Sunday, 17 April 2016

ClinicSpeak & BrainHealth: how active is active?

Are you an activant or a sedant? #ClinicSpeak #MSBlog #MSResearch

"I got very frustrated this morning. I woke in Vancouver at 3.30 am and wanted to go the gym to exercise, only to find that my budget hotel does not have a gym on the premises and that I would need to wait for the commercial gym around the corner to open to excercise. I tend to take being active for granted, which includes having access to a gym in congress hotels. I must admit I am on a tight budget and this hotel is short on luxuries. The point I am making is that I have to do extra activities beyond what I do in a typical day to make sure I achieve a target of physical activity. It is clear that for a the majority of MSers this is a problem. One way of getting some insight into how active you are is to measure your activity. There are a large number of relatively inexpensive devices, or accelerometers, available to measure how active or sedentary you are. The study below shows that accelerometers are relatively accurate and that by wearing them for a period of 3-7 days will give you an idea of your activity levels. It will tell you if you are an activant or a sedant."

"About two years ago I tested the Jawbone and FitBit accelerometers and found them quite motivating for increasing my activity. Sadly, both the devices failed and I got back into my old habits. We showed several years ago that activity measured using a wrist and ankle accelerometers were very accurate at assessing upper and lower limb disability. The question is whether or not you want to track your physical functioning using these devices. It may be great to show in early relapsing MS that your physical activity is stable or increasing and hence are doing well. On the other hand you may find it quite depressing to see your activity falling off with progression of your disease. The good thing about  the new generation of smart accelerometers is they are connected to the cloud and allow you to be social and compare your data and activity with other people. This sharing helps motivate people to try harder and may stimulate a bit of competition. We propose using Fitbit devices to take on the Australians in our Brain Health challenge. I would be interested to know if any of you are using these devices and how they have affected your day-to-day functioning?"


Klaren et al. Reliability of Accelerometer Scores for Measuring Sedentary and Physical Activity Behaviors in Persons With Multiple Sclerosis. Adapt Phys Activ Q. 2016 Apr;33(2):195-204. d

This brief research note examined the reliability of scores from an accelerometer as measures of sedentary and physical activity behaviors in persons with multiple sclerosis (MS). The analysis was performed on a combined data set from 2 previous longitudinal investigations of physical activity in MS. We focused on the number of days required to reliably estimate sedentary behavior, based on time spent in sedentary behavior per day and number of sedentary breaks, number of long sedentary bouts, and average length of sedentary bouts per day. We further examined the number of days required to reliably estimate physical activity behavior, based on time spent in light and moderate-to-vigorous physical activity and average length of activity bouts per day. Between 4-6 days of monitoring and 3-7 days of monitoring were necessary for good reliability of scores from all sedentary outcomes and physical activity outcomes, respectively. These results should guide research and practice examining sedentary and physical activity behaviors using accelerometry in persons with MS.

26 comments:

  1. Activity tracking is the best thing since sliced bread. I have used several devices and they all measure different things a bit differently, but it does not matter. I am comparing myself to myself every day and know when I have to move more.
    By the way, prof G, you have to vary your exercise routine :-) - some cardio, some strength training, some yoga for flexibility and mood :-). Try weight training using your own body weight - no equipment needed and no time wasted looking fo the gym - one of the most trendy forms of exercise. Or for more fun take a door sling with you - it weighs nothing, gives an excellent balance and strength training workout in no time at all, anywhere. ( cheapies work as well as expensive ones, no need to break the bank).

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    1. Thanks for the advice. I tried that this morning and went out for a 4 mile run along the water. Beautiful. My brain is feeling healthier for it.

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  2. What I'd be interested in is do you monitor your patients on DMTs. If someone is on a highly effective DMT are they relying entirely on medication rather than helping themselves by exercising and leading a healthy lifestyle. Surely this would influence your success rate. I ask this as I had a boss that was prescribed Statins and saw this as a green light to eat what he wanted. Sadly he is no longer with us

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  3. Sadly the perception of ProfG is not the reality. Here is some of a post I fished out of spam.

    Mouse, Thanks for the post. Prof G sent me the email below and asked me to forward it on to you: sorry I had to rush off last week (needed to close down my accounts in Panama and transfer to Isle of man). Arrived in Vancouver safely (lobster thermidor in First Class was excellent although wine selection was disappointing). Looking forward to neuro bowl and the tour of the town (pity I have to show my face at the bloody meetings). Hope I'm not asked any details about my three posters - one of the lab technicians produced them. Please can you make sure the mice are spotless - RSPCA are sniffing around. Let me know if you need any fags - they are dirt cheap in Canada and I can fill my Samsonite to the brim. Customs never pull me over as I play the "Do you know who you are speaking to" card. I'll try the casino / strip joint you recommended tonight - I can catch-up on sleep on AAN.

    Thanks for this pearl of wisdom but I dont smoke.

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    1. I wish. Economy plus on an old Boeing 747, dried haddock in a silver fast-food carton, cheap wine in a plastic bottle, a budget hotel (Comfort Inn) without a gym, no breakfast included and no fine dining. I suppose I can daydream as well.

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    2. I did notice that one of my movement disorder colleagues from London flew out on first class. May be I chose the wrong subspecialty?

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    3. MD, sour grapes on not being invited to the party???

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    4. Maybe your movement disorder colleague paid for his upgrade out of his own pocket.

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    5. NGD. No not sour grapes...I would rather have knitting needles shoved in my eyes than attend a week long clinical meeting..but note I didn't write comment..I fished it out of spam and removed some of the insulting bits, ProfG has a defence mechanisms against this type of tosh but is the general view of the average blog reader; the view of someone who thinks they are a comedian or a troll:-)

      P.S. Are you in Canada too?

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    6. An interesting piece of imagery, does it come with fake Hollywood blood? Maybe I missed the memo on trolling ;) and while Prof G is pondering his air miles, I'll be at home (UK) frying a decidedly large fish!

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  4. #Groan#

    The modern day world - it hasn't happened until it is on Facebook. And you need a gadget or guidebook to acheive anything. I'd rather just appreciate the organic and spontaneous, healthy, enjoyable outdoor activities, just _living_, getting on with it. Not monitoring my stats, competing with unseen, unknown people and then (the most important bit) - posting it online: Flipping nightmare.



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    1. "organic and spontaneous, healthy, enjoyable outdoor activities, just _living_, getting on with it."
      Oh those were the days, before MS.

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  5. I like the idea of these fitness trackers for personal goals. Though I am quite unwell and I don't think me being competitive with others will help me or is that suitable.

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    1. Well, I guess, you can chose who to compete with and how seriously to take it.

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  6. Go to Stanley Park and walk/run around the perimeter. No need for a gym!

    And you'll find people doing stuff like tai chi in parks or English Bay. Or if you really want some exercise, get a bus to Grouse Mountain and do the Grouse Grind.

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  7. Do these accelerometers measure all kinds of physical activity, or just what I'll term gross movement ? For example, how accurately would they capture someone propelling themselves in a wheelchair ?

    I swim once a week - because my local disability sports club has access to our community pool only once per week and I wouldn't be able to access the pool without the additional equipment the club has purchased. This is the only sport I've found so far that can provide me with cardiovascular exercise. I can't run, or walk any significant distance and balance issues affect me using static bikes or rowing machines.

    Any sensible suggestions for other forms of cardiovascular exercise that might be accessible to me ?

    Archery is my main sport and I've estimated I pull the equivalent of 1.5 metric tons per week. How would that be captured as a measure of activity ? Would my time shooting be classified as sedentary because I'm a seated archer ?

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    1. The garmin activity tracker may be better as you can wear it while swimming. None of them are terribly good for strength activities, but you may find a heart rate monitor interesting, some of them give you more insight as you can see your breathing rate as well.

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    2. Lisa, upper limb exercises which raise your heart rate >100bpm and works up a sweat wound be considered cardiovascular activity. Boxing style moves done as reps, with elevation of arms above your head (the heart works faster when pumping against gravity). The activity load can be increased by adding arm weights as bands around both arms. Make sure you have rests between the reps to reduce the risk of joint pain/injury. Good luck.

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  8. I recently (last 3 weeks or so) bought a jawbone. My concerns are (a) I don't think it registers all my steps either as a result of me having to hold onto furniture or use my cane (b) my initial goal was to register 1000 steps per day but the lowest 'goal' is 2000 so I fail every day (c) I'd love to compete with someone as I am very competitive but, everyone else I know is registering 15000 steps per day and I have no chance of doing that! So, I think they are a good idea but maybe not yet perfect for those of us with mobility problems.

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  9. Competition is nonsensical to me with MS: Everyone's MS is so different, individual. Pre-"PPMS" I was fit and strong. Nowadays my legs often feel like bits of wood strung together by elastic bands. If someone can walk further or faster than I can, that will have a lot to do with the type and extent of neurological damage I have suffered, and not much to do with a lack of training or effort on my part. Exercise should be about individual goals and wellbeing.

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    1. I agree with your comment "Exercise should be about individual goals and wellbeing".
      I walk for an hour a day at a fairly fast pace and also walk up some steps, and feel great when I get home. I have no car.
      I feel pleased about my exercise and don't really need to 'track and record it'.

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    2. I really like your discription legs "feeling like bits of wood strung together by elastic bands." The first time I had to discribe my MSlegs I called them Pinocchiolegs. Its so difficult to make a clear discription of a new symptom.

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