1. Physical activity in children with Spina Bifida comparison of a triaxial activity monitor, HR monitor and activity diary during every day activities

2. INTRODUCTION  Spina Bifida (SB)  Restricted in their daily life  1,5 hrs. vs. 3 hrs. (Berg-Emons et al., 2001)  Secondary health conditions  Insight in physical activity (PA)  Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure (WHO, 2014)

3. Observation Activity Monitor Pedometer Activity diary Questionnaires Doubly labeled water Heart rate monitor Subjecti ve Objectiv e Golden standard

4. PURPOSE Validation of an activity monitor during every day activities in children with SB aged 6-19 years Hypotheses During daily life activities the AM correlates moderately with the Heart Rate Monitor (HRM; r>0.50 & r 0.30 & r<0.69), in a positive direction Construct validation The relation between the AM with other instruments, measuring the same construct (Portney & Watkins, 2008). Also the degree to which the scores of the AM are consistent with hypotheses (COSMIN, 2014)

5. METHOD  Participants  48 children with SB  Aged 6-19 years  Manual wheelchair during daily life activities, during sport and/or during long distances  Testing procedure  3 days (2 weekdays, 1 weekend day)  Measurement from waking up till bedtime  Normal daily activities in their own environment

6. METHOD  Instruments: 1.Activity Monitor  Type of activity Lying, sitting, standing, walking, running, (bi-)cycling, wheelchair propulsion and general movements  Intensity Body Motility expressed as gravitational force 2.Activity Diary  Type of activity: Total minutes per type of activity 3.Heart Rate Monitor  Intensity: Beats per minute

7. METHOD  Statistical analysis (SPSS 22.0)  Intensity: Activity Monitor ↔ Heart Rate Monitor  21 complete data sets  Correlation coefficients (Spearman’s rank order)  Type of activity: Activity Monitor ↔ Activity Diary  27 complete data sets  Paired t-test & degree of agreement

8. RESULTS Feasibility

9. RESULTS Intensity N = 21 Mean r= 0.501 (p<.01)

10. RESULTS Intensity 5 sensors r= 0.584 (p<.01) 3 sensors r= 0.468 (p<.01)

11. DISCUSSION Intensity  Previous research R ranged from 0.52 – 0.71 (Sallis et al.,1990; Welk and Corbin, 1995; Coleman et al., 1997)  Labsetting  Environmental factors  HR tends to lag behind changes in physical movement  Difference between 3 sensors and 5 sensors  3 sensors HR of 102.8 bpm and of 5 sensors HR of 105.3 bpm  HR more variable and less reliable in lower intensities

12. DISCUSSION Type of activity  Consistent with previous studies (Coleman et al., 1997; Wickel et al., 2006; Martínez-Gómez et al., 2009)  Low agreement due to:  Over-reporting in children  15 minutes of reporting in AD  AM more sensitive  Different body shapes and postures in children with SB

13. DISCUSSION  Almost 50% of the participants had incomplete data  Cannot be worn during water activities or intensive sports (eg. boxing)  Some incorrect placed monitors  Difference between sedentary sitting and active sitting?

14. CONCLUSION AM related to HRM and AD Not interchangeable Some considerations with regard to the practical use in children with SB More research needed to validate AM during daily life activities in children with SB

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