Expiratory muscle strength and functional exercise tolerance in adults with cystic fibrosis: a cross‐sectional study

Gambazza, Simone; Turrin, Valentina; Speziali, Chiara; Brivio, Anna; Valmarana, L.; Carta, Federica; Bulfamante, Anna; Colombo, Carla

doi:10.1002/pri.1720

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…A relationship between MEP and 6MWD (r = 0.60) has previously been described in children with CF and may explain the low 6MWD [35]. A recently described cohort of adults with CF (MEP 77% predicted value) similarly reported that those with lower MEP had poorer functional exercise capacity [36]. However, explanations underlying this observation are still unclear since other studies have reported differing results [37,38].…”

Section: Plos Onementioning

confidence: 86%

Measurement properties of the one-minute sit-to-stand test in children and adolescents with cystic fibrosis: A multicenter randomized cross-over trial

et al. 2021

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Background Functional exercise capacity assessment is recommended in children with cystic fibrosis (CF). The six-minute walk test (6MWT) is a valid evaluation of exercise capacity but can be technically complex. Inversely, the sit-to-stand test (STST) is a simple method to evaluate exercise capacity, and is validated in healthy children and adults with CF. This study aimed to evaluate STST measurement properties in children and adolescents with CF. Methods In this multicenter study, children with CF (6 to 18 years) performed two iterations of both the STST and the 6MWT in a randomized order. Criterion validity was determined by assessing correlations between STST repetitions and 6MWT distance (6MWD). Intra-rater reliability, test-retest repeatability, mean bias and limits of agreement were also assessed. Relationships with other outcomes (i.e. respiratory and quadriceps muscle strength) and cardio-respiratory responses were analysed for both tests. Results Thirty-six children with CF were included (mean age 12.0 ±3.5 years and FEV1 95.8 ±25.0%). On average, 39.6 ±10.5 repetitions were performed during the STST and mean 6MWD was 596.0 ±102.6 meters. STST number of repetitions was significantly correlated with 6MWD (r = 0.48; p<0.01). Both tests had very good intra-rater reliability (ICCSTST = 0.91 (95%CI 0.76–0.96) and ICC6MWT = 0.94 (95%CI 0.85–0.97)), and a significant test-retest learning effect. The number of STST repetitions was not correlated with quadriceps or respiratory muscle strength test, and the STST induced fewer cardio-respiratory responses than the 6MWT. Conclusions The STST is an easy-to-use functional test with moderate criterion validity when compared to the 6MWT in children with CF, probably because both tests measure different components of functional exercise capacity. The STST is useful when the 6MWT is unfeasible, however further investigations are required to explore the clinical implications of STST results in children with CF. Clinical trial registration NCT03069625.

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Section: Plos Onementioning

confidence: 86%

Measurement properties of the one-minute sit-to-stand test in children and adolescents with cystic fibrosis: A multicenter randomized cross-over trial

et al. 2021

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“…In contrast, another study that evaluated the performance of children and adults with CF in the 6MWT and MSWT found a correlation between respiratory muscle strength and performance in both tests (Saglam et al., 2016). In adults with CF, MEP is related to increased exercise tolerance assessed by the 6MWT (Gambazza et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the modified shuttle walk test in children with cystic fibrosis and healthy controls

Mucha,

Gonçalves Wamosy,

Scalco

et al. 2023

Physiotherapy Res Intl

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ObjectiveTo evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls.MethodsA cross‐sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann‐Whitney and independent t‐tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation.ResultsSixty‐two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure.ConclusionsThere was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG.

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“…Indeed, children with CF over 8 years of age with a V ̇O2max of < 32 ml•kg -1 •min -1 have 60% increased mortality rate (Pianosi et al, 2005). Although participants in the current study had an average V ̇O2max of 36 ml•kg -1 •min -1 at baseline, higher than the aforementioned high-risk category threshold, eight weeks of IMT still significantly increased their V ̇O2max (Cunha et al, 2006;Gambazza et al, 2018). This discrepancy may be related to inter-study differences in the measurement of exercise capacity.…”

Section: Discussionmentioning

confidence: 56%

Exploring Pulmonary Rehabilitation Strategies for those with Respiratory Conditions

McCreery¹

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Effective rehabilitation strategies are paramount to improve physiological and psychological health in pulmonary disease. The aim of this thesis was to investigate traditional and alternative pulmonary rehabilitation strategies in those with chronic respiratory disease. Chapter Four found that traditional pulmonary rehabilitation (PR) was physiologically and psychologically effective, regardless of respiratory disease, with socioeconomic status being a key determinant of adherence. Chapter Five investigated the feasibility and acceptability of IMT. Children aged 10.8 ± 0.8 years with Cystic Fibrosis (CF) enjoyed the IMT intervention, perceiving improvements in their physical ability and psychosocial health. The care team highlighted that future interventions needed to be longer and to monitor engagement and adherence. Chapter Six assessed the effectiveness of an alternative rehabilitation strategy, using a four-week inspiratory muscle training (IMT) intervention, on lung function and heart rate variability in children with CF aged 10.8 ± 1.1 years. There were significant and clinically meaningful increases in respiratory muscle strength, a clinically meaningful decrease in sympathetic modulation, and decreases in respiratory symptoms. Subsequently, utilising the formative, physiological and psychological findings derived from Chapters Five and Six, an eight-week IMT intervention with live biofeedback, performed at 80% maximal inspiratory pressure, three times a week was implemented, with an eight-week optional IMT top-up. Overall, Chapter Seven found that eight weeks of IMT elicited significant increases in respiratory muscle strength, aerobic capacity and in CF-specific questionnaire domains in children (11.0 ± 2.2 years) with CF, which were maintained following the eight-week top-up period. Chapter Eight demonstrated significant improvements in inspiratory muscle strength and endurance after eight weeks, with sustained improvements in physiological health after 16-weeks in adults with bronchiectasis (64.5 ± 10.3 years). CF and bronchiectasis participants demonstrated high levels of adherence and reported competency and autonomy. Overall, IMT may be an effective and feasible alternative to pulmonary rehabilitation.

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Expiratory muscle strength and functional exercise tolerance in adults with cystic fibrosis: a cross‐sectional study

Abstract: Increased functional exercise tolerance is related to higher static expiratory pressure in patients with mild-to-normal cystic fibrosis lung disease. Difference in exercise performance might reflect a possible difference in body composition that needs to be further investigated.

Cited by 8 publications

References 28 publications

Measurement properties of the one-minute sit-to-stand test in children and adolescents with cystic fibrosis: A multicenter randomized cross-over trial

Measurement properties of the one-minute sit-to-stand test in children and adolescents with cystic fibrosis: A multicenter randomized cross-over trial

Comparison of the modified shuttle walk test in children with cystic fibrosis and healthy controls

Exploring Pulmonary Rehabilitation Strategies for those with Respiratory Conditions

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