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Cardiopulm Phys Ther J. 2010 December; 21(4): 23–29.
PMCID: PMC3004761

ABSTRACTS OF PLATFORM PRESENTATIONS

2010 December; 21(4): 23–29.

OUTCOMES OF PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICES ADMITTED TO ACUTE REHABILITATION: A PILOT STUDY

Purpose/Hypothesis: The government approved some ventricular assist devices (VADS) for destination therapy. This change created a new population of adults in need of inpatient rehabilitation as well as the need for qualified therapists to provide this service. The purpose of this study is to describe the development of an inpatient rehabilitation program at a freestanding facility for individuals with VADS and report the initial outcomes. Number of Subjects: Eight patients (6 males, 2 females) with a mean age of 61.6 ± 7.4 years transitioned to acute rehab over a six month period. Six of the patients were implanted with a Heartmate II LVAD® and two with a Heartware VAD™. These patients were admitted with rehabilitation diagnoses that included stroke, cardiac impairment and deconditioning. Patients received occupational and physical therapy for three hours per day provided by VAD trained therapists. Materials/Methods: Prior to admitting a patient with a VAD, a physical and occupational therapist at the rehabilitation facility were trained as VAD “superusers.” This process required the therapists complete a competency process comprised of inservice training from a manufacturer representative, one-on-one training with the primary acute care VAD therapist and multiple co-treatments. These superusers were responsible for providing therapy for the initial patients with VADs admitted to the facility as well as training the remaining therapy staff. Eight therapists and one aide completed the VAD training competency at the initiation of the program. Results: Mean length of stay for this sample was 18.9 ± 9.0 days. Subjects demonstrated a significant improvement in the FIM total scores increasing from 69.1 ± 8.2 at admission to 92.1 ± 1.2 at discharge (p < .001). The motor skills subtotal demonstrated a greater improvement from 43.3 ± 5.7 to 62.4 ± 9.2 (p < .001), while the cognitive skills subtotal improved from 24.9 ± 5.0 to 28.8 ± 3.6 (p < .05). A six-minute walk test was completed at discharge with a mean walk distance of 133.9 ± 65.3 meters. A patient progress form was developed and completed on a weekly basis as a communication tool. None of the eight patients required readmission to the hospital during their rehabilitation stay. All device issues were managed with the rehabilitation staff contacting the VAD coordinators by phone. Conclusions: The results of this pilot study demonstrate that patients with VADs are able to safely participate in an inpatient acute rehabilitation program and demonstrate significant improvements in FIM scores. These improvements are comparable to those seen in other patient populations who complete acute rehabilitation. Further studies are needed in a larger sample of patients to further document the efficacy of inpatient rehabilitation services in this population. Clinical Relevance: This pilot study demonstrates that with appropriate staff training, patients with VADs can successfully transition to a freestanding inpatient rehabilitation facility safely and complete an acute rehabilitation program with positive outcomes.

2010 December; 21(4): 23–29.

PHYSICAL THERAPIST'S PRACTICES IN THE EDUCATION OF STROKE SURVIVORS ON EXERCISE AND PHYSICAL ACTIVITY GUIDELINES

Purpose/Hypothesis: Stroke survivors are at risk for development of cardiovascular disease (CVD). Physical therapists (PTs) have the responsibility to educate these patients on risk factor modification for CVD. However, there have been no studies examining practice patterns for cardiac education in patients post stroke. The purpose of this study was to survey PTs to determine practice patterns in this area. It was hypothesized that PT degree and years in practice would affect practice patterns for cardiac education in this population. Number of Subjects: The participants of the present study were incidentally selected from email listings and ground mailed addresses obtained from New York Physical Therapy Association (NYPTA) website. A total of 1600 surveys were sent (1435 by email and 165 by ground mail). A total of 166 validated/completed surveys were utilized for a response rate of 10.3%. Materials/Methods: The study utilized a non-experimental, retrospective cross-sectional design. The survey consisted of 17 items addressing demographics, questions relating to education patterns on general CV risk, exercise to prevent CV disease and exercise implementation. Frequencies were utilized to describe the data. Kruskal-Wallis One Way Analysis of Variance by Ranks was utilized to determine practice pattern differences for type of PT degree and ANVOA for years of practice. Alpha was set at p<0.05. Results: The mean 6% of the PTs had certificates, 49% had bachelor, 34% had Masters and 11% had DPT degrees. 17% of the PTs never counsel their patient on CVD risk, 20% counsel between 1 and 25%, 13% counsel between 20 and 50%, 11% counsel between 51 and 75% and 28% counsel between 76 and 100% of their patients. 4% of the PTs never educate their patients on proper exercise, 19% spend 1–5% of treatment time, 22% between 6 and 11%, 13% between 11 and 20%, 14% between 21 and 30% and 13% >30% of their time education patients post stroke on exercise. Neither type of degree nor years of practice were associated with differences in educational practice patterns. Conclusions: The majority of the PTs responding reported counseling less than 50% of their patients on risk of CVD. Only a small amount of time was spent on education of CVD risk reduction. Neither physical therapy degree nor the PT's years of experience treating stroke survivors affected how many clients were counseled regarding stroke and increased risk of CV disease, the role of endurance exercise in CVD and health risk reduction, and with client/family education pertaining to safe performance of endurance exercise for fitness, wellness, and prevention. Clinical Relevance: Based on the results of this study, time educating stroke survivors on CVD risk and the role of exercise in CVD risk reduction is not a priority among practicing physical therapists. However, this population is at increased risk for CV events and PT's should take a more active role in educating this population on primary and secondary prevention. Additionally, given these findings, this concept should be emphasized in PT educational programs.

2010 December; 21(4): 23–29.

A HOME-BASED EXERCISE PROGRAM USING SELF MANAGEMENT STRATEGIES FOR INDIVIDUALS WITH TYPE 2 DIABETES

Purpose/Hypothesis: To determine the effect of an eight week home-based combined aerobic and resistive exercise program using self-management strategies on physical therapy and self reported measures and on the value of modifiable cardiovascular risk factors in individuals with type 2 diabetes. Additionally, this study explored perceived barriers and/or contributory factors to program compliance. Number of Subjects: 15 individuals with type 2 diabetes Materials/Methods: Design: A one group pretest-posttest mixed design was used. All participants participated in a home-based eight week combined aerobic and resistive exercise program using self-management strategies (telehealth monitor, action plan, exercise journal, feedback). Dependent variables included: 30-second sit to stand, 30-second arm curl test, 2 minute step test, timed up and go (physical therapy outcome measures), body mass index, waist circumference, heart rate, systolic and diastolic blood pressure, total cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, cholesterol/HDL ratio, and hemoglobin A1c (cardiovascular measures), diabetes self-efficacy, self-management of exercise and health status (self reported measures). One on one in depth interviews were conducted post eight week intervention with themes identified. Results: Data was analyzed using the Wilcoxon Signed Ranks Tests (P=.05) and Spearman's Rank Correlation Coefficients Tests. Statistically significant improvement was observed in all physical therapy and self reported measures. A statistically significant decrease in waist circumference was noted post eight weeks. Although other risk factor changes were not statistically significant, this study demonstrated a trend toward improved glycemic control (7.2% to 6.6%); decrease in cholesterol, cholesterol/HDL ratio, and an increase in HDL. Self reported measures were not correlated with any other dependent measures with the exception of self-efficacy and health status. Participants reported the components of the entire program (health buddy, action plan, exercise journal and physical therapist) provided a sense of accountability and promoted self confidence. Participants also perceived the feedback provided by the program facilitated self-management and adherence. Barriers and challenges to the program included: arthritis, use of the weights, blood pressure device and scale. Conclusions: An eight week home-based exercise program using self-management strategies was beneficial for individuals with type 2 diabetes with significant improvements in physical therapy and self reported measures along with a significant decrease in waist circumference. There was also a trend towards a significant decrease in hemoglobin A1C. Clinical Relevance: These findings are relevant to the physical therapy profession as they provide an evidence based treatment model for a short term (8wk) self-managed exercise program that can achieve statistically significant and clinically significant outcomes in individuals with type 2 diabetes within a home-based setting.

2010 December; 21(4): 23–29.

CHANGES IN CARDIOVASCULAR ENDURANCE AND EFFICIENCY AFTER 8-WEEK MULTI-MODAL EXERCISE TRAINING IN INDIVIDUALS WITH AMPUTATION

Purpose/Hypothesis: Although health promotion programs for individuals with disabilities are developing as a new frontier for physical therapists, few community-based exercise training programs exist for people with amputation. This study attempted to examine the effects of 8-week multimodal exercise training on cardiovascular endurance and energy efficiency in persons with lower-limb amputation in a community setting. Number of Subjects: Eleven subjects were initially enrolled, but only seven people (3 women, 4 men) completed the study: six with below-knee amputation and one with above-knee amputation (age: 53±13 yr, BH: 175± 10 cm, BW: 98±26 kg). They had stable medical conditions, lived a sedentary life, and walked independently with prosthesis. Materials/Methods: Outcome measures of the six-minute walk test (6MWT) and the 4-stage metabolic exercise test were evaluated pre- and post-training. The 6MWT was conducted on a 150-foot segment of hallway with blood pressure, perceived exertion, and telemetry electrocardiography monitoring. The exercise test utilized a 3-minute staged elliptical cycle ergometer protocol with 4 workloads (25, 50, 75, 100 w), and breath-by-breath gas analysis was performed synchronously via a metabolic cart. The 8-week training involved resistive exercise, balance exercises, and aerobic exercises and subjects were trained either onsite or at home. The onsite aerobic exercise consisted of 20 to 30 minutes of elliptical bike exercise at “moderate intensity” based on the Rating of Perceived Exertion scale. The home-based group followed a custom-design exercise booklet and a walking program with a pedometer. Descriptive statistics were analyzed for demographic data. Paired t test (one-tailed) was used to analyze the changes in distance of the 6MWT. Two-way (time × workload) repeated measures ANOVA was used to compare the oxygen consumption between pre- and post-training for the 4 workloads. Statistical significance was set at p < 0.05. Results: After training, the distance of the 6MWT significantly increased (p = 0.03). For the metabolic exercise test, the oxygen consumption was significantly lower after training at 50w, 75w, and 100w (p < 0.05 respectively); but there was no significant difference at 25 watts (p > 0.05). Conclusions: This community-based short term multimodal exercise training is effective for individuals with lower-limb amputation, as evidenced by the improved endurance on the walk test and a lower oxygen demand after training at three given submaximal workloads. Clinical Relevance: Community-based multimodal exercise training is feasible and beneficial for apparently healthy individuals with lower-limb amputation. Regular cardiovascular endurance exercise could lower risk factors of heart diseases and diabetes in the long run. Whether the onsite program is more effective than the home-based exercise program, it would require future studies with a larger sample size. Acknowledgement: We appreciate the funding support from the Texas Physical Therapy Foundation for this project.

2010 December; 21(4): 23–29.

CARDIOVASCULAR DISEASE AND VIETNAM VETERANS WITH WAR-RELATED AMPUTATION: FORTY YEARS POST INJURY

Purpose/Hypothesis: This presentation uses data collected from research performed through the Indiana-Ohio Center for Traumatic Amputation Rehabilitation Research. The Center was formed in 2006 with funding from the US Department of Defense, and its purpose is to assess long term health outcomes of Vietnam veterans with war-related amputation. The research hypothesis guiding the Center formation was that United States military personnel who experience a traumatic war related amputation would have unique rehabilitation needs in terms of their health and health care over their life span. One of the areas studied was cardiovascular disease and associated risk factors. Number of Subjects: The Center registry currently has 454 Vietnam veterans with war related amputations enrolled; 224 participated in this study. Materials/Methods: A comprehensive survey was created to assess health outcomes among Vietnam veterans with war-related amputations. Areas addressed were chosen based on literature review of relevant articles as well as feedback from veterans, clinicians, and the Center's Advisory Board. The survey was initially conducted by telephone and available on line. One hundred and one participants completed the survey through the telephone interview and 123 additional participants completed the survey on line. There were no statistically significant differences in results reported in the two groups and therefore the data were collapsed into a single database of 224 completed surveys. Results: Examining participants' responses to health related questions, in particular cardiovascular disease and related risk factors, there was a high rate of hypertension (66%) among these veterans. Other levels of cardiovascular disease were reported such as angina (20.5%), prior heart attack (17.6%), and congestive heart failure (2.7%). Level of amputation was not significantly associated with cardiovascular disease in our sample. Respondents also reported associated cardiovascular risk factors such as diabetes (23.4%), obesity (15.2%), and depression (33.3%). Conclusions: In contrast to other published studies, this study failed to find an association between amputation level and cardiovascular disease. Despite this lack of association it is evident that there is a high level of hypertension among this population of persons with amputations that is consistent with the literature. Study participants exhibited relatively low levels of other cardiovascular disease and risk factors. However, there did appear to be correlations among risk factors and the presence of cardiovascular disease. Clinical Relevance: This study is one of the few studies that examine the long term outcomes of people with amputations, albeit in a specific cohort-Vietnam veterans with war-related amputations. Physical therapists who evaluate and treat patients with amputations of long standing should be aware of the elevated risk for cardiovascular complications even in those patients for who amputation was not due to cardiovascular disease. This awareness will enhance patient care.

2010 December; 21(4): 23–29.

MAXIMAL OXYGEN CONSUMPTION IN COMPETITIVE RUNNERS AND CYCLISTS: A COMPARISON OF THREE SUB-MAXIMAL TESTS WITH THE 1.5 MILE RUN

Purpose/Hypothesis: Physical therapists are integrating more skilled preventative health care services in the fitness industry. As a result, a new paradigm of patient/client management will be required to address evidence-based exercise prescription in the healthy population. Knowledge of the most valid mechanisms to measure maximal oxygen consumption will be needed to assess cardiovascular fitness. The purpose of this study was to compare estimated maximal oxygen consumption values (VO2max) between three sub-maximal clinical tests and the 1.5 mile field run in competitive runners and cyclists. Number of Subjects: Data were collected from eighteen recreational runners (females: n=11, males: n = 7, mean age = 24.0 years) and eleven competitive cyclists (females: n=1, males: n=10, mean age = 42.8) for a total of 29 subjects. Materials/Methods: Subjects volunteered to run a 1.5 mile maximal field test, and complete three sub-maximal VO2 clinical tests, including: 1) Astrand-Rhyming Cycle Ergometer; 2) Single-Stage Treadmill Walking Test; 3) Single-Stage Treadmill Jogging Test. The 1.5 mile field test was completed on an indoor track. VO2 max values for all tests were calculated using standardized equations from the American College of Sports Medicine. Results: Pearson correlation coefficient values and standard estimates of error were calculated for all sub-maximal oxygen consumption tests in comparison to the 1.5 mile run. Data for runners: Astrand-Rhyming (r = 0.509, SEE = 3.34); Single-Stage Treadmill Walking Test (r = 0.828, SEE = 2.17); Single-Stage Treadmill Jogging Test (r = 0.849, SEE = 2.04). Data for cyclists: Astrand-Rhyming (r = 0.724, SEE = 2.79); Single-Stage Treadmill Walking Test (r = 0.556, SEE = 4.46); Single-Stage Treadmill Jogging Test (r = 0.918, SEE = 2.12). Combined data: Astrand-Rhyming (r = 0.520, SEE = 3.34); Single-Stage Treadmill Walking Test (r = 0.516, SEE = 3.71); Single-Stage Treadmill Jogging Test (r = 0.847, SEE = 2.30). Conclusions: The Single-Stage Sub-maximal Treadmill Jogging Test had a high correlation and small standard estimate of error in both runners and cyclists. When data from runners and cyclists were combined, the treadmill jog test maintained a high correlation value of 84.7%. These data indicate that use of a simple treadmill jog test is a good clinical predictor of maximal oxygen consumption in both runners and cyclists. In contrast, the Astrand-Rhyming Cycle Ergometer test poorly correlated to maximal oxygen consumption values in runners, and only marginally correlated in cyclists. Clinical Relevance: Results from this study may be used as a reference to select appropriate sub-maximal VO2 tests to prescribe cardiovascular intensity levels. Future Studies: Different versions of sub-maximal VO2 testing should be selected for comparison to maximal tests such as the 1.5 mile run. In addition, utilizing a maximal oxygen consumption test based on cycling versus running might yield a higher correlation to the sub-maximal Astrand-Rhyming cycle test, especially in competitive cyclists.

2010 December; 21(4): 23–29.

COPD PROGRAM: A NEW CONTINUUM

Purpose: Our COPD program is one of the only programs in Connecticut that manages the care of patients with COPD across the continuum. In 2008 a community health assessment for Middlesex County found 18% of adults reported being current smokers and 33% of adults reported being former smokers. The emergency room admission rate for people with COPD exacerbations was 478/100,000 visits, higher than the state average of 347/100,000 visits. Ninetyfive percent of hospitalized patients were discharged without any COPD disease specific care. Description: Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Standard the goal of COPD management at Middlesex Hospital is to relieve symptoms, prevent disease progression, improve exercise tolerance, improve health status, prevent and treat complications, prevent and treat exacerbations, reduce mortality, prevent or minimize side effects from treatments. Goals are achieved through assessment and monitoring of diseases, reducing risk factors, managing stable COPD, and managing exacerbations.

Upon admission to the hospital, patients with a diagnosis of COPD are assigned to the COPD pathway and evaluated by a therapist. All patients with a new diagnosis of COPD and/or newly prescribed oxygen receive therapy in the home. Homecare therapists identify signs of COPD exacerbation, risk factors, medication management, and performing standardized assessments such as the 6MWT, Barthel Index and Tinetti Test. Patients then participate in a 12 week outpatient physical therapy, occupational therapy and group therapy program. Evidenced based measures are used for evaluation including the Chronic Disease Questionnaire (CRQ), Pulmonary Functional Status and Dyspnea Questionnaire, BORG Scale, Geriatric Depression scale, 6MWT, Functional Reach test, and TUG. Vital signs are monitored to determine the need for supplemental oxygen with physician approval. Weight and glucose levels are monitored as needed. Patients participate in lectures by a multidisciplinary team. Individual referrals are made for Speech Therapy, Respiratory Therapy, Nutrition, Psychosocial intervention, Nursing and Smoking Cessation. After discharge from the outpatient program, patients participate in a Better Breathers' support group. Summary of Use: Since implementation of our COPD program in January 2009, there has been a 3% decrease in admissions of the patients with COPD to the emergency department, a 76% decrease in deaths amongst COPD patients and a 29% increase in the number of patients who were discharged home with services. In the outpatient setting the average improvement in the 6MWT is 59 meters. The CRQ scores also significantly improved: Dyspnea (19%), Fatigue (22%), Emotion (12%), and Mastery (22%). Importance to Members: Since the implementation of our program there has been a decrease in hospital/emergency department admissions and a significant increase in quality of life indicators with patients with COPD. If this program continues to be a success, we hope to use this program model for other populations, including geriatrics and obesity.

2010 December; 21(4): 23–29.

BREATH: A GAME TO MOTIVATE THE COMPLIANCE OF BREATHING EXERCISES

Purpose/Hypothesis: There is a need for breathing exercise programs to improve the lack of motivation often associated with exercise. This project involved the development and initial user testing of a game-based incentive spirometry system to motivate patients to perform breathing exercises. Number of Subjects: Six therapists and six persons with spinal cord injury and prior experience using an incentive spirometer evaluated two prototype systems. Materials/Methods: The spirometry input device uses airflow measured from an incentive spirometer and LabPro system (Vernier Software and Technology) to interact with the computer based video game environment. When attached to the Spirometer, the LabPro System measures the airflow from the spirometer and presents the data in graphical format on a computer screen. The prototype interaction device developed for this project was programmed to use the airflow measured from the spirometer as an input device to interact with two games developed using Microsoft's XNA Game Studio in C# programming language. The system provides individualized challenge levels and quantitative measurement of progress and compliance. A method was developed to provide the user with control over the settings of the game and to input their own breathing pattern in order to individualize treatment goals and level of challenge. The First game prototype was deep breathing game in which the user must control a person on a magic carpet flying over buildings and under bridges with their breath. The second game was a breath stacking game in which the user must control a camel trying to cross a river by jumping onto two or three logs (consecutive breathes in) and onto the shore (breath out). Participants were asked to play the two game prototypes and provide feedback on the system, hardware, gameplay, and the use of the system for breathing exercises. Results: Therapists were excited about the ability to calibrate the game-based tasks for specific patients. Five patients commented that the ability to calibrate the system to their own breathing ability was an important feature to them. Both therapists and patients agreed that the user interface was simple and easy to use. Suggestions were provided by both groups to add music to the game, providing auditory cues of the breathing pattern required in addition to the visual cues and feedback. Each patient stated that the use of this game based system would motivate them to perform breathing exercises more regularly than the existing system they use. All patients and therapists found the two games visually stimulating and fun to play. Conclusions: The feedback provided by participants has been incorporated into revised prototypes that will be assessed over Summer 2010, leading to a clinical trial at the end of 2010. Clinical Relevance: The integration of medical devices with video game technologies offers great potential to improve assessment, and collect objective data regarding patient compliance and lung function.

2010 December; 21(4): 23–29.

SMOKING CESSATION COUNSELING SKILLS AND CONFIDENCE ARE INCREASED IN DPT STUDENTS FOLLOWING COMMUNICATION SKILLS EDUCATION

Purpose/Hypothesis: Resolution of many conditions managed by physical therapists is impacted by smoking. While many physical therapists assess smoking status, most rarely engage in active smoking cessation counseling. Physical therapists are ideally positioned to provide smoking cessation counseling because, unlike other healthcare professionals that see patients once or twice per year, physical therapists have frequent patient contact during an episode of care, allowing for support, monitoring, and follow-up during a smoking cessation attempt. One approach to increase smoking cessation counseling by physical therapists may be to identify and subsequently reduce barriers to providing counseling during the physical therapists' academic preparation. We recently reported that the most common barrier identified by physical therapy students (n = 42) was a lack of sufficient communication skills to confidently engage in smoking cessation counseling (56%), particularly when providing motivation for increasing a patient's desire to stop smoking and when addressing issues related to an enabling spouse. The objective of this investigation was to examine the effect of a smoking cessation communication skills seminar (SCCSS) on the proficiency of counseling skills and willingness to engage in smoking cessation counseling in a cohort of physical therapy students. Number of Subjects: Physical therapy students (n = 44) participated in smoking cessation education that consisted of a lecture, two online continuing education courses, and a smoking cessation intervention knowledge assessment [mean (SD) = 88% (6%)]. Materials/Methods: Students then participated in a SCCSS provided by a seasoned counselor with academic and clinical expertise in addiction counseling techniques. Following the SCCSS, students rated their perceived counseling skill ability and willingness to engage in smoking cessation counseling on a 5 point Likert scale (1= poor; 5 = very good). Smoking cessation counseling skills were objectively evaluated during the practical examination of students who had a smoker for their case (n = 37). Results: Prior to the SCCSS, the majority of students perceived their smoking cessation counseling skills and willingness to engage in smoking cessation counseling to be AVERAGE [skills, median 3 (2 – 5); willingness, median 3 (2–5)]. Following the SCCSS, students' perceptions of their communication skills and willingness to engage in counseling increased on average by one unit to VERY GOOD. [skills, median 4 (3 – 5); willingness, median 4 (3–5); p < 0.001 for both]. Objective assessment of smoking cessation counseling skills revealed that 29 of 37 students met competency (p < 0.001). Conclusions: These preliminary findings suggest that a SCCSS increased students' perceived and objective counseling skills and willingness to engage in smoking cessation counseling. Clinical Relevance: Educational opportunities that enhance students' competence and confidence in counseling skills may facilitate active engagement of smoking cessation counseling in practicing physical therapists.

2010 December; 21(4): 23–29.

ASSESSMENT OF THE BUILT ENVIRONMENT AND THE EFFECTS ON THE PERCEPTIONS OF A HEALTHY CAMPUS

Purpose/Hypothesis: The purpose of this research study was to assess the built environment and the perceptions of faculty, staff and students on a college campus following an interdisciplinary initiative. Number of Subjects: 423 faculty, staff, and students from an urban university in the Northeast United States completed a survey. Materials/Methods: 423 respondents participated in a 33 question online survey about the built environment on campus, including self-reported physical activity and nutrition status. The survey was completed each fall for 3 consecutive years beginning in 2007. In addition, an observational assessment of the built environment was conducted using the CDC walkability audit tool during yr 1 and yr 3 of the study. Coalitions were strategically developed to plan interventions, coordinate implementation of interventions and serve as ‘champions for change’ for the proposed environmental changes. Policy and environmental changes included point of decision prompts, media campaigns, stairwell improvements, implementation of a bike share program and campus-wide policy changes. Changes in the built environment and the perceptions of the built environment were measured over a 3-yr period. Results: Of the 423 survey respondents, 37% were men and 68% were women, with a mean age 29.6 yr. The self-reported average BMI was 25.1 + 5.0 in yr 1, 24.7 + 5.1 in yr 2 and 24 + 3.9 in yr 3. A subset of questions was chosen for analysis, which focused on the perception of the built environment and self-reported physical activity. Using the Kruskal-Wallis test on the eight-question subset, a significant change was noted between years on 3 of the 8 questions. Two of these questions were about self-report daily vigorous or strengthening activities, with an overall greater number of participants reporting participation in aerobic or strengthening exercises. A significant change was also noted in the perceptions of the campus environment, with 26% of the respondents in yr 1 reporting that sidewalks were well maintained vs. 36 % in yr 3. Based on the CDC's walkability audit tool the campus is moderately walkable with the average walkability score for the three campuses of 68/100 on year 1 and 66/100 on year 3 (p>0.05). Conclusions: Although objective measures of campus walkability demonstrate no change, significant positive changes in self reported physical activity and perception of campus sidewalk maintenance are noted during a three year time frame in which specific programs and interventions where conducted on a college campus. Clinical Relevance: Obesity continues to be a public health concern in the United States and throughout the world. The American College Health Association estimates that three out of every 10 college students are overweight or obese. The built environment is one of the contributing causes of the obesity epidemic. The built environment needs to be part of interventions and assessments to increase physical activity and improve nutrition and decrease the risk factors associated with obesity.

2010 December; 21(4): 23–29.

INVESTIGATING THE NEED FOR HEALTH AND WELLNESS PROGRAMMING FOR EMPLOYEES OF THE UNIVERSITY OF SOUTH ALABAMA

Purpose/Hypothesis: Recently, employers, including universities, have begun to implement on-site health and wellness programming for their employees. These programs provide benefits to both employees and employers including decreased health care costs, decreased health insurance premiums, a lower turnover rate, decreased sick leave, increased employee job satisfaction and overall better employee fitness. The purpose of this study was to determine if additional health and wellness resources and programs would be both of interest to and beneficial to faculty and staff at the university medical and educational settings at the University of South Alabama (USA). Number of Subjects: 622 Materials/Methods: A survey was designed to investigate the need for and interest in further health promotion programming at the university, which included a Physical Activity Readiness-to-Change Questionnaire. An invitation to participate in the questionnaire, description of the questionnaire and a link to the questionnaire via Zoomerrang were emailed to all university employees. Employees without university computer access were accommodated with a paper format of the questionnaire. Results: Of the 622 respondents, 65.7% were female, 34.3% were male, 59.3% were staff, 23.8% were faculty, 9.2% were medical personnel, and 7.6% were administration. Over 65% of participants were overweight or obese using Body Mass Index (BMI). Approximately 86% of respondents reported a need for additional health and wellness resources. The most frequently reported barrier to participation in physical activity was lack of time (74.9%). The most frequently reported incentive was reduced healthcare insurance premiums (38.8%). Within the Readiness-to-Change Questionnaire, employees' scores indicate they are between the Contemplation Stage and the Action Stage. Conclusions: Respondents are aware that change is necessary and would like additional assistance and resources to better enable participation in physical activity and health promotion activities. Barriers to and incentives for participation need to be addressed in program development. Additionally, it is evident that there is a strong need for a health and wellness program at this university based on the BMI results of this questionnaire with this result probably being representative of the employees as a whole. Clinical Relevance: Healthcare risks and costs are greatly increased in those that are overweight or obese. Prevention of chronic disease should be a priority, particularly in the Southeast region of the United States where unhealthy lifestyle risk factors are more prevalent. The physical therapist should play an integral role in the development of interventions of health and wellness programming. The literature supports the employer's responsibility in facilitation of such programs.

2010 December; 21(4): 23–29.

A COMPARISON OF ENERGY EXPENDITURE ESTIMATES FROM THE ACTIHEART AND ACTICAL PHYSICAL ACTIVITY MONITORS DURING LOW INTENSITY ACTIVITIES, WALKING, AND JOGGING

Purpose/Hypothesis: Combining accelerometry with heart rate monitoring has been suggested to improve energy estimates, however, it remains unclear whether the single, currently existing commercially available device combining these data streams (Actiheart) provides improved energy estimates compared to simpler, less expensive, and less burdensome accelerometry-only devices. The purpose of this study was to compare the validity of the Actiheart and Actical devices during low and moderate intensity activities. Number of Subjects: Twentyseven participants [mean age; 26.3(7.3)] volunteered for the study. Materials/Methods: Participants wore one Actical on the left hip, an Actiheart on the chest and an indirect calorimeter (K4b2) on the back while card playing, sweeping, lifting weights, walking and jogging. Results: Both devices underestimated energy across all activities although the estimates by both devices were significantly associated with energy expenditure. Results regarding relative accuracy of the devices varied based on a consideration of all activities as a group or by each individual activity. Viewed across all activities, the correlation coefficients for the Actical (0.98) and Actiheart (0.99–1.00) devices to the indirect calorimeter were almost identical, however the slopes (Beta) of the Actical device were substantially better than the Actiheart device, being close to one (1.06) for the Actical and substantially above one (range: 1.46–1.74) for the Actiheart. This suggests that across all activities the Actical device provides superior estimates to the Actiheart device. However, viewed by individual activity, the Actiheart estimates were significantly better than the Actical estimates during card playing, sweeping, and weight lifting. Conclusions: Viewed across all activities, the Actical provides superior estimates of energy expenditure compared to the Actiheart when using the default group calibration formulas within the Actiheart. In contrast, the Actiheart appears to provide better estimates than the Actical for activities in which acceleration is not closely related to energy expenditure (card playing, sweeping, lifting weights). Clinical Relevance: The information provided by this study may be useful to researchers attempting to make practical decisions regarding the selection of accelerometry-only devices versus combined accelerometry plus heart rate devices. Researchers must clearly consider the specific population and specific activities being examined so the aims of the study can be aligned with the appropriate measurement device. This study suggests that, if the group calibration equations with the currently available Actiheart are to be used, there may be a limited number of physical activities for which the increased cost, complexity, and subject burden of the Actiheart are balanced by the degree of improvement in energy estimates.


Articles from Cardiopulmonary Physical Therapy Journal are provided here courtesy of Cardiopulmonary Physical Therapy Section of the American Physical Therapy Association