Maremka Zwinkels

Reproducibility and Validity of the 10-Meter Shuttle Ride Test in Wheelchair-Using Children and Adolescents With Cerebral Palsy

Background For children with cerebral palsy (CP) who are able to walk or run, the 10-m shuttle run test is currently the test of choice to assess cardiorespiratory fitness. This test, however, has not yet been examined in wheelchair-using youth with CP. Objective The purpose of this study was to investigate the test-retest reproducibility and validity of the 10-m shuttle ride test (SRiT) in youth with CP. Design Repeated measurements of the SRiT were obtained. Methods Twenty-three individuals with spastic CP (18 boys, 5 girls; mean age=13.3 years, SD=3.6 years) using a manual wheelchair for at least part of the day participated in this study. During the study, all participants performed one graded arm exercise test (GAET) and 2 identical SRiTs within 2 weeks. Peak oxygen uptake (V̇o2peak), peak heart rate (HRpeak), and respiratory exchange ratio (RER) were recorded. Intraclass correlation coefficients (2,1), the smallest detectable difference, and the limits of agreement (LOA) were calculated. The association between the results of the SRiT and GAET was tested using Pearson correlation coefficients. Results Intraclass correlation coefficients (.99, 95% confidence interval=.98–1.00) for all variables indicated highly acceptable reproducibility. The LOA analysis revealed satisfactory levels of agreement. The SRiT variables demonstrated strong, significant positive correlations for V̇o2peak values obtained during the SRiT and the GAET (r=.84, P<.01). Limitations Although the GAET is considered the gold standard, the cardiorespiratory demand during the GAET was significantly lower compared with during the SRiT. Future studies should determine whether the GAET can still be accepted as the gold standard for upper-extremity exercise. Conclusions The SRiT is a reproducible and valid test for measuring cardiorespiratory fitness in youth with spastic CP who self-propel a manual wheelchair.

Reliability and validity of short-term performance tests for wheelchair-using children and adolescents with cerebral palsy

To investigate the test–retest reproducibility of the Muscle Power Sprint Test (MPST), the 10 × 5‐m sprint test, and the arm‐cranking Wingate Anaerobic Test (WAnT) in children and adolescents with cerebral palsy (CP). A secondary objective was to assess the construct validity of the MPST.

Sport-2-Stay-Fit study : Health effects of after-school sport participation in children and adolescents with a chronic disease or physical disability

BackgroundChildren and adolescents with a chronic disease or physical disability have lower fitness levels compared to their non-disabled peers. Low physical fitness is associated with reduced physical activity, increased cardiovascular diseases, and lower levels of both cognitive and psychosocial functioning. Moreover, children and adolescents with a chronic disease or physical disability participate less in both recreational and competitive sports. A variety of intervention studies have shown positive, but only temporary, effects of training programs. Next to issues related to the chronic condition itself, various personal and environmental factors play a key role in determining the extent to which they participate in sports or physical activities. Due to these barriers, sport participation in the immediate after-school hours seems to be a feasible solution to get these children and adolescents physical active structurally. To investigate if an after school sport program can sustain the positive effects of an intervention, a standardized interval training will be given to improve physical fitness levels. High-intensity Interval Training (HIT) is superior to moderate-intensity continuous training in improving physical fitness in patients with chronic diseases. Therefore, the Sport-2-Stay-Fit study will investigate whether after school sport participation can increase the sustainability of a HIT program in children and adolescents with a chronic disease or physical disability.MethodsThe Sport-2-Stay-Fit study is a clinical controlled trial. A total of 74 children and adolescents in the age of 6–19 years with a chronic disease or physical disability will be included. This could be either a cardiovascular, pulmonary, metabolic, musculoskeletal or neuromuscular disorder. Both children and adolescents who are ambulatory or propelling a manual wheelchair will be included. All participants will follow a HIT program of eight weeks to improve their physical fitness level. Thereafter, the intervention group will participate in sport after school for six months, while the control group receives assessment only. Measurements will take place before the HIT, directly after, as well as, six months later. The primary objective is anaerobic fitness. Secondary objectives are agility, aerobic fitness, strength, physical activity, cardiovascular health, cognitive functioning, and psychosocial functioning.DiscussionIf effective, after school sport participation following a standardized interval training could be implemented on schools for special education to get children and adolescents with a chronic disease or physical disability active on a structural basis.Trial registrationThis trial is registered at the Dutch Trial Register #NTR4698.

The associations of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness in youth with chronic diseases or physical disabilities:

Background The evidence on the associations of cardiorespiratory fitness, body adiposity and sports participation with arterial stiffness in children and adolescents with chronic diseases or physical disabilities is limited. Methods Altogether 140 children and adolescents with chronic diseases or physical disabilities participated in this cross-sectional study. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake by body weight or fat-free mass. Body adiposity was assessed using waist circumference, body mass index standard deviation score and body fat percentage. Sports participation was assessed by a questionnaire. Aortic pulse wave velocity and augmentation index were assessed by a non-invasive oscillometric tonometry device. Results Peak oxygen uptake/body weight (standardised regression coefficient β −0.222, 95% confidence interval (CI) −0.386 to −0.059, P = 0.002) and peak oxygen uptake/fat-free mass (β −0.173, 95% CI −0.329 to −0.017, P = 0.030) were inversely and waist circumference directly (β 0.245, 95% CI 0.093 to 0.414, P = 0.002) associated with aortic pulse wave velocity. However, the associations of the measures of cardiorespiratory fitness with aortic pulse wave velocity were attenuated after further adjustment for waist circumference. A higher waist circumference (β −0.215, 95% CI −0.381 to −0.049, P = 0.012) and a higher body mass index standard deviation score (β 0.218, 95% CI −0.382 to −0.054, P = 0.010) were related to lower augmentation index. Conclusions Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in children and adolescents with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist circumference.

Exercise training programs to improve hand rim wheelchair propulsion capacity: a systematic review

Objective: An adequate wheelchair propulsion capacity is required to perform daily life activities. Exercise training may be effective to gain or improve wheelchair propulsion capacity. This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity. Data sources: PubMed and EMBASE databases were searched from their respective inceptions in October 2013. Review methods: Exercise training studies with at least one outcome measure regarding wheelchair propulsion capacity were included. In this study wheelchair propulsion capacity includes four parameters to reflect functional wheelchair propulsion: cardio-respiratory fitness (aerobic capacity), anaerobic capacity, muscular fitness and mechanical efficiency. Articles were not selected on diagnosis, training type or mode. Studies were divided into four training types: interval, endurance, strength, and mixed training. Methodological quality was rated with the PEDro scale, and the level of evidence was determined. Results: The 21 included studies represented 249 individuals with spinal-cord injury (50%), various diagnoses like spina bifida (4%), cerebral palsy (2%), traumatic injury, (3%) and able-bodied participants (38%). All interval training studies found a significant improvement of 18-64% in wheelchair propulsion capacity. Three out of five endurance training studies reported significant effectiveness. Methodological quality was generally poor and there were only two randomised controlled trials. Conclusion: Exercise training programs seem to be effective in improving wheelchair propulsion capacity. However, there is remarkably little research, particularly for individuals who do not have spinal-cord injury.

Body mass index and fitness in high-functioning children and adolescents with cerebral palsy: What happened over a decade?

BACKGROUND In recent decades, improving fitness has become an important goal in rehabilitation medicine in children and adolescents with cerebral palsy (CP). AIMS To compare body mass index (BMI), performance-related fitness, and cardiorespiratory fitness of children with CP measured in 2014 with a comparable sample from 2004. METHODS AND PROCEDURES In total, 25 high-functioning children with CP (i.e., GMFCS I-II) measured in 2004 (13 boys; mean age 13.2 (2.6) years) were matched to 25 children measured in 2014. Outcomes included body mass and BMI, muscle power sprint test (MPST), 10×5m sprint test, and a shuttle run test (SRT). Data of 15 participants from 2004 (10 boys; mean age 12.6 (2.5) years) were matched and analysed for VO2peak. OUTCOMES AND RESULTS Body mass and BMI were higher (both: p<0.05) in the 2014 cohort compared to the 2004 cohort. Further, performance-related fitness was better for the 2014 cohort on the MPST (p=0.004), the 10×5m sprint test (p=0.001), and the SRT (p<0.001). However, there were no differences for VO2peak. CONCLUSIONS AND IMPLICATIONS In high-funcitoning children with CP, there are positive ecological time trends in performance-related fitness, but not in VO2peak between 2004 and 2014. The substantial higher body mass and BMI is alarming and requires further investigation.

Effects of a School-Based Sports Program on Physical Fitness, Physical Activity, and Cardiometabolic Health in Youth With Physical Disabilities : Data From the Sport-2-Stay-Fit Study

Objective To investigate the effects of a school-based once-a-week sports program on physical fitness, physical activity, and cardiometabolic health in children and adolescents with a physical disability. Methods This controlled clinical trial included 71 children and adolescents from four schools for special education [mean age 13.7 (2.9) years, range 8–19, 55% boys]. Participants had various chronic health conditions including cerebral palsy (37%), other neuromuscular (44%), metabolic (8%), musculoskeletal (7%), and cardiovascular (4%) disorders. Before recruitment and based on the presence of school-based sports, schools were assigned as sport or control group. School-based sports were initiated and provided by motivated experienced physical educators. The sport group (n = 31) participated in a once-a-week school-based sports program for 6 months, which included team sports. The control group (n = 40) followed the regular curriculum. Anaerobic performance was assessed by the Muscle Power Sprint Test. Secondary outcome measures included aerobic performance, VO2 peak, strength, physical activity, blood pressure, arterial stiffness, body composition, and the metabolic profile. Results A significant improvement of 16% in favor of the sport group was found for anaerobic performance (p = 0.003). In addition, the sport group lost 2.8% more fat mass compared to the control group (p = 0.007). No changes were found for aerobic performance, VO2 peak, physical activity, blood pressure, arterial stiffness, and the metabolic profile. Conclusion Anaerobic performance and fat mass improved following a school-based sports program. These effects are promising for long-term fitness and health promotion, because sports sessions at school eliminate certain barriers for sports participation and adding a once-a-week sports session showed already positive effects for 6 months. Clinical Trial Registration This trial was registered with the Dutch Trial Registry (NTR4698).

Sport is belangrijk, ook voor jongeren met een fysieke beperking

In de toekomst zouden er meer sportmogelijkheden moeten komen voor jongeren met een fysieke beperking bij een sportvereniging in de buurt. Dit is een van de aanbevelingen uit het proefschrift vanMaremka Zwinkels [1]. Jongeren met een fysieke beperking zijn trainbaar volgens algemene trainingsprincipes, maar sporten minder vaak dan hun leeftijdgenoten en doen dit ook vaker bij aangepaste (naschoolse) sportverenigingen. Wanneer ze aansluiting vinden bij een lokale sportvereniging, zouden ze vaker kunnen sporten, komen ze in contact met jongeren uit de buurt en worden ze meer betrokken in de samenleving.