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Objective
The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer.
Design
Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait.
Results
Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of −0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp2 = 0.082) and increase in single-leg stance time (mean [median] = 1.1 [2.6] sec, respectively; F1,80 = 12.617, P = 0.001, ηp2 = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp2 = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05).
Conclusions
The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer.
Introduction
Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care.
Methods
This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation.
Discussion
After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs.
Trial registration
German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022.
University students frequently engage in unhealthy behaviors. However, there is a lack of studies examining a wide range of their lifestyle characteristics by sex and academic level of study. This cross-sectional survey of students enrolled in BSc, MSc, or PhD programs at one university in Germany (N = 3389) assessed physical activity (PA), sedentary behavior (SB), nutrition, sleep quality, and alcohol, tobacco, and other drug (ATOD) use by sex and academic level and was conducted with EvaSys version 8.0. Chi-squared tests compared categorical variables by sex, and binary logistic regression analyses adjusted for sex with Bonferroni adjustments evaluated differences across academic level. Although 91% of students achieved the aerobic PA guidelines, only 30% achieved the muscle strengthening exercises (MSE) guidelines, and 44% had high SB. Likewise, <10% met the fruit and vegetable consumption (FVC) recommendations, >40% of students experienced impaired sleep, and >30% had hazardous alcohol consumption. Less than 20% of the sample achieved the guideline/recommendation of all three PA, MSE and SB. Some behaviors exhibited significant sex and academic level differences. The identified at-risk groups included males (lower FVC), females (eating more during stress), and BSc students (poorer nutrition/sleep quality, more ATOD use). Given the above findings, multipronged strategies are needed with an overarching focus highlighting the health–academic achievement links. Behavioral interventions and environmental policies are required to raise awareness and promote student health.
Beach handball is a young discipline that is characterized by numerous high-intensity actions. By following up on previous work, the objective was to perform in-depth analyses evaluating external load (e.g., distance traveled, velocity, changes in direction, etc.) in beach handball players. In cross-sectional analyses, data of 69 players belonging to the German national or prospective team were analyzed during official tournaments using a local positioning system (10 Hz) and inertial measurement units (100 Hz). Statistical analyses comprised the comparison of the first and second set and the effects of age and sex (female adolescents vs. male adolescents vs. male adults) and playing position (goalkeepers, defenders, wings, specialists, and pivots) on external load measures. We found evidence for reduced external workload during the second set of the matches (p = 0.005, ηp2 = 0.09), as indicated by a significantly lower player load per minute and number of changes in direction. Age/sex (p < 0.001, ηp2 = 0.22) and playing position (p < 0.001, ηp2 = 0.29) also had significant effects on external load. The present data comprehensively describe and analyze important external load measures in a sample of high-performing beach handball players, providing valuable information to practitioners and coaches aiming at improving athletic performance in this new sport.
Studien haben wiederholt auf eine hohe Beschwerdelast Studierender hingewiesen und Hochschulen veranlasst, sich zunehmend im studentischen Gesundheitsmanagement zu engagieren, das darauf abzielt, gesundheitsfördernde Strukturen zu entwickeln sowie individuelle Ressourcen im Setting Hochschule zu fördern. Die körperliche Aktivität und mentale Gesundheit Studierender stellen hierfür Ansatzpunkte dar. International zeigen sich eindeutige Zusammenhänge zwischen dem Bewegungsverhalten Studierender und der psychischen Gesundheit, jedoch liegen bisher nur wenige nationale Erhebungen vor, was die Übertragbarkeit auf die deutsche Hochschullandschaft einschränkt. Dieser Beitrag untersucht, wie in dieser Zielgruppe die aktuellen Bewegungsempfehlungen, bestehend aus den Kategorien ausdauerorientierte körperliche Aktivitäten, Sitzzeiten und muskelkräftigende Aktivitäten, mit verschiedenen Indikatoren mentaler Gesundheit zusammenhängen.
Im Sommersemester 2019 nahmen 4.244 Studierende an einer hochschulweiten Umfrage teil. Neben dem Bewegungsverhalten wurden das Stresserleben erhoben und Screenings auf Kernelemente einer depressiven und angstbezogenen Störung sowie auf eine psychische Belastung durchgeführt. Positive Aspekte mentaler Gesundheit wurden über eine Skala zur Beurteilung studentischen Engagements erfasst. Als Assoziationsmaß wurden adjustierte Odds Ratios unter Berücksichtigung soziodemografischer und behavioraler Störvariablen berechnet.
Sämtliche Kriterien der Bewegungsempfehlungen werden von 9,6% der Studierenden erreicht. 48% der Befragten weisen ein hohes Stresserleben auf und 29% gelten als psychisch belastet. Das Befolgen aller Kriterien der Bewegungsempfehlungen ist mit signifikant geringeren Chancen für psychische Belastungsindikatoren assoziiert, wobei der stärkste Zusammenhang für depressive Symptome gefunden wurde. Studentisches Engagement war nicht signifikant mit dem Erreichen der Bewegungsempfehlungen assoziiert.
Die Ergebnisse bestätigen die hohe psychische Belastung Studierender und deuten das Optimierungspotenzial aus Sicht der Bewegungsförderung an. Hochschulen sollten die Studienbedingungen und das Gesundheitsverhalten der Studierenden systematisch und fortlaufend analysieren, um geeignete verhaltens- und verhältnisorientierte Maßnahmen wie bewegungsorientierte Lehre, Campusentwicklung und Ausbau des Hochschulsportangebots abzuleiten und zu evaluieren.
Background
Bone mineral density (BMD) accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this cross-sectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dual-energy x-ray absorptiometry (DXA) after completion of neoadjuvant chemotherapy.
Methods
DXA measurements of the lumbar spine (L2-4), both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years). Mean Z-scores, areal BMD (g/cm2), calculated volumetric BMD (g/cm3) and bone mineral content (BMC, g) were determined.
Results
Lumbar spine mean Z-score was -0.14 (95% CI: -0.46 to 0.18), areal BMD was 1.016 g/cm2 (95% CI: 0.950 to 1.082) and volumetric BMD was 0.330 g/cm3 (95% CI: 0.314 to 0.347) which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36), the difference between the affected and non-affected femoral neck was 12.1% (95% CI: -16.3 to -7.9) in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7% (95% CI: -29.3 to -14.0) for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from ρ = 0.55 to ρ = 0.80.
Conclusions
The tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis in later life. Furthermore, the peripheral assessment of BMD in the calcaneus via DXA is a feasible approach to quantify bone loss in the lower extremity in bone sarcoma patients and may serve as an alternative procedure, when the established assessment of femoral BMD is not practicable due to endoprosthetic replacements.
Background
Degenerative musculoskeletal disorders are among the most frequent diseases occurring in adulthood, often impairing patients' functional mobility and physical activity. The aim of the present study was to investigate and compare the impact of three frequent degenerative musculoskeletal disorders -- knee osteoarthritis (knee OA), hip osteoarthritis (hip OA) and lumbar spinal stenosis (LSS) -- on patients' walking ability.
Methods
The study included 120 participants, with 30 in each patient group and 30 healthy control individuals. A uniaxial accelerometer, the StepWatch™ Activity Monitor (Orthocare Innovations, Seattle, Washington, USA), was used to determine the volume (number of gait cycles per day) and intensity (gait cycles per minute) of walking ability. Non-parametric testing was used for all statistical analyses.
Results
Both the volume and the intensity of walking ability were significantly lower among the patients in comparison with the healthy control individuals (p < 0.001). Patients with LSS spent 0.4 (IQR 2.8) min/day doing moderately intense walking (>50 gait cycles/min), which was significantly lower in comparison with patients with knee and hip OA at 2.5 (IQR 4.4) and 3.4 (IQR 16.1) min/day, respectively (p < 0.001). No correlations between demographic or anthropometric data and walking ability were found. No technical problems or measuring errors occurred with any of the measurements.
Conclusions
Patients with degenerative musculoskeletal disorders suffer limitations in their walking ability. Objective assessment of walking ability appeared to be an easy and feasible tool for measuring such limitations as it provides baseline data and objective information that are more precise than the patients' own subjective estimates. In everyday practice, objective activity assessment can provide feedback for clinicians regarding patients' performance during everyday life and the extent to which this confirms the results of clinical investigations. The method can also be used as a way of encouraging patients to develop a more active lifestyle.
Objective assessment of brace wear times and physical activities in two patients with scoliosis
(2010)
Conservative treatment of adolescent idiopathic scoliosis consists of therapeutic exercise and the application of braces. The effectiveness of bracing mainly depends on patient compliance, which can be determined by means of temperature sensors. This methodological paper describes the feasibility of objectively determining compliance and daily physical activities before and during conservative scoliosis treatment, being a relevant indicator for quality of life in children and adolescents. One patient with low compliance (61.4±24.9%) reduced her activity level during bracing by 50.1%, whereas another patient with a satisfactory compliance (85.7±19.5%) increased her daily activity level by 33.7% during conservative treatment.
This review provides a survey of studies investigating physical activity and exercise interventions in patients during tumor treatment and survivors of childhood cancer. PubMed and Medline databases were searched using relevant terms. References of selected papers were tracked. A total of 28 studies could be identified. Seventeen studies investigated physical activity, 11 studies determined the effect of activity enhancing interventions during and after therapy. Even though most studies showed limitations and results were not consistent, considerably reduced physical activity is highly probable in patients during and after therapy. Studies on interventions provided promising results and revealed challenges to be faced. Pediatr Blood Cancer