Physical fitness in patients with CANS

Health related physical fitness in patients with complaints of hand, wrist, forearm and elbow (CANS).


Physical fitness with regards to patients with complaints of hand, wrist, forearm and/or elbow and its possible causes is still being explored. The aims of this study were to assess health-related physical fitness (HRPF) in these patients and then to compare HRPF with data from healthy people. They also wanted to explore whether HRPF had any relationship with symptom severity, upper limb function (ULF) and physical activity (PA).

Upper limb disorders, such as complaints of arm, neck and/or shoulder (CANS), occur frequently and may lead to pain and disability. CANS are musculoskeletal complaints of arm, neck and shoulder not caused by acute trauma or by any systemic disease. Therefore, these disorders can result in limitations in a variety of daily activities, such as work, hobbies and sports. To be able to carry out those daily activities, one has to be physically fit.  Therefore the main aim of this  study was to describe health-related physical fitness in patients with CANS. Followed by investigating the similarities and differences between the physical fitness levels of those with CANS and a healthy persons.

This cross-sectional study was performed in the Netherlands, between January 2016 and May 2017. All subjects gave written informed consent. Eligible subjects were outpatients visiting the department, aged ≥18 years and suffering from complaints of hand, wrist, forearm and/or elbow classified as CANS. Subjects did not need to receive treatment for CANS, nor were they excluded if they did.

During a single visit to the exercise laboratory of the department, measurements were taken to assess health-related physical fitness (cardiorespiratory fitness, muscular strength and body composition). Questionnaires to assess demographic, clinical and social characteristics, symptom severity and upper limb function and physical activity were filled out in the week prior to participants visiting the exercise laboratory.

The data from this study show that cardiorespiratory fitness of this sample of patients with CANS was lower than reference values from healthy people, however, hand grip strength and body composition did not seem to differ from reference values. Cardiorespiratory fitness was positively correlated with physical activity. A higher BMI was correlated with greater disability, but most other relationships between health-related physical fitness and symptom severity and upper limb function were low or non-existent. One might interpret very cautiously that, in this sample, levels of cardiorespiratory fitness seem to be determined by physical activity and not by symptom severity nor upper limb function.

physical fitness

Even though the causal relationship is still unknown, interventions to improve physical activity such as the frequency one exercises, how long for and what intensity should be considered.

Suggestions for further research include repetition of a similar study in a larger sample, to explore changes in health-related physical fitness over the course of CANS (from onset to improvement) and to assess the effect of interventions aimed at improving health-related physical fitness (both on physical fitness itself as on symptom severity and upper limb function). The ability to engage in physical activity (eg, work and sports) and the actual duration and intensity there of might also be studied in greater detail.

What do you think of this research? This research concludes that cardiorespiratory fitness was better in people meeting national physical activity (PA) guidelines. Do you think you are reaching the recommended physical activity guidelines? If not, can you try and think of ways you could improve this? If you struggle with CANS, our gym community offers knowledge regarding health and fitness, and our personal trainers can provide workouts tailored specifically to you if you’re experiencing pain in your hands, wrists, forearms, and elbows. We also have in-house physios who you can book in with if you require further treatment.


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