[Validity and reproducibility of a physical activity questionnaire used for health surveying among victims of the Great East Japan Earthquake]

OBJECTIVES

This study was performed to assess the validity and reproducibility of a questionnaire on physical activity status used for health surveying among victims of the Great East Japan Earthquake.

METHODS

Seventy-four residents (21 men and 53 women) living in temporary housing in Kamaishi City, Iwate Prefecture, participated in this study. The physical activity status questionnaire was composed of 4 questions regarding the frequency of performing domestic and occupational physical activities, the frequency of leaving their residence, walking duration per day, and sedentary time. The physical activity level for 2 weeks was measured using a tri-accelerometer to validate the responses to the questionnaire. Test-retest reproducibility was examined at 2-week intervals.

RESULTS

The physical activity levels were 4,521 +/- 2,266 steps/day for men and 4,533 +/- 2,070 steps/day for women. There was a significant difference in step count between those responding differently to the 3 options in the questionnaire regarding average walking duration per day: those who reported walking for > or = 60 min, 30-60 min, or < or = 30 min had step counts of 5,343 +/- 1,757, 4,760 +/- 1,752, and 3,063 +/- 1,772 steps/day, respectively (P < 0.05). When the response options for 3 questions (excluding those for sedentary time) were given scores (a higher score for a higher physical activity level), there were significant correlations between question score and step count (r = 0.486, P < 0.05) and the amount of moderate to vigorous physical activity (r = 0.342, P < 0.05). The test-retest trial showed a moderate degree of reproducibility, with weighted K coefficients of 0.41-0.65.

CONCLUSION

Three questions on physical activity levels may allow assessment of an individual's physical activity level, with a moderate degree of reproducibility.

Treadmill desks: A 1-year prospective trial

OBJECTIVE

Sedentariness is associated with weight gain and obesity. A treadmill desk is the combination of a standing desk and a treadmill that allow employees to work while walking at low speed.

DESIGN AND METHODS

The hypothesis was that a 1-year intervention with treadmill desks is associated with an increase in employee daily physical activity (summation of all activity per minute) and a decrease in daily sedentary time (zero activity). Employees (n = 36; 25 women, 11 men) with sedentary jobs (87 ± 27 kg, BMI 29 ± 7 kg/m(2) , n = 10 Lean BMI < 25 kg/m(2) , n = 15 Overweight 25 < BMI < 30 kg/m(2) , n = 11 Obese BMI > 30 kg/m(2) ) volunteered to have their traditional desk replaced with a treadmill desk to promote physical activity for 1 year.

RESULTS

Daily physical activity (using accelerometers), work performance, body composition, and blood variables were measured at Baseline and 6 and 12 months after the treadmill desk intervention. Subjects who used the treadmill desk increased daily physical activity from baseline 3,353 ± 1,802 activity units (AU)/day to, at 6 months, 4,460 ± 2,376 AU/day (P < 0.001), and at 12 months, 4,205 ± 2,238 AU/day (P < 0.001). Access to the treadmill desks was associated with significant decreases in daily sedentary time (zero activity) from at baseline 1,020 ± 75 min/day to, at 6 months, 929 ± 84 min/day (P < 0.001), and at 12 months, 978 ± 95 min/day (P < 0.001). For the whole group, weight loss averaged 1.4 ± 3.3 kg (P < 0.05). Weight loss for obese subjects was 2.3 ± 3.5 kg (P < 0.03). Access to the treadmill desks was associated with increased daily physical activity compared to traditional chair-based desks; their deployment was not associated with altered performance. For the 36 participants, fat mass did not change significantly, however, those who lost weight (n = 22) lost 3.4 ± 5.4 kg (P < 0.001) of fat mass. Weight loss was greatest in people with obesity.

CONCLUSIONS

Access to treadmill desks may improve the health of office workers without affecting work performance.

Regadenoson pharmacologic stress for myocardial perfusion imaging: a three-way comparison between regadenoson administered at peak exercise, during walk recovery, or no-exercise

BACKGROUND

Regadenoson (Reg) is being administered with increasing frequency either at peak exercise (ExPeak-Reg) or during a slow-down/walking recovery state (ExRec-Reg) rather than at rest (Rest-Reg). The aim of this study was to compare the clinical response of ExPeak-Reg, ExRec-Reg, and Rest-Reg.

METHODS

We compared 531 patients divided equally between Rest-Reg, ExPeak-Reg, and ExRec-Reg matched for age, sex, and BMI.

RESULTS

The average systolic blood pressure (SBP) rise following Reg was modest, but there was considerable heterogeneity and the ExPeak-Reg group had a higher percentage of patients who had a SBP rise of 40 mm Hg or a fall of 20 mm Hg than either the ExRec-Reg or the Rest-Reg groups (≥40 mm Hg rise 6.8%, 1.7%, and 1.7%, respectively) (P < .02) (≥20 mm Hg fall 15.8%, 13.0%, and 7.3%, respectively) (P < .05). Chest discomfort, nausea, dizziness, and interfering abdominal radiotracer activity were less common in both exercise Reg groups compared to Rest-Reg (P < .05).

CONCLUSION

Regadenoson injected at peak of symptom-limited exercise was generally well tolerated, but some patients had a significant rise or drop in SBP. There is no apparent advantage of administering regadenoson at peak exercise rather than during walk recovery, and the latter approach may have a greater safety margin.

Monocular visual scene understanding: understanding multi-object traffic scenes

Following recent advances in detection, context modeling, and tracking, scene understanding has been the focus of renewed interest in computer vision research. This paper presents a novel probabilistic 3D scene model that integrates state-of-the-art multiclass object detection, object tracking and scene labeling together with geometric 3D reasoning. Our model is able to represent complex object interactions such as inter-object occlusion, physical exclusion between objects, and geometric context. Inference in this model allows us to jointly recover the 3D scene context and perform 3D multi-object tracking from a mobile observer, for objects of multiple categories, using only monocular video as input. Contrary to many other approaches, our system performs explicit occlusion reasoning and is therefore capable of tracking objects that are partially occluded for extended periods of time, or objects that have never been observed to their full extent. In addition, we show that a joint scene tracklet model for the evidence collected over multiple frames substantially improves performance. The approach is evaluated for different types of challenging onboard sequences. We first show a substantial improvement to the state of the art in 3D multipeople tracking. Moreover, a similar performance gain is achieved for multiclass 3D tracking of cars and trucks on a challenging dataset.

Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up

BACKGROUND

Intensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention.

METHODS

Primary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion.

RESULTS

Intent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained.

CONCLUSIONS

The present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.

Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial

IMPORTANCE

Studies in experimental and human heart failure suggest that phosphodiesterase-5 inhibitors may enhance cardiovascular function and thus exercise capacity in heart failure with preserved ejection fraction (HFPEF).

OBJECTIVE

To determine the effect of the phosphodiesterase-5 inhibitor sildenafil compared with placebo on exercise capacity and clinical status in HFPEF.

DESIGN

Multicenter, double-blind, placebo-controlled, parallel-group, randomized clinical trial of 216 stable outpatients with HF, ejection fraction ≥50%, elevated N-terminal brain-type natriuretic peptide or elevated invasively measured filling pressures, and reduced exercise capacity. Participants were randomized from October 2008 through February 2012 at 26 centers in North America. Follow-up was through August 30, 2012.

INTERVENTIONS

Sildenafil (n = 113) or placebo (n = 103) administered orally at 20 mg, 3 times daily for 12 weeks, followed by 60 mg, 3 times daily for 12 weeks.

MAIN OUTCOME MEASURES

Primary end point was change in peak oxygen consumption after 24 weeks of therapy. Secondary end points included change in 6-minute walk distance and a hierarchical composite clinical status score (range, 1-n, a higher value indicates better status; expected value with no treatment effect, 95) based on time to death, time to cardiovascular or cardiorenal hospitalization, and change in quality of life for participants without cardiovascular or cardiorenal hospitalization at 24 weeks.

RESULTS

Median age was 69 years, and 48% of patients were women. At baseline, median peak oxygen consumption (11.7 mL/kg/min) and 6-minute walk distance (308 m) were reduced. The median E/e' (16), left atrial volume index (44 mL/m2), and pulmonary artery systolic pressure (41 mm Hg) were consistent with chronically elevated left ventricular filling pressures. At 24 weeks, median (IQR) changes in peak oxygen consumption (mL/kg/min) in patients who received placebo (-0.20 [IQR, -0.70 to 1.00]) or sildenafil (-0.20 [IQR, -1.70 to 1.11]) were not significantly different (P = .90) in analyses in which patients with missing week-24 data were excluded, and in sensitivity analysis based on intention to treat with multiple imputation for missing values (mean between-group difference, 0.01 mL/kg/min, [95% CI, -0.60 to 0.61]). The mean clinical status rank score was not significantly different at 24 weeks between placebo (95.8) and sildenafil (94.2) (P = .85). Changes in 6-minute walk distance at 24 weeks in patients who received placebo (15.0 m [IQR, -26.0 to 45.0]) or sildenafil (5.0 m [IQR, -37.0 to 55.0]; P = .92) were also not significantly different. Adverse events occurred in 78 placebo patients (76%) and 90 sildenafil patients (80%). Serious adverse events occurred in 16 placebo patients (16%) and 25 sildenafil patients (22%).

CONCLUSION AND RELEVANCE

Among patients with HFPEF, phosphodiesterase-5 inhibition with administration of sildenafil for 24 weeks, compared with placebo, did not result in significant improvement in exercise capacity or clinical status.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00763867.

A study of breast motion using non-linear dynamic FE analysis

This paper presents a new method to simulate non-linear breast motion by using a three-dimensional (3D) dynamic finite element model (FEM). The model consists of a thorax with two breasts and three skin layers with specific mechanical properties. Using free breast vibration, the viscous damping ratios were ascertained to be 0.215 for an 80B size breast. The shear modulus for the breast was derived as the value that gave the minimum difference between the FEM-predicted results and the experimental data. A hyper-elastic neo-Hookean material model simulated the large deformation of breast tissue. The mode shapes of breast motions at different natural frequencies were established. The highest breast displacement amplitude ratio relative to the thorax was at 4 Hz. The study showed that FEM can predict breast displacement with sufficient accuracy and thereby provide the basis by which bras may be engineered more ergonomically in the future.

PRACTITIONER SUMMARY

To facilitate a theoretical analysis of breast motion to enable the design of more supportive bras, a dynamic FEM based on reliable non-linear properties of breast tissues has been developed. The methods and findings have potential widespread benefit for developing new products to promote women's health and comfort.

[Effects of aquatic physical exercise on the kinematic gait pattern in patients with Parkinson's disease: a pilot study]

AIM. To determine the effects of an aquatic-based physical exercise program on gait parameters of patients with Parkinson's disease (PD). PATIENTS AND METHODS. A total of nine patients diagnosed with idiopathic PD (stages I-III according to the Hoehn and Yahr scale) carried out an aquatic physical exercise program which lasted for five months, with one session per week. A three-dimensional biomechanical analysis was used to determine the effects of the program on several kinematic variables (walking speed, cadence, stride length, step time, single and double support time, angles of the hip, knee and ankle joints) which were assessed by a treadmill-walking test. RESULTS. At the end of the program, significant improvement in walking speed, stride length and on the relationship between single and double support time (p < 0,05). Although improvements in all tested ranges of motion were obtained, these did not reach statistical significance. CONCLUSIONS. Aquatic-based physical exercise seems to have positive effects in some aspects of the gait kinematics parameters present in the typical gait pattern of patients with PD.

Perceived environment and public open space use: a study with adults from Curitiba, Brazil

BACKGROUND

The aim of this study was to investigate the association between the perceived environment and the use of public open spaces (POS).

METHODS

A cross-sectional study with household surveys was conducted in 1,461 adults from Curitiba, Brazil interviewed in person. The perceived environment was evaluated with the Neighborhood Environment Walkability Scale, and the POS use was evaluated using the ordinal scale (increased use).

RESULTS

The presence of interesting objects, heavy traffic, and the number of positive attributes of the environment was positively associated with POS use among men, and the presence of trees was associated with the use among women.

CONCLUSIONS

Managers should invest in the architectural attractiveness of neighborhoods and should plant and conserve trees to encourage POS use.

Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis

BACKGROUND

Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA.

METHODS

A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country.

RESULTS

A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e.g., U.S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA.

CONCLUSIONS

Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Physical activity and health-related quality of life among adult women in Cali, Colombia: a cross-sectional study

OBJECTIVES

To examine the associations of leisure-time physical activity (LTPA) and walking for transportation (WT) with the physical and mental dimensions of health-related quality of life (HR-QOL) among women.

METHODS

A cross-sectional study was carried out in 2009 among 1,263 women ages 18-59 years living in neighborhoods with low and middle-low socioeconomic status in the urban area of Cali. HR-QOL was assessed using the Short Form 8 (SF-8). LTPA and WT were measured using the long version of the International Physical Activity Questionnaire (IPAQ). Associations were assessed using linear regression models adjusting for potential confounders.

RESULTS

Low (10-149 min) and medium-high (at least 150 min) levels of WT were negatively associated with the mental and physical dimensions of HR-QOL. Low (10-149 min of moderate intensity PA, or 10-74 min of vigorous intensity PA) and medium-high (at least 150 or 75 min of moderate or vigorous intensity PA, respectively) levels of LTPA were positively associated with both dimensions. Significant interactions were observed between education level and perceived safety from traffic.

CONCLUSIONS

This study found that WT and LTPA were associated with HR-QOL both in the physical and mental dimensions; however, the direction and magnitude of the association varied by domain. These results highlight the need to better understand the links between PA and HR-QOL in urban contexts from Latin America.

Predictors of road crossing safety in pedestrians with Parkinson's disease

Road-crossing safety is an important issue in an aging society. Information regarding the risk of crossing the street to pedestrians with Parkinson's disease (PD) is limited. To assess the risk and predictors of unsafe crossing behaviors in patients with PD, we compared 31 pedestrians with mild-to-moderate PD to 50 age/gender/education-matched controls using a battery of cognitive, visual, and motor tests. With a simulated simple street-crossing situation, we determined the remaining time and safety margin for each participant in different traffic situations, including variable motor vehicle speed, time gap, and time of the day. Odds ratios (ORs) were estimated by logistic regression models. We found that pedestrians with PD were more vulnerable to traffic accidents than controls (OR 1.61 [1.28-2.02], P=0.01). The risk of crossing road correlated in a dose-dependent manner with the severity of PD, based on both Hoehn and Yahr (H&Y) stages and unified Parkinson's disease rating scale (UPDRS) motor scores (OR 1.13 for each increasing point of UPDSR, P<0.01). Among PD patients, scores of clock drawing test (OR 0.8 [0.74-0.88], P<0.01) and visual form discrimination (OR 1.14 [1.07-1.22], P<0.01) predicted worsening of safety errors, rather than executive function. Environmental factors, such as fast approaching motor vehicle speed (OR 4.50 [2.92-6.95], P<0.01), short time gap (OR 45.98 [27.04-78.18], P<0.01), and time of day (OR 4.45 [3.11-6.36], P<0.01) also affected road-crossing safety. Future large sample studies are needed to confirm our findings. Training programs or portable stimulator devices that compensate for the visual-spatial disabilities of PD patients are required to improve road safety for PD patients.

[Effects of stocking density on the behaviour and bodily state of broilers fattened with a target liveweight of 2 kg]

The current investigation is a contribution to the animal welfare debate on acceptable stocking densities in broiler chickens. Two stocking densities on similar levels as currently legally regulated (35 kg/m2 und 40 kg/m2) and two cleary lower stocking densities (18 kg/m2 und 25 kg/m2) were investigated in groups of 18 to 42 Lohmann broiler chickens (B) in three batches with each time one replication of all stocking densities. Target weight of the broiler chickens was 2 kg at 39 or 40 days of age. Mortality, final live weights and activity levels were not significantly different between stocking densities. The proportion of time birds were sitting/lying increased in general with age from about 56% to 82%, probably due to their rapid growth. Nevertheless, at the lower stocking densities there was only in single cases. Moreover, significantly more footpads showed medium grade alterations under higher density conditions; high grade alterations were also different between 35 kg/m2 and 40 kg/m2. Walking ability was only different between the lowest and the two higher densities. Altogether results reflect behavioural restriction at the higher stocking densities with increased risks for footpad alterations and lameness. In order to reach clear animal welfare improvements, e. g. in the framework of animal welfare labeling, a considerable lowering of the stocking density is consequently one important measure. However, this recommendation should be further validated under commercial conditions.

Activity patterns and perceptions about active transport to school

OBJECTIVES

To document physical activity patterns and perceptions about active transport to school.

METHODS

Children's activity was measured. Children and parents were surveyed about active transport to school.

RESULTS

Children were most active after (465 ± 20 cpm) and least active before (379 ± 18 cpm) and during school (351 ± 13 cpm). Weight was not related to activity. Boys were more confident than girls, whereas parents felt more confident than children did about active transport.

CONCLUSIONS

Active transport programs will likely have a greater impact on before-school activity than after school. Perceptions concerning active transport should be assessed, and parent/child discrepancies rectified prior to program implementation.

Effects of mobile Internet use on college student pedestrian injury risk

BACKGROUND

College-age individuals have the highest incidence of pedestrian injuries of any age cohort. One factor that might contribute to elevated pedestrian injuries among this age group is injuries incurred while crossing streets distracted by mobile devices.

OBJECTIVES

Examine whether young adult pedestrian safety is compromised while crossing a virtual pedestrian street while distracted using the Internet on a mobile "smartphone."

METHOD

A within-subjects design was implemented with 92 young adults. Participants crossed a virtual pedestrian street 20 times, half the time while undistracted and half while completing an email-driven "scavenger hunt" to answer mundane questions using mobile Internet on their cell phones. Six measures of pedestrian behavior were assessed during crossings. Participants also reported typical patterns of street crossing and mobile Internet use.

RESULTS

Participants reported using mobile Internet with great frequency in daily life, including while walking across streets. In the virtual street environment, pedestrian behavior was greatly altered and generally more risky when participants were distracted by Internet use. While distracted, participants waited longer to cross the street (F=42.37), missed more safe opportunities to cross (F=42.63), took longer to initiate crossing when a safe gap was available (F=53.03), looked left and right less often (F=124.68), spent more time looking away from the road (F=1959.78), and were more likely to be hit or almost hit by an oncoming vehicle (F=29.54; all ps<0.01). Results were retained after controlling for randomized order; participant gender, age, and ethnicity; and both pedestrian habits and mobile Internet experience.

CONCLUSION

Pedestrian behavior was influenced, and generally considerably riskier, when participants were simultaneously using mobile Internet and crossing the street than when crossing the street with no distraction. This finding reinforces the need for increased awareness concerning the risks of distracted pedestrian behavior.

Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis)

OBJECTIVE

While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence.

DESIGN AND METHODS

Data came from 4,008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1-mile buffer area. Obesity was defined as BMI ≥ 30 kg/m(2) . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression.

RESULTS

Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual-level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15).

CONCLUSIONS

Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.

Waist circumference does not correlate with functional lung capacity in moderate and severe chronic obstructive pulmonary disease

Waist circumference is a good predictor of the risk of heart diseases, but data on the relationship between waist circumference and pulmonary diseases are sparse. The aim of this study was to investigate its influence on pulmonary function regarding exercise capacity in moderate and severe chronic obstructive pulmonary disease (COPD), according to Global Initiative for Lung Diseases (GOLD) stages. During 2009, a total of 70 COPD patients aged 33 to 80 years were stratified into GOLD 2 and GOLD 3 stages. Diagnostic separation between COPD severity groups was made upon percentage of predicted forced expiratory volume in 1 second. Anthropometric measures, lung function testing and prognostic scoring systems were assessed. Logistic regression analysis was used to make comparisons while taking into account the possible confounding factors. Waist circumference did not show substantial variations between GOLD 2 and GOLD 3 stages (p > 0.5). There was a weak positive correlation between waist circumference and percent of predicted 6-minute walking distance (r = 0.237; p = 0.001). Another parameter, suprailiac skinfold, was significantly different between GOLD 2 and GOLD 3 stages (19.41 vs. 15.32 mm; p = 0.047). Although waist circumference is a meaningful marker of abdominal obesity, which influences pulmonary function, we failed to prove its importance in correlation with functional lung capacity in a selected COPD population. However, suprailiac skinfold deserves greater attention and further evaluation.

[The influence of locomotor treatment using robotic body-weight-supported treadmill training on rehabilitation outcome of patients suffering from neurological disorders]

Regaining one's ability to walk is of great importance for neurological patients and is a major goal of all rehabilitation programs. Treating neurological patients in the acute phase after the event is technically difficult because of their motor weakness and balance disturbances. Based on studies in spinalized animals, a novel locomotor training that incorporates high repetitions of task-oriented practice by the use of body weight-supported treadmill training (BWSTT) was developed to overcome these obstacles. The use of BWSTT enables early initiation of gait training, integration of weightbearing activities, stepping and balance by the use of a task-specific approach, and a symmetrical gait pattern. However, despite the theoretical potential of BWSTT to become an invaluable therapeutic tool, its effect on walking outcomes was disappointing when compared with conventional training of the same duration. To facilitate the deLivery of BWSTT, a motorized robotic driven gait orthosis (RBWSTT) was recently developed. It has many advantages over the conventional method, including less effort for the physiotherapists, longer session duration, more physiological and reproducible gait patterns, and the possibility of measuring a patient's performances. Several studies have been conducted using RBWSTT in patients after stroke, spinal cord injury, multiple sclerosis and other neurological diseases. Although some of the results were encouraging, there is still uncertainty regarding proper patient selection, timing and protocol for RBWTT treatment following neurological diseases. More large randomized controlled studies are needed in order to answer these questions.

The Six-Minute Walk Test for adults with intellectual disability: a study of validity and reliability

BACKGROUND

The Six-Minute Walk Test (6MWT) has been used with clinical and healthy populations to assess functional capacity and cardiovascular fitness. The aim of this study was to determine the test-retest reliability of a modified-6MWT as well as concurrent validity of walk distance with peak oxygen uptake (VO₂ peak).

METHOD

Participants were 13 adults (males = 7) with intellectual disability aged 18-44 years recruited from Special Olympics, and with no medical contraindications to exercise. The 6MWT was modified to include familiarisation, a 1:1 pacer, and encouragement every 15 s. Each participant performed the graded maximal treadmill test and the modified-6MWT twice.

RESULTS

Test-retest reliability of the modified-6MWT was ICC = .98, and linear regression revealed that the modified- 6MWT distance was significantly related to VO₂ peak (R = .84, p < .001).

CONCLUSIONS

The modified-6MWT is easy to administer and score and shows acceptable validity and excellent reliability for assessing cardiovascular fitness in adults with intellectual disability.

II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology: arthroscopy, traumatology, leg immobilization, minor orthopaedic procedures and spine surgery

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

Chronic refractory dyspnoea--evidence based management

BACKGROUND

Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases.

OBJECTIVE

To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea.

DISCUSSION

Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.

Walking performance: correlation between energy cost of walking and walking participation. new statistical approach concerning outcome measurement

Walking ability, though important for quality of life and participation in social and economic activities, can be adversely affected by neurological disorders, such as Spinal Cord Injury, Stroke, Multiple Sclerosis or Traumatic Brain Injury. The aim of this study is to evaluate if the energy cost of walking (CW), in a mixed group of chronic patients with neurological diseases almost 6 months after discharge from rehabilitation wards, can predict the walking performance and any walking restriction on community activities, as indicated by Walking Handicap Scale categories (WHS). One hundred and seven subjects were included in the study, 31 suffering from Stroke, 26 from Spinal Cord Injury and 50 from Multiple Sclerosis. The multivariable binary logistical regression analysis has produced a statistical model with good characteristics of fit and good predictability. This model generated a cut-off value of.40, which enabled us to classify correctly the cases with a percentage of 85.0%. Our research reveal that, in our subjects, CW is the only predictor of the walking performance of in the community, to be compared with the score of WHS. We have been also identifying a cut-off value of CW cost, which makes a distinction between those who can walk in the community and those who cannot do it. In particular, these values could be used to predict the ability to walk in the community when discharged from the rehabilitation units, and to adjust the rehabilitative treatment to improve the performance.