Ebook Rehabilitation: Mobility, Exercise and Sports (Part 2)

Chapter 6 Everyday Physical Activity 6.1 Oral Presentations This page intentionally left blank Rehabilitation: Mobility, Exercise and Sports 227 L.H.V. van der Woude et al. (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved. doi:10.3233/978-1-60750-080-3-227 Activities of daily living and CHD risk factors among individuals with chronic spinal cord injury S.P. HETZ a,1, A.E. LATIMERa, K.A. MARTIN GINISb, A.C. BUCHHOLZc, SHAPE-SCI RESEARCH GROUP a School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada b Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada c Department of Family Relations and Applied Human Nutrition, University of Guelph, Guelph, Ontario, Canada Abstract. The purpose of the study was to evaluate the relationships between participation in activities of daily living (ADL) and coronary heart disease (CHD) risk factors in individuals with SCI. Participants completed the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) and CHD risk factor assessment including waist circumference, total cholesterol, LDL-cholesterol (LDL), HDL-cholesterol (HDL), and triglycerides. Using generalized linear models, controlling for leisure time physical activity and covariates, increased Mobility ADL (transferring and wheeling) were associated with lower plasma total cholesterol and LDL. No other significant relationships emerged. Further investigation is needed to determine causality between Mobility ADL and CHD risk. Keywords. activities of daily living, non-exercise physical activity, coronary heart disease risk factors, spinal cord injury, SHAPE-SCI. 1. Introduction Although there is accumulating evidence to support the negative relationships between leisure time physical activity (LTPA) and coronary heart disease (CHD) risk, the relationships between activities of daily living (ADL; normal day-to-day fundamental tasks which are essential to every day life, such as mobility and domestic related activities) and CHD risk remain unknown. Therefore, the primary purpose of this study was to examine the relationships between ADL participation and CHD risk factors including waist circumference, total cholesterol, LDL-cholesterol (LDL), HDL-cholesterol (HDL), and triglycerides in the SCI population. 1 Samuel P. Hetz, School of Kinesiology and Health Studies, Physical Education Centre, 69 Union Street, Queen’s University, Kingston, ON, Canada, K7L 3N6, samuel.hetz@queensu.ca 228 S.P. Hetz et al. / Activities of Daily Living and CHD Risk Factors 2. Materials and Methods This study involved an analysis of seventy-five individuals who participated in the Study of Health and Activity in People with Spinal Cord Injury (SHAPE-SCI) [1]. A full list of measurements as well as inclusion and exclusion criteria of the SHAPE-SCI are reported elsewhere [1]. Sixty-one men and 14 women were included in the study (51% had paraplegia; M age = 42.39±11.78, M years post injury = 14.94±10.57). Participants completed a biometric evaluation consisting of venous blood sampling and waist circumference measurements in the individuals’ home and the Physical Activity Recall Assessment for People with SCI (PARA-SCI) via the telephone. The PARA-SCI [2] is a valid and reliable self-report measure of all activities performed over a 3-day recall period. Similar to past analyses using the PARA-SCI, activities which required similar functional movements were clustered [3]. For example, wheeling and transferring were combined into the ‘Mobility ADL’ class. Cleaning, food preparation, laundry, and yard work were combined into the ‘Domestic ADL’ class. This categorization helped to increase statistical power and provide more generalizable information regarding a class of activities (e.g. mobility and domestic activities) rather than specific activities (e.g. mopping the floor). 3. Results Participants spent an average of 118.81±121.29 minutes per day (min/d) engaged in Total ADL (Range= 0.00min/d to 468.83min/d), 17.35±27.07 min/d engaged in Mobility ADL (Range= 0.00min/d to 160.03min/d), and 15.78±30.45 min/d engaged in Domestic ADL (Range= 0.00min/d to 150.00min/d). The relationships between each ADL category (Total, Mobility, and Domestic) and each biometric indicator (waist circumference, total cholesterol, LDL, HDL, and triglycerides) were examined using a unique generalized linear model. An assessment of potential covariates indicated that women had higher HDL levels than men (F=12.11, df=1, p=.001), age was positively associated with waist circumferences (r=.34, p<.01), and triglycerides were positively associated with alcohol consumption (r=.40, p<.01). These associations, in addition to LTPA were controlled for in subsequent analyses. Due to three relationships being examined for each CHD risk factor, a Bonferroni correction was employed such that the p-value was set at .016. Individuals who spent more time participating in Mobility ADL had lower total cholesterol and LDL levels (B=-.005, Wald Chi-Square≥7.79, p≤.005). No other significant relationships emerged. 4. Discussion It has been well established that individuals with SCI spend a great deal of time participating in ADL [4]. However, there is limited evidence supporting the potential beneficial effects of ADL in decreasing the risk of CHD. The current study examined the relationships between ADL and CHD risk factors in individuals with chronic SCI. Mobility ADL were associated with lower total cholesterol and LDL. The specific physiological mechanisms underlying the study findings are complex and poorly understood. The aerobic characteristics of Mobility ADL may have contributed to these findings. It has been suggested that aerobic activities may be more effective than resistance training at decreasing LDL and total cholesterol [5]. S.P. Hetz et al. / Activities of Daily Living and CHD Risk Factors 229 Although Mobility ADL were associated with lower LDL and total cholesterol, we were not able to demonstrate similar findings with the other biometric indicators. The inconsistencies between our study and previous research [6] examining the relationship between short bouts of non-exercise physical activity and CHD risk factors may be due to measurement differences (self-report vs. objective measures of physical activity) or indicative of the variation between sample populations (able bodied individuals vs. individuals with SCI). Moreover, it is quite possible that the SCI specific ADL performed by the current sample were not of adequate intensity or duration to affect certain biomarkers. Total and Domestic ADL were unrelated to CHD risk factors. Total ADL encompasses very sedentary activity such as desk and office work. These sedentary activities likely weakened the relationships between ADL and CHD risk factors. Furthermore, it is possible that Domestic ADL are not performed for the same duration as the majority of Mobility ADL and that Mobility and Domestic ADL differ in the amount of physical exertion required to accomplish these tasks [7]. 5. Conclusion By classifying and examining SCI specific ADL, our preliminary findings suggest that increased Mobility ADL participation may be a strategy worth investigating as a means of decreasing CHD risk factors, particularly LDL and total cholesterol in individuals with SCI. The practical implications of the findings are that Mobility ADL participation should be promoted by practitioners in addition to LTPA in the SCI population. Notably, practitioners encouraging Mobility ADL participation should also remind clients of safe ADL practices in order to prevent injury. References [1] K.A. Martin Ginis, A.E. Latimer, A.C. Buchholz, S.R. Bray, B.C. Craven, K.C. Hayes, A.L. Hicks, M.A. McColl, K. Smith, D.L. Wolfe, Establishing evidence-based physical activity guidelines: Methods for the study of health and activity in people with spinal cord injury (SHAPE SCI), Spinal Cord 46 (2008), 216-221. [2] K.A. Martin Ginis, A.E. Latimer, A.L. Hicks, B.C. Craven. Development and evaluation of an activity measure for people with spinal cord injury. Med Sci Sports Exerc 37 (2005), 1099–1111. [3] S.P. Hetz, A.E. Latimer, K.A. Martin Ginis. Relationships between physical fitness and leisure time physical activity and activities of daily living in individuals with spinal cord injury. Spinal Cord In press (2008) [4] A.E. Latimer, K.A. Martin Ginis, B.C. Craven, A.L. Hicks. The physical activity recall assessment for people with spinal cord injury: validity. Med Sci Sports Exerc 38 (2006), 208-216. [5] J.L. Durstine, P.W. Grandjean, P.G. Davis, M.A. Ferguson, N.L. Alderson, K.D. DuBose. Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. Sports Med 31 (2001), 1033-1062. [6] G.N. Healy, D.W. Dunstan, J. Salmon, E. Cerin, J.E. Shaw, P.Z. Zimmet, N. Owen. Breaks in Sedentary Time beneficial associations with metabolic risk. Diabetes Care 31 (2008), 661-666. [7] T.W. Janssen, C.A. van Oers, H.E. Veeger, A.P. Hollander, L.H. van der Woude, R.H. Rozendal. Relationship between physical strain during standardized ADL tasks and physical capacity in men with spinal cord injuries. Paraplegia 32 (1994), 844-859. ... - tailieumienphi.vn