About
71
Publications
14,041
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
1,386
Citations
Introduction
Non-communicable disease (e.g. diabetes, heart disease) disproportionally affect those living in socio-economic hardship further accelerated by inadequate immediate and long-term care. I’m a research fellow @Stellenbosch University with a strong research focus on exercise and lifestyle interventions in the management and prevention of non-communicable disease for those living in low-resourced settings; working towards a future where health is a reflection of choices rather than circumstances.
Current institution
Additional affiliations
October 2016 - present
Position
- PostDoc Position
Description
- Joint post-doctoral fellowship on "exercise and lifestyle for chronic disease" at the Institute of Sports and Exercise Medicine together with the Centre for Rehabilitation Studies. Strong focus on rehab in low-resource settings.
July 2015 - July 2018
Position
- PostDoc Position
Description
- MS Walk - i (Funded by Dutch MS Research Foundation); assessment of walking-related motor fatigue in patients with Multiple Sclerosis APPECO; www.appeco.net (Funded by eurims.org); platform to facilitate translation of evidence into clinical practice.
October 2010 - June 2015
Education
September 2006 - September 2009
Publications
Publications (71)
Introduction. The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle- income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies ar...
Introduction
Sub-Saharan Africa is a subcontinent with a proud cultural richness and diversity, yet inexplicably also a region with severe health care challenges and inequity. To challenge this health equity gap and reduce the burden of disease, the patient’s voice in monitoring and evaluation of health and health care interventions is paramount. T...
Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity i...
Objective
Cardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source.
Methods
A cross-sectional online survey was administered to CR programmes globally. Need for CR was compu...
Introduction
The SCUBY project aimed to provide knowledge on the scaling-up of an Integrated Care Package (ICP) for type 2 diabetes and hypertension across three distinct health systems (Cambodia, Slovenia, and Belgium). Here, we analyse the different elements of the country-specific scale-up roadmaps to identify similarities and differences, and s...
In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries...
Introduction:
Complex health interventions (CHIs) are common in (public) health and social care practice and policy. A process evaluation (PE) is an essential part of designing and testing CHIs and questions what is implemented, the mechanisms of change, and how context affects implementation. The scale-up of CHIs is challenging and heterogeneous,...
Background
HIV clinical guidelines recommend hypertension detection and management to lower cardiovascular disease risk, but these have not been effectively implemented for people living with HIV (PWH). Addressing this implementation gap requires community-engaged implementation studies focused on addressing implementation barriers specific to the...
As the burden of chronic disease and multiple long-term conditions is increasing globally, disproportionally affecting those in low-resourced settings, there is an increasing call to action to scale effective models of care that can assist in mitigating the impact of chronic disease on functioning, activity, societal participation, and health-relat...
Background: The aim of the SCUBY project was to provide evidence on the scaling up of an Integrated Care Package (ICP) for type II Diabetes (T2D) and hypertension (HT) across three distinct health systems (Cambodia, Slovenia, and Belgium) through the development and implementation of country-specific roadmaps for a national scale-up strategy. Harne...
BACKGROUND: Community-based surveys suggest a substantial burden of chronic respiratory diseases (CRDs) in the Malawian population, causing significant morbidity and loss of economic productivity. Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with CRDs, but there is limited data on its feasibility and acc...
Introduction
The SCUBY project aimed to provide knowledge on the scaling-up of an Integrated Care Package (ICP) for type 2 diabetes and hypertension across three distinct health systems (Cambodia, Slovenia, and Belgium). Here, we analyse the different elements of the country-specific scale-up roadmaps to identify similarities and differences, and s...
Objectives:
Cardiac rehabilitation - programs comprehensively delivering outpatient secondary prevention - is under-available and under-studied in the resource-poor settings where it is needed most. This report summarizes the governance, participating sites, patient characteristics and outcomes, as well as knowledge translation activities during f...
Objectives
Sub-Saharan Africa is a world region rich and diverse in cultures and languages; yet, it is also challenged with regard to resources that may facilitate the cultural adaptation or development of patient-reported outcome measures (PROMs). Systematic exclusion of patients’ “voices,” because of gaps in the availability of PROMs, may perpetu...
The burden of non-communicable disease (NCDs) is increasing rapidly, disproportionally affecting those structurally exposed to adverse social determinants of health (in both high-income and low-to-middle-income countries). Moreover, in many settings, the burden of NCDs is colliding with a high burden of other chronic disease or disease with chronic...
In this data article, we present data obtained from a randomized clinical trial aimed at
determining the feasibility of patient-centred rehabilitation for people with non-
communicable disease (NCD) living in a low-resource setting. Patients were identified at
primary care level and considered eligible if having on or more of the NCDs central to
th...
Objective
To explore and synthesize critical factors for the scale-up of comprehensive rehabilitation care for people with non-communicable disease in low-resourced settings.
Methods
A core set of 81 articles were selected from two published scoping reviews. Using the principles of thematic analysis, the core set was analysed for factors that may...
Objectives
To determine the feasibility of using a trial within cohort design as a model to study pragmatic interventions in a low-resource setting to ensure that i) ethical concerns raised with the conventional clinical trial design could be alleviated, ii) key parameters could be obtained that may promote implementation of interventions in low-re...
Introduction: The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is developing a registry (ICRR) specifically for low-resource settings, where the burden of cardiovascular diseases is greatest and the need for program development highest. Herein we describe the development process, including the variable selection pro...
Background
The 6 min walk test (6MWT) is a validated tool used to assess functional capacity in a variety of patient populations. Space constraints often limit the practicality of the 6MWT according to the standard (2002) American Thoracic Society protocol, and therefore, adaptations to this protocol are common with potential implications for resea...
While resting heart rate (RHR) is known to have strong ties to genetics,¹ there is also a large amount of variability in RHR that can be attributed to different lifestyle factors like physical activity, diet, stress, and quality of sleep.² Consequently, RHR is an important and easily attainable proxy of cardiovascular and general health. The Framin...
Background: The 6-min walk test (6MWT) is a validated tool, of submaximal intensity, used to objectively measure functional exercise capacity. In 2002, the American Thoracic Society (ATS) developed guidelines on standardising the implementation of the 6MWT. Despite the relative ease of conducting the 6MWT as per these guidelines, adaptations are im...
Rationale, aims and objectives
Health illiteracy is an important contributor to the burden of non‐communicable diseases (NCDs); in particular in settings where health illiteracy is part of a perpetuating system of risk factors. Interventions that promote health literacy may provide an important tool in the primary and secondary prevention of NCDs....
With the current rate in growth of evidence in multiple sclerosis (MS) rehabilitation, systematic reviews and clinical guidelines typically lag behind the most currently published research findings. In addition, most healthcare professionals lack the time, resources, or adequate skills to identify and evaluate new evidence, and hands-on-tools to im...
Background: The objective of this review is to provide a synthesis of original studies in patients with MS, originating from sub-Saharan Africa. This review aims to facilitate a better understanding of the MS academic and health landscape in this region.
Methods: A scoping review of original research was conducted (20th of November 2019) in PubMed...
Background
The objective of this review is to provide a synthesis of original studies in patients with MS, originating from sub-Saharan Africa. This review aims to facilitate a better understanding of the MS academic and health landscape in this region.
Methods
A scoping review of original research was conducted (20th of November 2019) in PubMed,...
Purpose:
Cardiac rehabilitation (CR) is a recommendation in international clinical practice guidelines given its benefits; however, use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrollment and adherence into implementable recommendations.
Methods:
The writing panel was const...
Background:
Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations.
Methods:
The writing panel was con...
Social impact is embedded into Stellenbosch University’s institutional strategy and intent. The social impact framework supports social initiatives grouped around seven themes, which align with the sustainable development goals, national and provincial strategic goals.
Stellenbosch University (SU) is currently engaging with private and public part...
Introduction. While there is substantial evidence for the benefits of exercise-based rehabilitation in the prevention and management of non-communicable disease (NCD) in high-resource settings, it is not evident that these programmes can be effectively implemented in a low-resource setting (LRS). Correspondingly, it is unclear if similar benefits c...
Background:
This study aimed to examine muscle fatigue in lower leg muscles in of people with multiple sclerosis and healthy controls, and whether muscle fatigue coincided with potential changes in gait.
Methods:
In this case-control study, people with multiple sclerosis (n = 8; 3male; mean age (SD) = 49.7 (9.6) yr) and age-matched healthy contr...
Introduction: The burden of non-communicable diseases (NCDs), and cardiovascular disease (CVD) specifically, is growing exponentially in Africa, at a rate exceeding that globally. Cardiac rehabilitation (CR) is an established model of care designed to mitigate the burden of NCDs, and CVD specifically. Robust evidence from predominantly high-income...
https://doi.org/10.17159/2078-516X/2019/v31i1a7466
Introduction: It is important to understand how to facilitate behaviour change in the context of healthy lifestyle, where gratification is often delayed and not directly noticeable, to prevent and manage NCD risk factors. The objective of this cross-sectional and pragmatic study was to determine c...
https://doi.org/10.17159/2078-516X/2019/v31i1a7466
Introduction: Due to the improved medical management of patients with MS (pwMS) there has been an increased interest in secondary prevention of chronic comorbidity. It can be hypothesized that with increasing disease severity, pwMS are less likely to engage in physically activity thereby are predi...
Background:
Walking tests, like the 2-minute fast walk test, are simple, inexpensive performance-based tests, and therefore seem attractive to estimate the aerobic fitness in people with chronic diseases.
Objective:
To determine the criterion validity of the 2-minute fast walk test for estimating aerobic capacity in patients with Multiple Sclero...
Background: Reduced walking performance is an important clinical complaint reported by people with multiple sclerosis (PwMS). It is not clear whether muscles of PwMS fatigue during prolonged walking and whether this coincides with changes in walking performance.
Research question: Do lower leg muscles show more muscle fatigue-related changes in su...
Background: Walking tests, like the 2-minute fast walk test, are simple, inexpensive performance-based tests, that are used in clinical practice to estimate the aerobic fitness in people with Multiple Sclerosis.
Objective: To determine the criterion validity of the 2-minute fast walk test for estimating aerobic capacity in patients with Multiple S...
As of 2011, the leading cause of premature mortality in Africa is non-communicable rather than communicable disease (HIV/AIDS, tuberculosis). The burden of non-communicable diseases (NCDs), and cardiovascular disease (CVD) specifically, is growing exponentially in Africa (Fig. 1), at a rate exceeding that globally.1,2 Mortality rates for NCDs in su...
Introduction
Non-communicable diseases (NCDs) are the leading cause of death globally. Even though NCD disproportionally affects low-to-middle income countries, these countries including South Africa, often have limited capacity for the prevention and control of NCDs. The standard evidence-based care for the long-term management of NCDs includes re...
Background:
Patients with multiple sclerosis (pwMS) often experience a decline in motor function and performance during prolonged walking, which potentially is associated with reduced ankle push-off power and might be alleviated through structured exercise. The objectives of this pilot study were to assess ankle push-off power and walking performa...
Background: Due to the improved medical management of patients with MS (pwMS) there has been an increased interest in secondary prevention of chronic comorbidity. It can be hypothesised that with increasing disease severity, pwMS are less likely to engage in physically activity thereby are predisposed for factors for comorbidity and specifically ch...
Background
Evidence supporting the effectiveness of aerobic training, specific for fatigue, in severely fatigued patients with multiple sclerosis (MS) is lacking.
Objective
To estimate the effectiveness of aerobic training on MS-related fatigue and societal participation in ambulant patients with severe MS-related fatigue.
Methods
Patients (N = 9...
Objectives
to (1) assess real-time patterns of fatigue; (2) assess the association between a real-time fatigue score (RTFS) and three commonly used questionnaires (Checklist Individual Strength[CIS], fatigue subscale; Modified Fatigue Impact Scale[MFIS]; and Fatigue Severity Scale[FSS]); and (3) establish factors that confound the association betwe...
Background
Multiple sclerosis(MS) is an immune-mediated disease of the central nervous system affecting an estimated 1.3 million people worldwide. It is characterised by a variety of disabling symptoms of which excessive fatigue is the most frequent. Fatigue is often reported as the most invalidating symptom in people withMS. Various mechanisms dir...
Background
In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life.
Objective
To investigate the association between disease severity and cardiopulmonary fitness.
Methods
Data from cardiopu...
OBJECTIVE:
To investigate the feasibility and safety of Cardiopulmonary Exercise Testing (CPET) in patients with Multiple Sclerosis.
DATA SOURCES:
PUBMED, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC and the Psychology and Behavioral Sciences Collection were searched up to October 2014. References from retrieved articles were examined to identify...
Peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons with MS (PwMS) have not been extensively studied.
(1) to investi...
Aerobic capacity (VO2max) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO2max in PwMS.
The objectives of this study were to (1) systematically review th...
Dutch summary of the review on 'Aerobic Capacity in Persons with Multiple Sclerosis: A Systematic Review and Meta-Analysis.'[Sports Medicine; Epub ahead of print; 05-March-2015]
Background
Cardiopulmonary exercise testing (CPET) can be considered the gold standard for the assessment of cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in patients with Multiple Sclerosis (MS) and how these criteria behave across different levels of neurological disability.Objective
The objective of t...
To investigate the feasibility and safety of Cardiopulmonary Exercise Testing (CPET) in patients with Multiple Sclerosis.
PUBMED, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC and the Psychology and Behavioral Sciences Collection were searched up to October 2014. References from retrieved articles were examined to identify additional relevant studies...
Objective:
To examine the Oxygen Uptake Efficiency Slope (OUES) as an outcome for physical fitness in patients with multiple sclerosis.
Design:
Cross-sectional study.
Patients:
A maximal cycling ergometry test was performed by 56 patients with multiple sclerosis.
Methods:
The OUES was compared with healthy reference values. Correlation analy...
Purpose: Patients with Multiple Sclerosis (MS) are often inhibited
by central and peripheral deficits in reaching accepted criteria
during a maximal exercise test. The Oxygen Uptake Efficiency
Slope (OUES) may be a valuable fitness parameter in patients
unable to attain maximal exercise criteria.
Methods: In 56 patients with MS (mean age ± SD = 44...
Background:
TREFAMS is an acronym for TReating FAtigue in Multiple Sclerosis, while ACE refers to the rehabilitation treatment methods under study, that is, Aerobic training, Cognitive behavioural therapy, and Energy conservation management. The TREFAMS-ACE research programme consists of four studies and has two main objectives: (1) to assess the...
Background:
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system affecting an estimated 1.3 million people worldwide. It is characterised by a variety of disabling symptoms of which excessive fatigue is the most frequent. Fatigue is often reported as the most invalidating symptom in people with MS. Various mechanisms...
Energy flow models can be used to predict athletic performance and to test experimental variations in external conditions, equipment and tactics. However, to use energy flow models it is important to document how well they perform against real world performances.
PURPOSE: This study is designed to document the effect of skating oval altitude on th...
We tested hypothesis that cerebral deoxygenation near maximal exercise intensity is mediated by hyperventilation, via hypocapnia-induced reductions in cerebral blood flow, by utilizing canonical correlation analysis (CCA) to determine the relative influence of cardiopulmonary changes on cerebral oxygenation, as assessed by near infrared spectroscop...
Background: Gross mechanical efficiency (GE) is a predictor of exercise capacity, and a critical measurement when attributing energy output to aerobic or anaerobic sources. Ideally GE is measured during steady state exercise. However it is often inconvenient to perform an additional longer, constant power output (PO) exercise test to measure GE. Th...
Questions
Questions (2)
Dear Colleagues,
Any advice on a methodological framework I can use to review factors or variables that are associated with physical activity (outcome of interest)? I'm not necessarily interested in a meta-analysis on the strength of these associations, but rather interested in identifying the holistic "system" that has been associated with physical activity across various contexts. Almost like "systems thinking or concept mapping", but then based on literature rather than "interviews / workshops".
Thank you in advance
Martin
I'm looking for "interventions" to be used as a framework to teach research methods.
a) Quick to apply / have an immediate effect
b) Can be blinded easily
c) Related to the field of physiotherapy / rehabilitation medicine
d) Are ethical
For example, effect caffeinated versus de-caffeinated coffee on hand grip strength.
