Marco van Brussel

Reliability of hand-held dynamometry and functional strength tests for the lower extremity in children with Cerebral Palsy

Purpose. To evaluate the intertester reliability of two methods for measuring lower-limb strength in children with cerebral palsy (CP). Method. Twenty-five subjects with CP (7 – 17 years of age) participated in this study. Lower-limb muscle strength was measured on 2 occasions using a Hand-held Dynamometer (HHD; break-method and make-method) and a 30-sec Repetition Maximum (RM) during three functional strength tests for the lower extremities. Reliability was measured using the intraclass correlation coefficients (ICCs), the standard error of measurement (SEM) and the coefficient of variation (CV). Results. The intertester reliability of strength measurement using a HHD was questionable with ICC values ranging from 0.42 – 0.73 for the break-method, and from 0.49 – 0.82 for the make-method. The SEM and CV (%) values ranged from 27.9 – 58.9 and 22.2 – 35.3% for the break-method, and from 30.6 – 52.7 and 16.2 – 56.2% for make-method. The intertester reliability of strength measurement using the 30-sec RM was acceptable with ICC values ranging from 0.91 – 0.96, and SEM and CV (%) values ranging from 1.1 – 2.6 and 10.9 – 39.9% for the functional exercises. Conclusion. The intertester reliability of measuring muscle strength of the lower extremities using a hand-held dynamometer is questionable. The intertester reliability of the 30-sec RM for the lower extremity is acceptable.

Physical function and fitness in long-term survivors of childhood leukaemia.

Objective: To evaluate the physical function and fitness in survivors of childhood leukaemia 5–6 years after cessation of chemotherapy. Materials and methods: Thirteen children (six boys and seven girls; mean age 15.5 years) who were treated for leukaemia were studied 5–6 years after cessation of therapy. Physical function and fitness were determined by anthropometry, motor performance, muscle strength, anaerobic and aerobic exercise capacity. Results: On motor performance, seven of the 13 patients showed significant problems in the hand-eye co-ordination domain. Muscle strength only showed a significantly lower value in the mean strength of the knee extensors. The aerobic and the anaerobic capacity were both significantly reduced compared to reference values. Conclusion: Even 5–6 years after cessation of childhood leukaemia treatment, there are still clear late effects on motor performance and physical fitness. Chemotherapy-induced neuropathy and muscle atrophies are probably the prominent cause for these reduced test results. Physical training might be indicated for patients surviving leukaemia to improve fitness levels and muscle strength.

The oxygen uptake efficiency slope: what do we know?

PURPOSE: To summarize what is currently known about the oxygen uptake efficiency slope (OUES) as an objective and independent submaximal measure of cardiorespiratory fitness in health and disease. METHODS: A literature search was performed within the following electronic databases—pubmed, cochrane library, embase, web of science, CINAHL, psycINFO, Scopus, and MEDLINE—using the search terms “OUES,” “oxygen uptake efficiency slope,” and “ventilatory efficiency.” The search identified 51 articles. Selection, evaluation, and data extraction were accomplished independently by 2 authors. RESULTS: Twenty-four studies satisfied all inclusion criteria: 17 cross-sectional studies and 7 intervention studies. The results indicated that the OUES is relatively independent of exercise intensity, correlates highly with other exercise parameters, appears to have discriminative value, and is sensitive to the effects of physical training in patients with cardiac disease. Oxygen uptake efficiency slope values are considerably influenced by anthropometric variables and show large interindividual variation. CONCLUSION: Oxygen uptake efficiency slope is an independent and reproducible measure of cardiorespiratory function that does not require maximal exercise. It greatly reduces test variability because of motivational and subjective factors and is reliable and easily determinable in all subjects. Although OUES appears not interchangeable with maximal parameters of cardiopulmonary function, it seems to be a useful submaximal alternative in subjects unable to perform maximal exercise.

Brief Report: Association of Myositis Autoantibodies, Clinical Features, and Environmental Exposures at Illness Onset With Disease Course in Juvenile Myositis.

To identify early factors associated with disease course in patients with juvenile idiopathic inflammatory myopathies (IIMs).

Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis

To systematically assess contemporary knowledge regarding behavioral physical activity interventions including an activity monitor (BPAI+) in adults with overweight or obesity.

QUANTITATIVE MUSCLE ULTRASONOGRAPHY IN THE FOLLOW-UP OF JUVENILE DERMATOMYOSITIS

Introduction: We explored the use of quantitative muscle ultrasonography (QMUS) for follow‐up of juvenile dermatomyositis (JDM). Methods: Seven JDM patients were evaluated at diagnosis and 1, 3, 6, 12, and 24 months using the Childhood Myositis Assessment Scale (CMAS) and QMUS. Muscle thickness (MT) and quantitative muscle echo intensity (EI) were assessed with QMUS in 4 muscles. Results: Six patients experienced a monocyclic course. At diagnosis EI was slightly increased, and MT was relatively normal. After start of treatment MT first decreased and EI increased, with normalization of EI within 6–12 months (n = 4). One patient had higher EIs at diagnosis and slower normalization, indicating fibrosis, despite early normalization of CMAS. One patient experienced a chronic course, with high EIs and atrophy during follow‐up. Conclusions: QMUS can provide additional information for follow‐up of JDM regarding disease severity and residual muscle damage, particularly after normalization of CMAS. Muscle Nerve 52: 540–546, 2015

Myositis autoantibodies, clinical features, and environmental exposures at illness onset are associated with disease course in juvenile myositis.

To identify early factors associated with disease course in patients with juvenile idiopathic inflammatory myopathies (IIMs).

Aerobic capacity and disease activity in children, adolescents and young adults with juvenile idiopathic arthritis (JIA)

BackgroundAs patients with juvenile idiopathic arthritis (JIA) progress into adulthood, long-term outcome is determined by disease activity, physical and psychosocial development. Decreased aerobic capacity may play a critical role in health-related outcomes in JIA, since it has been linked with cardiovascular morbidity and mortality in late adulthood. The objectives of the current study are to examine the aerobic capacity and its relation to parameters of disease activity in children, adolescents and young adults with JIA.MethodsSixty-three patients with JIA (aged 10–27 years) were cross sectional studied regarding their aerobic capacity and correlations were made to demographic, disease-related variables, and medication utilization. in a cross-sectional study group of 63 patients of all subtypes. Patients were divided in three age groups, 10–13 years; 14–17 years and 18–27 years.ResultsReduced aerobic capacity is found in clinical remission as well as active disease in all subtypes and all age groups. Aerobic capacity is more impaired in active disease shown by DAS 28, JADAS 27, ESR and serum thrombocyte counts. Lower haemoglobin has a negative impact. Long-term used medication including methotrexate and corticosteroids didn’t influence outcome. There is no association with current sports participation.ConclusionReduced aerobic capacity is present in adolescents and young adults with JIA, both in active disease and in patients with remission. Measures of aerobic capacity may serve as important outcome measure in JIA.

Muscles in motion: a randomized controlled trial on the feasibility, safety and efficacy of an exercise training programme in children and adolescents with juvenile dermatomyositis

OBJECTIVE To study for the first time in a randomized controlled trial the feasibility, safety and efficacy of an exercise training programme in children and adolescents with JDM. METHODS Patients were randomly assigned to the Intervention Group (IG; n = 14) or Waiting Control Group (WCG; n = 12). The intervention comprised an individually tailored 12-week home-based exercise programme of treadmill interval training and strength exercises. The efficacy of the IG over usual care (WCG) was examined with mixed linear regression (intention-to-treat). Effect sustainability during 12 weeks follow-up was also examined. RESULTS Seventy-five percent of the participants completed the intervention. Reasons for discontinuation were motivation/fatigue, recurrent infections and increasing physical complaints. No hospitalizations occurred and immune suppressive therapy remained stable or decreased in the patients who participated in the intervention. The estimated marginal means after the intervention period were significantly in favour of the IG compared with the WCG for standing long jump distance [difference between groups (95% CI): 13 cm (2-23)], the 30-s number of push-ups [8 (3-13)] and sit-ups [4 (0.4-8)], and the parent Childhood Health Assessment Questionnaire 30 + 8 score [-0.13 (-0.24 to - 0.01)] and effects sustained at follow-up. A trend was seen for the maximal oxygen uptake divided by body mass during maximal exercise treadmill testing; the IG scored 3.0 ml/kg/min (-1.3 to 7.3) higher compared with the WCG. Other outcomes (e.g. isometric muscle strength and perception of fatigue) did not differ between IG and WCG. CONCLUSION Exercise training is of value in the clinical management of JDM.

Near‐infrared spectroscopy during exercise and recovery in children with juvenile dermatomyositis

Introduction: We hypothesized that microvascular disturbances in muscle tissue play a role in the reduced exercise capacity in juvenile dermatomyositis (JDM). Methods: Children with JDM, children with juvenile idiopathic arthritis (clinical controls), and healthy children performed a maximal incremental cycloergometric test from which normalized concentration changes in oxygenated hemoglobin (Δ[O2Hb]) and total hemoglobin (Δ[tHb]) as well as the half‐recovery times of both signals were determined from the vastus medialis and vastus lateralis muscles using near‐infrared spectroscopy. Results: Children with JDM had lower Δ[tHb] values in the vastus medialis at work rates of 25%, 50%, 75%, and 100% of maximal compared with healthy children; the increase in Δ[tHb] with increasing intensity seen in healthy children was absent in children with JDM. Other outcome measures did not differ by group. Conclusions: The results suggest that children with JDM may experience difficulties in increasing muscle blood volume with more strenuous exercise. Muscle Nerve, 2013