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Mucha FC, Gonçalves Wamosy RM, Scalco JC, Almeida ACDS, Itaborahy BDH, Cardoso J, Mayer AF, Santos Schivinski CI. Comparison of the modified shuttle walk test in children with cystic fibrosis and healthy controls. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2052. [PMID: 37818756 DOI: 10.1002/pri.2052] [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: 01/20/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. METHODS A cross-sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann-Whitney and independent t-tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. RESULTS Sixty-two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. CONCLUSIONS There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG.
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Affiliation(s)
- Francieli Camila Mucha
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Renata Maba Gonçalves Wamosy
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Janaina Cristina Scalco
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Ana Carolina da Silva Almeida
- Physiotherapy, Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Juliana Cardoso
- Physiotherapy, Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Anamaria Fleig Mayer
- Undergraduate and Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Undergraduate and Graduate Program in Human Movement Sciences, Center for Health and Sports Sciences, University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Camila Isabel Santos Schivinski
- Undergraduate and Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Ahmed MI, Dayman N, Blyth N, Madge J, Gaillard E. Impact of CFTR modulators on exercise capacity in adolescents with cystic fibrosis. ERJ Open Res 2024; 10:00687-2023. [PMID: 38375430 PMCID: PMC10875456 DOI: 10.1183/23120541.00687-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024] Open
Abstract
Background Exercise capacity is an independent predictor of clinical worsening in cystic fibrosis (CF). There is limited evidence of the impact of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on exercise capacity in children with CF. The aim of the present study was to assess the impact of CFTR modulators on exercise capacity in a cohort of adolescents with CF. Methods A prospective single-centre cohort study was carried out. Cardiopulmonary exercise testing (CPET) was performed at baseline, prior to starting Symkevi or Kaftrio and between 4 and 8 months after starting treatment. Results 19 adolescents with CF had CPET performed prior to and after CFTR modulator treatment, between December 2019 and March 2022. Breathing reserve improved in the whole cohort, with greater improvement in the modulator-naïve patients after starting treatment with Kaftrio. There was no improvement in peak oxygen uptake and anaerobic threshold after 4 to 8 months of treatment with CFTR modulators. Conclusion Exercise testing with CPET can be used as an additional tool to monitor response to CFTR modulators. Breathing reserve on CPET may provide a surrogate marker to monitor the improvement in CF lung disease with CFTR modulator treatment.
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Affiliation(s)
- Molla Imaduddin Ahmed
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory sciences, University of Leicester, Leicester, UK
| | - Naomi Dayman
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory sciences, University of Leicester, Leicester, UK
| | - Natalie Blyth
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joe Madge
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Erol Gaillard
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory sciences, University of Leicester, Leicester, UK
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Hamedi N, Kajbafvala M, ShahAli S, Pourahmadi M, Eshghi A, Estahbanati MM. The effects of aerobic exercises compared to conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life in children and adolescents with cystic fibrosis: a study protocol for randomized controlled trial study. Trials 2023; 24:695. [PMID: 37898788 PMCID: PMC10612191 DOI: 10.1186/s13063-023-07719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder caused by abnormal function of the chloride ion channels and characterized by pancreatic insufficiency and chronic endobronchial airway infection. Pulmonary dysfunction is very common and could lead to a reduction in the quality of life. Airway clearance techniques (ACT) and physical exercises are introduced as one of the main components of treatment. Therefore, it will be of interest to examine the effect of aerobic exercises compared to conventional chest physiotherapy (CPT) on pulmonary function, functional capacity, sputum culture, and quality of life in patients with CF. METHODS Thirty patients with CF will participate in a double-blind parallel controlled trial containing 18 sessions of treatment. Group A consists of CPT and placebo aerobic exercise, and group B includes aerobic exercise and placebo CPT. Pulmonary function, functional capacity, sputum culture, and quality of life will be evaluated with a spirometry test, 6-min walk test (6MWT), sputum culture test, and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), respectively, before and after the intervention. DISCUSSION We will evaluate and compare the effectiveness of aerobic exercises and conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life. Comparing these two treatment patterns can contribute to a better understanding of the effectiveness. Therefore, if there is a significant difference between the two treatments, the superior treatment will be prioritized clinically. TRIAL REGISTRATION https://www.irct.ir , IRCT20210505051181N5. Registered on 19 February 2023.
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Affiliation(s)
- Nadia Hamedi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Kajbafvala
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MohammadReza Pourahmadi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Eshghi
- Department of Paediatrics, School of Medicine, Ali-Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - MohammadReza Modaresi Estahbanati
- Department of Paediatrics, School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
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4
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Byrwa DJ, Perez GF, Roach CM, Prentice S, Goetz DM. Airway clearance therapy in the school environment: Retrospective analysis of a cohort of pediatric patients with cystic fibrosis. J Cyst Fibros 2023; 22:811-815. [PMID: 36702656 DOI: 10.1016/j.jcf.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adherence to airway clearance therapy (ACT) in pediatric cystic fibrosis (CF) patients is reported to be below 50% and inability to sustain daily care is linked to poor health outcomes7,8,9. Through a collaboration between a CF care center and several schools, we hypothesized that ACT completed at school by pediatric CF patients will improve lung function while decreasing pulmonary exacerbations (PEx), days of antibiotics (abx) and hospitalizations. METHODS This was a retrospective case-control study at a single CF care center consisting of 50 CF patients age < 18 at time when data was recorded (2012-2020). The case group used high-frequency chest wall oscillation or positive expiratory pressure devices at school for at least 1 year after self-reported or physician identified inadequate use at home. Lung function and measures of healthcare utilization were collected. RESULTS In the case group (n = 14), paired t-tests showed that after initiation of ACT at school, there were significant reductions in PEx requiring IV or PO abx (P = 0.010), total days of abx (P = 0.032), and visits to the CF care center (P = 0.037). There was no change in these outcomes in the matched control group (n = 36). CONCLUSIONS This is the first known study to highlight an initiative between a CF care center and schools which utilized airway clearance devices at school to ensure pediatric CF patients completed ACT. Through increased adherence, this relationship was associated with improved health outcomes. Use of alternative strategies may help patients with CF sustain adequate airway clearance.
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Affiliation(s)
- David J Byrwa
- John R. Oishei Children's Hospital, Buffalo, NY, United States; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; UBMD Pediatrics, Buffalo, NY, United States.
| | - Geovanny F Perez
- John R. Oishei Children's Hospital, Buffalo, NY, United States; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; UBMD Pediatrics, Buffalo, NY, United States
| | | | | | - Danielle M Goetz
- John R. Oishei Children's Hospital, Buffalo, NY, United States; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States; UBMD Pediatrics, Buffalo, NY, United States
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Corda J, E Holland A, Berry CD, Westrupp N, Cox NS. Validation of the 25 level modified shuttle test in children with cystic fibrosis. Pediatr Pulmonol 2023. [PMID: 37144876 DOI: 10.1002/ppul.26452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the validity and reliability of the modified shuttle 25-level test (MST-25) in children with cystic fibrosis (CF). METHODS A prospective single center study in clinically stable children with CF. Participants undertook two testing conditions on different days: (1) 2xMST-25 tests; (2) cardiopulmonary exercise test (CPET). Test order was randomized. Nadir oxygen saturation (SpO2 ), peak heart rate (HR), breathlessness (modified Borg), rate of perceived exertion (RPE), energy expenditure (EE) and metabolic equivalents (MET) from the MST-25 and CPET were compared to assess validity, while outcomes from 2xMST-25 tests were compared for reliability. CPET was performed using breath-by-breath analysis and EE from the MST-25 obtained using the SenseWear Armband. RESULTS Strong correlations were found between MST-25 distance and peak oxygen uptake, peak work and minute ventilation on CPET (all r > 0.7, p < 0.01). Moderate correlations were found between MST-25 distance and CPET for METs (r = 0.5) and HR (r = 0.6). Weak associations between tests were evident for nadir SpO2 (r = 0.1), modified Borg (rs = 0.2) and RPE (rs = 0.2). Test-retest reliability was excellent for MST-25 distance (ICC 0.91), peak EE (ICC 0.99) and peak METs (ICC 0.90). Good reliability was achieved for HR (ICC 0.84) and modified Borg score (ICC 0.77), while moderate reliability for nadir SpO2 (ICC 0.64) and RPE (ICC 0.68) was observed. CONCLUSION The MST-25 is a valid and reliable field test for the assessment of exercise capacity in children with CF. The MST-25 can be used to accurately monitor exercise capacity and prescribe exercise training, particularly when CPET is not available.
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Affiliation(s)
- Jennifer Corda
- Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia
- Department of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
- Infection and Immunity group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
- Infection and Immunity group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Narelle S Cox
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
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Ladune R, Filleul V, Falzon C, Hayotte M, Mély L, Vallier JM, Gruet M, Vuillemin A, d'Arripe-Longueville F. Perceptions of barriers to and facilitators of physical activity in adults with cystic fibrosis. Physiother Theory Pract 2023; 39:117-127. [PMID: 34845970 DOI: 10.1080/09593985.2021.2005201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical activity (PA) is a proven therapeutic tool to increase the quality of life and life expectancy in people with cystic fibrosis (pwCF). Despite this, the PA level of pwCF is lower than recommended. OBJECTIVES This study was conducted to identify the barriers to and facilitators of PA in adults with CF with heterogeneous severity. METHODS Twenty adults with CF (mean age = 33.3±11.7 years, mean FEV1% = 50.55±20.4%) were recruited from two specialized centers and interviewed about the factors that limit and facilitate their PA. The collected data were transcribed, coded and analyzed using deductive and inductive methods. RESULTS Barriers and facilitators were classified into physical, psychological and environmental dimensions. The main barriers were fatigue, breathing difficulties, lack of available facilities, negative perceptions of PA and perceived health risks. The most important facilitators were respiratory benefits, well-being, and social support. CONCLUSION Although some barriers and facilitators were similar to those found in children with CF or adults from other vulnerable populations, others were specific to adults with CF, such as the risk of cross-contamination and transplant preparation. The comprehensive study of the barriers and facilitators in adults will enhance PA counseling for pwCF and help improve their compliance with PA recommendations.
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Affiliation(s)
| | | | | | | | - Laurent Mély
- Université de Toulon, Laboratoire IAPS, Toulon, France.,Hôpital Renée Sabran Hospices Civils de Lyon, Cystic Fibrosis Center, Giens, France
| | | | - Mathieu Gruet
- Université de Toulon, Laboratoire IAPS, Toulon, France
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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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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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Rowbotham NJ, Daniels TE. Airway clearance and exercise for people with cystic fibrosis: Balancing longevity with life. Pediatr Pulmonol 2022; 57 Suppl 1:S50-S59. [PMID: 34672434 DOI: 10.1002/ppul.25734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/05/2022]
Abstract
Airway clearance has been an integral part of cystic fibrosis (CF) care for almost as long as CF has been identified as a condition. From diagnosis as a neonate through to end-of-life care, airway clearance is an everyday aspect of life, adding a considerable treatment burden to the lives of people with CF. There are many different techniques used for airway clearance which have evolved over time with an aim to improve effectiveness, support adherence and, more recently, to consider the impact of burden. A popular thought is whether airway clearance could be replaced by exercise. With new precision therapies in the form of CFTR modulators available, the CF landscape is rapidly changing, raising the question of whether certain treatments are needed at all. Depending on factors such as CFTR mutation, age, and pre-existing lung damage before starting a CFTR modulator, individuals with CF may need different levels of intensity and type of maintenance treatment. Precision medicine is likely to lead to the need for increased precision and individualized management around other maintenance therapies such as airway clearance.
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Affiliation(s)
- Nicola J Rowbotham
- Evidence Based Child Health Group, University of Nottingham, Nottingham, UK
| | - Tracey E Daniels
- York Hull Adult Cystic Fibrosis Centre, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.,School of Science, Technology and Health, York St John University, York, UK
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Gruet M, Saynor ZL, Urquhart DS, Radtke T. Rethinking physical exercise training in the modern era of cystic fibrosis: A step towards optimising short-term efficacy and long-term engagement. J Cyst Fibros 2021; 21:e83-e98. [PMID: 34493444 DOI: 10.1016/j.jcf.2021.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/18/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022]
Abstract
Exercise is considered as an important component of the package of care delivered to people with cystic fibrosis (pwCF). However, despite the well-known short-term physiological and psychological benefits, training effects are heterogenous and the transfer of structured exercise programmes to the daily life of pwCF is challenging. Training concepts and strategies developed over the last decades must be adapted to consider the aging population of pwCF with associated comorbidities, and also a new generation of young pwCF that are healthier than ever. In the present review we propose a new framework for optimising the choice among available exercise training procedures and we provide a theoretical and scientifically justified rationale for considering and testing new exercise training modalities. We propose a multidisciplinary approach, considering various physiological, psychological and logistical factors, with the aim to increase effects of exercise training and build positive long-term exercise behaviour.
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Affiliation(s)
- Mathieu Gruet
- IAPS Laboratory, University of Toulon, Toulon, France..
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, Scotland, UK.; Department of Child Life and Health, University of Edinburgh, Scotland, UK
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland
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11
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Brivio A, Orenti A, Barbisan M, Buonpensiero P, Ros M, Gambazza S. Home physiotherapists assisting follow-up treatment in cystic fibrosis: a multicenter observational study. Monaldi Arch Chest Dis 2021; 91. [PMID: 33926178 DOI: 10.4081/monaldi.2021.1619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 months in participants with cystic fibrosis (CF), when supervised or not by physiotherapists (PTs) at home. Participants in 8 Italian CF centers with a prescription of dry-powder antibiotic choose whether to be supervised at home (PT-FU) or not (non-PT-FU), in adjunct to routine clinic visits. PTs assisted participants with their inhaled therapies regimen and reviewed the airway clearance program in use. Mixed-effect regression models were fitted to evaluate the variation of selected endpoints over time. A total of 163 participants were included. Lung function declined over time in both groups, at higher extent in the non-PT-FU group at 6 months (-1.8, 95%CI: -4.4 to 0.7 % predicted), without reaching statistical significance, whereas in the PT-FU group only, nearly one visit less was recorded (p=0.027). Regardless the type of supervision adopted, the number of antibiotic courses did not change compared to the previous year. We counted 19/90 (21.1%) drop-out in the PT-FU, double compared to the group followed up at the clinics (p=0.065). Participants under a course of an inhaled antibiotic therapy showed a 1-year decline in lung function, whereas only the group receiving home supervision counted nearly one visit less at the CF center, whose clinical relevance should be further discussed.
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Affiliation(s)
- Anna Brivio
- Cystic Fibrosis Centre and U.O.C. Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan .
| | - Annalisa Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan.
| | - Mauro Barbisan
- UOS Fibrosi Cistica, Hospital S. Maria di Ca' Foncello, Treviso.
| | - Paolo Buonpensiero
- Department of Translational Medical Sciences, Cystic Fibrosis Centre, Federico II University of Naples.
| | - Mirco Ros
- UOS Fibrosi Cistica, Hospital S. Maria di Ca' Foncello, Treviso.
| | - Simone Gambazza
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan; 3Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan .
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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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13
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Interval versus constant-load exercise training in adults with Cystic Fibrosis. Respir Physiol Neurobiol 2021; 288:103643. [PMID: 33618051 DOI: 10.1016/j.resp.2021.103643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy of interval exercise (IE) compared to constant-load exercise (CLE) training remains unsettled in adults with Cystic Fibrosis (CF). METHODS Twenty-four adults with CF were randomised to 30-min IE (100 % peak work capacity (WRpeak) for 30-s alternated with 40 % WRpeak for 30-s; n = 12) or 30-min CLE (70 % WRpeak; n = 12) training, 3 times weekly, for 12 weeks. Isometric quadriceps muscle strength was assessed using a strain gauge Myometer. RESULTS The magnitude of improvement in quadriceps muscle strength was greater (p = 0.037) in the IE (by 32 ± 13 Nm) compared to the CLE (by 23 ± 12 Nm) groups. Maximum inspiratory and expiratory mouth pressures were significantly improved only in the IE group (by 30 ± 10 cmH2O; p = 0.009 and 13 ± 4 cmH2O; p = 0.007, respectively). Arterial oxygen saturation during training was higher (p = 0.002) for IE (94 ± 1%) compared to CLE (91 ± 1%), whereas dyspnoea scores were lower (p = 0.001) for IE (3.8 ± 0.7) compared to CLE (5.9 ± 0.8) CONCLUSIONS: IE is superior to CLE in improving peripheral and respiratory muscle strength and preferable to CLE because it is associated with lower exercise-induced arterial oxygen desaturation and breathlessness.
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The modified shuttle test as a predictor of risk for hospitalization in youths with cystic fibrosis: A two-year follow-up study: Modified shuttle test as a predictor of hospitalization. J Cyst Fibros 2021; 20:648-654. [PMID: 33422453 DOI: 10.1016/j.jcf.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) present exercise intolerance and episodes of pulmonary exacerbations. This study aimed to evaluate the association of the distance covered on the modified shuttle test (MST), as well as other clinical variables (anthropometry, chronic colonization by Pseudomonas aeruginosa, lung function), with the risk of hospitalization for pulmonary exacerbation. METHODS Cohort study including CF patients older than 6 years, from two specialized CF centers. All patients underwent a MST and a lung function test at the time of inclusion. Demographic, anthropometric and clinical data were collected. Free time until the first hospitalization, total days of hospitalization and use of antibiotics during the two years of follow-up were recorded. RESULTS Sixty-seven patients with a mean (SD) age of 12.4 (5.2) years and forced expiratory volume in the first second (FEV1) of 78.7% (22.4) were included. The mean distance covered (m) in the MST was 775.6 (255.7) (73.4 ± 19.5% of predicted). The distance achieved (MST) was considered as the main independent variable to predict the risk of hospitalization (Cox HR 0.97, p = 0.029). Patients who walked a distance of less than 80% of predicted in the MST showed an increase of 3.9 (95%CI 1.0-15.3) in the relative risk for hospitalization and significantly higher total number of days of hospitalization (p = 0.022). CONCLUSION There is an association between the distance covered in the MST and the risk of hospitalization in youths with CF. Patients with reduced exercise capacity presented a 3.9 times increase in the relative risk for hospitalization due to pulmonary exacerbation.
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Feiten TDS, Flores JDS, Rovedder PME, Dalcin PDTR, Ziegler B. Physical activity and quality of life of children and adolescents with cystic fibrosis: a cross-sectional study. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.032.ao70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Regular physical activity (PA) is part of outpatient care offered to most people with cystic fibrosis (CF). Objective: To determine the frequency of the self-reported PA and, secondarily evaluate associations between PA with clinical variables and health-related quality of life (HRQoL) in pediatric and adolescent CF subjects. Method: In this cross-sectional study, subjects between 6 and 17 years of age with a confirmed diagnosis of CF were recruited in the outpatient clinic. The subjects answered questions about the practices of PA, HRQoL questionnaire and clinical variables were collected. Subjects were classified into two groups according to weekly PA practice: PA performed ≥ 3 times/week and performed PA ≤ 2 times/week. Results: 66 subjects completed the study, 72.7% (n=48) had PA ≥ 3 times/week and 27.2% (n=18) had PA ≤ 2 times/week. Only twelve children (18,2%) reached the recommendations of the World Health Organization (WHO) to practice moderate to vigorous physical activities daily. The mean age of the subjects evaluated was 12.3 ± 3.2 years, forced expiratory volume in one second 90 ± 24.1% and forced vital capacity 95 ± 20.4%. The group that performed PA ≥ 3 times/week had a better clinical score (p=0.033), a lower number of hospitalizations in the year (p=0.002), a lower number of days hospitalized in the last year (p=0.020) and better score for the physical (p=0.003) and emotion (p=0.048) domains in HRQoL questionnaire. Conclusion: This study concluded that most subjects did not reach the WHO recommendations for the practice of PA. However, individuals who practice PA at least 3 times/week have better HRQoL, clinical score and fewer hospitalizations.
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Denford S, Hill DM, Mackintosh KA, McNarry MA, Barker AR, Williams CA. Using photo-elicitation to explore perceptions of physical activity among young people with cystic fibrosis. BMC Pulm Med 2019; 19:220. [PMID: 31771568 PMCID: PMC6878712 DOI: 10.1186/s12890-019-0985-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is recommended in the management of cystic fibrosis (CF). The aim of this study was to explore motives, barriers and enablers to physical activity among this population. METHODS Twelve participants (12-18 years) were recruited via convenience sampling. Photo-elicitation alongside semi-structured interviews were used to explore participants' views and experiences of physical activity. RESULTS Our findings revealed motives for physical activity including health, enjoyment and autonomy. Those with families who valued physical activity tended to have positive attitudes towards physical activity, and valued and integrated it into their lives. Moreover, they were likely to be intrinsically motivated to be active. Several factors enable and act as barriers to physical activity. Whilst CF influenced physical activity, the majority of enablers and barriers raised where congruent with the general populations. CONCLUSION This study provides support that healthcare providers should encourage both young people with CF and their families to be active, and subsequently informs the development of clinical interventions to support physical activity among young people with CF and their families.
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Affiliation(s)
- S Denford
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - D M Hill
- Applied Sports Science, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Swansea, UK
| | - K A Mackintosh
- Applied Sports Science, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Swansea, UK
| | - M A McNarry
- Applied Sports Science, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Swansea, UK
| | - A R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - C A Williams
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Razumov AN, Pogonchenkova IV, Khan MA, Lyan NA, Vakhova EL, Mikitchenko NA. [The application of the pulsed low-frequency electrostatic field in pediatrics]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2019; 96:55-62. [PMID: 30724883 DOI: 10.17116/kurort20199601155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of new methods for the physiotherapeutic treatment in pediatrics is the application of the pulsed low-frequency electrostatic field the action of which is based on the effects of deep resonant vibration on the affected tissue region with the minimal mecha-nical impact. Under the influence of the electrostatic field, the tissues at the site of interest become tightened and descend which causes their vibration due to the alternation of the pulses and intervals between them. The fast consecutive repetition of this process results in rhythmical deformation of the tissues. The electrostatic pulses are responsible for the increased friction between separate parts of the tissues while in the intervals between the pulses the tissue elastically resists their influence. In this way, the tissues subjected to such influence 'are pumped over' throughout their depth. It leads to the restoration of elasticity and mobilization of separate fibers and layers inside the tissue as well as to the development and improvement of the blood flow in the tissues and their blood supply. During the recent years, a large number of reports have been published in the literature concerning the possibilities of application of the pulsed low-frequency electrostatic field for the treatment and prevention of various di-seases in the children, including both monotherapy and its combination with other therapeutic modalities. The favourable action of the pulse low-frequency electrostatic field on the clinical course of bronchial asthma, mucoviscidosis, I and II degree scoliosis in the young children, remittent multiple sclerosis in the adolescents has been demonstrated. The data obtained give evidence of the high effectiveness of the proposed method, its excellent tolerance, and a wide range of beneficial effects on the main pathogenetic components of the diseases which creates the good prerequisites for the further active introduction of the therapeutic phy-sical factors in the practical work of the children's medical organizations.
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Affiliation(s)
- A N Razumov
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Department of Healthcare, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - I V Pogonchenkova
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Department of Healthcare, Moscow, Russia
| | - M A Khan
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Department of Healthcare, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N A Lyan
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Department of Healthcare, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E L Vakhova
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Department of Healthcare, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N A Mikitchenko
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Department of Healthcare, Moscow, Russia
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Patterson KD, Walsh A, McCormack P, Southern KW. Exercise versus airway clearance techniques for people with cystic fibrosis. Cochrane Database Syst Rev 2019. [DOI: 10.1002/14651858.cd013285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Katie D Patterson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust; Department of Respiratory Paediatrics; Royal Liverpool University Hospital Prescot Street Liverpool UK L7 8XP
| | - Adam Walsh
- Alder Hey Children's NHS Foundation Trust; Physiotherapy Department; Eaton Road Liverpool UK L12 2AP
| | - Pamela McCormack
- Alder Hey Children's NHS Foundation Trust; Department of Respiratory Physiotherapy; Eaton Road Liverpool UK L12 2AP
| | - Kevin W Southern
- University of Liverpool; Department of Women's and Children's Health; Alder Hey Children's NHS Foundation Trust Eaton Road Liverpool Merseyside UK L12 2AP
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Abstract
Introduction: Regular exercise and physical activity participation are recommended in guideline-based care for individuals with cystic fibrosis (CF) across the spectrum of age and disease severity. However, the best training methods to improve physical function and encourage ongoing exercise and activity participation are not clear, which is an ongoing challenge for clinicians. Areas covered: This perspective provides an overview of current evidence for exercise and physical activity relative to clinical outcomes and health-care utilization in people with CF, and highlights areas of future research need. Expert commentary: What kind, how much, how often, and how best to support people with CF to be physically active is uncertain. Whether new methods of training, the use of technology, or pharmaceutical developments could best deliver increased activity and physiological benefit without increased therapeutic burden is unclear. At present, if people with CF are going to be physically active, seemingly they should aim to perform this activity in the way most likely to confer some health benefit i.e. concerted exercise bouts of at least 10 min in addition to any incidental (habitual) activity performed during the course of daily life.
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Affiliation(s)
- Narelle S Cox
- a Discipline of Physiotherapy , La Trobe University , Melbourne , Victoria , Australia.,b Institute for Breathing and Sleep , Melbourne , Australia.,c Youth Activity Unlimited , Strategic Research Centre of the UK Cystic Fibrosis Trust
| | - Anne E Holland
- a Discipline of Physiotherapy , La Trobe University , Melbourne , Victoria , Australia.,b Institute for Breathing and Sleep , Melbourne , Australia.,c Youth Activity Unlimited , Strategic Research Centre of the UK Cystic Fibrosis Trust.,d Department of Physiotherapy , Alfred Hospital , Melbourne , Australia
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Urquhart DS, Saynor ZL. Exercise testing in cystic fibrosis: Who and why? Paediatr Respir Rev 2018; 27:28-32. [PMID: 30158079 DOI: 10.1016/j.prrv.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/19/2018] [Indexed: 10/16/2022]
Abstract
Annual review exercise testing is recommended by the Cystic Fibrosis (CF) Trust. Testing to date has focused on evaluating aerobic fitness, a key prognostic indicator. Tests available range from simple field tests, to comprehensive evaluations of aerobic exercise (dys)function - cardiopulmonary exercise testing (CPET). 'Field tests', although easy to perform are limited in the information they provide,whereas CPET, the 'gold standard' measure of aerobic fitness, is recommended as the first-choice exercise test by the European CF Society Exercise Working Group. CPET offers a precise cardiovascular, respiratory and metabolic evaluation of exercise capacity, including assessment of mechanism(s) of exercise limitation.
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Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Department of Child Life and Health, University of Edinburgh, United Kingdom.
| | - Z L Saynor
- Department of Sport and Exercise Science, University of Portsmouth, United Kingdom; Paediatric and Adult Respiratory Outpatient Departments, University Hospital Southampton, Southampton, United Kingdom
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Clinical interpretation of cardiopulmonary exercise testing in cystic fibrosis and implications for exercise counselling. Paediatr Respir Rev 2017; 24:72-78. [PMID: 26515919 DOI: 10.1016/j.prrv.2015.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/24/2022]
Abstract
The measurement of exercise capacity in persons with cystic fibrosis by Cardiopulmonary Exercise Testing (CPET) offers a functional assessment of lung performance and efficiency in a dynamic setting. Exercise performance can measured against predicted values and the mechanism by which exercise limitation occurs can be identified. In healthy subjects, exercise is limited by cardiac output, such that a significant breathing reserve exists at the end of exercise. However, other mechanisms of exercise limitation which may be identified in CF subjects include ventilatory limitation, and/or limitation due to physical deconditioning. A detailed understanding of exercise capacity and the mechanism for exercise limitation may enable health professionals to tailor an individualised exercise programme for each CF patient.
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Bieli C, Summermatter S, Boutellier U, Moeller A. Respiratory muscle training improves respiratory muscle endurance but not exercise tolerance in children with cystic fibrosis. Pediatr Pulmonol 2017; 52:331-336. [PMID: 28114723 DOI: 10.1002/ppul.23647] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/31/2016] [Accepted: 11/17/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Respiratory muscle endurance (RME) training has been shown to increase exercise endurance and lung function in adults with cystic fibrosis (CF). We conducted an interventional study to investigate the effectiveness of RME training on CF-related health outcomes in children. METHODS In a crossover trial, 22 children, aged 9-18 years, with CF performed 8 weeks of RME training and standard chest physiotherapy in a randomized sequence separated by a 1 week washout period. All children underwent training sessions using the RME training device before beginning the study. The primary outcomes were RME (in minutes) and exercise endurance (in minutes). Data were analyzed according to the intention-to-treat principle. RESULTS Sixteen of 22 children (73%) completed the study. Study dropouts tended to be older with more advanced lung disease. After RME training, respiratory muscle endurance significantly increased by 7.03 ± 8.15 min (mean ± standard deviation, P < 0.001), whereas exercise endurance was unchanged by RME training (0.80 ± 2.58 min, P = 0.169). No significant improvement in secondary outcomes (lung function, CF quality of life, and CF clinical score) were observed. The small sample size and short intervention time have to be acknowledged as limitations of our study. CONCLUSIONS RME training led to a significant increase in respiratory muscle endurance in children with CF. However, RME training did not improve exercise endurance or other CF-related health outcomes. Thus, our results do not support the routine use of RME training in the care of children with CF. Future studies in larger populations and with prolonged intervention time may overcome the limitations of our study. Pediatr Pulmonol. 2017;52:331-336. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Christian Bieli
- University Children's Hospital Zurich, Pediatric Pulmonology, Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Selina Summermatter
- University Children's Hospital Zurich, Pediatric Pulmonology, Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Urs Boutellier
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zürich, Switzerland
| | - Alexander Moeller
- University Children's Hospital Zurich, Pediatric Pulmonology, Steinwiesstrasse 75, 8032 Zürich, Switzerland
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Donadio MVF, Heinzmann-Filho JP, Vendrusculo FM, Frasson PXH, Marostica PJC. Six-Minute Walk Test Results Predict Risk of Hospitalization for Youths with Cystic Fibrosis: A 5-Year Follow-Up Study. J Pediatr 2017; 182:204-209.e1. [PMID: 28087053 DOI: 10.1016/j.jpeds.2016.11.071] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/28/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the association of 6-minute walk test (6MWT) and other variables (anthropometry, chronic Pseudomonas aeroginosa colonization, pulmonary function, and respiratory muscle strength) with the risk of hospitalization for pulmonary exacerbation in children and adolescents with cystic fibrosis (CF). STUDY DESIGN Cohort study that included patients with CF aged 6-18 years. All participants underwent spirometry, manovacuometry, and 6MWT during the 5-year follow-up. Anthropometric and clinical data were collected and the time to first hospitalization, total days of hospitalization, and antibiotic use during follow-up was recorded. RESULTS A total of 26 patients with CF, mean age 10.2 ± 2.8 years, were included. The group had mild impairment of lung function with a significant decline in forced expiratory volume in 1 second (P = .019) over the 5 years. Respiratory muscle strength and 6MWT proved to be preserved, although maximum inspiratory pressure increased (P < .001) and maximum expiratory pressure and 6-minute walk distance (6MWD) remained stable. There were inverse associations of 6MWD in meters (r = -0.813, P < .001) and z score (r = -0.417, P = .015) with total days of hospitalization. Moreover, there was a reduction in the risk of a first hospitalization (Cox HR 0.32; P = .037) in patients with a greater 6MWD. CONCLUSIONS We found an association between the 6MWT and the risk of hospitalization in children and adolescents with CF. Furthermore, functional capacity apparently does not follow the expected decline in pulmonary function over time, whereas inspiratory muscle strength increases with disease progression.
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Affiliation(s)
- Márcio V F Donadio
- Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.
| | - João P Heinzmann-Filho
- Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda M Vendrusculo
- Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patrícia X H Frasson
- School of Physiotherapy, Universidade Veiga de Almeida (UVA), Rio de Janeiro, Brazil
| | - Paulo J C Marostica
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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25
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Jantzen A, Opoku-Pare M, Bieli C, Ruf K, Hebestreit H, Moeller A. Perspective on cystic fibrosis and physical activity: Is there a difference compared to healthy individuals? Pediatr Pulmonol 2016; 51:1020-1030. [PMID: 27459056 DOI: 10.1002/ppul.23532] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/28/2016] [Accepted: 07/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this study was to compare habitual physical activity between cystic fibrosis (CF) patients and healthy controls and to investigate possible predictors for reduced physical activity in CF patients. METHODS Sixty-six patients with CF (3-44 years) and 65 healthy controls (3-55 years) were asked to wear an accelerometer (Actigraph GT1M) for 9 days (at least 10 hr/day). Physical activity was classified in five categories from very low to very strenuous. RESULTS In general, there was no difference in physical activity between CF patients and healthy controls. However, young school-aged 6-13 years old children with CF spent less time with strenuous and very strenuous activity than healthy controls (adjusted difference in activity -0.43 (-0.69, -0.17)). Patients with very low lung function were significantly less active, but other CF-associated conditions did not affect physical activity. CONCLUSIONS While we found similar levels of physical activity measured by accelerometry in patients with CF compared to healthy controls in general, young school-aged children showed less engagement in strenuous activities than their healthy counterparts. As the reduced physical activity in young school children was not likely to be explained by the disease state, strenuous physical activity may be enhanced by advocating exercise and sport. Pediatr Pulmonol. 2016;51:1020-1030. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Anika Jantzen
- Division of Paediatric Pulmonology, University Children's Hospital, Zuerich, Switzerland.,Children Research Center, CRC, Zuerich, Switzerland
| | - Miriam Opoku-Pare
- Department of Pediatrics, University of Wuerzburg, Würzburg, Germany
| | - Christian Bieli
- Division of Paediatric Pulmonology, University Children's Hospital, Zuerich, Switzerland.,Children Research Center, CRC, Zuerich, Switzerland
| | - Katharina Ruf
- Department of Pediatrics, University of Wuerzburg, Würzburg, Germany
| | - Helge Hebestreit
- Department of Pediatrics, University of Wuerzburg, Würzburg, Germany
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital, Zuerich, Switzerland. .,Children Research Center, CRC, Zuerich, Switzerland.
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Carbonera RP, Vendrusculo FM, Donadio MVF. Physiological responses during exercise with video games in patients with cystic fibrosis: A systematic review. Respir Med 2016; 119:63-69. [PMID: 27692149 DOI: 10.1016/j.rmed.2016.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Interactive video games are recently being used as an exercise tool in cystic fibrosis (CF). This study aimed to assess the literature describing whether video games generate a physiological response similar to the exercise intensity needed for training in CF. METHODS An online search in PubMed, Embase, Cochrane, SciELO, LILACS and PEDro databases was conducted and original studies describing physiological responses of the use of video games as exercise in CF were included. RESULTS In four, out of five studies, the heart rate achieved during video games was within the standards recommended for training (60-80%). Two studies assessed VO2 and showed higher levels compared to the six-minute walk test. No desaturation was reported. Most games were classified as moderate intensity. Only one study used a maximum exercise test as comparator. CONCLUSION Interactive video games generate a heart rate response similar to the intensity required for training in CF patients.
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Affiliation(s)
- Raquel Pinto Carbonera
- Faculty of Nursing, Nutrition and Physiotherapy, Health Multidisciplinary Residency Program, Hospital São Lucas (PREMUS/HSL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Maria Vendrusculo
- Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcio Vinícius Fagundes Donadio
- Faculty of Nursing, Nutrition and Physiotherapy, Health Multidisciplinary Residency Program, Hospital São Lucas (PREMUS/HSL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
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Le Gal C, Vandervelde L, Poncin W, Reychler G. [Impact of physical exercise in cystic fibrosis patients: A systematic review]. Rev Mal Respir 2016; 33:573-82. [PMID: 27209116 DOI: 10.1016/j.rmr.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Beneficial effects of physical exercise have been previously demonstrated in patients with chronic obstructive pulmonary disease. The aim of this systematic review was to summarize the evidence supporting physical exercise to improve on lung function, exercise capacity and quality of life in cystic fibrosis patients. METHODS Medline database was used to search clinical studies from 2000 to 2015. We also analyzed the bibliographic section of the included studies, in order to identify additional references. RESULTS A total of 17 studies were identified. A great disparity was found in the results of the different studies. No systematic benefit was found on lung function, exercise capacity or quality of life. No relationship between the type of program and the benefits achieved was observed. CONCLUSIONS Evidence that physical exercise benefits lung function, exercise capacity and quality of life in cystic fibrosis patient is inconsistent and evidence does not support a particular standardized program for all patients.
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Affiliation(s)
- C Le Gal
- Département de kinésithérapie, Parnasse-ISEI, 1200 Bruxelles, Belgique
| | - L Vandervelde
- Département de kinésithérapie, Parnasse-ISEI, 1200 Bruxelles, Belgique
| | - W Poncin
- Service de pneumologie, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique
| | - G Reychler
- Département de kinésithérapie, Parnasse-ISEI, 1200 Bruxelles, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique; Service de médecine physique et réadaptation, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique; Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, 1200 Bruxelles, Belgique.
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Abstract
PURPOSE OF REVIEW Regular physical activity and exercise have become important components of cystic fibrosis care. This review summarizes the recent evidence in favour of regular exercise in cystic fibrosis that has accumulated over the past years. RECENT FINDINGS Several recently published small randomized-controlled trials and observational studies have added to our knowledge on positive effects of exercise training on pulmonary function and aerobic fitness in cystic fibrosis. Relevant outcomes, such as body posture, health-related quality of life and rate of hospitalization, are increasingly studied. Findings from these studies suggest that exercise might also be beneficial for these outcomes. So far, many important questions such as the best way of integrating exercise in cystic fibrosis care and the determination of the optimal strategies for training and motivation remain mostly unanswered. SUMMARY Over the past years, evidence for the beneficial effects of regular exercise on lung health and aerobic exercise capacity is strengthening. Despite the fact that most of the knowledge is based on small studies, the observed effects are encouraging and there is no reason why exercise should not be implemented in all patients' care.
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Hebestreit H, Arets HG, Aurora P, Boas S, Cerny F, Hulzebos EH, Karila C, Lands LC, Lowman JD, Swisher A, Urquhart DS. Statement on Exercise Testing in Cystic Fibrosis. Respiration 2015; 90:332-51. [DOI: 10.1159/000439057] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022] Open
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Pérez M, Groeneveld IF, Santana-Sosa E, Fiuza-Luces C, Gonzalez-Saiz L, Villa-Asensi JR, López-Mojares LM, Rubio M, Lucia A. Aerobic fitness is associated with lower risk of hospitalization in children with cystic fibrosis. Pediatr Pulmonol 2014; 49:641-9. [PMID: 24019231 DOI: 10.1002/ppul.22878] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/06/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with cystic fibrosis (CF) often have to be hospitalized because of acute exacerbation of their respiratory symptoms. Given the fact that improved peak oxygen uptake (VO2peak ) is positively associated with lung function and overall health in children with CF, this study examined the association between VO2peak and the need for hospitalization in a cohort of pediatric CF patients. METHODS In a 3-year study, 77 CF children with mild-to-moderately severe CF (forced expiratory volume in 1 sec [FEV1 ] ≥ 50%) underwent a maximal exercise test to determine VO2peak . Anthropometric, lung function and muscle strength measurements were also conducted and dates of hospitalization were recorded for the study period. Associations were then determined between the variables recorded and hospitalization by univariate and multivariate Cox proportional hazards regression analyses. RESULTS VO2peak was 38.6 ± 6.7 ml kg(-1) min(-1) for boys and 31.9 ± 6.9 ml kg(-1) min(-1) for girls. In multivariate analyses, VO2peak was the only variable significantly associated with time to hospitalization (hazard ratio 0.91, P = 0.03). CONCLUSION A significant association was detected between greater aerobic fitness, and lower risk of hospitalization. Because hospitalization due to respiratory exacerbation is a powerful prognostic factor, our findings provide further support for the importance of aerobic fitness evaluation in the management of children with mild-to-moderately severe CF.
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Affiliation(s)
- Margarita Pérez
- School of Doctorate Studies and Research, European University of Madrid, Madrid, Spain
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Ledger SJ, Owen E, Prasad SA, Goldman A, Willams J, Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate–severe cystic fibrosis. J Cyst Fibros 2013; 12:766-72. [DOI: 10.1016/j.jcf.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis. Respir Med 2013; 107:684-90. [PMID: 23485096 DOI: 10.1016/j.rmed.2013.01.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/18/2013] [Accepted: 01/20/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND The beneficial role of exercise in maintaining health in patients with cystic fibrosis (CF) is well described. Few data exist on the effect of exercise on respiratory muscle function in patients with CF. Our objective was to compare respiratory muscle function indices in CF patients that regularly exercise with those CF patients that do not. METHODS This cross-sectional study assessed nutrition, pulmonary function and respiratory muscle function in 37 CF patients that undertook regular aerobic exercise and in a control group matched for age and gender which consisted of 44 CF patients that did not undertake regular exercise. Respiratory muscle function in CF was assessed by maximal inspiratory pressure (Pimax), maximal expiratory pressure (Pemax) and pressure-time index of the respiratory muscles (PTImus). RESULTS Median Pimax and Pemax were significantly higher in the exercise group compared to the control group (92 vs. 63 cm H2O and 94 vs. 64 cm H2O respectively). PTImus was significantly lower in the exercise group compared to the control group (0.089 vs. 0.121). Upper arm muscle area (UAMA) and mid-arm muscle circumference were significantly increased in the exercise group compared to the control group (2608 vs. 2178 mm2 and 23 vs. 21 cm respectively). UAMA was significantly related to Pimax in the exercising group. CONCLUSIONS These results suggest that CF patients that undertake regular aerobic exercise maintain higher indices of respiratory muscle strength and lower PTImus values, while increased UAMA values in exercising patients highlight the importance of muscular competence in respiratory muscle function in this population.
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