Walking on prescription: The utility of a pedometer pack for increasing physical activity in primary care

Objective

This study used a multi-method approach to examine the effectiveness of a pedometer-based intervention delivered by health professionals for increasing walking.

Methods

Pedometer packs were distributed to 374 patients who undertook a 12-week walking programme. Changes in walking were assessed at three months (using self-reported step-counts [n = 139] and questionnaire data [n = 104]) and at six months (using patient questionnaire data [n = 112]). Qualitative data were collected at both time points to identify underlying mechanisms.

Results

After 12 weeks patients had increased their step-counts by 4532 steps/day (p < .001) and at six months were achieving 2977 more steps/day (equivalent to around 30 min/day) than at baseline. Over half the patients reported achieving this target on at least 5 days/week. Qualitative data indicated that the pedometer pack was perceived to be most effective when patients were ready to change and when ongoing support was made available.

Conclusion

These findings support the use of pedometer-based interventions in primary care and suggest that the pedometer pack could lead to sustainable changes in walking. Further investigation, using a randomised controlled trial design, is warranted.

Practice implications

Provision of social support and accurate identification of patient readiness to change are important considerations in future implementation of the intervention.     

Socio-demographic and perceived environmental correlates of walking in Portuguese adults—A multilevel analysis

Several studies have identified associations between walking levels and socio-demographic and environmental variables. The aim of the present study was to describe walking patterns and examine associations between socio-demographic characteristics and perceived environmental attributes with walking among adults living in the Azorean Archipelago (Portugal). In all, 7330 adult participants (4104 women), aged 38.1±9.3 years, of the 2004 Azorean Physical Activity and Health Study answered the Environmental Module and the short version of the International Physical Activity Questionnaire. Among the Azoreans, the environmental dimension “infrastructures, access to destinations, social environment and aesthetics” and moderate to vigorous physical activity were positively associated with walking levels; and smoking, sitting time and being married were negatively related, regardless of gender, age or education level. Through the cross-sectional nature of this study, our results suggest that targeted programs for Azoreans aimed to increase walking levels should consider that infrastructures, access to destinations, social environment and aesthetics seem to act synergistically and associate positively with walking behaviour.     

Self-reported difficulty in climbing up or down stairs in nondisabled elderly

Verghese J, Wang C, Xue X, Holtzer R. Self-reported difficulty in climbing up or down stairs in nondisabled elderly.

Objective

To examine clinical and functional correlates of self-reported difficulty in climbing up or climbing down stairs in older adults.

Design

Cross-sectional survey.

Setting

Community sample.

Participants

Older adults (N=310; mean age, 79.7y; 62% women), without disability or dementia.

Interventions

Not applicable.

Main Outcome Measures

Clinical and functional status as well as activity limitations (able to perform activities of daily living [ADLs] with some difficulty).

Results

Of the 310 subjects, 140 reported difficulties in climbing up and 83 in climbing down stairs (59 both). Self-reported difficulty in climbing up stairs was associated with hypertension, arthritis, and depressive symptoms. Difficulty in climbing up stairs was also associated with poor balance and grip strength as well as neurologic gait abnormalities. Subjects with difficulty climbing down stairs had more falls. Both activities were associated with leg claudication, fear of falling, non-neurologic gait abnormalities, and slow gait. Examined individually, self-reported difficulty climbing down stairs captured a wider spectrum of ADL limitations than climbing up stairs. However, combined difficulty in both phases of stair climbing had a stronger association with activity limitations (vs no difficulty; odds ratio, 6.58; 95% confidence interval, 3.35−12.91) than difficulty in any one phase alone.

Conclusions

Self-reported difficulty in climbing up and down stairs revealed commonalities as well as differences in related clinical correlates. Difficulty in both climbing up and down stairs should be separately assessed to better capture clinical and functional status in older adults.     

The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease

Fisher BE, Wu AD, Salem GJ, Song J, Lin C-H, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.

Objectives

To obtain preliminary data on the effects of high-intensity exercise on functional performance in people with Parkinson's disease (PD) relative to exercise at low and no intensity and to determine whether improved performance is accompanied by alterations in corticomotor excitability as measured through transcranial magnetic stimulation (TMS).

Design

Cohort (prospective), randomized controlled trial.

Setting

University-based clinical and research facilities.

Participants

Thirty people with PD, within 3 years of diagnosis with Hoehn and Yahr stage 1 or 2.

Interventions

Subjects were randomized to high-intensity exercise using body weight-supported treadmill training, low-intensity exercise, or a zero-intensity education group. Subjects in the 2 exercise groups completed 24 exercise sessions over 8 weeks. Subjects in the zero-intensity group completed 6 education classes over 8 weeks.

Main Outcome Measures

Unified Parkinson's Disease Rating Scales (UPDRS), biomechanic analysis of self-selected and fast walking and sit-to-stand tasks; corticomotor excitability was assessed with cortical silent period (CSP) durations in response to single-pulse TMS.

Results

A small improvement in total and motor UPDRS was observed in all groups. High-intensity group subjects showed postexercise increases in gait speed, step and stride length, and hip and ankle joint excursion during self-selected and fast gait and improved weight distribution during sit-to-stand tasks. Improvements in gait and sit-to-stand measures were not consistently observed in low- and zero-intensity groups. The high-intensity group showed lengthening in CSP.

Conclusions

The findings suggest the dose-dependent benefits of exercise and that high-intensity exercise can normalize corticomotor excitability in early PD.     

Physical activity in patients with deep venous thrombosis: a systematic review

Objectives

We performed a systematic review to assess the benefits or risks of physical activity in patients with an acute or previous DVT of the leg.

Data sources

PubMed, EMBASE and Science Citation Index were searched without language restrictions up to July 2007. Bibliographies of retrieved articles and personal files were also searched.

Review methods

Randomized trials and prospective cohort studies that included patients with acute or previous DVT, described an exercise intervention or exercise exposure, and described any related clinical outcome were selected. Data were independently extracted by 2 investigators.

Results

Seven randomized trials and two prospective observational studies were included. Early exercise, compared with bed rest, was associated with a similar short-term risk of pulmonary embolism in patients with acute DVT and led to more rapid resolution of limb pain. In patients with acute DVT, a 6 month daily walking program led to similar degrees of vein recanalization and improvement in quality of life as controls. In patients with previous DVT, 30 min of vigorous treadmill exercise did not worsen venous symptoms and improved calf muscle flexibility; a 6 month exercise training program improved calf muscle strength and pump function; and high levels of physical activity at one month tended to be associated with reduced severity of postthrombotic symptoms during the subsequent 3 months.

Conclusions

Early walking exercise is safe in patients with acute DVT and may help to reduce acute symptoms. Exercise training does not increase leg symptoms acutely in patients with a previous DVT and may help to prevent or improve the postthrombotic syndrome.     

A pilot study of factors associated with falls in individuals with incomplete spinal cord injury

BACKGROUND/OBJECTIVE: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI). STUDY DESIGN: Cross-sectional mail survey. METHODS: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year. RESULTS: After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0-1.7), having arthritis (OR = 3.4, 95% CI = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% CI = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% CI = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9). CONCLUSIONS: Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.     

Fallbeispiel zum Aku-Taping: Pseudoradikuläre Lumboischialgie

A female patient with a six-year-old pseudoradicular lumboischialgia on the left side was diagnosed using methods of TCM and osteopathy. An osteopathic therapy was applied in combination with a mix of classic taping and acu-taping, as well as the encouragement to a more active lifestyle via Nordic Walking. Six weeks later the patient felt much better.