Research in Focus: Physical Activity and Sedentary Behavior 6 Months After MSK Trauma

  •   November 6, 2019

Full Citation

Ekegren CL, Climie RE, Simpson PM, Owen N, Dunstan DW, Veitch W, Gabbe BJ. Physical Activity and Sedentary Behavior 6 Months After Musculoskeletal Trauma: What Factors Predict Recovery? Physical Therapy, pzz151, https://doi.org/10.1093/ptj/pzz151

Background

Fractures are a common cause of hospitalization, with many individuals experiencing long-term functional impairment secondary to fractures of the upper (UL) or lower limb (LL). Activity level and sedentary behaviour are increasingly recognized as important indicators of health and predictors of an individual’s risk of developing a chronic, non-communicable disease. Activity levels are also increasingly recognized as an important indicator of functional recovery following fracture.

The purpose of this study was to identify attributes of working-age, musculoskeletal (MSK) trauma patients at greatest risk of poor activity recovery following fracture.

Methods

Study design:

  • Prospective cohort epidemiological study
  • Recruited during inpatient hospital stay

Sample characteristics:

  • Convenience sample
    • 445 eligible patients
    • 120 participants recruited
    • 83 returned data at two weeks
    • 63 participants retained at six months

Inclusion criteria:

  • 18-69 years old
  • Admitted to a major trauma center
  • New isolated upper or lower limb fracture
  • LOS >24 hours and home discharge

Exclusion criteria:

  • Pathological fracture
  • Cognitive deficit
  • Less than conversational English-language skills

Data collection:

  • Assessed at two weeks and six months post-surgery (or post-injury if managed non-surgically)
  • Self-reported premorbid activity level, height and weight and weightbearing status were collected at two weeks post-surgery
  • Activity data collected for 10 consecutive days
  • activPAL3 device, worn continuously, used to measure:
    • sitting time
    • time spent is sitting bouts of >30 minutes
    • sit-to-stand transitions
    • steps
  • ActiGraph triaxial accelerometer, worn during waking hours, used to measure:
  • Minutes of moderate-intensity and vigorous-intensity physical activity (MPA and VPA respectively)

Findings

  • Ankle fracture was the most common LL fracture
  • Wrist/forearm fracture was the most common UL fracture
  • At six months post-surgery:
    • LL fracture group reported lower health status than UL fracture group, but the difference was small and clinical significance was unclear.
    • LL fracture group sat on average two hours more per day than UL group.
    • Change in sitting time from two weeks to six months was greater for those with highest level of pre-injury physical activity and (unexpectedly) for participants who were overweight or obese.
    • LL fractures were associated with 66% fewer steps per day than UL fractures.
    • The oldest age group demonstrated the least change in steps from two weeks to six months.
    • LL fractures were associated with 77% fewer minutes of MPA per day than UL fractures.
    • Higher level of education was associated with fewer steps per day; however, those had not completed high school engaged in 68% less MPA than those with university education.

Discussion

  • Physical activity levels and sedentary behaviour improved significantly six months post fracture surgery. However, people with LL fractures had poorer outcomes for all measures including over one hour more of sitting time per day at six months.
  • 60% of sitting time was accumulated in bouts of 30 minutes or more. Prolonged sedentary periods have been associated with poorer health outcomes in the general population.
  • Greater improvements in sitting time were seen in people with higher self-reported pre-injury activity and those with higher BMI.
  • At six months, MPA levels were comparable to population-based norms, however most participants with LL fractures recorded no VPA. This finding is of concern as failure to meet activity guidelines is associated with poorer health outcomes in the general population.
  • Older people demonstrated lower activity levels at two weeks and less improvement at six months, signifying poorer recovery from fracture and greater functional impact. This impact appeared to begin in individuals as young as 50 years of age.
  • Many participants were injured while engaged in physical activity, which may have led to fear of re-injury and decreased participation.

Limitations

  • The study employed a convenience sample and may not be representative of all people experiencing MSK trauma.
  • The devices used to track activity could not be used to measure swimming and cycling, two forms of physical activity common among people recovering from MSK trauma.
  • The study did not use pain as an outcome measure. Pain may impact physical activity and sedentary behaviour and may mitigate other findings of the study.

Relevance to physiotherapy practice in Alberta

This study demonstrated significant decreases in steps taken and physical activity levels and significant increases in sedentary behaviour at six months post-surgery following MSK trauma. This is particularly true among individuals who sustained a LL fracture and older working-aged adults.

Advice to individuals recovering from MSK trauma should include discussion of sedentary behaviour and return to physical activity following recovery from fracture to mitigate against these long-term outcomes and their related negative health impacts. Physiotherapists working with this patient population should consider return to prior levels of MPA and VPA an important outcome of the rehabilitation process.

Disclaimer: The purpose of this summary is to highlight recently published research findings that are not openly accessible. Every effort is made to ensure accuracy and clarity of the summary. Readers are encouraged to review the published article in full for further information.