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Title: The movement continuum in children with asthma attacks in Kuwait
Author: Alshammari, Bandar Snafi Nassar
ISNI:       0000 0004 7226 3141
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2017
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Background: The major activity components that make up the 24 hours of daily life, the so-called 'movement continuum' are sleep, comprising ~40% of time, sedentary behaviour (~40%), low intensity physical activity (LPA) (~15%), and moderate-to-vigorous physical activity (MVPA) (~5%). To address fully the impact of movement behaviour on children's health, it is necessary to study the relationship between each of these components of the 'movement continuum' and children's health. Asthma is a chronic childhood disease that impacts children's activity and alters the balance between movement continuum components. Few studies have attempted to investigate the association between asthma and movement continuum components. The relationship between asthma in children and physical activity and sedentary behaviour is conflicting. Some studies suggested that asthmatic children are less physically active and more sedentary; others suggested that they are more active and less sedentary or that there are no differences between asthmatic and healthy children. The factors that led to this conflict are not clear. We conducted a systematic review that reviewed available published evidence regarding the association between objectively measured physical activity, sedentary behaviour and asthma in school aged children. The effect of asthma attacks on the movement continuum components is unclear, especially in the Middle East area. We hypothesized that in the acute stage following an asthma attack; children are less physically active, more sedentary and have sleep disturbances compared to the recovery stage. During recovery from asthma attack, there is inter individual variability in changes of movement continuum components. We conducted an observational study to measure levels of asthma control and movement continuum components of Kuwaiti school aged children week 1 and week 4 following an asthma attack. The study also compared movement continuum components of asthmatics at week 4 following an asthma attack with the same measurements in healthy controls. Methods: In our systematic review, a literature search of EMBASE, Medline, CINHAL, Cochrane library and PubMed was performed to identify articles published in English between 2000-2017 in which either physical activity or sedentary behaviour or both were assessed objectively in 6-12 years old school aged children with asthma in case-control, cross-sectional or longitudinal (cohort) studies. In our prospective study we recruited 23 asthmatic children admitted to Kuwaiti hospitals following an asthma attack (mean age of 8.1 (SD 2.02) yrs). For the control group, 23 healthy children from Kuwait youth centres (mean age of 9.0 (1.72) yrs) were recruited. Measurements of asthmatic children at week 1 (acute stage) were compared to those at week 4 after discharge from hospital (recovery stage). Measurements of asthmatic children at the recovery stage were compared to those in healthy controls. Asthma symptoms were assessed by Childhood Asthma Control Test (CACT) questionnaire. Pulmonary function testing was carried out using a portable spirometer. Physical activity, sedentary behaviour and sleeping behaviour were investigated using ActivPAL™ accelerometers. Results: In the systematic review, the literature search identified 71 publications. Of the studies identified, nine met the inclusion criteria (total subjects n= 2996 (asthmatics (n=839), and wheezers (n=37)). In eight studies (total subjects n=2644) there was no significant difference in physical activity between children with and without asthma. Only one study (n=352) reported that asthmatic children were less physically active. No study found that asthmatic children were more physically active. Sedentary behaviour was assessed objectively in 3 studies (n=609); one study suggested that asthmatic children were less sedentary; and two studies showed no differences in sedentary behaviour between children with and without asthma. Our prospective study showed that CACT score improved significantly from week one to week four (week 1, 19.1 ± 4.39; week 4, 22.7 ± 3.77, P=0.000). The number of steps at week four was significantly higher than at week one (week 4, 11876 ± 3924; week 1, 10087 ± 2720, P=0.02). Total sitting time at week 4 was significantly lower than at week 1 (week 4, 7.7 ± 1.10 h/day; week 1, 8.7 ± 1.13 hours/day, P=0.001). During recovery from asthma attack changes in measures of activity continuum varied between individuals. Physical activity duration was increased in 14, but decreased in nine asthmatic children. Number of steps was increased in 16, decreased in six and remained the same in one asthmatic child. Total sitting time was decreased in 19, and increased in four asthmatic children. Sleeping time was increased in 13, decreased in eight and remained the same in two asthmatic children. Physical activity parameters of asthmatic children at week four were significantly higher than those of healthy controls; duration of physical activity (asthmatics, 7.40 ± 1.12 hours/day; healthy, 6.63 ± 2.04 hours/day, P=0.038); total activity counts (asthmatics, 840 ± 271; healthy, 650 ± 157, P=0.006); and number of steps (asthmatics, 11876 ± 3924; healthy, 8602 ± 2128, P=0.001). Sedentary behaviour parameters of asthmatic children at week four were significantly better than those of healthy controls; total sitting time (asthmatics, 7.7 ± 1.10hours; healthy, 8.3 ± 1.56 hours, P=0.05); number of breaks in sitting (asthmatics, 247 ± 97; healthy, 199 ± 65, P=0.05); number of sedentary bouts (asthmatics, 254 ± 89; healthy, 209 ± 54, P=0.045); and fragmentation index (asthmatics, 33.5 ± 13.0; healthy, 26.2 ± 9.6, P=0.001). In the summer in Kuwait, at the hottest time of the year, bed time shifted eight hours (0400 vs 2100) and wake up time shifted to late in the afternoon (1300-1400 vs 0500-0600).The summer sleep duration was ten hours, one hour longer than at other times of the year. Conclusions: The balance of available evidence in the literature strongly suggests that asthmatic and healthy children were of similar physical activity. This study showed that during recovery from asthma attack, asthma symptoms improved, physical activity increased and sedentary behaviour reduced. There were inter-individual variability changes in the activity continuum during recovery. In Kuwait, asthmatic children admitted with an asthma attack were physically active, not sedentary and had no difference in sleep time compared to healthy controls. During the period of very high external environmental temperature in the summer in Kuwait, there was a significant association changes in children's sleeping time and pattern.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RJ Pediatrics