PURPOSE: The aim of this study was to determine changes in physical activity, nutrition, sleep behaviour and body composition in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application (app).METHODS: A 12-week pre-post intervention study was performed, starting with a 1-week control period. Physical activity and sleep behaviour were continuously measured with a Fitbit charge 3. Self-reported nutritional intake, body mass and waist circumference were collected. Pre-post outcomes were compared with a paired-sample t-test or Wilcoxon signed-rank test. Fitbit data were analysed with a mixed model or a panel linear model. Effect sizes were determined and significance was accepted at p < .05. RESULTS: Thirty participants completed the study. No significant changes in physical activity (+1.5 √steps) and sleep quality (-9.7 sleep minutes; -1.2% sleep efficiency) were found. Significant reduction in energy (-1022 kJ, d = 0.71), protein (-8.3 g, d = 0.61) and fat (-13.1 g, d = 0.87) intake, body mass (-2.2 kg, d = 0.61) and waist circumference (-3.3 cm, d = 0.80) were found. CONCLUSION: Positive changes were found in nutritional behaviour and body composition, but not in physical activity and sleep quality. The WHEELS app seems to partly support healthy lifestyle behaviour.Implications for RehabilitationHealthy lifestyle promotion is crucial, especially for wheelchair users as they tend to show poorer lifestyle behaviour despite an increased risk of obesity and comorbidity.The WHEELS lifestyle app seems to be a valuable tool to support healthy nutrition choices and weight loss and to improve body satisfaction, mental health and vitality.
BACKGROUND: Early mobilization has been proven effective for patients in intensive care units (ICUs) to improve functional recovery. However, early mobilization of critically ill, often mechanically ventilated, patients is cumbersome because of the attachment to tubes, drains, monitoring devices and muscle weakness. A mobile treadmill with bodyweight support may help to initiate mobilization earlier and more effectively. The aim of this study is to assess the effectiveness of weight-supported treadmill training in critically ill patients during and after ICU stay on time to independent functional ambulation. METHODS: In this randomized controlled trial, a custom-built bedside body weight-supported treadmill will be used and evaluated. Patients are included if they have been mechanically ventilated for at least 48 hours, are able to follow instructions, have quadriceps muscle strength of Medical Research Council sum-score 2 (MRC 2) or higher, can sit unsupported and meet the safety criteria for physical exercise. Exclusion criteria are language barriers, no prior walking ability, contraindications for physiotherapy or a neurological condition as reason for ICU admission. We aim to include 88 patients and randomize them into either the intervention or the control group. The intervention group will receive usual care plus bodyweight-supported treadmill training (BWSTT) daily. The BWSSTT consists of walking on a mobile treadmill while supported by a harness. The control group will receive usual care physiotherapy treatment daily consisting of progressive activities such as bed-cycling and active functional training exercises. In both groups, we will aim for a total of 40 minutes of physiotherapy treatment time every day in one or two sessions, as tolerated by the patient. The primary outcome is time to functional ambulation as measured in days, secondary outcomes include walking distance, muscle strength, status of functional mobility and symptoms of post-traumatic stress. All measurements will be done by assessors who are blinded to the intervention on the regular wards until hospital discharge. DISCUSSION: This will be the first study comparing the effects of BWSTT and conventional physiotherapy for critically ill patients during and after ICU stay. The results of this study contribute to a better understanding of the effectiveness of early physiotherapy interventions for critically ill patients. TRIAL REGISTRATION: Dutch Trial Register (NTR) ID: NL6766. Registered at 1 December 2017.
BACKGROUND: Over 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the protocol for the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, which aims to unravel the potential mechanisms behind HAD from admission to three months post-discharge.METHODS/DESIGN: The Hospital-ADL study is a multicenter, observational, prospective cohort study aiming to recruit 400 patients aged ≥70 years that are acutely hospitalized at departments of Internal Medicine, Cardiology or Geriatrics, involving six hospitals in the Netherlands. Eligible are patients hospitalized for at least 48 h, without major cognitive impairment (Mini Mental State Examination score ≥15), who have a life expectancy of more than three months, and without disablement in all six ADLs. The study will assess possible cognitive, behavioral, psychosocial, physical, and biological factors of HAD. Data will be collected through: 1] medical and demographical data; 2] personal interviews, which includes assessment of cognitive impairment, behavioral and psychosocial functioning, physical functioning, and health care utilization; 3] physical performance tests, which includes gait speed, hand grip strength, balance, bioelectrical impedance analysis (BIA), and an activity tracker (Fitbit Flex), and; 4] analyses of blood samples to assess inflammatory and metabolic markers. The primary endpoint is additional disabilities in ADLs three months post-hospital discharge compared to ADL function two weeks prior to hospital admission. Secondary outcomes are health care utilization, health-related quality of life (HRQoL), physical performance tests, and mortality. There will be at least five data collection points; within 48 h after admission (H1), at discharge (H3), and at one (P1; home visit), two (P2; by telephone) and three months (P3; home visit) post-discharge. If the patient is admitted for more than five days, additional measurements will be planned during hospitalization on Monday, Wednesday, and Friday (H2).DISCUSSION: The Hospital-ADL study will provide information on cognitive, behavioral, psychosocial, physical, and biological factors associated with HAD and will be collected during and following hospitalization. These data may inform new interventions to prevent or restore hospitalization-associated disability.
Along with the rapidly growing number of disabled people participating in competitive sports, there is an increased need for (para)medical support in disability sports. Disabled athletes experience differences in body composition, metabolism, training load and habitual activity patterns compared with non-disabled athletes. Moreover, it has been suggested that the well-recognized athlete triad, and low energy availability and low bone mineral density in particular, is even a greater challenge in disabled athletes. Therefore, it is not surprising that sport nutritionists of disabled athletes have expressed an urgency for increased knowledge and insights on the nutritional demands of this group. This project aims to investigate energy expenditure, dietary intake, body composition and bone health of disabled athletes, ultimately leading to nutritional guidelines that promote health and optimal sports performance for this unique population. For this purpose, we will conduct a series of studies and implementation activities that are inter-related and build on the latest insights from sports practice, technology and science. Our international consortium is highly qualified to achieve this goal. It consists of knowledge institutes including world-leading experts in sport and nutrition research, complemented with practical insights from nutritionists working with disabled athletes and the involvement of athletes and teams through the Dutch and Norwegian Olympic committees. The international collaboration, which is a clear strength of this project, is not only focused on research, but also on the optimization of professional practice and educational activities. In this regard, the outcomes of this project will be directly available for practical use by the (para)medical staff working with disabled athletes, and will be extensively communicated to sport teams to ensure that the new insights are directly embedded into daily practice. The project outcomes will also be incorporated in educational activities for dietetics and sport and exercise students, thereby increasing knowledge of future practitioners.
Along with the rapidly growing number of disabled people participating in competitive sports, there is an increased need for (para)medical support in disability sports. Disabled athletes experience differences in body composition, metabolism, training load and habitual activity patterns compared with non-disabled athletes. Moreover, it has been suggested that the well-recognized athlete triad, and low energy availability and low bone mineral density in particular, is even a greater challenge in disabled athletes. Therefore, it is not surprising that sport nutritionists of disabled athletes have expressed an urgency for increased knowledge and insights on the nutritional demands of this group. This project aims to investigate energy expenditure, dietary intake, body composition and bone health of disabled athletes, ultimately leading to nutritional guidelines that promote health and optimal sports performance for this unique population. For this purpose, we will conduct a series of studies and implementation activities that are inter-related and build on the latest insights from sports practice, technology and science. Our international consortium is highly qualified to achieve this goal. It consists of knowledge institutes including world-leading experts in sport and nutrition research, complemented with practical insights from nutritionists working with disabled athletes and the involvement of athletes and teams through the Dutch and Norwegian Olympic committees. The international collaboration, which is a clear strength of this project, is not only focused on research, but also on the optimization of professional practice and educational activities. In this regard, the outcomes of this project will be directly available for practical use by the (para)medical staff working with disabled athletes, and will be extensively communicated to sport teams to ensure that the new insights are directly embedded into daily practice. The project outcomes will also be incorporated in educational activities for dietetics and sport and exercise students, thereby increasing knowledge of future practitioners.
