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Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS. Guidance and standard operating procedures for functional exercise testing in cystic fibrosis. Eur Respir Rev 2023; 32:230029. [PMID: 37558263 PMCID: PMC10410399 DOI: 10.1183/16000617.0029-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.
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Affiliation(s)
- Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mathieu Gruet
- Laboratory of the Impact of Physical Activity on Health (IAPS), University of Toulon, Toulon, France
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK
| | - Brenda Button
- Department of Physiotherapy, Melbourne School of Health Science, University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Marlies Wagner
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Abbey Sawyer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helge Hebestreit
- Paediatric Department, University Hospitals Würzburg, Würzburg, Germany
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Don S Urquhart
- Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Wu K, Michalski A, Sykes J, Batt J, Stephenson AL, Mathur S. Comparison of quadriceps muscle size and quality in adults with cystic fibrosis with different severities of cystic fibrosis transmembrane conductance regulator protein dysfunction. Chron Respir Dis 2022; 19:14799731221131330. [PMID: 36380568 PMCID: PMC9669672 DOI: 10.1177/14799731221131330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Cystic fibrosis (CF) is characterized by CF transmembrane conductance
regulator (CFTR) dysfunction. CFTR protein is expressed in human skeletal
muscle; however, its impact on skeletal muscle is unknown. The objectives of
this study were to compare quadriceps muscle size and quality between adults
with various severities of CFTR protein dysfunction. Methods We conducted a prospective, cross-sectional study comparing 34 adults with
severe versus 18 with mild CFTR protein dysfunction, recruited from a
specialized CF centre. Ultrasound images of rectus femoris cross-sectional
area (RF-CSA) and quadriceps layer thickness for muscle size, and rectus
femoris echogenicity (RF-ECHO) (muscle quality) were obtained. Multivariable
linear regression models were developed using purposeful selection
technique. Results People with severe CFTR protein dysfunction had larger RF-CSA by
3.22 cm2, 95% CI (1.03, 5.41) cm2,
p=.0049], after adjusting for oral corticosteroid use
and Pseudomonas aeruginosa colonization. However, a
sensitivity analysis indicated that the result was influenced by the
specific confounders being adjusted for in the model. We did not find any
significant differences in quadriceps layer thickness or RF-ECHO between the
two groups. Conclusion We found no differential impact of the extent of diminished CFTR protein
activity on quadriceps muscle size or quality in our study cohort. Based on
these findings, CFTR mutation status cannot be used differentiate leg muscle
size or quality in people with CF.
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Affiliation(s)
- Kenneth Wu
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Michalski
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jenna Sykes
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jane Batt
- Department of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Anne L Stephenson
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sunita Mathur
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
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Bellini SG, Chapman P, Szendre K, McDonald C, Williams N, Hopkin L, Eggett D, Dean A. Changes in handgrip strength in children with cystic fibrosis compared to children without cystic fibrosis. Clin Nutr ESPEN 2021; 42:206-211. [PMID: 33745579 DOI: 10.1016/j.clnesp.2021.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Cystic Fibrosis (CF) may impact nutritional status. Handgrip strength (HGS) may be used for nutrition assessment. The objective of the study was to evaluate changes in HGS over time in children with CF compared to children without CF. A secondary purpose was to analyze the relationship of clinical characteristics of CF with HGS. METHODS A prospective, longitudinal study was conducted. The non-CF group (n = 76) was recruited from a school and the CF group (n = 75) from an accredited CF center. Height, weight, mid-upper arm circumference, triceps skinfold, and HGS were measured at baseline and approximately three and six months in both groups. Data for pulmonary function, nutrition risk, enteral supplementation, CF transmembrane conductance regulator modulator, steroids, antibiotics, vitamin levels, CF related diabetes (CFRD), and recent hospitalization were collected for the CF group. A mixed model determined the difference in the change in HGS between the CF group and the non-CF group. For all analyses, p=<0.05 was significant. RESULTS The rate of change in HGS z-score in the CF-group (0.18 ± 0.05) versus the non-CF group (0.06 ± 0.06) was not significant (p = 0.15). Initial mean dominant HGS z-score was significantly lower (p = 0.02) in those with vitamin D deficiency (-1.35 ± 0.09) versus those without (-1.02 ± 0.11). HGS z-score significantly (p = 0.02) decreased over time in children with CFRD (-0.19 ± 0.22) versus children without CFRD (0.32 ± 0.14), p = 0.02. CONCLUSION Serial measurements of HGS may help detect changes in muscle function related to CFRD and vitamin D deficiency. Further investigation is warranted to elucidate HGS's role in nutrition assessment of children with CF.
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Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Perry Chapman
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Kayla Szendre
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Catherine McDonald
- Primary Children's Hospital Cystic Fibrosis Center, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA.
| | - Nicole Williams
- Primary Children's Hospital Cystic Fibrosis Center, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA.
| | - Lauren Hopkin
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Dennis Eggett
- Statistics Department, Brigham Young University, Provo, UT 84602, USA.
| | - April Dean
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA; Freedom Prep Academy, 1190 W 900 N, Provo, UT 84604, USA.
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Wu K, Mendes PL, Sykes J, Stephenson AL, Mathur S. Limb muscle size and contractile function in adults with cystic fibrosis: A systematic review and meta-analysis. J Cyst Fibros 2021; 20:e53-e62. [PMID: 33648899 DOI: 10.1016/j.jcf.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the presence of limb muscle impairments in adults with cystic fibrosis (CF), and the factors associated with these muscle impairments. The objectives of this study were to compare limb muscle size and function between adults with CF and healthy controls; and to examine their associations with demographic and clinical variables in adults with CF. METHODS The systematic review was performed using PRISMA guidelines. Studies were included if they measured any aspect of limb muscle size or function in adults with CF. Meta-analyses were performed to compare muscle variables between CF and healthy controls; and to examine their associations with demographic and clinical variables. RESULTS Twenty-eight studies were included, with 747 adults with CF. The meta-analyses showed that adults with CF have smaller thigh muscles [standardized mean difference (SMD) = 0.57, p<.0011, I2=0%], and lower handgrip strength (SMD = 0.89, p=.0034, I2=74.03%), which was weakly correlated with forced expiratory volume in one second (FEV1) (r=0.24, p=.035, I2=0%) and lower in females with CF (SMD = 2.05, p<.0001, I2=0%). There is no significant difference between adults with CF and controls in knee extensor strength (SMD = 0.25, p=.095, I2=42.79%). CONCLUSIONS Leg muscle atrophy and lower handgrip strength were noted. There may be a subgroup of adults with CF with knee extensor (quadriceps) weakness. Future studies are needed to better understand muscle impairments in people with CF; to explore the factors that can predict these muscle impairments; and to investigate their clinical significance in people with CF.
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Affiliation(s)
- Kenneth Wu
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Polyana L Mendes
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Gastro/General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Jenna Sykes
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Anne L Stephenson
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Sunita Mathur
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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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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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. [PMID: 33283151 PMCID: PMC7689601 DOI: 10.12688/hrbopenres.13025.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 08/05/2024] 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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