Physical Activity and Sedentary Behaviour Subsequent to Serious - PowerPoint PPT Presentation

MONASH PUBLIC HEALTH & PREVENTIVE MEDICINE Physical Activity and Sedentary Behaviour Subsequent to Serious Orthopaedic Injury: A Systematic Review Dr Christina Ekegren NHMRC Early Career Fellow, Deputy head Pre-hospital, Emergency and Trauma Research Co-authors: Dr Ben Beck, Dr Rachel Climie, Prof Neville Owen, Prof David Dunstan, Prof Belinda Gabbe @CLEkegren @Physios4PA

Background Orthopaedic patients: ▪ Largest group of injury hospitalisations in Australia – Hip fractures expected to dramatically increase – Australian Guidelines: ▪ 150 mins moderate intensity exercise/week & minimise – prolonged sitting Potential for increased risk of inactivity-related chronic ▪ disease in orthopaedic patients What is the extent of the problem? @CLEkegren @Physios4PA

Study aim To systematically review and synthesise the evidence on physical ▪ activity and sedentary behaviour following serious orthopaedic injury @CLEkegren @Physios4PA

Methods Search strategy: ▪ 8 electronic databases + reference lists of relevant articles: inception to March 2016 – Inclusion criteria: ▪ Observational studies only – Serious orthopaedic injury = acute bone or soft-tissue injury requiring emergency – hospital admission and/or non-elective surgery Objective measurement only – @CLEkegren @Physios4PA

Search results 6 out of 31 studies included: ▪ Hip fractures (n=4) – Other orthopaedic injuries (n=2) – Moderate risk of bias: ▪ Small, non representative samples – (5 / 6 studies: n<50) High attrition – @CLEkegren @Physios4PA

Results 1: Sedentary behaviour: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury Davenport et al 2015 ActivPAL <0.5 Fleig et al 2016 Accelerometer 6.7 @CLEkegren @Physios4PA

Results 1: Sedentary behaviour: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury Davenport et al 2015 ActivPAL <0.5  Fleig et al 2016 Accelerometer 6.7 @CLEkegren @Physios4PA

Results 1: Sedentary behaviour: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Fleig et al 2016 Accelerometer 6.7 @CLEkegren @Physios4PA

Results 1: Sedentary behaviour: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Fleig et al 2016 Accelerometer 6.7 Davenport et al 2015 ActivPAL <0.5 Bernhardt et al 2005 Uptimer 1  Bernhardt et al 2005 Uptimer 1.2 Bernhardt et al 2005 Uptimer 1.5 @CLEkegren @Physios4PA

Results 1: Sedentary behaviour: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Fleig et al 2016 Accelerometer 6.7  Davenport et al 2015 ActivPAL <0.5  Bernhardt et al 2005 Uptimer 1   Bernhardt et al 2005 Uptimer 1.2  Bernhardt et al 2005 Uptimer 1.5 @CLEkegren @Physios4PA

Results 2: Physical activity: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury Davenport et al 2015 ActivPAL <0.5  Resnick et al 2011 Accelerometer 2.0 Fleig et al 2016 Accelerometer 6.7 @CLEkegren @Physios4PA

Results 2: Physical activity: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Resnick et al 2011 Accelerometer 2.0  Fleig et al 2016 Accelerometer 6.7 @CLEkegren @Physios4PA

Results 2: Physical activity: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Resnick et al 2011 Accelerometer 2.0  Fleig et al 2016 Accelerometer 6.7  Resnick et al 2011 Accelerometer 2.0  @CLEkegren @Physios4PA

Results 2: Physical activity: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Resnick et al 2011 Accelerometer 2.0  Fleig et al 2016 Accelerometer 6.7  Resnick et al 2011 Accelerometer 2.0   @CLEkegren @Physios4PA

Results 2: Physical activity: hip fracture Authors Device Months Mean (95% CI)  /Median (IQR)  post-injury  Davenport et al 2015 ActivPAL <0.5   Resnick et al 2011 Accelerometer 2.0  Fleig et al 2016 Accelerometer 6.7  Resnick et al 2011 Accelerometer 2.0     Fleig et al 2016 Accelerometer 6.7 @CLEkegren @Physios4PA

Results 3: Sedentary behaviour and physical activity: UL & LL fracture Mean (95% CI)  /Median (IQR)  Authors Injury Device Months post- injury Ceroni et al 2011 UL # Accelerometer 1 day Ceroni et al 2012 LL # Accelerometer 1 day  Ceroni et al 2012 LL # Accelerometer 6 Ceroni et al 2012 LL # Accelerometer 18 @CLEkegren @Physios4PA

Results 3: Sedentary behaviour and physical activity: UL & LL fracture Mean (95% CI)  /Median (IQR)  Authors Injury Device Months post- injury  Ceroni et al 2011 UL # Accelerometer 1 day  Ceroni et al 2012 LL # Accelerometer 1 day   Ceroni et al 2012 LL # Accelerometer 6  Ceroni et al 2012 LL # Accelerometer 18 @CLEkegren @Physios4PA

Results 3: Sedentary behaviour and physical activity: UL & LL fracture Mean (95% CI)  /Median (IQR)  Authors Injury Device Months post- injury  Ceroni et al 2011 UL # Accelerometer 1 day  Ceroni et al 2012 LL # Accelerometer 1 day   Ceroni et al 2012 LL # Accelerometer 6  Ceroni et al 2012 LL # Accelerometer 18 Ceroni et al 2011 UL # Accelerometer 1 day Ceroni et al 2012 LL # Accelerometer 1 day  Ceroni et al 2012 LL # Accelerometer 6 Ceroni et al 2012 LL # Accelerometer 18 @CLEkegren @Physios4PA

Results 3: Sedentary behaviour and physical activity: UL & LL fracture Mean (95% CI)  /Median (IQR)  Authors Injury Device Months post- injury  Ceroni et al 2011 UL # Accelerometer 1 day  Ceroni et al 2012 LL # Accelerometer 1 day   Ceroni et al 2012 LL # Accelerometer 6  Ceroni et al 2012 LL # Accelerometer 18  Ceroni et al 2011 UL # Accelerometer 1 day  Ceroni et al 2012 LL # Accelerometer 1 day   Ceroni et al 2012 LL # Accelerometer 6  Ceroni et al 2012 LL # Accelerometer 18 @CLEkegren @Physios4PA

Limitations Inconsistency of outcome ▪ reporting No pre-injury data – 3 studies ▪ ? compared with age-matched controls @CLEkegren @Physios4PA

Conclusions and future directions ▪ Low physical activity levels and high levels of sedentary behaviours found consistently throughout recovery – Similarities with stroke, TBI, SCI, other chronic diseases – Only 1 study >7 month follow up – in adolescents ▪ Physios: Capacity vs Activity! ▪ Activity  Recovery? @CLEkegren @Physios4PA

@CLEkegren @Physios4PA

MONASH PUBLIC HEALTH & PREVENTIVE MEDICINE Thank you Dr Christina Ekegren, Department Epidemiology and Preventive Medicine christina.ekegren@monash.edu @CLEkegren @Physios4PA