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Diab Cáceres L, Zamarrón de Lucas E. [Cystic fibrosis: Epidemiology, clinical manifestations, diagnosis and treatment]. Med Clin (Barc) 2023; 161:389-396. [PMID: 37558605 DOI: 10.1016/j.medcli.2023.06.006] [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: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
Cystic fibrosis is a genetic and multisystemic disease. The main comorbidity in adulthood is respiratory involvement, with the presence of bronchiectasis, chronic bronchial infection and airflow obstruction. Until a decade ago, treatments were aimed at favoring secretion drainage, reducing respiratory exacerbations, controlling chronic bronchial infection and slowing functional deterioration, but with the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the cystic fibrosis paradigm has changed. This novel treatment goes a step further in the management of this disease, it is able to improve the production of defective CFTR protein and increase its expression on the cell surface, thus achieving a better functioning of ion exchange, fluidizing respiratory secretions and reducing airflow obstruction. In addition, there are currently different lines of research aimed at correcting the genetic defect that causes cystic fibrosis.
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Affiliation(s)
- Layla Diab Cáceres
- Unidad de Fibrosis Quística, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Ester Zamarrón de Lucas
- Unidad de Fibrosis Quística, Servicio de de Neumología, Hospital Universitario La Paz, Madrid
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2
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Razi O, Teixeira AM, Tartibian B, Zamani N, Knechtle B. Respiratory issues in patients with multiple sclerosis as a risk factor during SARS-CoV-2 infection: a potential role for exercise. Mol Cell Biochem 2023; 478:1533-1559. [PMID: 36411399 PMCID: PMC9684932 DOI: 10.1007/s11010-022-04610-1] [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: 01/27/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
Coronavirus disease-2019 (COVID-19) is associated with cytokine storm and is characterized by acute respiratory distress syndrome (ARDS) and pneumonia problems. The respiratory system is a place of inappropriate activation of the immune system in people with multiple sclerosis (MS), and this may cause damage to the lung and worsen both MS and infections.The concerns for patients with multiple sclerosis are because of an enhance risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MS patients pose challenges in this pandemic situation, because of the regulatory defect of autoreactivity of the immune system and neurological and respiratory tract symptoms. In this review, we first indicate respiratory issues associated with both diseases. Then, the main mechanisms inducing lung damages and also impairing the respiratory muscles in individuals with both diseases is discussed. At the end, the leading role of physical exercise on mitigating respiratory issues inducing mechanisms is meticulously evaluated.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Ana Maria Teixeira
- Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Bakhtyar Tartibian
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001 St. Gallen, Switzerland
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3
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Stanford G, Daniels T, Brown C, Ferguson K, Prasad A, Agent P, Gates A, Morrison L. Role of the Physical Therapist in Cystic Fibrosis Care. Phys Ther 2022; 103:pzac136. [PMID: 36193006 PMCID: PMC9619615 DOI: 10.1093/ptj/pzac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022]
Abstract
In looking back on 2020 and 2021, this Perspective reflects on the monumental impacts of the rollout of cystic fibrosis (CF) transmembrane conductance regulator highly effective modulator therapies and the COVID-19 pandemic on the management of CF. Advancements in the clinical management of people with CF have been both enormous and rapid, and physical therapists specializing in the care of people with CF have been at the forefront of driving this evolution in care. This year sees the 30th anniversary of the UK Association of Chartered Physiotherapists in Cystic Fibrosis and, as is inevitable in reaching such milestones, thoughts have turned to origins, role, impacts, and the future. With the changing demographics of the population of people with CF after the introduction of highly effective modulator therapies, potentially with fewer secondary complications, the future role of the physical therapist who specializes in CF is in question. This Perspective reflects on and highlights the role of physical therapy within CF and provides insights into how physical therapists and respiratory therapists can evolve their roles to ensure relevance for the future.
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Affiliation(s)
- Gemma Stanford
- Royal Brompton and Harefield Hospitals, Guys and St. Thomas’ NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Tracey Daniels
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - Catherine Brown
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- West Midlands Adult Cystic Fibrosis Centre, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Katie Ferguson
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Ammani Prasad
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Penny Agent
- Royal Brompton and Harefield Hospitals, Guys and St. Thomas’ NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alison Gates
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- Oxford Adult Cystic Fibrosis Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Lisa Morrison
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- West of Scotland Adult Cystic Fibrosis Service, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
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4
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Potter A, Singh B, Scutter E, Maher C. The feasibility of collecting the physiotherapy outcomes airway clearance, physical activity and fitness for the Australian Cystic Fibrosis Data Registry. BMC Pulm Med 2022; 22:342. [PMID: 36088311 PMCID: PMC9463726 DOI: 10.1186/s12890-022-02141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Physiotherapy-related data, such as airway clearance techniques (ACTS), physical activity and aerobic fitness are not consistently included in international cystic fibrosis (CF) data registries. This study aimed to pilot the collection of ACTS, physical activity and fitness in a hospital CF clinic, as a step towards informing future national implementation.
Methods
This study was undertaken in a CF clinic within a major tertiary hospital. Patients and families were invited to participate. Participants completed self-report questionnaires on ACT use and those aged ≥ 10 years completed a physical activity questionnaire (Core Indicators and Measures of Youth Health Survey) and aerobic fitness test (the A-STEP test). Participants also completed a survey to explore the tolerance and acceptability of the fitness test, and the perceived accuracy of the self-reported data collection.
Results
Forty patients agreed to participate in the study (mean age = 9.8, SD = 4.1 years old; 52.5% female). All patients and/or families that were approached agreed to participate and completion rate for the ACTs and physical activity surveys was 98% and 100% (respectively). Completion rate for the fitness test was 55%, due to time constraints. Most participants agreed (≥ 90%) they could accurately provide ACT and physical activity data, and the assessments were tolerable and acceptable.
Conclusions
Patients with CF and their families are able to and can acceptably provide physiotherapy-related data, and collecting self-report ACTs and physical activity data is highly feasibly during routine CF clinic visits. However, aerobic fitness testing using the A-STEP test may be less feasible in clinic environments, due to time constraints.
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5
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Potter A, Pancholi B, Smith L, Maher C. Should the physiotherapy outcomes airway clearance, physical activity and fitness be recorded on the Australian Cystic Fibrosis Data Registry? A consensus approach. BMC Pulm Med 2021; 21:298. [PMID: 34548053 PMCID: PMC8456641 DOI: 10.1186/s12890-021-01669-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physiotherapy is a cornerstone of cystic fibrosis (CF) management, yet the Australian CF Data Registry (ACFDR) currently does not record physiotherapy-related data. This study aimed to gather opinions from lead Australian CF physiotherapists regarding the importance and feasibility of collecting physiotherapy-related data on the ACFDR. METHODS A three-round online Delphi survey was conducted to gather expert stakeholder opinion and consensus agreement. Lead physiotherapists from all 23 Australian CF centres were invited to participate. Round one explored the potential benefits, barriers and importance of recording three physiotherapy-related domains on the ACFDR: airway clearance, physical activity and fitness. Subsequent rounds were developed based on the findings from the previous round and sought consensus (80% agreement) for the inclusion of physiotherapy-related data on the ACFDR and for the most appropriate methods of collecting such data. RESULTS The response rate was > 80% for all rounds. Participants agreed that collection of airway clearance, physical activity and fitness data on the ACFDR was important and feasible. Findings suggested that airway clearance and physical activity should be collected using self-reported questionnaires, while fitness should be measured using a field-based test. CONCLUSIONS Australian lead CF physiotherapists believe that collection of airway clearance, physical activity and fitness on the ACFDR is important and feasible. Future work is needed to pilot the data collection procedure to examine its feasibility in real-world clinical settings. This study demonstrates how Delphi methodology can provide a contemporary summary of expert clinicians' opinion that may underpin nation-wide health service improvement.
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Affiliation(s)
- Angela Potter
- Physiotherapy Department, Women's and Children's Hospital, SA Health, 72 King William Rd, North Adelaide, SA, 5006, Australia
| | - Bhavita Pancholi
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Lahni Smith
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Carol Maher
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia. .,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
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6
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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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7
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Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review. Antibiotics (Basel) 2021; 10:antibiotics10050486. [PMID: 33922413 PMCID: PMC8144952 DOI: 10.3390/antibiotics10050486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/08/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease that causes absence or dysfunction of a protein named transmembrane conductance regulatory protein (CFTR) that works as an anion channel. As a result, the secretions of the organs where CFTR is expressed are very viscous, so their functionality is altered. The main cause of morbidity is due to the involvement of the respiratory system as a result of recurrent respiratory infections by different pathogens. In recent decades, survival has been increasing, rising by around age 50. This is due to the monitoring of patients in multidisciplinary units, early diagnosis with neonatal screening, and advances in treatments. In this chapter, we will approach the different therapies used in CF for the treatment of symptoms, obstruction, inflammation, and infection. Moreover, we will discuss specific and personalized treatments to correct the defective gene and repair the altered protein CFTR. The obstacle for personalized CF treatment is to predict the drug response of patients due to genetic complexity and heterogeneity of uncommon mutations.
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology, goal setting and text message feedback. HRB Open Res 2020; 3:21. [PMID: 33283151 PMCID: PMC7689601 DOI: 10.12688/hrbopenres.13025.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov
NCT03672058 (14/09/2018)
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Affiliation(s)
- Maire Curran
- School of Allied Health, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Audrey C Tierney
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Ireland.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | | | | | | | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brenda Button
- Departments of Respiratory Medicine and Physiotherapy, The Alfred, Melbourne, Australia.,Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Ireland
| | | | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Savi D, Graziano L, Giordani B, Schiavetto S, Vito CD, Migliara G, Simmonds NJ, Palange P, Elborn JS. New strategies of physical activity assessment in cystic fibrosis: a pilot study. BMC Pulm Med 2020; 20:285. [PMID: 33126875 PMCID: PMC7599110 DOI: 10.1186/s12890-020-01313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Regular physical activity (PA) is a valued part of cystic fibrosis (CF) care. Although the accelerometer, SenseWear Armband (SWA), accurately measures habitual PA in CF, it is mostly used for research purposes. For the first time, we analyzed different methods of measuring PA in daily life by the use of smartphones and other electronic devices such as smartwatch and Fitbit. Methods Twenty-four stable adults with CF (mean age 37.5 ± 11.5SD yrs.; FEV1 58 ± 19% predicted, BMI 22.9 ± 3.2) were studied. Daily PA was monitored for seven consecutive days. All patients wore the accelerometer SWA and at the same time they monitored PA with the electronic device they used routinely. They were allocated into one of four arms according to their device: Smartwatch, Fitbit, Android smartphones and iOS smartphones. PA related measurements included: duration of PA, energy expenditure, number of steps. Results There was a good agreement between SWA and Fitbit for number of steps (p = 0.605) and energy expenditure (p = 0.143). iOS smartphones were similar to SWA in monitoring the number of steps (p = 0.911). Significant differences were found between SWA and both Smartwatch and Android smartphones. Conclusions Fitbit and iOS smartphones seem to be a valuable approach to monitor daily PA. They provide a good performance to measure step number compared to SWA. Supplementary information Supplementary information accompanies this paper at 10.1186/s12890-020-01313-5.
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Affiliation(s)
- Daniela Savi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185, Rome, Italy. .,Adult Cystic Fibrosis Centre, Royal Brompton Hospital and Imperial College, London, SW3 6NP, UK.
| | - Luigi Graziano
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185, Rome, Italy
| | | | - Stefano Schiavetto
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Nicholas J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital and Imperial College, London, SW3 6NP, UK
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185, Rome, Italy
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK
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10
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology. HRB Open Res 2020; 3:21. [DOI: 10.12688/hrbopenres.13025.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)
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Abstract
Cystic fibrosis (CF) is an autosomal recessive, inherited congenital disease caused by the mutation of the family autosomal CF gene, with cumulative exocrine secretion characterized by inflammation, tracheal remodeling, and mucus accumulation. With the development of modern medical technology, CF patients are living longer lives and receiving more and more treatments, including traditional drugs, physical therapy, and gene therapy. Exercise is widely used to prevent and treat metabolic diseases such as cardiovascular diseases, obesity, diabetes, and metabolic syndrome. Regular exercise is beneficial to aerobic capacity and lung health. Exercise therapy has been of great interest since people realized that CF can be affected by exercise. Exercise alone can be used as an ACT (airway clearance technique), which promotes the removal of mucosal cilia. Exercise therapy is more easily accepted by any society, which helps to normalize the lives of CF patients, rather than placing a psychological burden on them. In this chapter, we will review the latest research progress about exercise in CF.
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Affiliation(s)
- Shengguang Ding
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chongjun Zhong
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
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12
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Shei RJ, Mackintosh KA, Peabody Lever JE, McNarry MA, Krick S. Exercise Physiology Across the Lifespan in Cystic Fibrosis. Front Physiol 2019; 10:1382. [PMID: 31780953 PMCID: PMC6856653 DOI: 10.3389/fphys.2019.01382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/21/2019] [Indexed: 01/19/2023] Open
Abstract
Cystic fibrosis (CF), a severe life-limiting disease, is associated with multi-organ pathologies that contribute to a reduced exercise capacity. At present, the impact of, and interaction between, disease progression and other age-related physiological changes in CF on exercise capacity from child- to adult-hood is poorly understood. Indeed, the influences of disease progression and aging are inherently linked, leading to increasingly complex interactions. Thus, when interpreting age-related differences in exercise tolerance and devising exercise-based therapies for those with CF, it is critical to consider age-specific factors. Specifically, changes in lung function, chronic airway colonization by increasingly pathogenic and drug-resistant bacteria, the frequency and severity of pulmonary exacerbations, endocrine comorbidities, nutrition-related factors, and CFTR (cystic fibrosis transmembrane conductance regulator protein) modulator therapy, duration, and age of onset are important to consider. Accounting for how these factors ultimately influence the ability to exercise is central to understanding exercise impairments in individuals with CF, especially as the expected lifespan with CF continues to increase with advancements in therapies. Further studies are required that account for these factors and the changing landscape of CF in order to better understand how the evolution of CF disease impacts exercise (in)tolerance across the lifespan and thereby identify appropriate intervention targets and strategies.
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Affiliation(s)
- Ren-Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, United Kingdom
| | - Jacelyn E. Peabody Lever
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
- Medical Scientist Training Program, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, United Kingdom
| | - Stefanie Krick
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
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Vendrusculo FM, Heinzmann-Filho JP, Campos NE, Gheller MF, de Almeida IS, Donadio MVF. Prediction of peak oxygen uptake using the modified shuttle test in children and adolescents with cystic fibrosis. Pediatr Pulmonol 2019; 54:386-392. [PMID: 30614221 DOI: 10.1002/ppul.24237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/20/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Several tests may be used to assess exercise intolerance in cystic fibrosis (CF), including the gold standard cardiopulmonary exercise test (CPET) and the Modified Shuttle Test (MST). OBJECTIVE To evaluate the use of the MST as a predictor of peak oxygen uptake (VO2 peak) and to compare VO2 peak and maximal heart rate (HRmax) obtained in both tests. METHODS Cross-sectional study including individuals with CF aged between 6 and 20 years old. Participants who were unable to perform the tests and/or presented signs of pulmonary exacerbation were excluded. Demographic, anthropometric, clinical and spirometric values were collected. CPET and the MST were performed in two consecutive outpatient visits. HRmax, peripheral oxygen saturation, dyspnea, and VO2 peak measured and estimated were compared. RESULTS Twenty-four patients, mean age 15.7 ± 4.2 years and FEV1 (% predicted) 76.4 ± 23.8, were included. Mean values of HRmax (bpm) and HRmax in percent of predicted (HRmax%) were lower (P = 0.01) in the MST (171.6 ± 14.5 and 87.1 ± 7.5) compared to CPET (180.9 ± 10.0 and 91.9 ± 5.4). However, there was no significant differences between tests in the variation (delta) for HRmax and HRmax% (P = 0.17). A strong correlation (r = 0.79; P < 0.0001) was found between distance achieved (MST) and VO2 peak (CPET). The regression model to estimate VO2 peak resulted in the following equation: VO2 (mL · kg-1 · min-1 ) = 20.301 + 0.019 × MST distance (meters). There was no difference (P = 0.50) between VO2 peak measured (CPET) and estimated by the equation. CONCLUSION The MST may be an alternative method to evaluate exercise capacity and to predict VO2 peak in children and adolescents with CF.
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Affiliation(s)
- Fernanda M Vendrusculo
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - João P Heinzmann-Filho
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Natália E Campos
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Mailise F Gheller
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ingrid S de Almeida
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcio V F 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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Ward N, Stiller K, Holland AE. Exercise as a therapeutic intervention for people with cystic fibrosis. Expert Rev Respir Med 2019; 13:449-458. [PMID: 30902029 DOI: 10.1080/17476348.2019.1598861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The complex multisystem nature of cystic fibrosis (CF) commonly results in reduced exercise tolerance, which is independently associated with poor clinical outcomes. Exercise is routinely recommended as part of the therapeutic regimen in CF to improve both respiratory and non-respiratory impairments. Areas covered: This article summarises the most recent evidence regarding the use of exercise as a therapeutic intervention in CF and discusses some of the practical considerations for exercise prescription in this setting. Clinical trials in progress and future research priorities are outlined. Expert opinion: On the balance of available evidence, exercise is likely to assist in improving physical fitness and health-related quality of life (HRQOL) and may be associated with a slower rate of decline in respiratory function in CF. Limitations to current studies include small sample sizes, study durations insufficient to achieve a training effect and difficulty distinguishing the effects of exercise training from that of other interventions implemented as part of a package of care. Larger, multi-centred trials are required to clarify the role of exercise in CF in improving physical fitness, respiratory function, HRQOL, as a substitute for traditional airway clearance techniques and in the management of common CF-related comorbidities.
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Affiliation(s)
- Nathan Ward
- a Physiotherapy , Royal Adelaide Hospital , Adelaide , SA , Australia.,b Physiotherapy , La Trobe University , Melbourne , Vic , Australia
| | - Kathy Stiller
- c Allied Health , Central Adelaide Local Health Network , Adelaide , SA , Australia
| | - Anne E Holland
- d La Trobe University and Alfred Health , Melbourne , Vic , Australia
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Ward N, Stiller K, Holland AE, Bishop J, Button B, Chambers R, Cobb R, Corda J, Dentice R, Green M, Hall K, Hauser J, Morrow S, Netluch R, Nichols A, Rowe H, Shaw A, Shortall D, Smith T, Wood J. Exercise is commonly used as a substitute for traditional airway clearance techniques by adults with cystic fibrosis in Australia: a survey. J Physiother 2019; 65:43-50. [PMID: 30559063 DOI: 10.1016/j.jphys.2018.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022] Open
Abstract
QUESTIONS What airway clearance techniques and exercise regimens are used by adults with cystic fibrosis (CF) in Australia when well or unwell? What proportion of these adults believe that exercise can be used as a substitute for traditional airway clearance techniques, and how have they come to this belief? What type of exercise is used as a substitute for traditional airway clearance techniques? DESIGN Cross-sectional survey at 13 CF centres in Australia, using a purpose-designed questionnaire. PARTICIPANTS Six hundred and ninety-two adults with CF completed the questionnaire. OUTCOME MEASURES The questionnaire included questions about: the participants' current use of traditional airway clearance techniques and exercise, when well and unwell; and beliefs regarding the use of exercise as a substitute for traditional airway clearance techniques. RESULTS Coughing, huffing and positive expiratory pressure were the most commonly used airway clearance techniques. Walking, jogging and lifting weights were the most commonly used forms of exercise. Overall, 43% of participants believed that exercise could be used as a substitute for traditional airway clearance techniques, with 44% having substituted exercise for traditional airway clearance techniques in the previous 3 months. Personal experience was the most commonly reported factor influencing participants' beliefs about the use of exercise as a substitute for traditional airway clearance techniques. CONCLUSION Exercise is commonly used as a substitute for traditional airway clearance techniques. Physiotherapists should advise patients that whilst there is some research suggesting a possible mechanism for exercise as a form of airway clearance, there are currently no medium-term to long-term data supporting exercise as a stand-alone form of airway clearance. These results suggest that future research to investigate the clinical effectiveness of exercise as a substitute for traditional airway clearance techniques should be a priority. REGISTRATION ACTRN12616000994482.
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Affiliation(s)
- Nathan Ward
- Cystic Fibrosis Service, Royal Adelaide Hospital, Adelaide, Australia; Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia.
| | - Kathy Stiller
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Anne E Holland
- Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia; Physiotherapy, Alfred Health, Melbourne, Australia
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Hebestreit H, Lands LC, Alarie N, Schaeff J, Karila C, Orenstein DM, Urquhart DS, Hulzebos EHJ, Stein L, Schindler C, Kriemler S, Radtke T. Effects of a partially supervised conditioning programme in cystic fibrosis: an international multi-centre randomised controlled trial (ACTIVATE-CF): study protocol. BMC Pulm Med 2018; 18:31. [PMID: 29422091 PMCID: PMC5806352 DOI: 10.1186/s12890-018-0596-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA) and exercise have become an accepted and valued component of cystic fibrosis (CF) care. Regular PA and exercise can positively impact pulmonary function, improve physical fitness, and enhance health-related quality of life (HRQoL). However, motivating people to be more active is challenging. Supervised exercise programs are expensive and labour intensive, and adherence falls off significantly once supervision ends. Unsupervised or partially supervised programs are less costly and more flexible, but compliance can be more problematic. The primary objective of this study is to evaluate the effects of a partially supervised exercise intervention along with regular motivation on forced expiratory volume in 1 s (FEV1) at 6 months in a large international group of CF patients. Secondary endpoints include patient reported HRQoL, as well as levels of anxiety and depression, and control of blood sugar. METHODS/DESIGN It is planned that a total of 292 patients with CF 12 years and older with a FEV1 ≥ 35% predicted shall be randomised. Following baseline assessments (2 visits) patients are randomised into an intervention and a control group. Thereafter, they will be seen every 3 months for assessments in their centre for one year (4 follow-up visits). Along with individual counselling to increase vigorous PA by at least 3 h per week on each clinic visit, the intervention group documents daily PA and inactivity time and receives a step counter to record their progress within a web-based diary. They also receive monthly phone calls from the study staff during the first 6 months of the study. After 6 months, they continue with the step counter and web-based programme for a further 6 months. The control group receives standard care and keeps their PA level constant during the study period. Thereafter, they receive the intervention as well. DISCUSSION This is the first large, international multi-centre study to investigate the effects of a PA intervention in CF with motivational feedback on several health outcomes using modern technology. Should this relatively simple programme prove successful, it will be made available on a wider scale internationally. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01744561 ; Registration date: December 6, 2012.
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Affiliation(s)
- Helge Hebestreit
- Paediatric Department, Julius-Maximilians University, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| | - Larry C Lands
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Alarie
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Schaeff
- Paediatric Department, Julius-Maximilians University, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Chantal Karila
- Service de Pneumologie et Allergologie pédiatriques, Centre de Ressources et Compétences dans la Mucoviscidose, Hôpital Necker Enfants Malades, Université Paris V - Descartes, Paris, France
| | - David M Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - Erik H J Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lothar Stein
- Hannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Athanazio RA, Silva Filho LVRFD, Vergara AA, Ribeiro AF, Riedi CA, Procianoy EDFA, Adde FV, Reis FJC, Ribeiro JD, Torres LA, Fuccio MBD, Epifanio M, Firmida MDC, Damaceno N, Ludwig-Neto N, Maróstica PJC, Rached SZ, Melo SFDO. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis. ACTA ACUST UNITED AC 2017; 43:219-245. [PMID: 28746534 PMCID: PMC5687954 DOI: 10.1590/s1806-37562017000000065] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Alberto Andrade Vergara
- . Hospital Infantil João Paulo II, Rede Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | | | | | | | - Fabíola Villac Adde
- . Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Francisco José Caldeira Reis
- . Hospital Infantil João Paulo II, Rede Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | - José Dirceu Ribeiro
- . Hospital de Clínicas, Universidade Estadual de Campinas, Campinas (SP) Brasil
| | - Lídia Alice Torres
- . Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Marcelo Bicalho de Fuccio
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | - Matias Epifanio
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Neiva Damaceno
- . Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo (SP) Brasil
| | - Norberto Ludwig-Neto
- . Hospital Infantil Joana de Gusmão, Florianópolis (SC) Brasil.,. Serviço de Fibrose Cística e Triagem Neonatal para Fibrose Cística, Secretaria Estadual de Saúde de Santa Catarina, Florianópolis (SC) Brasil
| | - Paulo José Cauduro Maróstica
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil.,. Universidade Federal do Rio Grande do Sul Porto Alegre (RS) Brasil
| | - Samia Zahi Rached
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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18
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Currie S, Greenwood K, Weber L, Khakee H, Legasto M, Tullis E, Wu K, Tsang A, Szego E, Mathur S. Physical Activity Levels in Individuals with Cystic Fibrosis-Related Diabetes. Physiother Can 2017; 69:171-177. [PMID: 28539697 PMCID: PMC5435394 DOI: 10.3138/ptc.2015-92ep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The literature on physical activity (PA) in adults with cystic fibrosis, particularly in those with cystic fibrosis-related diabetes (CFRD), is limited. PA may be an important part of blood glucose management in CFRD. The purpose of this study was to describe PA levels in adults with CFRD and determine their adherence to the Canadian Diabetes Association (CDA) aerobic exercise training guidelines. Methods: Adults with CFRD were recruited from a hospital-based CF clinic. PA was measured using the Seven-Day Physical Activity Recall (telephone interview), adherence to CFRD management with the Self-Care Inventory-Revised (questionnaire), and blood glucose control from glycated hemoglobin levels documented in participants' medical chart within 3 months. Results: Eighteen adults (mean age 41 [SD 9] y) with diagnosed CFRD participated in the study. They varied in volume of PA (range 13,080-17,362 metabolic equivalent min/wk). Of the study participants, 12 (67%) met the CDA guidelines of 150 minutes of moderate to vigorous PA per week with no more than 2 consecutive days without exercise. No differences were found in clinical factors between those who met the aerobic exercise guidelines and those who did not. Conclusion: The majority of individuals with CFRD are meeting the recommended amount of aerobic PA. The factors influencing PA and blood glucose control in adults with CFRD require further investigation.
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Affiliation(s)
- Sarah Currie
- Department of Physical Therapy, University of Toronto
| | | | - Lara Weber
- Department of Physical Therapy, University of Toronto
| | | | | | - Elizabeth Tullis
- Department of Medicine, St. Michael's Hospital and University of Toronto
| | - Kenneth Wu
- Department of Physical Therapy, University of Toronto
- St. Michael's Hospital, Toronto
| | | | - Erika Szego
- Department of Physical Therapy, University of Toronto
- St. Michael's Hospital, Toronto
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto
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19
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Eckman MH, Kopras EJ, Montag-Leifling K, Kirby LP, Burns L, Indihar VM, Joseph PM. Shared Decision-Making Tool for Self-Management of Home Therapies for Patients With Cystic Fibrosis. MDM Policy Pract 2017; 2:2381468317715621. [PMID: 30288426 PMCID: PMC6136161 DOI: 10.1177/2381468317715621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/15/2017] [Indexed: 12/11/2022] Open
Abstract
Objective: Patients with cystic fibrosis (CF) undertake time-consuming programs of home therapies. Our objective was to develop a tool to help CF patients prioritize personal goals for some of these treatments. We describe the development and results of initial evaluation of this shared decision-making tool. Methods: Multicriteria decision-making method to develop a shared decision-making tool that integrates patient's values and perceptions of treatment impact on functionality/sense of well-being. Treatment efficacy data obtained through comprehensive review of English language literature and Cochrane reviews. Field study of 21 patients was performed to assess acceptability of the approach, understandability of the tool, and to determine whether there was sufficient patient-to-patient variability in treatment goals and patient preferences to make use of a personalized tool worthwhile. Results: Patients found the tool easy to understand and felt engaged as active participants in their care. The tool was responsive to variations in patient preferences. Priority scores were calculated (0-1.0 ± SD). Patients' most important treatment goals for improving lung health included improving breathing function (0.27 ± 0.11), improving functionality/sense of well-being (0.24 ± 0.13), preventing lung infection (0.21 ± 0.08), minimizing time to complete treatments (0.16 ± 0.12), and minimizing cost (0.11 ± 0.09). Conclusions: A shared decision-making tool that integrates patients' values and best evidence is feasible and could result in improved patient engagement in their own care.
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Affiliation(s)
- Mark H. Eckman
- Mark H. Eckman, MD, MS University of
Cincinnati Medical Center, PO Box 670535, Cincinnati, OH 45267-0535, USA;
telephone: (513) 558-7581; e-mail:
| | - Elizabeth J. Kopras
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Karen Montag-Leifling
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Lari P. Kirby
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Lisa Burns
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Veronica M. Indihar
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Patricia M. Joseph
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
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20
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Backström-Eriksson L, Bergsten-Brucefors A, Hjelte L, Melin B, Sorjonen K. Associations between genetics, medical status, physical exercise and psychological well-being in adults with cystic fibrosis. BMJ Open Respir Res 2016; 3:e000141. [PMID: 27933179 PMCID: PMC5133424 DOI: 10.1136/bmjresp-2016-000141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 01/25/2023] Open
Abstract
Background Cystic fibrosis (CF) is the most common autosomal recessive, life-shortening disease among people of European origin. Type of genetic mutation and regular physical exercise has an impact on clinical outcome. This cross-sectional study explores the associations between genetics, medical status, physical exercise and psychological well-being in adult patients with CF. Methods Adult patients with CF (N=68; mean age: 32.2; range 18–67 years; 46% women) completed the Cystic Fibrosis Questionnaire-Revised and Hospital Anxiety Depression Scale. Measures about lung function/forced expiratory volume in 1 s per cent predicted, body mass index, physical working capacity, immunoglobulin G, CF Transmembrane Conductance Regulator (CFTR) mutations, and physical exercise were obtained. structural equation modelling was used to fit models to data. Results A cftr gene mutation×age interaction effect indicates a psychological disadvantage increasing with age of having more severe CFTR mutations; >65% of the effect is mediated by medical status. Physical exercise has a positive effect on psychological well-being, but >75% of the effect is mediated by medical status. Conclusions Psychological well-being decreases with age in patients with more severe cftr mutations, to a large extent due to a parallel deterioration of medical status. Physical exercise has a positive effect on psychological well-being if resulting in better health only. To manage the complexity of these patients' needs, the CF-care should emphasise a holistic approach and offer individualised exercise/treatment programmes and psychological competence.
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Affiliation(s)
- Lena Backström-Eriksson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Solna, Sweden; Karolinska University Hospital, Stockholm CF-center, Stockholm, Sweden
| | | | - Lena Hjelte
- Karolinska University Hospital, Stockholm CF-center, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Bo Melin
- Department of Clinical Neuroscience, Division of Psychology , Karolinska Institutet , Solna , Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience, Division of Psychology , Karolinska Institutet , Solna , Sweden
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Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2016; 25 Suppl 3:1-72. [PMID: 26606383 DOI: 10.1111/sms.12581] [Citation(s) in RCA: 1658] [Impact Index Per Article: 207.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism and The Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Saltin
- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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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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Savi D, Simmonds N, Di Paolo M, Quattrucci S, Palange P, Banya W, Hopkinson NS, Bilton D. Relationship between pulmonary exacerbations and daily physical activity in adults with cystic fibrosis. BMC Pulm Med 2015; 15:151. [PMID: 26627849 PMCID: PMC4667472 DOI: 10.1186/s12890-015-0151-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/24/2015] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to examine the relationship between pulmonary exacerbations and physical activity (PA) in adults with cystic fibrosis (CF). Methods We grouped adults with CF according to their exacerbation status in the year before study enrolment: (1) <1 exacerbation/year; (2) 1–2 exacerbations/year; and (3) >2 exacerbations/year. PA was assessed objectively by means of an accelerometer at the time of study enrolment. Results Patients with >2 exacerbations/year spent less time in PA; specifically, fewer activities of mild intensity [>3 metabolic equivalents (METs)], and lower active energy expenditure (P = 0.01 and P = 0.03, respectively). After correcting for relevant confounders, PA levels were not related to the exacerbation frequency in the preceding year. PA at moderate intensity (4.8–7.2 METs) or greater (>7.2 METs) was independently associated with gender and FEV1 % predicted (P = 0.007 and P = 0.04, respectively). Compared with men, women had reduced vigorous activities (P = 0.01) and active energy expenditure (P = 0.01). Conclusions Adult CF patients with more pulmonary exacerbations in the preceding year have more advanced disease and are less active than their peers. PA was independently associated with gender and airflow obstruction. Gender differences in PA are evident in CF adults.
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Affiliation(s)
- Daniela Savi
- Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Viale Regina Elena, 324-00185, Rome, Italy. .,Department of Cystic Fibrosis, Royal Brompton Hospital and Imperial College, London, SW3 6NP, UK.
| | - Nicholas Simmonds
- Department of Cystic Fibrosis, Royal Brompton Hospital and Imperial College, London, SW3 6NP, UK. .,NIHR Respiratory BRU, Royal Brompton Hospital NHS Foundation Trust, London, SW3 6NP, UK.
| | - Marcello Di Paolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy.
| | - Serena Quattrucci
- Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Viale Regina Elena, 324-00185, Rome, Italy.
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy. .,Eleonora Lorrillard-Spencer Cenci Foundation, 00185, Rome, Italy.
| | - Winston Banya
- NIHR Respiratory BRU, Royal Brompton Hospital NHS Foundation Trust, London, SW3 6NP, UK.
| | - Nicholas S Hopkinson
- NIHR Respiratory BRU, Royal Brompton Hospital NHS Foundation Trust, London, SW3 6NP, UK.
| | - Diana Bilton
- Department of Cystic Fibrosis, Royal Brompton Hospital and Imperial College, London, SW3 6NP, UK.
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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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Aznar S, Gallardo C, Fiuza-Luces C, Santana-Sosa E, López-Mojares LM, Santalla A, Rodríguez-Romo G, Pérez M, Garatachea N, Lucia A. Levels of moderate–vigorous physical activity are low in Spanish children with cystic fibrosis: A comparison with healthy controls. J Cyst Fibros 2014; 13:335-40. [DOI: 10.1016/j.jcf.2013.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
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Abstract
Exercise training is an underused intervention in paediatric healthcare. This is surprising, since initial evidence demonstrates its effectiveness and safety; furthermore it confers socioeconomic benefits for healthcare systems. Pilot studies have assessed and confirmed the feasibility of exercise training in many paediatric disease settings. However, more research is needed to understand the pathophysiology, quantify treatment effects and monitor outcomes. A concerted effort from researchers, health professionals and police makers will be necessary to make exercise training an evidence-based and cost-effective intervention in paediatric care.
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Affiliation(s)
- Guido E Pieles
- Congenital Heart Unit, Bristol Royal Hospital for Children/Bristol Heart Institute, Upper Maudlin St, , Bristol, UK
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Gruber W, Orenstein DM, Braumann KM, Beneke R. Interval exercise training in cystic fibrosis — Effects on exercise capacity in severely affected adults. J Cyst Fibros 2014; 13:86-91. [DOI: 10.1016/j.jcf.2013.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/05/2013] [Accepted: 06/08/2013] [Indexed: 11/28/2022]
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Parent and child perceptions of a self-regulated, home-based exercise program for children with cystic fibrosis. Nurs Res 2013; 62:305-14. [PMID: 23995464 DOI: 10.1097/nnr.0b013e3182a03503] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite recognized benefits, many children with cystic fibrosis (CF) do not consistently participate in physical activities. There is little empirical literature regarding the feelings and attitudes of children with CF toward exercise programs, parental roles in exercise, or factors influencing exercise experiences during research participation. OBJECTIVES The aim of this study is to describe the exercise experiences of children with CF and their parents during participation in a 6-month program of self-regulated, home-based exercise. METHODS This qualitative descriptive study was nested within a randomized controlled trial of a self-regulated, home-based exercise program and used serial semistructured interviews conducted individually at 2 and 6 months with 11 purposively selected children with CF and their parent(s). RESULTS Six boys and five girls, ages 10-16 years, and parents(nine mothers, four fathers) participated in a total of 44 interviews. Five major thematic categories describing child and parent perceptions and experience of the bicycle exercise program were identified in the transcripts: (a) motivators, (b) barriers, (c) effort/work, (d) exercise routine, and (e) sustaining exercise. Research participation, parent-family participation, health benefits, and the child's personality traits were the primary motivators. Competing activities, priorities, and responsibilities were the major barriers in implementing the exercise program as prescribed. Motivation waned, and the novelty wore off for several (approximately half) parent-child dyads, who planned to decrease or stop the exercise program after the study ended. DISCUSSION We identified motivators and barriers to a self-regulated, home-based exercise program for children with CF that can be addressed in planning future exercise interventions to maximize the health benefits for children with CF and the feasibility and acceptability to the children and their families.
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Santana-Sosa E, Gonzalez-Saiz L, Groeneveld IF, Villa-Asensi JR, Barrio Gómez de Aguero MI, Fleck SJ, López-Mojares LM, Pérez M, Lucia A. Benefits of combining inspiratory muscle with 'whole muscle' training in children with cystic fibrosis: a randomised controlled trial. Br J Sports Med 2013; 48:1513-7. [PMID: 23681502 DOI: 10.1136/bjsports-2012-091892] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The purpose of this study (randomised controlled trial) was to assess the effects of an 8-week combined 'whole muscle' (resistance+aerobic) and inspiratory muscle training (IMT) on lung volume, inspiratory muscle strength (PImax) and cardiorespiratory fitness (VO2 peak) (primary outcomes), and dynamic muscle strength, body composition and quality of life in paediatric outpatients with CF (cystic fibrosis, secondary outcomes). We also determined the effects of a detraining period. METHODS Participants were randomly allocated with a block on gender to a control (standard therapy) or intervention group (initial n=10 (6 boys) in each group; age 10±1 and 11±1 years). The latter group performed a combined programme (IMT (2 sessions/day) and aerobic+strength exercises (3 days/week, in-hospital)) that was followed by a 4-week detraining period. All participants were evaluated at baseline, post-training and detraining. RESULTS Adherence to the training programme averaged 97.5%±1.7%. There was a significant interaction (group×time) effect for PImax, VO2peak and five-repetition maximum strength (leg-press, bench-press, seated-row) (all (p<0.001), and also for %fat (p<0.023) and %fat-free mass (p=0.001), with training exerting a significant beneficial effect only in the intervention group, which was maintained after detraining for PImax and leg-press. CONCLUSION The relatively short-term (8-week) training programme used here induced significant benefits in important health phenotypes of paediatric patients with CF. IMT is an easily applicable intervention that could be included, together with supervised exercise training in the standard care of these patients.
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Affiliation(s)
- Elena Santana-Sosa
- School of Doctorate Studies and Research, Universidad Europea de Madrid, Spain
| | - Laura Gonzalez-Saiz
- School of Doctorate Studies and Research, Universidad Europea de Madrid, Spain
| | - Iris F Groeneveld
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Steven J Fleck
- Department of Health, Exercise Science and Sport Management, University of Wisconsin-Parkside, Kenosha, Wisconsin, USA
| | | | - Margarita Pérez
- School of Doctorate Studies and Research, Universidad Europea de Madrid, Spain
| | - Alejandro Lucia
- School of Doctorate Studies and Research, Universidad Europea de Madrid, Spain Instituto de Investigación i+12, Madrid, Spain
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Physical activity levels of patients with cystic fibrosis hospitalised with an acute respiratory exacerbation. Respir Med 2013; 107:1014-20. [PMID: 23601566 DOI: 10.1016/j.rmed.2013.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/27/2013] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The physical activity levels of adult patients with cystic fibrosis hospitalised for an acute respiratory exacerbation is unknown. METHODS A prospective observational study was undertaken. Physical activity levels were measured for a 24-h period using an activity monitor (SenseWear(®) Pro 3) during hospitalisation for an acute respiratory exacerbation and one month post-discharge. Measures of exercise tolerance and muscle strength were also recorded. RESULTS Twenty-four patients completed the study. Most outcomes significantly increased from hospitalisation to one month post-discharge. Time spent doing physical activity (≥3 METs) increased from a mean ± SD of 95 ± 58 to 209 ± 111 min. CONCLUSIONS Hospitalisation for an acute respiratory exacerbation was associated with less time spent performing physical activity compared to one month post-discharge. Physical activity levels were higher than anticipated, even during hospitalisation, suggesting an increased metabolic rate may have contributed to the physical activity levels documented. Activity level definitions for moderate intensity exercise that are based on higher MET levels seemed more appropriate in this patient setting. CLINICAL TRIAL REGISTRY Australian New Zealand Clinical Trials Registry Number: ACTRN12610000595011.
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Warren K, Thompson N, Wannemuehler M, Kohut M. Antibody and CD8+ T cell memory response to influenza A/PR/8/34 infection is reduced in treadmill-exercised mice, yet still protective. J Appl Physiol (1985) 2013; 114:1413-20. [PMID: 23493360 DOI: 10.1152/japplphysiol.01355.2012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Moderate exercise may decrease the severity of influenza infection and reduce lung viral load. The possibility that an exercise-associated reduction in lung viral load early in infection could contribute to decreased serum antibody and reduced memory response were investigated. BALB/c mice exercised for 8 wk and were then infected with influenza A/PR/8/34 (intranasal route). Influenza-specific serum antibody was assessed for 6 mo post primary infection, at which time mice were infected again with influenza A/PR/8/34. After primary infection, exercise reduced morbidity/mortality, attenuated lung cytokines, and decreased serum anti-influenza IgG and IgG2a from day 14 to day 180 post primary infection. After secondary infectious challenge, exercised mice did not show any signs of illness, but had reduced serum anti-influenza IgG and IgG2a, increased IgG1, and reduced influenza-specific recruited and resident CD8+ granzyme B+ T cells within the lungs. When influenza virus was administered by an intraperitoneal route during primary infection, exercise did not alter serum anti-influenza IgG, IgG1, or IgG2a, suggesting the exercise effect was specific to the lung environment. Exercise-induced enhancement of respiratory host defense to primary influenza infection results in decreased serum antibody and lung CD8+ T cell memory response, but does not compromise resistance to secondary infectious challenge.
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Affiliation(s)
- Kristi Warren
- Program of Immunobiology, Iowa State University, Ames, Iowa, USA
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van de Weert-van Leeuwen PB, Arets HGM, van der Ent CK, Beekman JM. Infection, inflammation and exercise in cystic fibrosis. Respir Res 2013; 14:32. [PMID: 23497303 PMCID: PMC3599254 DOI: 10.1186/1465-9921-14-32] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/17/2013] [Indexed: 01/13/2023] Open
Abstract
Regular exercise is positively associated with health. It has also been suggested to exert anti-inflammatory effects. In healthy subjects, a single exercise session results in immune cell activation, which is characterized by production of immune modulatory peptides (e.g. IL-6, IL-8), a leukocytosis and enhanced immune cell functions. Upon cessation of exercise, immune activation is followed by a tolerizing phase, characterized by a reduced responsiveness of immune cells. Regular exercise of moderate intensity and duration has been shown to exert anti-inflammatory effects and is associated with a reduced disease incidence and viral infection susceptibility. Specific exercise programs may therefore be used to modify the course of chronic inflammatory and infectious diseases such as cystic fibrosis (CF).Patients with CF suffer from severe and chronic pulmonary infections and inflammation, leading to obstructive and restrictive pulmonary disease, exercise intolerance and muscle cachexia. Inflammation is characterized by a hyper-inflammatory phenotype. Patients are encouraged to engage in exercise programs to maintain physical fitness, quality of life, pulmonary function and health.In this review, we present an overview of available literature describing the association between regular exercise, inflammation and infection susceptibility and discuss the implications of these observations for prevention and treatment of inflammation and infection susceptibility in patients with CF.
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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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Prévotat A, Denis F, Leroy S, Garet M, Wemeau-Stervinou L, Perez T, Halm AM, Wallaert B. [Daily physical activity in adult patients with cystic fibrosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:3-9. [PMID: 23333050 DOI: 10.1016/j.pneumo.2012.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 06/01/2023]
Abstract
Assessment of daily physical activity (DPA) is a major element in the development of respiratory rehabilitation. The aim of this study was to evaluate the DPA and the daily energy expenditure (DEE) in adult patients with cystic fibrosis. Thirty adult patients (16 women, 14 men, mean age 27.1±8.4 years) with cystic fibrosis (FVC: 69.2±19%, FEV1: 55.1±24%, BMI: 20.5±3.6kg/m(2)), in stable condition were included in the study. The questionnaire allowed DPA to estimate DEE from the intensity and type of activity. This tool divides the DEE into four intensity levels: less than 1 Metabolic Equivalent Task (MET), greater than 1 and less than 3 METs, 3-5 METs, and greater than 5 METs. A shuttle test for estimating VO(2) peak was performed in all patients. The DEE reached 9478.4±3224.3kJ24h(-1) and was significantly and highly correlated with calculated peak VO(2) (l/min) (r=0.876, P=<0.001); 22% DEE was less than 3 METs, 10% between 3 and 5 METs et 2,5% greater than 5 METs; 65% DEE was less than 1 MET. There was a strong correlation between DEE and BMI (r=0.860, P=<0.001), a low correlation with FVC (r=0.423, P=0.02). This questionnaire is relevant for estimating DPA and DEE in patients with cystic fibrosis and is an interesting test to be used to evaluate changes in patients after pulmonary rehabilitation.
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Affiliation(s)
- A Prévotat
- Centre de ressources et de compétences pour la mucoviscidose, université de Lille 2, clinique des maladies respiratoires, hôpital Calmette, 59037 Lille, France
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Vivodtzev I, Decorte N, Wuyam B, Gonnet N, Durieu I, Levy P, Cracowski JL, Cracowski C. Benefits of Neuromuscular Electrical Stimulation Prior to Endurance Training in Patients With Cystic Fibrosis and Severe Pulmonary Dysfunction. Chest 2013; 143:485-493. [DOI: 10.1378/chest.12-0584] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Rand S, Prasad SA. Exercise as part of a cystic fibrosis therapeutic routine. Expert Rev Respir Med 2012; 6:341-51; quiz 352. [PMID: 22788948 DOI: 10.1586/ers.12.19] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The role of exercise in cystic fibrosis (CF) is well established, and over the last three decades it has become an important component in the management of all individuals with CF. The role of exercise as a prognostic indicator or therapeutic tool is an important area of research interest in CF care internationally. This article summarizes the currently available evidence regarding exercise capacity in CF, the potential effects of exercise on health outcomes in CF and the challenges faced when trying to incorporate exercise into a CF therapeutic routine, and highlights some methods to facilitate the incorporation of exercise into CF therapeutic routines.
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Affiliation(s)
- Sarah Rand
- Cystic Fibrosis Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Dentice RL, Elkins MR, Bye PTP. Adults with cystic fibrosis prefer hypertonic saline before or during airway clearance techniques: a randomised crossover trial. J Physiother 2012; 58:33-40. [PMID: 22341380 DOI: 10.1016/s1836-9553(12)70070-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
QUESTION Among adults with cystic fibrosis, does the timing of hypertonic saline relative to airway clearance techniques affect lung function, perceived efficacy, tolerability, or satisfaction with the entire airway clearance regimen, and is the preferred timing regimen stable over time? DESIGN A randomised crossover trial with concealed allocation, intention-to-treat analysis, and blinded assessors. PARTICIPANTS 50 adults with cystic fibrosis and stable lung function at the end of a hospital admission. INTERVENTION Participants performed 3 sessions of airway clearance techniques per day for 3 days. On each day, participants were randomised to inhale hypertonic saline either before, during, or after the airway clearance techniques. Participants readmitted within one year repeated the 3-day study. OUTCOME MEASURES The primary outcome was the change in forced expiratory volume in one second (FEV(1)) from before to 2 hours after an entire airway clearance session. Secondary outcomes were change in forced vital capacity, perceived efficacy, tolerability, satisfaction, adverse events, and adherence. RESULTS All 50 participants completed the study. The effects on lung function were non-significant or were of borderline statistical significance favouring inhalation of hypertonic saline before airway clearance techniques. Satisfaction was rated significantly worse on a 100mm scale when hypertonic saline was inhaled after the airway clearance techniques: mean differences 20mm (95% CI 12 to 29) compared to before the airway clearance techniques and 15 mm (95% CI 6 to 24) compared to during the techniques. Perceived effectiveness showed similar effects but other outcomes were unaffected. All 14 participants who were readmitted repeated the study and most preferred the same timing regimen. Conclusion People with cystic fibrosis could be encouraged to time hypertonic saline before or during airway clearance techniques to maximise perceived efficacy and satisfaction, even though lung function may not be better with these timing regimens. TRIAL REGISTRATION ACTRN12611000673943.
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Affiliation(s)
- Ruth L Dentice
- Royal Prince Alfred Hospital, The University of Sydney, Australia.
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Fergus P, El Rhalibi A, Carter C, Cooper S. Towards an avatar mentor framework to support physical and psychosocial treatments. HEALTH AND TECHNOLOGY 2012. [DOI: 10.1007/s12553-011-0013-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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