Reliability and Validity of Objective Measures of Physical Activity in Youth With Cerebral Palsy Who Are Ambulatory

O’Neil, Margaret E.; Fragala-Pinkham, Maria; Lennon, Nancy; George, Ameeka; Forman, Jeffrey; Trost, Stewart G.

doi:10.2522/ptj.20140201

Cited by 58 publications

(56 citation statements)

References 41 publications

(48 reference statements)

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“…The results of these studies show accelerometer output to be strongly correlated with measured energy expenditure and sensitive to changes in PA intensity (4,21,22). In addition, several investigators have completed calibration studies for the purpose of deriving intensity-related thresholds or cut-points for classifying accelerometer counts as sedentary (SED), light-intensity PA (LPA), or moderate-to-vigorous intensity PA (MVPA).…”

Section: Introductionmentioning

confidence: 89%

“…Additionally, during each walking trial, a physical therapist walked alongside each participant to help them maintain a consistent pace throughout the 6 minutes. The walking protocol was validated in a previous study (21,22). …”

Section: Methodsmentioning

confidence: 99%

“…A sample line running from the turbine to the analyzer unit delivered expired air for the determination of O 2 and CO 2 content. The Cosmed K4b2 has been shown to provide valid measures of oxygen uptake over a range of exercise intensities (24) and has been validated for youth with CP (21,22). …”

Section: Methodsmentioning

confidence: 99%

“…The accelerometers were positioned on the left and right mid-axilla line at the level of the iliac crest. Given the previously reported high level of agreement between monitors placed on the left and right hips observed in this sample (22), only accelerometer output from the right hip were used in the current analyses.…”

Section: Methodsmentioning

confidence: 99%

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Decision Trees for Detection of Activity Intensity in Youth with Cerebral Palsy

Trost

Fragala-Pinkham

Lennon

et al. 2016

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose To develop and test decision tree (DT) models to classify physical activity (PA) intensity from accelerometer output and Gross Motor Function Classification System (GMFCS) classification level in ambulatory youth with cerebral palsy (CP); and 2) compare the classification accuracy of the new DT models to that achieved by previously published cut-points for youth with CP. Methods Youth with CP (GMFCS Levels I - III) (N=51) completed seven activity trials with increasing PA intensity while wearing a portable metabolic system and ActiGraph GT3X accelerometers. DT models were used to identify vertical axis (VA) and vector magnitude (VM) count thresholds corresponding to sedentary (SED) (< 1.5 METs), light PA (LPA) (≥1.5 and <3 METs) and moderate-to-vigorous PA (MVPA) (≥ 3 METs). Models were trained and cross-validated using the “rpart” and “caret” packages within R. Results For the VA (VA_DT) and VM decision trees (VM_DT), a single threshold differentiated LPA from SED, while the threshold for differentiating MVPA from LPA decreased as the level of impairment increased. The average cross-validation accuracy for the VC_DT was 81.1%, 76.7%, and 82.9% for GMFCS levels I, II, and III, respectively. The corresponding cross-validation accuracy for the VM_DT was 80.5%, 75.6%, and 84.2%, respectively. Within each GMFCS level, the DT models achieved better PA intensity recognition than previously published cut-points. The accuracy differential was greatest among GMFCS level III participants, in whom the previously published cut-points misclassified 40% of the MVPA activity trials. Conclusion GMFCS-specific cut-points provide more accurate assessments of MVPA levels in youth with CP across the full spectrum of ambulatory ability.

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Section: Introductionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Decision Trees for Detection of Activity Intensity in Youth with Cerebral Palsy

Trost

Fragala-Pinkham

Lennon

et al. 2016

Medicine &Amp; Science in Sports &Amp; Exercise

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“…This study is part of a larger study on validation of accelerometry for children and adolescents with CP. 19 …”

Section: Methods Participantsmentioning

confidence: 99%

Validity of theOMNIrating of perceived exertion scale for children and adolescents with cerebral palsy

Fragala-Pinkham

O’Neil

Lennon

et al. 2015

Develop Med Child Neuro

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AIM This study evaluated the validity of the OMNI Walk/Run Rating of Perceived Exertion (OMNI-RPE) scores with heart rate and oxygen consumption (VO 2 ) for children and adolescents with cerebral palsy (CP). METHOD Children and adolescents with CP, aged 6 to 18 years and Gross Motor FunctionClassification System (GMFCS) levels I to III completed a physical activity protocol with seven trials ranging in intensity from sedentary to moderate-to-vigorous. VO 2 and heart rate were recorded during the physical activity trials using a portable indirect calorimeter and heart rate monitor. Participants reported OMNI-RPE scores for each trial. Concurrent validity was assessed by calculating the average within-subject correlation between OMNI-RPE ratings and the two physiological indices.RESULTS For the correlational analyses, 48 participants (22 males, 26 females; age 12y 6mo, SD 3y 4mo) had valid bivariate data for VO 2 and OMNI-RPE, while 40 participants (21 males, 19 females; age 12y 5mo, SD 2y 9mo) had valid bivariate data for heart rate and OMNI-RPE. VO 2 (r=0.80; 95% CI 0.66-0.88) and heart rate (r=0.83; 95% CI 0.70-0.91) were moderately to highly correlated to OMNI-RPE scores. No difference was found for the correlation of physiological data and OMNI-RPE scores across the three GMFCS levels. The OMNI-RPE scores increased significantly in a dose-response manner (F 6,258 =116.1, p<0.001) as exercise intensity increased from sedentary to moderate-to-vigorous.INTERPRETATION OMNI-RPE is a clinically feasible option to monitor exercise intensity in ambulatory children and adolescents with CP.National guidelines recommend that children and adolescents participate in 60 minutes or more of moderateto-vigorous intensity physical activity each day to achieve health benefits.1 Also, in recent years, more attention is being placed on reducing sedentary behaviors with recommendations to limit prolonged sitting. Cardiometabolic health consequences and obesity in children and adolescents may be related to increased sedentary behavior and decreased physical activity. 2Many children and adolescents with cerebral palsy (CP) do not participate in sufficient physical activity frequency or intensity.3-5 They also tend to spend more time in sedentary activity. 5,6 In addition, the rates of obesity have increased in ambulatory children and adolescents with CP over the last several years.7 With this information in hand, rehabilitation professionals have shifted to interventions that increase physical activity participation, decrease sedentary behaviors, and promote overall health and functional mobility. 8,9 Physical activity or exercise intensity can be objectively measured by oxygen consumption (VO 2 ), heart rate monitors, or accelerometry; however, these methods may not always be practical in the clinic or community setting because of cost and measurement burden.Another option for determining exercise intensity is with the use of perceived exertion rating scales.10 These scales provide a low-cost, field-based subjective method for sys...

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