Bloemen M.1, van den Berg-Emons R.2, Tuijt M.1, Nooijen C.2,3, Takken T.4, Backx F.5, Vos M.1, de Groot J.1,4
1HU University of Applied Sciences Utrecht, Researchgroup Lifestyle and Health, Utrecht, Netherlands, 2Erasmus MC University Medical Center Rotterdam, Department of Rehabilitation Medicine, Rotterdam, Netherlands, 3Karolinska Institute, Department of Public Health, Stockholm, Sweden, 4University Medical Center Utrecht, Child Development and Exercise Center, Utrecht, Netherlands, 5University Medical Center Utrecht, Department of Rehabilitation, Physiotherapy Science and Sports, Utrecht, Netherlands

Background: Physical behavior consists of time spent in sedentary activities and physical-active activities. Extensive literature shows associations between physical behavior (in this study expressed in terms of activities and intensity) and health-related outcomes. The majority of typically developing youth does not meet the guidelines for physical behavior. Youth with a disability like spina bifida (SB) are even at higher risk of developing unfavorable physical behavior as a consequence of their reduced mobility or time spent in the wheelchair. Combining type of activity and intensity as physical strain of activities is interesting as it might be different in clinical populations. Understanding physical behavior and physical strain in wheelchair-using youth with SB will help us to tailor and optimize interventions specific for this population.

Purpose: To assess physical behavior and physical strain in wheelchair-using youth with SB.

Methods: Accelerometry-based VitaMove data of 34 (13.7 + 3.2 years) and Actiheart data of 36 (13.5 + 3.6 years) wheelchair-using children with SB were used to assess physical behavior. The children used a wheelchair for daily life, long distances or sports. The VitaMove measures the type of activities. The VitaMove-data were compared to available reference data from typically developing peers. Sedentary activities were defined as sitting and lying. Physical-active activities were walking, running, wheeling, (hand)biking and non-cyclic moving. The Actiheart measures the intensity based on the heart rate. The % of heart rate reserve was used to classify the intensity into categories ranging from very light intensity to (near to) maximal intensity, based on the American College of Sports Medicine. For determining the physical strain, data of the VitaMove and data of the Actiheart were combined using MatLab.

Results: Wheelchair-using children with SB showed significantly more sedentary activities (94.3% versus 78.0%, p 0.05) and significantly less physical-active activities (5.0% versus 12.2%, p 0.05) compared to typically developing peers. Wheelchair-using children with SB spent 90% of the wear time (IQR 8%) sitting or lying during a school day compared to 96% (IQR 10%) during a weekend day (p 0.01). Moreover, the intensity of the activities was significantly higher during a school day compared to a weekend day. The results for physical strain show that lying, sitting and non-cyclic moving were mostly performed at very light intensity, standing, wheeling and (hand)biking at light intensity and walking at moderate intensity. Nevertheless, the physical strain of the different activities varied extensively between the participants.

Conclusion(s): Wheelchair-using children with SB are significantly more sedentary and less physically active compared to typically developing peers. Comparison of schooldays and weekend days showed that physical behavior on weekend days was less favorable. The physical strain of the different activities varied extensively between participants.

Implications: Our results show the necessity to improve physical behavior in wheelchair-using children with SB, as evidence has shown that activity levels during childhood track into adulthood. The challenge is how to achieve this goal. There seems to be an opportunity during weekend days and individual approaches seem appropriate because of the variations observed in physical strain. Keywords: Youth, spina bifida, physical behavior

Funding acknowledgements: Personal PhD grant (HU University of Applied Sciences Utrecht) and unconditional grant (2011-13-35P) of the Dutch Foundation Innovation Alliance (SIA-RAAK)

Topic: Paediatrics

Ethics approval: The Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands, approved the study procedures (number 11-557).

All authors, affiliations and abstracts have been published as submitted.

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