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Kinaupenne M, De Craemer M, Schaballie H, Vandekerckhove K, Van Biervliet S, Demeyer H. Physical activity and its correlates in people with cystic fibrosis: a systematic review. Eur Respir Rev 2022; 31:220010. [PMID: 38743505 DOI: 10.1183/16000617.0010-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
Abstract
Cystic fibrosis (CF) is a life-shortening genetic disease, affecting multiple life domains including physical activity (PA). Although higher PA levels are associated with multiple health benefits, little insight exists on the PA level of people with CF (PwCF) compared to healthy peers. Evidence on the influencing factors (i.e. correlates) of PA in this clinical population is scarce, but essential to fully understand their PA behaviour. Therefore, the present review aims to provide an overview of the PA level of PwCF compared to healthy peers, and the correlates of PA in PwCF. A systematic search of three databases resulted in 46 included studies. Analysis of 16 studies showed that the CF population is equally active compared to healthy peers, but there is a trend towards less high-intensity PA in youths with CF. Furthermore, PA is positively associated with quality of life, lung function, (maximal) exercise capacity, bone mineral density and quadriceps force. Also, PA was lower on weekdays compared to weekend days and lower when experiencing pulmonary exacerbations. More high-quality research is required in PwCF, particularly longitudinal studies that further explore the correlates of PA, with PA investigated as a primary outcome and measured objectively.
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Affiliation(s)
- Manon Kinaupenne
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Marieke De Craemer
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Heidi Schaballie
- Dept of Pediatric Pulmonology, Infectious Diseases and Primary Immunodeficiencies, Ghent University Hospital, Ghent, Belgium
| | | | | | - Heleen Demeyer
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
- Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Anifanti M, Giannakoulakos S, Hatziagorou E, Kampouras A, Tsanakas J, Deligiannis A, Kouidi E. Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis. SENSORS (BASEL, SWITZERLAND) 2022; 22:4884. [PMID: 35808375 PMCID: PMC9269327 DOI: 10.3390/s22134884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
Several studies have shown that patients with cystic fibrosis (CF), even at a young age, have pulmonary and cardiac abnormalities. The main complications are cardiac right ventricular (RV) systolic and/or diastolic dysfunction and pulmonary hypertension, which affects their prognosis. Exercise training (ET) is recommended in patients with CF as a therapeutic modality to improve physical fitness and health-related quality of life. However, questions remain regarding its optimal effective and safe dose and its effects on the patients’ cardiac function. The study aimed to provide a wearable activity tracker (WAT)-based ET to promote physical activity in CF patients and assess its effects on cardiac morphology and function. Forty-two stable CF individuals (aged 16.8 ± 3.6 years) were randomly assigned to either the intervention (Group A) or the control group (Group B). Group A participated in a 1-year WAT-based ET program three times per week. All patients underwent a 6-min walking test (6-MWT) and an echocardiographic assessment focused mainly on RV anatomy and function at the baseline and the end of the study. RV systolic function was evaluated by measuring the tricuspid annular plane systolic excursion (TAPSE), the systolic tricuspid annular velocity (TVS’), the RV free-wall longitudinal strain (RVFWSL), and the right ventricular four-chamber longitudinal strain (RV4CSL). RV diastolic function was assessed using early (TVE) and late (TVA) diastolic transtricuspid flow velocity and their ratio TVE/A. Pulmonary artery systolic pressure (PASP) was also estimated. In Group A after ET, the 6MWT distance improved by 20.6% (p < 0.05), TVA decreased by 17% (p < 0.05), and TVE/A increased by 13.2% (p < 0.05). Moreover, TAPSE, TVS’, RVFWSL, and RV4CSL increased by 8.3% (p < 0.05), 9.0% (p < 0.05), 13.7% (p < 0.05), and 26.7% (p < 0.05), respectively, while PASP decreased by 7.6% (p < 0.05). At the end of the study, there was a significant linear correlation between the number of steps and the PASP (r = −0.727, p < 0.01) as well as the indices of RV systolic function in Group A. In conclusion, WAT is a valuable tool for implementing an effective ET program in CF. Furthermore, ET has a positive effect on RV systolic and diastolic function.
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Affiliation(s)
- Maria Anifanti
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
| | - Stavros Giannakoulakos
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
| | - Elpis Hatziagorou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.H.); (A.K.); (J.T.)
| | - Asterios Kampouras
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.H.); (A.K.); (J.T.)
| | - John Tsanakas
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.H.); (A.K.); (J.T.)
| | - Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thermi, Greece; (M.A.); (S.G.); (A.D.)
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McLeod C, Wood J, Tong A, Schultz A, Norman R, Smith S, Blyth CC, Webb S, Smyth AR, Snelling TL. The measurement properties of tests and tools used in cystic fibrosis studies: a systematic review. Eur Respir Rev 2021; 30:200354. [PMID: 33980667 PMCID: PMC9489019 DOI: 10.1183/16000617.0354-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/26/2020] [Indexed: 11/05/2022] Open
Abstract
There is no consensus on how best to measure responses to interventions among children and adults with cystic fibrosis (CF). We have systematically reviewed and summarised the characteristics and measurement properties of tests and tools that have been used to capture outcomes in studies among people with CF, including their reliability, validity and responsiveness. This review is intended to guide researchers when selecting tests or tools for measuring treatment effects in CF trials. A consensus set of these tests and tools could improve consistency in how outcomes are captured and thereby facilitate comparisons and synthesis of evidence across studies.
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Affiliation(s)
- Charlie McLeod
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Nedlands, Australia
- Infectious Diseases Dept, Perth Children's Hospital, Nedlands, Australia
| | - Jamie Wood
- Physiotherapy Dept, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, Australia
| | - Sherie Smith
- Evidence Based Child Health Group, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Nedlands, Australia
- Infectious Diseases Dept, Perth Children's Hospital, Nedlands, Australia
- Pathwest Laboratory Medicine WA, QEII Medical Centre, Nedlands, Australia
| | - Steve Webb
- St John of God Hospital, Subiaco, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alan R Smyth
- Evidence Based Child Health Group, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Thomas L Snelling
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Australia
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Muollo V, Rossi AP, Milanese C, Zamboni M, Rosa R, Schena F, Pellegrini B. Prolonged unsupervised Nordic walking and walking exercise following six months of supervision in adults with overweight and obesity: A randomised clinical trial. Nutr Metab Cardiovasc Dis 2021; 31:1247-1256. [PMID: 33549445 DOI: 10.1016/j.numecd.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS This study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults. METHODS AND RESULTS After a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HRmean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HRmean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05). CONCLUSION Despite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03212391 (July 11, 2017).
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Affiliation(s)
- Valentina Muollo
- Department of Medicine, Clinical and Experimental Biomedical Sciences, University of Verona, Verona, Italy.
| | - Andrea P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Raffaela Rosa
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy; CeRiSM, Sport, Mountain and Health Research Center, University of Verona, Rovereto, Italy
| | - Barbara Pellegrini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy; CeRiSM, Sport, Mountain and Health Research Center, University of Verona, Rovereto, Italy
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Edwards TC, Emerson J, Genatossio A, McNamara S, Goss C, Patrick DL, Onchiri F, Rosenfeld M. Initial development and pilot testing of observer-reported outcomes (ObsROs) for children with cystic fibrosis ages 0-11years. J Cyst Fibros 2018; 17:680-686. [PMID: 29358075 DOI: 10.1016/j.jcf.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Patient-reported outcomes are important clinical trial endpoints. Young children may not be able to reliably report on how they feel or function, so observer-reported outcomes (ObsROs) may be more appropriate for them. The purpose of this study was to develop and pilot field test electronic parent-reported observational instruments for children with cystic fibrosis (CF) 0-6 and 7-11years of age. METHODS We performed concept elicitation interviews with parents of children with CF ≤11years of age to elicit the respiratory signs they could observe at baseline and during an acute respiratory illness. The resulting instruments were refined based on interviews with parents and clinicians. We conducted a pilot field test to evaluate test-retest reliability and the ability of items to distinguish well and sick periods. RESULTS The instruments consist of 17 items assessing respiratory signs and observable CF-related impacts. Test-retest reliability was acceptable for both age groups but discrimination was low for ages 7-11, likely reflecting less direct observation of older children by their parents. CONCLUSIONS An ObsRO for children with CF ages 0-6 appears promising, while self-report may be more appropriate for children >6years of age. Next steps for the 0-6year old instrument will be utilizing it as an exploratory endpoint in clinical trials to enable item reduction, scale development, and further reliability and validity testing. Ultimately, this ObsRO could be a promising endpoint for early intervention trials in young children with CF.
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Affiliation(s)
- T C Edwards
- Department of Health Services, University of Washington, 1208 NE 43rd St. - Campus Box 359455, Seattle, WA 98195-9455, United States.
| | - J Emerson
- Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
| | - A Genatossio
- Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
| | - S McNamara
- Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
| | - C Goss
- Department of Medicine and Pediatrics, University of Washington, Division of Pulmonary and Critical Care Medicine, United States.
| | - D L Patrick
- Department of Health Services, University of Washington, 1208 NE 43rd St. - Campus Box 359455, Seattle, WA 98195-9455, United States.
| | - F Onchiri
- Center for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA, United States; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States.
| | - M Rosenfeld
- Department of Pediatrics, University of Washington, Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
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Wide Disagreement Between Alternative Assessments of Premorbid Physical Activity: Subjective Patient and Surrogate Reports and Objective Smartphone Data. Crit Care Med 2017; 45:e1036-e1042. [PMID: 28915184 DOI: 10.1097/ccm.0000000000002599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Surrogate-decision maker and patient self-reported estimates of the distances walked prior to acute illness are subjective and may be imprecise. It may be possible to extract objective data from a patient's smartphone, specifically, step and global position system data, to quantify physical activity. The objectives were to 1) assess the agreement between surrogate-decision maker and patient self-reported estimates of distance and time walked prior to resting and daily step-count and 2) determine the feasibility of extracting premorbid physical activity (step and global position system) data from critically ill patients. DESIGN Prospective cohort study. SETTING Quaternary ICU. PATIENTS Fifty consecutively admitted adult patients who owned a smartphone, who were ambulatory at baseline, and who remained in ICU for more than 48 hours participated. MEASURMENTS AND MAIN RESULTS There was no agreement between patients and surrogates for all premorbid walking metrics (mean bias 108% [99% lower to 8,700% higher], 83% [97% to 2,100%], and 71% [96% to 1,080%], for distance, time, and steps, respectively). Step and/or global position system data were successfully extracted from 24 of 50 phones (48%; 95% CI, 35-62%). Surrogate-decision makers, but not patient self-reported, estimates of steps taken per day correlated with smartphone data (surrogates: n = 13, ρ = 0.56, p < 0.05; patients: n = 13, ρ = 0.30, p = 0.317). CONCLUSION There was a lack of agreement between surrogate-decision maker and patient self-reported subjective estimates of distance walked. Obtaining premorbid physical activity data from the current-generation smartphones was feasible in approximately 50% of patients.
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VanDevanter DR, Heltshe SL, Spahr J, Beckett VV, Daines CL, Dasenbrook EC, Gibson RL, Raksha J, Sanders DB, Goss CH, Flume PA. Rationalizing endpoints for prospective studies of pulmonary exacerbation treatment response in cystic fibrosis. J Cyst Fibros 2017; 16:607-615. [PMID: 28438499 DOI: 10.1016/j.jcf.2017.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/08/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the variability in pulmonary exacerbation (PEx) management within and between Cystic Fibrosis (CF) Care Centers, it is possible that some approaches may be superior to others. A challenge with comparing different PEx management approaches is lack of a community consensus with respect to treatment-response metrics. In this analysis, we assess the feasibility of using different response metrics in prospective randomized studies comparing PEx treatment protocols. METHODS Response parameters were compiled from the recent STOP (Standardized Treatment of PEx) feasibility study. Pulmonary function responses (recovery of best prior 6-month and 12-month FEV1% predicted and absolute and relative FEV1% predicted improvement from treatment initiation) and sign and symptom recovery from treatment initiation (measured by the Chronic Respiratory Infection Symptom Score [CRISS]) were studied as categorical and continuous variables. The proportion of patients retreated within 30days after the end of initial treatment was studied as a categorical variable. Sample sizes required to adequately power prospective 1:1 randomized superiority and non-inferiority studies employing candidate endpoints were explored. RESULTS The most sensitive endpoint was mean change in CRISS from treatment initiation, followed by mean absolute FEV1% predicted change from initiation, with the two responses only modestly correlated (R2=.157; P<0.0001). Recovery of previous best FEV1 was a problematic endpoint due to missing data and a substantial proportion of patients beginning PEx treatment with FEV1 exceeding their previous best measures (12.1% >12-month best, 19.6% >6-month best). Although mean outcome measures deteriorated approximately 2-weeks post-treatment follow-up, the effect was non-uniform: 62.7% of patients experienced an FEV1 worsening versus 49.0% who experienced a CRISS worsening. CONCLUSIONS Results from randomized prospective superiority and non-inferiority studies employing mean CRISS and FEV1 change from treatment initiation should prove compelling to the community. They will need to be large, but appear feasible.
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Affiliation(s)
- D R VanDevanter
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
| | - S L Heltshe
- University of Washington, Seattle, WA 98121, USA; CFF Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA 98105, USA
| | - J Spahr
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA
| | - V V Beckett
- CFF Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA 98105, USA
| | - C L Daines
- University of Arizona, Tucson, AZ 85724, USA
| | - E C Dasenbrook
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - R L Gibson
- CFF Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA 98105, USA
| | - Jain Raksha
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - D B Sanders
- University of Wisconsin, Madison, WI 53792, USA
| | - C H Goss
- University of Washington, Seattle, WA 98121, USA; CFF Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA 98105, USA
| | - P A Flume
- Medical University of South Carolina, Charleston, SC 29425, USA
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Bradley J, O'Neill B, Kent L, Hulzebos EH, Arets B, Hebestreit H, Alison J, Arets B, Boas S, Bradley J, Button B, Bye P, Cerny F, Cooper D, Downs A, Dwyer T, Forster E, Gallagher C, Gruber W, Hebestreit A, Hebestreit H, Huber M, Hulzebos E, Johnstone Z, Lands L, Lannefors L, Lessine F, Lindblad A, Lowman J, Mandrusiak A, Martensson M, McIlwaine M, Möller A, Molloy M, Montgomery G, Morrison L, Murray J, Nippins M, Orenstein D, Prasaad A, Renner S, Salhberg M, Schneiderman J, Swisher A, Urquhart D, Zeitoun M. Physical activity assessment in cystic fibrosis: A position statement. J Cyst Fibros 2015. [DOI: 10.1016/j.jcf.2015.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Higher mobility scores in patients with cystic fibrosis are associated with better lung function. Pulm Med 2015; 2015:423219. [PMID: 25789173 PMCID: PMC4348578 DOI: 10.1155/2015/423219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether mobility and physical activity were associated with lung function in adults with cystic fibrosis (CF). DESIGN This was a prospective cohort observational study in an urban, academic, specialized care center. Participants were ambulatory, nonhospitalized adults with CF. MAIN OUTCOME MEASURES Mobility was assessed monthly by the Life-Space Assessment (LSA) questionnaire and quarterly by pedometer. Lung function was assessed by spirometry. RESULTS Twenty-seven subjects participated. Subjects recorded mean pedometer steps of 20,213 ± 11,331 over three days and FEV1% predicted of 77.48% ± 22.60% over one year. The LSA score at enrollment was correlated with initial pedometer steps (r = 0.42 and P = 0.03), and mean LSA score over one year was correlated with mean number of steps (r = 0.51 and P = 0.007). LSA mobility and pedometer scores were correlated with FEV1% predicted at enrollment and throughout the study. CONCLUSIONS Mobility and physical activity measured by LSA questionnaire and pedometer are positively associated with lung function in adults with CF. This study confirms the importance of mobility and physical activity and supports the utility of a simple office-based questionnaire as a measure of mobility in adults with CF.
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Affiliation(s)
- Steven D Nathan
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA.
| | - A Whitney Brown
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA
| | - Nargues A Weir
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA
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Hulzebos E, Dadema T, Takken T. Measurement of physical activity in patients with cystic fibrosis: a systematic review. Expert Rev Respir Med 2014; 7:647-53. [DOI: 10.1586/17476348.2013.839248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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