Physical Activity In Patients Research Articles

Pediatricians’ Interventions Aimed to Reduce Overweight and Obesity in Children and Adolescents in Primary Healthcare in Poland. A Cross-sectional Study

Abstract Background Overweight and obesity in children and adolescents are associated with serious health problems and a higher risk of obesity in adults. Objectives This study aimed to determine how often pediatricians identify the condition of overweight and obesity in children and adolescents based on anthropometric measurements. The researchers also wanted to obtain information on counseling provided by pediatricians regarding diet and physical activity in patients. Material and methods In 2022, an observational, cross-sectional study was conducted with the participation of 55 pediatricians working in primary health care sector in the city of Lodz. An anonymous questionnaire consisted of sections regarding the characteristics of the treated patient population, barriers and improvements in the process of patient assessment, control, and management, as well as the health status and health behaviors of pediatricians. Results About 90.9% of the pediatricians declared that they measured body weight on a scale. Similarly, 89.1% of them measured body height. Among the surveyed doctors, 67.3% calculated waist circumference or the ratio of waist-to-hip ratio. All the pediatricians provided advice on diet/eating habits and physical activity to both healthy and overweight/obese patients. In most cases, the study participants indicated that this counseling was provided „often” (83.6%). Only every tenth pediatrician provided detailed dietary advice and every sixth detailed advice on physical activity at each patient visit. A higher chance of providing dietary advice to children and adolescents was observed among pediatricians providing ≤ 100 patient visits during a routine work week (OR = 5.13; p < 0.05). Normal BMI (OR = 12.35; p < 0.05) and having ≤ 100 patient visits per week during a routine work week (OR = 8.28; p < 0.05) were significant correlates of physical activity advice. Conclusions Pediatricians should perform accurate anthropometric measurements to prevent obesity in children and adolescents. During each patient visit, the pediatrician should give advice on diet and physical activity.

Cross-Cultural Adaptation and Validation of the Russian-Language Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS)

Background. Developed in 1994 by H. Kitaoka et al. the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS-AHS) allows to assess pain, function, deformity and alignment of the foot and ankle. There is no Russian-language AOFAS-AHS questionnaire adapted according to current standards in the scientific literature.
 The aim of this paper is to perform the cross-cultural adaptation and to assess the validity of the Russian-language version of the AOFAS-AHS scale, including the evaluation of its psychometric properties.
 Methods. The original English version of the AOFAS-AHS scale was translated from English into Russian by a native Russian speaker. Then the questionnaire was back-translated into English by another translator whose native language is English. The next stage was the comparison of the original and back-translated versions, followed by the presentation of a pre-final cross-culturally adapted version, which was tested on 10 patients to ensure that the questions were comprehensible. The next step was the approval of the final version and its completion by patients to be operated on the hindfoot or ankle. The printed copy of the final version of the questionnaire was completed by the patients with an interval of 3 days. Total of 44 consecutive patients were enrolled, including 18 women (41%) and 26 men (59%), with a mean age of 61.7 (32-78) years. The psychometric properties of the Russian-language version of the AOFAS-AHS questionnaire (internal consistency, retest reliability, measurement error, responsiveness, and construct validity) were assessed based on the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) principles.
 Results. The mean score according to the AOFAS-AHS scale was 49.6 (min 2; max 82) out of a possible 100. The average time to complete the questionnaire was 4.2 minutes. All hypotheses formulated showed correlations of varying moderate to strong degrees. The Cronbach’s alpha coefficient was 0.76, which indicates a high level of internal consistency of the elements of the validated questionnaire. A good intra-class consistency of 0.83 was obtained, which shows a high degree of reliability of the questionnaire’s reproducibility. The ceiling and floor effects for the primary results of the questionnaires did not exceed 15%. The mean value of the Russian-language version of the AOFAS-AHS increased to 86.6 after surgical treatment. The values of standardized effect size (ES) and standardized response mean (SRM) were 5.56 and 4.83, respectively.
 Conclusion. The adapted Russian-language version of the AOFAS-AHS scale showed good psychometric properties and can be recommended for assessment of the physical activity in patients with ankle and hindfoot-related pathology and can also be used for monitoring the changes during the treatment.

Outcomes Vary by Pre-Operative Physical Activity Levels in Total Knee Arthroplasty Patients.

Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA.

Development of a behavior change intervention to improve physical activity in patients with COPD using the behavior change wheel: a non-randomized trial

The aim of this study was to evaluate whether a theory-based behavior change intervention could promote changes in physical activity (PA) and sedentary behavior (SB) among patients with chronic obstructive pulmonary disease (COPD), as well as its effects on symptoms of dyspnea, lung function, exercise capacity, self-efficacy, and health-related quality of life (HRQoL). A quasi-experimental design and convenience sampling were adopted. A total of 92 patients with stable COPD were recruited from outpatient and inpatient centers of two hospitals in Zhejiang Province, China. Both the experimental and control groups received standard medical care provided in the hospital. The experimental group performed a PA program based on the behavior change wheel theory. Outcomes were measured at baseline (T0) and after 4 weeks (T1), 8 weeks (T2), and 12 weeks of the intervention (T3). The primary outcome was PA measured by the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included SB measured by the IPAQ, dyspnea measured by the modified Medical Research Council (mMRC) questionnaire, exercise capacity assessed by 6-min walk distance (6MWD), self-efficacy measured by the Exercise Self-Regulatory Efficacy Scale (EX-SRES), and HRQoL measured by the COPD Assessment Test (CAT). In addition, we measured lung function using a spirometer at baseline and 12 weeks. Of the 89 patients included in this study, 64 were male (71.91%), with a mean age of 67.03 ± 6.15 years. At 12 weeks, the improvements in PA, SB, mMRC, 6MWD, EX-SRES and CAT were all statistically significant (P < 0.05) in the experimental group compared to the control group. Repeated measures analysis of variance showed that there were group effects and time effects on total PA, SB, mMRC, 6MWD, EX-SRES, and CAT in both groups (P < 0.001). However, there was no significant difference in pulmonary function between the two groups before and after intervention (P < 0.05). The PA program based on theory significantly increased PA levels, reduced sedentary time, enhanced exercise capacity and self-efficacy as well as HRQoL in patients with stable COPD. Due to the limited intervention time in this study, the pulmonary function of COPD patients may not be reversed in a short time, and the long-term effect of this program on the pulmonary function of patients needs to be further explored.Trial registration: Clinical Trials.gov (ChiCTR2200060590). Registered 05/06/2022.

Utility of the low physical activity questionnaire for hemodialysis patients with frailty: a cross-sectional study

BackgroundThe low physical activity questionnaire (LoPAQ), which has been developed to assess the low levels of physical activity in patients on dialysis, is so far available only in English. Moreover, no study has examined whether the LoPAQ can be used to screen for frailty in patients on hemodialysis. The purpose of this study was to translate the original LoPAQ into Japanese and evaluate its utility in screening for frailty among patients on hemodialysis.MethodsFor this cross-sectional study, we enrolled patients from two hemodialysis facilities in Japan between April 2018 and June 2019. We used the LoPAQ to calculate physical activity for one week, with pedometer steps (steps/week) as the standard reference. We used Spearman’s rank test and two multiple linear regression models to assess the relationship between the Japanese LoPAQ results and pedometer step counts. Finally, we examined whether the LoPAQ had the ability to screen for frailty (Fried scale ≥ 3) using area under the curves.ResultsIn total, 220 patients on hemodialysis completed the LoPAQ and wore a pedometer for one week. Their mean age was 67.8 ± 11.6 years, and 59.1% were men. The LoPAQ showed a total physical activity of 825.0 kilocalories/week and walking activity of 315.0 kilocalories/week. The LoPAQ total physical activity and walking activity were significantly correlated with pedometer step counts (r = 0.37–0.53, P < 0.01). Furthermore, LoPAQ total physical activity and walking activity were associated with pedometer step counts despite adjusting for covariates (β: 3.33–5.45, P < 0.001, β: 8.63–16.80, P < 0.001, respectively). In addition, the LoPAQ total physical activity and walking activity showed good values in the area under the curves to identify frailty (0.72 and 0.73, respectively).ConclusionsPhysical activity assessed using the LoPAQ significantly correlated with pedometer step counts in Japanese patients on hemodialysis. Furthermore, the LoPAQ total physical activity and walking activity had a moderate screening ability for frailty. The results indicate that the LoPAQ questionnaire is useful as a physical activity assessment tool and as a screening tool for frailty in patients on hemodialysis.

Association of physical activity with bleeding events and safety in patients with haemophilia A starting emicizumab prophylaxis: an interim analysis of the TSUBASA study

IntroductionLittle information exists on the relationship between bleeding outcomes and physical activity in patients with haemophilia A (PwHA).AimThis interim analysis of the TSUBASA study (UMIN-CTR ID: UMIN000037448) evaluated the association of physical activity with bleeding and safety in PwHA starting emicizumab.MethodsPwHA without factor VIII inhibitors were recruited. Physical activity and bleed data were obtained using an electronic patient-reported outcome application and wearable activity tracker. Adverse events (AEs) were documented.ResultsAt data cut-off (31-May-2021), 107 PwHA were enrolled, with a median (range) age of 35 (0–73) years. Physical activity data were obtained for 74 participants. Of these, 47 (63.5%) recorded a total of 396 exercise events. The most common exercise events were walking (32.4%), cycling (14.9%), and football (5.4%). Two (0.5%) exercise events in the same individual were associated with bleeding (running, weight training).The safety analysis population consisted of 106 participants treated with emicizumab (median observation period: 241.5 days). Twenty-one (19.8%) participants experienced a total of 39 AEs. Five (4.7%) experienced a serious AE, none of which was emicizumab-related, and three (2.8%) experienced an adverse drug reaction.ConclusionsPwHA receiving emicizumab in the TSUBASA study experienced minimal bleeding associated with physical activity.Trial registrationTrial registration: UMIN-CTR ID: UMIN000037448.

Phase angle as an indicator of physical activity in patients with stable chronic obstructive pulmonary disease

ObjectivesPhase angle (PhA) reflects cell membrane integrity and vitality and is an indicator of sarcopenia. PhA is associated with physical function in patients with stable chronic obstructive pulmonary disease (COPD). To our knowledge, the association between PhA and physical activity (PA) has not been investigated. Therefore, the aim of this study was to investigate whether PhA reflects PA in patients with COPD. MethodsThis single-center, cross-sectional, observational study included 103 patients with stable COPD (87 men; mean age, 74.7 ± 8.1 y; mean forced expiratory volume in 1s %predicted value, 58.9 ± 20.4%). PhA was measured by bioelectrical impedance analysis. Patients were stratified into low (n = 54) and high (n = 49) PhA groups based on median values (4.3° ± 0.6° and 5.4° ± 0.5°, respectively). PA was calculated as the average daily duration of high-intensity light PA (HLPA; 2.0–2.9 metabolic equivalents [METs] of PA) and moderate- to vigorous-intensity PA (MVPA; >3 METs). Correlation and multivariate analyses using multiple regression analysis were performed to confirm the association between PhA and PA. ResultsThe high-PhA group demonstrated greater HLPA (104.4 [16.5–332.5] versus 131.3 [61.1–328.7] min, P = 0.005) and MVPA (19.5 [4.7–96.0] versus 46.6 [8.9–139.3] min, P < 0.001) than the low-PhA group. PhA was positively correlated with HLPA (r = 0.32, P < 0.001) and MVPA (r = 0.49, P < 0.001). MVPA (β = 0.178, P = 0.029) and HLPA (β = 0.158, P = 0.026) were associated with PhA independent of age, sex, body mass index, respiratory function, muscle strength, skeletal muscle mass index, and 6-min walking distance. ConclusionIn patients with COPD, PhA may reflect PA as well as muscle function.

Analysis of the status and factors influencing physical activity in patients undergoing ovarian cancer chemotherapy.

Ovarian cancer is a common gynecological malignancy, leading to approximately 200,000 deaths globally in 2020. Research has shown that regular physical activity can reduce the toxic side effects of cancer treatment, reduce morbidity and mortality, extend survival time, and improve quality of life. We aimed to evaluate physical activity regimens in patients undergoing chemotherapy for ovarian cancer and analyze the factors influencing physical activity levels. To facilitate the selection of patients with ovarian cancer hospitalized for chemotherapy in the Third Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Zhengzhou University from August 2022 to February 2023, questionnaire surveys were conducted using the General Information Questionnaire, International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale, and Revised Piper Fatigue Scale. Data were collected from 167 patients with ovarian cancer. Overall, 96 (57.5%) patients had low physical activity levels, 53 (31.7%) had moderate physical activity levels, and 18 (10.8%) had high physical activity levels. Logistic regression analysis revealed that sleep status, social support, anxiety, depression, and cancer-related fatigue were the main factors influencing physical activity in patients undergoing chemotherapy for ovarian cancer. Physical activity levels of patients undergoing ovarian cancer chemotherapy were generally low. Therefore, healthcare professionals should pay greater attention to the physical activity in these patients. Targeted and individualized health guidance is recommended, and activity interventions should be implemented according to the influencing factors to promote disease understanding and increase physical activity levels.

Assessment of quality of life and physical activity in patients with oligoarticular juvenile idiopathic arthritis in remission.

The purpose of this study was to evaluate physical activity (PA) and health-related quality of life (HRQOL) in children with oligoarticular juvenile idiopathic arthritis (JIA) in remission in comparison with healthy peers and to determine the disease-related factors affecting PA levels. This study was conducted with 50 oligoarticular JIA patients in remission and 50 healthy peers between 9 and 14years. Demographic and clinical characteristics, laboratory parameters, and treatments were noted from electronic medical records. HRQOL was assessed with the Pediatric Quality of Life Inventory (PedsQL). PA was evaluated with the Physical Activity Questionnaire for Children (PAQ-C). Oligoarticular JIA patients had significantly lower self-reported median PedsQL scores in the domains of school functioning and social functioning compared to the control group (67.5 (10) vs. 75 (25), p = 0.001 and 70 (15) vs. 85 (26.3), p < 0.001, respectively). The median PAQ-C score was 2.6 (1.1) in patients with JIA and 3 (0.9) in their healthy peers (p = 0.02). The PAQ-C score was 2.8 (1.2) in patients < 8years at the disease onset and 2.3 (1) in those aged ≥ 8years (p = 0.022). There was no significant difference in the number of affected joints, type of affected joint, MTX and biologic agent treatment, and remission with or without drugs with the total score of the PedsQL and PAQ-C. All PedsQL domains were positively correlated with the PAQ-C. Conclusion: Oligoarticular JIA patients demonstrated lower PA and HRQOL scores compared to healthy controls despite favorable disease control. What is Known: • Oligoarticular JIA has fewer functional limitations and disabilities compared to other JIA subtypes. • As JIA can affect all aspects of a child's life, there is a need to improve the quality of life related to the disease. What is New: • It should be considered that patients with oligoarticular JIA may show lower PA and HRQOL scores compared to healthy controls despite favorable disease control. • Since there may be a relationship between PA and HRQOL, factors that may affect PA should be investigated to provide a holistic approach to JIA treatment.

Effect of Adapted Physical Activity in Patients With Advanced Pancreatic Cancer: The APACaP GERCOR Randomized Trial.

The impact of adapted physical activity (APA) on health-related quality of life (HRQoL) in patients with advanced pancreatic ductal adenocarcinoma (aPDAC) is unknown. This study evaluated whether APA in addition to standard care improved HRQoL in patients who have aPDAC who are receiving first-line chemotherapy. Patients with locally advanced/metastatic PDAC and an ECOG performance status of 0 to 2 were randomized (1:1) to receive standard care (standard arm) or standard care plus a home-based 16-week APA program (APA arm). The primary objective was the effect of the APA program on 3 dimensions of the EORTC QLQ-C30: global health status, physical function, and fatigue at week 16 (W16), with a one-sided type I error of 0.017 for each dimension. The primary HRQoL analysis was performed in patients with available baseline and W16 scores for the dimensions (ie, the modified intention-to-treat population 1 [mITT1]), and secondary longitudinal HRQoL analyses using the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods were performed in the mITT1 population and in patients with baseline and at least one follow-up questionnaire (mITT2 population). A difference of ≥5 points was considered to be clinically relevant. Of 326 included patients, 313 were randomized to the standard (n=157) or APA (n=156) arms. In the mITT1 population (n=172), the mean differences in global health status, physical function, and fatigue at W16 adjusted from baseline were -0.98 (SD, 23.9; P=.39), -2.08 (SD, 21.3; P=.26), and 4.16 (SD, 29.2; P=.17), respectively, showing a non-statistically significant benefit with APA. In the mITT2 population (n=259), APA was associated with statistically significant and clinically relevant improvement in 5 and 8 dimensions of the HRQoL in the longitudinal MMRM and TUDD analyses, respectively. APA improved several dimensions of HRQoL in patients with aPDAC receiving first-line chemotherapy and standard care.

Fabrication of ethosuximide loaded alginate/polyethylene oxide scaffolds for epilepsy research using 3D-printing method.

Epilepsy is a medical condition that causes seizures and impairs the mental and physical activities of patients. Unfortunately, over one-third of patients do not receive adequate relief from oral Antiepileptic Drugs (AEDs) and continue to experience seizures. In addition to that, long term usage of Antiepileptic Drugs can cause a range of side effects. To overcome this problem, the precision of 3D printing technology is combined with the controlled release capabilities of biodegradable polymers, allowing for tailored and localized AED delivery to specific seizure sites. As a result of this novel technique, therapeutic outcomes can be enhanced, side effects of AEDs are minimized, and patient-specific dosage forms can be created. This study focused on the use of ethosuximide, an antiepileptic drug, at different concentrations (10, 13, and 15mg) loaded into 3D-printed sodium alginate and polyethylene oxide scaffolds. The scaffolds contained varying concentrations (0.25%, 0.50%, and 0.75% w/v) and had varying pores created by 3D patterning sizes from 159.86 ± 19.9µm to 240.29 ± 10.7µm to optimize the releasing system for an intracranial administration. The addition of PEO changed the Tg and Tm temperatures from 65°C to 69°C and from 262°C to 267°C, respectively. Cytotoxicity assays using the human neuroblastoma cell line (SH-SY5Y) showed that cell metabolic activity reached 130% after 168h, allowing the cells to develop into mature neural cells. In vitro testing demonstrated sustained ethosuximide release lasting 2hours despite crosslinking with 3% CaCl2. The workpaves the way for the use of ethosuximide -loaded scaffolds for treating epilepsy.

Long-term effect of non-severe COVID-19 on pulmonary function, exercise capacities and physical activities: a cross-section study in Sakaka Aljouf.

COVID-19 has serious consequences on different body systems particularly the respiratory system with its impact on pulmonary function, exercise capacities, and physical activities. This study aimed to investigate the long-term effect of COVID-19 on pulmonary function, exercise capacities, and physical activities in patients with non-severe COVID-19. 160 individuals were selected to participate in a cross-section study. Group-I: 80 male and female patients with non-severe COVID-19 at least 3 months after the recovery time. Group-II: 80 male and female matched (non-infected with COVID-19) participants. The spirometer, six-minute walk test (6MWT), and International Physical Activity Questionnaire (IPAQ) were used to assess pulmonary function, exercise capacities, and physical activities respectively. The Kolmogorov-Smirnov test was used to test normality of data. The Mann-Whitney and independent t-tests were used to compare the significant differences between both groups. The results show significant differences in FVC & FEV 1 of the pulmonary function, exercise capacities, and physical activities of the work & transportations between both COVID-19 and matched groups p-value = (0.001 & 0.001, 0.001 and 0.005 & 0.012) respectively. Pulmonary function, exercise capacities, and physical activities are negatively influenced by COVID-19 as long-term consequences indicating the need for extended health care, and prescription of proper rehabilitative training programs for non- severe COVID-19 patients whatever their severity degree of infection or history of hospitalization. Outcome reflections of the current results raise awareness of physical therapists to the importance of the proper rehabilitative training programs for non-severe COVID-19 patients.

Physical Activity and Exercise in Patients with Epilepsy: a Single-Centre Uncontrolled Retrospective Cohort Study

INTRODUCTION. For a long time, persons with epilepsy have been told to stay away from physical activity and sports to prevent seizure triggers. However, in recent years, evidence has accumulated to the contrary, suggesting that sports may help with preventing seizures.&#x0D; AIM. To examine the level of physical activity and sports among patients of the Russian Epileptology Center.&#x0D; MATERIALS AND METHODS. We conducted a study on physical activity in patients with childhood epilSepsy and in patients currently suffering from epilepsy in 2018–2019 at Polenov Neurosurgical Institute. They answered 3 blocks of questions: first block — physical activity and sporting activity during the school years, second block — current assessment of motor activity, third block — effect of physical activity on the course of the disease (triggering/reduction of seizure frequency.&#x0D; RESULTS. Fifty patients with a verified diagnosis of epilepsy were enrolled in the study. According to study findings, 30 % of patients with childhood-onset epilepsy were not allowed to participate in physical activity when they were in school, and the majority of them were forced to give up their sports after developing epilepsy. It was also found that when the seizures were controlled, the children tried to match their peers in terms of physical activity and participated in classes despite being exempted from physical education and some continued to play sports. The results showed that in 70 % of the cases physical activity did not have negative effect on the course of the disease and in 26 % of the cases the patients reported a positive effect of regular physical activity on the course of the disease.&#x0D; CONCLUSION. Therefore, patients continued to exercise despite severe limitations in the compensated course of the disease, as physical activity with the right type and level of sport has a positive effect on the somatic and psychological state of patients with epilepsy and physical activity is chosen.

Remote Monitoring of Patients after Allogeneic Stem Cell Transplantation: A Mobile Phone Application to Report Symptoms, Vital Signs and Activity in Real Time

Introduction: One of the major obstacles for early inpatient discharge after allogeneic stem cell transplantation (aSCT) is, aside from frailty and bloodwork required, the high risk for infections and the need for monitoring of graft versus host disease (GvHD). This requires frequent hospital visits which are often a challenge especially when travelling to hospitals imposes significant costs for the patient. Furthermore, structured data acquisition in the home care setting is missing. Methods: We have developed a fully patient centered, easy to operate mobile phone application for aHSCT patients that allows for treatment specific symptom reporting. In combination with a wearable device (smart watch), a blood pressure monitor and a thermometer, this application incorporates online monitoring of all major vital signs in almost real time. The application currently captures more than 50 static and dynamic metrics relevant for aSCT and provides a photo function to capture skin images in a patient specific image library. Daily symptom reporting can be performed as often as necessary and data from wearable devices are obtained in very high frequency. Symptom reporting includes information on general wellbeing, nausea, oral mucositis, bowel movement frequency and consistency, information on oral calorie and fluid uptake, and it captures and calculates body surface areas affected by rash. All data are streamed in almost real time and displayed on a browser-based dashboard to the healthcare team. The user interface for the physician dashboard was developed using the React JavaScript library whereas the mobile application utilized React Native to enable Android and iOS applications. The collection, storage, and presentation of patient data via the physician dashboard is facilitated using various AWS technologies such as Lambda, S3 and Timestream. Data can be stored according to federal laws and regulations the software is operating in. Access to the dashboard is center-specific and secured by a dual verification process. Summary: Daily symptom reporting by the patient is easy, comprehensive and can be completed within minutes. Data from wearable devices are obtained 24/7 at high frequency. All data are displayed on a dashboard to the corresponding physician with only a few minutes delay. The system captures vital signs (blood pressure, temperature, pulse, breathing rate, oxygen saturation, etc.) and GvHD related symptoms such as skin rash including body surface area affected, and frequency/volume of bowel movements. It provides information based on the patient's physical activity, food intake, fluid intake, sleeping patterns in a structured fashion. The physician's dashboard displays all transplant relevant static information like HLA match, conditioning regimen, type of immunosuppression, ABO incompatibility, serologies of patient and donor. It displays all data reported longitudinally and allows physicians to observe trends and developments providing interactive graphs on each metrics. It provides a medication plan that captures daily dosage, duration of treatment and calculates cumulative doses. Changes in medication and dosing will alert the patient on the mobile phone application. All data can be obtained in a structured fashion for research purposes by the participating institution. Conclusion: This mobile phone application in combination with a wearable device allows for remote monitoring of patients after aHSCT. Its function is comprehensive and not only provides structured data, but allows for monitoring success of medical treatment. It is developed in a modular fashion that can be easily adapted to specific requirements in other cell therapies such CAR CD19, AML induction therapies or autologous SCT.

Development of mobile health-based interventions to promote physical activity in patients with head and neck cancer: a qualitative study.

Despite the well-grounded benefits of physical activity (PA), poor compliance with the PA guidelines has been reported among head and neck cancer (HNC) patients. Mobile health (mHealth)-based interventions can help cancer survivors increase their PA levels and increase the reach or efficiency of rehabilitation services. However, there is limited knowledge about the needs and perceptions of HNC patients regarding these interventions. This study explored the perceptions and needs of HNC patients regarding mHealth-based PA programs before developing such interventions to ensure their improved effectiveness. A constructivist qualitative study. We purposively selected 17 adult HNC patients aged 40-80 years to determine their needs and perceptions of future mHealth-based PA programs. Semi-structured face-to-face interviews were conducted, and the data were analyzed via thematic analysis. The report followed the Consolidated Criteria for Qualitative Research Reports guidelines. Four themes were analyzed from the interview transcripts regarding the needs and perceptions of mHealth-based PA programs: (1) functionality needs; (2) system usage requirements; (3) social support; and (4) perceived barriers and facilitators. HNC patients expect highly customized and specialized mHealth interventions that consider individual factors, address their concerns about security, network, and cost, and prefer improved comfort. Moreover, they expect to receive support from their healthcare providers, families, and peers. The study provides pragmatic ready-to-use recommendations to design interventions for inactive HNC patients to achieve the recommended PA levels. Future mHealth interventions should be tailored according to the needs of the HNC patients by utilizing perceived facilitators and removing perceived barriers to help them engage in PA actively.

Physical activity for patients with chronic low back pain: What are physical therapists prescribing?

Despite the extensive evidence supporting physical activity (PA) for managing chronic low back pain (CLBP), little is known about PA prescription by physical therapists treating patients with CLBP. 1) Explore how PA prescriptions provided by outpatient physical therapists treating patients with CLBP align with PA guidelines. 2) Examine the barriers and facilitators of PA prescription among physical therapists working with patients with CLBP. We conducted a qualitative study with outpatient physical therapists who treat CLBP. Semi-structured interviews provided an understanding of physical therapist experience with PA prescription among patients with CLBP. The interviews were transcribed, coded, and analyzed thematically. The 18 participants had an average of 13.4 (6.4) years of clinical experience in outpatient physical therapy. Thematic analysis revealed: 1) Physical therapists' articulate knowledge of PA guidelines and importance of physical activity; 2) Patient factors take priority over the PA guidelines for people with CLBP; and 3) The importance of building and maintaining a strong patient-therapist relationship influences physical therapist prescription of PA for patients with CLBP. When providing PA recommendations for patients with CLBP, general movement recommendations are emphasized in place of explicit PA prescriptions. Our findings highlight factors for consideration when prescribing movement and PA for patients with CLBP.

Cross‑cultural adaptation and validation of the Persian version of the new Knee Society Knee Scoring System (KSS)

BackgroundThe new Knee Society Knee Scoring System (KSS) has been widely used to assess the symptoms, satisfaction, expectations, and physical activities of patients who undergo total knee arthroplasty (TKA). KSS has been translated and validated into many languages but not Persian. The aim of this study was to translate and evaluate the validity and reliability of the Persian version of the new KSS.MethodsThe Persian version of the new KSS was translated and culturally adapted according to international guidelines, including translation, back-translation, pre-testing, and expert committee review. A total of 142 patients scheduled to undergo TKA were included in this study and were asked to complete the Persian-KSS, Oxford Knee Score (OKS), and the Visual Analogue Scale (VAS) index both two weeks before the surgery and 6 months after the surgery. Face, content, and construct validity were evaluated to assess the validity of Persian-KSS.ResultsThe Persian-KSS was comprehensive, indicating that the Persian version of KSS was clear and easy to understand for Persian-speaking patients undergoing TKA. The reliability of the Persian-KSS, assessed by Cronbach’s alpha, was 0.894 and 0.800 for the pre- and post-operative stages, respectively. The intraclass correlation coefficient (ICC) assessed the test–retest reliability, which was 0.766 and 0.796 for the pre- and post-operative stages, respectively. The construct validity analysis of Persian-KSS demonstrated a statistically significant correlation between Persian-KSS and the OKS (r = − 0.935, p-value = 0.000 for the pre-operative stage, and r = − 0.809, p-value = 0.000 for the post-operative stage) and VAS index (r = − 0.401, p-value = 0.001 for the pre-operative stage and r = − 0.259, p-value = 0.029 for the post-operative stage).ConclusionThe Persian-KSS, developed after the translation and cross-cultural adaptation process, was proven to be a reliable and valid assessment measure for those who undergo TKA.

Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders.

Degenerative thoracolumbar disorders (DTDs) typically cause pain and functional impairment. However, little is known regarding the DTD impact on patient's real-life physical activity. The objective of this study is to validate a wearable measure of physical activity monitoring in patients with DTD and to create gender- and sex-specific performance thresholds that are standardized to the mean of a control population. A commercially available smartwatch (Apple Watch) was used to monitor preoperative physical activity in patients undergoing surgery for DTD. Mean preoperative physical activity 2 weeks before the scheduled surgery was expressed as raw step count. Standardized z-scores were referenced to age- and sex-specific values of a control population from a large public database. Step counts were assessed for convergent validity with established patient-reported outcome measures, and impairment in activity was stratified into performance groups based on z-score cutoff values. Sixty-five patients (62% female) with a mean (±SD) age of 63.8 (±12.8) years had a mean preoperative daily step count of 5556 (±3978). Physical activity showed significant correlation with patient-reported outcome measures, including Oswestry disability index (r = -0.26, 95% CI: -0.47-0.01), 36-Item Short Form Survey Physical Component Summary score (r = 0.30, 95% CI: 0.06-0.51), and Patient-Reported Outcomes Measurement Information System Physical Function (r = 0.49, 95% CI: 0.27-0.65). "No," "Mild," "moderate," and "severe impairment" in activity performance were defined as corresponding z-scores of >0, 0 to -0.99, -1 to -1.99, and ≤-2, accounting for 22%, 34%, 40%, and 5% of the study population. Each one-step category increase in activity impairment resulted in increased subjective disability as measured by the Oswestry Disability Index, 36-Item Short Form Survey Physical Component Summary, and Patient-Reported Outcomes Measurement Information System Physical Function (all P -values <.05). We establish the first wearable objective measure of real-life physical activity for patients with DTD, with the first age- and sex-adjusted standard scores to enable clinicians and researchers to set treatment goals and directly compare activity levels between individual patients with DTD and normal controls.

Association of physical activity with the risk of major adverse cardiac and cerebrovascular events and mortality in patients with concomitant atrial fibrillation and coronary artery disease

Abstract Background Although regular physical activity benefits cardiovascular health, there is a concern that intense exercise is linked to the promotion of atrial fibrillation (AF) and coronary plaque rupture. However, the impact of physical activity on the outcomes of patients with concomitant AF and coronary artery disease (CAD) remains unclear. Purpose This study aimed to evaluate the association with clinical outcomes according to the level of physical activity in patients with concomitant AF and CAD. Methods We assessed 551 patients with AF and CAD (mean age, 67.1±9.8 years) who completed a self-reported questionnaire for physical activity from 2015 to 2020 in a single tertiary-care hospital. Physical activity levels were converted into metabolic equivalent of task (MET) per week and categorized to correspond with multiple public health recommendations. We examined the association between physical activity, all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE). Results The risks of all-cause mortality (P for linear trend=0.017) and MACCE (P for linear trend=0.05) were appeared inverse trend with a greater level of physical activity. Compared with inactive patients, patients who met the recommended target range of physical activity (500–1,000 MET-min/week: unadjusted hazard ratio [HR]=0.58, 95% confidence interval [CI]=0.36–0.99) and highly active patients who exceeded the minimum recommended level (≥1,000 MET-min/week: unadjusted HR=0.47, 95% CI=0.25–0.88) had a lower risk of all-cause mortality in the unadjusted model; however, these associations did not remain significant after adjusting for the model. There was no evidence of increased risk of all-cause mortality and MACCE at levels of physical activity above the recommended target range, even with vigorous intensity physical activity exceeding the recommended target range. Conclusions There appears to be an inverse trend between physical activity levels and all-cause mortality and MACCE in patients with concomitant AF and CAD. No excess risk of mortality or MACCE was found at exercise levels above the recommended target range. Further large-scale studies are warranted to create an improved evidence base concerning the effects of physical activity in patients with AF and CAD.

Effect of exercise training on cardiorespiratory fitness, quality of life and objectively measured physical activity in patients undergoing anthracycline-based chemotherapy: the Caprice RCT

Abstract Introduction Exercise training based cardio-oncologic rehabilitation programmes (ET) were shown to counteract the loss in cardiorespiratory fitness and quality of life (QoL) and reduce cancer fatigue during anthracycline-based chemotherapies (AC). It is unknown whether these changes are due to greater volumes of physical activity (PA) induced by ET and whether ET is associated with greater objectively measured daily PA compared to guideline-based recommendation of PA. Method Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres in Switzerland and randomly assigned to three months centre-based ET during (EXduringAC) or after (EXpostAC) AC. All patients were counselled on guideline directed PA and PA was measured with an activity tracker. Primary endpoints were peak VO2, fatigue and QoL after AC (AC-end) and at 3 months follow-up. PA and steps were compared between days with and without centre-based training session. Results Data of 51 patients were available. Neither Intention-to-Treat (ITT) nor Per-Protocol (PP) analyses revealed between group differences with regard to peak VO2, fatigue, and QoL at neither AC-end nor follow-up (Figure 1). There was also no between group difference with regard to PA and steps, however, compared to EXpostAC, in EXduringAC the steep decline in PA and steps in AC cycles 3 and 4 was prevented (PP analysis, Figure 2). PA on days with centre-based training sessions was 28 (95% confidence interval 24-32) min higher and patients performed 4382 (3995-4768) steps more compared to days without centre-based training sessions. Conclusion ET performed during or after AC had no additional effect on changes in peak VO2, fatigue, or QoL assessed at AC-end or follow-up compared to using an activity tracker alone, possibly due to the lack of additional PA completed by patients during ET. This is the first study that objectively measured the effect of ET on PA and daily step count during and following AC. While days with centre-based ET had significantly more PA and steps, this surplus was likely to be compensated on days without centre-based ET.Figure 1Figure 2