Physical activity, metabolic issues, and assessment

Medium-Term Disability and Long-Term Functional Impairment Persistence in Survivors of Severe COVID-19 ARDS: Clinical and Physiological Insights

BACKGROUND

Although the medium- and long-term sequelae of survivor of acute respiratory distress syndrome (ARDS) of any cause have been documented, little is known about the way in which COVID-19-induced ARDS affects functional disability and exercise components. Our aims were to examine the medium-term disability in severe COVID-19-associated ARDS survivors, delineate pathophysiological changes contributing to their exercise intolerance, and explore its utility in predicting long-term functional impairment persistence.

METHODS

We studied 108 consecutive subjects with severe COVID-19 ARDS who remained alive 6 months after intensive care unit (ICU) discharge. Lung morphology was assessed with chest non-contrast CT scans and CT angiography. Functional evaluation included spirometry, plethysmography, muscle strength, and diffusion capacity, with assessment of gas exchange components through diffusing capacity of nitric oxide. Disability was assessed through an incremental exercise test, and measurements were repeated 12 and 24 months later in patients with functional impairments.

RESULTS

At 6 months after ICU discharge, a notable dissociation between morphological and clinical-functional sequelae was identified. Moderate-severe disability was present in 47% of patients and these subjects had greater limitation of ventilatory mechanics and gas exchange, as well as greater symptomatic perception during exercise and a probable associated cardiac limitation. Female sex, hypothyroidism, reduced membrane diffusion component, lower functional residual capacity, and high-attenuation lung volume were independently associated with the presence of moderate-severe functional disability, which in turn was related to higher frequency and greater intensity of dyspnea and worse quality of life. Out of the 71 patients with reduced lung volumes or diffusion capacity at 6 months post-ICU discharge, only 19 maintained a restrictive disorder associated with gas exchange impairment at 24 months post-discharge. In these patients, 6-month values for diffusion membrane component, maximal oxygen uptake, ventilatory equivalent for CO2, and dead space to tidal volume ratio were identified as independent risk factors for persistence of long-term functional sequelae.

CONCLUSIONS

Less than half of survivors of COVID-19 ARDS have moderate-severe disability in the medium term, identifying several risk factors. In turn, diffusion membrane component and exercise tolerance at 6-month ICU discharge are independently associated with the persistence of long-term functional sequelae.

The Sport Training Process of Para-Athletes: A Systematic Review

The aim of this systematic review was to identify the main factors affecting the training process of para-athletes, as well as the barriers they encounter. For this purpose, a systematic review was carried out in accordance with the PRISMA declaration guidelines, in which six databases were analysed (Web of Science, Scopus, SportDiscus, Pubmed, Eric, and PsycInfo). A total of 19 articles were selected for analysis after applying the inclusion criteria. The results show that the figures of the coach and families in the sporting and social contexts, respectively, had a relevant influence on the training process of para-athletes. Furthermore, in terms of psychological aspects, stress reduction, the importance of self-esteem, and motivation were highlighted. On the other hand, there are some barriers hindering the training and performance of athletes, which are related to the lack of financial support, lack of visibility in the media, and dependence on other people. These considerations can be of great help to coaches and competent institutions in the field (Paralympic committees, federations, etc.) in order to improve the training process and performance of para-athletes and to eliminate the barriers encountered by this group, promoting policies which facilitate access to sports for people with disabilities.

Accelerometer-Assessed Habitual Physical Activity and Sedentary Time of Chinese Children and Adolescents with Visual Impairments

Introduction:

Physical activity is a key component of a healthy lifestyle for youths with visual impairments (i.e., blindness or low vision). This study aims to examine the habitual physical activity and sedentary time of Chinese children and adolescents with visual impairments and to determine whether age, gender, and body composition significantly influence their behavior.

Methods:

A purposeful sample method was utilized to recruit 137 Chinese youths with visual impairments from a special school for individuals with visual and hearing impairments. A total of 72 students with visual impairments (aged 7–17 years; M age = 13.4) participated in this study. ActiGraph GT3X accelerometers were used to measure the habitual physical activity and sedentary time.

Results:

Youths with visual impairments in this study spent an average of 287.86 (standard deviation [ SD] = 45.67) minutes of light physical activity, 146.79 ( SD = 56.95) minutes of moderate physical activity, 18.47 ( SD = 15.15) minutes of vigorous physical activity, 165.26 ( SD = 69.83) minutes of moderate-to-vigorous-intensity physical activity, and 979.51 ( SD = 109.10) minutes of sedentary time per day. Children with visual impairments in elementary school engaged in more habitual physical activity and had less sedentary time than did students in middle and high school. Differences in gender and body composition with regard to time spent being active or sedentary were insignificant.

Discussion:

Findings demonstrated that Chinese youths with visual impairments in this study had sufficient health-enhancing physical activity and were habitually active. Future research is needed to identify the factors that account for the high habitual physical activity levels of Chinese youths with visual impairments.

Implications for practitioners:

Transition planning for students with visual impairments to facilitate active habitual physical activity participation when children grow up is warranted.

Effect of yoga practices on psycho-motor abilities among intellectually disabled children

The children with intellectual disabilities show disorders at motor development and coordination. Hence, the objective of this study was to see the effect of yoga practices on psycho-motor abilities of intellectually disabled children. Seventy intellectually disabled children were divided into experimental group and control group. Both experimental and control group were assessed on the first day and after 12 weeks of the yoga intervention for static balance, eye hand coordination, agility and reaction time. The subjects of experimental group then underwent a training of yoga practices, for 1 hr for a total period of 12 weeks. The result of within group comparison revealed significant improvement in static balance, eye hand coordination, agility, and reaction time (P< 0.001) in subjects of yoga group however no change was observed in control group. The present study demonstrated that 12 weeks of yoga is effective in improving psycho-motor abilities of intellectually disabled children.

Accelerometer-Assessed Physical Activity and Sedentary Time in Youth With Disabilities

This study compared accelerometer-assessed habitual physical activity (PA), sedentary time, and meeting PA recommendations among 102 youth with disabilities (7-20 years) in four subgroups-physical/visual impairments, intellectual disability, autism spectrum disorders, and hearing impairment-and 800 youth with typical development (8-16 years). Low proportions of youth with disabilities met PA recommendations, and they generally were less physically active and more sedentary than youth with typical development. The hearing impairment and autism spectrum disorder groups were the most and least physically active, respectively. Older age and to some extent female sex were related to less PA and more sedentary time. Considering the suboptimal levels of PA in youth with disabilities, effective interventions directed at factors associated with PA among them are needed.

The effects of multi-component weight management interventions on weight loss in adults with intellectual disabilities and obesity: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Adults with intellectual disabilities have been shown to experience higher rates of obesity in comparison to the general population.

AIM

To examine the effectiveness of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity.

METHODS AND PROCEDURES

A systematic search of six electronic databases was conducted from database inception to January 2016. Risk of bias was assessed by the Cochrane Collaboration tool. Behavioural change techniques were defined by coding against the Coventry Aberdeen LOndon REfined (CALO-RE) taxonomy. Meta-analyses were conducted as Weighted Mean Difference (WMD) between intervention and control/comparator intervention.

OUTCOMES AND RESULTS

Six randomised controlled trials were included. The interventions did not adhere to clinical recommendations [the inclusion of an energy deficit diet (EDD), physical activity, and behaviour change techniques]. Meta-analysis revealed that current multi-component weight management interventions are not more effective than no treatment (WMD: -0.38kg; 95% CI -1.34kg to 0.58kg; p=0.44).

CONCLUSION AND IMPLICATIONS

There is a paucity of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. Current interventions, based on a health education approach are ineffective. Future long-term interventions that include an EDD and adhere to clinical recommendations on the management of obesity are warranted.

Mechanisms contributing to gait speed and metabolic cost in children with unilateral cerebral palsy

BACKGROUND

Gait speed and metabolic cost are indicators of functional capacity in children with cerebral palsy. Uncovering their mechanisms helps guide therapeutic actions.

OBJECTIVES

To investigate the contributions of energy-generating and energy-conserving mechanisms to gait speed and metabolic cost of children with unilateral cerebral palsy.

METHODS

Data on eccentric and concentric muscle work, co-contraction, elastic torque and vertical stiffness of the affected-limb, forcing torque of the non-affected limb, gait speed and metabolic cost were collected from 14 children with unilateral cerebral palsy, aged 6-12 years. Analyses included two groups of multiple regression models. The first group of models tested the association between each dependent variable (i.e., speed and metabolic cost) and the independent variables that met the input criteria. The second group verified the contribution of the non-selected biomechanical variables on the predictors of the first model.

RESULTS

Gait speed (R²=0.80) was predicted by elastic torque (β=0.62; 95%CI: 0.60, 0.63), vertical stiffness (β=-0.477; 95%CI: -0.479, -0.474) and knee co-contraction (β=0.27; 95%CI: -1.96, 2.49). The production of eccentric work by the affected limb proved relevant in adjusting the vertical stiffness (R²=0.42; β=-0.64; 95%CI: 0.86, -0.42); elastic torque of the affected-leg was associated with impulsive torque of the non-affected leg (R²=0.31; β=0.55; 95%CI: 0.46, 0.64). Metabolic cost of gait (R²=0.48) was partially predicted by knee co-contraction (β=0.69; 95%CI: 0.685, 0.694).

CONCLUSIONS

The chain of associations revealed by the two steps models helped uncover the mechanisms involved in the locomotion of children with unilateral cerebral palsy. Intervention that changes specific energy conserving and generating mechanisms may improve gait of these children.

Physical activity of disabled individuals in the context of meeting WHO recommendations and support of local authorities

Objectives

This study aims to evaluate physical activity of disabled individuals in the context of fulfilling the World Health Organization (WHO) recommendations and to investigate the relationship between the risk of inactivity and activity of local authorities in this field.

Materials and methods

The sample consisted of 155 disabled individuals selected from a representative sample of the Polish society. The long version of the International Physical Activity Questionnaire (IPAQ-LF) and the survey of the determinants of a sport activity among the Polish population were applied. The relationship between meeting the WHO recommendations and environmental factors were investigated.

Results

According to the IPAQ-LF, 68.2% of the Polish disabled adults performed a recommended dose of physical activity during their leisure time. The total leisure activity was composed mainly of vigorous activities (58.8%), in a less extent of moderate activities (11.8%), and walking (7.2%). According to the survey of the sport activity determinants, 10.3% is active (0.7% exercises for ≥60 min 3 to 4 times a week, 3.9% per day).

Conclusion

Based on our study results, there is a need to increase the activity of local authorities, promoting a participation in sport for all among Polish disabled individuals. In addition, these study results indicate methodological problems related with the implementation of the IPAQ-LF.

The effects of physical activity interventions on preventing weight gain and the effects on body composition in young adults with intellectual disabilities: systematic review and meta-analysis of randomized controlled trials

The aim of this study was to examine the literature on randomized controlled trials examining the efficacy of physical activity interventions to prevent weight gain and the effects on body composition in young adults with intellectual disabilities.A systematic search of Medline, Emabse, CINHAL, PsychINFO, Cochrane library and ERIC was conducted from 1946 to September 2014. Eligibility criteria included; randomized controlled trials of a physical activity intervention: objective measure of body weight and body composition; young adults (age range 16-24 years) with intellectual disabilities. Six studies met the eligibility criteria. The interventions varied in their prescription of physical activity including aerobic and strength-based activities. The mean duration of the interventions was 15.3 (range 10-21 weeks). There was no significant effect of physical activity interventions on body weight (weighted mean difference: -0.17 kg, 95% confidence interval, -1.04 kg to 0.72 kg) and body composition outcomes. The meta-analysis showed that physical activity interventions did not prevent weight gain in young adults with intellectual disabilities. Published studies are inadequate to form firm conclusions. Future longer term studies of interventions specifically designed for this population group are required to elucidate the effects of physical activity interventions on body composition and the prevention of weight gain in young adults with intellectual disabilities.

Assessment protocols of maximum oxygen consumption in young people with Down syndrome--a review

Maximum oxygen consumption is considered the gold standard measure of cardiorespiratory fitness. Young people with Down syndrome (DS) present low values of this indicator compared to their peers without disabilities and to young people with an intellectual disability but without DS. The use of reliable and valid assessment methods provides more reliable results for the diagnosis of cardiorespiratory fitness and the response of this variable to exercise. The aim of the present study was to review the literature on the assessment protocols used to measure maximum oxygen consumption in children and adolescents with Down syndrome giving emphasis to the protocols used, the validation process and their feasibility. The search was carried out in eight electronic databases--Scopus, Medline-Pubmed, Web of science, SportDiscus, Cinhal, Academic Search Premier, Scielo, and Lilacs. The inclusion criteria were: (a) articles which assessed VO2peak and/or VO2max (independent of the validation method), (b) samples composed of children and/or adolescents with Down syndrome, (c) participants of up to 20 years old, and (d) studies performed after 1990. Fifteen studies were selected and, of these, 11 measured the VO2peak using tests performed in a laboratory, 2 used field tests and the remaining 2 used both laboratory and field tests. The majority of the selected studies used maximal tests and conducted familiarization sessions. All the studies took into account the clinical conditions that could hamper testing or endanger the individuals. However, a large number of studies used tests which had not been specifically validated for the evaluated population. Finally, the search emphasized the small number of studies which use field tests to evaluate oxygen consumption.

Validity of pedometers in people with physical disabilities: a systematic review

OBJECTIVE

To review the literature for the criterion validity of pedometers for use in child and adult populations with physical disabilities.

DATA SOURCES

Academic Search Premier, ERIC, SPORTDiscus, MEDLINE, AMED, Scopus, CINAHL, Web of Science, and EMBASE databases, searched from inception to September 7, 2011.

STUDY SELECTION

Studies were included if they were peer-reviewed articles, included populations with physical disabilities, and reported primary data for pedometer validity in comparison with direct observation. A consensus approach was used to apply the inclusion and exclusion criteria. Of the 163 articles identified in the database searches (excluding duplicates), 7 studies met the inclusion criteria.

DATA EXTRACTION

The quality of the studies was assessed independently by 2 reviewers, using a purpose-designed appraisal tool, with a consensus approach used to settle disagreement. A single reviewer extracted data relating to sample size, participant characteristics, pedometer model, main variables tested, duration of tests, and method of direct observation.

DATA SYNTHESIS

The methodologic quality of the studies was generally high; however, there was a wide variation of population and methodology between studies. The correlation between pedometer step counts and directly observed step counts was moderate to excellent (intraclass correlation coefficient, .52-.87), and percent errors ranged from 0.5% to 24.7%. Secondary variables reported included the effect of speed of movement, pedometer placement, comparison of pedometer makes/models, and test-retest reliability.

CONCLUSIONS

Available evidence suggests that pedometers are valid for use in clinical and research settings in people with physical disabilities. Further research examining the validity of pedometers in less heterogeneous populations of people with disabilities is warranted to determine validity for specific disability populations and to determine optimal pedometer placement.

Physical activity patterns of youth with Down syndrome

The purpose of this study was to examine the physical activity patterns of children with Down syndrome. A cross-sectional approach and accelerometry were used to measure the time children with Down syndrome (N = 104) spent in sedentary, light, and moderate-to-vigorous physical activity. Results indicated that adolescents from ages 14 to 15 years were the most sedentary and spent the least amount of time in light and moderate-to-vigorous physical activity. A general trend of decreasing physical activity as children increase in age was found. This trend is similar to that found among typically developing youth. Participants in this study were found to spend a majority of their day engaged in sedentary activities. Results indicate that most participants were not accumulating the recommended 60 minutes of moderate or vigorous physical activity.

The role of fitness in health and disease: status of adults with cerebral palsy

Physical activity has significant health benefits and is positively associated with health-related quality of life and psychosocial functioning. Persons with disability are at particular risk of inactivity. For adults with cerebral palsy (CP), impaired health and function typically impede participation in physical activity, setting into motion a downward spiral of prolonged inactivity. Adults with CP may not be engaging in sufficient physical activity to produce the improvements in fitness required to experience associated health benefits. However, the literature related to physical activity and fitness in adults with CP is sparse. As more and more persons with CP lead productive lives into their golden years, it is imperative that the scientific community provide definitive information to help guide decisions related to the type and extent of fitness-related activities most beneficial to these individuals. This information will facilitate development of physical training programs that promote maintenance of function and fitness while preventing the onset of secondary conditions. This presentation will address the state-of-the-science regarding physical activity and fitness for adults with CP and how fitness training relates to physical activity and health in this population. Gaps in the evidence, as well as possible directions for future research, will be presented.

Evaluation of the nutrition counselling component of a fitness programme for children with disabilities

OBJECTIVE

To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities.

METHODS

Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented.

RESULTS

No significant BMI changes were recorded for the entire group (n=28) or a sub-group with a goal to decrease BMI (n=8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar.

CONCLUSION

Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.

Age- and sex-standardised lean and fat indices derived from bioelectrical impedance analysis for ages 7-11 years: functional associations with cardio-respiratory fitness and grip strength

Indices for lean and fat mass adjusted for height derived from bioelectrical impedance for children aged 7 years have been published previously and their usefulness in the clinical assessment of undernutrition has been demonstrated. However, there is a need for norms that cover a wider age range and to explore their functional significance. The aim of the present study is to derive lean and fat indices for children aged 7-11 years and investigate associations with objective measures of cardio-respiratory fitness and grip strength. Subjects were 9574 children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Bioelectrical impedance analysis (BIA) data collected longitudinally between ages 7 and 11 were used to derive lean and fat indices using the method of standardised residuals. Cardio-respiratory fitness (CRF) (9 years) and grip strength (11 years) were also measured. Correlation coefficients and 95 % CI were calculated to assess the strength of association between lean index, fat index and CRF and grip strength. Equations for calculating lean and fat indices in children aged 7-11 years relative to the ALSPAC population are presented. Lean index was linearly associated with CRF (rboys 0.20 (95 % CI 0.15, 0.25), rgirls 0.26 (95 % CI 0.22, 0.30)) and grip strength (rboys 0.29 (95 % CI 0.26, 0.32), rgirls 0.26 (95 % CI 0.23, 0.29)). BMI showed slightly weaker associations, while fat index was unrelated to either CRF or grip strength. Lean indices relate to muscle function and fitness while fat index does not.

Physical activity for youth with disabilities: a critical need in an underserved population

The recommended amount of daily physical activity for youth is 60 minutes a day, most days of the week. Youth with disabilities are not achieving this target and are significantly less active and more obese than their non-disabled peers. The combination of the health risks associated with physical inactivity and obesity presents a serious health concern in this population. While there is a small amount of research on interventions aimed at improving fitness among youth with disabilities, the majority of these studies were conducted in clinical settings where most or all of the common barriers to participation were eliminated (e.g. transportation, lack of knowledgeable staff, adaptation of programmes and/or facilities to child's needs). One of the most important challenges for paediatric rehabilitation and healthcare professionals is finding ways to increase physical activity and fitness among youth with disabilities in community-based settings. The use of information technology (IT) to customize physical activity programmes for youth with disabilities offers a promising approach to addressing this important health issue in the future.

Training programs for children: literature review

INTRODUCTION

Training programs are increasingly being prescribed for occupational therapy for adults affected by chronic illness and/or handicap, but their use is more recent for children and teenagers.

OBJECTIVE

A review of the literature to synthesize information concerning training programs for children, whether healthy or with disease or handicap, considering the target population, methodology, the results and limitations.

METHODS

We searched the Medline database with use of the key words retraining, training, training programs, physical activity, physical training, fitness program, sport, children, disability, and handicap. We also searched references of the selected articles for appropriate studies.

DISCUSSION/CONCLUSION

Physical activity seems to be a good means of primary preventing adverse health in the healthy child and secondary prevention in children with chronic disease or handicap. Thus, training programs could be adapted and integrated into the global treatment of sick or handicapped children in the health care situation or in the home. These programs are feasible and do not undermine children's health, but few studies have shown clear data on the methods of the programs. The suggested training programs, not always validated, included two to five sessions from 30 to 60 min/week, for 6-16 weeks, of variable activity and intensity, adapted to the condition and the objectives of therapy. Training programs adapted to children should be validated to allow their accessibility by health care professionals dealing with children with chronic disease and/or handicap.

Physical and sedentary activity in adolescents with cerebral palsy

Participation in regular physical activity (PA) provides health, psychological, and physiological benefits for people with and without a physical disability. This study investigated the physical and sedentary activity patterns of adolescents with cerebral palsy (CP). A cross-sectional, descriptive, postal survey was used, consisting of the Physical Activity Questionnaire for Adolescents (PAQ-A), self-reported level of gross motor function (based on the Gross Motor Function Classification System [GMFCS]), and specific questions regarding weekly sedentary activities. Following piloting to determine test-retest reliability (intraclass correlation [ICC] for PA=0.90; total weekly sedentary time=0.84) and concurrent validity (survey PA score vs pedometry, Pearson's r=0.24; survey PA score vs accelerometry, r=-0.21; survey weekly sedentary time vs logbook, r=0.38), the survey was mailed to all adolescents with CP in South Australia registered with Novita Children's Services (n=219). One hundred and twelve valid surveys were returned (76 males, 36 females; age range 11-17y, mean age 13y 11mo [SD 23mo]; GMFCS Level I, n=42; Level II, n=27; Level III, n=10; Level IV, n=17; Level V, n=15; level not reported, n=1). Results were compared with recent normative age- and sex-matched data sets. Key findings were that PA level of adolescents with CP was related to level of gross motor function and inversely related to age, and that adolescents with CP were less physically active than their peers without disability. Comparisons with normative data sets suggested that adolescents with CP tend to participate in less structured and lower intensity PA compared with non-disabled adolescents, though sedentary activity patterns (TV and computer use) of adolescents with and without CP were similar.

Exercise Testing and Training in a Cancer Rehabilitation Program: The Advantage of the Steep Ramp Test

OBJECTIVE

To compare the short maximal exercise capacity test (steep ramp test) with the submaximal test to determine the most appropriate exercise test in cancer rehabilitation.

DESIGN

A prospective study in which a submaximal test, a maximal short exercise capacity test (steep ramp test), and a maximal oxygen consumption test (Vo(2)max test) were performed before and after an 18-week training program. Vo(2)max testing, the criterion standard for the measurement of physical capacity, was compared with the submaximal test and the steep ramp test.

SETTING

Community hospital and physiotherapy.

PARTICIPANTS

Thirty-seven cancer survivors (10 men, 27 women) treated with chemotherapy. The subjects' mean age +/- standard deviation (SD) was 48+/-11 years.

INTERVENTION

An 18-week training program including strength training, interval aerobic training, and home-based activities (endurance).

MAIN OUTCOME MEASURES

Estimated Vo(2)max (submaximal test) and maximal workload (steep ramp test) were assessed during the exercise tests and compared with the results of the Vo(2)max test.

RESULTS

A paired t test showed a significant improvement in Vo(2)max (+13%, P<.001) and maximal workload (+19%, P<.001) after the training program. This improvement was confirmed in the steep ramp test (maximal workload, +13%, P<.001) but not in the submaximal test (estimated Vo(2)max, +4%, P=.192). Pearson correlation quantified only a moderate correlation between the Vo(2)max test and the submaximal test and a high correlation between the Vo(2)max test and the steep ramp test. Intraclass correlation determined the test-retest reliability of the submaximal test (.873) and the steep ramp test (.996). A linear regression model (Vo(2)max, 6.7; steep ramp Wmax, +356.7) was estimated to predict Vo(2)max from the steep ramp test outcome, implying a prediction margin of +/-2 SDs (616 mL/min).

CONCLUSIONS

The submaximal test proved to be invalid, whereas the steep ramp test seems to be a practicable, reliable, and valid test for the assessment of the training dose. The steep ramp test can be regularly repeated during the training program, providing information needed to readjust the training dose according to the progress made.

Effect of Motorized Scooters on Physical Performance and Mobility: A Randomized Clinical Trial

OBJECTIVE

To investigate the effects of providing a motorized scooter on physical performance and mobility.

DESIGN

Randomized clinical trial comparing scooter users with usual care.

SETTING

One academic and 1 Veterans Affairs medical center.

PARTICIPANTS

Ambulatory, community-dwelling outpatients with rheumatoid arthritis or osteoarthritis of the knee.

INTERVENTION

Provision of a motorized scooter for 3 months.

MAIN OUTCOME MEASURES

Six-minute walk distance (6MWD) and mobility methods in diverse locations at baseline, 1 month, and 3 months, and accidents while using the scooter.

RESULTS

The majority of scooter subjects (n=16/22 [72.7%]) used the scooter 4 or more days per week. The difference+/-standard deviation between the 2 groups in change in 6MWD over the study period was not statistically significant (scooter users, 16.9+/-73.0 m [55.5+/-239.6 ft]; usual care, 17.2+/-72.5 m [56.5+/-238.0 ft], P=.55). Four (18.1%) scooter users reported 9 accidents. Over the study period, the proportion of persons reporting use of a scooter (provided by the study or otherwise available) increased in the scooter-users group (eg, food stores, 16.7% to 52.6%; doctor's office, 0% to 35.7%) but not the usual-care group (food stores, 9.1% to 9.5%; doctor's office, 0% to 0%).

CONCLUSIONS

Motorized scooters provided to ambulatory persons with arthritis were used intermittently. The greatest short-term risk from scooter usage appeared to be minor collisions.

Heart rate response to therapeutic riding in children with cerebral palsy: an exploratory study

PURPOSE

The study was designed to document the heart rate response to therapeutic riding in children with cerebral palsy having mild-to-severe disability.

METHODS

Participants consisted of eight youth riders with cerebral palsy, divided into two groups: ambulatory and wheelchair dependent. The riders received continuous digital heart rate monitoring during 10 weekly 20-minute therapeutic horseback riding sessions.

RESULTS

The averaged resting, median, and peak heart rate values, as well as the peak percentage heart rate reserve values, were significantly higher in the wheelchair-dependent group.

CONCLUSIONS

The youth with severe disability (The Gross Motor Function Classification System level IV) who were wheelchair dependent demonstrated higher heart rate values during therapeutic riding than their ambulatory counterparts. In view of these higher heart rate values, further studies are needed to address the role of monitoring heart rate response during therapeutic riding.

Physical activity measurement in persons with chronic and disabling conditions: methods, strategies, and issues

Measuring the physical activity of persons with chronic and disabling conditions presents complexities related to measuring instruments, the intensity of the activity being measured, the population being measured, and individual behavior and health status. They often have limitations in mobility that do not preclude physical activity but contribute to the complexity of measuring it, such as slow or altered gait, inability to walk, and the need for assistive devices. This article reviews currently available ways to measure physical activity, describes strengths and weaknesses of various measures, and provides examples of complexities in measuring physical activity in people who move differently.

Utility of a step activity monitor for the measurement of daily ambulatory activity in children

OBJECTIVES

To evaluate the reliability and validity of the StepWatch Activity Monitor (SAM) as a reliable and valid measurement tool for assessing ambulatory activity in able-bodied children and to assess the ambulatory activity of able-bodied children.

DESIGN

Descriptive study.

SETTING

General community.

PARTICIPANTS

Ninety-seven able-bodied children, aged 6 to 20 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Anthropometric parameters, calibration of a step activity monitor to ensure accuracy, and 3 days of simultaneous heart rate and step activity monitoring.

RESULTS

The SAM had an accuracy of 99.87% compared with the observer-counted steps and was shown to be valid and reliable when compared with heart rate monitoring. The subjects in all age groups (6-10 y, 11-15 y, 16-20 y) spent most of their active time at low step rate but took the fewest steps at this rate. Although the least amount of time was spent at high step rate, it accounted for the most steps. The 6- to 10-year-old group took more total steps per day than any of the other groups. Boys spent significantly more time at high step rate than girls in all age groups (mean for boys, 66+/-4 min/d; girls, 47+/-4 min/d).

CONCLUSIONS

The SAM is an accurate, valid, and useful tool for measuring continuous, time-based step activity during real-world community activity for children and adolescents.