Publications by authors named "Mathieu H G de Greef"

39 Publications

Home-based Physical Activity to Alleviate Fatigue in Cancer Survivors: A Systematic Review and Meta-analysis.

Med Sci Sports Exerc 2021 Dec;53(12):2661-2674

Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, THE NETHERLANDS.

Purpose: Physical activity (PA) affects fatigue and mental health in cancer survivors favorably, but participation in PA interventions tends to be low. More participants may be reached by home-based PA owing to greater accessibility and self-monitoring. This systematic review therefore evaluated the effects of home-based PA of low to moderate intensity on symptoms of fatigue, depression, and anxiety among cancer survivors.

Methods: PubMed, CINAHL, PsycINFO, and Web of Science were systematically searched for randomized controlled trials. We included investigations of home-based PA interventions in adults treated curatively for cancer and evaluating fatigue, depression, or anxiety as outcomes. We performed a random-effect meta-analysis for the effects of PA interventions on fatigue in the short and long terms. Subgroup analyses were performed for the frequency of counseling. Standardized mean differences (SMD) and 95% confidence intervals are reported.

Results: Eleven articles comprising 1066 participants were included: 77% had a history of breast cancer; 14%, ovarian cancer; 4%, colorectal cancer; 4%, prostate cancer; and 1%, "other" cancer (not specified). Concerning the outcomes, nine articles reported on fatigue and two reported on depression or anxiety. Meta-analyses showed a significant effect of home-based PA on fatigue immediately after the intervention (SMD = 0.22 [0.06-0.37]), at 3 months' follow-up (SMD = 0.27 [0.04-0.51]), and at 6-9 months' follow-up (SMD = 0.31 [0.08-0.55]). PA interventions that used frequent counseling were associated with larger improvements in fatigue than those using no or infrequent counseling.

Conclusions: Home-based PA interventions can reduce fatigue among adult cancer survivors for up to 9 months, and frequent counseling may improve the benefits of these interventions.
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http://dx.doi.org/10.1249/MSS.0000000000002735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594505PMC
December 2021

A systematic review of the association between nursing staff and nursing-sensitive outcomes in long-term institutional care.

J Adv Nurs 2021 Aug 25;77(8):3303-3316. Epub 2021 Mar 25.

Department of Health Science, Section of Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Aims: To examine the association between type of nursing staff and nursing-sensitive outcomes in long-term institutional care.

Design: This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020.

Data Sources: The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included.

Review Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to critically appraise the reporting of the studies.

Results: Fifteen articles were included. Of 33 quality of care outcomes, 21 were identified as nursing-sensitive outcomes of which 13 showed a significant association with nursing staff, specifically: Activities of daily living, aggressive behavior, bladder/bowel incontinence, contractures, expressive language skills, falls, infection (including vaccination), range of motion, pain, pressure ulcers, and weight loss. However, studies reported inconsistent results regarding the association among RNs, LPNs, CNAs, and HCAs and these nursing-sensitive outcomes, evidence shows that more RNs have a positive impact on nursing-sensitive outcomes. As to the evidence regarding the other type of nursing staff, especially HCA, findings regularly showed a negative association.

Conclusion: Future research should be expanded with structure and process variables of which the mediating and moderating effect on nursing-sensitive outcomes is known. These may explain variances in quality of care and guide quality improvement initiatives. Researchers should consider fully applying Donabedian's structure-process-outcomes framework as it is a coherent entirety for quality assessment.

Impact: This review provides an overview of quality of care outcomes that are responsive to nursing interventions in long-term institutional care. As the effects can be monitored and documented, quality assessment should focus on these nursing-sensitive outcomes. The inconclusive results make it difficult to provide recommendations on who should best perform which care.
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http://dx.doi.org/10.1111/jan.14840DOI Listing
August 2021

The consistency between planned and actually given nursing care in long-terminstitutional care.

Geriatr Nurs 2020 Sep - Oct;41(5):564-570. Epub 2020 Mar 29.

Department of Health Science, Section of Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Continuous information exchange between healthcare professionals is facilitated by individualized care plans. Compliance with the planned care as documented in care plans is important to provide person-centered care which contributes to the continuity of care and quality of care outcomes. Using the Nursing Interventions Classification, this study examined the consistency between documented and actually provided interventions by type of nursing staff with 150 residents in long-term institutional care. The consistency was especially high for basic (93%) and complex (79%) physiological care. To a lesser extent for interventions in the behavioral domain (66%). Except for the safety domain, the probability that documented interventions were provided was high for all domains (≥ 91%, p > 0.05). NAs generally provided the interventions as documented. Findings suggest that HCAs worked beyond there scope of practice. The results may have implications for the deployment of nursing staff and are of importance to managers.
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http://dx.doi.org/10.1016/j.gerinurse.2020.03.001DOI Listing
March 2021

Accuracy of documentation in the nursing care plan in long-term institutional care.

Geriatr Nurs 2017 Nov - Dec;38(6):578-583. Epub 2017 May 25.

University of Groningen and University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands.

Nursing staff working in long-term institutional care attend to residents with an increasing number of severe physical and cognitive limitations. To exchange information about the health status of these residents, accurate nursing documentation is important to ensure the safety of residents. This study examined the accuracy of nursing documentation in 197 care plans of five long-term institutional care facilities. Based on the phases of the nursing process, the D-Catch instrument measures the accuracy of the content and coherence of documentation. Inadequacies were especially found in the description of residents' care needs and stated nursing diagnoses as well as in progress and outcome reports. In somatic and psycho-geriatric units, higher accuracy scores were determined compared with residential care units. Investments in resources (e.g., time), reasoning skills of nursing staff, and implementation of professional standards in accordance with legal requirements may be needed to enhance the quality of nursing documentation.
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http://dx.doi.org/10.1016/j.gerinurse.2017.04.007DOI Listing
February 2018

Randomized Trial of a Lifestyle Program in Obese Infertile Women.

N Engl J Med 2016 05;374(20):1942-53

From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a

Background: Small lifestyle-intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcomes, but large randomized, controlled trials are lacking.

Methods: We randomly assigned infertile women with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 29 or higher to a 6-month lifestyle intervention preceding treatment for infertility or to prompt treatment for infertility. The primary outcome was the vaginal birth of a healthy singleton at term within 24 months after randomization.

Results: We assigned women who did not conceive naturally to one of two treatment strategies: 290 women were assigned to a 6-month lifestyle-intervention program preceding 18 months of infertility treatment (intervention group) and 287 were assigned to prompt infertility treatment for 24 months (control group). A total of 3 women withdrew consent, so 289 women in the intervention group and 285 women in the control group were included in the analysis. The discontinuation rate in the intervention group was 21.8%. In intention-to-treat analyses, the mean weight loss was 4.4 kg in the intervention group and 1.1 kg in the control group (P<0.001). The primary outcome occurred in 27.1% of the women in the intervention group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99).

Conclusions: In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1530.).
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http://dx.doi.org/10.1056/NEJMoa1505297DOI Listing
May 2016

Effect of diagnosis with a chronic disease on physical activity behavior in middle-aged women.

Prev Med 2016 Feb 4;83:56-62. Epub 2015 Dec 4.

The University of Queensland, School of Human Movement Studies, Brisbane, Australia. Electronic address:

Objective: Although regular physical activity is an effective secondary prevention strategy for patients with a chronic disease, it is unclear whether patients change their daily physical activity after being diagnosed. Therefore, the aims of this study were to (1) describe changes in levels of physical activity in middle-aged women before and after diagnosis with a chronic disease (heart disease, diabetes, asthma, breast cancer, arthritis, depression); and to (2) examine whether diagnosis with a chronic disease affects levels of physical activity in these women.

Methods: Data from 5 surveys (1998-2010) of the Australian Longitudinal Study on Women's Health (ALSWH) were used. Participants (N=4840, born 1946-1951) completed surveys every three years, with questions about diseases and leisure time physical activity. The main outcome measure was physical activity, categorized as: nil/sedentary, low active, moderately active, highly active.

Results: At each survey approximately half the middle-aged women did not meet the recommended level of physical activity. Between consecutive surveys, 41%-46% of the women did not change, 24%-30% decreased, and 24%-31% increased their physical activity level. These proportions of change were similar directly after diagnosis with a chronic disease, and in the years before or after diagnosis. Generalized estimating equations showed that there was no statistically significant effect of diagnosis with a chronic disease on levels of physical activity in women.

Conclusion: Despite the importance of physical activity for the management of chronic diseases, most women did not increase their physical activity after diagnosis. This illustrates a need for tailored interventions to enhance physical activity in newly diagnosed patients.
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http://dx.doi.org/10.1016/j.ypmed.2015.11.030DOI Listing
February 2016

Examining Time Use of Dutch Nursing Staff in Long-Term Institutional Care: A Time-Motion Study.

J Am Med Dir Assoc 2016 Feb 9;17(2):148-54. Epub 2015 Oct 9.

School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands; School of Nursing and Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Objectives: Increasing residents' acuity levels and available resources in long-term institutional care requires insight into the care provided by nursing staff so as to guide task allocation and optimal use of resources, and enhance quality of care. The purpose of this study was to examine the relationship between time use and type of nursing staff, residents' acuity levels, and unit type by using a standardized nursing intervention classification.

Design: A multicenter cross-sectional observational study was performed using time-motion technique.

Setting: Five Dutch long-term institutional care facilities participated. In total, 4 residential care units, 3 somatic units, and 6 psycho-geriatric units were included.

Participants: Data were collected from 136 nursing staff members: 19 registered nurses, 89 nursing assistants, 9 primary caregivers, and 19 health care assistants.

Measurements: A structured observation list was used based on the Nursing Interventions Classification (NIC). Residents' acuity levels, representing residents' needs, were based on the Dutch Care Severity Index. Medians and interquartile ranges were calculated for time spent on interventions per type of nursing staff and units. Linear mixed models were used to examine the relationship between time spent on nursing interventions and the type of nursing staff, residents' acuity levels, and unit type.

Results: Observations resulted in 52,628 registered minutes for 102 nursing interventions categorized into 6 NIC domains for 335 residents. Nursing staff spent the most time on direct care interventions, particularly in the domain of basic physiological care. Variances in time spent on interventions between types of nursing staff were minimal. Unit type was more significantly (P < .05) associated with time spent on interventions in domains than the type of nursing staff. Residents' acuity levels did not affect time spent by nursing staff (P > .05).

Conclusion: The current study found limited evidence for task allocation between the types of nursing staff, which may suggest a blurring of role differentiation. Also, findings suggest that residents received similar care regardless of their needs, implying that care is predominantly task-oriented instead of person-centered. Managers may reconsider whether the needs of residents are adequately met by qualified nursing staff, considering the differences in education and taking into account increasing acuity levels of residents and available resources.
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http://dx.doi.org/10.1016/j.jamda.2015.09.002DOI Listing
February 2016

Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

Respir Res 2015 Feb 19;16:27. Epub 2015 Feb 19.

Background: Although the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR.

Methods: Data were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen's effect size was used as distribution based method.

Results: The estimated MID of the ESWT with the different anchors ranged from 186-199 s, 76-82% and 154-164 m. Using the distribution based method the MID was 144 s, 61% and 137 m.

Conclusions: Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186-199 s, 76-82% or 154-164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions.

Trial Registration: ClinicalTrials.Gov (ID NCT00135538).
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http://dx.doi.org/10.1186/s12931-015-0182-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336738PMC
February 2015

Short- and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial.

Respir Med 2015 Jan 22;109(1):112-21. Epub 2014 Nov 22.

University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.

Background: We were interested in the effects of a physical activity (PA) counselling programme in three groups of COPD patients from general practice (primary care), outpatient clinic (secondary care) and pulmonary rehabilitation (PR).

Methods: In this randomized controlled trial 155 COPD patients, 102 males, median (IQR) age 62 (54-69) y, FEV1predicted 60 (40-75) % were assigned to a 12-weeks' physical activity counselling programme or usual care. Physical activity (pedometer (Yamax SW200) and metabolic equivalents), exercise capacity (6-min walking distance) and quality of life (Chronic Respiratory Questionnaire and Clinical COPD Questionnaire) were assessed at baseline, after three and 15 months.

Results: A significant difference between the counselling and usual care group in daily steps (803 steps, p = 0.001) and daily physical activity (2214 steps + equivalents, p = 0.001)) from 0 to 3 months was found in the total group, as well as in the outpatient (1816 steps, 2616 steps + equivalents, both p = 0.007) and PR (758 steps, 2151 steps + equivalents, both p = 0.03) subgroups. From 0 to 15 months no differences were found in physical activity. However, when patients with baseline physical activity>10,000 steps per day (n = 8), who are already sufficiently active, were excluded, a significant long-term effect of the counselling programme on daily physical activity existed in the total group (p = 0.02). Differences in exercise capacity and quality of life were found only from 0 to 3 months, in the outpatient subgroup.

Conclusion: Our PA counselling programme effectively enhances PA level in COPD patients after three months. Sedentary patients at baseline still benefit after 15 months. ClinicalTrials.gov: registration number NCT00614796.
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http://dx.doi.org/10.1016/j.rmed.2014.10.020DOI Listing
January 2015

Selecting the increment size for a maximal incremental cycle test in patients with COPD.

Respirology 2015 Feb 3;20(2):352-5. Epub 2014 Dec 3.

Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Currently, to our knowledge, there are no chronic obstructive pulmonary disease (COPD)-specific formulas to predict the maximum workload of an incremental cycle ergometer test. The aim of the study was to investigate different prediction models including COPD-specific variables of maximum workload in 113 mild to very severe COPD patients. This study shows that simple measures like forced expiratory volume in 1 s, chair-stand test and modified Medical Research Council dyspnoea score may improve the accuracy of the predicted maximum workload in COPD patients.
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http://dx.doi.org/10.1111/resp.12451DOI Listing
February 2015

Physical activity recommendations in patients with chronic obstructive pulmonary disease.

Respiration 2014 14;88(2):92-100. Epub 2014 May 14.

Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: Physical activity recommendations are hardly studied in patients with chronic obstructive pulmonary disease (COPD), and specifically recommendations that are individualized to a patient's aerobic fitness level are not studied.

Objectives: To compare individualized (relative) and nonindividualized (absolute) physical activity recommendations in patients with COPD and to assess whether there are differences between patients with mild to moderate and (very) severe COPD.

Methods: We compared 7 different physical activity recommendations that were described in the literature. Four recommendations were individualized based on the patient's aerobic fitness level measured by a maximal cycle ergometer test. Three recommendations were nonindividualized. The recommendations were measured with an accelerometer, pedometer or questionnaire in 115 patients with mild to very severe COPD (68% male, mean age 65 years, mean FEV1 58% predicted).

Results: The percentage of patients that met the different recommendations ranged from 22 to 86% and only 8 patients met all 7 recommendations. The agreement between the different recommendations was poor (intraclass correlation coefficient, 0.28). Individualizing the recommendations resulted in a higher number of patients with severe or very severe COPD meeting the individualized recommendations compared to the nonindividualized recommendations. In contrast, patients with mild to moderate COPD less frequently met the individualized recommendations.

Conclusions: Our study showed that applying various physical activity recommendations with small differences in frequency, intensity or time led to large differences in the classification of patients with COPD into being sufficiently physically active or not. Consequently, the used recommendation will highly affect the proposed physical activity advice to the patient.
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http://dx.doi.org/10.1159/000360298DOI Listing
April 2015

Functional and psychological variables both affect daily physical activity in COPD: a structural equations model.

Respir Med 2013 Nov 28;107(11):1740-7. Epub 2013 Jun 28.

University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, P.O. Box 30001, Internal Mail Address AA11, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, P.O. Box 30002, Internal Mail Address CD24, 9750 RA Haren, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, P.O. Box 30001, Internal Mail Address FA40, 9700RB Groningen, The Netherlands. Electronic address:

Background: Daily physical activity (DPA) level is reduced in patients with COPD. The aim of this study was to investigate the association of DPA with functional and psychological variables in these patients.

Methods: 155 COPD patients (102 males, median (IQR) age 62 years (54-69 years), predicted FEV1 60% (40-75%) were included. We assessed DPA (DigiWalker SW-200), functional capacity and psychological factors.

Results: DPA level was significantly associated with all functional capacity variables and two psychological variables (Perceived Physical Ability Subscale, depression subscale of the Hospital Anxiety and Depression Scale). The six-minute walking distance and St. George Respiratory Questionnaire activity score explained 37% of the variance of DPA in a regression analysis. A structural equations model revealed that psychological variables indirectly explained DPA through functional capacity variables. DPA was stronger associated with functional capacity variables and weaker with psychological variables in patients with lower functional status than in patients with higher functional status.

Conclusions: Higher levels of DPA are associated with better functional capacity, but interestingly, DPA is also affected by psychological factors, though only indirectly, via functional capacity. The effect of specific treatment addressing psychological factors on DPA level and exercise tolerance needs further investigation.

Clinical Trial Registration: ClinicalTrials.gov, NCT00614796.
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http://dx.doi.org/10.1016/j.rmed.2013.06.002DOI Listing
November 2013

Self-efficacy for physical activity and insight into its benefits are modifiable factors associated with physical activity in people with COPD: a mixed-methods study.

J Physiother 2013 Jun;59(2):117-24

Department of Pulmonary Diseases, University of Groningen, Groningen, The Netherlands.

Questions: What are the perceived reasons for people with chronic obstructive pulmonary disease (COPD) to be physically active or sedentary? Are those reasons related to the actual measured level of physical activity?

Design: A mixed-methods study combining qualitative and quantitative approaches.

Participants: People with mild to very severe COPD.

Outcome Measures: Participants underwent a semi-structured interview and physical activity was measured by a triaxial accelerometer worn for one week.

Results: Of 118 enrolled, 115 participants (68% male, mean age 65 years, mean FEV1 57% predicted, mean modified Medical Research Council dyspnoea score 1.4) completed the study. The most frequently reported reason to be physically active was health benefits, followed by enjoyment, continuation of an active lifestyle from the past, and functional reasons. The most frequently reported reason to be sedentary was the weather, followed by health problems, and lack of intrinsic motivation. Mean steps per day ranged between 236 and 18 433 steps. A high physical activity level was related to enjoyment and self-efficacy for physical activity. A low physical activity level was related to the weather influencing health, financial constraints, health and shame.

Conclusion: We identified important facilitators to being physically active and barriers that could be amenable to change. Furthermore, we distinguished three important potential strategies for increasing physical activity in sedentary people with COPD, namely reducing barriers and increasing insight into health benefits, tailoring type of activity, and improvement of self-efficacy.
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http://dx.doi.org/10.1016/S1836-9553(13)70164-4DOI Listing
June 2013

Are grown-ups with congenital heart disease willing to participate in an exercise program?

Congenit Heart Dis 2014 Jan-Feb;9(1):38-44. Epub 2013 Apr 22.

Professorship in Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Objective: To examine the willingness of grown-ups with congenital heart disease (GUCH) to participate in the GUCH Training Program-Individualised (GTI), an exercise program specifically designed for GUCH, and to identify factors affecting their willingness to participate.

Design And Setting: In this cross-sectional study, all outpatient GUCH of the University Medical Center Groningen in The Netherlands, living within a 30-km radius of Groningen (n = 311), were asked to participate.

Patients: In total, 116 (37%) of the 311 GUCH who are invited to participate in our study returned completed questionnaires. The median age of the respondents was 40 (interquartile range 31-50) years and 55% were women.

Outcome Measures: Respondents (n = 116) completed a questionnaire that queried physical activity, perceived physical fitness, psychosocial determinants (motivation, self-efficacy, and social support) related to physical activity, and willingness to participate in GTI.

Results: Of the 116 respondents, 68 (59%) were willing to participate in GTI. They were less physically active, had worse perceived physical fitness, were less satisfied with their fitness, were generally more motivated to engage in physical activity, and had more social support than patients unwilling to participate. The best logistic regression model predicting willingness to participate in GTI included the variables perceived physical fitness and motivation for physical activity in general.

Conclusions: Asking GUCH to participate in an exercise program supervised by physical therapists is a good strategy. Taken into account nonresponse, a participation rate in the exercise program of over 20% is to be expected. Perceived physical fitness and motivation for physical activity in general are important predictors of patients' willingness to participate.
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http://dx.doi.org/10.1111/chd.12069DOI Listing
September 2014

Daily physical activity in stable heart failure patients.

J Cardiovasc Nurs 2014 May-Jun;29(3):218-26

Manon L. Dontje, MSc PhD Student, Professorship in Health Care and Nursing, Hanze University of Applied Sciences, and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Martje H. L. van der Wal, PhD, RN Researcher and HF Nurse, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Ronald P. Stolk, MD, PhD Professor, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Johan Brügemann, MD, PhD Cardiologist, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Tiny Jaarsma, PhD, RN Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköpings Universitet, Norrköping, Sweden. Petra E. P. J. Wijtvliet, MSc PhD Student, Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands. Cees P. van der Schans, PhD, PT, CE Professor, Professorship in Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Mathieu H. G. de Greef, PhD Researcher and Professor, Institute of Human Movement Sciences, University of Groningen, and Professor in Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.

Background: Physical activity is the only nonpharmacological therapy that is proven to be effective in heart failure (HF) patients in reducing morbidity. To date, little is known about the levels of daily physical activity in HF patients and about related factors.

Objective: The objectives of this study were to (a) describe performance-based daily physical activity in HF patients, (b) compare it with physical activity guidelines, and (c) identify related factors of daily physical activity.

Methods: The daily physical activity of 68 HF patients was measured using an accelerometer (SenseWear) for 48 hours. Psychological characteristics (self-efficacy, motivation, and depression) were measured using questionnaires. To have an indication how to interpret daily physical activity levels of the study sample, time spent on moderate- to vigorous-intensity physical activities was compared with the 30-minute activity guideline. Steps per day was compared with the criteria for healthy adults, in the absence of HF-specific criteria. Linear regression analyses were used to identify related factors of daily physical activity.

Results: Forty-four percent were active for less than 30 min/d, whereas 56% were active for more than 30 min/d. Fifty percent took fewer than 5000 steps per day, 35% took 5000 to 10 000 steps per day, and 15% took more than 10 000 steps per day. Linear regression models showed that New York Heart Association classification and self-efficacy were the most important factors explaining variance in daily physical activity.

Conclusions: The variance in daily physical activity in HF patients is considerable. Approximately half of the patients had a sedentary lifestyle. Higher New York Heart Association classification and lower self-efficacy are associated with less daily physical activity. These findings contribute to the understanding of daily physical activity behavior of HF patients and can help healthcare providers to promote daily physical activity in sedentary HF patients.
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http://dx.doi.org/10.1097/JCN.0b013e318283ba14DOI Listing
December 2014

Self-reported physical fitness in frail older persons: reliability and validity of the Self-Assessment of Physical Fitness (SAPF).

Percept Mot Skills 2012 Dec;115(3):797-810

Research and Innovation Group in Health Care and Nursing, Hanze University Groningen, Applied Sciences, Groningen, The Netherlands.

In very old and/or frail older people living in long-term care facilities, physical inactivity negatively affects activities of daily living. The main reason to assess older adults' perceived fitness is to establish the relation with their beliefs about their ability to perform physical activity adjusted to daily tasks. The Self-Assessment of Physical Fitness scale was developed to address these needs. The aim of this study was to estimate the test-retest reliability and construct validity of the scale. 76 elderly people (M age = 86.0 yr., SD = 6.3) completed the test. Cronbach's a was .71. One-week test-retest reliability ICC's ranged from .66 (SAPF aerobic endurance and SAPF balance) to .70 (SAPF sum score). Concurrent validity with the Groningen Fitness Test for the Elderly was fair to moderate. Despite the limited number of participants (N = 76), results suggest that the scale may be useful as an assessment of perceived fitness in older adults.
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http://dx.doi.org/10.2466/10.06.15.PMS.115.6.797-810DOI Listing
December 2012

Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire.

BMC Musculoskelet Disord 2013 Feb 1;14:53. Epub 2013 Feb 1.

Hanze University of Applied Sciences, Groningen, the Netherlands.

Background: The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric properties of the Brief Illness Perception Questionnaire in common musculoskeletal disorders like acute low back pain have not been adequately studied. Patients' perceptions vary across different populations and affect coping styles. Thus, our aim was to determine the internal consistency, test-retest reliability and validity of the Dutch language version of the Brief Illness Perception Questionnaire in acute non-specific low back pain patients in primary care physical therapy.

Methods: A non-experimental cross-sectional study with two measurements was performed. Eighty-four acute low back pain patients, in multidisciplinary health care center in Dutch primary care with a sample mean (SD) age of 42 (12) years, participated in the study. Internal consistency (Cronbach's α) and test-retest procedures (Intraclass Correlation Coefficients and limits of agreement) were evaluated at a one-week interval. The concurrent validity of the Brief Illness Perception Questionnaire was examined by using the Mental Health Component of the Short Form 36 Health Survey.

Results: The Cronbach's α for internal consistency was 0.73 (95% CI, 0.67 - 0.83); and the Intraclass Correlation Coefficient test-retest reliability was acceptable: 0.72 (95% CI, 0.53 - 0.82), however, the limits of agreement were large. The Intraclass Correlation Coefficient measuring concurrent validity 0.65 (95% CI, 0.46 - 0.80).

Conclusion: The Dutch version of the Brief Illness Perception Questionnaire is an appropriate instrument for measuring patients' perceptions in acute low back pain patients, showing acceptable internal consistency and reliability. Concurrent validity is adequate, however, the instrument may be unsuitable for detecting changes in low back pain perception over time.
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http://dx.doi.org/10.1186/1471-2474-14-53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570488PMC
February 2013

Study protocol: EXERcise and cognition in sedentary adults with early-ONset dementia (EXERCISE-ON).

BMC Neurol 2012 Aug 16;12:75. Epub 2012 Aug 16.

Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.

Background: Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia.

Methods/design: One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an aerobic exercise program in a rehabilitation centre or a flexibility and relaxation program in a rehabilitation centre. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a daily physical activity program set at home making use of pedometers. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures.

Discussion: The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life.

Trial Registration: The present study is registered within The Netherlands National Trial Register (ref: NTR2124).
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http://dx.doi.org/10.1186/1471-2377-12-75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488467PMC
August 2012

Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain: a systematic review.

J Physiother 2012 ;58(3):165-72

Hanze University of Applied Sciences, Groningen, The Netherlands.

Question: Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain?

Design: Systematic review with meta-analysis of prospective inception cohort studies.

Participants: Adults with acute or subacute non-specific low back pain.

Outcome Measure: Absence from usual work at a given time point greater than 12 weeks after the onset of pain due to ongoing pain.

Results: Ten studies involving 4683 participants were included in the review. Participants with acute or subacute pain and negative expectations about their recovery had significantly greater odds of being absent from usual work at a given time point more than 12 weeks after the onset of pain: OR 2.17 (95% CI 1.61 to 2.91). The exclusion of five studies with the greatest risk of bias showed that the result was similar when more rigorous quality criteria were applied: OR 2.52 (95% CI 1.47 to 4.31).

Conclusion: The odds that adults with acute or subacute non-specific low back pain and negative recovery expectations will remain absent from work due to progression to chronic low back pain are two times greater than for those with more positive expectations. These results were consistent across the included studies despite variations in the risk of bias.
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http://dx.doi.org/10.1016/S1836-9553(12)70107-8DOI Listing
October 2012

The minimal important difference for residual volume in patients with severe emphysema.

Eur Respir J 2012 Nov 22;40(5):1137-41. Epub 2012 Mar 22.

Dept of Pulmonary Diseases AA11, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.

Residual volume (RV) measured by body plethysmography is a routine measurement in clinical pulmonary practice and is often an important outcome variable in clinical trials. However, it is not known what size of improvement can be regarded as being important in severe emphysema patients. Therefore, the aim of the study is to establish the minimal important difference (MID) for RV in severe emphysema patients undergoing bronchoscopic lung volume reduction. 91 severe emphysema patients were included. RV and total lung capacity (TLC) were measured by body plethysmography. MID estimates were calculated by anchor-based and distribution-based methods. Forced expiratory volume in 1 s, 6-min walk distance and St George's Respiratory Questionnaire total score were used as anchors and Cohen's effect size was used as distribution-based method. The calculated MID estimates according to the different anchors and methods ranged between -0.31 and -0.43 L for RV, -6.1 and -8.6% for percentage change in RV (RV%) from baseline, and -2.8 and -4.0% for RV/TLC. These MID estimates are useful for sample size determination in new studies on interventions aimed at reducing RV and for interpreting the results from clinical trials in severe emphysema patients.
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http://dx.doi.org/10.1183/09031936.00219111DOI Listing
November 2012

Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomised trial.

J Physiother 2012 ;58(1):17-22

Hanze University of Applied Sciences, Groningen.

Question: In adults who experience nocturnal leg cramps, does stretching of the calf and hamstring muscles each day just before sleep reduce the frequency and severity of the cramps?

Design: A randomised trial with concealed allocation and intention-to-treat analysis.

Participants: Eighty adults aged over 55 years with nocturnal leg cramps who were not being treated with quinine.

Intervention: The experimental group performed stretches of the calf and hamstring muscles nightly, immediately before going to sleep, for six weeks. The control group performed no specific stretching exercises. Both groups continued other usual activities.

Outcome Measures: Participants recorded the frequency of nocturnal leg cramps in a daily diary. Participants also recorded the severity of the pain associated with nocturnal leg cramps on a 10-cm visual analogue scale. Adverse events were also recorded.

Results: All participants completed the study. At six weeks, the frequency of nocturnal leg cramps decreased significantly more in the experimental group, mean difference 1.2 cramps per night (95% CI 0.6 to 1.8). The severity of the nocturnal leg cramps had also decreased significantly more in the experimental group than in the control group, mean difference 1.3 cm (95% CI 0.9 to 1.7) on the 10-cm visual analogue scale.

Conclusion: Nightly stretching before going to sleep reduces the frequency and severity of nocturnal leg cramps in older adults.

Trial Registration: NCT01421628.
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http://dx.doi.org/10.1016/S1836-9553(12)70068-1DOI Listing
April 2012

A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients.

Respir Med 2012 May 6;106(5):694-700. Epub 2011 Dec 6.

Department of Pulmonary Diseases, University Medical Centre Groningen, University of Groningen, P.O. Box 30001, Internal Mail Address AA11, 9700 RB Groningen, The Netherlands.

Purpose: Pulmonary rehabilitation (PR) has positive effects on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD). However, not all COPD patients benefit from PR to the same extent. We investigated whether there is a patient profile, which is associated with the improvement in endurance exercise capacity.

Methods: In this observational study, we included 102 COPD patients who followed PR (age 60 ± 10 (mean ± SD) years, FEV(1)%predicted 44 ± 16%, 54 men). Lung function, maximal incremental cycle testing (Wpeak, VO(2)peak, Δlactate), quadriceps force and incremental and endurance shuttle walk test (ISWT/ESWT) were performed at the start of PR. The ESWT was repeated after 7 weeks of PR.

Results: Mean change in ESWT (ΔESWT) was 100 ± 154%. Four variables showed a statistically significant negative correlation with ΔESWT: FEV(1)%pred. (ρ = -0.20), Wpeak (ρ = -0.24), Δlactate (ρ = -0.33) and incremental shuttle walk test (ISWT) (ρ = -0.31). A cluster analysis identified two patient profiles: A profile with high ΔESWT, TLC and RV and low FEV(1), VO(2)peak, quadriceps force, Δlactate, HR(peak)%pred. and ISWT distance and a profile with low ΔESWT, TLC and RV and high FEV(1), VO(2)peak, quadriceps force, Δlactate, HR(peak)%pred. and ISWT distance.

Conclusions: Single variables from lung function or exercise testing at baseline have limited predictive value for response to exercise training. However, patients with worse disease status (i.e. a combination of lower FEV(1), more hyperinflation, lower exercise capacity and worse quadriceps force) improve more in endurance exercise capacity.
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http://dx.doi.org/10.1016/j.rmed.2011.11.008DOI Listing
May 2012

Daily physical activity in patients with chronic obstructive pulmonary disease: a systematic review.

COPD 2011 Aug 5;8(4):306-19. Epub 2011 Jul 5.

University Medical Center Groningen, University of Groningen, Pulmonary Department, The Netherlands.

Patients with chronic obstructive pulmonary disease (COPD) are often limited in their daily physical activity. However, the level, type and intensity of daily physical activity are not known, nor there is a clear insight in the contributing factors. The aim of this review is to describe daily physical activity of COPD patients, and to examine its relationship with demographic factors, pulmonary function, physical fitness, systemic inflammation and quality of life. A systematic literature search was conducted, including studies assessing daily physical activity in all stages of COPD by various different types of measurement techniques. In total, 47 studies were selected; 17 performance-, 20 questionnaire-, and 12 interview-based. Two studies used both a performance- and questionnaire-based method. Overall, COPD patients have a lower level and intensity of daily physical activity compared to healthy controls. This was reported by performance- as well as questionnaire-based studies, yet with a large variation (42-86% and 28-97%, respectively). Reduced daily physical activity is associated with higher levels of airway obstruction, higher levels of systemic inflammation, and lower levels of physical fitness. The association between daily physical activity and quality of life is less clear. In conclusion, this is the first review that examined the level, type and determinants of daily physical activity in COPD. It demonstrates that reduced daily physical activity frequently occurs in COPD patients, yet with a large variation. Methods of measuring and reporting daily physical activity should be more standardized.
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http://dx.doi.org/10.3109/15412555.2011.578601DOI Listing
August 2011

Low physical activity and risk of cardiovascular and all-cause mortality in renal transplant recipients.

Clin J Am Soc Nephrol 2011 Apr 3;6(4):898-905. Epub 2011 Mar 3.

Department of Nephrology, University Medical Center Groningen, Sector A, PO Box 30001, 9700 RB, Groningen, The Netherlands.

Background And Objectives: Low physical activity (PA) is a risk factor for mortality in the general population. This is largely unexplored in renal transplant recipients (RTRs). We studied whether PA is associated with cardiovascular and all-cause mortality in a prospective cohort of RTR.

Design, Setting, Participants, & Measurements: Between 2001 and 2003, 540 RTRs were studied (age, 51 ± 12 years; 54% male). PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). Cardiovascular and all-cause mortality were recorded until August 2007.

Results: Independent of age, PA was inversely associated with metabolic syndrome, history of cardiovascular disease, fasting insulin, and triglyceride concentration, and positively associated with kidney function and 24-hour urinary creatinine excretion (i.e., muscle mass). During follow-up for 5.3 years (range, 4.7 to 5.7 years), 81 RTRs died, with 37 cardiovascular deaths. Cardiovascular mortality was 11.7, 7.2, and 1.7%, respectively, according to gender-stratified tertiles of PA (P=0.001). All-cause mortality was 24.4, 15.0, and 5.6% according to these tertiles (P<0.001). In Cox regression analyses, adjustment for potential confounders including history of cardiovascular disease, muscle mass, and traditional risk factors for cardiovascular disease did not materially change these associations.

Conclusions: Low PA is strongly associated with increased risk for cardiovascular and all-cause mortality in RTRs. Intervention studies are necessary to investigate whether PA improves long-term survival after renal transplantation.
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http://dx.doi.org/10.2215/CJN.03340410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069385PMC
April 2011

Determinants of overweight and obesity in lung transplant recipients.

Respiration 2011 5;82(1):28-35. Epub 2011 Jan 5.

Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. l.bossenbroek @ long.umcg.nl

Background: Obesity-related diseases have been shown to affect post-lung transplantation survival. An estimated 30% of lung transplant recipients develop overweight.

Objective: The aim of this study was to examine the possible determinants of large increases in weight after lung transplantation. The contribution of physical activity, food intake, and resting energy expenditure was examined in lung transplant recipients.

Methods: In this cross-sectional study 21 overweight lung transplant recipients (11 men, mean age 57 ± 7 years; BMI 30 ± 3) and 21 normal-weight lung transplant recipients (11 men, mean age 56 ± 5 years; BMI 22 ± 3) were matched for disease, gender, age, prescribed medication, and time since lung transplantation. Physical activity was measured by a pedometer and a questionnaire; resting energy expenditure was measured by the ventilated-hood technique, and daily food intake by a dietician. Additionally, fat-free mass, lower-body strength, and fatigue were measured.

Results: The overweight lung transplant recipients had a significantly lower number of steps per day (4,686 ± 3,266 vs. 7,524 ± 3,448 steps/day, p = 0.01) and a lower fat-free mass (64 ± 9 vs. 75 ± 6%, p < 0.05) compared to normal-weight recipients. Obese subjects had a lower percentage of predicted resting energy expenditure level compared to normal-weight recipients (90 ± 14 vs. 100 ± 14% predicted, p = 0.04).

Conclusion: Our data suggest that overweight in lung transplant recipients is associated with a lower fat-free mass and lower levels of physical activity and resting energy expenditure compared to normal-weight recipients.
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http://dx.doi.org/10.1159/000322833DOI Listing
October 2011

Consequences of physical inactivity in chronic obstructive pulmonary disease.

Expert Rev Respir Med 2010 Dec;4(6):735-45

Department of Pulmonary Medicine, University Medical Centre Groningen, University of Groningen, The Netherlands.

The many health benefits of regular physical activity underline the importance of this topic, especially in this period of time when the prevalence of a sedentary lifestyle in the population is increasing. Physical activity levels are especially low in patients with chronic obstructive pulmonary disease (COPD). Regular physical activity and an active lifestyle has shown to be positively associated with outcomes such as exercise capacity and health-related quality of life, and therefore could be beneficial for the individual COPD patient. An adequate level of physical activity needs to be integrated into daily life, and stimulation of physical activity when absent is important. This article aims to discuss in more detail the possible role of regular physical activity for a number of well-known outcome parameters in COPD.
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http://dx.doi.org/10.1586/ers.10.76DOI Listing
December 2010

Frail institutionalized older persons: A comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life.

Am J Phys Med Rehabil 2011 Feb;90(2):156-68

Centre for Applied Research in Health Care and Nursing, Hanze University Groningen, The Netherlands.

The objective of this study was to perform a systematic review on training outcomes influencing physical fitness, activity of daily living performance, and quality-of-life in institutionalized older people. We reviewed 27 studies on older people (age, ≥70 yrs) in long-term care facilities and nursing homes. Our ultimate goal was to propose criteria for an evidence-based exercise protocol aimed at improving physical fitness, activity of daily living performance, and quality-of-life of frail institutionalized older people. The interventions, described in the reviewed studies that showed strong or very strong effect sizes were used to form an exercise prescription. The conclusion is that there is firm evidence for training effects on physical fitness, functional performance, activity of daily living performance, and quality-of-life. The training should contain a combination of progressive resistance training, balance training, and functional training. The proposed intensity is moderate to high, assessed on a 0-10 scale for muscle strengthening activities. The training frequency was three times a week, and the total duration was at least 10 wks.
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http://dx.doi.org/10.1097/PHM.0b013e3181f703efDOI Listing
February 2011

The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review.

Exerc Immunol Rev 2009 ;15:6-41

Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands.

Background: Chronic inflammatory diseases strike millions of people all over the world, and exercise is often prescribed for these patients to improve overall fitness and quality of life. In healthy individuals, acute and chronic exercise is known to alter inflammatory markers; however, less is known about these effects in patients with a chronic inflammatory disease.

Objective: The purpose of this review is to clearly define the effects of acute and chronic exercise on inflammatory markers in patients compared with healthy controls to determine whether exercise elicits an abnormal inflammatory response in those patients.

Data Sources: A literature search was conducted through MEDLINE and EMBASE (until January 2009).

Study Selection: A distinction was made between children and adults, acute (i.e., single exercise session) and chronic exercise (i.e., training) and endurance and resistance exercise. To evaluate and compare the exercise responsiveness of various reported inflammatory markers, pre- to post-test effect sizes were calculated.

Data Extraction: A methodological quality scoring as well as an assessment of the quality of exercise paradigms were both made.

Results: In total, 19 studies were included in this systematic review (children, n=7; adults, n=12). Of these, 7 were acute exercise studies in children, 8 were acute exercise in adults, 5 were chronic endurance exercise training studies, and I was a chronic resistance exercise training study. No exercise training studies were found involving children. Single bouts of exercise might elicit an aggravated inflammatory response in patients; this was reported for patients with type I diabetes mellitus, cystic fibrosis and chronic obstructive pulmonary disease. More severely affected patients may experience a more aggravated inflammatory response. Levels ofinflammatory markers, principally IL-6 but also T-cells, total leukocytes and lymphocytes, remained elevated longer into the recovery period following an acute bout of exercise in patients compared with healthy controls. Evidence was found that chronic endurance exercise training programs can attenuate systemic inflammation in patients with chronic heart failure and type 2 diabetes mellitus.

Conclusions: In patients with a chronic inflammatory disease, both acute and chronic exercise might elicit different inflammatory responses (i.e., exaggerated after acute exercise & attenuated after training) compared to healthy matched controls. However, the results reveal a major gap in our knowledge regarding the effects of acute and chronic exercise on inflammatory markers in patients with a chronic inflammatory disease. Results are often inconsistent, and differences in training programs (intensity, frequency and duration), heterogeneity of disease populations studied, and analytic methods may be just some of the causes for these discrepancies. To optimize exercise prescriptions and recommendations for patients with a chronic inflammatory disease, more research is needed to define the nature of physical activity that confers health benefits without exacerbating underlying inflammatory stress associated with disease pathology.
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January 2010

Cross-sectional assessment of daily physical activity in chronic obstructive pulmonary disease lung transplant patients.

J Heart Lung Transplant 2009 Feb;28(2):149-55

Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands.

Background: Information about daily physical activity of chronic obstructive pulmonary disease (COPD) lung transplant patients is relevant for evaluation of the functional recovery of physical capacity after lung transplantation. The objective of this study was to cross-sectionally assess daily physical activity, pulmonary function, physical fitness, fear of physical activity and motivation to exercise in COPD patients who were lung transplant candidates and lung transplant recipients.

Methods: Fifteen COPD lung transplant candidates (5 men and 10 women, mean age 53 years, forced expiratory volume in 1 second [FEV(1)] 20% predicted) and 47 recipients (18 men and 29 women, mean age 55 years, FEV(1) 93% predicted, 39 bilateral and 8 unilateral transplants) were enrolled in this observational study. Daily physical activity was measured using a pedometer (Digiwalker SW-200) and the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). Physical fitness was measured by the sit-to-stand test and the arm curl test. Fear of physical activity and motivation to exercise were measured by the Tampa Scale for Kinesiophobia-Dutch version Questionnaire and the Exercise Self-Regulation Questionnaire.

Results: Mean (+/-SD) number of steps per day in lung transplant recipients was higher compared with transplant candidates: 6,642 (+/-2,886) and 1,407 (+/-1,166), respectively (p < 0.05). Number of steps per day correlated significantly with FEV(1) (r = 0.32, p = 0.03) and lower body strength (r = 0.45, p = 0.002) in lung transplant recipients. There was no significant difference in daily physical activity, physical fitness, fear and motivation between bi- and unilateral transplant recipients.

Conclusion: Our data suggest that lung transplantation improves daily physical activity, lower body strength and FEV(1).
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http://dx.doi.org/10.1016/j.healun.2008.11.905DOI Listing
February 2009
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