[Objective measurement tools for the assessment of physical activity]

Dauer vs. Intensität in der Trainingstherapie

Bewegungsinterventionen sind in Gesundheitsförderung und Prävention sowie Therapie und Rehabilitation essenziell, da Bewegung positiv und multidimensional auf die Gesundheit wirkt. Zur Bewertung der Wirkungsweise von Bewegungsinterventionen werden bisher oft Messmethoden herangezogen, welche lediglich einen oberflächlichen Anteil der erzielbaren Effekte abbilden. Eine Voraussetzung für eine erfolgreiche Bewegungsintervention sind eine gute Adhärenz sowie ein adäquates Dosis-Wirkungs-Prinzip. Wie die objektiven und subjektiven Messgrößen in Zusammenhang mit der Adhärenz und infolgedessen mit dem Dosis-Wirkungs-Prinzip stehen, ist nicht ausreichend untersucht. In einer retrospektiven Datenanalyse von 66,988 chronischen Rückenschmerzpatienten, die zwischen 1992 und 2021 an der FPZ RückenTherapie teilgenommen haben, wurden die Zusammenhänge im Ursachen- und Wirkungsdreieck zwischen Therapieadhärenz beziehungsweise Dosis der verabreichten Trainingsreize und damit der benötigten Dauer für ein Programm mit festgelegter Einheit an Trainingseinheiten, dem Zugewinn an isometrischer Maximalkraft der Rumpfmuskulatur sowie dem Gewinn an gesunden Lebensjahren untersucht. Es zeigt sich, dass der Kraftzuwachs abhängig von der Zeit ist, die für die Therapie benötigt wird. Eine andere zeitliche Abhängigkeit zeigt der Gewinn an gesunden Lebensjahren mit steigendem Zeitrahmen, in dem die 24 Einheiten wahrgenommen wurden. Kein Zusammenhang lässt sich dagegen zwischen dem relativen Gewinn an isometrischer Maximalkraft und dem Gewinn an gesunden Lebensjahren feststellen. Die Ergebnisse dieser Studie zeigen wichtige Zusammenhänge zwischen dem zeitlichen Ablauf einer Therapie sowie den angewandten Messparametern auf und sind damit wegweisend für zukünftige Therapieformen. Bisherige Messmethoden müssen ergänzt werden, um die Wirkungsweise von Bewegung und deren multidimensionale Effekte in Gänze abbilden zu können.

Start moving - benefits of an onsite workplace health program in the age of digitalization

Background

The process of digitization should simplify our work and improve related processes (i.e. quality, transparency). Moreover, it enables the home office, which is greatly expanded due to the current pandemic. Regarding workplace health, it should be noted that with increasing digitization, physical activity decreases, and as a result, the number of work-related diseases will increase. On the other hand, increasing digitization also offers promising opportunities for new approaches to workplace health promotion. With these positive as well as negative effects in mind, we designed a workshop to increase physical activity at work. This protocol describes our approach to a live workshop concept.

Methods

We use a randomized controlled trial with two intervention groups: a live workshop with and without additional reminders. The workshop intervention design consists of a baseline measurement, two workshops, and one follow-up measurement. Each workshop takes place in small groups (n < 11). We use a randomized allocation to both groups. To control for health-related effects and the expected behavior change we examine (i) physical activity (i.e. active time, taken steps, etc.) by a tracking device (ii) physical wellbeing, motivation, and volition by an online questionnaire, and (iii) participants also report physical activity by a diary. All measurements are taken one week before the respective workshop and 24 weeks after the initial baseline measures.

Discussion

A live workshop offers advantages such as very personal interactions and a low technical effort. However, during the current pandemic, there are some limitations (i.e. small groups, pay attention to hygienic guidelines). Based on the upcoming experiences of this workshop, a web-based approach might offer some advantages (i.e. easier daily implementation, independent from a participant’s location) regarding home office workplaces and the increasing digitization. On the other hand, there are also mandatory requirements as a stable internet connection and technical equipment (i.e. webcam, microphone). Overall, a step by step development of a web-based workshop, based on the experience of the live workshop, can be regarded as advantageous.

Trial registration

Since this article reports a health promotion intervention concept with human participants, we registered it in the German Clinical Trials Register (DRKS). Number:DRKS00021512, Date:30.10.2020.

Accelerometer-measured physical activity and its impact on sleep quality in patients suffering from restless legs syndrome

BACKGROUND

The primary symptoms of restless legs syndrome (RLS) are sleep onset insomnia and difficulty to maintain sleep. Previous studies have shown that regular physical activity can reduce the risk of developing RLS. However, the relationship between physical activity and sleep quality parameters in individuals suffering from RLS has not yet been investigated by applying accelerometry. Thus, the present study investigates the impact of physical activity (measuring both intensity levels and duration of physical activity) during the day (7-12 h, 12-18 h, 18-23 h) on sleep quality in patients suffering from idiopathic RLS by applying a real-time approach.

METHODS

In a sample of 47 participants suffering from idiopathic RLS, physical activity and sleep quality were measured over one week using accelerometers. For data analysis, physical activity levels and step counts during three periods of the day (morning, afternoon, evening) were correlated with sleep quality parameters of the subsequent night.

RESULTS

This observational study revealed that in most instances physical activity was not correlated with sleep parameters (two exceptions exist: steps taken in the morning were negatively correlated with periodic leg movements during sleep, and physical activity in the evening was negatively correlated with total sleep time). The physical activity levels of the participants in this study, however, were unexpectedly high compared to population-level data and variance in physical activity was low. The average activity was 13,817 (SD = 4086) steps and 347 (SD = 117) minutes of moderate physical activity per day in females, and 10,636 (SD = 3748) steps and 269 (SD = 69) minutes of moderate physical activity in males, respectively. Participants did not engage in any vigorous physical activity.

CONCLUSIONS

Further interventional studies are needed to investigate the daily effects of different intensities of physical activity on RLS symptoms.

Effectiveness Studies in Health Promotion: A Review of the Methodological Quality of Studies Reporting Significant Effects on Physical Activity in Working Age Adults

The methodology of intervention studies on physical activity (PA) promotion is of great importance regarding evidence development in complex interventions. The aim of this review was to provide an overview of the methodological quality of those studies which reported statistically significant effects of interventions promoting PA. PUBMED was searched for reviews on PA promotion to identify studies reporting effective interventions with participants of working age (16⁻67 years). Selected reviews were screened and data from primary studies with effective interventions were extracted to assess methodological quality. Forty-six reviews with 600 primary studies were identified, of which 33 met the inclusion criteria. Twenty-one studies were conducted as randomized controlled trials, 13 included an intervention control group, 25 measured PA by questionnaire, and 13 included objective measurements. Information on used statistics was often scarce, and long-term follow-up measurements were frequently missing. The overall methodological quality was moderate for randomized studies and low for non-randomized studies; information on methods and results was often lacking. To overcome these methodological issues, standardized guidelines for reporting study results should be considered, not only when publishing results but also when designing studies. This review provides a solid foundation for the development of practical advice for planning application-oriented studies in PA promotion.

Impact of different recruitment strategies on accelerometry adherence and resulting physical activity data: A secondary analysis

Strategies for increasing adherence to physical activity assessments are often linked to extra financial or personal effort. This paper aims to investigate the influence of the recruitment strategy on participants' adherence to accelerometry and resulting PA data. Data were used from two previous studies conducted in 2013 and 2016 in Cologne, Germany, differing in recruitment strategy (N = 103, 40.8% male, mean age 20.9 ± 3.7 years, mean BMI 23.7 ± 4.1 kg/m²). In the passive recruitment (PR) group, vocational students took part in the accelerometry (ActiGraph GT3X+) in line with the main study unless they denied participation. In the active recruitment (AR) group, vocational students were invited to actively volunteer for the accelerometry. Impact of recruitment strategy on adherence and PA data was examined by regression analysis. Average adherence to the accelerometry was 66.7% (AR) and 74.0% (PR). No statistically significant influence of recruitment strategy on adherence and resulting PA was found (all p > 0.05). The difference in recruitment strategy did not affect adherence to accelerometry. The data imply that AR may be applicable. Future studies using larger sample sizes and diverse populations should further investigate these trends.

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Active and passive volunteer recruitment strategy for accelerometry are presented.

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Active volunteer recruitment for accelerometry does not increase adherence.

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Active and passive volunteer recruitment do not differ in objective physical activity.

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Active volunteer recruitment is applicable in large sample sizes.

An objective measure of hyperactivity aspects with compressed webcam video

BACKGROUND

Objective measures of physical activity are currently not considered in clinical guidelines for the assessment of hyperactivity in the context of Attention-Deficit/Hyperactivity Disorder (ADHD) due to low and inconsistent associations between clinical ratings, missing age-related norm data and high technical requirements.

METHODS

This pilot study introduces a new objective measure for physical activity using compressed webcam video footage, which should be less affected by age-related variables. A pre-test established a preliminary standard procedure for testing a clinical sample of 39 children aged 6-16 years (21 with a clinical ADHD diagnosis, 18 without). Subjects were filmed for 6 min while solving a standardized cognitive performance task. Our webcam video-based video-activity score was compared with respect to two independent video-based movement ratings by students, ratings of Inattentiveness, Hyperactivity and Impulsivity by clinicians (DCL-ADHS) giving a clinical diagnosis of ADHD and parents (FBB-ADHD) and physical features (age, weight, height, BMI) using mean scores, correlations and multiple regression.

RESULTS

Our video-activity score showed a high agreement (r = 0.81) with video-based movement ratings, but also considerable associations with age-related physical attributes. After controlling for age-related confounders, the video-activity score showed not the expected association with clinicians' or parents' hyperactivity ratings.

CONCLUSIONS

Our preliminary conclusion is that our video-activity score assesses physical activity but not specific information related to hyperactivity. The general problem of defining and assessing hyperactivity with objective criteria remains.

Placement makes a difference: accuracy of an accelerometer in measuring step number and stair climbing

Accurate and easy-to-use measurement tools are required to evaluate the effect of treatments on patient activity. Comfortable device placement and fixation are important for patient compliance. The aim of this study was the evaluation of the accuracy of an accelerometer at different placements and slow velocities.

METHODS

A total of 43 healthy volunteers were included for a literature-based treadmill protocol using five accelerometer positions; a subset of 18 volunteers performed an extended treadmill protocol with velocities between 0.1 and 2.6m/s and finally stair climbing.

RESULTS

An alternative accelerometer position at the anterolateral aspect of the middle shank did measure steps more accurately than at the manufacturer suggested position, especially during slow velocities. Participants preferred the alternative placement at the shank. The accuracy of different accelerometer positions was excellent at velocities between 1.0 and 2.2m/s. During slow velocities below 1.0m/s steps were recorded less accurately. Accepting an error of five percent, the accelerometer recorded steps accurately from 0.5m/s at the alternative placement and from 0.8m/s at the manufacturer suggested placement. Stair climbing was not recorded accurately by any accelerometer position.

CONCLUSION

For measuring step number during slow velocities, the alternative position should be favoured. Stair climbing was not recorded accurately by any tested placement.