Measuring physical fitness in Persons with Severe/Profound ...

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Body weightTo determine the body weight, we instructed the participant to remove his shoes, to wear onlyswimming clothes and to stand on an electronic calibrated gauged pair of scales (Weigh plateaufor wheelchairs PM-9050, Lopital Nederland BV, Oisterwijk, the Netherlands). When a participantwas unable to stand independently without moving (e.g. because of anxiety), the participant wasweighed in a wheelchair. The weight (kg) of the participant was then calculated according to thefollowing formula: body weight = measured weight – mass of wheelchair.BMIThe following formula was used to calculate BMI:BMI = (body weight, kg)/(body length, m)2.Waist circumferenceWe used a measuring tape (Seca 201 tape measurer, accurate at the 0.1 cm level, Hamburg,Germany) to determine waist circumference. Waist circumference was measured at the pointlocated halfway between the crista iliaca and the tenth rib. We took two measurements, one asthe participant breathed in and one as he breathed out. The average of these two values was usedfor analysis. We deviate from The International Society for the Advancement of Kinanthropometryprocedure, because in our participants a normal expiration in these circumstances may be difficultto recognize.Skinfold measurementsSkinfolds were measured in mm at four sites according to the guidelines of the ACSM [8] andHarpenden Skinfold Calliper (Model: HSK-BI, Baty International, West Sussex, UK) was used. Theparticipant was asked to stand straight for all measurements, and skinfolds on the right side weremeasured twice. The average of the two measurements was used for analysis. Triceps and bicepsskinfolds were measured at the midpoint between the acromion border and the proximal borderof the olecranon. Subscapular skinfolds were measured by palpating the participants’ angulusinferior scapulae and pinching the skinfold located just lateral to and under the angulus inferiorat an angle of 45 degrees (with the spine). Suprailiac skinfolds were measured by palpating thecrista iliaca of the pelvis and pinching the skinfold just before the top of the crista iliaca.Tibia lengthThe participant was asked to sit in a chair with his knees flexed at 90 degrees. Next, we palpatedthe medial malleolus and the proximal end of the tibia, and then measured the distance (cm)between the distal border of the medial malleolus and the proximal end of the tibia with ameasuring tape.Data analysisThe data were analysed using spss 14.0.FeasibilityTo determine feasibility, we compared the number of successful measurements with the totalnumber of measurements. The feasibility was considered to be sufficient when 95% of themeasurements were successful.Chapter 2 | 27
ReliabilityFirst, to determine whether significant differences between measurements 1 and 2 exist, weanalysed the differences using the Wilcoxon signed rank test. Wilcoxon signed rank tests wereused because the data were not normally distributed. The level of statistical significance wasset at 5%. Limits of agreement (LOA) between two measurements of the same variables werecalculated according to the procedure described by Bland & Altman [44]. The LOA is consideredto be an indicator of reliability. LOAs are expressed in units and as a percentage of the mean ofthe first measurement. Measurements were considered reliable when the LOA was less than 10%of the mean of the first measurement.Finally, the intraclass correlation coefficients (ICC two-way random, absolute agreement) ofmeasurements 1 and 2 of the same variables were computed. Reliability is considered acceptablewhen the ICC value is greater than 0.80 and the 95% confidence interval is 0.04 or less. Tocompare the reliability determined in the present study with those from other studies, we madesimilar calculations of similar variables: the standard error of measurement (SEM = SD/√n); thecoefficient of variation 1 (CV1 = SD/mean x 100%); the technical error (TE = √Sd 2 /2n, where d isthe difference between paired measures of n subjects); and the coefficient of variation 2 (CV2 =100 x TE/mean of measures taken).Calculation of heightThe long bone length/height ratio has been shown to vary among populations [45] and it isknown that this ratio does vary to some degree with differences in stature [46, 47]. To addressthese differences, specific formulae have been generated for certain populations [48, 49, 50, 51,52, 53]. For that reason, we used the formula to estimate a subject’s height from his tibia lengthof Stevenson [54]. The calculated height data were compared with the actual measured heightusing Wilcoxon rank tests and ICC (two-way random, total agreement). Also, LOAs between twomeasurements of the same variables were calculated according to the procedure described byBland & Altman [44]. If necessary, a linear regression analysis was performed to determine themost appropriate equation for calculating a subject’s height from tibia length.Body weight statusIf feasibility and reliability were acceptable, the outcomes were compared with the normal WHOvalues [55, 56, 32].ResultsReliabilityTable 1 summarizes the means and standard deviations of body length, body weight, BMI, waistcircumference, and skinfold measurements, the results of Wilcoxon signed rank test, LOA, ICC,and LOA expressed as a percentage of the means. There were no significant differences betweenmeasurements 1 and 2. The LOAs expressed as a percentage of the means for the skinfoldmeasurements were more than 10%, whereas the LOAs for all the other variables were less than10%. Intraclass correlation coefficients for all variables, except those for biceps, subscapular andsuprailiac skinfold measurements, were 0.90 or above.28 | Chapter 2
Page 2 and 3: Measuring physical fitnessin person
Page 4: Rijksuniversiteit GroningenMeasurin
Page 10 and 11: Chapter 1IntroductionChapter 1 | 9
Page 12 and 13: overweight [15]. This prevalence is
Page 14 and 15: Theoretical framework of the studyI
Page 16 and 17: Components of physical fitnessThe a
Page 18 and 19: Therefore, a study is put forward w
Page 20 and 21: 2002;40:436-444.19 Temple VA, Frey
Page 22 and 23: Chapter 2Feasibility and reliabilit
Page 24 and 25: IntroductionPhysical fitness and he
Page 26 and 27: GMFCS was presented to the investig
Page 30 and 31: Table 1 Results of Wilcoxon rank te
Page 32 and 33: Calculation of heightThe mean (SD)
Page 34 and 35: DiscussionThe results of our study
Page 36 and 37: References1 Bouchard C, Shepard RJ,
Page 38 and 39: 37 Rimmer J, Kelly LE, Rosentswieg
Page 40 and 41: Chapter 3Measuring waist circumfere
Page 42 and 43: IntroductionChildren and adults wit
Page 44 and 45: participants. These calculations as
Page 46 and 47: Data analysisThe data were analyzed
Page 48: Table 2. Simple regression analysis
Page 54 and 55: Chapter 4Feasibility and reliabilit
Page 56 and 57: IntroductionPeople with intellectua
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Page 64 and 65: Table 3. Mean peak heart rate achie
Page 66 and 67: AcknowledgementsThis research was f
Page 68 and 69: 21 Hopkins WG, Gaeta H, Thomas AC,
Page 70 and 71: Chapter 5Psychometric quality of a
Page 72 and 73: IntroductionIntellectual disability
Page 74 and 75: Exclusion criteria were mental or p
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Table 2. Descriptive results peak h
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Table 3. Test-retest reliability of
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Table 4. Correlation scored motivat
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preceding GXT results on HR peak. G
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References1 Schalock R, Brown I, Br
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37 Stanish HI, Temple VA, Frey GC.
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Chapter 6Feasibility and reliabilit
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IntroductionLocomotor skills in peo
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this study was to evaluate the feas
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obtained from the legal representat
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Modified Berg Balance Scale scoresI
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Modified Berg Balance Scale scoresT
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References1 Van Erkelens-Zwets JHJ
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39 Dorai-Raj S. Binomial Confidence
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Chapter 7Feasibility, test-retest r
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IntroductionPersons with profound i
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DesignThe muscle tone and spasticit
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Interrater reliabilityFirstly, to d
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Table 3. Summary of the statistical
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Table 6. Summary of the statistical
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RecommendationsThe feasibility of c
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18 Gielen EJJM. Is spasticiteit te
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Chapter 8Heart Rate Pattern as an I
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IntroductionIt is important to gain
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48 persons18 persons lacked permiss
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Furthermore, the mean and the range
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Table 3. Day-to-day outline of the
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Relation between heart rate pattern
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patterns in this study we can concl
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References1 Emerson E. Underweight,
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38 Multilevel Models Project (2004)
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Chapter 9General DiscussionChapter
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on this. To sum up, testing in pers
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for future research it is recommend
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studies. Randomized Controlled Tria
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of these individuals require more?
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19 Lahtinen U, Rintala P, Malin A.
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SummarySummary | 151
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problems in both locomotor skills a
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subjects are to be applied to perso
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may be an indicator of activity lev
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SamenvattingSamenvatting | 159
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InleidingVoldoende bewegen en fithe
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verstandelijk niveau en bepaalde mo
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Hieruit bleek, dat de motivatie van
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Verder is duidelijk geworden dat me
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DankwoordDankwoord | 169
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De leden van de leescommissie, prof
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Judith van der Boom, dank je wel vo
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Dankwoord | 175
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Curriculum vitaeCurriculum vitae |
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Curriculum vitae | 179
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