Objective assessment of physical activity and sedentary behaviour in knee osteoarthritis patients – beyond daily steps and total sedentary time

Abstract

BackgroundKnee osteoarthritis patients may become physically inactive due to pain and functional limitations. Whether physical activity exerts a protective or harmful effect depends on the frequency, intensity, time and type (F.I.T.T.). The F.I.T.T. dimensions should therefore be assessed during daily life, which so far has hardly been feasible. Furthermore, physical activity should be assessed within subgroups of patients, as they might experience different activity limitations. Therefore, this study aimed to objectively describe physical activity, by assessing the F.I.T.T. dimensions, and sedentary behaviour of knee osteoarthritis patients during daily life. An additional goal was to determine whether activity events, based on different types and durations of physical activity, were able to discriminate between subgroups of KOA patients based on risk factors.MethodsClinically diagnosed knee osteoarthritis patients (according to American College of Rheumatology criteria) were monitored for 1 week with a tri-axial accelerometer. Furthermore, they performed three functional tests and completed the Knee Osteoarthritis Outcome Score. Physical activity levels were described for knee osteoarthritis patients and compared between subgroups.ResultsSixty-one patients performed 7303 mean level steps, 319 ascending and 312 descending steps and 601 bicycle crank revolutions per day. Most waking hours were spent sedentary (61%), with 4.6 bouts of long duration (> 30 min). Specific events, particularly ascending and descending stairs/slopes, brief walking and sedentary bouts and prolonged walking bouts, varied between subgroups.ConclusionsFrom this sample of KOA patients, the most common form of activity was level walking, although cycling and stair climbing activities occurred frequently, highlighting the relevance of distinguishing between these types of PA. The total active time encompassed a small portion of their waking hours, as they spent most of their time sedentary, which was exacerbated by frequently occurring prolonged bouts.In this study, event-based parameters, such as stair climbing or short bouts of walking or sedentary time, were found more capable of discriminating between subgroups of KOA patients compared to overall levels of PA and sedentary time. Thereby, subtle limitations in physical behaviour of KOA-subgroups were revealed, which might ultimately be targeted in rehabilitation programs.Trial registrationGerman Clinical Trials Registry under ‘DRKS00008735’ at 02.12.2015.

<p>Behavioral Conformity of Physical Activity and Sedentary Behavior in Older Couples with One Partner Suffering from End-Stage Osteoarthritis</p>

“…Their male patients climbed more stairs and slopes and performed better in functional tests but were also more sedentary compared to women. 52 The data of our study confirm their findings that PA and SB are two distinct dimensions that should be assessed separately to get a comprehensive overview of activity-related health risks in specific populations. 58 We were surprised to see that the spouses' and controls' time spent sitting could hardly be distinguished from the data of the patients.…”

“…4.330-7.750 steps/day). 15,34,52 Subjects, who served as controls in our study, fulfilled these minimum requirements and reached a sufficient number of steps on average (9.298 ± 3.490 steps/day). Differences in PA between the three groups of our study were quantified by four separate accelerometric parameters.…”

Improvements in Objectively Measured Activity Behaviors Do Not Correlate With Improvements in Patient-Reported Outcome Measures Following Total Knee Arthroplasty

“…Tools such as the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee Score (OKS) are used to record patients' perceptions of pain, symptoms, and physical function and are commonly used to evaluate short-term and long-term treatment outcomes following joint arthroplasty [29e31]. Given that the activity behavior profile of older adults with knee OA predominantly constitutes low-intensity activities (SB and LPA) [25,27,32] and that these activities are often incidental with activities of daily living [33], the aim of this study is to determine the relationship between objectively measured activity behaviors and patient-reported measures of pain, symptoms, and physical function before and after TKA. The association between the 2 constructs could be used to better understand the clinical utility of objective measures of PA as one of the markers of surgical success, but also to better understand whether improvements in pain and functional ability translate into more time spent being physically active.…”

Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review

“…Accelerometry has also been used to study the relationship of physical activity with pain in patients with knee osteoarthritis, since these patients may become more inactive due to pain and functional limitations [174]. Conversely, the results obtained in [25] indicated an increase in physical activity in patients with osteoarthritis of the facet joint after a paravertebral spinal injection.…”