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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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2
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Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS. Guidance and standard operating procedures for functional exercise testing in cystic fibrosis. Eur Respir Rev 2023; 32:230029. [PMID: 37558263 PMCID: PMC10410399 DOI: 10.1183/16000617.0029-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.
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Affiliation(s)
- 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
- Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mathieu Gruet
- Laboratory of the Impact of Physical Activity on Health (IAPS), University of Toulon, Toulon, France
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK
| | - Brenda Button
- Department of Physiotherapy, Melbourne School of Health Science, University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Marlies Wagner
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Abbey Sawyer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helge Hebestreit
- Paediatric Department, University Hospitals Würzburg, Würzburg, Germany
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Don S Urquhart
- Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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3
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Britto CJ, Ratjen F, Clancy JP. Emerging Approaches to Monitor and Modify Care in the Era of Cystic Fibrosis Transmembrane Conductance Regulators. Clin Chest Med 2022; 43:631-646. [PMID: 36344071 DOI: 10.1016/j.ccm.2022.06.006] [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: 11/06/2022]
Abstract
As we characterize the clinical benefits of highly effective modulator therapy (HEMT) in the cystic fibrosis (CF) population, our paradigm for treating and monitoring disease continues to evolve. More sensitive approaches are necessary to detect early disease and clinical progression. This article reviews evolving strategies to assess disease control and progression in the HEMT era. This article also explores developments in pulmonary function monitoring, advanced respiratory imaging, tools for the collection of patient-reported outcomes, and their application to profile individual responses, guide therapeutic decisions, and improve the quality of life of people with CF.
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Affiliation(s)
- Clemente J Britto
- Yale Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine.
| | - Felix Ratjen
- Division of Respiratory Medicine, Translational Medicine, University of Toronto Hospital for Sick Children, 555 University Avenue, Toronto Ontario M5G 1X8, Canada
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4
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Antos NJ, Savant AP. Cystic fibrosis year in review 2020: Section 2 pulmonary disease, infections, and inflammation. Pediatr Pulmonol 2022; 57:347-360. [PMID: 34033706 DOI: 10.1002/ppul.25459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
The outlook for those with cystic fibrosis (CF) has never been brighter with ever increasing life expectancy and the approval of the highly effective CFTR modulators, such as elexacaftor/tezacaftor/ivacaftor. With that being said, the progressive pulmonary decline and importance of lung health, infection, and inflammation in CF remains. This review is the second part in a three-part CF Year in Review 2020. Part one focused on the literature related to CFTR modulators while part three will feature the multisystem effects related to CF. This review focuses on articles from Pediatric Pulmonology, including articles from other journals that are of particular interest to clinicians. Herein, we highlight studies published during 2020 related to CF pulmonary disease, infection, treatment, and diagnostics.
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Affiliation(s)
- Nicholas J Antos
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Pediatric Pulmonology, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Adrienne P Savant
- Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, Louisiana, USA.,Department of Pediatrics, Tulane University, New Orleans, Louisiana, USA
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5
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Kampouras A, Hatziagorou E, Kalantzis T, Avramidou V, Kontouli K, Kirvassilis F, Tsanakas J. The Fitter the Better? Cardiopulmonary Exercise Testing Can Predict Pulmonary Exacerbations in Cystic Fibrosis. CHILDREN-BASEL 2021; 8:children8060527. [PMID: 34205505 PMCID: PMC8235320 DOI: 10.3390/children8060527] [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: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022]
Abstract
Background: The role of cardiopulmonary exercise testing (CPET) in the assessment of prognosis in CF (cystic fibrosis) is crucial. However, as the overall survival of the disease becomes better, the need for examinations that can predict pulmonary exacerbations (PEx) and subsequent deterioration becomes evident. Methods: Data from a 10-year follow up with CPET and spirometry of CF patients were used to evaluate whether CPET-derived parameters can be used as prognostic indexes for pulmonary exacerbations in patients with CF. Pulmonary exacerbations were recorded. We used a survival analysis through Cox Regression to assess the prognostic role of CPET parameters for PeX. CPET parameters and other variables such as sputum culture, age, and spirometry measurements were tested via multivariate cox models. Results: During a 10-year period (2009–2019), 78 CF patients underwent CPET. Cox regression analysis revealed that VO2peak% (peak Oxygen Uptake predicted %) predicted (hazard ratio (HR), 0.988 (0.975, 1.000) p = 0.042) and PetCO2 (end-tidal CO2 at peak exercise) (HR 0.948 (0.913, 0.984) p = 0.005), while VE/VO2 and (respiratory equivalent for oxygen at peak exercise) (HR 1.032 (1.003, 1.062) p = 0.033) were significant predictors of pulmonary exacerbations in the short term after the CPET. Additionally, patients with VO2peak% predicted <60% had 4.5-times higher relative risk of having a PEx than those with higher exercise capacity. Conclusions: CPET can provide valuable information regarding upcoming pulmonary exacerbation in CF. Patients with VO2peak <60% are at great risk of subsequent deterioration. Regular follow up of CF patients with exercise testing can highlight their clinical image and direct therapeutic interventions.
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Affiliation(s)
- Asterios Kampouras
- Pediatric Pulmonology and CF Unit, 3rd Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.H.); (V.A.); (K.K.); (F.K.); (J.T.)
- Correspondence: ; Tel.: +30-231-099-2878
| | - Elpis Hatziagorou
- Pediatric Pulmonology and CF Unit, 3rd Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.H.); (V.A.); (K.K.); (F.K.); (J.T.)
| | | | - Vasiliki Avramidou
- Pediatric Pulmonology and CF Unit, 3rd Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.H.); (V.A.); (K.K.); (F.K.); (J.T.)
| | - Kalliopi Kontouli
- Pediatric Pulmonology and CF Unit, 3rd Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.H.); (V.A.); (K.K.); (F.K.); (J.T.)
| | - Fotios Kirvassilis
- Pediatric Pulmonology and CF Unit, 3rd Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.H.); (V.A.); (K.K.); (F.K.); (J.T.)
| | - John Tsanakas
- Pediatric Pulmonology and CF Unit, 3rd Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.H.); (V.A.); (K.K.); (F.K.); (J.T.)
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de Freitas Coelho P, Barbosa RRB, dos Santos Lugao R, Liberato FMG, Vidal PR, de Cássia Nunes Cruz Melotti R, Donadio MVF. Heart rate variability, exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate cystic fibrosis. Hong Kong Physiother J 2021; 42:5-14. [PMID: 35782696 PMCID: PMC9244599 DOI: 10.1142/s1013702522500019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored. Objective: This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF. Methods: A cross-sectional study including individuals with CF aged 6–18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test — MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated. Results: 30 individuals (20 females) aged [Formula: see text] years, mean FEV[Formula: see text]%, were included. A sympathovagal balance (LF/HF) increase ([Formula: see text]) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV1 ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text]; respectively). MST distance also correlated positively and significantly with SDNN ([Formula: see text], [Formula: see text]), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50[Formula: see text]ms — RMSSD ([Formula: see text], [Formula: see text]), low frequency — LF ([Formula: see text], [Formula: see text]), HF ([Formula: see text], [Formula: see text]), dispersion of points perpendicular to the short-term identity line — SD1 ([Formula: see text], [Formula: see text]) and negatively with LF/HF ([Formula: see text], [Formula: see text]). Regarding daily physical activity, SDNN at rest ([Formula: see text], [Formula: see text]) and exercise ([Formula: see text], [Formula: see text]) showed positive correlations with time in moderate-to-vigorous activities. When normalizing the SDNN and classifying individuals as normal or altered, those presenting altered SDNN showed poorest FEV1 ([Formula: see text]) and lower exercise capacity ([Formula: see text]). Conclusion: HRV correlates with lung function, exercise capacity and levels of daily physical activity in children and adolescents with CF. The study highlights the influence of CF on autonomic function and suggests HRV measurement as an easy tool to be used in clinical settings as an alternative marker to monitor CF individuals.
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Affiliation(s)
- Pitiguara de Freitas Coelho
- Escola Superior de Ciˆencias da Santa Casa de Misericórdia de, Vitória – EMESCAM, Vitória, Espírito Santo, Brazil
| | | | - Rodrigo dos Santos Lugao
- Escola Superior de Ciˆencias da Santa Casa de Misericórdia de, Vitória – EMESCAM, Vitória, Espírito Santo, Brazil
| | | | - Pâmela Reis Vidal
- Escola Superior de Ciˆencias da Santa Casa de Misericórdia de, Vitória – EMESCAM, Vitória, Espírito Santo, Brazil
| | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica, do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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7
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Leite LR, Queiroz KCV, da Silva FH, Coelho CC, Donadio MVF, Aquino EDS. Clinical use of the modified shuttle test in children with cystic fibrosis: Is one test sufficient? Pediatr Pulmonol 2021; 56:1550-1557. [PMID: 33650810 DOI: 10.1002/ppul.25348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the reproducibility of the modified shuttle test (MST) and to determine whether the test needs to be performed more than once to assess the exercise capacity of children and adolescents with cystic fibrosis (CF). METHODS This was a longitudinal study including patients diagnosed with CF aged more than 6 years. The participants were followed for a period of 9 months and were evaluated at three different time points (visits 1, 2, and 3). Spirometric, anthropometric, clinical, and genetic data were collected, and two MSTs were performed at each visit. RESULTS Forty-eight clinically stable volunteers with a mean age of 10.1 ± 2.7 years were initially included. The reproducibility of the test was evaluated using the distance achieved (DA) as the main variable. There were no significant differences in the DA (visit 1, p = .23; visit 2, p = .24; visit 3, p = .85), baseline heart rate (HR) (visit 1, p = .35; visit 2, p = .20; visit 3, p = .98), and peak HR (visit 1, p = .16; visit 2, p = .94; visit 3, p = .23) between the tests performed at each visit. The test-retest reliability demonstrated a high intraclass correlation coefficient at all visits (visit 1, 2, and 3: 0.83, 0.90, and 0.80, respectively) and the variation in HR was the main factor associated with the DA in the MST over time. CONCLUSION The MST was found to be a reproducible and reliable test. The data presented here support the use of a single MST to evaluate and monitor exercise capacity of patients with CF during clinic visits.
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Affiliation(s)
- Luanna Rodrigues Leite
- João Paulo II Pediatric Hospital, Fundação Hospital of the State of Minas Gerais-FHEMIG, Belo Horizonte, Brazil.,Betim Campus, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Karen Caroline Vasconcelos Queiroz
- João Paulo II Pediatric Hospital, Fundação Hospital of the State of Minas Gerais-FHEMIG, Belo Horizonte, Brazil.,Betim Campus, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Franciely Helena da Silva
- João Paulo II Pediatric Hospital, Fundação Hospital of the State of Minas Gerais-FHEMIG, Belo Horizonte, Brazil.,Betim Campus, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristiane Cenachi Coelho
- João Paulo II Pediatric Hospital, Fundação Hospital of the State of Minas Gerais-FHEMIG, Belo Horizonte, Brazil
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Evanirso da Silva Aquino
- João Paulo II Pediatric Hospital, Fundação Hospital of the State of Minas Gerais-FHEMIG, Belo Horizonte, Brazil.,Betim Campus, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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Du Berry C, Westrupp N, Shanthikumar S, Welsh L. Associations between peak oxygen uptake, lung function, and bronchiectasis in children with cystic fibrosis in the era of CFTR modulators. Pediatr Pulmonol 2021; 56:1490-1495. [PMID: 33458944 DOI: 10.1002/ppul.25275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND With the emergence of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, forced expiratory volume in 1 s (FEV1 ) may become a less sensitive measure of pulmonary disease progression in children with cystic fibrosis (CF). Increasing evidence shows that peak oxygen uptake (VO2peak ) is a strong predictor of prognosis in CF. The primary aim of this study was to describe the associations between peak oxygen uptake, lung function, and bronchiectasis in children with CF in the era of CFTR modulators. METHODS Spirometry and a maximal cardiopulmonary exercise test (CPET) were performed on the same day and compared to markers of disease severity. Markers of disease severity included a number of pulmonary exacerbations resulting in hospital admission within the preceding 12 months, body mass index, Pseudomonas aeruginosa (PsA) infection, and bronchiectasis. RESULTS Fifty-two subjects (24 female) with CF participated in the study with a mean (SD) age of 13.8 (2.4) years, range 8-18 years. Forty-nine participants met satisfactory criteria for a maximal CPET. A significant correlation was found between relative VO2peak %predicted and FEV1 %predicted (r = .546, p < .001). A total of 4/49 children demonstrated an impaired aerobic capacity despite normal spirometry. Participants who had experienced one or more pulmonary exacerbations in the previous 12 months had a significantly lower relative VO2peak %predicted (p = .02). CONCLUSIONS In children with CF who have mild pulmonary disease, there is significant correlation between FEV1 and VO2peak . In all, 8.2% of participants had an abnormal CPET result despite normal spirometry, and preceding pulmonary exacerbations were associated with poorer CPET outcomes. CPET may offer important prognostic information for clinical decision making in this new era of CFTR modulators.
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Affiliation(s)
- Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Parkville, Victoria, Australia
| | - Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Parkville, Victoria, Australia
| | - Liam Welsh
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Parkville, Victoria, Australia
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Emirza C, Aslan GK, Kilinc AA, Cokugras H. Effect of expiratory muscle training on peak cough flow in children and adolescents with cystic fibrosis: A randomized controlled trial. Pediatr Pulmonol 2021; 56:939-947. [PMID: 33421333 DOI: 10.1002/ppul.25259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cough is an important defense and airway clearance mechanism for removing thick and viscous secretions in cystic fibrosis (CF). The primary aim of this study was to investigate the effect of expiratory muscle training (EMT) on peak cough flow (PCF) and secondly on respiratory muscle functions, functional exercise capacity, and quality of life (QoL) in CF. METHODS Thirty patients were randomized as training and sham groups. Both groups were trained with the EMT protocol, which involved twice per day for at least 5 days per week for 6 weeks. The training intensity in the training group was 30% of the maximal expiratory pressure (MEP). In the sham group, it remained at the lowest pressure (5 cmH2 O). The primary outcome was PCF. The secondary outcomes were MEP, maximal inspiratory pressure (MIP), spirometric measures, six-minute walking distance (6MWD), and QoL (Cystic Fibrosis Questionnaire-Revised). RESULTS Twenty-eight patients completed the study. Changes in PCF (p = .041) and MEP (p = .003) were higher in the training group than the sham group. Also, treatment burden (p = .008), digestive symptoms (p = .019), and vitality (p = .042) in QoL were more improved in the training group. MIP (p = .028) and 6MWD (p = .035) changed significantly only in the training group. Spirometric measurements did not change (p > .05). CONCLUSIONS The results of the study show that EMT could improve PCF, MEP, treatment burden, digestive symptoms, and vitality domains of QoL in patients with CF. Moreover, MIP and functional exercise capacity improved in the training group with EMT.
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Affiliation(s)
- Cigdem Emirza
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Goksen Kuran Aslan
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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10
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Armstrong N, Welsman J. Influence of sex-specific concurrent changes in age, maturity status, and morphological covariates on the development of peak ventilatory variables in 10-17-year-olds. Eur J Appl Physiol 2020; 121:783-792. [PMID: 33289062 PMCID: PMC7892727 DOI: 10.1007/s00421-020-04569-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
Purposes (i) To investigate the influence of concurrent changes in age, maturity status, stature, body mass, and skinfold thicknesses on the development of peak ventilatory variables in 10–17-year-olds; and, (ii) to evaluate the interpretation of paediatric norm tables of peak ventilatory variables. Methods Multiplicative multilevel modelling which allows both the number of observations per individual and the temporal spacing of the observations to vary was used to analyze the expired ventilation (peak \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E) and tidal volume (peak VT) at peak oxygen uptake of 420 (217 boys) 10–17-year-olds. Models were founded on 1053 (550 from boys) determinations of peak ventilatory variables supported by anthropometric measures and maturity status. Results In sex-specific, multiplicative allometric models, concurrent changes in body mass and skinfold thicknesses (as a surrogate of FFM) and age were significant (p < 0.05) explanatory variables of the development of peak \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E, once these covariates had been controlled for stature had no additional, significant (p > 0.05) effect on peak \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E. Concurrent changes in age, stature, body mass, and skinfold thicknesses were significant (p < 0.05) explanatory variables of the development of peak VT. Maturity status had no additional, significant (p > 0.05) effect on either peak \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E or peak VT once age and morphological covariates had been controlled for. Conclusions Elucidation of the sex-specific development of peak \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\mathrm{V}}}_{\mathrm{E}}$$\end{document}V˙E requires studies which address concurrent changes in body mass, skinfold thicknesses, and age. Stature is an additional explanatory variable in the development of peak VT, in both sexes. Paediatric norms based solely on age or stature or body mass are untenable.
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Affiliation(s)
- Neil Armstrong
- Children's Health and Exercise Research Centre, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Jo Welsman
- Children's Health and Exercise Research Centre, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
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