Associations Between Objectively-Measured Physical Activity And Functional Impairment In Samples With Ongoing Pain Or Mobility Concerns:A Systematic Review And Meta-Analysis And An Investigation

Physical activity(PA) was defined as “any bodily movement produced by contraction of skeletal muscle that result in energy expenditure”. Benefits of regular moderate to vigorous PA on quality of life and mortality risk have been widely documented in the general population. In addition,the importance of continuing daily activities as a means of maintaining high quality of life and protecting against emotional distress has been emphasized in various models of adjustment to chronic illness, such as the activity restriction(A-R) model and fear-avoidance model. Although numerous studies have reported that reductions in daily activity are related to increases in pain,impairment, and or emotional distress, the results based on different daily PA measures. Other reviewers have expressed concerns that studies reliant upon self-report measures are susceptible to retrospective biases that distort recall of past behavior including PA. In light of these concerns,lightweight, wearable devices(e.g., pedometers, accelerometers) that provide objective type,intensity and duration of daily PA have become increasingly popular. While objective PA measures control for pitfalls related to self-report scales, links between PA and functioning have varied widely between samples with ongoing pain and/or impaired mobility. Some researchers have reported more objectively-measured PA corresponds to significantly less functional impairment while others have found weaker, non-significant effect sizes. Given highly variable results across individual studies,the main purpose was to perform a meta-analysis to(1) evaluated associations between objectivelymeasured PA and key aspects of functioning(i.e., impairment, affective distress, pain intensity) in groups having medical conditions accompanied by pain and/or mobility concerns and(2) to identify potential moderating effects of medical condition characteristics, demographics, and methodological factors on these associations.A systematic search of the literature on PA and functioning resulted in the initial consideration of 4577 studies. Screening of these studies for appropriate papers resulted in the identification of 33 studies 33 studies comprising 4462 participants were retained for analyses. Data analysis indicated that objectively measured PA had negative overall relations with impairment(r =-.305, p < 0.001,95% CI:-.365 to-.242), affective distress(r =-.125, p <.001, 95% CI:-.188 to-.060) and pain intensity(r =-.121, p <.05, 95% CI:-.215 to-.025).However, the results also showed significant, high levels of heterogeneity in the analysis of PA-impairment effect sizes as well as significant, low heterogeneity levels for PA-affective distress and PA-pain intensity effect sizes. Moderator analyses indicated nature of medical condition(i.e., back pain versus joint pain versus non-specific pain versus multiple sclerosis versus breathing conditions versus other conditions) had a highly significant moderating effect on PA-impairment associations.PA-affective distress relations were moderated by gender composition and continuously-measured PA duration. However, moderator analyses failed to identify medical conditions, sample or methodological factors that helped to explain variability in effect sizes reflecting PA-pain intensity relations. Finally, results of trim and fill analyses conducted to adjust for effects of publication bias indicated that adjusted effect sizes of PA and each of the three outcomes were very similar to unadjusted effect sizes.The purposes of study 2 were to assess the prediction of objective and self-ported PA-related factors on health-related outcomes. In study 2, 262 adults without catactrophic medical conditions that precluding ambulatory PA were recruited to participate the study. Participants were asked to wear the SWA for at least 8 consecutive days, 24 h each day, to obtain at least 6 consecutive days data. Participants were instructed to take the armband off when performing any tasks that might put the armband at risk of getting wet. For the accurate record, they were told to fill out the sleep diary form immediately after they got up every morning during the wearing periods. However, the other questionnaires were finished at the last day before they returned the armbands and questionnaires.Finally, 232 adults including 149 females and 83 males finished the investigation.Hierarchical multiple regression analyses indicated that self-reported PA failed to make a unique, additional contribution to Physical Component Summary( PCS) of the Medical Outcomes Study Short Form-12 Health Survey( SF-12) beyond effects of established risk demographic factor( age). Objectively measured factors combined for marginally significant additional variance in PCS after controlling for other predictors, but only metablic equivalent( MET) made a unique contribution. Self-ported sleep duration made a significant variance in the prediction of Mental Component Summary( MCS) after controlling for demographic factors.The present research creatively used meta-analyses to summarized the associations between objectively-measured PA and key aspects of functioning. And, the research was the first to measure PA with SWA in Chinese mainland sample.