Isotemporal Substitution of Sedentary Behavior by Different Physical Activity Intensities on Pain and Disability of Patients With Chronic Low Back Pain: A Cross-Sectional Study

ObjectiveTo investigate the association of isotemporal substitution modeling (ISM) of time spent in sedentary activities with physical activity in different intensities on pain and disability of patients with chronic low back pain (LBP).DesignObservational and cross-sectional study. Device-measured physical activity levels were assessed using an actigraph. Pain intensity was measured using the 11-point numeric rating scale, and disability was measured using the Roland Morris Disability Questionnaire. The ISM was used to estimate the theoretical substitution association of reallocating time from 1 exposure variable to an equal amount of time in another exposure variable while holding total activity time constant.SettingsOutpatient physical therapy clinic.ParticipantsThis study included data from 358 patients (N=358) with chronic LBP aged between 18 and 60 years.Main Outcome MeasuresPain and disability.ResultsOur results suggest that replacing 60 minutes of sedentary behavior with 60 minutes of vigorous activity in a week is significantly associated with a decrease in pain (β=?1.67; 95% confidence interval [CI], ?3.18 to ?0.15). Additionally, replacing 60 minutes of light physical activity (β=?1.67; 95% CI, ?3.18 to ?0.16) or moderate activity (β=?1.67; 95% CI, ?3.21 to ?0.13) with the same amount of time of vigorous activity per week may also favorable reductions in pain. For the analysis of disability, no significant associations (P>.05) for disability in any of the isotemporal models were found.ConclusionsOur results showed that replacing 60 minutes of sedentary behavior with equal amounts of vigorous activity per week was associated with reductions in pain intensity. Similarly, replacing a light or moderate activities with vigorous activity was also associated with reductions in pain intensity. Finally, no significant associations were observed between time spent in sedentary activities with physical activity in different intensities for disability.     

Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study

A survey of adolescent schoolchildren and their parents through a self-administered questionnaire was conducted to determine the prevalence of low back pain (LBP) in schoolchildren and their parents and to assess its association with exposure to known and presumed risk factors. A previously validated, self-administered questionnaire was used for collecting information on back pain history, anthropometric measures, physical and sports activity, academic problems, hours of leisure sitting, smoking, and alcohol intake. Schoolchildren between the ages of 13 and 15 in schools of the island of Mallorca and their parents (n=16,394) took part in the study. The lifetime prevalence of LBP was 50.9% for boys and 69.3% for girls; point prevalence (7 days) was 17.1% for boys and 33% for girls. There was a significant association with LBP and pain in bed (OR=13.82, 95% CI: 10.47-18.25, P<0.001), reporting scoliosis (OR=2.87, 95% CI: 2.45-3.37, P<0.001), reporting difference in leg length (OR=1.26, 95% CI: 1.02-1.56, P=0.033), practice of any sport more than twice a week (OR=1.23, 95% CI: 1.09-1.39, P=0.001) and being female (OR=1.11, 95% CI: 1.04-1.19, P=0.001). There was no association found between LBP and body mass index, the manner in which books were transported, hours of leisure sitting, alcohol intake or cigarette smoking. Among parents, the lifetime prevalence of LBP was 78.2% for mothers and 62.6% for fathers; point prevalence (7 days) was 41% for mothers and 24.3% for fathers, and there were significant associations with LBP and pain in bed (OR=18.07, 95% CI: 14.72-22.19, P<0.001), report of scoliosis (OR=8.77, 95% CI: 6.44-11.95, P<0.001), report of difference in leg length (OR=2.21, 95% CI: 1.60-3.04, P<0.001), being a university graduate (OR=1.89, 95% CI: 1.21-2.98, P=0.006), being female (OR=1.49, 95% CI: 1.33-1.67, P<0.001), and swimming (OR=1.10, 95% CI: 1.4-1.18, P=0.002). There was no association found between LBP and alcohol intake, cigarette smoking or the practice of other sports. Although there was a positive association in terms of scoliosis between biological parents and their children (P<0.001), there was no association found in familial (biological or not) occurrence of LBP. The prevalence of LBP among adolescents in southern Europe is similar to northern Europe, it is comparable to that in adults, and is associated with several factors. There is a strong association between pain in bed or upon rising in both adolescents and adults. Scoliosis, but not LBP, appears to be related to heredity. Further longitudinal studies are necessary to establish risk factors that are predictive for LBP in adolescents.     

Global physical activity levels among people living with HIV: a systematic review and meta-analysis

Purpose: It is unclear how much physical activity people living with HIV (PLWH) engage in. We conducted a meta-analysis to investigate physical activity levels and its predictors in PLWH.

Methods: PubMed, PsycARTICLES, and CINAHL Plus were searched by two independent reviewers from inception till 1 April 2016 using the keywords: “HIV” OR “AIDS” AND “physical activity” OR “exercise” OR “sports”. A random effects meta-analysis was conducted.

Results: Across 24 studies including 34 physical activity levels there were 3780 (2471♂) PLWH (mean age range: 37–58 years). PLWH spent 98.9 (95%CI?=?64.8–133.1) minutes per day being physically active which is lower than in most other populations with chronic diseases. 50.7% (95%CI?=?39.3–62%) (n?=?2052) of PLWH complied with the physical activity guidelines of 150?min moderate intensity physical activity per week. The number of steps walked per day in 252 PLWH was 5899 (95%CI?=?5678–6418), which is below the 10,000 steps per day recommendation.

Conclusions: Our data demonstrate that a considerable proportion of PLWH are insufficiently physically active. Future lifestyle interventions specifically targeting the prevention of physical inactivity in PLWH are warranted.

• Implications for Rehabilitation

• Many people living with HIV do not comply with general health recommendations.

• Physical activity counseling should be key in the rehabilitation of people living with HIV.

     

Socioeconomic disparities in physical activity among Swedish women and trends over time – the population study of women in Gothenburg

Abstract

Objective: To explore secular trends in physical activity in relation to socioeconomic position in middle-aged women, with focus on whether the social gaps have become wider, narrower, or remain unchanged.

Design: Cohort comparisons between two representative samples of women, recruited in 1980–81 and 2004–05 as a part of the Population Study of Women in Gothenburg.

Setting: Gothenburg, the second largest city of Sweden, with ≈ 450?000 inhabitants.

Subjects: Population-based cohorts of 38- and 50-year-old women, invited in 1980–81 and 2004–05 to free health examinations. The study population in 1980 was n?=?477, 38- and 50-year-old women born in 1930 (n?=?355) and 1942 (n?=?122), and in 2004 n?=?500, 38- and 50-year- old women born in 1966 (n?=?207) and 1954 (n?=?293).

Main outcome measure: Physical activity at work and leisure time. Socioeconomic position was defined based on socio-occupational group and level of education. Physical activity during work and leisure time was based on questionnaires.

Results: On average 38- and 50-year-old women were more physically active at work and leisure time in 2004–05 compared to 1980–81; odds ratio (OR) for increase over time for physical activity at work for 38-year-olds: 2.59, (95% confidence interval (CI) 1.65–4.07), and for 50-year-olds: OR 2.09 (1.52–2.88); OR for increase physical activity leisure time in 38-year-olds: 1.93 (1.25–2.98), and in 50-year-olds 2.04 (1.49–2.79). There were no significant differences between socioeconomic groups in physical activity levels changes over time.

Conclusion: Women in different socioeconomic groups improved their physical activity at work and leisure time to the same extent from 1980 to 2004, indicating that the socioeconomic gap in physical activity is neither increasing nor decreasing.

• Key Points

• The gap in physical activity levels between socioeconomic groups seems to have remained stable for middle-aged women the last 25 years.

• ??However, women were more physically active in 2004 at work and during leisure time, independent of socioeconomic position, compared to 1980.

• ??It remains a great challenge to create structures that enable these behaviours for all social groups.

     

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

ObjectiveTo develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept.DesignFocus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study.SettingDutch primary care physiotherapy practices (n = 21 therapists).ParticipantsAdults with non-specific LBP (n = 41).Interventione-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals’ level of physical activity. The intervention could be tailored to patients’ risk of persistent disabling LBP, according to the STarT Back Screening Tool.Main outcome measuresFunctional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks.ResultsAfter 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) ?12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD ?2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5 minutes/day; 95% CI ?47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD ?23.0 minutes/day; 95% CI ?8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application.ConclusionsThe results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.     

Has the Prevalence of Invalidating Musculoskeletal Pain Changed Over the Last 15 Years (1993–2006)? A Spanish Population-Based Survey

The aim of the current study was to estimate the prevalence and time trend of invalidating musculoskeletal pain in the Spanish population and its association with socio-demographic factors, lifestyle habits, self-reported health status, and comorbidity with other diseases analyzing data from 1993–2006 Spanish National Health Surveys (SNHS). We analyzed individualized data taken from the SNHS conducted in 1993 (n = 20,707), 2001 (n = 21,058), 2003 (n = 21,650) and 2006 (n = 29,478). Invalidating musculoskeletal pain was defined as pain suffered from the preceding 2 weeks that decreased main working activity or free-time activity by at least half a day. We analyzed socio-demographic characteristics, self-perceived health status, lifestyle habits, and comorbid conditions using multivariate logistic regression models. Overall, the prevalence of invalidating musculoskeletal pain in Spanish adults was 6.1% (95% CI, 5.7–6.4) in 1993, 7.3% (95% CI, 6.9–7.7) in 2001, 5.5% (95% CI, 5.1–5.9) in 2003 and 6.4% (95% CI 6–6.8) in 2006. The prevalence of invalidating musculoskeletal pain among women was almost twice that of men in every year (P < .05). The multivariate analysis showed that occupational status (unemployed), sleep <8 hours/day and having any accident in the preceding year were significantly associated in both gender with a higher likelihood of suffering from invalidating musculoskeletal pain among Spanish adults. Within men, other predictors of invalidating musculoskeletal pain were to be married and lower educational level, whereas in women were age of 45–64 years old (OR 1.89, 95% CI 1.32–2.7), obesity (OR 1.23, 95% CI 1.06–1.42), a sedentary lifestyle (OR 1.23, 95% CI 1.06–1.42), and presence of comorbid chronic diseases (OR 1.32, 95% CI 1.14–1.53). Further, worse self-reported health status was also related to a greater prevalence of invalidating musculoskeletal pain (OR 6.88, 95% 5.62–8.40 men, OR 7.24, 95% 6.11–8.57 women). Finally, we found that the prevalence of invalidating musculoskeletal pain increased from 1993 to 2001 for both men (OR 1.31, 95% 1.08–1.58) and women (OR 1.19, 95% 1.03–1.39) with no significant increase from the remaining surveys. Our results suggest that invalidating musculoskeletal pain deserves an increased awareness among health professionals. More educational programs which address postural hygiene, physical exercise, and how to prevent obesity and sedentary lifestyle habits should be provided by Public Health Services.PerspectiveThis population-based study indicates that invalidating musculoskeletal pain that reduces main working activity is a public health problem in Spain. The prevalence of invalidating musculoskeletal pain was higher in women than in men and associated to lower income, poor sleeping, worse self-reported health status, and other comorbid conditions. Further, the prevalence of invalidating musculoskeletal pain increased from 1993 to 2001, but remained stable from the last years (2001 to 2006).     

Association of Self-reported Walking Pace With Type 2 Diabetes Incidence in the UK Biobank Prospective Cohort Study

ObjectiveTo investigate the association between self-reported walking pace and type 2 diabetes (T2D) incidence and whether it differed by physical activity levels and walking time.MethodsThere were 162,155 participants (mean age, 57.1 years; 54.9% women) from the UK Biobank prospective study, recruited between 2006 and 2010, included in the study. Walking pace was self-reported and classified as brisk, average, or slow. Total physical activity and walking time were self-reported using the International Physical Activity Questionnaire. Association between walking pace and T2D incidence and the potential moderating role of physical activity and walking time were investigated using Cox proportional hazards models.ResultsThe median follow-up was 7.4 (interquartile range, 6.7 to 8.2) years. There were 4442 participants in whom T2D developed during the follow-up period. In the fully adjusted model (sociodemographic factors, diet, body mass index, and physical activity), average walking pace (hazard ratio [HR], 1.28; 95% CI, 1.14 to 1.44) and slow walking pace (HR, 1.91; 95% CI, 1.62 to 2.24) were associated with a higher T2D risk compared with brisk walking among women. Among men, average walking pace (HR, 1.28; 95% CI, 1.17 to 1.40) and slow walking pace (HR, 1.73; 95% CI, 1.50 to 1.99) were also associated with higher T2D risk. Compared with slow walkers, brisk walkers have the same diabetes incidence rate 18.6 and 16.0 years later, for women and men, respectively.ConclusionAverage and slow walking pace was associated with a higher risk of incident T2D in both men and women, independent of major confounding factors. The associations were consistent across different physical activity levels and walking time.     

Low back pain prevalence in Sao Paulo,Brazil: A cross-sectional study

BackgroundLow back pain (LBP) is the leading cause of disability worldwide, and the burden of LBP is expected to increase in coming decades, particularly in middle-income countries. There is a lack of large and high-quality studies investigating the prevalence of LBP in Brazil.ObjectiveTo estimate the point, one-year, and lifetime prevalence of non-specific LBP in adults from the city of São Paulo, Brazil.MethodsThis community-based, cross-sectional study recruited 3000 participants in flow point locations randomly selected from census sectors of São Paulo. Interviews and self-administered questionnaires were used to estimate point prevalence, one-year prevalence, and lifetime prevalence of LBP.ResultsThe estimate of point prevalence was 9.8% (95% CI: 8.8, 11.0), one-year prevalence was 48.1% (95% CI: 46.3, 49.9), and lifetime prevalence was 62.6% (95% CI: 60.8, 64.3). One-year and lifetime prevalence were higher in females, obese people, people insufficiently active and sedentary, current smokers, people who are exposed to repetitive movements, crouched or kneeling position, people dissatisfied with their job, people a little bit or very stressed, a little bit or very anxious, and a little bit depressed, and people with good and fair or poor general health. Lifetime prevalence was also higher in people exposed to standing positions and exposure to carrying weight.ConclusionsThe high point, one-year, and lifetime prevalence of LBP in Brazil indicates that there is a need for coordinated efforts from government, the private sector, universities, health workers, and civil society to deliver appropriate management of LBP in middle-income countries.     

Fitbit Activity,Quota-Based Pacing,and Physical and Emotional Functioning Among Adults With Chronic Pain

Physical activity can improve function in patients with chronic pain, however, adherence is low, in part due to inconsistent activity patterns. Smart wearable activity trackers, such as Fitbits, may help promote activity. In our program for chronic pain, we examined: 1) Fitbit activity patterns (ie, step count, moderate-to-vigorous physical activity (MVPA), sedentary behavior), and 2) whether achievement of weekly, individualized Fitbit step goals was associated with functional outcomes. We conducted a secondary analysis of Fitbit data from our 10-week mind-body activity program for chronic pain (GetActive-Fitbit arm, N = 41). Participants self-reported emotional and physical function and completed performance-based and accelerometer-based assessments. From week 1 to week 10, 30% of participants increased >800 steps; 32.5% increased MVPA; and 30% decreased sedentary behavior. Only step count significantly changed across time with mean steps peaking at week 8 (M = +1897.60, SD = 467.67). Fitbit step goal achievement was associated with improvements in anxiety (ß = -.35, CI [-2.80, -.43]), self-reported physical function (ß = -.34, CI [-5.17, 8.05]), and performance-based physical function (ß = .29, CI [-71.93, 28.38]), but not accelerometer-based physical function or depression. Adhering to individualized Fitbit step goals in the context of a mind-body activity program may improve anxiety and self-reported and performance-based physical function.PerspectiveWe examine Fitbit activity patterns and the association between quota-based pacing and functional outcomes within a mind-body activity program for adults with chronic pain. Complementing quota-based pacing and coping skills with Fitbits may be a useful approach to promote activity engagement and behavior change in chronic pain populations.     

Motivación para cambiar estilos de vida no saludables y riesgo cardiovascular

ObjectiveStudy the relationship between motivation to change unhealthy life styles and cardiovascular risk.MethodCross sectional study, random, stratified by age, carried out in the field of primary care with a sample of 369 people. It was felt that with smoking or smoking cessation active consumption less than a year, the physical habit was valued at work and leisure, food habits were assessed in adherence to mediterranean diet and the stages of motivation were categorized precontemplative phase to maintenance phase. The cardiovascular risk was stratified with the SCORE table calibrated in Spain.ResultsThe 49.6% were men and 50.4% were women, with an average age of 41.2 years. The prevalence of smoking was 31.4% (95% CI 26.56-36,30), 58% in sedentary lifestyle (95% CI 52.27-62,63) and 68% for bad diet (95% CI 63.97-73,69). The 69.8% of smokers, 77.8% of sedentary and 48.4% of people without proper diet was precontemplative to change their lifestyles.ConclusionsPrecontemplative stages in unhealthy life styles have association with risk factors and increase the global cardiovascular risk. The transtheoretical model is a useful tool for the assessment of unhealthy behaviors in lifestyles.     

Nurses,age, job demands and physical activity at work and at leisure: A cross-sectional study

BackgroundThe nursing workforce is ageing and increased age and demands at work, can impact on physical activity levels in the workplace and at leisure. Research has shown that work physical activity, without activity at leisure, is insufficient to prolong well-being. This study investigated the physical activity levels of a sample of nurses and aimed to determine if age and job demands are associated with engaging in recommended physical activity levels at work and at leisure.MethodsA cross-sectional study was conducted with data collected during 2016. Two-hundred and ten nurses participated in the study. Two validated instruments were used: the Copenhagen Psychosocial Questionnaire (quantitative and cognitive demands) and the International Physical Activity Questionnaire.ResultsOlder nurses (≥40-years) were significantly less likely to report engaging in recommended physical activity levels at work than younger nurses [OR 0.47, 95% CI (0.25–0.88) p = 0.02]. Nurses with high quantitative demands were over twice as likely to engage in recommended levels of physical activity at work and at leisure. Engaging in recommended levels of physical activity at work was not associated with leisure-time physical activity reports.ConclusionInitiatives need to be put in place to ensure older nurses can fulfil their nursing role within their capabilities. These could include offering personal physical activity education to both on and off-duty nurses. Assessment of ability and patient acuity may be necessary.     

Effects of sitting time associated with media consumption on physical activity patterns and daily energy expenditure of Saudi school students

[Purpose] This study was performed to assess the effect of daily sitting time during media consumption on physical fitness, total energy expenditure (TEE), and body composition indices of Saudi school children. [Subjects and Methods] A total of 180 healthy Saudi school students (8–18 years) were included in this study. Sitting time, total energy expenditure, and levels of physical activity were evaluated with pre-validated internet based questionnaires. Body composition indices were evaluated using anthropometric analysis. [Results] Out of the studied participants, only 22.2% of students were physically inactive. Children with moderate and active physical scores demonstrated less sedentary behavior (TV viewing and computer usage), lower body composition values (BMI, WC, WHtR), and higher TEE than sedentary or mild activity level participants. Boys showed higher fitness scores and less sedentary behavior than girls. Media sitting time among the studied subjects correlated negatively with physical scores and positively with body composition. [Conclusion] The data presented here suggests that poor physical fitness, lower TEE, and longer sitting times differentially influence normal body composition indices among school children which may lead to overweight or obese individuals. Thus, decreasing sitting time during media consumption and enhancing physical activity may play a pivotal role in preventing obesity in young children.Key words: Media sitting time, Body composition, Physical activity     

The Long-Term Prognosis in People With Recent Onset Low Back Pain From Emergency Departments: An Inception Cohort Study

Most studies investigating the course of recent-onset low back pain (LBP) included patients from primary care. We aimed to describe the prognosis in people with recent-onset LBP presenting to emergency departments (EDs) and to identify prognostic factors for nonrecovery. This inception cohort study with a 1-year follow-up recruited 600 consecutive acute LBP patients presenting to 4 EDs. The outcomes measured the days to recover from pain, recover from disability, return to previous work hours and duties, and complete recovery. Within 12 months, 73% of participants (95% confidence interval [CI] = 69–77) recovered from pain, 86% (95% CI = 82–90) recovered from disability, 79% (95% CI = 71–87) returned to previous work hours and duties, and 70% (95% CI = 66–74) completely recovered. The median recovery times were 67 days (95% CI = 54–80) to recover from pain, 37 days (95% CI = 31–43) to recover from disability, 37 days (95% CI = 25–49) to return to previous work hours and duties, and 70 days (95% CI = 57–83) to recover completely. Higher pain levels, a higher perceived risk of persistent LBP, more days of reduced activity due to LBP, more pain sites, and higher duration of LBP were associated with complete nonrecovery within 6 months.PerspectiveThis information relates to prognosis and to likely recovery times for patients with recent-onset LBP in EDs. The findings also confirm previous factors associated with poor outcomes in patients with recent-onset LBP.     

Objectively measured physical activity in Brazilians with visual impairment: description and associated factors

Background: Low level of physical activity is a serious health issue in individuals with visual impairment. Few studies have objectively measured physical activity in this population group, particularly outside high-income countries. The aim of this study was to describe physical activity measured by accelerometry and its associated factors in Brazilian adults with visual impairment.

Methods: In a cross-sectional design, 90 adults (18–95 years old) answered a questionnaire and wore an accelerometer for at least 3 days (including one weekend day) to measure physical activity (min/day).

Results: Sixty percent of the individuals practiced at least 30?min/day of moderate-to-vigorous physical activity. Individuals who were blind were less active, spent more time in sedentary activities and spent less time in moderate and vigorous activities than those with low vision. Individuals who walked mainly without any assistance were more active, spent less time in sedentary activities and spent more time in light and moderate activities than those who walked with a long cane or sighted guide.

Conclusion: Our data highlight factors associated with lower levels of physical activity in people with visual impairment. These factors, such as being blind and walking without assistance should be tackled in interventions to increase physical activity levels among visual impairment individuals.

• Implications for Rehabilitation

• Physical inactivity worldwide is a serious health issue in people with visual impairments and specialized institutions and public policies must work to increase physical activity level of this population.

• Those with lower visual acuity and walking with any aid are at a higher risk of having low levels of physical activity.

• The association between visual response profile, living for less than 11 years with visual impairment and PA levels deserves further investigations

• Findings of the present study provide reliable data to support rehabilitation programs, observing the need of taking special attention to the subgroups that are even more likely to be inactive.

     

Prediction of return-to-work of low back pain patients sicklisted for 3-4 months

The purpose of this Dutch prospective population-based study was to identify prognostic factors for return-to-work of employees with 3-4 months sick leave due to low back pain (LBP). A cohort of 328 employees was formed and baseline data were collected. One year after the first day of the sick leave, 91% of the original cohort participated in a second interview (n=298). During the baseline measurement, information was collected about health status, history of LBP, occupational variables, job characteristics and social economic variables. At the second interview, 66% of the employees had returned to work (n=198). Return-to-work was independently predicted by having a better general health status (OR 1.53; 95% CI 1.30-1.80), having better job satisfaction (OR 1.26; 95% CI 1.11-1. 44), being a bread winner (OR 2.46; 95% CI 1.37-4.40), having a lower age (OR 0.70; 95% CI 0.52-0.93) and reporting less pain (OR 0. 85; 95% CI 0.73-0.99) all measured at cohort entry. This study shows that psycho-social aspects of health and work in combination with economic aspects have a significantly larger impact on return-to-work when compared to relatively more physical aspects of disability and physical requirements of the job. This suggests that interventions aimed at return-to-work of employees sicklisted with LBP should predominantly be focused on these psycho-social aspects such as health behavior and job satisfaction, and on the (lack of) economic incentives for return-to-work.     

Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis

ObjectiveTo assess the effectiveness of mind-body (MB) exercise interventions provided by physical therapists for reducing pain and disability in people with low back pain (LBP).Data SourcesMEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published in English between December 2010 and June 2020.Study SelectionRandomized controlled trials evaluating the effects of Pilates, yoga, and tai chi interventions performed by physical therapists on pain or disability outcomes in adults with musculoskeletal LBP were included.Data ExtractionData were extracted by 2 independent reviewers. Quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework and Cochrane risk of bias tools, respectively.Data Synthesis21,230 exercise trials were identified; 161 progressed to full-text review. Eight trials, 7 reporting on Pilates and 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [CI]: -1.65 to -0.021) and disability (SMD: -0.74 95% CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention. Tests for subgroup differences between studies with exercise vs non-exercise control groups revealed a moderating effect on short-term outcomes where larger effects were observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD: -0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested that MB exercise is not more effective than control interventions for pain or disability. Quality of the evidence ranged from very low to low.ConclusionsPhysical therapist-delivered MB exercise interventions, which overwhelmingly consisted of Pilates, were more effective than control in the short and long-term for pain and in the short-term for disability, with differences in the short-term effects lessened when compared with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP.     

Validity and Accuracy of Step Count as an Indicator of a Sedentary Lifestyle in People With Chronic Obstructive Pulmonary Disease

ObjectiveTo determine the validity and accuracy of <5000 steps/day as a sedentary lifestyle indicator, and the optimal step count cut point value for indicating a sedentary lifestyle in people with chronic obstructive pulmonary disease (COPD).DesignAnalysis of baseline data from a randomized clinical trial.SettingSydney, Australia.ParticipantsStable COPD on the waitlist for pulmonary rehabilitation.InterventionsNot applicable.Main Outcome MeasuresStep count and time in sedentary behavior (SB) were assessed using thigh-worn accelerometry. A sedentary lifestyle was defined as <5000 steps/day. Pearson correlation coefficients were analyzed between step count and time spent in SB. Sensitivity, specificity, and accuracy were calculated for the <5000 steps/day threshold. Receiver operating characteristic curves with the area under the curve were computed for step count in identifying a sedentary lifestyle.Results69 people with COPD (mean age=74 years, SD=9; forced expiratory volume in 1 second, mean=55%, SD=19 predicted) had sufficient wear data for analysis. There was a moderate inverse correlation between step count and time spent in SB (r=−0.58, P<.001). Step count had a fair discriminative ability for identifying a sedentary lifestyle (area under the curve=0.80, 95% confidence interval [CI], 0.68-0.91). The <5000 steps/day threshold had a sensitivity, specificity, and accuracy of 82% (95% CI, 70-94), 70% (95% CI, 54-86), and 78%, respectively. A lower threshold of <4300 steps/day was more accurate for ruling in a sedentary lifestyle.ConclusionsCompared with thigh-worn accelerometry, <5000 steps/day is a valid and reasonably accurate indicator of a sedentary lifestyle in this population.