1. 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

2. 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

3. The Netherlands……………..

4. The Netherlands……………..

5. The Netherlands……………..

6. 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

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

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

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

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

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

12. 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:

13. 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

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

15. 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)

16. 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)

17. 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)

18. 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!

20. VitaMove