Physical activity and fitness in young people with Spina Bifida Rita van den Berg-Emons Programleader MoveFit Jetty van Meeteren Erasmus Medical Center, Rotterdam, The Netherlands Rehabilitation Medicine & Physical Therapy

CDC & ACSM recommendation healthy adults Moderate-intensity aerobic physical activity for a minimum of 30 min on five days each week OR Vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week

The Netherlands……………..

The Netherlands……………..

The Netherlands……………..

Activity levels in the Netherlands Norm % adult population % elderly (65+) Inactive 5,5 14 Actnorm 60,9 52,8 Fitnorm 23,5 10,4 Combinorm 68,2 58,4

Disabled people Difficulties in performing daily activities and sports Great risk for inactive lifestyle

Consequences inactive lifestyle  Physical fitness  Fatigue  Fatness  Health risk ► Diabetes ► Cardiovascular disease ► Cancer  Participation  Quality of life

Who is at risk? VitaPort system: developed and validated Erasmus MC (Bussmann) Accelerometry Free-living measurement (48 hours) Ambulatory and non-ambulatory

Automatic detection postures/activities Postures: lying, sitting, standing Activities: walking (stairs), running, wheelchair-driving, handcycling, cycling, general movement

Percentage subnormal duration activities patients -------------------------------------------------- X 100% duration activities able-bodied age-mates

Activity spectrum Adolescents/young adults MMC: <1 uur Healthy age-mates: > 2.5 uur Berg-Emons van den RJ, Bussmann JB, Stam HJ. Accelerometry-based activity spectrum in persons with chronic physical conditions. Arch Phys Med Rehabil 2010;91:1856-1861

Potential consequences on fitness Laurien Buffart (PhD) Aerobic fitness Muscle strength Body composition Study sample N = 51 community ambulator (n=15) household ambulator (n=8) non-ambulator (n=28) 21 (5) years of age

Measurements Aerobic fitness Muscle strength Body composition VO2 peak hip flexors, knee extensors shoulder abductors, elbow extensors Body composition skinfolds

Impaired fitness VO2peak (cycle ergometry): 67 (15) % of Dutch reference values (Agre et al; De Groot et al; Sherman et al) Muscle strength: Z-score -2.1 (1.8) (Agre et al; McDonald et al; Schoenmakers et al; De Groot et al.) Skinfolds: 159 (77) % of Dutch reference values (Bandini et al; Mita et al; Shepherd et al)

Potential consequences on Participation & Quality of Life Participation: Life Habits Health-related Quality of Life: Short Form 36 Results participation 63% difficulties in daily activities 59% difficulties in social roles (Buran et al; Verhoef et al) Results QoL Physical QoL: 81 % of Dutch reference values Mental QoL: 115% of Dutch reference values (Verhoef et al; Abresch et al)

Working mechanisms  physical activity is related to  aerobic fitness (only in non-ambulators)  physical activity or  aerobic fitness difficulties in daily activities physical health-related QoL  body fat (aerobic fitness)

Clinical implications Stronger focus on physical activity and fitness Health perspective; participation / QoL Aware of high risk Adapt treatment accordingly 6-month module “Active Lifestyle and Sports Participation” Outpatient clinic young adults Daily life activities (personalised tailored activity counselling) Sports participation (counselling & work shops) Fitness training (aerobic fitness & muscle strength) Need for effect studies (particularly long-term behaviour)! Workshop this afternoon!

h.j.g.vandenberg@erasmusmc.nl www.erasmusmc.nl/revalidatie

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