{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T02:16:04Z","timestamp":1779329764416,"version":"3.51.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016670","name":"Region \u00d6sterg\u00f6tland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016670","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008448","name":"Rune och Ulla Aml\u00f6vs Stiftelse f\u00f6r Neurologisk och Reumatologisk Forskning","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008448","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003744","name":"Stiftelsen Handlanden Hjalmar Svenssons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003744","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007190","name":"Sveriges Regering","doi-asserted-by":"publisher","award":["ALFGBG 720121"],"award-info":[{"award-number":["ALFGBG 720121"]}],"id":[{"id":"10.13039\/501100007190","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Most patients with idiopathic normal pressure hydrocephalus (iNPH) improve gait after surgery. However, knowledge on physical capacity and activity after shunt surgery is limited. One of the aims of this study was to evaluate the effect of shunt surgery in patients with iNPH on short-distance walking, functional exercise capacity, functional strength, and variables of activity and sleep, 3 and 6 months postoperatively. Another aim was to evaluate the effect of a physical exercise program. Additionally, we studied how changes in short-distance walking were correlated with functional exercise capacity and voluntary walking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In total, 127 patients were consecutively included and randomized to the exercise group (<jats:italic>n<\/jats:italic> = 62) or the control group (<jats:italic>n<\/jats:italic> = 65). Participants in the exercise group underwent the supervision of a 12-week exercise program. All patients were assessed before surgery, at 3 and 6 months postoperatively with the 10-m walk test (10MWT), the 6-min walk test (6MWT), 30-s chair stand test (30sCST), and with the actigraphic recordings of activity variables measured for a total of 24 h\/day for at least 3 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients improved at 3 months postoperatively in the 10MWT (<jats:italic>p<\/jats:italic> &amp;lt; 0.001), 6MWT (<jats:italic>p<\/jats:italic> &amp;lt; 0.001), and 30sCST (<jats:italic>p<\/jats:italic> &amp;lt; 0.001). These results were maintained after 6 months. Actigraphic recordings for voluntary walking (steps per minute) were improved and nighttime sleep (%) increased after 6 months (<jats:italic>p<\/jats:italic> = 0.01, <jats:italic>p<\/jats:italic> = 0.04). There were no significant differences between the exercise group and the control group, except for the postoperative change in the proportion of daytime sleep after 3 months, which was slightly more reduced compared to baseline in the exercise group (<jats:italic>p<\/jats:italic> = 0.04). Changes after 3 months in the 10MWT and 6MWT were moderately correlated (\u03c1= \u22120.49, <jats:italic>p<\/jats:italic> = 0.01) whereas the correlation between the 10MWT and voluntary walking was weak (\u03c1 = \u22120.34, <jats:italic>p<\/jats:italic> = 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Shunt surgery improved short-distance walking, functional exercise capacity, functional strength, and voluntary walking. An exercise program did not affect these outcomes. Short-distance walking was weakly correlated with voluntary walking, indicating improved physical capacity does not directly translate to increased physical activity. Further research should address how interventions should be tailored to promote physical activity after shunt surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p><jats:ext-link>clinicaltrials.gov<\/jats:ext-link>, Id: NCT02659111.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2022.845976","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T01:20:53Z","timestamp":1648603253000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Physical Capacity and Activity in Patients With Idiopathic Normal Pressure Hydrocephalus"],"prefix":"10.3389","volume":"13","author":[{"given":"Johanna","family":"Rydja","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lena","family":"Koll\u00e9n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Ulander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mats","family":"Tullberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Lundin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1227\/01.NEU.0000168185.29659.C5","article-title":"Diagnosing idiopathic normal pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005","journal-title":"Neurosurgery."},{"key":"B2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","article-title":"Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus","volume":"61","author":"Nakajima","year":"","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1212\/WNL.0000000000002193","article-title":"Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response","volume":"85","author":"Halperin","year":"2015"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1977","DOI":"10.1007\/s00701-013-1835-5","article-title":"Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus","author":"Toma","year":"2013","journal-title":"Acta Neurochirurgica. Acta Neurochir (Wien)."},{"key":"B5","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/j.1600-0404.2012.01676.x","article-title":"One-year outcome in the European multicentre study on iNPH","volume":"126","author":"Klinge","year":"2012","journal-title":"Acta Neurol Scan."},{"key":"B6","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1093\/neuros\/nyz297","article-title":"Cerebrospinal fluid shunting improves long-term quality of life in idiopathic normal pressure hydrocephalus","volume":"86","author":"Israelsson","year":"2020","journal-title":"Neurosurgery."},{"key":"B7","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.clineuro.2012.05.009","article-title":"How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study","volume":"115","author":"Lundin","year":"2013","journal-title":"Clin Neurol Neurosurg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1093\/ptj\/86.4.489","article-title":"A high intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function","volume":"86","author":"Littbrand","year":"2006","journal-title":"Phys Ther"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12987-021-00287-8","article-title":"Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial","volume":"18","author":"Rydja","year":"2021","journal-title":"Fluids Barriers CNS 2021."},{"key":"B10","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1053\/apmr.2001.9396","article-title":"Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment","volume":"82","author":"Rossier","year":"2001","journal-title":"Arch Phys Med Rehabil"},{"key":"B11","first-page":"919","article-title":"The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure","volume":"132","author":"Guyatt","year":"1985","journal-title":"Can Med Assoc J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","article-title":"A 30-s chair-stand test as a measure of lower body strength in community-residing older adults","volume":"70","author":"Jones","year":"1999","journal-title":"Res Q Exerc Sport."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2013.00090","article-title":"Physical activity and physical activity induced energy expenditure in humans: Measurement, determinants, and effects","author":"Westerterp","year":"2013","journal-title":"Front Physiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1249\/00005768-199301000-00011","article-title":"Compendium of Physical Activities: classification of energy costs of human physical activities","volume":"25","author":"Ainsworth","year":"1993","journal-title":"Med Sci Sport Exerc"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1021","DOI":"10.1212\/WNL.0000000000005168","article-title":"Gait analysis in PSP and NPH","volume":"90","author":"Selge","year":"2018","journal-title":"Neurology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"16255","DOI":"10.1038\/s41598-019-52448-3","article-title":"Quantitative gait analysis and cerebrospinal fluid tap test for idiopathic normal-pressure hydrocephalus","volume":"9","author":"Lim","year":"2019","journal-title":"Sci Rep"},{"key":"B17","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1136\/jnnp.70.3.289","article-title":"Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease","volume":"70","author":"Stolze","year":"2001","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.3171\/2018.5.JNS1875","article-title":"Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis","volume":"131","author":"Giordan","year":"2019","journal-title":"J Neurosurg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jocn.2015.10.044","article-title":"Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus","volume":"29","author":"Shaw","year":"2016","journal-title":"J Clin Neurosci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jns.2018.05.022","article-title":"The phenotype of idiopathic normal pressure hydrocephalus-a single center study of 429 patients","volume":"391","author":"Agerskov","year":"2018","journal-title":"J Neurol Sci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"105385","DOI":"10.1016\/j.clineuro.2019.105385","article-title":"Associations among falls, gait variability, and balance function in idiopathic normal pressure hydrocephalus","volume":"183","author":"Nikaido","year":"2019","journal-title":"Clin Neurol Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"106810","DOI":"10.1016\/j.clineuro.2021.106810","article-title":"Evaluation of the effect comorbid Parkinson syndrome on normal pressure hydrocephalus assessment","volume":"207","author":"Davis","year":"2021","journal-title":"Clin Neurol Neurosurg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1159\/000347147","article-title":"Association between Milder Brain Deformation before a Shunt Operation and Improvement in Cognition and Gait in Idiopathic Normal Pressure Hydrocephalus","volume":"35","author":"Yamamoto","year":"2013","journal-title":"Dement Geriatr Cogn Disord."},{"key":"B24","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.parkreldis.2019.07.021","article-title":"A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus: The Bologna PRO-Hydro study","volume":"66","author":"Giannini","year":"2019","journal-title":"Park Relat Disord."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12987-021-00298-5","article-title":"The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients","volume":"19","author":"Sundstr\u00f6m","year":"2022","journal-title":"Fluids Barriers CNS."},{"key":"B26","doi-asserted-by":"publisher","first-page":"86","DOI":"10.2519\/jospt.1996.24.2.86","article-title":"Thomas MW. Walking Speed: Reference Values and Correlates for Older Adults","volume":"24","author":"Bohannon","year":"1996","journal-title":"J Orthop Sports Phys Ther"},{"key":"B27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.exger.2018.11.001","article-title":"Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia","volume":"115","author":"Chan","year":"2019","journal-title":"Exp Gerontol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12883-020-01719-y","article-title":"Standardized regression-based clinical change score cutoffs for normal pressure hydrocephalus","volume":"20","author":"Davis","year":"2020","journal-title":"BMC Neurol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1111\/ane.12853","article-title":"Intermittent gait disturbance in idiopathic normal pressure hydrocephalus","volume":"137","author":"Nikaido","year":"2018","journal-title":"Acta Neurol Scand."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.3390\/jcm9051561","article-title":"Determinants of performance in the timed up-and-go and six-minute walk tests in young and old healthy adults","volume":"9","author":"Montgomery","year":"2020","journal-title":"J Clin Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1016\/j.clineuro.2013.02.015","article-title":"Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest)","volume":"115","author":"Lundin","year":"2013","journal-title":"Clin Neurol Neurosurg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.gaitpost.2017.02.017","article-title":"Trunk sway in idiopathic normal pressure hydrocephalus-Quantitative assessment in clinical practice","volume":"54","author":"B\u00e4cklund","year":"2017","journal-title":"Gait Posture."},{"key":"B33","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.clineuro.2018.06.032","article-title":"Postural control before and after cerebrospinal fluid shunt surgery in idiopathic normal pressure hydrocephalus","volume":"172","author":"Nikaido","year":"2018","journal-title":"Clin Neurol Neurosurg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1034\/j.1600-0404.2000.102005284.x","article-title":"Postural disturbance in patients with normal pressure hydrocephalus","volume":"102","author":"Blomsterwall","year":"2000","journal-title":"Acta Neurol Scand"},{"key":"B35","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/ageing\/26.1.15","article-title":"Comfortable and maximum walking speed of adults aged 20-\u221279 years: reference values and determinants","volume":"26","author":"Bohannon","year":"1997","journal-title":"Age Ageing"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1227\/01.neu.0000306100.83882.81","article-title":"The neuropsychology of patients with clinically diagnosed idiopathic normal pressure hydrocephalus","volume":"61","author":"Hellstr\u00f6m","year":"2007","journal-title":"Neurosurgery."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11910-019-0952-9","article-title":"Sleep-disordered breathing and idiopathic normal-pressure hydrocephalus: recent pathophysiological advances","volume":"19","author":"Rom\u00e1n","year":"2019"},{"key":"B38","doi-asserted-by":"publisher","first-page":"zsab265","DOI":"10.1093\/sleep\/zsab265","article-title":"Sleep-disordered breathing is frequently associated with idiopathic normal pressure hydrocephalus but not other types of hydrocephalus","volume":"45","author":"Riedel","year":"2021","journal-title":"Sleep"},{"key":"B39","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1111\/j.1600-0404.2004.00325.x","article-title":"Impaired wakefulness is associated with reduced anterior cingulate CBF in patients with normal pressure hydrocephalus","volume":"110","author":"Tullberg","year":"2004","journal-title":"Acta Neurol Scand."},{"key":"B40","doi-asserted-by":"publisher","first-page":"e0180902","DOI":"10.1371\/journal.pone.0180902","article-title":"Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews","volume":"12","author":"Zubala","year":"2017","journal-title":"PLoS One."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12966-017-0509-8","article-title":"The association between social support and physical activity in older adults: A systematic review","volume":"14","author":"Lindsay Smith","year":"2017","journal-title":"Int J Behav Nutr Phys Act."},{"key":"B42","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1080\/17437199.2013.876238","article-title":"A review and analysis of the use of \u2018habit' in understanding, predicting and influencing health-related behaviour","volume":"9","author":"Gardner","year":"2015","journal-title":"Health Psychol Rev."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.845976\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T01:20:59Z","timestamp":1648603259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.845976\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,28]]},"references-count":42,"alternative-id":["10.3389\/fneur.2022.845976"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.845976","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,28]]},"article-number":"845976"}}