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Aukštuolytė-Bačienė E, Daunoravičienė A, Tamulionytė V, Berškienė K, Narbutaitė J, Razon S, Slapšinskaitė-Dackevičienė A. Present but Ignored: Physical Condition and Health-Related Quality of Life in College-Aged Females with Generalized Joint Hypermobility. Healthcare (Basel) 2024; 12:1065. [PMID: 38891140 PMCID: PMC11171803 DOI: 10.3390/healthcare12111065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is prevalent among young adults, necessitating effective monitoring of musculoskeletal health, particularly among college-aged females. This study aimed to identify physical fitness and health-related quality of life (HR-QoL) characteristics associated with GJH. METHODS A total of 67 participants were assessed: 26 with GJH (mean age 20.06, SD 1.2 years), and 41 without (mean age 20.15, SD 2.2 years). Assessments included hypermobility, anthropometric data, foot posture, balance, flexibility, strength, and HR-QoL. We used the Mann-Whitney test for two independent samples, categorical variables were analyzed with Cramer's V test. The results indicated that participants with GJH exhibited inferior balance and back muscle static strength endurance but greater flexibility compared to those without GJH. Significant differences were observed in foot posture. However, handgrip strength, explosive strength, and abdominal muscle static strength endurance did not differ significantly between groups. No significant differences were observed in HR-QoL components between the two groups. In conclusion, there appears to be a link between GJH and increased flexibility, impaired balance, reduced back muscle static strength endurance, and altered posture of both feet.
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Affiliation(s)
- Ernesta Aukštuolytė-Bačienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Algė Daunoravičienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Vilma Tamulionytė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Kristina Berškienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Jurgita Narbutaitė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
| | - Selen Razon
- Department of Kinesiology, College of Health Sciences, West Chester University of Pennsylvania, West Chester, PA 19383, USA;
| | - Agnė Slapšinskaitė-Dackevičienė
- Department of Sports Medicine, Faculty of Nursing, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania; (E.A.-B.); (A.D.); (V.T.); (K.B.); (J.N.)
- Health Research Institute, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania
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Barboza M, Oliveira C, Mont'Alverne D, Morano M, Lima V, Velloso M. Cardiopulmonary responses during unsupported upper limb exercise tests and limitations in activities of daily living in individuals with chronic obstructive pulmonary disease. Physiother Theory Pract 2024; 40:695-703. [PMID: 36528786 DOI: 10.1080/09593985.2022.2157688] [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: 08/25/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cardiopulmonary responses during unsupported upper limb function assessment may vary in chronic obstructive pulmonary disease (COPD). OBJECTIVE To compare the cardiopulmonary responses during the function assessment with the Six-Minute Pegboard and Ring Test (6PBRT) and the incremental Unsupported Upper Limb Exercise (UULEX) test in COPD and to investigate the correlations with muscle strength and the limitations on activity of daily living (ADLs). METHODS This was a cross-sectional study. Cardiopulmonary variables were recorded during tests using a breath-by-breath analyzer. Muscle strength was assessed using a hand-held dynamometer. Self-reported ADL was evaluated using the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M). Paired t-test, Wilcoxon signed rank test, and Spearman correlation coefficients were used. RESULTS Fifteen individuals with moderate-to-severe COPD participated (66 ± 9 years old, forced expiratory volume in the first second [FEV1]: 48%±14% of predicted). The UULEX induced higher oxygen consumption (0.54 ± 0.20 vs. 0.44 ± 0.09 L/min, p = .01) and dyspnea (4.0 [2.6 to 6.9] vs. 0.5 [0.9 to 5.1], p < .01) than 6PBRT. The performance in both tests was correlated with self-reported ADL limitations on PFSDQ-M (6PBRT: r = -0.69, p < .01; UULEX: r = -0.62, p = .01). CONCLUSION The UULEX promoted greater cardiopulmonary responses than 6PBRT, and performance in 6PBRT and UULEX was correlated with ADL limitations in individuals with COPD.
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Affiliation(s)
- Michelli Barboza
- Physical Therapy Course, University of Fortaleza, Fortaleza, Brazil
- Postgraduate Research Program on Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristino Oliveira
- Postgraduate Research Program on Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Research Program on Rehabilitation Sciences and Physical Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de For a, Juiz de Fora, Brazil
| | - Daniela Mont'Alverne
- Masters Program in Physical Therapy and Functioning, Department of Physical Therapy, Federal University of Ceará, Fortaleza, Brazil
| | - Maria Morano
- Physical Therapy Course, University of Fortaleza, Fortaleza, Brazil
- Pulmonary Rehabilitation division, Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | - Vanessa Lima
- Postgraduate Research Program on Rehabilitation and Functional Performance, Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Marcelo Velloso
- Postgraduate Research Program on Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Li L, Li S. Pinch force sense test-retest reliability evaluation using contralateral force matching task. Sci Rep 2024; 14:1063. [PMID: 38212469 PMCID: PMC10784472 DOI: 10.1038/s41598-024-51644-0] [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: 01/09/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
A high test-retest reliability in measurement of pinch force sense is required to assess a clinical parameter accurately over a longitudinal study. Ipsilateral reproduction (IR) task and contralateral matching (CM) task have commonly been used for the assessment of force sense. To date, there has been little research on the test-retest reliability of pinch force sense utilizing the contralateral force matching task. This research aimed to explore this phenomenon across a spectrum of reference force levels (10, 30, and 50 percent maximum voluntary isometric contraction (MVIC)) using a contralateral matching task. Every participant in the study was tested twice by the same skilled experts, with each session separated by one week. Although normalized variable error indicated a poor level of reliability (intraclass correlation coefficient (ICC) = - 0.25 to 0.05) for these force sense tests, normalized constant error (ICC = 0.76-0.85) and normalized absolute error (ICC = 0.61-0.81) results indicated a fair to good of reliability. The lower bound of 95% CI of ICC for NAE and NCE indicated fair test-retest reliability (0.41-0.69). These findings suggest that investigators can reasonably obtain a fair to good test-retest reliability when investigating pinch force sense using the contralateral matching task. The Bland-Altman plots, SEM, and MDD95% were lower at these lower reference force level (10% MVIC) compared to the level of higher reference forces (30% and 50% MVIC). Therefore, when the reference force level increases, the participant needs a larger NAE or NCE decrease to show that their pinch force sense has indeed improved.
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Affiliation(s)
- Lin Li
- Department of Physical Education, Renmin University of China, No. 59 Zhongguancun Street, Beijing, 100872, China
| | - Shuwang Li
- Department of Physical Education, Renmin University of China, No. 59 Zhongguancun Street, Beijing, 100872, China.
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Cazorla S, Busegnies Y, D’Ans P, Héritier M, Poncin W. Breathing Control Exercises Delivered in a Group Setting for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11060877. [PMID: 36981534 PMCID: PMC10048700 DOI: 10.3390/healthcare11060877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Breathing control exercises are an important component of occupational therapy in patients with chronic obstructive pulmonary disease (COPD). Delivering these exercises in group settings may enhance their benefits. Therefore, this study assessed the effectiveness of breathing control exercises delivered in a group format to patients with severe COPD remitting from an acute pulmonary exacerbation. This randomized controlled trial of 6 weeks’ duration compared the addition of breathing exercise sessions delivered in a group setting to a standard exercise inpatient rehabilitation program (usual care) versus usual care alone. The standard exercise program consisted of endurance and strength training and therapeutic patient education. The intervention group received, in addition to usual care, 20 sessions of 30 min duration of breathing control exercises in a group setting. The primary outcome was quality of life (Saint George’s Respiratory Questionnaire). Secondary outcomes were the COPD assessment test, modified Borg scale, handgrip strength test, and five-time sit-to-stand test. Thirty-seven patients aged 69 ± 7 years were recruited. After the 6-week period, all outcomes significantly improved and exceeded the minimal clinically important difference in the intervention group only. Between-group changes were significant for each outcome. Conclusions: breathing control exercises in a group setting provide clinically relevant benefits in patients with severe COPD who are remitting from an acute pulmonary exacerbation.
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Affiliation(s)
- Sibylle Cazorla
- Haute École Libre de Bruxelles Ilya Prigogine (HELB), 1070 Brussels, Belgium
- Correspondence:
| | - Yves Busegnies
- Haute École Libre de Bruxelles Ilya Prigogine (HELB), 1070 Brussels, Belgium
| | - Pierre D’Ans
- Haute École Libre de Bruxelles Ilya Prigogine (HELB), 1070 Brussels, Belgium
| | | | - William Poncin
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, 1200 Brussels, Belgium
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Hegelund MH, Ritz C, Nielsen TL, Olsen MF, Søborg C, Braagaard L, Mølgaard C, Krogh-Madsen R, Lindegaard B, Faurholt-Jepsen D. Multidimensional individualized nutritional therapy for individuals with severe chronic obstructive pulmonary disease: study protocol for a registry-based randomized controlled trial. Trials 2023; 24:86. [PMID: 36747276 PMCID: PMC9900973 DOI: 10.1186/s13063-023-07099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Individuals with severe chronic obstructive pulmonary disease (COPD) are often at risk of undernutrition with low health-related quality of life (HRQoL). Undernutrition can worsen COPD and other comorbidities, be an independent predictor of morbidity and functional decline resulting in increased healthcare consumption and increased risk of death. Especially exacerbations and acute infections result in unintentional weight loss. The aim is to investigate the effect of an individualized nutritional intervention among individuals with severe COPD. METHODS An open-label randomized controlled trial with two parallel groups. Participants are recruited from the pulmonary outpatient clinic at the Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark, and randomly allocated to either the intervention (intervention + standard of care) or control group (standard of care). The intervention has a duration of 3 months and combines individual nutritional care with adherence support and practical tools. It contains 4 elements including an individual nutritional plan, regular contacts, adherence support, and weight diary. The primary outcome is a difference in HRQoL (EQ-5D-5L) between the intervention and control group 3 months after baseline. Difference in functional capacity (grip strength, 30-s stand chair test, and physical activity), disease-specific quality of life (COPD Assessment Test), anxiety and depression (Hospital Anxiety and Depression Scale), nutritional parameters (energy and protein intake), anthropometry (weight, body mass index, waist, hip, and upper arm circumference), body composition (total fat-free and fat mass and indices), and prognosis (exacerbations, oxygen therapy, hospital contacts, and mortality) 3 months after baseline will be included as secondary outcomes. Data will be collected through home visits at baseline and 1 and 3 months after baseline. DISCUSSION Currently, nutritional care is a neglected area of outpatient care among individuals with severe COPD. If this patient-centered approach can demonstrate a positive impact on HRQoL, mortality, and hospital contacts, it should be recommended as part of end-of-life care for individuals with severe COPD. TRIAL REGISTRATION ClinicalTrials.gov NCT04873856 . Registered on May 3, 2021.
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Affiliation(s)
- Maria H. Hegelund
- grid.4973.90000 0004 0646 7373Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Christian Ritz
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, Copenhagen, Denmark
| | - Thyge L. Nielsen
- grid.4973.90000 0004 0646 7373Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Mette F. Olsen
- grid.4973.90000 0004 0646 7373Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Rigshospitalet Denmark ,grid.5254.60000 0001 0674 042XDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Christian Søborg
- grid.4973.90000 0004 0646 7373Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Lone Braagaard
- grid.4973.90000 0004 0646 7373Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Christian Mølgaard
- grid.4973.90000 0004 0646 7373Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Rigshospitalet Denmark
| | - Rikke Krogh-Madsen
- grid.4973.90000 0004 0646 7373Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark ,grid.4973.90000 0004 0646 7373Center for Physical Activity Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte Lindegaard
- grid.4973.90000 0004 0646 7373Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Daniel Faurholt-Jepsen
- grid.5254.60000 0001 0674 042XDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
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Li YX, Li L, Chen X, Zhao Y, Zhao X, Zhang CL. Assessment of grip force sense test-retest reliability in healthy male participants. ERGONOMICS 2022; 65:1621-1630. [PMID: 35179447 DOI: 10.1080/00140139.2022.2044521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
There has been a lack of research to date regarding the test-retest reliability of grip force sense in healthy adult males. This study was therefore designed to explore this topic across a series of target force levels using an ipsilateral force reproduction task. The same experienced research staff conducted two testing sessions for each study participant, with 1 week between test sessions. Intraclass correlation coefficient values indicated that these force sensing tests exhibited good to fair reliability with respect to both absolute error (0.42-0.63) and constant error (0.49-0.60), although variable error was indicative of poor reliability (-0.85 to 0.14). Together, these results suggest that researchers can achieve a fair level of test-retest reliability when analysing grip force sense in healthy adult males, with results being most reliable at force levels of 20 N and 50 N, as determined based upon measured constant error and absolute error. Practitioner summary: To ensure that grip force sense can be accurately interpreted over time, it is important to assess the test-retest reliability. It is recommended that practitioners measure the absolute error and constant error at force levels of 20 N and 50 N when assessing grip force sense in a clinical setting.
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Affiliation(s)
- Yan-Xia Li
- College of Physical Education, Langfang Teachers University, Hebei, China
| | - Lin Li
- Department of Physical Education, Renmin University of China, Beijing, China
| | - Xing Chen
- College of Physical Education, Langfang Teachers University, Hebei, China
| | - Yang Zhao
- College of Physical Education, Langfang Teachers University, Hebei, China
| | - Xi Zhao
- College of Physical Education, Langfang Teachers University, Hebei, China
| | - Chong-Long Zhang
- College of Physical Education, Langfang Teachers University, Hebei, China
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Karagiannis C, Savva C, Korakakis V, Adamide T, Georgiou A, Matheou I, Prodromou A, Xanthos T. Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2021; 41:426-431. [PMID: 34117184 DOI: 10.1097/hcr.0000000000000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. METHODS Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. RESULTS Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. CONCLUSIONS In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus (Drs Karagiannis and Savva and Ms Matheou); Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar (Dr Korakakis); Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus (Dr Adamide); Private Doctor, Nicosia, Cyprus (Dr Georgiou); Physiotherapy Department, Nicosia General Hospital, and Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus (Ms Prodromou); and School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Xanthos)
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Rajabally YA, Afzal S, Ghasemi M. Minimal important differences and self‐identifying treatment response in chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2021; 64:37-42. [DOI: 10.1002/mus.27250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Yusuf A. Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology University Hospitals Birmingham Birmingham UK
- Aston Medical School Aston University Birmingham UK
| | - Saadia Afzal
- Inflammatory Neuropathy Clinic, Department of Neurology University Hospitals Birmingham Birmingham UK
| | - Majid Ghasemi
- Inflammatory Neuropathy Clinic, Department of Neurology University Hospitals Birmingham Birmingham UK
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van Bakel SIJ, Gosker HR, Langen RC, Schols AMWJ. Towards Personalized Management of Sarcopenia in COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:25-40. [PMID: 33442246 PMCID: PMC7800429 DOI: 10.2147/copd.s280540] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
The awareness of the presence and consequences of sarcopenia has significantly increased over the past decade. Sarcopenia is defined as gradual loss of muscle mass and strength and ultimately loss of physical performance associated with aging and chronic disease. The prevalence of sarcopenia is higher in chronic obstructive pulmonary disease (COPD) compared to age-matched controls. Current literature suggests that next to physical inactivity, COPD-specific alterations in physiological processes contribute to accelerated development of sarcopenia. Sarcopenia in COPD can be assessed according to current guidelines, but during physical performance testing, ventilatory limitation should be considered. Treatment of muscle impairment can halt or even reverse sarcopenia, despite respiratory impairment. Exercise training and protein supplementation are currently at the basis of sarcopenia treatment. Furthermore, effective current and new interventions targeting the pulmonary system (eg, smoking cessation, bronchodilators and lung volume reduction surgery) may also facilitate muscle maintenance. Better understanding of disease-specific pathophysiological mechanisms involved in the accelerated development of sarcopenia in COPD will provide new leads to refine nutritional, exercise and physical activity interventions and develop pharmacological co-interventions.
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Affiliation(s)
- Sophie I J van Bakel
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Ramon C Langen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
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