Characterizations of the preliminary assessment and the management in activity adapted physical for the management of chronic disease

Avec l'avènement de notre société moderne, l'activité physique quotidienne n'a cessé de diminuer et la sédentarité est devenue aujourd'hui un enjeu majeur de santé publique. L'inactivité physique et le comportement sédentaire sont des facteurs de risques identifiés et considérables des pathologies chroniques.Depuis 2016, les médecins Français ont la possibilité de prescrire de l'activité physique adaptée (APA) à leurs patients porteurs d'une maladie chronique reconnue comme affection de longue durée (ALD). Cependant, bien qu'il existe des recommandations pour leur prescription médicale, il n'y a pas de caractérisation objective de la réalité pratique des programmes d'APA, pouvant influencer cette prescription. Ce travail de thèse s'inscrit dans le but d'explorer la réalité pratique de l'APA et de mieux caractériser les programmes mis en œuvre, ainsi que le bilan initial à réaliser. Dans un premier temps il s'agit d'évaluer l'intensité réelle de l'exercice pratiqué lors de séances APA, en conditions écologiques dans un centre de référence. Ensuite une analyse de l'apport des tests environnementaux (test de marche de 6 minutes et test du lever de chaise) dans l'évaluation des capacités physiologiques à l'effort d'un patient présentant une ALD a été menée.Les résultats de ce programme de recherche, nous permettrons de mettre en place des préconisations adaptées aux réalités pratiques afin d'accompagner au mieux la promotion de l'activité physique à des fins de santé chez les patients porteurs de pathologies chroniques.With the advent of the modern society, physical activity has been steadily decreasing, to the point that physical inactivity has become a major public health problem. Physical inactivity and sedentary lifestyle have for instance been identified as important risk factors for chronic diseases.Since 2016, French physicians have been authorized to prescribe adapted physical activity (APA) to their patients with a chronic disease recognized as a long-term condition (ALD affection de longue durée). Although there are recommendations for medical prescription, there is no objective characterization of the practical reality of APA programs, which could even influence this prescription. This work was carried out to explore the practical reality of APA and to better characterize the programs set up as well as the initial assessment to be carried out.First, we evaluated the real intensity of the exercise practiced during the APA sessions, under ecological conditions in a reference centre. Secondly, we analysed the contribution of environmental tests (six-minute walk test and one-minute sit-to-stand test) in the evaluation of the physiological capacities to exercise of patients with ALD. The results of this studies program allowed us to suggest recommendations adapted to the practical reality in order to best promote physical activity for health purposes in patients with a chronic pathology

Caractérisations de l'évaluation préalable et de la prise en charge en activité physique adaptée des patients porteurs d'une maladie chronique

With the advent of the modern society, physical activity has been steadily decreasing, to the point that physical inactivity has become a major public health problem. Physical inactivity and sedentary lifestyle have for instance been identified as important risk factors for chronic diseases.Since 2016, French physicians have been authorized to prescribe adapted physical activity (APA) to their patients with a chronic disease recognized as a long-term condition (ALD affection de longue durée). Although there are recommendations for medical prescription, there is no objective characterization of the practical reality of APA programs, which could even influence this prescription. This work was carried out to explore the practical reality of APA and to better characterize the programs set up as well as the initial assessment to be carried out.First, we evaluated the real intensity of the exercise practiced during the APA sessions, under ecological conditions in a reference centre. Secondly, we analysed the contribution of environmental tests (six-minute walk test and one-minute sit-to-stand test) in the evaluation of the physiological capacities to exercise of patients with ALD. The results of this studies program allowed us to suggest recommendations adapted to the practical reality in order to best promote physical activity for health purposes in patients with a chronic pathology.Avec l'avènement de notre société moderne, l'activité physique quotidienne n'a cessé de diminuer et la sédentarité est devenue aujourd'hui un enjeu majeur de santé publique. L'inactivité physique et le comportement sédentaire sont des facteurs de risques identifiés et considérables des pathologies chroniques.Depuis 2016, les médecins Français ont la possibilité de prescrire de l'activité physique adaptée (APA) à leurs patients porteurs d'une maladie chronique reconnue comme affection de longue durée (ALD). Cependant, bien qu'il existe des recommandations pour leur prescription médicale, il n'y a pas de caractérisation objective de la réalité pratique des programmes d'APA, pouvant influencer cette prescription. Ce travail de thèse s'inscrit dans le but d'explorer la réalité pratique de l'APA et de mieux caractériser les programmes mis en œuvre, ainsi que le bilan initial à réaliser. Dans un premier temps il s'agit d'évaluer l'intensité réelle de l'exercice pratiqué lors de séances APA, en conditions écologiques dans un centre de référence. Ensuite une analyse de l'apport des tests environnementaux (test de marche de 6 minutes et test du lever de chaise) dans l'évaluation des capacités physiologiques à l'effort d'un patient présentant une ALD a été menée.Les résultats de ce programme de recherche, nous permettrons de mettre en place des préconisations adaptées aux réalités pratiques afin d'accompagner au mieux la promotion de l'activité physique à des fins de santé chez les patients porteurs de pathologies chronique

Alexithymia and Athletic Performance: Beneficial or Deleterious, Both Sides of the Medal? A Systematic Review

Background: Numerous studies have been published on alexithymia among athletes in the last decades. The objective, here, is to provide a critical review on alexithymia in sport and identify elements demonstrating that alexithymic athletes can attain a competitive advantage. Methods: The Center for Reviews and Dissemination guidelines were used. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines served as the template for reporting the present systematic review. We searched PubMed, Embase, Science Direct, and PsycINFO, without language or date restrictions. Results: Within 72 eligible studies, 23 articles fulfilling the selection criteria were included in the review. Alexithymia is associated with various pathologies and considered to be counter-performing. However, despite considerable suspicion of an advantageous performance effect of alexithymia, there is a lack of data to quantify this effect. Studies identified are heterogeneous (different scales of measurement of alexithymia used or outcomes, different sports), that do not allow us to conclude on an observed causal relationship, because the studies are mostly observational. Conclusion: This systematic review opens a new search field on alexithymia, as possibly promoting performance

The USSe (UltraSound Score for Erosions) in the evaluation of bone erosions in RA compared to the SHSe (Van der Heijde-modified Sharp score for erosions)

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An Association between Alexithymia and the Characteristics of Sport Practice: A Multicenter, Cross-Sectional Study

Background: This was a multicenter, cross-sectional study which aimed to investigate the relationship between the characteristics of sport practice (weekly training duration, level of practice) and alexithymia in adults who were officially licensed at a sports club. Methods: From a sample of sports club licensed adults, 188 participants were included. The participants completed computerized questionnaires on anthropometric data and characteristics of sport practice (level and weekly time spent on sport practice) as well as alexithymia (TAS 20), depression (BDI-13) and anxiety traits (STAI-Y form B). Results: In this sample, 91 (48.4%) and 97 (51.6%) athletes engaged in recreational and competitive sport practice, respectively. We observed a prevalence of 31.9% for alexithymia. Moreover, alexithymics were more involved in competitive than recreational practice (40.2% versus 23.1%, respectively; p = 0.019) and they were less anxious (63.9% versus 80.2%, respectively; p = 0.010). Finally, alexithymia was significantly more pronounced than non-alexithymia among sports competition practitioners (OR: 3.57 (95 CI [1.26–10.08]; p = 0.016) and we observed less alexithymia in team sports practice than confrontation sports (OR: 0.20 (95 CI [0.05–0.78]; p = 0.020). Conclusions: Alexithymic athletes were more involved in competition than recreational sports compared to non-alexithymic subjects, whilst there were more alexithymic athletes in confrontation sports than in team sports

Remote Photoplethysmography Is an Accurate Method to Remotely Measure Respiratory Rate: A Hospital-Based Trial

Remote photoplethysmography imaging (rPPG) is a new solution proposed to measure vital signs, such as respiratory rate (RR) in teleconsultation, by using a webcam. The results, presented here, aim at evaluating the accuracy of such remote measurement methods, compared with existing measurement methods, in a real-life clinical setting. For each patient, measurement of RR, using the standard system (control), has been carried out concomitantly with the experimental system. A 60-s time frame was used for the measurements made by our rPPG system. Age, gender, BMI, and skin phototype were collected. We performed the intraclass correlation coefficient and Bland–Altman plot to analyze the accuracy and precision of the rPPG algorithm readings. Measurements of RR, using the two methods, have been realized on 963 patients. Comparison of the two techniques showed excellent agreement (96.0%), with most of the patients (n = 924—standard patients) being in the confidence interval of 95% in Bland–Altman plotting. There were no significant differences between standard patients and outlier patients for demographic and clinical characteristics. This study indicates a good agreement between the rPPG system and the control, thus allowing clinical use of this remote assessment of the respiratory rate

Occurrence of Alexithymia and Its Association with Sports Practice from a Sample of University Students: Results from a French Cross-Sectional Study

International audienceBackground: This study aimed to assess the prevalence of alexithymia in a sample of university students and to determine its association with specific sports practice characteristics (competition and training).Methods: In this cross-sectional study, anthropometric data and characteristics of sport practice were collected, as well as level of alexithymia (Toronto Alexithymia Scale, (TAS-20)).Results: The study included 253 French university students who completed a questionnaire specifying their regular sports practice and level of alexithymia (TAS-20). We found 76 subjects (30%) who had proven alexithymia and 92 (36.4%) who were borderline alexithymic. A significant positive relationship between alexithymia and the weekly amount of training practice was observed. It should be noted that students who engage in more than 5 h of physical activity are more prone to be borderline or alexithymic (respectively, 19.6 and 19.7% versus 7.1% for non-alexithymics; p = 0.03).Conclusion: With a 30% frequency, alexithymia is more prevalent in this context than in the general population. Furthermore, alexithymia and borderline alexithymia are most favorably associated with higher physical activity (over 5 h per week

Case Report: Stress Fracture in an International Triple Jumper: Importance of an Integrated Care Approach Which Also Incorporates Biomechanics

International audienceAthletes fear stress fracture (SF) injuries as they can put a premature end to their athletic careers. Understanding any mechanical constraints can suggest preventive management approach. Specifically, for the triple jump, the mechanical stresses that occur during the event appear to be the main factors for risk of injury. This clinical case describes three successive episodes of anterior tibial fracture in an international triple jumper between 2011 and 2013. The first fracture received surgical treatment involving intramedullary nailing. The second fracture occurred in the same location and was considered a recurrence requiring medical treatment, whilst the third was a complete fracture of the surgical material and required surgical revision. These recurrent fractures can be explained by the fatigue of materials (bone and nail) induced by triple jump practice and emphasize the importance of integrating biomechanics into an assessment of the case. The use of biomechanical modelization to identify these weaknesses could be an approach for clinical management of such patients. Observation of the intrinsic mechanical stresses during high-level triple jump may lead to identification of modifiable risk factors for bone fragility