Physical Activity and Rehabilitation
Physical Activity and Rehabilitation: improving community independence and wellbeing
The Physical Activity and Rehabilitation research program is based on the premise that promoting physical activity is a major goal in the management of many health conditions. Our program aims to investigate measurement of physical activity in clinical populations, understanding the mechanisms and the physiological consequences of inactivity, evaluate the effect of interventions on physical activity, and research the best ways of implementing the evidence from research into practice.
Lack of activity is recognized as a major public health issue, resulting in long term health problems. A key goal of rehabilitation is to improve physical activity levels and facilitate independent living. Because of their health condition, people who require rehabilitation often find it more difficult to move and so are particularly at risk of being inactive. La Trobe University’s School of Allied Health with its clinical schools provides a close relationship between internationally recognized clinical researchers and patients receiving rehabilitation in a number of major Victorian health services. This relationship along with the skills and background of our key clinical researchers provides a unique opportunity to coordinate a program of research that will improve the outcomes and physical activity of people receiving rehabilitation. The program of research will include first, basic research around measurement of physical activity in clinical populations and understanding the mechanisms and the physiological consequences of inactivity , second, evaluations of the effect of interventions on physical activity, and third, research into the best ways of implementing the evidence from research into practice.
Key research projects & partnerships
Large scale physical activity programs for community dwelling people with chronic disease in the 21st century – web-based technology to facilitate health behaviour change
Improving physical activity levels is a key treatment goal across a wide range of chronic diseases. Physical activity can improve physical fitness and wellbeing, reduce the risk of adverse health outcomes and maintain the ability to live well in the community. Some people with chronic diseases such as heart and lung disease have access to short-term rehabilitation programs which improve physical fitness, but there are few long-term programs that help to maintain the positive changes in physical activity behaviours. Some people with chronic disease do not have access to any rehabilitation programs. Our goal is to ensure that all Australians with chronic diseases can experience the health benefits that come from increased physical activity levels. As the number of people living with chronic disease continues to rise, we will need new ways to improve and maintain physical activity that can be delivered to large numbers of people in a cost effective manner. The aim of this project is to develop a large scale physical activity program for community-dwelling people with chronic disease using web-based technologies. We aim to develop a web platform that will enable people with chronic diseases to become part of an online community of peers and clinicians. The aims of the online community will be to build motivation for improved physical activity levels, improve confidence to participate in physical activity, receive feedback about achievement of physical activity goals and maintain healthy behaviours over time. In this pilot project we will build the web platform and test its feasibility in a group of young adults with cystic fibrosis. In the future we aim to extend the program to people with a wide range of chronic diseases across all age groups.
Project Lead: Ass Prof Anne Holland
Motivational Interviewing to increase physical activity: a systematic review
One primary goal of the Physical Activity and Rehabilitation research program is to develop effective and cost-efficient methods to increase physical activity in rehabilitation settings. Large systematic reviews have shown that long-term changes in physical activity require more than information alone. Motivational Interviewing (MI) is one promising strategy for inclusion in programs designed to increase physical activity in rehabilitation settings. Motivational Interviewing, which is a client centred approach that focuses on following several well articulated principles for increasing motivation for change by assisting the client to reduce their own resistance to change, has the advantage of being user-friendly for both clients and practitioners. Thus, principles of MI could be embedded within the design of innovative programs designed to increase physical activity in rehabilitation settings. However, this would require a solid evidence base regarding the effectiveness of MI on physical activity both generally and in particular in rehabilitation settings. Whilst systematic and meta-analytic reviews have provided strong evidence regarding the effectiveness of MI in areas such as addictive behaviours, at present there is only occasional reference to physical activity (usually in conjunction with diet) in such reviews. A focused synthesis of current research evidence regarding MI to increase physical activity both in general settings and with a particular focus on rehabilitation settings will address this gap in the literature. More importantly data from this review regarding moderators of the effectiveness of MI (e.g. mode or frequency of delivery) will be pivotal in the design of future interventions developed by the Physical Activity and Rehabilitation research program for the purposes of increasing physical activity in populations that would clearly benefit from such increases.
Project lead: Dr Paul O’Halloran
MisMeasurement of physical activity in clinical populationssion
To study physical activity (PA) in people with disease we need to be able to obtain accurate measures of activity patterns in both the short and long term. At present, the field is plagued with poor definition and inadequate testing of proposed tools. Most current systems of measuring PA are costly, complex and limited in their application often to patients with chronic disease. Implementation of PA interventions in patients requires accurate systems that are robust, yet simple and broadly applicable. This project will test the feasibility and accuracy of physical activity and physiological data, including energy expenditure, derived from commercially available activity monitors that appear to meet this need. Using a standardised activity and exercise protocol in 20 patients with acute stroke we will compare the output from commercial activity monitors against that from a ‘gold standard’ portable metabolic cart. There will be two possible 45 minute testing protocols that will be selected based on functional severity after stroke. Safety criteria will apply and be measured both before and during testing. At the end of each session fatigue and perceived exertion will also be measured. Key outcomes of interest are mean physical activity (METS), step counts and total energy expenditure (joules). Predicted and measured activity will be compared. METs will be used to define categories of activity. We will adopt the classification used by Clanchy et al. (2011) for people with cerebral palsy: with sedentary activity <1.5 METs, light activity ≥ 1.5 but <4 METS, and moderate-vigorous activity is ≥ 4 METs. Agreement will be calculated between activity classifications with the device and gold standard. Step count and body position will be compared using continuous observation and behavioural mapping.
This study will determine the feasibility and accuracy of commercially available devices to measure PA in hospitalised patients. The protocol will also be tested with adults with Down syndrome to determine the applicability of the system in other rehabilitation populations. If the system tested is found to meet our needs for an accurate, robust measure of PA that can be used to record continuous data over a week or more, this system is likely to be adopted across a range of studies in this program to allow researchers in our group to ‘talk the same language’.
Project lead: Ass Prof Julie Bernhardt
Nicholas Taylor is Professor of Allied Health in the School of Allied Health with key research interests in the role of exercise and physical activity for people with disability and during rehabilitation.
Nicholas Taylor, Health Sciences
