learn 2 move 16-24 - uio

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

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20

40

60

80

100

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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

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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)

Rita van den Berg-Emons Marij Roebroeck

h.j.g.vandenberg@erasmusmc.nl m.roebroeck@erasmusmc.nl

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…