learn 2 move 16-24 - uio
TRANSCRIPT
LEARN 2 MOVE 16-24
Effectiveness of a lifestyle program
in adolescents and young adults with cerebral palsy;
a randomized controlled trial
H.J.G. van den Berg-Emons, J. Slaman, M.E. Roebroeck, H.J. Stam
Erasmus University Medical Centre, Dept Rehabilitation Medicine
Jorrit Slaman
PhD Defence: November 2014
Introduction
Healthy lifestyle mediated by sufficient levels of
• physical activity (PA)
• physical fitness
• low sedentary time
Physical activity spectrum
0
20
40
60
80
100
%su
bn
orm
al
vd Berg-Emons et al. Arch Phys Med Rehabil 2010;91:1856-1861
Furthermore………
Low physical fitness in young adults with CP
• Aerobic
• Muscle strength
High sedentary time
Severely fatigued
A modular treatment program
Y
o u
n g
A
d u
l t
T
e a
m s
a lifestyle prgram
Intervention:
Active Lifestyle and Sports Participation
Sport counseling
Fitness training
Counseling:
Movement behaviour
Sports counseling
Intervention aims:
Physical behavior
Physical fitness
Intervention:
Active Lifestyle and Sports Participation
3 months
Total: 6 months
Research questions
Effects on:
Primary
Movement behaviour
Fitness
Randomized controlled trial
Young adults with CP (GMFCS level I to IV)
Aged: 16-24 years
No intellectual disability
Intervention group (n=28)
Control group (n=29)
Usual care = no counseling/
fitness training
Differences:
Intervention period (6 months/ 3 months)
Follow-up period (12 months)
Lifestyle intervention
6 month
difference
-----------------------------------------------------
Physical Fitness
Peak oxygen uptake +
Body composition +
Physical Behaviour
Level physical activity (accelerometer) n.s.
Level physical activity (self-report) +
Slaman et al , Arch Phys Med Rehabil 2014
Slaman et al, Dev Med Child Neurol 2015
Lifestyle intervention
6 month 12 month
difference difference
-----------------------------------------------------
Physical Fitness
Peak oxygen uptake + n.s.
Body composition + +
Physical Behaviour
Level physical activity (accelerometer) n.s. n.s.
Level physical activity (self-report) + n.s.
Slaman et al , Arch Phys Med Rehabil 2014
Slaman et al, Dev Med Child Neurol 2015
Self-reported PA (PASIPD)
Effect of intervention during the intervention period (p=0.05) a
No longer present at follow-up
a More time spent on sports activities largely contributed to this effect.
Objective measures
No effects at all
Volume of daily PA / sedentary time
Intensity of daily PA
Number / duration periods of sitting, walking
Lifestyle intervention
Physical Fitness
Physical Activity
mediating effects
explaining 16-23%
explaining 23-25%
Secondary outcomes:
Mental health + Fatigue + Pain +
Slaman et al , Clin Rehabil 2015
LESSONS LEARNED
PA and sedentary time unfavourable
The intervention effective in increasing self-reported PA during
intervention period (sports activities largely contributed to effect)
No maintenance of effects at 1 year follow-up
Not supported by objective measurements
Self-reported PA (PASIPD):
*Low validity daily physical activity
*socially desirable answers?
*also weekend days
LESSONS LEARNED
DIFFICULT TO CHANGE MOVEMENT BEHAVIOUR
Age?
Compensation?
Lifestyle program?
LESSONS LEARNED
Favourable effects of the intervention on several aspects of
physical fitness low intensive training program
The fitness training had a duration of 3 months. We found several effects
at 6 months Persistence attributable to counselling sessions?
Effects on fatigue, mental health and pain were mediated by
effects on PA & Fitness
In summary…
The intervention was
Not effective in reaching a behavioural change (long-term) towards
more physical activity or less sedentary time
Effective in increasing several aspects of cardiopulmonary and
metabolic fitness, which seem to endure longer than with regular
exercise training programs in CP
Future
Optimalisation
- Objective feedback (activity monitors)
- Booster sessions for maintenance
- E-learning (therapists, patients)
- At present implemented in Rijndam Rehabilitation Institute
(Outpatient Clinic)
Active Lifestyle and Sports
Participation
Daily PA counseling
Based on motivational interviewing
Aimed to ↑ PA in daily life (not perse sports) and ↓ sedentary time
6 sessions spread over a 6-month period
Sports counseling
2-4 sessions to find appropriate sports and sports facilities
Preferences, capabilities, financial situation, transportation are discussed
Possibility to practice sports with movement therapist
Active Lifestyle and Sports
Participation
Fitness training
Aimed to ↑ aerobic capacity & muscle strength
Weekly group training at center & weekly individual training at home
24 sessions spread over first 3 months
Baseline
All Control group Intervention group P-value
N 57 29 28 -
Gender (M / F) 27 / 30 15 / 14 12 / 16 0.50
Age (years) 20 ± 3 20 ± 3 20 ± 3 0.64
Body mass (kg) 67 ± 18 65 ± 18 70 ± 18 0.24
Height (cm) 170 ± 10 170 ± 9 169 ± 11 0.66
CP distribution (unilateral / bilateral) 29 / 27 14 / 14 15 / 13 0.79
GMFCS* distribution ( I / II / III / IV) 33 / 18 / 5 / 1 16 / 9 / 3 / 1 17 / 9 / 2 / 0 0.75
Duration of PA (% / day) 8.52 ± 3.01 8.26 ± 2.94 8.80 ± 3.12 0.54
Sedentary time (% / day) 79.63 ± 7.06 81.10 ± 6.86 78.11 ± 7.08 0.16
Motility during PA (g) 44.00 ± 8.09 43.18 ± 8.74 44.91 ± 7.37 0.47
Effects on:
Fatigue severity (CIS) (T0-T6; p=0.03)
HR-QoL (SF-36) (T0-T6; p=0,05)
Secondary
Effects on Fitness
Intervention period
VO2peak (p=0.01)
VO2 on AT(p=0,01)
Load on AT (p=0,00)
Waist circumference (p=0.01)
Follow-up period
Skinfolds (p=0.01)
Systolic BP (p=0.04)
Total cholesterol (p=0,02)
Max Load
Max VE
Muscle strength
6 minute walk distance
HDL cholesterol
No effects on…