[Freiburg Questionnaire of physical activity--development, evaluation and application]

Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial

BACKGROUND

Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF.

METHODS

Based on evidence extracted from a literature review, a curriculum for the self-management program was elaborated. The curriculum was reviewed and validated by an interdisciplinary expert group and the training-modules will be pretested with a small number of participants and discussed in terms of feasibility and acceptance.To determine the efficacy of the program a randomised controlled trial will be carried out: 300 patients will be recruited from oncological practices in Bremen, Germany, and will be allocated to intervention or control group. The intervention group participates in the program, whereas the control group receives standard care and the opportunity to take part in the program after the end of the follow-up (waiting control group). Primary outcome measure is the level of fatigue, secondary outcome measures are quality of life, depression, anxiety, self-efficacy and physical activity. Data will be collected before randomisation, after intervention, and after a follow-up of 6 months.

DISCUSSION

Because there are no comparable self-management programs for cancer survivors with fatigue, the development of the curriculum has been complex; therefore, the critical appraisal by the experts was an important step to validate the program and their contributions have been integrated into the curriculum. The experts appreciated the program as filling a gap in outpatient cancer care.If the results of the evaluation prove to be satisfactory, the outpatient care of cancer patients can be broadened and supplemented.

TRIAL REGISTRATION

ClinicalTrials NCT00552552.

A comparison of the physiologic effects of acute whole-body vibration exercise in young and older people

OBJECTIVE

To examine the acute physiologic effects of acute whole-body vibration (WBV) exercise in young and older people.

DESIGN

Every participant performed 9 conditions in a static squat position, consisting of no vibration and WBV at 30Hz and 3 loads corresponding to (1) no load (0% body mass), (2) load of 20% body mass, and (3) load of 40% body mass. A Jendrassik voluntary contraction was also performed with no vibration and WBV at 30Hz with no load and 20% body mass.

SETTING

Laboratory facilities at a university in the United Kingdom.

PARTICIPANTS

Healthy young people (n=12; 6 men, 6 women; mean age, 21.5y) and 12 healthy older people (6 men, 6 women; mean age, 69.2y) from the local community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Physical Activity Questionnaire, anthropometric measures, counter-movement jump, and isometric maximal voluntary contraction with the Jendrassik maneuver were assessed in both groups. Oxygen uptake (Vo2), blood pressure, heart rate, and rating of perceived exertion (RPE) were recorded during WBV and load conditions as the outcome of the study.

RESULTS

Both vibration and load were associated with an increase (P<.001) in Vo2 for older and young groups. WBV elicited the equivalent of a .35 metabolic equivalent (MET) increase in Vo2, with additional loads of 20% and 40% body mass increasing Vo2 by 0.8 and 1.2 METs, respectively. Additionally, there was an interaction effect of vibration and group in which the WBV-related Vo2 increase was less in the old compared with the young. Both vibration and load caused an increase in heart rate, blood pressure, and RPE (all P<.001); however, there were no significant group differences between young and older groups. The Jendrassik maneuver elicited an increase in Vo2 by 27.6% for the old and 33% for the young group (P<.001); however, there was no significant difference between groups.

CONCLUSIONS

Vo2 significantly increased in both the older and young people with vibration and additional load and when the Jendrassik maneuver was superimposed with vibration and load. However, the elicited increase in Vo2 (1.2mL x kg(-1).min(-1)) from WBV may be an insufficient stimulus to improve cardiovascular fitness.

Effects of two guideline implementation strategies on patient outcomes in primary care: a cluster randomized controlled trial

STUDY DESIGN

Cluster randomized controlled trial.

OBJECTIVE

To improve quality of care for patients with low back pain (LBP) a multifaceted general practitioner education alone and in combination with motivational counseling by practice nurses has been implemented in German general practices. We studied effects on functional capacity (main outcome), days in pain, physical activity, quality of life, or days of sick leave (secondary outcomes) compared with no intervention.

SUMMARY OF BACKGROUND DATA

International research has lead to the development of the German LBP guideline for general practitioners. However, there is still doubt about the most effective implementation strategy. Although effects on process of care have been observed frequently, changes in patient outcomes are rarely seen.

METHODS

We recruited 1378 patients with LBP in 118 general practices, which were randomized to 1 of 3 study arms: a multifaceted guideline implementation (GI), GI plus training of practice nurses in motivational counseling (MC), and the postal dissemination of the guideline (controls, C). Data were collected (questionnaires and patient interviews) at baseline and after 6 and 12 months. Multilevel mixed effects modeling was used to adjust for clustering of data and potential confounders.

RESULTS

After 6 months, functional capacity was higher in the intervention groups with a cluster adjusted mean difference of 3.650 between the MC group and controls (95% CI = 0.320-6.979, P = 0.032) and 2.652 between the GI group and controls (95% CI = -0.704 to 6.007, P = 0.120). Intervention effects were more pronounced regarding days in pain per year with an average reduction of 16 (GI) to 17 days (MC) after 6 months (12 and 9 days after 12 months) compared with controls.

CONCLUSION

Active implementation of the German LBP guideline results in slightly better outcomes during 6 months follow-up than its postal dissemination. Results are more distinct when practice nurses are trained in motivational counseling.

TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting--A cluster-randomized controlled trial

OBJECTIVE

To investigate the effectiveness of a TTM-based motivational counselling approach by trained practice nurses to promote physical activity of low back pain patients in a German primary care setting.

METHODS

Data were collected in a cluster-randomized controlled trial with three study arms via questionnaires and patient interviews at baseline and after 6 and 12 months. We analysed total physical activity and self-efficacy by using random effect models to allow for clustering.

RESULTS

A total of 1378 low back pain patients, many with acute symptoms, were included in the study. Nearly 40% of all patients reported sufficient physical activity at baseline. While there were significant improvements in patients' physical activity behaviour in all study arms, there was no evidence for an intervention effect.

CONCLUSION

The outcome may be explained by insufficient performance of the practice nurses, implementation barriers caused by the German health care system and the heterogenous sample.

PRACTICE IMPLICATIONS

Given the objective to incorporate practice nurses into patient education, there is a need for a better basic training of the nurses and for a change towards an organizational structure that facilitates patient-nurse communication. Counselling for low back pain patients has to consider more specificated aims for different subgroups.

Sequential based analysis of Intima-Media Thickness (IMT) in common carotid artery studies

INTRODUCTION

Carotid Intima-Media Thickness (IMT) is used widely to assess an individual's risk of myocardial infarction and stroke. Although significant associations have been showed, IMT as used in major studies does not improve prediction of cardiovascular events much compared to traditional risk factors. Therefore, a new approach to IMT-measurements is sought-after by examining the wall structure continuously throughout several heart cycles.

MATERIALS AND METHODS

Computerized single-image analysis (IA) and sequential analysis (SA) were used to assess latter's capability in predicting risk of cardiovascular disease and to compare both. Healthy subjects (mean+/-S.D., age 46.1+/-5.6 years, n=490) were compared with subjects suffering from confirmed coronary artery disease (CAD) (mean+/-S.D., age 47.3+/-6.2 years, n=51).

RESULTS

SA could differentiate between both groups better then single IA, especially when looking at the maximal and mean IMT-values (SA<-->IA, p<0.01<-->p<0.05). The area under the curve (AUC) for maximal and mean IMT was greater for sequences then for single images as well.

DISCUSSION

Due to our findings sequential analysis can offer an extensive and complete examination of the carotid wall with a maximal reduction of bias. Commonly used IA may disguise vascular conditions and therefore the patient's risk, since IMT-values, as proven with SA, seems to usually be higher. Therefore, the need for further studies arises, examining if and to what extend common IMT-studies underestimate differences between groups.

[A novel questionnaire to assess activity in patients after hip arthroplasties]

BACKGROUND

Until now, the activity of the lower limb could only be exactly measured with expensive electronic pedometers. The aim of this study was to develop a feasible questionnaire to measure the activity of patients after arthroplasty.

METHODS

The "Daily Activity Questionnaire" (DAQ) was developed in several steps and the evaluation was carried out in three groups of patients with osteoarthritis of the hip (160 patients and 855 investigated days). The psychometric characteristics were verified.

RESULTS

The retest reliability (ICC) of the DAQ is in a range comparable to the electronic pedometer StepWatch. The testing of the criterion validity showed high correlations between the StepWatch and the DAQ (r=0.743).

CONCLUSION

Because of its high correlations to the load changes actually performed, the DAQ is especially suited to answer arthroplasty-related questions. In all patient groups, projected load changes between 1.8 and 2.4 million per year were found, which by far exceed the generally accepted test standards for endoprostheses.

Depressivität, Bewegungsangst-Kognitionen und körperliche Aktivität bei Patienten mit Rückenschmerz

Zusammenfassung. Ziel der Arbeit war die Untersuchung der Rolle von Depression und Bewegungsangst-Kognitionen (“fear-avoidance beliefs”) für die Bereitschaft zur Aufnahme und zur Beibehaltung körperlicher Aktivität bei Patienten mit Rückenschmerz. In die Sekundäranalyse einer randomisierten, kontrollierten Interventionsstudie gingen Daten von N = 1378 Patienten mit vorwiegend akuten Rückenschmerzen ein (58 % weiblich, mittleres Alter 49 Jahre). Personen mit hoher Depressivität und gleichzeitig starken “fear-avoidance beliefs” zeigten den niedrigsten Aktivitätsumsatz zur Baseline (kcal/Woche). Bedeutsamster Prädiktor für den Aktivitätsumsatz nach sechs bzw. 12 Monaten war neben der Baseline-Aktivität eine hohe Selbstwirksamkeitserwartung zur Baseline; Rückfälle in Inaktivität wurden v.a. durch geringe Selbstwirksamkeit und geringe wahrgenommene Vorteile von Bewegung vorhergesagt. Weder Depressivität noch Bewegungsangst erwiesen sich als bedeutsame Prädiktoren für körperliche Aktivität bzw. Rückfall in Inaktivität nach sechs bzw. 12 Monaten. Vergleichsweise stabile Konstrukte wie Depressivität oder Bewegungsangst-Kognitionen sind offenbar wenig geeignet, die Bereitschaft zur Aktivität oder tatsächliche Aktivität vorherzusagen. Es wird angeregt, verstärkt die Bedeutung von kognitiven und affektiven Aspekten situativer Entscheidungsprozesse für die Ausübung körperlicher Aktivität zu thematisieren.

High impact running improves learning

Regular physical exercise improves cognitive functions and lowers the risk for age-related cognitive decline. Since little is known about the nature and the timing of the underlying mechanisms, we probed whether exercise also has immediate beneficial effects on cognition. Learning performance was assessed directly after high impact anaerobic sprints, low impact aerobic running, or a period of rest in 27 healthy subjects in a randomized cross-over design. Dependent variables comprised learning speed as well as immediate (1 week) and long-term (>8 months) overall success in acquiring a novel vocabulary. Peripheral levels of brain-derived neurotrophic factor (BDNF) and catecholamines (dopamine, epinephrine, norepinephrine) were assessed prior to and after the interventions as well as after learning. We found that vocabulary learning was 20 percent faster after intense physical exercise as compared to the other two conditions. This condition also elicited the strongest increases in BDNF and catecholamine levels. More sustained BDNF levels during learning after intense exercise were related to better short-term learning success, whereas absolute dopamine and epinephrine levels were related to better intermediate (dopamine) and long-term (epinephrine) retentions of the novel vocabulary. Thus, BDNF and two of the catecholamines seem to be mediators by which physical exercise improves learning.

Training induced adaptations in characteristics of postural reflexes in elderly men

The aging neuromuscular system is affected by structural and functional changes which lead to a general slowing down of neuromuscular performance and an increased risk of falling. The impact of heavy resistance (HR) training in the elderly on maximum voluntary contraction (MVC) and rate of force development (RFD) has been investigated in the past. However, the influence of sensorimotor (SENSO) training and HR training on the ability to compensate for gait perturbations has not yet been investigated in the elderly. Therefore, the purpose of the study was to examine the impact of HR and SENSO training in elderly men on unexpected treadmill perturbations. Functional reflex activity was recorded by means of surface EMG in 40 male subjects (>60 years) before and after 13 weeks of HR and SENSO training and in another 20 male subjects (>60 years), which served as a CONTROL-group. SENSO training resulted in a decrease in onset latency, an enhanced reflex activity in the prime mover as well as a decrease in maximal angular velocity of the ankle joint complex during the perturbation impulses. No significant changes were observed in the HR- and in the CONTROL-group. The results clearly indicate that SENSO training has an impact on spinal motor control mechanisms in the elderly. Training induced improvements in perception and procession of afferent information could be a possible reason for the increase in reflex contraction. Due to these adaptive processes, SENSO training could be a well-suited method for fall preventive programs in elderly people.

Diagnose körperlich-sportlicher Aktivität im Erwachsenenalter

Zusammenfassung. Vor dem Hintergrund der Suche nach effektiven Maßnahmen in der Prävention und Therapie von Krankheiten einerseits sowie der Frage nach der Bedeutung von körperlich-sportlichen Aktivitäten für eine gesunde Entwicklung über die Lebensspanne hinweg andererseits wird der Beziehung von körperlich-sportlicher Aktivität und Gesundheit seit Jahren nachgegangen. Dabei stellt sich bei vielen Untersuchungen vielfach das Problem, Art und Ausmaß körperlicher bzw. sportlicher Aktivitäten des jeweils interessierenden Personenkreises zu eruieren. Im vorliegenden Beitrag wird zunächst ein Beitrag zur Konzeptualisierung von körperlich-sportlicher Aktivität geleistet und verschiedene Facetten körperlich-sportlicher Aktivität unter einer gesundheitsorientierten Perspektive abgegrenzt. Diverse methodische Zugangswege zur Erfassung körperlich-sportlicher Aktivität werden vorgestellt und im Hinblick auf ihre Vor- und Nachteile diskutiert. Der Zugangsweg der Erfassung über Selbstaussagen mittels Fragebogen bei Personen im Erwachsenenalter wird dabei einer besonders intensiven Betrachtung unterzogen. Die empirischen Studien zur Entwicklung von Fragebogen haben in den letzten fünf Jahren vor allem im internationalen Bereich stark zugenommen. Im deutschsprachigen Bereich besteht hingegen noch deutlich Nachholbedarf. Perspektiven - insbesondere für die sportpsychologische Forschung - bestehen in der Entwicklung von Fragebogen, die über die Erhebung des Energieverbrauchs durch körperlich-sportliche Aktivität hinausgehen und vor dem Hintergrund eines biopsychosozialen Gesundheitsverständnisses auch biopsychosoziale Aspekte von körperlich-sportlicher Aktivität in die Erfassung einbeziehen.