T. Moseng

Health-Related Physical Fitness Measures: Reference Values and Reference Equations for Use in Clinical Practice

OBJECTIVE To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice. DESIGN Cross-sectional design. SETTING General community. PARTICIPANTS Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test). RESULTS The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age. CONCLUSIONS The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.

Does outpatient physical therapy with the aim of improving health-related physical fitness influence the level of physical activity in patients with long-term musculoskeletal conditions?

OBJECTIVE To evaluate any change in self-reported level of physical activity in patients receiving a general physical exercise programme in addition to disease-specific physiotherapy treatment. DESIGN Pre-post-intervention study. SETTING Outpatient physiotherapy clinics. PARTICIPANTS One hundred and ninety patients with long-term musculoskeletal conditions attending outpatient physiotherapy were recruited from seven physiotherapy clinics. INTERVENTIONS Physiotherapy including disease-specific modalities and a general individually tailored exercise programme. Patients were evaluated at baseline and at the end of the programme. MAIN OUTCOME MEASURES International Physical Activity Questionnaire short form (IPAQ-sf) and COOP WONCA functional assessment charts. RESULTS Forty-two patients were excluded from the analysis because they did not complete the IPAQ-sf correctly or dropped out during the treatment period. There was a significant increase in the number of metabolic equivalent task (MET)-min/week for vigorous and moderate-intensity activities, walking and total physical activity. The number of exercise sessions per week increased from 1.8 [standard deviation (SD) 0.9] to 2.2 (SD 1.2) (P=0.001). The proportion of patients with a low level of physical activity decreased by 12%, and the proportion of the participants who did not/could not exercise decreased from 26% to 8%. The COOP WONCA charts showed significant improvements in the physical fitness, feelings, daily activities and social activities items. CONCLUSION A significant increase was found in the number of MET-min/week for all activity levels. Therefore, a general physical exercise programme initiated by a physiotherapist led to a positive change in level of physical activity.

Patients with musculoskeletal conditions do less vigorous physical activity and have poorer physical fitness than population controls: a cross-sectional study

OBJECTIVES To compare physical activity and physical fitness in patients with various musculoskeletal conditions receiving physiotherapy in primary care with population controls. DESIGN Cross-sectional. PARTICIPANTS One hundred and sixty-seven patients with musculoskeletal conditions receiving physiotherapy in primary care and 313 population controls from various settings and geographical areas. MAIN OUTCOME MEASURES Physical activity was measured with the International Physical Activity Questionnaire short-form (IPAQ-sf) and reported in metabolic equivalents (METs). The 6-minute walk test and 30-second sit-to-stand test reflected cardiorespiratory endurance and muscular strength, respectively. RESULTS Differences in physical activity between the groups were explored using the Mann-Whitney U-test. The patient group reported significantly less vigorous activity compared with the control group {median 0 [interquartile range (IQR) 0 to 960] vs median 240 [IQR 0 to 1440] MET minutes/week, respectively)} (P=0.001). A similar proportion of patients (68%) and controls (75%) reached the recommended level of health-enhancing physical activity (P=0.11). Linear regression analyses adjusted for age, body mass index and gender showed significantly poorer fitness in the patient group compared with the control group, reflected by the 6-minute walk test and the 30-second sit-to-stand test {mean difference 69m [95% confidence interval (CI) 52 to 85; P≤0.001] and six repetitions [95% CI 5 to 7; P≤0.001], respectively}. CONCLUSIONS Patients with various long-term musculoskeletal conditions receiving physiotherapy in primary care had significantly poorer physical fitness and reported less vigorous physical activity compared with population controls.

AB0833-HPR Health-related physical fitness testing in physiotherapy practice – reliability and feasibility

Background People with musculoskeletal conditions (MSCs) tend to be less physically active1 and more deconditioned than healthy controls2;3. Thus, physiotherapists seeing patients with MSCs should include an individually tailored exercise program in the treatment plan. According to current recommendations, these exercise programs should focus on health-related physical fitness4. For measuring patients’ physical fitness, reliable and feasible instruments are needed. Objectives To examine reliability and feasibility of frequently used patient-reported and performance-based instruments for measuring health-related physical fitness in patients with a variety of MSCs. Methods In a test-retest study, 81 patients were tested twice one week apart. Patients conducted five performance-based tests (the 6 min walk test (6MWT), the stair test (ST), the handgrip test, the 30 sec sit-to-stand test (30sSTS) and the modified fingertip-to-floor test (FTF)) and answered two questionnaires (the Self-assessed physical fitness questionnaire and the COOP/WONCA Charts). Reliability and measurement error was calculated with ICC2.1 or weighted kappa and Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC). ICC2.1 and weighted kappa values of <0.70 were considered acceptable. Results All performance-based tests and the Self-assessed physical fitness questionnaire and three of six charts in the COOP/WONCA Charts showed acceptable reliability. SDC90% was calculated to 49 meters, 8 sec and 4 kg for the 6MWT, the ST and the handgrip test, respectively. Correspondingly, 4 sit-to-stands and 9 cm fingertip-to-floor distance was shown for the 30sSTS and the FTF test. Changes of two points were needed to detect changes beyond measurement error in the Self-assessed physical fitness questionnaire. The 6MWT was the most time consuming, with all other instruments each taking less than 3 min to complete. About 40% needed assistance in answering the COOP/WONCA Charts, while the corresponding value for the Physical Fitness Quetionnaire was about 20%. Conclusions All instruments seem feasible for use in patients with MSCs. The 6MWT, the ST, the handgrip test and the Self-assessed physical fitness questionnaire can be recommended as reliable instruments with acceptable measurement error, while the 30sSTS test and the modified FTF test showed high variability for use in assessing change in health-related physical fitness. The COOP/WONCA Chart might be more suitable for screening purposes. References Farr et al. Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Arthritis Rheum 2008; 59(9):1229-1236. Ryan et al. Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls: an observational study. Aust J Physiother 2009; 55(1):53-58. Hodselmans et al. Nonspecific chronic low back pain patients are deconditioned and have an increased body fat percentage. Int J Rehabil Res 2010; 33(3):268-270. Nelson et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39(8):1435-1445. Disclosure of Interest None Declared

AB0834-HPR Health-related physical fitness testing in physiotherapy practice – reference values

Background People with musculoskeletal conditions (MSCs) tend to be less physically active1 and more deconditioned than healthy controls2. Recommendations for management of MSCs emphasize exercise as an important part of the treatment3. According to current recommendations, patients should be offered an individually tailored exercise program focusing on health-related physical fitness4. To improve the clinical usefulness of fitness-measures capturing the patients physical fitness, relevant reference values for these instruments are needed. Objectives The objective was to establish reference values and distribution of scores for frequently used measures of health-related physical fitness derived from age- and gender-groups of the general population. Methods In a cross-sectional study, 370 males and females 18-90 years of age were recruited. Five tests (6 min walk test, stair test, handgrip test, 30 sec sit-to-stand test and modified fingertip-to-floor test) and two questionnaires (Physical fitness questionnaire and COOP/WONCA) were included. Results Performance on all tests, except the modified fingertip-to-floor test, were stable until about 50 years of age, later performance was reduced with increasing age. Responses on patient-reported instrument were stable with gender and age. Distribution of scores are presented i Kernel plots. Image/graph Conclusions The reference values can improve the interpretability and clinical usefulness of fitness measures. References Farr et al. Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Arthr Rheum 2008; 59(9):1229-1236. Hodselmans et al. Nonspecific chronic low back pain patients are deconditioned and have an increased body fat percentage. Int J Rehabil Res 2010; 33(3):268-270. Hochberg et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthr Care Res 2012; 64(4):465-474. Nelson et al. Physical activity and public health in older adults: recommendation from the ACSM and the AHA. Med Sci Sports Exerc 2007; 39(8):1435-1445 Disclosure of Interest None Declared