LEARN 2 MOVE 16-24

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

%subnormal

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)

+

Lifestyle intervention

6 month 12 month difference 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

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

[email protected] [email protected]

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…