Physical Activity and Fitness in Adolescents and Young Adults with Myelomeningocele

The introductory Chapter 1 describes the various types of spina bifida, including the most severe myelomeningocele (MMC), and its associated symptoms. Furthermore, it introduces new challenges that rise in medical care with the increased life expectancy of children who are born with this condition. Similarly to persons with other chronic conditions, there is a shift from disability prevention towards prevention of secondary conditions. Sufficient levels of physical activity and fitness are important for disease prevention, maintenance of functional independence, participation and quality of life. Studies on this topic in people with MMC are scarce. Therefore, this thesis aimed to obtain insight in the levels of daily physical activity and fitness of adolescents and young adults with MMC and to study the associations with personal and environmental factors, participation, health-related quality of life and cardiovascular disease (CVD) risk

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

Introduction: Objective measurements of levels of physical activity and fitness in patients with head and neck cancer (HNC) are lacking. Furthermore, demographic, clinical and lifestyle-related correlates of low levels of physical activity and fitness in patients with HNC are unknown. This study aims to investigate the levels of accelerometer that assessed physical activity and fitness in patients with HNC and to identify their demographical, clinical and lifestyle-related correlates. Methods: Two hundred and fifty-four patients who were recently diagnosed with HNC and participated in the NETherlands QUality of life and Biomedical cohort studies In head and neck Cancer (NET-QUBIC) study were included. Physical activity (accelerometer), cardiorespiratory fitness (Chester Step Test), hand grip strength (hand dynamometer) and lower body muscle function (30-second chair-stand test) were assessed. Multivariable linear regression analyses with a stepwise forward selection procedure were used. Results: Patients spent 229 min/d in physical activity of which 18 min/d in moderate-to-vigorous physical activity. The mean predicted VO2max was 27.9 ml/kg/min, the mean hand grip strength was 38.1 kg and the mean number of standings was 14.3. Patients with lower educational level, more comorbidity and higher tumor stage spent significantly less time in physical activity. Older patients, females and patients with a higher tumor stage had significantly lower cardiorespiratory fitness levels. Older patients, females, patients with more comorbidity, patients with normal weight and patients who have never smoked had significantly lower hand grip strength. Older patients, patients with lower educational level, smokers and patients with more comorbidity had a significantly lower function of lower body muscle. Conclusions: Pre-treatment levels of physical activity, cardiorespiratory fitness and lower body muscle function are low in patients with HNC. Based on this study, exercise programs targeted and tailored to patients with low levels of physical activity and fitness can be developed

Effects of a combined physical and psychosocial training for children with cancer: a randomized controlled trial

BACKGROUND: Physical fitness and psychosocial function is often reduced in children during or shortly after cancer treatment. This study evaluates the effect of a combined physical exercise and psychosocial intervention on cardiorespiratory fitness, muscle strength, body composition, psychosocial function and health-related quality of life (HrQoL). In addition, intervention mediators, applicability and adherence were examined. METHODS: This multicenter randomized controlled trial included 68 children with cancer [mean age 13.2 (SD: 3.1) years; 54% male] during treatment or within 12-months post-treatment. The 12-week intervention consisted of 24 individual physical exercise sessions supervised by a physiotherapist, and 6 psychosocial training sessions for children and 2 for parents. Physical fitness and psychosocial function were assessed at baseline, directly post-intervention and at 12 months' post-baseline. Generalized estimating equations were used to simultaneously assess intervention effects at short and long-term. Additionally, we evaluated within-group differences over time. Potential physical and psychosocial mediators in the intervention effect on HrQoL were examined using the product-of-coefficient test. Applicability and adherence were assessed by trainer-report. RESULTS: This study was able to compare 26 children who received the study intervention, with 33 children who received usual care. No significant differences in the effects of the intervention were found on physical fitness and psychosocial function at short-term. At 12-months follow-up, significantly larger improvements in lower body muscle strength (β = 56.5 Newton; 95% CI: 8.5; 104.5) were found in the intervention group when compared to the control group. Within-group changes showed significant improvements over time in HrQoL and bone density in both groups. Intervention effects on HrQoL were not significantly mediated by physical fitness and psychological function. Intervention applicability was satisfactory with an average session attendance of 67% and 22% dropout (mainly due to disease recurrence). CONCLUSIONS: This 12-week physical exercise and psychosocial training intervention for children with cancer was applicable and showed satisfactory adherence. We found no significant between-group differences in effect, except for a significant improvement in lower body muscle strength at long-term in the intervention group compared to the control group. Yet, both the intervention and the control group showed improvements in bone mineral density and HrQoL over time. TRIAL REGISTRATION: The trial was registered at the Dutch Trial Registry ( NTR1531 ). Regist

Sports participation in adolescents and young adults with myelomeningocele and its role in total physical activity behaviour and fitness

Objective: To assess sports participation in young adults with myelomeningocele and its association with personal, disease-related and psychosocial factors, physical activity and fitness. Design: Cross-sectional study. Subjects: Fifty-one persons (26 males) with myelomeningocele, mean age 21.1 (standard deviation 4.5) years. Methods: We assessed self-reported sports participation, ambulatory status, presence of hydrocephalus, functional independence, social support, perceived competence, exercise enjoyment, objective and self-reported physical activity, peak oxygen uptake, muscle strength and body fat. Associations were studied using regression analyses. Results: Thirty-five subjects (69%) participated in sports. Sports participation was not associated with disease-related characteristics, but was associated with social support from family, perceived athletic competence and physical appearance (p≤0.05), and tended to be associated with global self-worth (p=0.10). Sports participants had higher self-reported physical activity levels than non-participants (p≤0.05); objective results did not support this. Furthermore, sports participants tended to be less likely to have subnormal muscle strength (odds ratio = 0.26; p = 0.08) and their peak oxygen uptake was 0.19 l/ min higher, but not statistically significantly (p=0.13). Conclusion: Sports participation seems to be due to personal preferences rather than physical ability; it could benefit from improving social support and perceived competence, and is associated with higher self-reported physical activity