No abstract

Objective: To evaluate the exercise capacity of children and adolescents with severe therapy resistant asthma (STRA) aiming to identify its main determinants. Methods: Cross-sectional study including individuals aged 6-18 years with a diagnosis of STRA. Clinical (age and gender), anthropometric (weight, height and body mass index) and disease control data were collected. Lung function (spirometry), cardiopulmonary exercise testing (CPET) and exercise-induced bronchoconstriction (EIB) test were performed. Results: Twenty-four patients aged 11.5 ± 2.6 years were included. The mean forced expiratory volume in one second (FEV 1 ) was 91.3 ± 9.2%. EIB occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO 2peak ) was 34.1 ± 7.8 mL kg À1 min À1 . A significant correlation between ventilatory reserve and FEV 1 (r ¼ 0.57; p ¼ 0.003) was found. Similarly, there was a significant correlation between CPET and percent of FEV 1 fall in the EIB test for both V E /VO 2 (r ¼ 0.47; p ¼ 0.02) and V E /VCO 2 (r ¼ 0.46; p ¼ 0.02). Patients with FEV 1 <80% had lower ventilatory reserve (p ¼ 0.009). In addition, resting heart rate correlated with VO 2peak (r¼-0.40; p ¼ 0.04), V E /VO 2 (r ¼ 0.46; p ¼ 0.02) and V E /VCO 2 (r ¼ 0.48; p ¼ 0.01). Conclusions: Exercise capacity is impaired in approximately 30% of children and adolescents with STRA. The results indicate that different aspects of aerobic fitness are influenced by distinct determinants, including lung function and EIB.

IntroductionSeveral tests may be used to assess exercise intolerance in severe therapy-resistant asthma (STRA), including the gold standard cardiopulmonary exercise test (CPET) and the modified shuttle test (MST).ObjectiveTo correlate the distance achieved in the MST with peak oxygen uptake (VO2peak) and to compare the maximal heart rate (HRmax) obtained in both tests in children and adolescents with STRA.MethodsThis is a cross-sectional study, with 19 children and adolescents with STRA. Demographic, anthropometric, clinical data, and spirometric values were collected. CPET and the MST were performed in two consecutive visits. HRmax, pulse oxygen saturation, and dyspnea were compared between tests. The distance achieved in the MST was correlated with VO2peak.ResultsNineteen patients with a mean age of 11.5 ± 2.5 years were included. The mean HRmax (bpm) achieved was 180.8 ± 12.10 for the MST and 187.6 ± 9.35 for CPET, whereas the mean HRmax as a percentage of predicted (HRmax%) was 90.7 ± 6.5 for the MST and 93.8 ± 4.5 for CPET. A difference of only 6 bpm was found for HRmax (p = 0.10) and of 3% for HRmax% (p = 0.06) between tests. A strong correlation was found between the MST (r = 0.79; p = 0.001) and VO2peak measured through CPET. However, there were no correlations between the MST and both body mass index (r = −0.14; p = 0.564) and forced expiratory volume in the first second – FEV1 (r = −0.02; p = 0.917).ConclusionThe results demonstrate that the MST distance strongly correlates with VO2peak, measured through CPET, and the main physiological variable responses were similar between both tests. Our results provide additional data for the use of the MST to assess exercise capacity in children and adolescents with STRA.

Objective: Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children.In addition, we have analyzed the association between clinical history and the presence of asthma.Study Design: Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7-17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated.Results: Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p < .05) lower in the asthmatic group when compared to healthy peers, as well as the cardiorespiratory fitness, muscle strength, lifestyle and functionality. Moreover, asthmatic children were more likely to have atopic dermatitis, allergic reactions, food allergies, and a family history of asthma when compared to healthy children.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cystic fibrosis (CF) is a disease caused by a defect in the CF transmembrane conductance regulator gene (CFTR), characterised by progressive loss of lung function and exercise intolerance, mainly as a consequence of airway obstruction, caused by abnormal production of mucus, and the presence of chronic inflammation and recurrent infections. 1,2 Several factors have been associated with a worse prognosis in CF individuals, including malnutrition, female sex, increased number of exacerbations and presence of chronic airway colonisation. [3][4][5][6] Moreover, lung function decline, in addition to exercise intolerance, are identified as determinants of mortality. 7,8 The progressive decrease in aerobic fitness, combined with physical inactivity and sedentary lifestyle, starts a vicious cycle in which worsening dyspnoea is associated with increasingly less physical efforts, also compromising peripheral muscle strength and leading to plain myopathy. 9,10 Evidence shows that individuals with CF do not express the CFTR protein in the muscles, leading to metabolic and contractile cellular changes. 11,12 In addition, studies show that patients with CF, when compared with healthy individuals, have

Objective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU). Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale. Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low. Conclusions: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.

Background Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ventilation on exercise capacity in individuals with severe therapy-resistant asthma (STRA) are unknown. This study aimed to evaluate the immediate effect of continuous positive airway pressure (CPAP) on exercise tolerance in children with STRA. Methods We performed a controlled, randomized, crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA. Clinical, anthropometric and lung function data were collected. The participants in the intervention group (IG) used CPAP (PEEP 10cmH 2 O and FiO 2 0.21) for a period of 40 min. Subjects in the control group (CG) used CPAP with minimum PEEP at 1 cmH 2 0 also for 40 min. Afterwards, subjects from both groups underwent cardiopulmonary exercise testing (CPET). After a 15-day washout period, on a subsequent visit, subjects participated in the opposite group to the initial one. Results Thirteen subjects with a mean age of 12.30 ± 1.7 years were included. The variables of peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV 1 ) before using CPAP and after performing CPET did not show significant differences. Regarding CPET results, there was no significant difference (P = 0.59) between groups at peak exercise for oxygen consumption-VO 2 (CG: 33.4 ± 6.3 and IG: 34.5 ± 5.9, mL kg −1 min −1 ). However, the IG (12.4 ± 2.1) presented a total test time (min) significantly (P = 0.01) longer than the CG (11.5 ± 1.3). ConclusionThe results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.

AIMS: To evaluate the applicability of the predictive equations of maximum heart rate during exercise tests in non-athlete children and adolescents.METHODS: It is a systematic review, carried out through Pubmed, Lilacs, Scielo and PEDro. We included studies comparing the maximum heart rate measured and estimated by predictive equations during stress tests in non-athlete children and adolescents. The following search strategy was used: Exercise test OR Exercise testing OR Cardiopulmonary exercise test OR Cardiopulmonary exercise testing OR Peak oxygen uptake OR Maximal oxygen consumption OR Exercise tolerance OR Exercise capacity AND Heart rate OR Heart rates OR Pulse rate OR Pulse rates OR Heart rate control OR Cardiac chronotropic OR Predictive value test AND Predictive equations. The methodological quality was assessed by the Agency for Health Care Research and Quality scale.RESULTS: Of a total of 858 articles located, only four were included. The articles totaled 325 participants (seven to 18 years). All studies measured the maximum heart rate by cardiopulmonary stress test. While no study recommended (04/04=100%; 01/01=100%) the formulas “220 - age” and “207 - 0.7 x age”, the equations “208 - (0.7 x age)” and “200 - 0.48 x age” were adequate in 02/03 (66.6%) articles and 01/01 (100%) document, respectively. The methodological quality was considered high in all articles evaluated, ranging from 76 to 97 points.CONCLUSIONS: The findings seem to suggest that the formula “208 - (0.7 x age)” was the most tested and adequate equation to a large extent for estimating maximum heart rate in non-athlete children and adolescents. However, further studies are still needed to confirm these results.