The objective of this study was to determine the feasibility and efficacy of an exercise training program to improve exercise capacity and fatigue level in pediatric patients with end-stage renal disease (ESRD). Twenty children on dialysis intended to perform a 12-week graded community-based exercise program. Exercise capacity and fatigue level were studied; muscle force and health-related quality of life were secondary outcomes. All outcomes were measured at baseline (T = 0) and after intervention (T = 1). Fourteen of the 20 patients (70%) either did not start the program or did not complete the program. Of these patients, seven did not complete or even start the exercise program because of a combination of lack of time and motivational problems. Six patients were not able to continue the program or were unable to do the follow-up measurements because of medical problems. Exercise capacity and muscle strength was higher after the exercise program in the children who completed the training. In conclusion, exercise training is difficult to perform in children with ESRD and is not always feasible in real-life situations for many children with ESRD.
OBJECTIVE: To examine the use of a submaximal exercise test in detecting change in fitness level after a physical training program, and to investigate the correlation of outcomes as measured submaximally or maximally.DESIGN: A prospective study in which exercise testing was performed before and after training intervention.SETTING: Academic and general hospital and rehabilitation center.PARTICIPANTS: Cancer survivors (N=147) (all cancer types, medical treatment completed > or =3 mo ago) attended a 12-week supervised exercise program.INTERVENTIONS: A 12-week training program including aerobic training, strength training, and group sport.MAIN OUTCOME MEASURES: Outcome measures were changes in peak oxygen uptake (Vo(2)peak) and peak power output (both determined during exhaustive exercise testing) and submaximal heart rate (determined during submaximal testing at a fixed workload).RESULTS: The Vo(2)peak and peak power output increased and the submaximal heart rate decreased significantly from baseline to postintervention (P<.001). Changes in submaximal heart rate were only weakly correlated with changes in Vo(2)peak and peak power output. Comparing the participants performing submaximal testing with a heart rate less than 140 beats per minute (bpm) versus the participants achieving a heart rate of 140 bpm or higher showed that changes in submaximal heart rate in the group cycling with moderate to high intensity (ie, heart rate > or =140 bpm) were clearly related to changes in VO(2)peak and peak power output.CONCLUSIONS: For the monitoring of training progress in daily clinical practice, changes in heart rate at a fixed submaximal workload that requires a heart rate greater than 140 bpm may serve as an alternative to an exhaustive exercise test.
Osteoarthritis (OA) is characterized by pain, and problems with activities of daily life, especially if the hip or knee joint is affected. The aim of this project was to study associations between strength, voluntary activation and physical functioning in elderly patients with OA. People with OA of the knee often have lower muscle strength, but also a lower ability to voluntarily activate their knee extensors. In Chapter 2 we investigated the effects of relatively low stimulation currents on the assessment of VA of the knee extensor muscles. We concluded that by using submaximal muscle stimulation overestimation of VA may even be less compared with maximal nerve stimulation. In Chapter 3, we investigated physical functioning longitudinally in a large cohort of participants with and without self-reported hip or knee OA. Physical functioning was tested with a short battery consisting of a chair stand test, a balance test and a 6 meter walk test, performed in the participants’ home. Chair stand and walking performance were lower in participants with OA 3 to 6 years after OA was reported for the first time, and men were more affected than women. In the laboratory, more elaborate lab tests can be done, such as muscle function tests, standardized stair climb tests and longer walk tests. Such tests may be more sensitive to detect impairments. In Chapter 4, we investigated whether there are differences in muscle function in people with and without OA, Only the battery of home tests showed lower scores in participants with OA, and there were no differences in muscle function. In Chapter 5, we investigated the feasibility and effectiveness of 6 weeks of preoperative training for elderly OA patients undergoing total knee arthroplasty. Pre and post-operative outcome measures were not different compared to a standard training group. We conclude that physical functioning, but not VA is impaired in older people with OA and that strength and physical functioning is more impaired just before total knee arthroplasty. When assessing physical functioning in older participants or patients with musculoskeletal disorders, home tests are a good alternative to lab tests to obtain a representative sample. Preoperative training before total knee arthroplasty can prevent the decline in functioning often observed before surgery, but there were no additional effects of intensive strength training.
A-das-PK; een APK-straat voor rijhulpsystemen Uit recent onderzoek en vragen vanuit de autobranche blijkt een duidelijke behoefte naar goed onderhoud, reparatie en borging van de werking van Advanced Driver Assistance Systems (ADAS), vergelijkbaar met de reguliere APK. Een APK voor ADAS bestaat nog niet, maar de branche wil hier wel op te anticiperen en haar clientèle veilig laten rijden met de rijhulpsystemen. In 2022 worden 30 ADAS’s verplicht en zal de werking van deze systemen ook gedurende de levensduur van de auto gegarandeerd moeten worden. Disfunctioneren van ADAS, zowel in false positives als false negatives kan leiden tot gevaarlijke situaties door onverwacht rijgedrag van het voertuig. Zo kan onverwacht remmen door detectie van een niet bestaand object of op basis van verkeersborden op parallelwegen een kettingbotsing veroorzaken. Om te kijken welke gevolgen een APK heeft voor de autobranche wil A-das-PK voor autobedrijven kijken naar de benodigde apparatuur, opleiding en hard- en software voor een goed werkende APK-straat voor ADAS’s, zodat de kansrijke elementen in een vervolgonderzoek uitgewerkt kunnen worden.
Teachers have a crucial role in bringing about the extensive social changes that are needed in the building of a sustainable future. In the EduSTA project, we focus on sustainability competences of teachers. We strengthen the European dimension of teacher education via Digital Open Badges as means of performing, acknowledging, documenting, and transferring the competencies as micro-credentials. EduSTA starts by mapping the contextual possibilities and restrictions for transformative learning on sustainability and by operationalising skills. The development of competence-based learning modules and open digital badge-driven pathways will proceed hand in hand and will be realised as learning modules in the partnering Higher Education Institutes and badge applications open for all teachers in Europe.Societal Issue: Teachers’ capabilities to act as active facilitators of change in the ecological transition and to educate citizens and workforce to meet the future challenges is key to a profound transformation in the green transition.Teachers’ sustainability competences have been researched widely, but a gap remains between research and the teachers’ practise. There is a need to operationalise sustainability competences: to describe direct links with everyday tasks, such as curriculum development, pedagogical design, and assessment. This need calls for an urgent operationalisation of educators’ sustainability competences – to support the goals with sustainability actions and to transfer this understanding to their students.Benefit to society: EduSTA builds a community, “Academy of Educators for Sustainable Future”, and creates open digital badge-driven learning pathways for teachers’ sustainability competences supported by multimodal learning modules. The aim is to achieve close cooperation with training schools to actively engage in-service teachers.Our consortium is a catalyst for leading and empowering profound change in the present and for the future to educate teachers ready to meet the challenges and act as active change agents for sustainable future. Emphasizing teachers’ essential role as a part of the green transition also adds to the attractiveness of teachers’ work.
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
