Rita van den Berg-Emons

A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge

OBJECTIVES To assess the change over time in the physical activity level after a spinal cord injury (SCI), to explore its determinants, and to compare the physical activity level 1 year after discharge from the rehabilitation center with the level in able-bodied persons. DESIGN Prospective cohort study. Measurements were obtained at the start of active rehabilitation, 3 months later, at discharge, 2 months after discharge, and 1 year after discharge. SETTING Rehabilitation center in The Netherlands and the participants home. PARTICIPANTS Persons (n=40) with SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The physical activity level, as indicated by the duration of dynamic activities (ie, wheelchair driving, walking, cycling, noncyclic movement) per day, and the intensity of everyday activity; both were measured with an accelerometry-based activity monitor during 2 consecutive weekdays. RESULTS Random coefficient analyses showed that the duration of dynamic activities and the intensity of everyday activity increased during inpatient rehabilitation at rates of 41% and 19%, respectively (P<.01). Shortly after discharge, there was a strong decline (33%; P<.001) in the duration of dynamic activities. One year after discharge, this decline was restored to the discharge level but was low in comparison with levels in able-bodied persons. The level of lesion and completeness of lesion were determinants of the change in the physical activity level after discharge. CONCLUSIONS The physical activity level increased during inpatient rehabilitation, but this increase did not continue after discharge, and the level 1 year after discharge was distinctly lower than the level in able-bodied persons. Subpopulations had a different change over time in the physical activity level after discharge.

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.

Energy expenditure in chronic stroke patients playing Wii Sports: A pilot study

BackgroundStroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing.MethodsTen chronic (≥ 6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (> 6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines.ResultsAmong the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (± SD) energy expenditure during Wii Sports game play was 3.7 (± 0.6) METs for tennis and 4.1 (± 0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures > 3 METs.ConclusionsWith the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.

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

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.

Impact of chronic pain on everyday physical activity.

Although patients with chronic pain are often considered to have reduced levels of everyday physical activity, data on their activity levels are scarce and inconclusive. Therefore, this study explored whether patients with chronic pain have reduced activity levels, as objectively measured with an activity monitor. The activity monitor is based on long‐term ambulatory monitoring of signals from body‐fixed accelerometers during everyday life, aimed at assessment of mobility‐related activities. Measurements with the monitor were performed during a weekday (24h) in 18 patients with chronic pain and compared with measurements obtained from 18 gender and age matched healthy comparison subjects.

VALIDITY OF AMBULATORY ACCELEROMETRY TO QUANTIFY PHYSICAL ACTIVITY IN HEART FAILURE

The purpose was to assess the validity of a novel Activity Monitor to quantify physical activity in congestive heart failure. The Activity Monitor is based on long-term ambulatory monitoring of signals from body-fixed accelerometers. Information can be obtained on which mobility-related activity is performed, when, how intense, and for how long. Ten patients performed several functional activities. Continuous registrations of accelerometer signals were made and the output was compared with visual analysis of simultaneously made video recordings (reference method). Overall results showed an agreement between both methods of 90%. Percentages of sensitivity and predictive value were higher than 80% for most activities. Overall number of transitions was determined well (Activity Monitor, 153; video, 149; p = 0.33). It was concluded that the Activity Monitor is a valid instrument to quantify several aspects of everyday physical activity in congestive heart failure.

Triad of physical activity, aerobic fitness and obesity in adolescents and young adults with myelomeningocele.

OBJECTIVE Comprehensively and objectively assess physical activity, aerobic fitness and body fat in adolescents and young adults with myelomeningocele and to investigate their relationships. DESIGN Cross-sectional study. SUBJECTS Fifty-one persons (26 males) with myelomeningocele aged 21.1 (standard deviation) 4.5) years. METHODS Physical activity was measured with an accelerometry-based activity monitor. Aerobic fitness was defined as the maximum oxygen uptake during the last minute of a maximal exercise test. Body fat was assessed using sum of 4 skin-folds and body mass index. Correlations were studied using multiple regression analyses. RESULTS Thirty-nine percent of the participants were inactive and another 37% were extremely inactive. Aerobic fitness was 42% lower than normative values and 35% were obese. Ambulatory status was related to daily physical activity (beta = 0.541), aerobic fitness (beta = 0.397) and body fat (beta = -0.243). Gender was related to aerobic fitness (beta = -0.529) and body fat (beta = 0.610). Physical activity was related to aerobic fitness in non-ambulatory persons with myelomeningocele (beta = 0.398), but not in ambulatory persons. CONCLUSION Adolescents and young adults with myelomeningocele were physically inactive, had poor aerobic fitness and high body fat. Differences exist between subgroups regarding gender and ambulatory status.

Energy Expenditure in Adults With Cerebral Palsy Playing Wii Sports

OBJECTIVE To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. DESIGN Cross-sectional study. SETTING University medical center. PARTICIPANTS Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. INTERVENTION Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. MAIN OUTCOME MEASURE By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. RESULTS Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. CONCLUSIONS Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels.

Accelerometry-Based Activity Spectrum in Persons With Chronic Physical Conditions

OBJECTIVES (1) To give an overview of the impact of a variety of chronic physical conditions on accelerometry-based levels of everyday physical activity and to identify high-risk conditions; and (2) to compare these objectively assessed activity levels with the levels estimated by rehabilitation physicians. INTERVENTIONS Not applicable. DESIGN Cross-sectional study. SETTING Participants home environment. PARTICIPANTS Patients (n=461) with 18 chronic physical (sub)conditions and able-bodied subjects (n=96). MAIN OUTCOME MEASURES We summarized data on the level of everyday physical activity as objectively measured with an accelerometry-based activity monitor. Thirty-one rehabilitation physicians filled in a questionnaire designed to obtain their estimates of the level of physical activity in patients with the various conditions. RESULTS Only 4 of the studied conditions had normal activity levels (≥90% of the able-bodied level). Persons with transtibial amputation (vascular), spinal cord injury, and myelomeningocele (wheelchair dependent) had the lowest levels of activity, less than 40% of the able-bodied level. In general, rehabilitation physicians were aware of the inactive lifestyles, but considerably underestimated the magnitude of inactivity in the high-risk conditions. CONCLUSIONS This is the first study to provide an objectively assessed activity spectrum in a variety of chronic physical conditions. We hope this study will increase the awareness of health professionals as to which chronic physical conditions are at increased risk for an inactive lifestyle, and will contribute to adaptation of patient management accordingly.

Chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy

Aim  To investigate the prevalence and co‐occurrence of chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy (SBCP) and explore associations of chronic pain and fatigue with depressive symptoms and daily functioning.