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Ladune R, Hayotte M, Vuillemin A, d'Arripe-Longueville F. Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals. JMIR Form Res 2024; 8:e54322. [PMID: 39078689 PMCID: PMC11322687 DOI: 10.2196/54322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. OBJECTIVE This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. METHODS This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. RESULTS In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO_BALAD, designed for people with CF aged ≥18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. CONCLUSIONS This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study.
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Affiliation(s)
- Raphaelle Ladune
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Meggy Hayotte
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Anne Vuillemin
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
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Filipow N, Bladen M, Raywood E, Robinson E, Chugh D, Douglas H, Thorpe N, O'Connor R, Murray N, Main E. Using reference equations to standardise incremental shuttle walk test performance in children and young people with chronic conditions and facilitate the evaluation of exercise capacity and disease severity. BMJ Open 2024; 14:e075733. [PMID: 38458782 DOI: 10.1136/bmjopen-2023-075733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
AIMS The aim was to evaluate whether standardised exercise performance during the incremental shuttle walk test (ISWT) can be used to assess disease severity in children and young people (CYP) with chronic conditions, through (1) identifying the most appropriate paediatric normative reference equation for the ISWT, (2) assessing how well CYP with haemophilia and cystic fibrosis (CF) perform against the values predicted by the best fit reference equation and (3) evaluating the association between standardised ISWT performance and disease severity. METHODS A cross-sectional analysis was carried out using existing data from two independent studies (2018-2019) at paediatric hospitals in London,UK. CYP with haemophilia (n=35) and CF (n=134) aged 5-18 years were included. Published reference equations for standardising ISWT were evaluated through a comparison of populations, and Bland-Altman analysis was used to assess the level of agreement between distances predicted by each equation. Associations between ISWT and disease severity were assessed with linear regression. RESULTS Three relevant reference equations were identified for the ISWT that standardised performance based on age, sex and body mass index (Vardhan, Lanza, Pinho). A systematic proportional bias of standardised ISWT was observed in all equations, most pronounced with Vardhan and Lanza; the male Pinho equation was identified as most appropriate. On average, CYP with CF and haemophilia performed worse than predicted by the Pihno equation, although the range was wide. Standardised ISWT, and not ISWT distance alone, was significantly associated with forced expiratory volume in 1 s in CYP with CF. Standardised ISWT in CYP with haemophilia was slightly associated with haemophilia joint health score, but this was not significant. CONCLUSIONS ISWT performance may be useful in a clinic to identify those with worsening disease, but only when performance is standardised against a healthy reference population. The development of validated global reference equations is necessary for more robust assessment.
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Affiliation(s)
- Nicole Filipow
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Melanie Bladen
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emma Raywood
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Elisabeth Robinson
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deepti Chugh
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Helen Douglas
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nikki Thorpe
- Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rachel O'Connor
- Paediatric Cystic Fibrosis Centre, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Nicky Murray
- Paediatric Physiotherapy, Royal Brompton Hospital, London, UK
| | - Eleanor Main
- Physiotherapy, Great Ormond Street Institute of Child Health, University College London, London, UK
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Purgato M, Cadorin C, Prina E, Cabral Ferreira M, Del Piccolo L, Gerber M, Jordans MJD, Ostuzzi G, Richards J, Rudi D, Vitali F, Cortese S, Schena F, Barbui C. Umbrella Systematic Review and Meta-Analysis: Physical Activity as an Effective Therapeutic Strategy for Improving Psychosocial Outcomes in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2024; 63:172-183. [PMID: 37331468 DOI: 10.1016/j.jaac.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Physical activity (PA) interventions are part of many interdisciplinary programs for the management of children and adolescents with or without physical or psychological conditions or disabilities. Aiming to summarize the available evidence, we conducted an umbrella review of meta-analyses of PA interventions that included psychosocial outcomes in populations of children and adolescents. METHOD Literature searches were conducted in PubMed, Cochrane Central, Web of Science, Medline, SPORTDiscus, and PsychInfo from January 1, 2010, to May 6, 2022. Meta-analyses of randomized and quasi-randomized studies investigating the efficacy of PA interventions for psychosocial outcomes in children and adolescents were included. Summary effects were recalculated using common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small study effects, and whether the results of the observed positive studies were greater than expected due to chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Quality was assessed using the AMSTAR 2 tool. This study is registered with the Open Science Framework, https://osf.io/ap8qu. RESULTS A total of 112 studies from 18 meta-analyses generating 12 new meta-analyses comprising 21,232 children and adolescents in population groups including attention-deficit/hyperactivity disorder, cancer, cerebral palsy, chronic respiratory diseases, depression, neuromotor impairment, and obesity and in general populations were included. PA interventions were efficacious in reducing psychological symptoms in all meta-analyses across the different population groups using random-effects models. However, umbrella review criteria suggested a weak strength of association for this outcome, and GRADE credibility of evidence ranged from moderate to very low. For psychological well-being, 3 out of 5 meta-analyses identified significant effects, but the strength of these associations was weak, and GRADE credibility of evidence ranged from moderate to very low. Similarly, for social outcomes, meta-analyses reported a significant summary effect, but the strength of association was weak, and GRADE credibility of evidence ranged from moderate to very low. For self-esteem, one meta-analysis in children with obesity failed to show any effect. CONCLUSION Even though existing meta-analyses suggested a beneficial effect of PA interventions on psychosocial outcomes across different population groups, the strength of associations was weak, and the credibility of evidence was variable depending on the target population, outcome, and condition or disability. Randomized studies of PA interventions in children and adolescents with and without different physical and psychological conditions or disabilities should always include psychosocial outcomes as an important dimension of social and mental health. STUDY PREREGISTRATION INFORMATION Prenatal Maternal Infection and Adverse Neurodevelopment: A Structural Equation Modelling Approach to Downstream Environmental Hits; https://osf.io/; ap8qu.
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Affiliation(s)
- Marianna Purgato
- University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | - Giovanni Ostuzzi
- University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy
| | | | | | | | - Samuele Cortese
- University of Southampton, Solent NHS Trust, Southampton, United Kingdom, the University of Nottingham, Nottingham, United Kingdom, and New York University Grossman School of Medicine, New York
| | | | - Corrado Barbui
- University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy
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Sosa-Pedreschi A, Donadio MVF, Iturriaga-Ramírez T, Yvert T, Pérez-Salazar F, Santiago-Dorrego C, Barceló-Guido O, Sanz-Santiago V, Girón R, Punter RMG, Rubio-Alonso M, Pérez-Ruiz M. Effects of a remotely supervised resistance training program on muscle strength and body composition in adults with cystic fibrosis: Randomized controlled trial. Scand J Med Sci Sports 2024; 34:e14564. [PMID: 38268067 DOI: 10.1111/sms.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Among the limited studies on physical exercise interventions in adults with cystic fibrosis (CF), few have specifically addressed the improvement of peripheral muscle strength and body fat-free mass. The aim of this study was to examine the impacts of a remotely supervised, individualized 8-week resistance training program of moderate to high intensity on strength and body composition in these subjects. METHODS This was a randomized controlled trial performed in adults with CF. The exercise group (EX) performed three 1-h resistance training sessions per week over 8 weeks. The control group (CON) followed the physical activity recommendations of their physician. The main outcomes were muscle strength and body composition, with secondary measures including pulmonary function and quality of life. Two-way repeated measures analysis was used. RESULTS In 23 participants (age 32.13 ± 7.72 years), the intervention showed a significant beneficial effect on leg press strength, with a large effect size, both in absolute (p = 0.011;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.281) and relative (p = 0.007;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.310) terms. Large intervention effects were observed on total fat mass (p < 0.001;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.415), body adiposity index (p < 0.001;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.436), and fat mass index (p < 0.001;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.445), all showing reduction in the EX group. In addition, significant large size effects were detected on total fat-free mass (p = 0.046;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.177), trunk fat-free mass (p = 0.039;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.188), and fat-free mass index (p = 0.048;η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.174), all favoring exercise. No significant effects were observed on pulmonary function and quality of life. CONCLUSIONS An 8-week remotely supervised resistance training program, with moderate to high intensity, effectively improved lower limb muscle strength and body composition.
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Affiliation(s)
- Alicia Sosa-Pedreschi
- Departamento de Ciencias del Deportes y Fisioterapia, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Márcio Vinícius Fagundes Donadio
- Departmento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Laboratorio de Atividade Física em Pediatria, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Tamara Iturriaga-Ramírez
- Departamento de Ciencias del Deportes y Fisioterapia, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Thomas Yvert
- Departamento de Salud y Rendimiento Humano, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Fernanda Pérez-Salazar
- Departmento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Catalina Santiago-Dorrego
- Departamento de Ciencias del Deportes y Fisioterapia, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Olga Barceló-Guido
- Departamento de Ciencias del Deportes y Fisioterapia, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | - Rosa Girón
- Servicio de Neumología, Unidad de Fibrosis Quística, Fundación Investigación Hospital Universitario La Princesa, Madrid, Spain
| | - Rosa Mar Gómez Punter
- Servicio de Neumología, Unidad de Fibrosis Quística, Fundación Investigación Hospital Universitario La Princesa, Madrid, Spain
| | - Margarita Rubio-Alonso
- Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Margarita Pérez-Ruiz
- Departamento de Salud y Rendimiento Humano, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
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Pinto ACPN, Piva SR, Rocha A, Gomes-Neto M, Atallah ÁN, Saconato H, Trevisani VF. Digital technology for delivering and monitoring exercise programs for people with cystic fibrosis. Cochrane Database Syst Rev 2023; 6:CD014605. [PMID: 37294546 PMCID: PMC10251804 DOI: 10.1002/14651858.cd014605.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although exercise is recommended as part of the cystic fibrosis (CF) therapeutic routine, adherence to exercise is still limited. Digital health technologies can provide easy-to-access health information and may help improve healthcare and outcomes in individuals with long-term conditions. However, its effects for delivering and monitoring exercise programs in CF have not yet been synthesized. OBJECTIVES To evaluate the benefits and harms of digital health technologies for delivering and monitoring exercise programs, increasing adherence to exercise regimens, and improving key clinical outcomes in people with CF. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 21 November 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) or quasi-RCTs of digital health technologies for delivering or monitoring exercise programs in CF. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. physical activity, 2. self-management behavior, and 3. pulmonary exacerbations. Our secondary outcomes were 4. usability of technologies, 5. quality of life, 6. lung function, 7. muscle strength, 8. exercise capacity, 9. physiologic parameters, and 10. ADVERSE EVENTS We used GRADE to assess certainty of evidence. MAIN RESULTS We identified four parallel RCTs (three single-center and one multicenter with 231 participants aged six years or older). The RCTs evaluated different modes of digital health technologies with distinct purposes, combined with diverse interventions. We identified important methodologic concerns in the RCTs, including insufficient information on the randomization process, blinding of outcome assessors, balance of non-protocol interventions across groups, and whether the analyses performed corrected for bias due to missing outcome data. Non-reporting of results may also be a concern, especially because some planned outcome results were reported incompletely. Furthermore, each trial had a small number of participants, resulting in imprecise effects. These limitations on the risk of bias, and on the precision of effect estimates resulted in overall low- to very low-certainty evidence. We undertook four comparisons and present the findings for our primary outcomes below. There is no information on the effectiveness of other modes of digital health technologies for monitoring physical activity or delivering exercise programs in people with CF, on adverse events related to the use of digital health technologies either for delivering or monitoring exercise programs in CF, and on their long-term effects (more than one year). Digital health technologies for monitoring physical activity Wearable fitness tracker plus personalized exercise prescription compared to personalized exercise prescription alone One trial (40 adults with CF) evaluated this outcome, but did not report data for any of our primary outcomes. Wearable fitness tracker plus text message for personalized feedback and goal setting compared to wearable fitness tracker alone The evidence is very uncertain about the effects of a wearable fitness tracker plus text message for personalized feedback and goal setting, compared to wearable technology alone on physical activity measured by step count at six-month follow-up (mean difference [MD] 675.00 steps, 95% confidence interval [CI] -2406.37 to 3756.37; 1 trial, 32 participants). The same study measured pulmonary exacerbation rates and reported finding no difference between groups. Web-based application to record, monitor, and set goals on physical activity plus usual care compared to usual care alone Using a web-based application to record, monitor, and set goals on physical activity plus usual care may result in little to no difference on time spent in moderate-to-vigorous physical activity measured via accelerometry compared to usual care alone at six-month follow-up (MD -4 minutes/day, 95% CI -37 to 29; 1 trial, 63 participants). Low certainty-evidence from the same trial suggests that the intervention may result in little to no difference on pulmonary exacerbations during 12 months of follow-up (median 1 respiratory hospitalization, interquartile range [IQR] 0 to 3) versus control (median 1 respiratory hospitalization, IQR 0 to 2; P = 0.6). Digital health technologies for delivering exercise programs Web-based versus face-to-face exercise delivery The evidence is very uncertain about the effects of web-based compared to face-to-face exercise delivery on adherence to physical activity as assessed by the number of participants who completed all exercise sessions after three months of intervention (risk ratio 0.92, 95% CI 0.69 to 1.23; 1 trial, 51 participants). AUTHORS' CONCLUSIONS The evidence is very uncertain about the effects of an exercise program plus the use of a wearable fitness tracker integrated with a social media platform compared with exercise prescription alone and on the effects of receiving a wearable fitness tracker plus text message for personalized feedback and goal setting, compared to a wearable fitness tracker alone. Low-certainty evidence suggests that using a web-based application to record, monitor, and set goals on physical activity plus usual care may result in little to no difference in time spent in moderate-to-vigorous physical activity, total time spent in activity, pulmonary exacerbations, quality of life, lung function, and exercise capacity compared to usual care alone. Regarding the use of digital health technologies for delivering exercise programs in CF, the evidence is very uncertain about the effects of using a wearable fitness tracker plus personalized exercise prescription compared to personalized exercise prescription alone. Further high-quality RCTs, with blinded outcome assessors, reporting the effects of digital health technologies on clinically important outcome measures, such as physical activity participation and intensity, self-management behavior, and the occurrence of pulmonary exacerbations in the long term are needed. The results of six ongoing RCTs identified through our searches may help clarify the effects of different modes of digital health technologies for delivering and monitoring exercise programs in people with CF.
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Affiliation(s)
- Ana Carolina Pereira Nunes Pinto
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde, Departamento de Medicina de Urgência, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Department of Emergency Medicine, Evidence-Based Health Post-Graduation Program, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Sara R Piva
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aline Rocha
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Mansueto Gomes-Neto
- Departamento de Biofunção, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Álvaro N Atallah
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Humberto Saconato
- Department of Medicine, Santa Casa de Campo Mourão, Campo Mourão, Brazil
| | - Virginia Fm Trevisani
- Medicina de Urgência and Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo and Universidade de Santo Amaro, São Paulo, Brazil
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Does Regular Exercise Impact the Lung Function of Healthy Children and Adolescents? A Systematic Review and Meta-Analysis. Pediatr Exerc Sci 2022:1-9. [PMID: 36538934 DOI: 10.1123/pes.2022-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the quality of the available evidence on the effect of exercise for the improvement of lung function in healthy children and adolescents. METHOD We performed a systematic review and meta-analysis of intervention studies examining the effects of regular exercise on spirometric parameters of healthy children and adolescents aged ≤18 years. RESULTS Within the exercise groups, there were significant improvements in forced vital capacity (mean difference: 0.17 L; 95% confidence interval, 0.07 to 0.26; P < .05) and forced expiratory volume in the first second (mean difference: 0.14 L; 95% confidence interval, 0.06 to 0.22; P < .05). Results were consistent across different age groups and duration of interventions. In the between-group analysis, forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow were higher in the exercise group compared with the nonexercise group, but the differences did not reach statistical relevance. There was significant statistical heterogeneity between studies. CONCLUSION Regular exercise has the potential to improve lung function parameters in healthy children and adolescents; however, the small number of studies and the heterogeneity between them raise concern about the quality of the currently available evidence. These findings bring to attention the need for well-designed trials addressing this important public health issue.
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García-Pérez-de-Sevilla G, Yvert T, Blanco Á, Sosa Pedreschi AI, Thuissard IJ, Pérez-Ruiz M. Effectiveness of Physical Exercise Interventions on Pulmonary Function and Physical Fitness in Children and Adults with Cystic Fibrosis: A Systematic Review with Meta-Analysis. Healthcare (Basel) 2022; 10:2205. [PMID: 36360546 PMCID: PMC9690212 DOI: 10.3390/healthcare10112205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 10/15/2023] Open
Abstract
Objective: Physical exercise is associated with several benefits in the treatment of cystic fibrosis (CF), associated with a reduction in patient mortality. The aim of this systematic review was to determine the effectiveness of exercise interventions on physical condition and lung function in children and adults with CF to establish the most appropriate type and dose of physical exercise used so far. Methods: The studies included were randomized controlled trials with physical exercise interventions performed with children or adults with CF, analyzing the effects on pulmonary function, cardiorespiratory capacity, and muscle strength. The variables analyzed in at least four studies in the same population (children or adults) with the same measuring test were included in the meta-analysis. Results:Pulmonary function: There were no changes in the forced expiratory volume 1 s, but mouth expiratory/inspiratory pressures were improved in some studies. Physical fitness: In children, the interventions did not manage to improve the VO2peak (SMD = 0.22; 95%CI: -0.25 to 0.68; p = 0.73) but improved muscle strength. In adults, physical exercise interventions based on high-intensity aerobic training showed positive results in the VO2peak, and in some muscle strength outcomes. Conclusions: Exercise interventions in children and adults with CF are effective in improving muscle strength, cardiovascular capacity, and respiratory muscle function. However, they do not achieve improvements in lung function. The most effective programs are those using strength training or cardiovascular high-intensity interval training, although to date there have been few such interventions.
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Affiliation(s)
| | - Thomas Yvert
- Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Ángela Blanco
- Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Israel J. Thuissard
- Faculty of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Margarita Pérez-Ruiz
- Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
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Steps Ahead: Optimising physical activity in adults with cystic fibrosis: A pilot randomised trial using wearable technology, goal setting and text message feedback. J Cyst Fibros 2022:S1569-1993(22)01411-4. [DOI: 10.1016/j.jcf.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
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Giannakoulakos S, Gioulvanidou M, Kouidi E, Peftoulidou P, Kyrvasili SS, Savvidou P, Deligiannis A, Tsanakas J, Hatziagorou E. Physical Activity and Quality of Life among Patients with Cystic Fibrosis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1665. [PMID: 36360393 PMCID: PMC9688592 DOI: 10.3390/children9111665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 03/14/2024]
Abstract
BACKGROUND Physical activity (PA) improves exercise capacity, slows the decline in lung function, and enhances Quality of Life (QoL) in patients with cystic fibrosis (pwCF). OBJECTIVES The study aimed to evaluate PA and QoL among children with CF compared to healthy controls; the secondary aim was to assess the correlation between PA, QoL, and lung function (FEV1). METHODS Forty-five children and adolescents with CF and 45 age-matched controls completed two self-administered validated questionnaires: The Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the DISABKIDS for QoL. Moreover, pwCF performed spirometry and multiple breath washout tests (MBW). In addition, weight, height, and BMI were recorded. The Godin Leisure-Time Exercise Questionnaire was used to evaluate physical activity; QOL was assessed using the DISABKIDS Questionnaire. The correlation of PA with QOL was assessed as well. RESULTS Mean age of the CF population was 13.22 (±4.6) years, mean BMI 19.58 (±4.1) kg/m2, mean FEV1% 91.15 ± 20.46%, and mean LCI 10.68 ± 4.08. 68% of the CF group were active, 27% were medium active, 5% were sedentary, while 83% of the control group were active and 17% were medium active. PwCF with higher PA scores showed significantly higher emotional health (r2: 0.414, p: 0.006) and total QOL score (r2: 0.372; p: 0.014). The PA score showed no significant correlation with FEV1% or LCI. CONCLUSIONS The children with CF showed satisfactory PA levels, which positively correlated to their QoL. More research is needed on the effect of increased levels of habitual physical activity to establish the decline in pulmonary function among pwCF.
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Affiliation(s)
| | - Maria Gioulvanidou
- Pediatric Respiratory Unit, 3rd Paediatric Clinic, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, 57001 Thermi, Greece
| | - Pauline Peftoulidou
- Pediatric Respiratory Unit, 3rd Paediatric Clinic, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Syrmo Styliani Kyrvasili
- Pediatric Respiratory Unit, 3rd Paediatric Clinic, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Parthena Savvidou
- Pediatric Respiratory Unit, 3rd Paediatric Clinic, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, 57001 Thermi, Greece
| | - John Tsanakas
- Pediatric Respiratory Unit, 3rd Paediatric Clinic, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Elpis Hatziagorou
- Pediatric Respiratory Unit, 3rd Paediatric Clinic, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
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10
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Dillenhoefer S, Stehling F, Welsner M, Schlegtendal A, Sutharsan S, Olivier M, Taube C, Mellies U, Koerner-Rettberg C, Brinkmann F, Gruber W. Barriers for Sports and Exercise Participation and Corresponding Barrier Management in Cystic Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13150. [PMID: 36293733 PMCID: PMC9603748 DOI: 10.3390/ijerph192013150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nowadays physical activity (PA)/exercise is an important component of cystic fibrosis (CF) therapy. The aim of the study was to assess the barriers to PA and the barrier management and to explore the effect of supervision on the barriers and barrier management during an exercise program. METHODS In total, 88 people with CF (pwCF) of the ages 6 to 50 years old (mean 24.2 ± 7.9 yrs) participated in the partially supervised 12-month exercise program and filled in a structured and validated questionnaire about barriers to sports and barrier management at baseline. Additionally, 23 pwCF filled in the questionnaire after 6 months and 12 months. The items were clustered into physical and psychosocial barriers and into preventive counter strategies and situational counter strategies and analyzed at baseline and over time. RESULTS Physical barriers were more relevant than psychosocial barriers and no trend could be seen in the situational and preventive counter strategies. When divided in subgroups, the less active pwCF (<7500 steps/day), more active pwCF (>7500 steps/day), physical barriers, and psychosocial barriers showed no significant differences. However physical barriers showed a tendency to have a higher value in the less active group compared to the more active group (p > 0.05). Stratified by age or FEV1%pred between the subgroups, no differences could be seen regarding barriers and counter strategies. CONCLUSIONS Physical barriers seemed to have a higher priority when it comes to not participating in PA/exercise. Supervision over 6 months during an exercise program did not show a beneficial effect on barriers and barrier management. Besides the motivational aspect of sport counselling, the volitional aspect seemed to be more important to incorporate more PA into daily life. Individual barriers and their concrete counter strategies should be discussed with the patient with CF. Sport counselling is needed permanently and should be part of the CF routine care.
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Affiliation(s)
- Stefanie Dillenhoefer
- Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, 44791 Bochum, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany
| | - Anne Schlegtendal
- Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, 44791 Bochum, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
| | | | - Folke Brinkmann
- Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, 44791 Bochum, Germany
| | - Wolfgang Gruber
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
- Institute of Human Nutrition and Food Science, Christian Albrechts University Kiel, 24118 Kiel, Germany
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11
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Radtke T, Smith S, Nevitt SJ, Hebestreit H, Kriemler S. Physical activity and exercise training in cystic fibrosis. Cochrane Database Syst Rev 2022; 8:CD002768. [PMID: 35943025 PMCID: PMC9361297 DOI: 10.1002/14651858.cd002768.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Physical activity (including exercise) may form an important part of regular care for people with cystic fibrosis (CF). This is an update of a previously published review. OBJECTIVES To assess the effects of physical activity interventions on exercise capacity by peak oxygen uptake, lung function by forced expiratory volume in one second (FEV1), health-related quality of life (HRQoL) and further important patient-relevant outcomes in people with cystic fibrosis (CF). SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The most recent search was on 3 March 2022. We also searched two ongoing trials registers: clinicaltrials.gov, most recently on 4 March 2022; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), most recently on 16 March 2022. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs comparing physical activity interventions of any type and a minimum intervention duration of two weeks with conventional care (no physical activity intervention) in people with CF. DATA COLLECTION AND ANALYSIS Two review authors independently selected RCTs for inclusion, assessed methodological quality and extracted data. We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 24 parallel RCTs (875 participants). The number of participants in the studies ranged from nine to 117, with a wide range of disease severity. The studies' age demographics varied: in two studies, all participants were adults; in 13 studies, participants were 18 years and younger; in one study, participants were 15 years and older; in one study, participants were 12 years and older; and seven studies included all age ranges. The active training programme lasted up to and including six months in 14 studies, and longer than six months in the remaining 10 studies. Of the 24 included studies, seven implemented a follow-up period (when supervision was withdrawn, but participants were still allowed to exercise) ranging from one to 12 months. Studies employed differing levels of supervision: in 12 studies, training was supervised; in 11 studies, it was partially supervised; and in one study, training was unsupervised. The quality of the included studies varied widely. This Cochrane Review shows that, in studies with an active training programme lasting over six months in people with CF, physical activity probably has a positive effect on exercise capacity when compared to no physical activity (usual care) (mean difference (MD) 1.60, 95% confidence interval (CI) 0.16 to 3.05; 6 RCTs, 348 participants; moderate-certainty evidence). The magnitude of improvement in exercise capacity is interpreted as small, although study results were heterogeneous. Physical activity interventions may have no effect on lung function (forced expiratory volume in one second (FEV1) % predicted) (MD 2.41, 95% CI ‒0.49 to 5.31; 6 RCTs, 367 participants), HRQoL physical functioning (MD 2.19, 95% CI ‒3.42 to 7.80; 4 RCTs, 247 participants) and HRQoL respiratory domain (MD ‒0.05, 95% CI ‒3.61 to 3.51; 4 RCTs, 251 participants) at six months and longer (low-certainty evidence). One study (117 participants) reported no differences between the physical activity and control groups in the number of participants experiencing a pulmonary exacerbation by six months (incidence rate ratio 1.28, 95% CI 0.85 to 1.94) or in the time to first exacerbation over 12 months (hazard ratio 1.34, 95% CI 0.65 to 2.80) (both high-certainty evidence); and no effects of physical activity on diabetic control (after 1 hour: MD ‒0.04 mmol/L, 95% CI ‒1.11 to 1.03; 67 participants; after 2 hours: MD ‒0.44 mmol/L, 95% CI ‒1.43 to 0.55; 81 participants; moderate-certainty evidence). We found no difference between groups in the number of adverse events over six months (odds ratio 6.22, 95% CI 0.72 to 53.40; 2 RCTs, 156 participants; low-certainty evidence). For other time points (up to and including six months and during a follow-up period with no active intervention), the effects of physical activity versus control were similar to those reported for the outcomes above. However, only three out of seven studies adding a follow-up period with no active intervention (ranging between one and 12 months) reported on the primary outcomes of changes in exercise capacity and lung function, and one on HRQoL. These data must be interpreted with caution. Altogether, given the heterogeneity of effects across studies, the wide variation in study quality and lack of information on clinically meaningful changes for several outcome measures, we consider the overall certainty of evidence on the effects of physical activity interventions on exercise capacity, lung function and HRQoL to be low to moderate. AUTHORS' CONCLUSIONS Physical activity interventions for six months and longer likely improve exercise capacity when compared to no training (moderate-certainty evidence). Current evidence shows little or no effect on lung function and HRQoL (low-certainty evidence). Over recent decades, physical activity has gained increasing interest and is already part of multidisciplinary care offered to most people with CF. Adverse effects of physical activity appear rare and there is no reason to actively discourage regular physical activity and exercise. The benefits of including physical activity in an individual's regular care may be influenced by the type and duration of the activity programme as well as individual preferences for and barriers to physical activity. Further high-quality and sufficiently-sized studies are needed to comprehensively assess the benefits of physical activity and exercise in people with CF, particularly in the new era of CF medicine.
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Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Helge Hebestreit
- Paediatric Department, Julius-Maximilians University, Würzburg, Germany
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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12
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Gurses HN, Ucgun H, Zeren M, Denizoglu Kulli H, Cakır E. Does the effect of comprehensive respiratory physiotherapy home-program differ in children with cystic fibrosis and non-cystic fibrosis bronchiectasis? Eur J Pediatr 2022; 181:2961-2970. [PMID: 35595860 DOI: 10.1007/s00431-022-04509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Bronchiectasis is a form of airway damage as a consequence of endobronchial infection and inflammation and may be present in different diseases. The underlying aetiologies include both cystic fibrosis (CF) and a group of non-cystic fibrosis diseases (NCFB) such as immunodeficiency, primary ciliary dyskinesia, or severe pulmonary infection. Although children with CF and non-cystic fibrosis bronchiectasis (NCFB) have many similar clinical features, their responses to exercise may be different. The aim of this study was to compare the efficacy of a comprehensive respiratory physiotherapy (CRP) home-program in children with CF and NCFB. Thirty children with CF and thirty children with NCFB were included in the study. Both groups performed the CRP home-program twice daily for 8 weeks. Pulmonary function, exercise capacity, and respiratory and peripheral muscle strength were assessed at baseline and after 8 weeks of training. Both groups experienced significant improvements in pulmonary function, exercise capacity, and respiratory and peripheral muscle strength (p < 0.001). Maximum expiratory pressure, exercise capacity, and peripheral muscle strength were further improved in NCFB group compared to CF (p < 0.05); however, there was a great variability in the improvements for each variable. CONCLUSION CRP is beneficial both for children with CF and NCFB and adherence to the program was high in both groups. WHAT IS KNOWN • Different physiotherapy approaches in the management of non-cystic fibrosis bronchiectasis have been based on the experience gained from the research studies performed in cystic fibrosis. • Although having similar pathophysiology, these two diseases show variation in some pulmonary and extrapulmonary features. WHAT IS NEW • The respiratory muscle strength and the efficacy of comprehensive respiratory physiotherapy have been compared for the first time in children with cystic fibrosis and non-cystic fibrosis bronchiectasis. • Comprehensive respiratory physiotherapy provides higher increases in children with non-cystic fibrosis bronchiectasis in exercise capacity and expiratory and peripheral muscle strength; however, there was a great variability in these improvements. Nevertheless, it can be concluded that both groups significantly benefited from the CRP program.
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Affiliation(s)
- Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No:189, 34060, Istanbul, Turkey. .,Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hilal Denizoglu Kulli
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Erkan Cakır
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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13
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Effects of a Long-Term Monitored Exercise Program on Aerobic Fitness in a Small Group of Children with Cystic Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137923. [PMID: 35805585 PMCID: PMC9265477 DOI: 10.3390/ijerph19137923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022]
Abstract
Background: The aim of this study was to investigate the effects of a monitored exercise program on aerobic fitness in children with cystic fibrosis (CF). Methods: Six children (2f/4m) with ages ranging from 6 to 14 years (11.3 ± 3.3 years.) and a mean ppFEV1 102.5 ± 13.5% pred. participated in the partially monitored 12-month exercise program. VO2peak and Wpeak were used as parameters of aerobic fitness. Incremental Cardio-Pulmonary Exercise Tests (CPETs) were performed before the program began (T1), after 6 months (T3) of monitoring, and after a further 6 months (T4) without monitoring. Habitual physical activity (HPA) was assessed with accelerometry. Results: The values of VO2peak and Wpeak improved slightly from T1 to T3 (p > 0.05), without a further increase after monitoring was stopped (T4). However, the VO2peak and Wpeak values were higher after monitoring was stopped compared to at T1. The exercise program with and without monitoring (p > 0.05) had no or only a slight effect on the FEV1 values, steps/day, and the intensity of HPA. Conclusions: Monitoring seems to facilitate the achievement of beneficial effects on physical fitness in CF children. For that reason, continuous individual exercise monitoring programs that involve close contact with an exercise therapist should be provided to maintain long-term motivation and participation in physical activities and sport activities during leisure time.
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14
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Anifanti M, Giannakoulakos S, Hatziagorou E, Kampouras A, Tsanakas J, Deligiannis A, Kouidi E. Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis. SENSORS (BASEL, SWITZERLAND) 2022; 22:4884. [PMID: 35808375 PMCID: PMC9269327 DOI: 10.3390/s22134884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
Several studies have shown that patients with cystic fibrosis (CF), even at a young age, have pulmonary and cardiac abnormalities. The main complications are cardiac right ventricular (RV) systolic and/or diastolic dysfunction and pulmonary hypertension, which affects their prognosis. Exercise training (ET) is recommended in patients with CF as a therapeutic modality to improve physical fitness and health-related quality of life. However, questions remain regarding its optimal effective and safe dose and its effects on the patients’ cardiac function. The study aimed to provide a wearable activity tracker (WAT)-based ET to promote physical activity in CF patients and assess its effects on cardiac morphology and function. Forty-two stable CF individuals (aged 16.8 ± 3.6 years) were randomly assigned to either the intervention (Group A) or the control group (Group B). Group A participated in a 1-year WAT-based ET program three times per week. All patients underwent a 6-min walking test (6-MWT) and an echocardiographic assessment focused mainly on RV anatomy and function at the baseline and the end of the study. RV systolic function was evaluated by measuring the tricuspid annular plane systolic excursion (TAPSE), the systolic tricuspid annular velocity (TVS’), the RV free-wall longitudinal strain (RVFWSL), and the right ventricular four-chamber longitudinal strain (RV4CSL). RV diastolic function was assessed using early (TVE) and late (TVA) diastolic transtricuspid flow velocity and their ratio TVE/A. Pulmonary artery systolic pressure (PASP) was also estimated. In Group A after ET, the 6MWT distance improved by 20.6% (p < 0.05), TVA decreased by 17% (p < 0.05), and TVE/A increased by 13.2% (p < 0.05). Moreover, TAPSE, TVS’, RVFWSL, and RV4CSL increased by 8.3% (p < 0.05), 9.0% (p < 0.05), 13.7% (p < 0.05), and 26.7% (p < 0.05), respectively, while PASP decreased by 7.6% (p < 0.05). At the end of the study, there was a significant linear correlation between the number of steps and the PASP (r = −0.727, p < 0.01) as well as the indices of RV systolic function in Group A. In conclusion, WAT is a valuable tool for implementing an effective ET program in CF. Furthermore, ET has a positive effect on RV systolic and diastolic function.
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Affiliation(s)
- Maria Anifanti
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
| | - Stavros Giannakoulakos
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
| | - Elpis Hatziagorou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.H.); (A.K.); (J.T.)
| | - Asterios Kampouras
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.H.); (A.K.); (J.T.)
| | - John Tsanakas
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.H.); (A.K.); (J.T.)
| | - Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
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15
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Heinz KD, Walsh A, Southern KW, Johnstone Z, Regan KH. Exercise versus airway clearance techniques for people with cystic fibrosis. Cochrane Database Syst Rev 2022; 6:CD013285. [PMID: 35731672 PMCID: PMC9216233 DOI: 10.1002/14651858.cd013285.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are many accepted airway clearance techniques (ACTs) for managing the respiratory health of people with cystic fibrosis (CF); none of which demonstrate superiority. Other Cochrane Reviews have reported short-term effects related to mucus transport, but no evidence supporting long-term benefits. Exercise is an alternative ACT thought to produce shearing forces within the lung parenchyma, which enhances mucociliary clearance and the removal of viscous secretions. Recent evidence suggests that some people with CF are using exercise as a substitute for traditional ACTs, yet there is no agreed recommendation for this. Additionally, one of the top 10 research questions identified by people with CF is whether exercise can replace other ACTs. Systematically reviewing the evidence for exercise as a safe and effective ACT will help people with CF decide whether to incorporate this strategy into their treatment plans and potentially reduce their treatment burden. The timing of this review is especially pertinent given the shifting landscape of CF management with the advent of highly-effective small molecule therapies, which are changing the way people with CF are cared for. OBJECTIVES To compare the effect of exercise to other ACTs for improving respiratory function and other clinical outcomes in people with CF and to assess the potential adverse effects associated with this ACT. SEARCH METHODS On 28 February 2022, we searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. We searched online clinical trial registries on 15 February 2022. We emailed authors of studies awaiting classification or potentially eligible abstracts for additional information on 1 February 2021. SELECTION CRITERIA We selected randomised controlled studies (RCTs) and quasi-RCTs comparing exercise to another ACT in people with CF for at least two treatment sessions. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for the included studies. They assessed the certainty of the evidence using GRADE. Review authors contacted investigators for further relevant information regarding their publications. MAIN RESULTS We included four RCTs. The 86 participants had a wide range of disease severity (forced expiratory volume in one second (FEV1) ranged from 54% to 95%) and were 7 to 41 years old. Two RCTs were cross-over and two were parallel in design. Participants in one RCT were hospitalised with an acute respiratory exacerbation, whilst the participants in three RCTs were clinically stable. All four RCTs compared exercise either alone or in combination with another ACT, but these were too diverse to allow us to combine results. The certainty of the evidence was very low; we downgraded it due to low participant numbers and high or unclear risks of bias across all domains. Exercise versus active cycle of breathing technique (ACBT) One cross-over trial (18 participants) compared exercise alone to ACBT. There was no change from baseline in our primary outcome FEV1, although it increased in the exercise group before returning to baseline after 30 minutes; we are unsure if exercise affected FEV1 as the evidence is very low-certainty. Similar results were seen for other measures of lung function. No adverse events occurred during the exercise sessions (very low-certainty evidence). We are unsure if ACBT was perceived to be more effective or was the preferred ACT (very low-certainty evidence). 24-hour sputum volume was less in the exercise group than with ACBT (secondary outcome). Exercise capacity, quality of life, adherence, hospitalisations and need for additional antibiotics were not reported. Exercise plus postural drainage and percussion (PD&P) versus PD&P only Two trials (55 participants) compared exercise and PD&P to PD&P alone. At two weeks, one trial narratively reported a greater increase in FEV1 % predicted with PD&P alone. At six months, the other trial reported a greater increase with exercise combined with PD&P, but did not provide data for the PD&P group. We are uncertain whether exercise with PD&P improves FEV1 as the certainty of evidence is very low. Other measures of lung function did not show clear evidence of effect. One trial reported no difference in exercise capacity (maximal work rate) after two weeks. No adverse events were reported (1 trial, 17 participants; very low-certainty evidence). Adherence was high, with all PD&P sessions and 96% of exercise sessions completed (1 trial, 17 participants; very low-certainty evidence). There was no difference between groups in 24-hour sputum volume or in the mean duration of hospitalisation, although the six-month trial reported fewer hospitalisations due to exacerbations in the exercise and PD&P group. Quality of life, ACT preference and need for antibiotics were not reported. Exercise versus underwater positive expiratory pressure (uPEP) One trial (13 participants) compared exercise to uPEP (also known as bubble PEP). No adverse events were recorded in either group (very low-certainty evidence). Trial investigators reported that participants perceived exercise as more fatiguing but also more enjoyable than bubble PEP (very low-certainty evidence). There were no differences found in the total weight of sputum collected during treatment sessions. The trial did not report the primary outcomes (FEV1, quality of life, exercise capacity) or the secondary outcomes (other measures of lung function, adherence, need for antibiotics or hospitalisations). AUTHORS' CONCLUSIONS As one of the top 10 research questions identified by clinicians and people with CF, it is important to systematically review the literature regarding whether or not exercise is an acceptable and effective ACT, and whether it can replace traditional methods. We identified an insufficient number of trials to conclude whether or not exercise is a suitable alternative ACT, and the diverse design of included trials did not allow for meta-analysis of results. The evidence is very low-certainty, so we are uncertain about the effectiveness of exercise as an ACT. Longer studies examining outcomes that are important to people with CF are required to answer this question.
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Affiliation(s)
- Katie D Heinz
- Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Adam Walsh
- Physiotherapy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Zoe Johnstone
- Paediatric Cystic Fibrosis Unit, Royal Hospital for Sick Children, Edinburgh, UK
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16
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Bianchim MS, McNarry MA, Holland A, Cox NS, Dreger J, Barker AR, Williams CA, Denford S, Mackintosh KA. A Compositional Analysis of Physical Activity, Sedentary Time, and Sleep and Associated Health Outcomes in Children and Adults with Cystic Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5155. [PMID: 35564550 PMCID: PMC9102111 DOI: 10.3390/ijerph19095155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
This study sought to investigate the association of light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time (SED), and sleep with lung function in children and adults with CF. In total, 86 children (41 females; 13.6 ± 2.8 years; FEV1%predicted: 86 ± 1%) and 43 adults (21 females; 24.6 ± 4.7 years; FEV1%predicted: 63 ± 21%) with CF participated in this study. Wrist-worn accelerometery was used to assess PA, SED and sleep. Compositional linear regression models were conducted following normalisation via isometric log-ratio transformations. Sequential binary partitioning was applied to investigate the impact of reallocating 10 to 30 min between each behaviour on FEV1%predicted. A decline in FEV1%predicted was predicted with the reallocation of 30 min from MVPA to SED or LPA or sleep to any other behaviour in children (-3.04--0.005%) and adults (-3.58--0.005%). Conversely, improvements in FEV1%predicted were predicted when 30 min was reallocated to MVPA from LPA or SED in children (0.12-1.59%) and adults (0.77-2.10%), or when 30 min was reallocated to sleep from any other behaviour in both children (0.23-2.56%) and adults (1.08-3.58%). This study supports the importance of MVPA and sleep for maintaining and promoting lung function in people with CF.
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Affiliation(s)
- Mayara S. Bianchim
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University Bay Campus, Swansea SA1 8EN, UK; (M.S.B.); (K.A.M.)
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA, UK
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University Bay Campus, Swansea SA1 8EN, UK; (M.S.B.); (K.A.M.)
| | - Anne Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne 3004, Australia; (A.H.); (N.S.C.); (J.D.)
- Alfred Health, Australia Institute for Breathing and Sleep, Melbourne 3004, Australia
- Alfred Health, Physiotherapy Department, Melbourne 3004, Australia
| | - Narelle S. Cox
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne 3004, Australia; (A.H.); (N.S.C.); (J.D.)
- Alfred Health, Australia Institute for Breathing and Sleep, Melbourne 3004, Australia
| | - Julianna Dreger
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne 3004, Australia; (A.H.); (N.S.C.); (J.D.)
- Alfred Health, Physiotherapy Department, Melbourne 3004, Australia
| | - Alan R. Barker
- Children’s Health and Exercise Research Centre, University of Exeter, Exeter EX1 2LU, UK; (A.R.B.); (C.A.W.); (S.D.)
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, University of Exeter, Exeter EX1 2LU, UK; (A.R.B.); (C.A.W.); (S.D.)
| | - Sarah Denford
- Children’s Health and Exercise Research Centre, University of Exeter, Exeter EX1 2LU, UK; (A.R.B.); (C.A.W.); (S.D.)
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University Bay Campus, Swansea SA1 8EN, UK; (M.S.B.); (K.A.M.)
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López-Liria R, Checa-Mayordomo D, Vega-Ramírez FA, García-Luengo AV, Valverde-Martínez MÁ, Rocamora-Pérez P. Effectiveness of Video Games as Physical Treatment in Patients with Cystic Fibrosis: Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:1902. [PMID: 35271048 PMCID: PMC8914851 DOI: 10.3390/s22051902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 05/08/2023]
Abstract
Physical training at home by making individuals play active video games is a new therapeutic strategy to improve the condition of patients with cystic fibrosis (CF). We reviewed studies on the use of video games and their benefits in the treatment of CF. We conducted a systematic review with data from six databases (PubMed, Medline, Scopus, Web of Science, PEDro, and Cochrane library plus) since 2010, according to PRISMA standards. The descriptors were: "Cystic Fibrosis", "Video Game", "Gaming Console", "Pulmonary Rehabilitation", "Physiotherapy", and "Physical Therapy". Nine articles with 320 participants met the inclusion criteria and the study objective. Patients who played active video games showed a high intensity of exercise and higher ventilatory and aerobic capacity compared to the values of these parameters in tests such as the cardiopulmonary stress test or the six-minute walk test. Adequate values of metabolic demand in these patients were recorded after playing certain video games. A high level of treatment adherence and satisfaction was observed in both children and adults. Although the quality of the included studies was moderate, the evidence to confirm these results was insufficient. More robust studies are needed, including those on evaluation and health economics, to determine the effectiveness of the treatment.
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Affiliation(s)
- Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain;
| | | | | | - Amelia Victoria García-Luengo
- FQM228-Research Team, Department of Mathematics, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain
| | - María Ángeles Valverde-Martínez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain;
| | - Patricia Rocamora-Pérez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain;
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Effects of Exercise on Nutritional Status in People with Cystic Fibrosis: A Systematic Review. Nutrients 2022; 14:nu14050933. [PMID: 35267909 PMCID: PMC8912872 DOI: 10.3390/nu14050933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Physical exercise is an important part of regular care for people with cystic fibrosis (CF). It is unknown whether such exercise has beneficial or detrimental effects on nutritional status (body composition). Thus, the objective of this review was to evaluate the effect of exercise on measures of nutritional status in children and adults with CF. METHODS Standardized reporting guidelines for systematic reviews were followed and the protocol was prospectively registered. Multiple databases were utilized (e.g., PubMed, Scopus, and CINHAL). Two reviewers independently reviewed titles/abstracts and then the full text for selected studies. RESULTS In total, 924 articles were originally identified; data were extracted from 4 eligible studies. These four studies included only children; pulmonary function ranged from severe to normal, and the majority of participants were at or below their recommended weight. Exercise training did not worsen nutritional status in any study; two studies that included resistance exercise reported an increase in fat-free mass. Three of the four studies also reported increased aerobic capacity and/or muscle strength. CONCLUSIONS Exercise training can produce positive physiologic changes in children with CF without impairing their nutritional status. In fact, resistance exercise can help improve body mass. Much less is known about how exercise may affect adults or those who are overweight.
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Burghard M, Takken T, Nap-van der Vlist MM, Nijhof SL, van der Ent CK, Heijerman HGM, Hulzebos HJE. Physiological predictors of cardiorespiratory fitness in children and adolescents with cystic fibrosis without ventilatory limitation. Ther Adv Respir Dis 2022; 16:17534666211070143. [PMID: 35012387 PMCID: PMC8755930 DOI: 10.1177/17534666211070143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives: [1] To investigate the cardiorespiratory fitness (CRF) levels in children and
adolescents with cystic fibrosis (CF) with no ventilatory limitation
(ventilatory reserve ⩾ 15%) during exercise, and [2] to assess which
physiological factors are related to CRF. Methods: A cross-sectional study design was used in 8- to 18-year-old children and
adolescents with CF. Cardiopulmonary exercise testing was used to determine
peak oxygen uptake normalized to body weight as a measure of CRF. Patients
were defined as having ‘low CRF’ when CRF was less than 82%predicted.
Physiological predictors used in this study were body mass index z-score,
P. Aeruginosa lung infection, impaired glucose
tolerance (IGT) including CF-related diabetes, CF-related liver disease,
sweat chloride concentration, and self-reported physical activity. Backward
likelihood ratio (LR) logistic regression analysis was used. Results: Sixty children and adolescents (51.7% boys) with a median age of 15.3 years
(25th–75th percentile: 12.9–17.0 years) and a mean percentage predicted
forced expiratory volume in 1 second of 88.5% (±16.9) participated. Mean
percentage predicted CRF (ppVO2peak/kg) was 81.4% (±12.4, range:
51%–105%). Thirty-three patients (55.0%) were classified as having ‘low
CRF’. The final model that best predicted low CRF included IGT
(p = 0.085; Exp(B) = 6.770) and P.
Aeruginosa lung infection (p = 0.095; Exp(B) = 3.945). This
model was able to explain between 26.7% and 35.6% of variance. Conclusions: CRF is reduced in over half of children and adolescents with CF with normal
ventilatory reserve. Glucose intolerance and P. Aeruginosa
lung infection seem to be associated to low CRF in children and adolescents
with CF.
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Affiliation(s)
- Marcella Burghard
- Child Development, Exercise, and Physical Literacy Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 EA Utrecht, The Netherlands.,Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Takken
- Child Development, Exercise, and Physical Literacy Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel M Nap-van der Vlist
- Department of Social Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Social Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Kors van der Ent
- Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harry G M Heijerman
- Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.,Division Heart and Lung, Department of Pulmonology, Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H J Erik Hulzebos
- Child Development, Exercise, and Physical Literacy Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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Williams CA, Barker AR, Denford S, van Beurden SB, Bianchim MS, Caterini JE, Cox NS, Mackintosh KA, McNarry MA, Rand S, Schneiderman JE, Wells GD, Anderson P, Beever D, Beverley Z, Buckley R, Button B, Causer AJ, Curran M, Dwyer TJ, Gordon W, Gruet M, Harris RA, Hatziagorou E, Erik Hulzebos HJ, Kampouras A, Morrison L, Cámara MN, Reilly CM, Sawyer A, Saynor ZL, Shelley J, Spencer G, Stanford GE, Urquhart DS, Young R, Tomlinson OW. The Exeter Activity Unlimited statement on physical activity and exercise for cystic fibrosis: methodology and results of an international, multidisciplinary, evidence-driven expert consensus. Chron Respir Dis 2022; 19:14799731221121670. [PMID: 36068015 PMCID: PMC9459449 DOI: 10.1177/14799731221121670] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The roles of physical activity (PA) and exercise within the management of cystic fibrosis (CF) are recognised by their inclusion in numerous standards of care and treatment guidelines. However, information is brief, and both PA and exercise as multi-faceted behaviours require extensive stakeholder input when developing and promoting such guidelines. METHOD On 30th June and 1st July 2021, 39 stakeholders from 11 countries, including researchers, healthcare professionals and patients participated in a virtual conference to agree an evidence-based and informed expert consensus about PA and exercise for people with CF. This consensus presents the agreement across six themes: (i) patient and system centred outcomes, (ii) health benefits, iii) measurement, (iv) prescription, (v) clinical considerations, and (vi) future directions. The consensus was achieved by a stepwise process, involving: (i) written evidence-based synopses; (ii) peer critique of synopses; (iii) oral presentation to consensus group and peer challenge of revised synopses; and (iv) anonymous voting on final proposed synopses for adoption to the consensus statement. RESULTS The final consensus document includes 24 statements which surpassed the consensus threshold (>80% agreement) out of 30 proposed statements. CONCLUSION This consensus can be used to support health promotion by relevant stakeholders for people with CF.
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Affiliation(s)
- Craig A Williams
- Children's Health and Exercise Research Centre, Sport and Health Science, 3286University of Exeter, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust Hospital, Exeter, UK
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Science, 3286University of Exeter, Exeter, UK
| | - Sarah Denford
- 1980Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, 1980University of Bristol, Bristol, UK
- School of Psychological Science, 1980University of Bristol, Bristol, UK
| | | | - Mayara S Bianchim
- 7622University of Stirling, NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Jessica E Caterini
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
- School of Medicine, Queen's University, Kingston, Canada
| | - Narelle S Cox
- Respiratory Research @ Alfred, Department of Immunology and Pathology, 2541Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, 7759Swansea University, Swansea, UK
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, 7759Swansea University, Swansea, UK
| | - Sarah Rand
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane E Schneiderman
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Greg D Wells
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | | | - Daniel Beever
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Z Beverley
- Adult Cystic Fibrosis Unit, 4964Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Ronan Buckley
- National Referral Centre for Adult Cystic Fibrosis, St Vincent's University Hospital, Dublin, Republic Of Ireland
| | - Brenda Button
- Faculty of Medicine Nursing and Health Sciences, 2541Monash University, Melbourne, Australia
- Department of Respiratory Medicine, 5392Alfred Health, Melbourne, Australia
| | - Adam J Causer
- Department for Health, 1555University of Bath, Bath, UK
| | - Máire Curran
- School of Allied Health, 8808University of Limerick, Limerick, Republic Of Ireland
- University Hospital Limerick, Limerick, Republic Of Ireland
- Health Research Institute, 8808University of Limerick, Limerick, Republic Of Ireland
| | - Tiffany J Dwyer
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | | | - Mathieu Gruet
- 27017University of Toulon, IAPS Laboratory, Toulon, France
| | - Ryan A Harris
- Georgia Prevention Institute, Department of Medicine, 1421Augusta University, Augusta GA, United States Of America
| | - Elpis Hatziagorou
- Paediatric Pulmonology and CF Unit, 3rd Paediatric Department, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H J Erik Hulzebos
- Department of Pediatrics, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Asterios Kampouras
- Paediatric Pulmonology and CF Unit, 3rd Paediatric Department, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
- Paediatric Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Lisa Morrison
- West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Marietta N Cámara
- Hospital Carlos Van Buren, Department of Pediatrics, Division of Pulmonary, Cystic Fibrosis & Home Mechanical Ventilation, Valparaíso, Chile
- School of Medicine & Postgraduate, Department of Pediatrics, 28068Universidad de Valparaíso, Viña del Mar, Chile
| | - Clare M Reilly
- National Referral Centre for Adult Cystic Fibrosis, St Vincent's University Hospital, Dublin, Republic Of Ireland
| | - Abbey Sawyer
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, 6697University of Portsmouth, Portsmouth, UK
| | - James Shelley
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, 7759Swansea University, Swansea, UK
| | - Grace Spencer
- 1555Department of Psychology University of Bath, Bath, UK
| | - Gemma E Stanford
- Adult Cystic Fibrosis Unit, 4964Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, 59842Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Rachel Young
- All Wales Adult Cystic Fibrosis Centre, 97605University Hospital Llandough, Llandough, UK
| | - Owen W Tomlinson
- Children's Health and Exercise Research Centre, Sport and Health Science, 3286University of Exeter, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust Hospital, Exeter, UK
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Rocamora-Pérez P, Benzo-Iglesias MJ, Valverde-Martínez MDLÁ, García-Luengo AV, Aguilar-Parra JM, Trigueros R, López-Liria R. Effectiveness of positive expiratory pressure on patients over 16 years of age with cystic fibrosis: systematic review and meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221089467. [PMID: 35485916 PMCID: PMC9058457 DOI: 10.1177/17534666221089467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Cystic fibrosis (CF) is an autosomal recessive disease that involves the cells that produce mucus and sweat, affecting many organs, especially the lungs. Positive expiratory pressure (PEP) devices generate a pressure opposite to that exerted by the airways during expiration, thus improving mucociliary clearance. OBJECTIVES To evaluate the efficacy of PEP devices as a resource to facilitate the mucus removal and other outcomes in people with CF, as well as the possible adverse effects derived from their use. MATERIAL AND METHOD A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were 'cystic fibrosis', 'PEP', and 'physiotherapy and/or physical therapy'. The search was performed in four databases: PubMed, PEDro, and Web of Science and Scopus, in July 2021. The inclusion criteria were randomized controlled trials (RCTs) over the last 10 years. The methodological quality of the studies was analyzed and meta-analysis was performed with Review Manager software. RESULTS Ten RCTs met the objectives and criteria, with a total of 274 participants. The trials score a moderate methodological quality on the PEDro scale. No clear results were obtained on whether PEP provides better lung function than other breathing techniques (such as airway clearance); but it does achieve a higher rate of lung clearance than physical exercise. CONCLUSIONS PEP is more effective than usual care or no intervention, although there is not enough evidence to confirm that PEP achieves improvements in forced expiratory volume in the first second (FEV1) compared with other techniques. It is a safe technique, without adverse effects.
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Affiliation(s)
- Patricia Rocamora-Pérez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
| | | | | | - Amelia Victoria García-Luengo
- FQM228-Research Team, Random Models and Design of Experiments, Department of Mathematics, University of Almería, Almería, Spain
| | | | - Rubén Trigueros
- Health Research Centre, Department of Psychology, University of Almería, Almería, Spain
| | - Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain
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Abstract
BACKGROUND Autogenic drainage is an airway clearance technique that was developed by Jean Chevaillier in 1967. The technique is characterised by breathing control using expiratory airflow to mobilise secretions from smaller to larger airways. Secretions are cleared independently by adjusting the depth and speed of respiration in a sequence of controlled breathing techniques during exhalation. The technique requires training, concentration and effort from the individual but it has previously been shown to be an effective treatment option for those who are seeking techniques to support and promote independence. However, at a time where the trajectory and demographics of the disease are changing, it is important to systematically review the evidence demonstrating that autogenic drainage is an effective intervention for people with cystic fibrosis. OBJECTIVES To compare the clinical effectiveness of autogenic drainage in people with cystic fibrosis with other physiotherapy airway clearance techniques. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews, as well as two ongoing trials registers (02 February 2021). Date of most recent search of the Cochrane Cystic Fibrosis Trials Register: 06 July 2021. SELECTION CRITERIA We identified randomised and quasi-randomised controlled studies comparing autogenic drainage to another airway clearance technique or no therapy in people with cystic fibrosis for at least two treatment sessions. DATA COLLECTION AND ANALYSIS Data extraction and assessments of risk of bias were independently performed by three authors. The authors assessed the quality of the evidence using the GRADE system. The authors contacted seven teams of investigators for further information pertinent to their published studies. MAIN RESULTS Searches retrieved 64 references to 37 individual studies, of which eight (n = 212) were eligible for inclusion. One study was of parallel design with the remaining seven being cross-over in design; participant numbers ranged from 4 to 75. The total study duration varied between four days and two years. The age of participants ranged between seven and 63 years with a wide range of disease severity reported. Six studies enrolled participants who were clinically stable, whilst participants in two studies received treatment whilst hospitalised with an infective exacerbation. All studies compared autogenic drainage to one (or more) other recognised airway clearance technique. Exercise is commonly used as an alternative therapy by people with cystic fibrosis; however, there were no studies identified comparing exercise with autogenic drainage. The certainty of the evidence was generally low or very low. The main reasons for downgrading the level of evidence were the frequent use of a cross-over design, outcome reporting bias and the inability to blind participants. The review's primary outcome, forced expiratory volume in one second, was the most common outcome measured and was reported by all eight studies; only three studies reported on quality of life (also a primary outcome of the review). One study reported on adverse events and described a decrease in oxygen saturation levels whilst performing active cycle of breathing techniques, but not with autogenic drainage. Seven of the eight included studies measured forced vital capacity and three of the studies used mid peak expiratory flow (per cent predicted) as an outcome. Six studies reported sputum weight. Less commonly used outcomes included oxygen saturation levels, personal preference, hospital admissions, intravenous antibiotics and pseudomonas gene expression. There were no statistically significant differences found between any of the techniques used with respect to the outcomes measured except when autogenic drainage was described as being the preferred technique of the participants in one study over postural drainage and percussion. AUTHORS' CONCLUSIONS Autogenic drainage is a challenging technique that requires commitment from the individual. As such, this intervention merits systematic review to ensure its effectiveness for people with cystic fibrosis, particularly in an era where treatment options are changing rapidly. From the studies assessed, autogenic drainage was not found to be superior to any other form of airway clearance technique. Larger studies are required to better evaluate autogenic drainage in comparison to other airway clearance techniques in view of the relatively small number of participants in this review and the complex study designs. The studies recruited a range of participants and were not powered to assess non-inferiority. The varied length and design of the studies made the analysis of pooled data challenging.
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Affiliation(s)
- Paul Burnham
- Servicio de Medicina Fisica y Rehabilitacion, Hospital La Paz, Madrid, Spain
| | - Gemma Stanford
- Department of Cystic Fibrosis, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Insititute, Imperial College London, London, UK
| | - Ruth Stewart
- Royal Hospital for Children and Young People, Edinburgh, UK
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Monteiro KS, Santino TA, Pakhale S, Balfour L, Pereira Pinto de Mendonça KM. Translation, cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Cystic Fibrosis Knowledge Scale (CFKS). PLoS One 2021; 16:e0259232. [PMID: 34784376 PMCID: PMC8594816 DOI: 10.1371/journal.pone.0259232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Information on the level of knowledge about cystic fibrosis (CF) among affected people and their families is still scarce. OBJECTIVE This study aimed to translate, cross-culturally adapt and analyze the psychometric properties of the Brazilian version of Cystic Fibrosis Knowledge Scale (CFKS). MATERIALS AND METHODS The translation and cross-cultural adaptation involved the stages of translation, synthesis of translations, reverse translation, synthesis of reverse translations, review by a multi-professional committee of experts and pre-testing. The reliability, viability, construct, predictive, concurrent and discriminant validity were investigated. RESULTS The sample consisted of 40 individuals with cystic CF, 47 individuals with asthma, 242 healthcare workers and 81 students from the health area. The Brazilian version of the CFKS presented high internal consistency (α = 0.91), moderate floor and ceiling effects, without differences in the test-retest scores. An analysis of factorial exploration identified three dimensions. Confirmatory factor analysis led to an acceptable data-model fit. There was good predictive validity, with a difference in the scores among all the evaluated groups (p <0.001), as well as good discriminant validity since individuals with asthma had greater knowledge of asthma compared to CF (r = 0.401, p = 0.005; r2 = 0.162). However, there was no difference between the diagnosis time and knowledge about CF (r = -0.25, p = 0.11; r2 = 0.06), either between treatment adherence and knowledge about CF (r = -0.04, p = 0.77; r2 = 0.002). CONCLUSION The Brazilian version of the CFKS indicated that the scale is able to provide valid, reliable and reproducible measures for evaluating the knowledge about CF.
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Affiliation(s)
- Karolinne Souza Monteiro
- Faculty of Health Science of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
- * E-mail:
| | - Thayla Amorim Santino
- Graduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Smita Pakhale
- Faculty of Medicine, University of Ottawa, Ottawa, Canadá
| | - Louise Balfour
- Faculty of Medicine, University of Ottawa, Ottawa, Canadá
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Potter A, Pancholi B, Smith L, Maher C. Should the physiotherapy outcomes airway clearance, physical activity and fitness be recorded on the Australian Cystic Fibrosis Data Registry? A consensus approach. BMC Pulm Med 2021; 21:298. [PMID: 34548053 PMCID: PMC8456641 DOI: 10.1186/s12890-021-01669-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physiotherapy is a cornerstone of cystic fibrosis (CF) management, yet the Australian CF Data Registry (ACFDR) currently does not record physiotherapy-related data. This study aimed to gather opinions from lead Australian CF physiotherapists regarding the importance and feasibility of collecting physiotherapy-related data on the ACFDR. METHODS A three-round online Delphi survey was conducted to gather expert stakeholder opinion and consensus agreement. Lead physiotherapists from all 23 Australian CF centres were invited to participate. Round one explored the potential benefits, barriers and importance of recording three physiotherapy-related domains on the ACFDR: airway clearance, physical activity and fitness. Subsequent rounds were developed based on the findings from the previous round and sought consensus (80% agreement) for the inclusion of physiotherapy-related data on the ACFDR and for the most appropriate methods of collecting such data. RESULTS The response rate was > 80% for all rounds. Participants agreed that collection of airway clearance, physical activity and fitness data on the ACFDR was important and feasible. Findings suggested that airway clearance and physical activity should be collected using self-reported questionnaires, while fitness should be measured using a field-based test. CONCLUSIONS Australian lead CF physiotherapists believe that collection of airway clearance, physical activity and fitness on the ACFDR is important and feasible. Future work is needed to pilot the data collection procedure to examine its feasibility in real-world clinical settings. This study demonstrates how Delphi methodology can provide a contemporary summary of expert clinicians' opinion that may underpin nation-wide health service improvement.
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Affiliation(s)
- Angela Potter
- Physiotherapy Department, Women's and Children's Hospital, SA Health, 72 King William Rd, North Adelaide, SA, 5006, Australia
| | - Bhavita Pancholi
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Lahni Smith
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Carol Maher
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia. .,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
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Hillen B, Simon P, Schlotter S, Nitsche O, Bähner V, Poplawska K, Pfirrmann D. Feasibility and implementation of a personalized, web-based exercise intervention for people with cystic fibrosis for 1 year. BMC Sports Sci Med Rehabil 2021; 13:95. [PMID: 34412703 PMCID: PMC8377819 DOI: 10.1186/s13102-021-00323-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/29/2021] [Indexed: 12/29/2022]
Abstract
Background Regular participation in exercise is important for people with cystic fibrosis (CF). Therefore, we implemented a personalized, web-based exercise intervention over the course of one year for people with CF. The aims were to investigate the feasibility of the intervention and to evaluate changes in exercise participation, lung function, and exercise capacity. Methods In total, 11/17 participants [aged 12–52 years; FEV1%pred. 72.3 (SD: 17.3)] were included in the final data analysis. Every week, the participants received an individual training recommendation at the start and uploaded their training report on our website at the end of each week. The number of training minutes and sessions performed were analyzed over 13 four-week training sections. The participation in exercise (physical activity questionnaire), lung function and exercise capacity were assessed at baseline (T0), after 12 weeks (T1) and after 52 weeks (T2). Results A training duration of 178 min (SD: 75.5) and 3.3 (SD: 0.89) training sessions could be achieved weekly. In the first four-week training section, the participants performed 137.31 (SD: 95.7) minutes of training, with an increase of 42% in the third training section (195.01, SD: 134.99). Minutes of training reported on the questionnaire increased by 39.7% from T0 (179.38 min, SD: 120.9) to T1 (250.63 min, SD: 124.1) but decreased at T2 (166.88, SD: 155.4). There were slight decreases in lung function (FEV1 − 3.9%pred.; FVC − 1.9%pred.) and slight increases in exercise capacity (VO2peak + 1.5 ml/min/kg; six-minute-walk-test-distance + 26 m). Noticeably, five participants experienced deteriorations in their FEV1 of more than 5% but simultaneously experienced improvements in the parameters of exercise capacity of more than 5% throughout the year. Conclusions The web-based concept was feasible for the participants over the course of a year and supported exercise participation. The improvement in exercise capacity due to increased exercise participation over a prolonged period of time, despite a decrease in lung function, should be further investigated. Finally, if integrated into usual care, this approach could facilitate the prescription of regular personalized exercise and promote exercise participation in the daily lives of people with CF.
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Affiliation(s)
- Barlo Hillen
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University, Mainz, Germany
| | - Perikles Simon
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Schlotter
- Medical Department of Pediatrics Pulmonology, Allergology and Cystic Fibrosis, University Medical Centre, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Oliver Nitsche
- Medical Department of Pediatrics Pulmonology, Allergology and Cystic Fibrosis, University Medical Centre, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Viola Bähner
- Medical Department of Pediatrics Pulmonology, Allergology and Cystic Fibrosis, University Medical Centre, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Krystyna Poplawska
- Medical Department of Pediatrics Pulmonology, Allergology and Cystic Fibrosis, University Medical Centre, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Daniel Pfirrmann
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University, Mainz, Germany
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Van Biervliet S, Declercq D, Dereeper S, Vermeulen D, Würth B, De Guschtenaere A. The effect of an intensive residential rehabilitation program on body composition in patients with cystic fibrosis. Eur J Pediatr 2021; 180:1981-1985. [PMID: 33474579 DOI: 10.1007/s00431-021-03943-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
The pulmonary function of patients with cystic fibrosis (CF) is associated with nutritional status not only expressed as body mass index (BMI) but also as fat-free mass index (FFMI). This study evaluated the effect of a residential rehabilitation program on nutritional status (BMI, FFMI). The rehabilitation program provided supervised respiratory and nutritional treatment and daily physical activity for 3 weeks (median stay 20 (19-25) days). At the start and the end of the program, weight, height, pulmonary function, and body composition using dual-energy X-ray absorptiometry were prospectively collected. Supervised weighed food records were obtained, and physical activity intensity was measured using a SenseWear Pro3 Armband. CF-related complications were collected from the patient. Thirty-four patients (21 males, median age 18 years old (12-27)) were included. The diet contained a median of 30 EN% fat, 16 EN% protein, and 52 EN% of carbohydrates. A significant median weight gain (+1.45 kg (0.58; 2.6) (p < 0.0001) and a significant increase in BMI (+0.24 kg/m2 (0.11; 0.38)) (p < 0.0001), FFMI (+0.26 kg/m2 (0.01; 0.55)) (p < 0.0001), and FMI (+0.19 kg/m2 (0.04; 0.41)) (p < 0.0001) were obtained.Conclusion: A short rehabilitation program in individuals with CF between 6 and 40 years old is able to improve nutritional status and body composition.Trial registration: NCT04527796 What is Known: • Fat-free mass depletion is frequently present in CF. • In CF pulmonary function is associated with nutritional status measured as body mass index but also fat-free mass index. What is New: • Nutritional status and body composition improve significantly after a short-term rehabilitation program. • The rehabilitation program was able to improve nutritional outcome even with a diet containing less fat than currently advised in the guidelines.
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Affiliation(s)
- Stephanie Van Biervliet
- Cystic Fibrosis Reference Center, Gent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Dimitri Declercq
- Cystic Fibrosis Reference Center, Gent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | | | - Drieke Vermeulen
- Cystic Fibrosis Reference Center, Gent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Girón Moreno RM, García-Clemente M, Diab-Cáceres L, Martínez-Vergara A, Martínez-García MÁ, Gómez-Punter RM. Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review. Antibiotics (Basel) 2021; 10:486. [PMID: 33922413 PMCID: PMC8144952 DOI: 10.3390/antibiotics10050486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/08/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease that causes absence or dysfunction of a protein named transmembrane conductance regulatory protein (CFTR) that works as an anion channel. As a result, the secretions of the organs where CFTR is expressed are very viscous, so their functionality is altered. The main cause of morbidity is due to the involvement of the respiratory system as a result of recurrent respiratory infections by different pathogens. In recent decades, survival has been increasing, rising by around age 50. This is due to the monitoring of patients in multidisciplinary units, early diagnosis with neonatal screening, and advances in treatments. In this chapter, we will approach the different therapies used in CF for the treatment of symptoms, obstruction, inflammation, and infection. Moreover, we will discuss specific and personalized treatments to correct the defective gene and repair the altered protein CFTR. The obstacle for personalized CF treatment is to predict the drug response of patients due to genetic complexity and heterogeneity of uncommon mutations.
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Affiliation(s)
- Rosa María Girón Moreno
- Servicio de Neumología, Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain; (R.M.G.M.); (R.M.G.-P.)
| | - Marta García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, C/Avenida de Roma S/n, 33011 Oviedo, Spain
| | - Layla Diab-Cáceres
- Servicio de Neumología, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | | | | | - Rosa Mar Gómez-Punter
- Servicio de Neumología, Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain; (R.M.G.M.); (R.M.G.-P.)
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Filleul V, Ladune R, Gruet M, Falzon C, Fuchs A, Mély L, Hayotte M, Vallier JM, Giovannetti P, Ramel S, Vuillemin A, Corrion K, d'Arripe-Longueville F. Development and validation of the Cystic Fibrosis Decisional Balance for Physical Activity scale (CF-DB-PA). BMC Pulm Med 2021; 21:121. [PMID: 33853554 PMCID: PMC8048282 DOI: 10.1186/s12890-021-01471-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with cystic fibrosis (pwCF) derive several physiological and psychological benefits from regular physical activity (PA), but the practice is lower than recommended. Knowledge about the facilitators of and barriers to PA at the individual level is important to act positively on PA behaviors. This study validated the Cystic Fibrosis Decisional Balance for Physical Activity scale (CF-DB-PA) for adults with CF. METHODS French adults with CF were recruited in several specialist centres in France. The CF-DB-PA scale was validated following a quantitative study protocol comprising four stages: (1) tests of the clarity and relevance of a preliminary 44-item version and reduction analysis, (2) confirmatory factor analysis and tests of dimensionality through equation modelling analysis, (3) tests of reliability with Cronbach alphas for the internal consistency and a test-retest with a 2-to-3 week interval for temporal stability, and 4) tests of construct validity with Spearman correlations to measure the associations between each subscale and the theoretically related constructs (i.e., quality of life, PA and exercise tolerance). RESULTS A total of 201 French adults with CF participated in the validation study. The CF-DB-PA comprises 23 items divided into two factors: facilitators of and barriers to PA. Each factor is divided into three subscales: physical, psychological and environmental. The factors (facilitators and barriers) can be used independently or combined as a whole. A general score of decisional balance for PA can also be calculated. The bi-factor model presented satisfactory adjustment indexes: χ2 (194) = 362.33; p < .001; TLI = .87; CFI = .90; RMSEA = .067. The scale showed satisfactory internal consistency (Cronbach's α = .77). The test-retest reliability was not significant for either subscale, indicating stability over time. The facilitators subscale correlated significantly with the self-reported score of PA (r = .33, p < .01) and quality of life (r = .24, p < .05). The barriers subscale correlated significantly with the self-reported scores of PA (r = - .42, p > .01), quality of life (r = - .44, p < .01), exercise tolerance (r = - .34, p < .01) and spirometry tests (r = - .30, p < .05). CONCLUSIONS The CF-DB-PA is a reliable and valid questionnaire assessing the decisional balance for PA, the facilitators of and the barriers to PA for adults with CF in French-speaking samples.
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Affiliation(s)
| | | | - Mathieu Gruet
- Université de Toulon, Unité de Recherche Impact de l'Activité Physique sur la Santé, Toulon, France
| | | | - Amélie Fuchs
- Laboratoire de thérapeutiques non médicamenteuses innovantes Mooven, Montpellier, France
| | - Laurent Mély
- Hôpital Renée Sabran, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM), Giens, France
| | | | - Jean-Marc Vallier
- Université de Toulon, Unité de Recherche Impact de l'Activité Physique sur la Santé, Toulon, France
| | - Philippe Giovannetti
- Service de Pneumologie, Centre de Ressource et de Compétence de la Mucoviscidose (CRCM) adulte et pôle d'Activités Médicales Intersite de Médecine Physique et de Réadaptation APHM-CHU Hôpital Nord, Marseille, France
| | - Sophie Ramel
- Fondation Ildys, site de Perharidy, Roscoff, France
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Estévez-González AJ, Donadio MVF, Cobo-Vicente F, Fernández-Luna Á, Sanz-Santiago V, Villa Asensi JR, Iturriaga Ramirez T, Fernández-Del-Valle M, Diez-Vega I, Larumbe-Zabala E, Pérez-Ruiz M. Effects of a Short-Term Resistance-Training Program on Heart Rate Variability in Children With Cystic Fibrosis-A Randomized Controlled Trial. Front Physiol 2021; 12:652029. [PMID: 33859572 PMCID: PMC8042150 DOI: 10.3389/fphys.2021.652029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Cystic fibrosis (CF) affects the autonomic nervous system (ANS) and exercise in healthy children modulates the interaction between sympathetic and parasympathetic activity. This study aimed to evaluate the effects of a short-term resistance exercise program on heart rate variability (HRV) in children and adolescents with CF. Methods: A randomized controlled trial was carried out in children diagnosed with CF aged 6–18 years. Individuals were divided into two groups: control (CON) and resistance-training (EX). Individuals in the EX group completed an individualized guided resistance program (5-RM—60–80%) for 8 weeks (3 sessions of 60 min/week). Upper and lower limbs exercises (seated bench press, seated lateral row, and leg press) were used. HRV was measured using a Suunto watch with subjects in lying position. Results: Nineteen subjects (13 boys) were included (CON = 11; and EX = 8). Mean age was 12.2 ± 3.3, FEV1 (forced expiratory volume in the first second) z-score was 1.72 ± 1.54 and peak oxygen consumption (VO2peak) 42.7 ± 7.4 mL.Kg–1.min–1. Exercise induced significant changes in the frequency-domain variables, including a decrease in LF power (p = 0.001, d = 0.98) and LF/HF ratio (p = 0.020, d = 0.92), and an increase in HF power (p = 0.001, d = −0.97), compared to the CON group. No significant changes were found for time-domain variables, although increases with a moderate effect size were seen for SDNN (p = 0.152, d = −0.41) and RMSSD (p = 0.059, d = −0.49) compared to the CON group. Conclusion: A short-term resistance exercise-training program was able to modulate HRV in children and adolescents with CF presenting mild to moderate lung function impairment and good physical condition. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04293926.
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Affiliation(s)
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | | | | | | | - Tamara Iturriaga Ramirez
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Ignacio Diez-Vega
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Kalamara EI, Ballas ET, Pitsiou G, Petrova G. Pulmonary rehabilitation for cystic fibrosis: A narrative review of current literature. Monaldi Arch Chest Dis 2021; 91. [PMID: 33792230 DOI: 10.4081/monaldi.2021.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Pulmonary rehabilitation is a key component in cystic fibrosis care. This review summarizes the recent evidence in the area of pulmonary rehabilitation for cystic fibrosis in the form of questions and answers regarding interventions, indications, benefits and risks of pulmonary rehabilitation. Pulmonary rehabilitation includes airway clearance techniques, exercise training, education and behaviour change and can improve patients' exercise capacity, muscle strength, quality of life and nutritional status. Airway clearance techniques have beneficial effects for clearing mucous. Over the past years, evidence for the beneficial effects of exercise training on exercise capacity and overall lung health is growing. In cystic fibrosis, multiple factors result in reduced exercise capacity. All modalities of pulmonary rehabilitation should be offered to patients with cystic fibrosis, as the benefits in most cases outweigh the risks, though the optimal regimens need to be yet defined.
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Affiliation(s)
- Evgenia I Kalamara
- Respiratory Failure Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece.
| | | | - Georgia Pitsiou
- Respiratory Failure Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki; Medical School, Aristotle University of Thessaloniki, Greece.
| | - Guergana Petrova
- Medical University of Sofia; Pediatric Clinic, University Hospital Alexandrovska, Sofia, Bulgaria.
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31
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Trainability of Health-Related and Motor Performance Fitness in Adults with Cystic Fibrosis within a 12-Month Partially Supervised Exercise Program. Pulm Med 2021; 2021:5581812. [PMID: 33763240 PMCID: PMC7964122 DOI: 10.1155/2021/5581812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Regular physical activity plays an important role in the treatment of patients with cystic fibrosis (CF). This study is aimed at investigating the effects of a 12-month partially supervised exercise program on attributes of health-related and motor performance fitness, lung function (ppFEV1), BMI, and habitual physical activity (HPA, steps/day) in adults with CF. Methods Attributes of health-related and motor performance fitness were examined at the beginning (T0), after 6 (T1), and 12 months (T2) on the basis of five test items: forward bend (FB), bent knee hip extension (HE), plank leg raise (PLR), standing long jump (SLJ), and standing on one leg (OLS). Additionally, we recorded HPA by accelerometry, peak exercise performance (W peak) by an incremental cycle test, ppFEV1, and BMI. During the first six months, there was close supervision by an experienced sport therapist. Results 26 CF patients (8 female, mean age 26.5 ± 7.9 years; ppFEV1 53.7 ± 21.0) completed the exercise program. Significant improvements were recorded from T0 to T1 (FB: p ≤ 0.05; PLR, OLS: p ≤ 0.01) and from T0 to T2 (FB, PLR: p ≤ 0.01 and HE, OLS: p ≤ 0.05). W peak, ppFEV1, BMI, and HPA showed no significant improvement between the single test points and over the entire study period (all p > 0.05). Conclusion Our results show trainability of adults with CF in aspects of health-related and motor performance fitness during a partially supervised exercise program. Close supervision positively influences the results. Using a simple test setup seems to be a promising tool for evaluating the effects of exercise programs in CF and could serve as an additional outcome parameter in future clinical trials. Trial registration: ClinicalTrials.gov (retrospectively registered May 8, 2018).
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Tomlinson OW, Denford S, Barker AR, Schneiderman JE, Campisi ES, Douglas H, Rand S, McNarry MA, Mackintosh KA, Williams CA. The impact of physical activity and exercise interventions for physical health in people with cystic fibrosis: protocol for a systematic review. Syst Rev 2021; 10:64. [PMID: 33637136 PMCID: PMC7913325 DOI: 10.1186/s13643-021-01614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetically inherited, life-limiting condition, affecting ~90,000 people globally. Physical activity (PA) and exercise form an integral component of CF management, and have been highlighted by the CF community as an area of interest for future research. Previous reviews have solely focused on PA or structured exercise regimens independent of one another, and thus a comprehensive assessment of the physical health benefits of all PA, including exercise, interventions, is subsequently warranted. Therefore, the purpose of this review is to evaluate the effects of both PA and exercise upon outcomes of physical health and healthcare utilisation in people with CF. METHODS A systematic review has been registered and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P guidelines. This will include randomised control trials on the effects of PA and exercise, relative to usual treatment, upon people with CF. Primary outcomes will include variables associated with fitness, PA, lung health, inflammation, body composition, glycaemic control and patient-reported outcomes. Secondary outcomes will include adverse events and healthcare utilisation. Searches will be undertaken in Ovid MEDLINE, OVID EMBASE, PsychINFO, ERIC, SPORTDiscus, ASSIA, CCTR, CINHAL and Web of Science databases, and will be searched from date of inception onwards. Two reviewers will independently screen citations and abstracts, and full-texts, for inclusion and data extraction, respectively. Methodological quality will be assessed using the Cochrane Risk of Bias-2 tool. If feasible, random-effects meta-analyses will be conducted where appropriate. Additional analyses will explore potential sources of heterogeneity, such as age, sex, and disease severity. DISCUSSION This systematic review will build on previous research, by comprehensively assessing the impact of both PA and exercise upon physical health and healthcare utilisation in people with CF. Results of this review will be utilised to inform discussions that will ultimately result in a consensus document on the impact of physical activity and exercise for people with CF. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020184411.
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Affiliation(s)
- Owen W Tomlinson
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.,Royal Devon and Exeter NHS Foundation Trust Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Sarah Denford
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.,Centre for Public Health and Epidemiology, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK
| | - Jane E Schneiderman
- Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Emma S Campisi
- University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Helen Douglas
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Sarah Rand
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Bay Campus, Swansea University, Fabian Way, Swansea, SA1 8EN, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Bay Campus, Swansea University, Fabian Way, Swansea, SA1 8EN, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK. .,Royal Devon and Exeter NHS Foundation Trust Hospital, Barrack Road, Exeter, EX2 5DW, UK.
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Hatziagorou E, Kampouras A, Avramidou V, Toulia I, Chrysochoou EA, Galogavrou M, Kirvassilis F, Tsanakas J. Toward the Establishment of New Clinical Endpoints for Cystic Fibrosis: The Role of Lung Clearance Index and Cardiopulmonary Exercise Testing. Front Pediatr 2021; 9:635719. [PMID: 33718306 PMCID: PMC7946844 DOI: 10.3389/fped.2021.635719] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 01/25/2023] Open
Abstract
As Cystic Fibrosis (CF) treatment advances, research evidence has highlighted the value and applicability of Lung Clearance Index and Cardiopulmonary Exercise Testing as endpoints for clinical trials. In the context of these new endpoints for CF trials, we have explored the use of these two test outcomes for routine CF care. In this review we have presented the use of these methods in assessing disease severity, disease progression, and the efficacy of new interventions with considerations for future research.
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Affiliation(s)
- Elpis Hatziagorou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Kampouras
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Avramidou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilektra Toulia
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet-Anna Chrysochoou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Galogavrou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotios Kirvassilis
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Tsanakas
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
BACKGROUND Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. OBJECTIVES To determine the effectiveness of respiratory muscle training on clinical outcomes in people with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: 11 June 2020. A hand search of the Journal of Cystic Fibrosis and Pediatric Pulmonology was performed, along with an electronic search of online trial databases. Date of most recent search: 05 October 2020. SELECTION CRITERIA Randomised controlled studies comparing respiratory muscle training with a control group in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Review authors independently selected articles for inclusion, evaluated the methodological quality of the studies, and extracted data. Additional information was sought from trial authors where necessary. The quality of the evidence was assessed using the GRADE system. MAIN RESULTS Authors identified 20 studies, of which 10 studies with 238 participants met the review's inclusion criteria. There was wide variation in the methodological and written quality of the included studies. Four of the 10 included studies were published as abstracts only and lacked concise details, thus limiting the information available. Eight studies were parallel studies and two of a cross-over design. Respiratory muscle training interventions varied dramatically, with frequency, intensity and duration ranging from thrice weekly to twice daily, 20% to 80% of maximal effort, and 10 to 30 minutes, respectively. Participant numbers ranged from 11 to 39 participants in the included studies; five studies were in adults only, one in children only and four in a combination of children and adults. No differences between treatment and control were reported in the primary outcome of pulmonary function (forced expiratory volume in one second and forced vital capacity) or postural stability (very low-quality evidence). Although no change was reported in exercise capacity as assessed by the maximum rate of oxygen use and distance completed in a six minute walk test, a 10% improvement in exercise duration was found when working at 60% of maximal effort in one study (n = 20) (very low-quality evidence). In a further study (n = 18), when working at 80% of maximal effort, health-related quality of life improved in the mastery and emotion domains (very low-quality evidence). With regards to the review's secondary outcomes, one study (n = 11) found a change in intramural pressure, functional residual capacity and maximal inspiratory pressure following training (very low-quality evidence). Another study (n=36) reported improvements in maximal inspiratory pressure following training (P < 0.001) (very low-quality evidence). A further study (n = 22) reported that respiratory muscle endurance was longer in the training group (P < 0.01). No studies reported significant differences on any other secondary outcomes. Meta-analyses could not be performed due to a lack of consistency and insufficient detail in reported outcome measures. AUTHORS' CONCLUSIONS There is insufficient evidence to suggest whether this intervention is beneficial or not. Healthcare practitioners should consider the use of respiratory muscle training on a case-by-case basis. Further research of reputable methodological quality is needed to determine the effectiveness of respiratory muscle training in people with cystic fibrosis. Researchers should consider the following clinical outcomes in future studies; respiratory muscle function, pulmonary function, exercise capacity, hospital admissions, and health-related quality of life. Sensory-perceptual changes, such as respiratory effort sensation (e.g. rating of perceived breathlessness) and peripheral effort sensation (e.g. rating of perceived exertion) may also help to elucidate mechanisms underpinning the effectiveness of respiratory muscle training.
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Affiliation(s)
- Gemma Stanford
- Department of Cystic Fibrosis, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Insititute, Imperial College London, London, UK
| | | | - Arturo Solis-Moya
- Servicio de Neumología, Hospital Nacional de Niños, San José, Costa Rica
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Checa J, Aran JM. Airway Redox Homeostasis and Inflammation Gone Awry: From Molecular Pathogenesis to Emerging Therapeutics in Respiratory Pathology. Int J Mol Sci 2020; 21:E9317. [PMID: 33297418 PMCID: PMC7731288 DOI: 10.3390/ijms21239317] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 02/06/2023] Open
Abstract
As aerobic organisms, we are continuously and throughout our lifetime subjected to an oxidizing atmosphere and, most often, to environmental threats. The lung is the internal organ most highly exposed to this milieu. Therefore, it has evolved to confront both oxidative stress induced by reactive oxygen species (ROS) and a variety of pollutants, pathogens, and allergens that promote inflammation and can harm the airways to different degrees. Indeed, an excess of ROS, generated intrinsically or from external sources, can imprint direct damage to key structural cell components (nucleic acids, sugars, lipids, and proteins) and indirectly perturb ROS-mediated signaling in lung epithelia, impairing its homeostasis. These early events complemented with efficient recognition of pathogen- or damage-associated recognition patterns by the airway resident cells alert the immune system, which mounts an inflammatory response to remove the hazards, including collateral dead cells and cellular debris, in an attempt to return to homeostatic conditions. Thus, any major or chronic dysregulation of the redox balance, the air-liquid interface, or defects in epithelial proteins impairing mucociliary clearance or other defense systems may lead to airway damage. Here, we review our understanding of the key role of oxidative stress and inflammation in respiratory pathology, and extensively report current and future trends in antioxidant and anti-inflammatory treatments focusing on the following major acute and chronic lung diseases: acute lung injury/respiratory distress syndrome, asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and cystic fibrosis.
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Affiliation(s)
| | - Josep M. Aran
- Immune-Inflammatory Processes and Gene Therapeutics Group, IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
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Hurley N, Kehoe B, McCaffrey N, Redmond K, Cullen L, Moyna NM. Recommendations to improve physical activity prescription for the cystic fibrosis population: an Irish perspective. BMC Health Serv Res 2020; 20:1052. [PMID: 33213453 PMCID: PMC7678110 DOI: 10.1186/s12913-020-05910-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Physical activity (PA) is a well-established therapeutic modality for the maintenance and improvement of long-term health in cystic fibrosis (CF). Healthcare professionals (HCP) are considered credible and well-placed messengers for the delivery of PA advice. Limited research exists investigating the extent of PA prescription within CF care. This study aimed to identify Irish HCP i) knowledge and practice of, and ii) motivators and barriers to PA prescription, and iii) proposed strategies to optimize PA promotion and prescription in CF populations. METHODS HCP from six designated CF centres in Ireland and members of the national physiotherapy CF clinical interest group were invited to participate. Following an expression of interest, each HCP (n = 81) received an email containing the plain language statement and link to the online survey. 48 HCP (physiotherapists n = 24, other n = 24) completed the 30-item investigator-developed survey, which included multiple choice single answer, matrix style and open-ended questions. RESULTS Most HCP (81%) acknowledged that discussing PA with CF patients was part of their professional role. Almost all physiotherapists (95%) reported having sufficient knowledge regarding PA prescription, compared to 17% of other HCP. All physiotherapists reported discussing PA at every patient interaction, with 81% employing the current consensus guidelines, compared to 33 and 5% of other HCP, respectively. Among the most common barriers reported by HCP to recommending PA to their CF patients were; lack of motivation and compliance among patients to adhere to PA advice, limited availability of PA programmes to refer their patients to, limited time with patients during clinic visits and a lack of knowledge regarding PA prescription for CF care. Three-quarters of HCP reported a need to improve PA services for CF patients in Ireland. CONCLUSION As people with CF are living longer, it is imperative that HCP are expanding their scope of practice to include discussions around PA at every patient visit. Formal educational opportunities in the form of continuing professional development programmes are warranted for CF HCP to optimize long-term patient management and outcomes. There is also a need to develop patient-centered and evidence-based PA programmes underpinned by theories of behaviour change to enhance motivation and compliance among CF patients.
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Affiliation(s)
- Nicola Hurley
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.
| | - Bróna Kehoe
- Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | | | - Karen Redmond
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall M Moyna
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Posadzki P, Pieper D, Bajpai R, Makaruk H, Könsgen N, Neuhaus AL, Semwal M. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 2020; 20:1724. [PMID: 33198717 PMCID: PMC7670795 DOI: 10.1186/s12889-020-09855-3] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. METHODS Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. RESULTS Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. CONCLUSION There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. TRIAL REGISTRATION Registered in PROSPERO ( CRD42019120295 ) on 10th January 2019.
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Affiliation(s)
- Pawel Posadzki
- Kleijnen Systematic Reviews Ltd., York, UK
- Nanyang Technological University, Singapore, Singapore
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.
| | - Ram Bajpai
- School of Medicine, Keele University, Staffordshire, UK
| | - Hubert Makaruk
- Jozef Pilsudski University of Physical Education in Warsaw, Faculty Physical Education and Health, Biala Podlaska, Poland
| | - Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Annika Lena Neuhaus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Monika Semwal
- Health Outcomes Division, University of Texas at Austin College of Pharmacy, Austin, USA
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Fernandez‐del‐Valle M, Donadio MVF, Pérez‐Ruiz M. Physical exercise as a tool to minimize the consequences of the Covid-19 quarantine: An overview for cystic fibrosis. Pediatr Pulmonol 2020; 55:2877-2882. [PMID: 32841519 PMCID: PMC7461195 DOI: 10.1002/ppul.25041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/20/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus (SARS-CoV-2) outbreak leading to the coronavirus disease (Covid-19) has become a global pandemic. Patients with Cystic fibrosis are considered of major risk, as respiratory tract infections are more severe than in the general population, with a higher risk of complications and a negative impact on lung function. The performance of physical exercise is considered as key for its well-known general benefits and also as a complementary method to help airway clearance. Therefore, physical exercise is also considered as key in the therapeutic strategy during the quarantine period. However, the impossibility to perform exercise with appropriate prescription and monitoring is of considerable worry to health care professionals. Thus, alternative strategies, such as online measures to monitor this therapy and, consequently, to achieve a safe and effective dose are highly needed. Exercise regimens should include strength and endurance, as well as balance and flexibility exercises. Patients are highly encouraged to participate in exercise programs to maintain fitness and exercise should be continued during the quarantine period. This commentary provides a summary of the main effects and benefits of physical exercise, as well as the main recommendations for its adequate execution, including exercise modality, frequency, intensity, and volume.
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Affiliation(s)
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Infant CenterPontifícia Universidade Católica do Rio Grande do Sul (PUCRS)AlegreBrazil
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Ronan P, Mian A, Carr SB, Madge SL, Lorenc A, Robinson N. Learning to breathe with Tai Chi online - qualitative data from a randomized controlled feasibility study of patients with cystic fibrosis. Eur J Integr Med 2020; 40:101229. [PMID: 33106755 PMCID: PMC7578181 DOI: 10.1016/j.eujim.2020.101229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/04/2022]
Abstract
Introduction Tai Chi (TC), a gentle exercise, incorporates meditative movement and respiratory control. The high risk of cross infection for people with cystic fibrosis (CF) requires close management in healthcare settings, limiting group activities such as TC. A mixed-methods randomized controlled feasibility study compared teaching TC over the internet with in-person, face to face TC tuition provided to CF patients. This article explores qualitative data from patients and TC instructors on their attitudes, acceptability and engagement with the two modes of TC delivery. Methods Qualitative data from CF patients (>6 years) were collected using Skype interviews/focus groups and written feedback. TC instructors provided weekly written feedback, and took part in interviews/ focus groups at the end of the study. Patient and instructor interviews explored their experiences and engagement with TC online delivery and ability to practice. Results Irrespective of the type of TC delivery, all CF participants interviewed (n = 28) practiced between lessons and most wanted to continue TC. Teenagers were more likely to miss TC appointments. Internet delivery was well received by both patients and TC instructors. Two patients reported difficulties with screen size/camera and one with internet connectivity. Conclusion Both face-to-face and internet delivery of TC lessons were equally well received and perceived as beneficial. In the current COVID-19 pandemic, CF patients self-isolating could find this intervention provides important support, therefore the programme was made available on YouTube in April 2020 and linked to the websites of the CF charities funding the research. The study was registered on the clinical trials.gov website (Registration number: NCT02054377)
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Affiliation(s)
- Patricia Ronan
- Allied Health Sciences, School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
| | - Awais Mian
- Allied Health Sciences, School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
| | - Siobhán B Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, United Kingdom
| | - Susan L Madge
- Adult Cystic Fibrosis Department, Royal Brompton and Harefield NHS Foundation Trust, London, Sydney Street, London, SW3 6NP, United Kingdom
| | - Ava Lorenc
- Population Health Sciences Department, University of Bristol, Beacon House, Queens Road, Bristol, BS8 1QU, England
| | - Nicola Robinson
- Allied Health Sciences, School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.,Centre for Evidence based Chinese Medicine, Beijing University of Chinese Medicine No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China
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40
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Elce V, Del Pizzo A, Nigro E, Frisso G, Martiniello L, Daniele A, Elce A. Impact of Physical Activity on Cognitive Functions: A New Field for Research and Management of Cystic Fibrosis. Diagnostics (Basel) 2020; 10:diagnostics10070489. [PMID: 32708398 PMCID: PMC7400241 DOI: 10.3390/diagnostics10070489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/06/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
Cystic Fibrosis (CF) is a genetic disease inherited by an autosomal recessive mechanism and characterized by a progressive and severe multi-organ failure. Mutations in Cystic Fibrosis Conductance Regulator (CFTR) protein cause duct obstructions from dense mucus secretions and chronic inflammation related to organ damage. The progression of the disease is characterized by a decline of lung function associated with metabolic disorders and malnutrition, musculoskeletal disorders and thoracic deformities, leading to a progressive decrement of the individual’s quality of life. The World Health Organization (WHO) qualifies Physical Activity (PA) as a structured activity produced by skeletal muscles’ movements that requires energy consumption. In the last decade, the number of studies on PA increased considerably, including those investigating the effects of exercise on cognitive and brain health and mental performance. PA is recommended in CF management guidelines, since it improves clinic outcomes, such as peripheral neuropathy, oxygen uptake peak, bone health, glycemic control and respiratory functions. Several studies regarding the positive effects of exercise in patients with Cystic Fibrosis were carried out, but the link between the effects of exercise and cognitive and brain health in CF remains unclear. Animal models showed that exercise might improve learning and memory through structural changes of brain architecture, and such a causal relationship can also be described in humans. Indeed, both morphological and environmental factors seem to be involved in exercise-induced neural plasticity. An increase of gray matter volume in specific areas is detectable as a consequence of regular training in humans. Neurobiological processes associated with brain function improvements include biochemical modifications, such as neuromodulator or neurohormone release, brain-derived neurotrophic factor (BDNF) production and synaptic activity changes. From a functional point of view, PA also seems to be an environmental factor enhancing cognitive abilities, such as executive functions, memory and processing speed. This review describes the current state of research regarding the impacts of physical activity and exercise on cognitive functions, introducing a possible novel field of research for optimizing the management of Cystic Fibrosis.
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Affiliation(s)
- Valentina Elce
- MoMiLab, IMT School for Advanced Studies, Piazza San Francesco 19, 55100 Lucca, Italy;
| | - Alessandro Del Pizzo
- Dipartimento di Fisica, University of Pisa, Largo Bruno Pontecorvo, 3, 56127 Pisa, Italy;
| | - Ersilia Nigro
- Dipartimento di Scienze e Tecnologie Ambientali, Biologiche, Farmaceutiche, Università della Campania Luigi Vanvitelli, Via Vivaldi, 81110 Caserta, Italy; (E.N.); (A.D.)
- CEINGE Biotecnologie Avanzate SCarl, Via Gaetano Salvatore 486, 80145 Napoli, Italy;
| | - Giulia Frisso
- CEINGE Biotecnologie Avanzate SCarl, Via Gaetano Salvatore 486, 80145 Napoli, Italy;
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Lucia Martiniello
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, isola F2, 80143 Napoli, Italy;
| | - Aurora Daniele
- Dipartimento di Scienze e Tecnologie Ambientali, Biologiche, Farmaceutiche, Università della Campania Luigi Vanvitelli, Via Vivaldi, 81110 Caserta, Italy; (E.N.); (A.D.)
- CEINGE Biotecnologie Avanzate SCarl, Via Gaetano Salvatore 486, 80145 Napoli, Italy;
| | - Ausilia Elce
- CEINGE Biotecnologie Avanzate SCarl, Via Gaetano Salvatore 486, 80145 Napoli, Italy;
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, isola F2, 80143 Napoli, Italy;
- Correspondence:
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mandy Jones
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care; Brunel University; Uxbridge UK
| | - Fiona Moffatt
- School of Health Sciences; University of Nottingham; Nottingham UK
| | - Alex Harvey
- School of Health Sciences and Social Care; Brunel University; Uxbridge UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies; Brunel University London; Uxbridge UK
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Abstract
BACKGROUND Chest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis. Oscillating devices generate intra- or extra-thoracic oscillations orally or external to the chest wall. Internally they create variable resistances within the airways, generating controlled oscillating positive pressure which mobilises mucus. Extra-thoracic oscillations are generated by forces outside the respiratory system, e.g. high frequency chest wall oscillation. This is an update of a previously published review. OBJECTIVES To identify whether oscillatory devices, oral or chest wall, are effective for mucociliary clearance and whether they are equivalent or superior to other forms of airway clearance in the successful management of secretions in people with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conference proceedings. Latest search of the Cystic Fibrosis Trials Register: 29 July 2019. In addition we searched the trials databases ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Latest search of trials databases: 15 August 2019. SELECTION CRITERIA Randomised controlled studies and controlled clinical studies of oscillating devices compared with any other form of physiotherapy in people with cystic fibrosis. Single-treatment interventions (therapy technique used only once in the comparison) were excluded. DATA COLLECTION AND ANALYSIS Two authors independently applied the inclusion criteria to publications, assessed the quality of the included studies and assessed the evidence using GRADE. MAIN RESULTS The searches identified 82 studies (330 references); 39 studies (total of 1114 participants) met the inclusion criteria. Studies varied in duration from up to one week to one year; 20 of the studies were cross-over in design. The studies also varied in type of intervention and the outcomes measured, data were not published in sufficient detail in most of these studies, so meta-analysis was limited. Few studies were considered to have a low risk of bias in any domain. It is not possible to blind participants and clinicians to physiotherapy interventions, but 13 studies did blind the outcome assessors. The quality of the evidence across all comparisons ranged from low to very low. Forced expiratory volume in one second was the most frequently measured outcome and while many of the studies reported an improvement in those people using a vibrating device compared to before the study, there were few differences when comparing the different devices to each other or to other airway clearance techniques. One study identified an increase in frequency of exacerbations requiring antibiotics whilst using high frequency chest wall oscillation when compared to positive expiratory pressure (low-quality evidence). There were some small but significant changes in secondary outcome variables such as sputum volume or weight, but not wholly in favour of oscillating devices and due to the low- or very low-quality evidence, it is not clear whether these were due to the particular intervention. Participant satisfaction was reported in 13 studies but again with low- or very low-quality evidence and not consistently in favour of an oscillating device, as some participants preferred breathing techniques or techniques used prior to the study interventions. The results for the remaining outcome measures were not examined or reported in sufficient detail to provide any high-level evidence. AUTHORS' CONCLUSIONS There was no clear evidence that oscillation was a more or less effective intervention overall than other forms of physiotherapy; furthermore there was no evidence that one device is superior to another. The findings from one study showing an increase in frequency of exacerbations requiring antibiotics whilst using an oscillating device compared to positive expiratory pressure may have significant resource implications. More adequately-powered long-term randomised controlled trials are necessary and outcomes measured should include frequency of exacerbations, individual preference, adherence to therapy and general satisfaction with treatment. Increased adherence to therapy may then lead to improvements in other parameters, such as exercise tolerance and respiratory function. Additional evidence is needed to evaluate whether oscillating devices combined with other forms of airway clearance is efficacious in people with cystic fibrosis.There may also be a requirement to consider the cost implication of devices over other forms of equally advantageous airway clearance techniques. Using the GRADE method to assess the quality of the evidence, we judged this to be low or very low quality, which suggests that further research is very likely to have an impact on confidence in any estimate of effect generated by future interventions.
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Affiliation(s)
- Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital (The Southern General Hospital), Glasgow, UK
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Denford S, van Beurden S, O'Halloran P, Williams CA. Barriers and facilitators to physical activity among children, adolescents, and young adults with cystic fibrosis: a systematic review and thematic synthesis of qualitative research. BMJ Open 2020; 10:e035261. [PMID: 32086360 PMCID: PMC7045130 DOI: 10.1136/bmjopen-2019-035261] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Physical activity is widely recommended in the treatment and management of cystic fibrosis (CF). Despite the numerous physical and psychological benefits, many young people with CF are not achieving the recommended levels of physical activity. The aim of this systematic review was to identify and synthesise available qualitative investigations exploring the motives for, barriers to and facilitators of physical activity among young people with CF. METHODS The following six electronic databases were systematically searched: Applied Social Sciences Index and Abstracts (ASSIA), CINAH, EMBASE, MEDLINE, MEDLINE-in-process, PsycINFO up to August 2019. Keywords were used to identify qualitative research that explored engagement in physical activity among young people with CF. Titles and abstracts were screened by two independent reviewers, and potentially relevant articles were retrieved in full. Articles were eligible for inclusion if they employed any qualitative method and recruited participants under the age of 24 years with CF. Risk of bias of included studies was assessed via the Critical Appraisal Skills Programme. Results were synthesised using a thematic approach. RESULTS Seven studies met our inclusion criteria and were included in the review. Overall, studies were of moderate to high quality. Thematic synthesis identified nine main themes that encompass motives for, barriers to and facilitators of physical activity among young people with CF. These were (1) Perceptions of physical activity. (2) Value attributed to physical activity. (3) Social influences. (4) Competing priorities. (5) Fluctuating health. (6) Normality. (7) Control beliefs. (8) Coping strategies. (9) Availability of facilities. Previous reviews have been unable to identify intervention characteristics that influence physical activity behaviour. CONCLUSIONS This review provides detailed information on the physical (biological-clinical), psychological, social and environmental influences on physical activity behaviour, thus providing numerous targets for future interventions. This in turn could facilitate promotion of physical activity among young people with CF.
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Affiliation(s)
- Sarah Denford
- Children's Health & Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Samantha van Beurden
- Children's Health & Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Craig Anthony Williams
- Children's Health & Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
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Abstract
Aims: This study aimed to investigate motor performance in children with cystic fibrosis (CF) and the relationship with respiratory and anthropometric outcome measures.Methods: A cross-sectional exploratory study investigated 12 children with CF, mean (SD) age 6.17 (0.67) years, using the Movement Assessment Battery for Children 2nd edition (MABC-2), spirometry, body weight, height, body mass index, and age-related anthropomorphic z-scores.Results: MABC-2 total scores indicated 9/12 (75%) children performed below average (<50th percentile), of which 4/12 children (33.3%) had motor delay and 2/12 (16.7%) were at risk for motor delay. The balance subscale showed the lowest scores, with 5/12 (41.7%) participants performing at or below the 5th percentile and a median (IQR) percentile score of 9.00 (5.00-62.50). A significant negative correlation was found between the manual dexterity subscale and both height and height for age z-scores (p = 0.017 and p = 0.019, respectively), as well as peak expiratory flow in liter (p = 0.027). The balance subscale scores were positively correlated with forced expiratory volume in %predicted (p = 0.048). No other significant correlations were found.Conclusion: Children with CF may be at risk for delayed motor development, particularly their balance skills. Poor lung function might affect motor development but further research is recommended.
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Affiliation(s)
- Lieselotte Corten
- Department of Health and Rehabilitation Sciences (Physiotherapy), University of Cape Town, Cape Town, South Africa
| | - Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Lowman JD, Solomon GM, Rowe SM, Yuen HK. Gaming Console Home-Based Exercise for Adults with Cystic Fibrosis: Study Protocol. INTERNATIONAL JOURNAL OF CARING SCIENCES 2020; 13:1530-1540. [PMID: 33163109 PMCID: PMC7643879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite evidence of exercise benefits to lung function, adherence to routine exercise in adults with cystic fibrosis (CF) is low. The incorporation of interactive virtual reality video exergame activities in home-based programs as an incentive may help improve motivation and adherence to exercise. This proposed study will attempt to improve the physical fitness and respiratory function of sedentary adults with CF by engaging them in a Nintendo Wii Fit Plus™ home-based exercise program. METHODS A single group pretest-posttest design will be used to examine the immediate (12-weeks) and long-term effect (24-weeks) of a home-based exergame program on improving pulmonary-related function (physical fitness and respiratory function) in sedentary adults with CF. Participants will receive a one-time orientation to the Wii Fit Plus, and will be requested to use it to exercise according to the recommended guidelines 3 times a week for 30 min in the following 24 weeks. Monthly phone monitoring will be conducted during the first 12 weeks. Besides evaluating the efficacy of a home-based exergame program on improving aerobic capacity, physical activity, and respiratory-related symptoms, we will examine the impact of the exergame on airway ion transport as measured by nasal potential difference, which will be collected at baseline and at the end of 12-weeks only. DISCUSSION This is the first study to evaluate the feasibility, acceptability and potential effectiveness of a low-cost exercise avenue (i.e., exergames) for adults with CF to improve their pulmonary-related function, which is important for CF disease management and prevention of complications. In addition, the proposed study will be the first to investigate the therapeutic efficacy of home-based exergames on airway ion transport among adults with CF. Through an increase in physical activity, it is expected that participants will improve their physical fitness and respiratory function at the end of the study. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02277860.
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Affiliation(s)
- John D Lowman
- Department of Physical Therapy, School of Health Professions, and the Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - George M Solomon
- Department of Medicine and the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, AL, USA
| | - Steven M Rowe
- Departments of Medicine, Pediatrics, and Cell Developmental and Integrative Biology; Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hon K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, USA
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Monteiro KS, Azevedo MDP, Jales LM, da Silva FEP, Arrais RF, de Mendonça KMPP. Effects of aerobic interval training on glucose tolerance in children and adolescents with cystic fibrosis: a randomized trial protocol. Trials 2019; 20:768. [PMID: 31878961 PMCID: PMC6933706 DOI: 10.1186/s13063-019-3803-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) may develop CF-related diabetes (CFDR). This comorbidity is related to a poorer quality of life, microvascular complications, a decline in lung function, and an increase in exacerbations, as well as delayed growth and puberty. Evidence exists that physical exercise contributes to glycemic control in individuals with non-CF-related diabetes. This exercise is usually continuous with moderate intensity and long duration, which can cause muscle dyspnea and fatigue in CF individuals. Aerobic interval training (AIT) emerges as a safe and effective alternative for treating these individuals. The objective of this study is to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. METHODS This study will be a two-arm, prospectively registered, randomized controlled trial with blind assessors and twenty 6- to 18-year-old individuals with cystic fibrosis (CF) from two different Brazilian states. People with CF will be randomly allocated to either the experimental or control group using block randomization, stratified by puberty stage,. Participants from both groups will receive an educational intervention and will be asked to continue their usual daily treatment for the full duration of the study. Those in the experimental group will perform AIT on a cycle ergometer at home three times a week, for 8 consecutive weeks. The sample characterization will include an assessment of puberty stage, socioeconomic status, dyspnea, and anthropometry. The primary outcome will be the change in glucose tolerance, while the secondary outcomes will include lung function, exercise tolerance, respiratory muscle strength, quality of life, and CF exacerbations. All outcomes will be assessed at baseline, week 9, and week 17. DISCUSSION This is the first study to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. This study will serve as a basis for guiding clinical practice and decision-making in treating glucose intolerance and CF-related diabetes (CFRD) in children and adolescents with CF. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: NCT03653949. Registered on August 31, 2018.
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Affiliation(s)
- Karolinne Souza Monteiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
- Faculty of Health Science of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brasil
| | - Matheus de Paiva Azevedo
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
| | - Lucas Menescal Jales
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
| | | | - Ricardo Fernando Arrais
- Department of Pediatrics, Pediatric and Adolescent Unit of University Hospital Prof. Onofre Lopes of Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
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Welsman J, Armstrong N. The 20 m shuttle run is not a valid test of cardiorespiratory fitness in boys aged 11-14 years. BMJ Open Sport Exerc Med 2019; 5:e000627. [PMID: 31921438 PMCID: PMC6937111 DOI: 10.1136/bmjsem-2019-000627] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 01/23/2023] Open
Abstract
Objectives The 20 m shuttle run test (20mSRT) is used to estimate cardiorespiratory fitness (CRF) through the prediction of peak oxygen uptake ( V ˙ O 2 ), but its validity as a measure of CRF during childhood and adolescence is questionable. This study examined the validity of the 20mSRT to predict peak V ˙ O 2 . Methods Peak V ˙ O 2 was measured during treadmill running. Log-linear regression was used to correct peak V ˙ O 2 for body mass and sum of skinfolds plus age. Boys completed the 20mSRT under standardised conditions. Maximum speed (km/h) was used with age to predict peak V ˙ O 2 using the equation developed by Léger et al. Validity was examined from linear regression methods and limits of agreement (LoA). Relationships between 20mSRT performance and allometrically adjusted peak V ˙ O 2 , and predicted per cent fat were examined. Results The sample comprised 76 boys aged 11-14 years. Predicted and measured mass-related peak V ˙ O 2 (mL/kg/min) shared common variance of 32%. LoA revealed that measured peak V ˙ O 2 ranged from 15% below to 25% above predicted peak V ˙ O 2 . There were no significant relationships (p>0.05) between predicted peak V ˙ O 2 and measured peak V ˙ O 2 adjusted for mass, age and skinfold thicknesses. Adjusted for body mass and age, peak V ˙ O 2 was not significantly related (p>0.05) to 20mSRT final speed but a weak, statistically significant (r=0.24, p<0.05) relationship was found with peak V ˙ O 2 adjusted for mass and fatness. Predicted per cent fat was negatively correlated with 20mSRT speed (r=-0.61, p<0.001). Conclusions The 20mSRT reflects fatness rather than CRF and has poor validity grounded in its flawed estimation and interpretation of peak V ˙ O 2 in mL/kg/min.
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Affiliation(s)
- Jo Welsman
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, Devon, UK
| | - Neil Armstrong
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, Devon, UK
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Cox NS, Eldridge B, Rawlings S, Dreger J, Corda J, Hauser J, Button BM, Bishop J, Nichols A, Middleton A, Ward N, Dwyer T, Tomlinson OW, Denford S, Barker AR, Williams CA, Kingsley M, O’Halloran P, Holland AE. A web-based intervention to promote physical activity in adolescents and young adults with cystic fibrosis: protocol for a randomized controlled trial. BMC Pulm Med 2019; 19:253. [PMID: 31856791 PMCID: PMC6921562 DOI: 10.1186/s12890-019-0942-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/20/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Regular participation in physical activity by people with cystic fibrosis (CF) promotes positive clinical and health outcomes including reduced rate of decline in lung function, fewer hospitalizations and greater wellbeing. However adherence to exercise and activity programs is low, in part due to the substantial daily therapy burden for young people with CF. Strict infection control requirements limit the role of group exercise programs that are commonly used in other clinical groups. Investigation of methods to promote physical activity in this group has been limited. The Active Online Physical Activity in Cystic fibrosis Trial (ActionPACT) is an assessor-blinded, multi-centre, randomized controlled trial designed to compare the efficacy of a novel web-based program (ActivOnline) compared to usual care in promoting physical activity participation in adolescents and young adults with CF. METHODS Adolescents and young adults with CF will be recruited on discharge from hospital for a respiratory exacerbation. Participants randomized to the intervention group will have access to a web-based physical activity platform for the 12-week intervention period. ActivOnline allows users to track their physical activity, set goals, and self-monitor progress. All participants in both groups will be provided with standardised information regarding general physical activity recommendations for adolescents and young adults. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and at 3-months followup. Healthcare utilization will be assessed at 12 months from intervention completion. The primary outcome is change in moderate-to-vigorous physical activity participation measured objectively by accelerometry. Secondary outcomes include aerobic fitness, health-related quality of life, anxiety and depression and sleep quality. DISCUSSION This trial will establish whether a web-based application can improve physical activity participation more effectively than usual care in the period following hospitalization for a respiratory exacerbation. The web-based application under investigation can be made readily and widely available to all individuals with CF, to support physical activity and exercise participation at a time and location of the user's choosing, regardless of microbiological status. TRIAL REGISTRATION Clinical trial registered on July 13, 2017 with the Australian and New Zealand Clinical Trials Register at (ACTRN12617001009303).
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Affiliation(s)
- Narelle S. Cox
- Monash University, La Trobe University and Institute for Breathing and Sleep, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
| | - Beverley Eldridge
- La Trobe University, Level 4, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
| | - Sarah Rawlings
- Monash Children’s Hospital Monash University and La Trobe University , 246 Clayton Rd, Clayton, Vic 3168 Australia
| | - Julianna Dreger
- Monash University, La Trobe University and Alfred Health, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
| | - Jennifer Corda
- Physiotherapy Department Royal Children’s Hospital, 50 Flemington Road Parkville, Victoria, 3052 Australia
| | - Jennifer Hauser
- Tasmanian Adult Cystic Fibrosis Unit, Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania 7000 Australia
| | - Brenda M. Button
- Departments of Physiotherapy and Respiratory Medicine Alfred Health and Department of Medicine, Nursing and Health Sciences, Monash University, 55 Commercial Road, Melbourne, Vic 3004 Australia
| | - Jennifer Bishop
- Adult Cystic Fibrosis Service, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145 Australia
| | - Amanda Nichols
- Monash Children’s Hospital/Monash Health CF Service, 246 Clayton Rd, Clayton, Victoria 3168 Australia
| | - Anna Middleton
- Physiotherapy Department, Children’s Hospital at Westmead, Hawkesbury Road, Westmead, NSW 2145 Australia
| | - Nathan Ward
- Physiotherapy and Cystic Fibrosis Services, 8E055.08, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000 Australia
| | - Tiffany Dwyer
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
| | - Owen W. Tomlinson
- Children’s Health & Exercise Research Centre (CHERC), Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke’s Campus, University of Exeter, Heavitree Road, Exeter, Devon EX1 2LU UK
| | - Sarah Denford
- Children’s Health & Exercise Research Centre (CHERC), Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke’s Campus, University of Exeter, Heavitree Road, Exeter, Devon EX1 2LU UK
| | - Alan R. Barker
- Children’s Health & Exercise Research Centre (CHERC), Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke’s Campus, University of Exeter, Heavitree Road, Exeter, Devon EX1 2LU UK
| | - Craig A. Williams
- Children’s Health & Exercise Research Centre (CHERC), Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke’s Campus, University of Exeter, Heavitree Road, Exeter, Devon EX1 2LU UK
| | - Michael Kingsley
- La Trobe Rural Health School, La Trobe University, Bendigo, Vic 3552 Australia
| | - Paul O’Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Vic 3086 Australia
| | - Anne E. Holland
- Monash University La Trobe University, Alfred Health and Institute for Breathing and Sleep, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
| | - On behalf of Youth Activity Unlimited – A Strategic Research Centre of the UK Cystic Fibrosis Trust
- Monash University, La Trobe University and Institute for Breathing and Sleep, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
- La Trobe University, Level 4, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
- Monash Children’s Hospital Monash University and La Trobe University , 246 Clayton Rd, Clayton, Vic 3168 Australia
- Monash University, La Trobe University and Alfred Health, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
- Physiotherapy Department Royal Children’s Hospital, 50 Flemington Road Parkville, Victoria, 3052 Australia
- Tasmanian Adult Cystic Fibrosis Unit, Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania 7000 Australia
- Departments of Physiotherapy and Respiratory Medicine Alfred Health and Department of Medicine, Nursing and Health Sciences, Monash University, 55 Commercial Road, Melbourne, Vic 3004 Australia
- Adult Cystic Fibrosis Service, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145 Australia
- Monash Children’s Hospital/Monash Health CF Service, 246 Clayton Rd, Clayton, Victoria 3168 Australia
- Physiotherapy Department, Children’s Hospital at Westmead, Hawkesbury Road, Westmead, NSW 2145 Australia
- Physiotherapy and Cystic Fibrosis Services, 8E055.08, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000 Australia
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
- Children’s Health & Exercise Research Centre (CHERC), Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke’s Campus, University of Exeter, Heavitree Road, Exeter, Devon EX1 2LU UK
- La Trobe Rural Health School, La Trobe University, Bendigo, Vic 3552 Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Vic 3086 Australia
- Monash University La Trobe University, Alfred Health and Institute for Breathing and Sleep, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia
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Singh M, Singh M. Exercise for Healthy Lungs. Indian J Pediatr 2019; 86:977-978. [PMID: 31468310 DOI: 10.1007/s12098-019-03044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Meenu Singh
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manvi Singh
- Center for Evidence-Based Child Health, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Cakmak A, Inal-Ince D, Sonbahar-Ulu H, Bozdemir-Ozel C, Tekerlek H, Saglam M, Calik-Kutukcu E, Vardar-Yagli N, Yalcin EE, Ozcelik U, Arikan H. Aerobic exercise training in Kartagener's syndrome: case report. J Exerc Rehabil 2019; 15:468-471. [PMID: 31316943 PMCID: PMC6614767 DOI: 10.12965/jer.1938144.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 11/22/2022] Open
Abstract
Kartagener’s syndrome is a rare, autosomal recessive inherited disease, which is characterized by a triad of chronic sinusitis, bronchiectasis, and situs inversus. In this report, we aimed to represent the effect of aerobic exercise training in addition to chest physiotherapy in an outpatient with Kartagener’s syndrome. An 18-year-old female diagnosed with Kartagener’s syndrome applied with the complaints of productive cough and dyspnea with exertion and attended pulmonary rehabilitation program comprising exercise training in addition to standard treatment. Aerobic exercise training was performed three times weekly at 80% of the peak heart rate, for 8 weeks as supervised sessions. Respiratory physiotherapy and postural exercises were taught to the patient to be performed at home each day of the week. Before and after pulmonary rehabilitation program, incremental shuttle walk test (ISWT) was performed; dyspnea and fatigue were assessed using Borg Scale. Pulmonary function test was evaluated using spirometer. The patient wore activity monitor for 7 consecutive days before and after training. After pulmonary rehabilitation program, 90-m increase in ISWT was observed. We recommend exercise training in patients with Kartagener’s syndrome to increase exercise capacity. Further randomized control trial is needed to clarify the effects.
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Affiliation(s)
- Aslihan Cakmak
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hazal Sonbahar-Ulu
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Haluk Tekerlek
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Elmas Ebru Yalcin
- Department of Pediatric Chest Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Chest Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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