MOVEMENT BEHAVIOR IN PATIENTS WITH PERSISTENT PHYSICAL SYMPTOMS: WHO AND HOW MANY ARE AVOIDING ACTIVITY?

S.A.J. Toonders^1,2,3, P.E. van Westrienen^1,2,3, R. Wondergem⁴, C. Veenhof^2,3,5, M.F. Pisters^1,2,3

¹Fontys University of Applied Sciences, Health Innovation and Technology, Eindhoven, Netherlands, ²University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, Utrecht, Netherlands, ³Center for Physical Therapy Research and Innovation in Primary Care, Physiotherapy, Utrecht, Netherlands, ⁴Fontys University of Applied Sciences, Move to Be, Eindhoven, Netherlands, ⁵University of Applied Sciences Utrecht, Research Group Innovation of Human Movement Care, Utrecht, Netherlands

Background: The World Health Organization (WHO) strongly recommends all adults undertake regular physical activity and should limit sedentary time for physical, mental, and cognitive health. Movement behavior is considered as daily behavior pattern of a person in any combination of sedentary behavior (SB) and physical activity (PA). In patients with Persistent Physical Symptoms (PPS) complaints such as pain, fatigue and dizziness are the result of the complex interplay of biomedical, psychological and social factors. Literature shows that avoiding PA affects experienced pain, physical and cognitive symptoms in this population. Interventions, therefore, aim to stimulate PA and reduce SB. However, insight into movement behavior patterns of patients with PPS and their clinical characteristics is still unclear.

Purpose: To identify movement behavior patterns in patients with PPS.

Methods: This cross-sectional study was conducted using data from a multicenter cluster randomized clinical trial. Patients who regularly visited the general practitioner with a PPS-related symptom in primary care were included. Patients were excluded when diagnosed with fibromyalgia, chronic fatigue syndrome, or irritable bowel syndrome. Movement behavior was measured on seven constructive days using a pocket worn accelerometer. Movement behavior variables were standardized using z-scores and contributed to one or more components using Principal Component Analysis. The compressed components were used to identify movement behavior patterns using the non-hierarchical k-means clustering algorithm. Differences between the patterns were evaluated using ANOVA. Bonferonni correction for post hoc analyses was performed for multiple comparisons.

Results: A total of 149 participants participated in this study. The average movement behavior of the participants showed 8.9 sedentary hours, 2.9 hours of LPA, and 2.4 hours of moderate-vigorous physical activity a day. This study identified three statistic different patterns. ‘Sedentary Movers’ (n=64) spend 9.9 h/d and reached 1.8 hours of MVPA a day. 'Active Movers’ (n=45) were less sedentary with a mean of 7 h/d. They spent more hours per day LPA and MVPA. Movement behavior of ‘Active Movers’ was mainly done while standing (4.2 h/d) and walking (2.7 h/d). ‘Sedentary Exercisers’ (n=40) were sedentary with 9.5 hours a day and were more physically active on MVPA compared to the other clusters, particularly when cycling (1.2 h/d) and running (0.04 h/d). The entire study sample (100%) was physically active for more than 150 minutes of MVPA per week. Sixty percent of the participants were sedentary for less than 9.5 hours per day.

Conclusions: This study provides a clear and better understanding of the movement behavior patterns in patients with PPS. Remarkably, we found no movement behavior pattern of people avoiding PA. The entire sample complies with WHO guidelines of healthy movement behavior.

Implications: More research is needed into the role of movement behavior patterns in PPS management and prognosis. It seems that stimulating additional minutes of PA is therefore not nescessary.

Funding acknowledgements: This work was supported by SIA-RAAK-public [Grant No. 2015-02-24P].

Keywords:
Physical activity
Sedentary behavior
Persistent physical symptoms

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Primary health care
Mental health

Did this work require ethics approval? Yes

Institution: UMC Utrecht

Committee: Medical Research Ethics Committee (MREC)

Ethics number: NL57931.041.16