From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) (ie, progressive exercise provocation in association with serial electrocardiograms [ECG], hemodynamics, oxygen saturation, and subjective symptoms) and measurement of ventilatory gas exchange amounts to a superior method to: 1) accurately quantify cardiorespiratory fitness (CRF), 2) delineate the physiologic system(s) underlying exercise responses, which can be applied as a means to identify the exercise-limiting pathophysiologic mechanism(s) and/or performance differences, and 3) formulate function-based prognostic stratification. Cardiopulmonary ET certainly carries an additional cost as well as competency requirements and is not an essential component of evaluation in all patient populations. However, there are several conditions of confirmed, suspected, or unknown etiology where the data gained from this form of ET is highly valuable in terms of clinical decision making
Optimizing protein intake is a novel strategy to prevent age associated loss of muscle mass and strength in older adults. Such a strategy is still missing for older adults from ethnic minority populations. Protein intake in these populations is expected to be different in comparison to the majority of the population due to several socio-cultural factors. Therefore, the present study examined the dietary protein intake and underlying behavioral and environmental factors affecting protein intake among older adults from ethnic minorities in the Netherlands. We analyzed frequency questionnaire (FFQ) data from the Healthy Life in an Urban Setting (HELIUS) cohort using ANCOVA to describe dietary protein intake in older adults from ethnic minorities in the Netherlands (N = 1415, aged >55 years, African Surinamese, South Asian Surinamese, Moroccan, and Turkish). Additionally, we performed focus groups among older adults from the same ethnic minority populations (N = 69) to discover behavioral and environmental factors affecting protein intake; 40-60% of the subjects did not reach minimal dietary protein recommendations needed to maintain muscle mass (1.0 g/kg bodyweight per day (BW/day)), except for Turkish men (where it was 91%). The major sources of protein originated from animal products and were ethnic specific. Participants in the focus groups showed little knowledge and awareness about protein and its role in aging. The amount of dietary protein and irregular eating patterns seemed to be the major concern in these populations. Optimizing protein intake in these groups requires a culturally sensitive approach, which accounts for specific protein product types and sociocultural factors.
Movement is an essential part of our lives. Throughout our lifetime, we acquire many different motor skills that are necessary to take care of ourselves (e.g., eating, dressing), to work (e.g., typing, using tools, care for others) and to pursue our hobbies (e.g., running, dancing, painting). However, as a consequence of aging, trauma or chronic disease, motor skills may deteriorate or become “lost”. Learning, relearning, and improving motor skills may then be essential to maintain or regain independence. There are many different ways in which the process of learning a motor skill can be shaped in practice. The conceptual basis for this thesis was the broad distinction between implicit and explicit forms of motor learning. Physiotherapists and occupational therapists are specialized to provide therapy that is tailored to facilitate the process of motor learning of patients with a wide range of pathologies. In addition to motor impairments, patients suffering from neurological disorders often also experience problems with cognition and communication. These problems may hinder the process of learning at a didactic level, and make motor learning especially challenging for those with neurological disorders. This thesis focused on the theory and application of motor learning during rehabilitation of patients with neurological disorders. The overall aim of this thesis was to provide therapists in neurological rehabilitation with knowledge and tools to support the justified and tailored use of motor learning in daily clinical practice. The thesis is divided into two parts. The aim of the first part (Chapters 2‐5) was to develop a theoretical basis to apply motor learning in clinical practice, using the implicit‐explicit distinction as a conceptual basis. Results of this first part were used to develop a framework for the application of motor learning within neurological rehabilitation (Chapter 6). Afterwards, in the second part, strategies identified in first part were tested for feasibility and potential effects in people with stroke (Chapters 7 and 8). Chapters 5-8 are non-final versions of an article published in final form in: Chapter 5: Kleynen M, Moser A, Haarsma FA, Beurskens AJ, Braun SM. Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study. Disabil Rehabil. 2017 Aug;39(17):1729-1737. doi: 10.1080/09638288.2016.1207111. Chapter 6: Kleynen M, Beurskens A, Olijve H, Kamphuis J, Braun S. Application of motor learning in neurorehabilitation: a framework for health-care professionals. Physiother Theory Pract. 2018 Jun 19:1-20. doi: 10.1080/09593985.2018.1483987 Chapter 7: Kleynen M, Wilson MR, Jie LJ, te Lintel Hekkert F, Goodwin VA, Braun SM. Exploring the utility of analogies in motor learning after stroke: a feasibility study. Int J Rehabil Res. 2014 Sep;37(3):277-80. doi: 10.1097/MRR.0000000000000058. Chapter 8: Kleynen M, Jie LJ, Theunissen K, Rasquin SM, Masters RS, Meijer K, Beurskens AJ, Braun SM. The immediate influence of implicit motor learning strategies on spatiotemporal gait parameters in stroke patients: a randomized within-subjects design. Clin Rehabil. 2019 Apr;33(4):619-630. doi: 10.1177/0269215518816359.
