluate the validity of the single-unit Activ8 activity monitor to classify several body postures and movements. METHODS: Twelve healthy adults performed a series of activities, representative for everyday life, according to a standard protocol. Activ8 was both worn in the trouser pocket (prescribed location) and fixated to the front of the thigh. Activities were video recorded and analyzed thereafter. Postures and movements that were analyzed were lying/sitting, standing, walking, cycling, and running. RESULTS: The agreement between Activ8 output and video analysis was 89.7% (inter-subject range: 66.0 to 96.6%) for the pocket location and 91.9% (range 85.5 to 95.1%) for the thigh location. Sensitivity and positive predictive value scores for both locations were all above 80%, except for standing (69% or higher). Differences in classified duration of separate postures and movements were within 20% for walking, sitting and running. CONCLUSION: The Activ8 is a valid instrument to quantify a defined set of body postures and movements. Because of the smaller time difference, the thigh location is preferred for research purposes.

Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre.

OBJECTIVE: To determine the most important barriers to and facilitators of the level of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. DESIGN: Qualitative study with both cross-sectional and retrospective questions. SUBJECTS: Thirty-two persons with a spinal cord injury. METHODS: Semi-structured interview with questions concerning the current situation (>9 months after discharge) and retrospective questions concerning the period shortly after discharge (=3 months). The interview consisted of 10 topic categories assumed to have an impact on the level of everyday physical activity and covering the main parts of the International Classification of Functioning, Disability and Health (ICF) model. RESULTS: In the current situation, the most important barriers were problems with accessibility of stores and buildings, physical health problems and mental health problems. Shortly after discharge, the most important barriers were emotional distress, problems with self-care, and mental health problems. The most frequently mentioned facilitators were preparation in the rehabilitation centre with respect to daily activities and social activities and stimulation to be physically active. CONCLUSION: Persons with a spinal cord injury experience important barriers to physical activity, particularly on the ICF component Body Functions and Structure.

Small increase of actual physical activity 6 months after total hip or knee arthroplasty.

UNLABELLED: Limitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA or TKA on patients' actual physical activity and body function (pain, stiffness), capacity to perform tasks, and self-reported physical functioning. We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA and whether the improvements vary between these different outcome measures. We recruited patients with long-standing end-stage osteoarthritis of the hip or knee awaiting THA or TKA. Measurements were performed before surgery and 3 and 6 months after surgery. Actual physical activity improved by 0.7%. Patients' body function, capacity, and self-reported physical functioning also improved. The effects of the surgery on these aspects of physical functioning were similar for THA and TKA. The effect on actual physical activity (8%) was smaller than on body function (80%-167%), capacity (19%-36%), and self-reported physical functioning (87%-112%). Therefore, in contrast to the large effect on pain and stiffness, patients' capacity, and their self-reported physical functioning, the improvement in actual physical activity of our patients was less than expected 6 months after surgery. LEVEL OF EVIDENCE: Level I, prospective study. See the Guidelines for Authors for a complete description of levels of evidence.

Does aerobic training lead to a more active lifestyle and improved quality of life in patients with chronic heart failure?

BACKGROUND: Due to dyspnea and fatigue, patients with chronic heart failure (CHF) are often restricted in the performance of everyday activities, which gradually may lead to hypoactivity. AIMS: To assess whether aerobic training leads to a more active lifestyle and improved quality of life (QoL) in patients with CHF. METHODS: Patients with stable CHF (NYHA II/III; 59 (11) years) were randomly assigned to a training group (n=18; 3-month aerobic program above standard treatment) or control group (n=16; standard treatment without special advice for exercise). Measurements were performed on level of everyday physical activity (PA, novel accelerometry-based activity monitor) and QoL, and on several related parameters. RESULTS: Training did not result in a more active lifestyle or improved QoL, but improved (P<0.05) peak power (17%), 6-min walk distance (10%), muscle strength (13-15%) and depression (-1.3 unit). Changes in level of everyday PA were related to changes in peak Vo(2) (r=0.58, P=0.01) and knee extension strength (r=0.48, P=0.05). CONCLUSIONS: At group level training did not result in a more active lifestyle or improved QoL. However, correlations between training-related changes in parameters suggest that aerobic training has the potential to increase levels of everyday PA in CHF.

Determinants of the sit-to-stand movement: a review.

BACKGROUND AND PURPOSE: The sit-to-stand (STS) movement is a skill that helps determine the functional level of a person. Assessment of the STS movement has been done using quantitative and semiquantitative techniques. The purposes of this study were to identify the determinants of the STS movement and to describe their influence on the performance of the STS movement. METHODS: A search was made using MEDLINE (1980-2001) and the Science Citation Index Expanded of the Institute for Scientific Information (1988-2001) using the key words "chair," "mobility," "rising," "sit-to-stand," and "standing." Relevant references such as textbooks, presentations, and reports also were included. Of the 160 identified studies, only those in which the determinants of STS movement performance were examined using an experimental setup (n=39) were included in this review. RESULTS: The literature indicates that chair seat height, use of armrests, and foot position have a major influence on the ability to do an STS movement. Using a higher chair seat resulted in lower moments at knee level (up to 60%) and hip level (up to 50%); lowering the chair seat increased the need for momentum generation or repositioning of the feet to lower the needed moments. Using the armrests lowered the moments needed at the hip by 50%, probably without influencing the range of motion of the joints. Repositioning of feet influenced the strategy of the STS movement, enabling lower maximum mean extension moments at the hip (148.8 N m versus 32.7 N m when the foot position changed from anterior to posterior). DISCUSSION AND CONCLUSION: The ability to do an STS movement, according to the research reviewed, is strongly influenced by the height of the chair seat, use of armrests, and foot position. More study of the interaction among the different determinants is needed. Failing to account for these variables may lead to erroneous measurements of changes in STS performance.

Prevalence of low back pain after transfemoral amputation related to physical activity and other prosthesis-related parameters.

BACKGROUND: Although clinical experience indicates that prolonged use of a prosthesis after transfemoral amputation (TFA) is related to a higher incidence of low back pain (LBP), few data are available to substantiate this impression. Therefore, in a TFA population, we investigated the prevalence of LBP and its relationship with years since amputation, as well as the level of daily physical activity and other prosthesis-related parameters. METHOD: Questionnaires were sent to 490 subjects with TFA. Of these, 240 questionnaires could be used for analysis. RESULTS: Trauma and tumours were the most frequent reasons for amputation. The majority of the study group was aged under 30 years at the time of surgery, had been using a prosthesis more than 10 years, and had a moderately active life. Serious LBP (i.e. frequent or permanent LBP) was reported in 26.3% of the participants. No relationship was found between LBP and years since amputation or physical activity. CONCLUSION: The data show that the prevalence of LBP in our study group is higher than in the general population, and higher in the female than in the male participants. The initial assumption that there is a higher and increasing length of time since amputation and physical activity level is not confirmed in this study.

Effects of naratriptan versus naproxen on daily functioning in the acute treatment of migraine: a randomized, double-blind, double-dummy, crossover study.

OBJECTIVE: To evaluate the effect of acute treatment on ictal behavioral functioning of patients with migraine via ambulatory accelerometry. BACKGROUND: The inability to carry out daily activities often complicates migraine attacks. Research into the effects of pharmacological drugs on this outcome parameter in the acute treatment of migraine has been based on subjective reports only. METHODS: In a double-blind, double-dummy, crossover study, 12 patients with migraine treated 2 migraine attacks with the nonspecific antimigraine drug, naproxen (500-mg capsule) or the more specific antimigraine drug, naratriptan (2.5-mg tablet). The clinical symptoms of headache, nausea, vomiting, photophobia, and phonophobia, and the subjective symptoms reflecting mood, sleepiness, and level of functioning were measured by use of a daily log. RESULTS: During the first 6 hours after intake of the study medication, the objective behavioral parameters showed no significant effect of time and no significant differences between naproxen and naratriptan, but naratriptan was significantly more efficacious than naproxen in relieving headache, nausea, and vomiting; the interval between treatment and relief was significantly shorter after intake of naratriptan. CONCLUSIONS: Consciously perceived clinical and subjective symptoms do not necessarily run in parallel with their behavioral equivalents. It, thus, may be important to assess the effects of treatment on behavioral functioning in the evaluation of the general efficacy of antimigraine drugs in the acute treatment of a migraine attack.