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BACKGROUND: Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes. METHODS: We studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a 'standard' CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in <75% of the scheduled exercise sessions. Patients were followed-up for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events (MACE) included all-cause mortality, non-fatal myocardial infarction and coronary revascularisation. RESULTS: A total of 142 (16%) patients had incomplete CR. They had a higher incidence of MACE than their counterparts who completed CR (11.3% versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval [CI] 1.47-5.26). Furthermore, the incidence of any cardiac event, including MACE and coronary revascularisation, was higher (20.4% versus 11.0%, aHR 1.54; 95% CI 0.98-2.44). Patients with incomplete CR were more often persistent smokers than those who completed CR (31.7% versus 11.5%), but clinical characteristics were similar otherwise. CONCLUSION: Post-ACS patients who did not complete a 'standard' 12-week CR programme had a higher incidence of adverse cardiac events during long-term follow-up than those who completed the programme. Since CR is proven beneficial, further research is needed to understand the reasons why patients terminate prematurely.

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Little is known about long-term effects of neonatal intensive care on exercise capacity, physical activity, and fatigue in term borns. We determined these outcomes in 57 young adults, treated for neonatal respiratory failure; 27 of them had congenital diaphragmatic hernia with lung hypoplasia (group 1) and 30 had normal lung development (group 2). Patients in group 2 were age-matched, with similar gestational age and birth weight, and similar neonatal intensive care treatment as patients in group 1. All patients were born before the era of extracorporeal membrane oxygenation, nitric oxide administration, and high frequency ventilation. Exercise capacity was measured by cycle ergometry, daily physical activity with an accelerometry-based activity monitor, and fatigue by the fatigue severity scale. Median (range) VO2peak in mL/kg/min was 35.4 (19.6-55.0) in group 1 and 37.6 (15.7-52.7) in group 2. There was a between-group P-value of 0.65 for exercise capacity. Daily activity and fatigue were also similar in both groups. So, residual lung hypoplasia did not play an important role in this cohort. There were no significant associations between exercise capacity and perinatal characteristics. Future studies need to elucidate whether exercise capacity is impaired in patients with more severe lung hypoplasia who nowadays survive.

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STUDY DESIGN: A prospective cohort study. OBJECTIVES: To study the longitudinal relationship between objectively measured everyday physical activity level, and physical fitness and lipid profile in persons with a recent spinal cord injury (SCI). SETTING: A rehabilitation centre in the Netherlands and the participant's home environment. METHODS: Data of 30 persons with a recent SCI were collected at the start of active rehabilitation, 3 months later, at discharge from inpatient rehabilitation, and 1 year after discharge. Physical activity level (duration of dynamic activities as % of 24 h) was measured with an accelerometry-based activity monitor. Regarding physical fitness, peak oxygen uptake (VO(2)peak) and peak power output (POpeak) were determined with a maximal wheelchair exercise test, and upper extremity muscle strength was measured with a handheld dynamometer. Fasting blood samples were taken to determine the lipid profile. RESULTS: An increase in physical activity level was significantly related to an increase in VO(2)peak and POpeak, and an increase in physical activity level favourably affected the lipid profile. A nonsignificant relation was found with muscle strength. CONCLUSION: Everyday physical activity seems to have an important role in the fitness and health of persons with a recent SCI. An increase in physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease.

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The Bruce treadmill protocol is suitable for children 4 years of age and older. Dutch reference values were established in 1987. We considered that children's exercise capacity has deteriorated due to changes in physical activity patterns and eating habits. We determined new reference values and evaluated determinants of exercise capacity. Healthy Dutch children (n=267) aged 6-13 years participated in this cross-sectional observational study. The maximal endurance time on the treadmill was the criterion of exercise capacity. Furthermore, we obtained data on anthropometry, smoking habits, socioeconomic status, ethnicity, sports participation, and school transport habits. The maximal endurance time for children aged up till 10 was lower (up to 1.6 and 1.4 min in girls and boys, respectively) than previously published. Body mass index was negatively, and intense sports participation was positively associated with endurance time (beta=-0.412 and 0.789, respectively; P<0.001). In conclusion, exercise capacity seems to have deteriorated in Dutch children aged up till 10 years whereas the values from the older children are remarkably similar to those from the previous study.

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The aim of this study was to assess whether percentage of body fat (BF) can be predicted adequately from skinfold measurements in comparative studies of children with spastic cerebral palsy (CP) and healthy control children. The deuterium dilution technique (D2O) was used as a reference method. In contrast with what was expected, %BF predicted from skinfold measurements was considerably lower than that determined by the D2O method in children with CP, whereas in the controls this was not seen. A proportionally large internal fat deposit and a different distribution of subcutaneous fat in children with CP may be responsible for this. It was concluded that skinfold measurements are not suitable for predicting %BF in comparative studies of children with CP and control children. For evaluation of diet- or exercise-related interventions in children with CP, the use of skinfold measurements seems to be justified. However, it may be more appropriate to use skinfold thicknesses without converting them to BF.

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Effects of two 9-month sports programmes (four or two sessions per week) on level of daily physical activity (PA), fat mass (FM), and physical fitness were assessed in children with spastic cerebral palsy (CP; n = 20, 9.2 +/- 1.4 yr), randomly assigned to an experimental and control group after matching. Four sessions per week tended to increase PA ratio (24-h energy expenditure/sleeping (resting) energy expenditure) after 9 months from 1.34 +/- 0.25 to 1.55 +/- 0.18 (P = 0.07; not different versus controls). FM increased continuously in the control group (after 9 months + 1.1 +/- 1.6 kg, P < 0.05), whereas the experimental groups showed no changes. Training (respectively four and two sessions) increased peak aerobic power 35% (P < 0.01; P < 0.05 versus controls) and 21% (P < 0.01; P = 0.17 versus controls). Results also suggest that training has a favourable effect on isokinetic muscle strength. No training-related effects were found on anaerobic power. It was concluded that although aerobic training has a limited effect on PA in children with CP, it may prevent deterioration in body composition and muscle strength. Furthermore, training has a favourable effect on peak aerobic power.

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Test-retest reliability of measurements of peak aerobic power (cycle ergometer), anaerobic power (cycle ergometer), and isokinetic muscle strength of the knee (Cybex) was established in 12 young children with cerebral palsy (spastic diplegia/tetraplegia; mean age 8.8 years) and in addition in 39 healthy controls (mean age 9.2 years). The cycle ergometer tests were found to be reliable in both the group with CP and the control group (test-retest correlations varying from 0.72 to 0.96). The isokinetic strength test in the group with CP was only reliable at 30 degrees/s, whereas in the control group high test-retest correlations were also found at 60 degrees/s and 120 degrees/s.

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The aim of the study was to assess whether heart rate (HR) monitoring is suitable to estimate energy expenditure in spastic cerebral palsied (CP) children, who are known to have very low levels of daily physical activity. Total daily energy expenditure (TEE) predicted from HR recording (TEEHR, measured over 2 or 3 d) was therefore compared with TEE measured by doubly labeled water (TEEDLW, measured over 14 d) in nine children with spastic diplegia/tetraplegia (mean +/- SD age 10.7 +/- 1.6 yr). At group level, there was no difference in TEEDLW (7.4 +/- 2.1 MJ.d-1) and TEEHR (7.4 +/- 2.2 MJ.d-1). Spearman correlation between both methods was 0.88 (P < 0.001). Individual estimates of TEEHR ranged from -16.9% to +20.0%, with five TEEHR values within +/- 10% of TEEDLW. It was concluded that also in children with low levels of daily physical activity, HR monitoring (preferably 3 sampling days) can provide a close group estimate of energy expenditure. At the individual level, the method is not suitable.

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