Objective measurement of free-living physical activity (performance) in lumbar spinal stenosis: are physical activity guidelines being met?

Abstract

BACKGROUND Research suggests that people with lumbar spinal stenosis (LSS) would benefit from increased physical activity. Yet, to date, we do not have disease-specific activity guidelines for LSS, and the nature of free-living physical activity (performance) in LSS remains unknown. LSS care providers could endorse the 2008 United States Physical Activity Guidelines; however, we do not know if this is realistic. The goal of the present study was to determine the proportion of individuals with LSS meeting the 2008 Guidelines. A secondary goal was to better understand the nature of physical performance in this population. STUDY DESIGN Retrospective study. PATIENT SAMPLE People from the Lumbar Spinal Stenosis Accelerometry Database, all of whom have both radiographic and clinical LSS and are seeking various treatments for their symptoms. OUTCOME MEASURES Seven-day accelerometry (functional outcome) and demographics (self-reported). METHODS For the present study, we analyzed only baseline data that were obtained before any new treatments. Patients with at least 4 valid days of baseline accelerometry data were included. We determined the proportion of individuals with LSS meeting the 2008 US Physical Activity Guidelines of at least 150 minutes of moderate-vigorous (MV) physical activity per week in bouts of 10 minutes or more. We also used the novel Physical Performance analysis designed by our group to determine time spent in varying intensities of activity. There are no conflicts of interest to disclose. RESULTS We analyzed data from 75 individuals with a mean age of 68 (SD 9), 37% of whom were male. Three people (4%) were considered Meeting Guidelines (at least 150 MV minutes/week), and 56 (75%) were considered Inactive with not even 1 MV minute/week. With the 10-minute bout requirement removed, 10 of 75 (13%) achieved the 150-minute threshold. The average time spent in sedentary activity was 82%, and of time spent in nonsedentary activity, 99.6% was in the light activity range. CONCLUSIONS In conclusion, the present study confirms that people with symptomatic LSS, neurogenic claudication, walking limitations, and LSS-related disability are extremely sedentary and are not meeting guidelines for physical activity. There is an urgent need for interventions aimed at reducing sedentary behavior and increasing the overall level of physical activity in LSS, not only to improve function but also to prevent diseases of inactivity. The present study suggests that reducing sedentary time, increasing time spent in light intensity activity, and increasing time spent in higher intensities of light activity may be appropriate as initial goals for exercise interventions in people with symptomatic LSS and neurogenic claudication, transitioning to moderate activity when appropriate. Results of the present study also demonstrate the importance of employing disease-specific measures for assessment of performance in LSS, and highlight the potential value of these methods for developing targeted and realistic goals for ph...

Patients with severe low back pain exhibit a low level of physical activity before lumbar fusion surgery: a cross-sectional study

“…This suggests that a majority of the patients in our study do not reap the health benefits of being sufficiently physically active and are therefore at risk of developing additional disease and poor health [ 7 ]. Similar findings have been found by Mobbs et al, [ 16 ] and Norden et al, [ 21 ]. Mobbs et al studied a mixed group of patients with degenerative lumbar disorders and found that the mean value for the variable “steps per day” (5255 steps) was below the threshold for a physically active lifestyle [ 16 ].…”

“…They also used an accelerometer but only presented the variable as “steps per day”. Norden et al showed that only 4% of their patients with spinal stenosis met the physical activity recommendations before decompression surgery [ 21 ]. Moreover, a recently published systematic review and meta-analysis by Koenders et al, [ 45 ], concluded that “research should provide more information regarding the clinical care pathway, psychosocial and physical conditions of the patients undergoing first time lumbar fusion surgery, and without this information, it remains impossible to improve lumbar fusion surgery management” .…”

“…There are some studies available that have studied physical activity in relation to lumbar spine surgery [ 16 – 20 ]. To our knowledge four studies have assessed the preoperative physical activity level [ 16 , 18 , 19 , 21 ], in various lumbar degenerative conditions. None of these has investigated physical activity specifically for patients with degenerative disc disease.…”

“…Since these patients differ from patients with spinal stenosis in that they are on average younger and have less leg pain [ 3 ], we hypothesised that the physical activity pattern would differ. Moreover, all but Norden et al used self-reported data [ 18 , 19 , 21 ], which are considered less valid than those collected by objective measures such as an accelerometer [ 22 ]. We will therefore use accelerometers, considered to be one of the most valid measure, to accurately estimate levels of physical activity in daily life.…”

Objective activity tracking in spine surgery: a prospective feasibility study with a low-cost consumer grade wearable accelerometer

“…In a systematic review of the literature, accelerometer and physical activity analyses using wearable devices ranked among the top five most frequently applied methods for objective outcome measurement in spine care 4 . To date, the activity levels of about 340 patients with lumbar degenerative diseases of the spine have been reported in nine research articles, which included patients with low back pain (LBP), lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) [8][9][10][11][12][13][14][15][16] .…”