Post-operative delayed ambulation after thymectomy is associated withpre-operative six-minute walk distance

Objective: Delayed post-operative ambulation is a risk of post-operative complications and increases overall healthcare costs. We investigated pre-operative and intraoperative variables associated with delayed ambulation in patients who underwent thymectomy.

Methods: A total of 57 consecutive patients undergoing thymectomy were included in this study. Pre-operative functional exercise capacity was evaluated by six-minute walk distance. Ambulation was considered to be delayed if the patient could not walk the ward on post-operative day 1. Binary logistic regression analysis was performed to clarify the factors associated with delayed ambulation.

Results: Pre-operative six-minute walk distance was the only significant variable that was associated with delayed ambulation. The area under the receiver operating characteristic curve for predicting delayed ambulation was 0.684 (95% confidential interval: 0.546–0.823, p?=?0.017), and the optimal discriminatory pre-operative six-minute walk distance value was 498 m. Post-operative hospital stay was significantly longer in patients with low six-minute walk distance (<498 m) than those with high six-minute walk distance (≥498 m). In contrast, the presence of myasthenia gravis or adjuvant chemoradiotherapy was not associated with delayed ambulation.

Conclusions: Our results suggest that low pre-operative six-minute walk distance is associated with delayed post-operative ambulation and longer post-operative hospital stay in patients who underwent thymectomy.

• Implications for rehabilitation

• The predictors for delayed ambulation after thymectomy are not fully investigated.

• The presence of myasthenia gravis was not associated with delayed ambulation.

• Low pre-operative six-minute walk distance was associated with delayed ambulation.

     

Self-efficacy is an independent predictor for postoperative six-minute walk distance after elective open repair of abdominal aortic aneurysm

Objectives: Open surgery is performed to treat abdominal aortic aneurysm (AAA), although the subsequent surgical stress leads to worse physical status. Preoperative self-efficacy has been reported to predict postoperative physical status after orthopedic surgery; however, it has not been sufficiently investigated in patients undergoing abdominal surgery. The purpose of the present study is to investigate the correlation between preoperative self-efficacy and postoperative six-minute walk distance (6MWD) in open AAA surgery.

Methods: Seventy patients who underwent open AAA surgery were included. Functional exercise capacity was measured using preoperative and 1 week postoperative 6MWD. Self-efficacy was preoperatively measured using self-efficacy for physical activity (SEPA). The correlations of postoperative 6MWD with age, height, BMI, preoperative 6MWD, SEPA, Hospital Anxiety and Depression Scale (HADS) score, operative time, and blood loss were investigated using multivariate analysis.

Results: Single regression analysis showed that postoperative 6MWD was significantly correlated with age (r?=??0.553, p?≤?0.001), height (r?=?0.292, p?=?0.014), Charlson’s comorbidity index (r?=??0.268, p?=?0.025), preoperative 6MWD (r?=?0.572, p?≤?0.001), SEPA (r?=?0.586, p?≤?0.001), and HADS-depression (r?=??0.296, p?=?0.013). Multiple regression analysis showed that age (p?=?0.002), preoperative 6MWD (p?=?0.013), and SEPA (p?=?0.043) score were significantly correlated with postoperative 6MWD.

Conclusions: Self-efficacy was an independent predictor for postoperative 6MWD after elective open AAA surgery. This suggests the importance of assessing not only physical status but also psychological factors such as self-efficacy.

• Implications for Rehabilitation

• Preoperative self-efficacy has been limited to reports after orthopedic surgery.

• We showed that preoperative self-efficacy predicted postoperative 6MWD after AAA surgery.

• Treatment to improve self-efficacy might be useful in patients receiving AAA surgery in rehabilitation.

     

Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial

Purpose: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals.

Materials and methods: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65–85 years) with a stroke 1–3 years previously were allocated to an intervention group (IG, n?=?34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n?=?33). The primary outcomes were balance (Berg Balance Scale, 0–56 points) and mobility (Short Physical Performance Battery, 0–12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy.

Results: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p?p?=?0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes.

Conclusions: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months.

• Implications for Rehabilitation

• A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke.

• People with poor balance and motor function discontinued the study more often and may require additional support.

• There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

     

Muscle function and body composition profile in adolescents with restrictive anorexia nervosa: does resistance training help?

Purpose: The aim of this study was to analyze the effects of short-term resistance training on the body composition profile and muscle function in a group of Anorexia Nervosa restricting type (AN-R) patients. Methods: The sample consisted of AN-R female adolescents (12.8?±?0.6 years) allocated into the control and intervention groups (n?=?18 each). Body composition and relative strength were assessed at baseline, after 8 weeks and 4 weeks following the intervention. Results: Body mass index (BMI) increased throughout the study (p?=?0.011). Significant skeletal muscle mass (SMM) gains were found in the intervention group (p?=?0.045, d?=?0.6) that correlated to the change in BMI (r?=?0.51, p?p?=?0.047, d?=?0.6) and correlated (r?>?0.60) with change in BMI in both the groups. Significant relative strength increases (p?Conclusions: SMM gain is linked to an increased relative strength when resistance training is prescribed. Although FM, relative body fat (%BF), BMI and body weight (BW) are used to monitor nutritional progress. Based on our results, we suggest to monitor SMM and relative strength ratios for a better estimation of body composition profile and muscle function recovery.

• Implications for Rehabilitation

• Anorexia Nervosa Restricting Type (AN-R)

• AN-R is a psychiatric disorder that has a major impact on muscle mass content and function. However, little or no attention has been paid to muscle recovery.

• High intensity resistance training is safe for AN-R after hospitalization and enhances the force generating capacity as well as muscle mass gains.

• Skeletal muscle mass content and muscular function improvements are partially maintained for a short period of time when the exercise program ceases.

     

Are cardiovascular and metabolic responses to field walking tests interchangeable and obesity-dependent?

Purpose: To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals.

Method: Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20–45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland–Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables.

Results: There was an agreement between CPX and both the 6MWT [oxygen uptake (VO₂ mL?kg^?1?min^?1)?=?6.9 (CI: 5.7–8.1), and heart rate (bpm)?=?37.0 (CI: 33.3–40.7)] and ISWT [VO₂ (mL?kg^?1?min^?1)?=?6.1 (CI: 4.9–7.3), and heart rate (bpm)?=?36.2 (CI: 32.1–40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO₂ ( r?=?0.70); dyspnoea (r?=?0.80); and leg fatigue (r?=?0.70).

Conclusions: 6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited.

• Implications for Rehabilitation

• Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk.

• Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing.

• Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

     

Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial

Purpose: The aim of the study was to compare the efficacy of Nordic pole walking (NPW) training with traditional treadmill training (TT) on a claudication (CD) and maximum walking distance (MWD) in patients with peripheral arterial disease (PAD). Method: Patients with intermittent claudication (IC) (n?=?70; age=68.27) in the Fontaine class II were randomized into a two three-month rehabilitation programs performed three times per week. TT were finished by 31 patients, NPW by 21. Walking capacity was measured by an exercise treadmill test (ETT) with the Gardner–Skinner protocol (before and after the program) and six minute walk test (6MWT) (before, during and after the program). Results: In an ETT both groups reached significant increase in CD and MWD (p?≤?0.005). In 6MWT NPW group reached significant increase in both CD (p?=?0.001) and MWD (p?=?0.001), whereas the TT group only in MWD (p?=?0.001). Conclusions: NPW has been shown to be as effective as the standard TT and is much less expensive. It should be the preferred method of exercise for PAD patients with IC.

• Implications for Rehabilitation

• Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease (PAD) patients with intermittent claudication (IC).

• Nordic walking has been shown to be as efficient as traditional treadmill training. It is however more cost-effective method of rehabilitation in PAD patients.

     

Six-minute walking test in children

• Implications for Rehabilitation

• Six-minute walking test.

• The six-minute walking test is safe and widely performed in the world because of its easy implementation and low cost.

• Many countries have established normal values to the six-minute walking test in healthy children.

• However, the applicability of this test also gains popularity among children with other disease conditions.

     

Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke

Purpose: Post-stroke hemiparesis may manifest as asymmetric gait, poor balance, and inefficient movement patterns. We investigated improvements in lower-limb muscle activation and function during Wii-based Movement Therapy (WMT), a rehabilitation program specifically targeting upper-limb motor-function.

Methods: Electromyography (EMG) was recorded bilaterally from tibialis anterior (TA) in 20 stroke patients during a 14-day WMT program. EMG amplitude and burst duration were analyzed during stereotypical movement sequences of WMT activities. Functional movement ability was assessed pre- and post-therapy including 6-min walk test (6MWT), stair-climbing speed, and Wolf Motor Function Test timed-tasks.

Results: TA EMG burst duration during Wii-golf increased by 30% on the more-affected side (p?=?0.04) and decreased by 28% on the less-affected side. Patients who did not step during Wii-tennis had a 16% decrease in more-affected TA burst sum (p?=?0.047) resulting in more symmetrical activation ratio at late-therapy, with the ratio changing from 3.24?±?2.25 to 0.99?±?0.11 (p?=?0.047). Six-minute walk and stair-climbing speed improved (p?=?0.005 and 0.03, respectively), as did upper-limb movement (p?≤?0.001).

Conclusion: This study provides physiological evidence for lower-limb improvements with WMT. Different patterns of muscle activation changes were evident across the WMT activities. Despite the relatively good pre-therapy lower-limb function, muscle activation and symmetry improved significantly with upper-limb WMT.

• Implications for rehabilitation

• WMT is an upper-limb neurorehabilitation program that also improves lower-limb motor-function.

• We report a shift towards more symmetrical muscle activation of tibialis anterior on the more- and less-affected sides that were reflected in increased distance walked during the 6MWT.

• The use of standing during therapy not only improves lower-limb function but also permits larger and more powerful upper-limb movements.

• Targeted upper-limb rehabilitation can also significantly improve mobility and balance, whether dynamic or static, that should reduce the risk of falls post-stroke.

     

Validity of the shuttle walk test as a functional assessment of walking ability in individuals with polyneuropathy

Purpose: This study assessed the validity of the shuttle walk test (SWT) to evaluate walking ability in patients with polyneuropathy.

Methods: Forty-one patients with chronic idiopathic axonal polyneuropathy (CIAP) and 49 patients with multifocal motor neuropathy (MMN) performed both the 10-meter walk test (10MWT) and the SWT. Face validity was assessed by evaluating whether patients considered both tests to reflect their walking ability (Likert scale: 1?=?not at all, 10?=?very well). Concurrent validity was determined by Spearman rank-correlation analyses performed on the outcomes of both tests.

Results: Mean (SD) scores for how well the 10MWT and SWT reflected daily walking ability were 6.8 (1.3) and 7.4 (1.6) (p?=?0.117) in patients with CIAP and 6.9 (1.2) and 7.9 (1.0) (p?=?0.001) in patients with MMN, respectively. Correlation scores between both tests ranged from ?0.70 to ?0.82, except for 18 patients with MMN with a “normal” walking speed at the 10MWT (?0.21).

Conclusion: The SWT seems a valid instrument for assessing walking ability in individuals with CIAP and MMN. Moreover, the SWT seems to be useful for investigating the symptoms elicited by walking long distances and may be more sensitive to changes when compared to the 10MWT.

• Implications for Rehabilitation

• Patients with polyneuropathy mainly experience problems when walking long distances.

• The 10-meter walk test does not possess sufficient psychometrics to diagnose walking abilities in these circumstances.

• The shuttle walk test is a valid instrument for assessing walking ability in individuals with polyneuropathy and might be the preferred instrument of choice when compared to the 10-meter walk test.

     

The 6-minute walk distance cannot be accurately assessed at home in people with COPD

Abstract

Purpose: The 6-minute walk test (6MWT) is commonly used to measure exercise capacity in COPD, but it is unclear if this test is accurate when performed at home. This study aimed to determine whether exercise capacity can be accurately assessed at home using the 6MWT in COPD. Methods: A total of 19 participants with stable COPD (mean [SD] FEV₁/FVC 52[13]) undertook the 6MWT at home and at the hospital, in random order, with two tests performed on each occasion. Hospital tests were conducted on a 30-metre walking track whilst home tests (indoor or outdoor) were conducted using the longest available track. Agreement for 6-minute walk distance (6MWD) was examined using the Bland and Altman method. Results: The track length at home was mean [SD] of 17[9]?m. The home 6MWD was shorter than the hospital 6MWD (mean 30?m shorter, limits of agreement ?167 to 102?m). For the home tests, a shorter track length was associated with a greater reduction in 6MWD (r_s?=?0.59, p?=?0.01), but not an increased number of turns (r_s?=??0.41, p?=?0.08). Conclusions: The 6MWD underestimates exercise capacity when conducted at home in COPD. Alternative tests suitable for the home environment should be considered if a comprehensive assessment is to be performed at home.

• Implications for Rehabilitation

• The 6-minute walk test is commonly used to assess change in exercise capacity following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease, and may be conducted on varying track lengths, indoors or outdoors.

• When conducted at home, the 6-minute walk test underestimates exercise capacity in chronic obstructive pulmonary disease, due to a shorter track length available in the home environment.

• This suggests that results from 6-minute walk tests performed at home environment cannot be directly compared to results from centre-based tests

     

Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results

Purpose: Cerebral palsy (CP) leads to various clinical signs mainly induced by muscle spasticity and muscle weakness. Among these ones impaired balance and posture are very common. Traditional physical therapy exercise programs are focusing on this aspect, but it is difficult to motivate patients to regularly perform these exercises, especially at home without therapist supervision. Specially developed serious games (SG) could therefore be an interesting option to motivate children to perform specific exercise for balance improvement. Method: Ten CP children participated in this study. Patients received four sessions of SG included into conventional therapy (1 session of 30?min a week during 4 weeks). Trunk control and balance were assessed using Trunk Control Motor Scale (TCMS) before and after interventions. Results: Children presented a significant improvement in TCMS global score after interventions [37.6 (8.7) and 39.6 (9.5) before and after interventions, respectively, p?=?0.04]. Conclusion: SG could therefore be an interesting option to integrate in the conventional treatment of CP children.

• Implication for Rehabilitation

• Cerebral palsy (CP) leads to balance issues.

• Rehabilitation exercises are not performed (enough) at home.

• Serious games (SG) could increase patients’ motivation.

• SG increase balance control of CP children.

     

Applicability,validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.

Method: The cross-sectional study included 30 patients (66% females; 41.5?±?14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM? (18–126 points) by two raters (A and B) at the same day and 1 week later (A).

Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC?=?0.9). Correlation between the SCIM III and the motor FIM? was appropriate (r?=?0.6; p?=?0.0). SCIM III subscales and FIM? domains correlated strongly for self-care (r?=?0.8; p?≤?0.001), moderately for transfers (r?=?0.6; p?=?0.0005) and locomotion (r?=?0.6; p?=?0.0006). SCIM III mobility subscale positively correlated with the cadence (r?=?0.8; p?≤?0.01), gait speed (r?=?0.7; p?≤?0.01) and step length (r?=?0.6; p?≤?0.01).

Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF? for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.

• Implications for Rehabilitation

• Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.

• There are not many studies focused on patients with non-traumatic spinal cord lesion.

• Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.

• We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

     

The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study

Background: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait.

Aim: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs.

Method: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters.

Results: Maximum hip joint extension was significantly increased (p?=?0.011), and hip abduction and adduction were both significantly reduced (p?=?0.011 and p?=?0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p?=?0.035) was demonstrated but there were no significant increases in either walking speed or cadence.

Conclusions: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs.

• Implications for Rehabilitation

• The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using.

• Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear.

• The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis.

• In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced.

• The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.

     

A new equation based on the 6-min walking test to predict VO2peak in women with obesity

Objective: The 6-min walking test (6?MWT) is commonly used to assess obese patients’ aerobic fitness, but it has rarely been compared with a direct measurement of maximal aerobic capacities (VO_2max or VO_2peak) in obese adults. The aim of this study was to investigate the relationship between the distance covered during a 6?MWT with objectively measured VO_2peak and to propose a new equation to predict VO_2peak from this walking test in obese patients.

Methods: One hundred and thirty-seven obese patients (45.6?±?12.5?years) admitted to our hospital for a multidisciplinary rehabilitation program were enrolled. After assessment of their body composition, the participants were asked to perform a 6?MWT and their maximal aerobic capacities (VO_2peak) were measured.

Result: There is a significant linear relation between VO_2peak and the distance covered during the 6?MWT (p?r?=?0.349). The determinant of VO_2peak was body mass index, waist-to-hip ratio, fat free mass, leading to the follow prediction equation VO_2peak such as VO_2peak (l/min)?=?(body mass index ×0.0150065)???(waist-to-hip-ratio?×?0.8595088)?+?(fat-free-mass?×?0.0295478)?+?(6-min walk test?×0.0020672)???0.5853372.

Conclusion: The 6-min walk test is a reliable method to reflect obese women’s aerobic capacities and the distance covered can be used to accurately estimate VO_2peak according to our newly proposed equation.

• Implication for rehabilitation

• Obesity is a worldwide disease and physical capacity evaluation is a key point for rehabilitation.

• The six minutes’ walk test is commonly used in obese people to assess aerobic fitness.

• This study proposes a new equation using 6?MWT performance to estimate VO_2peak.

     

The effect of whole-body vibration therapy on bone metabolism,motor function,and anthropometric parameters in women with postmenopausal osteoporosis

Purpose: To review the research literature on the effectiveness of whole-body vibration (WBV) therapy in women with postmenopausal osteoporosis.

Methods: A systematic review was conducted by two independent reviewers. Mean differences (MDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with the I² test. The Cochrane risk of bias tool was used to assess the methodological quality of the selected studies.

Results: Nine randomized controlled trials involving 625 patients met the inclusion criteria. No significant improvement was found in bone mineral density (BMD) (SMD?=??0.06, 95%CI=??0.22–0.11, p?=?0.50); bone turnover markers (MD?=??0.25, 95%CI=??0.54–0.03, p?=?0.08); anthropometric parameters, including muscle mass, fat mass, body mass index (BMI), and weight (SMD?=?0.02, 95%CI=??0.16–0.21, p?=?0.81); or maximal isotonic knee extensor strength (SMD?=?0.16, 95%CI=??0.63–0.95, p?=?0.69). However, maximal isometric knee extensor strength improved (SMD?=?0.71, 95%CI?=?0.34–1.08, p?=?0.0002).

Conclusions: WBV is beneficial for enhancing maximal isometric knee extensor strength, but it has no overall treatment effect on BMD, bone turnover markers, anthropometric parameters, or maximal isotonic knee extensor strength in women with postmenopausal osteoporosis.

• Implication of rehabilitation

• Osteoporosis is the leading underlying cause of fractures in postmenopausal women, whole body vibration (WBV) has received much attention as a potential intervention for the management of osteoporosis in recent years.

• Whole body vibration is beneficial for enhancing maximal isometric knee extensor strength in women with postmenopausal osteoporosis.

• Whole body vibration has no overall treatment effect on bone mineral density, bone turnover markers, anthropometric parameters and maximal isotonic knee extensor strength in women with postmenopausal osteoporosis.

     

Reliability,validity, and norms of the 2-min walk test in children with and without neuromuscular disorders aged 6–12

Purpose: The 2-min walk test may be more appropriate functional exercise test for young children. This study aimed to examine the 2-min walk test’s reliability; validity; and minimal clinically important difference; and to establish norms for children aged 6–12.

Methods: Sixty-one healthy children were recruited to examine the 2-min walk test’s reliability. Forty-six children with neuromuscular disorders (63% cerebral palsy) were recruited to test the validity. The normative study involved 716 healthy children without neuromuscular disorders (male?=?51%, female?=?49%). They walked at a self-selected speed for 2?min along a smooth, flat path 15 m in length.

Results: The mean distance covered in the 2-min walk test was 152.8 m (SD?=27.5). No significant difference was found in the children’s test-retest results (p?>?0.05). The intra- and inter-rater reliability were high (all intra-class correlation coefficients >0.8). All children, except one with neuromuscular disorders, completed the 2-min walk test, of which the minimal clinically important difference at 95% confidence interval was 23.2 m for the entire group, 15.7 m for children walking with aids, and 16.6 m for those walking independently.

Conclusions: The 2-min walk test is a feasible, reliable, and valid exercise test for children with and without neuromuscular disorders aged 6–12. The first normative references and minimal clinically important difference for children with neuromuscular disorders were established for children of this age group.

• Implications for rehabilitation

• The 2-min walk test is a feasible, safe, reliable, and valid time-based walk test for children aged 6–12 years.

• Normative references have been established for healthy children aged 6–12 years.

• Minimal clinically important difference at 95% confidence interval were calculated for children with neuromuscular disorders who walked without aids (i.e., independent and stand-by supervision) and those who walked with aids equal to 16.6 and 15.7 m, respectively.

• Distance covered by the healthy children in the 2?min did not correlate with age, gender, height, and weight of the children.

     

Exercise habits and factors associated with exercise in systemic sclerosis: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study

Objective: Exercise is associated with improved health in many medical conditions. Little is known about the exercise habits of people with systemic sclerosis (SSc, or scleroderma). This study assessed the proportion of individuals with SSc who exercise and associations of demographic and disease variables with exercise. Additionally, the weekly amount of time spent exercising and the types of exercise performed were assessed among patients exercising.

Methods: The sample consisted of adult participants with SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed baseline questionnaires from March 2014 through August 2015. Baseline questionnaires included questions on exercise habits, physician-reported medical characteristics, self-report demographic characteristics, the Health Assessment Questionnaire-Disability Index, Patient Health Questionnaire-9, and Patient-Reported Outcomes Measurement Information System-29.

Results: Of 752 patients, 389 (51.7%) reported presently engaging in exercise, and these patients exercised on average 4.7?h [standard deviation (SD)?=?2.8] per week. Among patients who reported exercising, walking was most commonly reported (n?=?295, 75.8%). In bivariate analyses, present exercise was associated with more education, lower body mass index, some (versus no) alcohol consumption, non-smoking, limited/sine disease subtype, absence of skin thickening, lower disability, higher physical function, lower symptoms of anxiety and depression, less fatigue, lower sleep disturbance, higher ability to participate in social roles and activities, and less pain.

Conclusions: Approximately half of SSc patients reported that they are currently exercising with walking being the most common form of exercise. Understanding exercise patterns and factors associated with exercise will help better inform intervention programs to support exercise for patients with SSc.

• Implications for rehabilitation

• Systemic sclerosis is a rare autoimmune rheumatic disease associated with great morbidity and highly diverse presentation.

• Approximately half of people with both limited and diffuse systemic sclerosis report exercising.

• Most exercisers walk, but patients engage in a wide variety of exercise-related activities.

• Individually designed exercise programs are most likely to support and encourage exercise in patients with diverse disease manifestations.