Sedentary behaviour in patients in hospital
Transcript of Sedentary behaviour in patients in hospital
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Sedentary behaviour in patients in
hospital
Jorunn L Helbostad The Geriatrics, Movement and Stroke research group
Norwegian University of Science and Technology,
Trondheim, Norway
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Sitting time in Norwegian politicians
http://www.aftenposten.no/nyheter/iriks/Verdens-sprekeste-folk-Tvert-i-
mot--7765990.html
Mean
545 minutes
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Sedentary time in the Norwegian adult population (minutes per day)
Sedentary=
<100 counts/min
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Sitting time in Europe, aged 18-64 years
Bauman et al. 2011
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Sample Women n=833, 53% Men n=759, 48%
Age (years) 72.5 ± 2.1 72.4 ± 2.1
Height (cm) 163.4 ± 5.2 176.9 ± 5.9
Weight (kg) 68.2 ± 10.7 83.0 ± 11.8
BMI (kg/m2) 25.5 ± 3.7 26.5 ± 3.3
No. medications 1.2 ± 1.9 2.5 ± 3.9
Fallen past year 32 % 30 %
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Physical activity and sitting time
Women Men
Normal gait speed (m/sec) 1.29 ± 1.94 1.33 ± 2.00
Active >30 minutes daily 79 % 68 %
Daily sitting time (hours) 5.5 ± 3.7 6.5 ± 4.5
Daily time in MVA 34.8 ± 19.8 min 36.6 ± 20.9 min
Sitting time is not associated with
physical activity, but with lower muscle
strength
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Sitting time, physical activity and
depression
Van Uffelen og medarb., 2013
>7 hours 47% increased risk
< 150 min
per uke 99% increased risk
+ 196% increased risk
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Effect of inactivity in older people
Ten days of bed rest
• ↓ 1 kg muscle mass
• ↓ 16% muscle strength
• Physical performance did not decline
Long term immobilization
• ↓ Activities of daily living
• ↓ Mobility
• ↓ Physical activity
• ↓ Social activity
Kortebein P. et al 2007, 2008
Gill TM et al 2004
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Kortebein et.al 2007, JAMA http://nhi.no/livsstil/livsstil/diverse/sengeleie-gir-hurtig-tap-av-styrke-og-muskelmasse-25827.html
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Reduced muscle strength with increasing
age and spare capacity
alder
Threshold for function
strength
spare
capacity
100%
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Frailty and vulnerability
Clegg et al., Lancet 2013
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Time in upright during the day by
location
Figure 1 — Mean time upright by hour and location
Grant, JAPA, 2010
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Time in upright during the day by location
• Community-dwellers: 360 ±112 minutes
• Day hospital: 233• ± 112 minutes
• Ward (city): 70 ±• 50 minutes
• Ward (rural): 80 • ±• 41 minutes
Grant, JAPA, 2010
15 Harstad apirl 2011
Monitored activity during a rehab stay and
at home
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The Trondheim hip fracture trial
• An RCT comparing the effect of being treated in an orthogeriatric ward
compared to an orthopeadic ward (n=397)
Inclusion criteria
• Home-dwelling before the fracture
• >70 years of age
• Able to walk before the fracture
• Length of stay
– Orthogeriatric department: 12.6 ± 0.43 days
– Orthopeadic department: 11.0 ± 0.54 days
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Mobilization regime in the orthogeriatric ward
• Interdiciplinary team approach
• Individually tailored mobilisation
plans
• Physiotherapists prioritized the
frailest patients
• Use of pre-fracture ADL level to set
goals for the mobilisation
Saltvedt et al. 2013
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Activity monitoring
Day 4 after surgery
4 months
12 months
27 min
Upright time
3 h 58 min
Upright time
3 h 16 min
Upright time
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Results – 4th day after hip surgery
Orthogeriatric Orthopeadic
Taraldsen et al. 2013
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Time in upright through the day
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Tid
i o
pp
reis
t sti
llin
g (
min
utt
er)
DG
DOS
GERIATRISK AVDELING
ORTOPEDISK AVDELING
Taraldsen m.fl, J Gerontol A Biol Sci Med 2013
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Mean upright time and number of sedentary breaks 4 days after surgery
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H1 H2 H3 H4 H5 H6 H7 H8 H9 H10H11H12H13H14H15H16H17H18H19H20H21H22H23H24
No of sedentary breaks
Orthogeriatric
Orthopeadic
Upright time
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Activity pattern over four days for a patient with impaired cognition
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Upright time and number of sedentary breaks 4 and 12 months after surgery
4 months 12 months
Orthoger. Orthopead.
p=0.003 p=0.018
Upright time in favour of the orthogeriatric group Hospital: 13 minutes 4 months: 40 minutes 12 months: 32 minutes
Orthoger. Orthopead.
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Gait speed
Better than normal: > 1.4 m/s m/sec
Normal: 1.0 – 1.4 m/s
Reduced: 0.6-1.0 m/s
Severely reduced: < 0.6 m/sec
4mnth 12mnth 12mnth 4mnth
Orthogeriatric Orthopeadic The I.A.N.A task force, 2009
Older people
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Physical activity and sedentary behaviour the
first six months after stroke: Median (IQR) Askim et al. 2013
2 weeks 1 month 3 months 6 months
Lying (minutes) 924
(714-1130)
755
(656-910)
760
(663-877)
786
(655-919)
Standing (minutes) 92
(11-141)
146
(29-321)
144
(31-248)
144
(66-232)
Transitions (no) 50
(16-103)
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(32-103)
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(35-123)
59
(48-89)
Change in upright time was associated
with change in function (Berg Balance
Scale, ADL)
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Physical activity early after stroke
-Behavioural mapping
Askim et al. 2011
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Percentage of time spent on different
activities
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Stroke patients: Time spent in bed in
relation to severity of the stroke
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Who are the stroke patients spending time
with?
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Physical activity in hospitalised stroke patients
West and Bernhardt, 2014
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Physical activity in hospitalised stroke patients
• Nearly 50% of the time is spent inactive
• About 50% of the time is spent alone in the bedroom
• About 1 hour per day is spent in physiotherapy and in occupational
therapy
– Limited amount of time with therapists is spent in moderate to high level
activity
• Activity is lowest the twoo first weeks after the stroke
– Activity is lower in neurological wards compared to stroke units.
West and Bernhardt, 2014
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Summary
• Old hospital patients are vulnerable for functional decline
• Hip fracture patients and stroke patients in hospital spend
most of the day in sitting/lying
• Ward matters when it comes to sedentary and low
intensity activity
• Inactive time in hospital predicts function
• Reducing sedentary time and increasing mobilisation
during the hospital stay improve functional outcomes up to
a year after the hospital stay
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Thank you!