Pulmonary Function and Oxygen Uptake During Exercise in 16 Year Old Boys with Cystic Fibrosis

Hjeltnes, Nils; Jk, Stanghelle; Skyberg, D

doi:10.1111/j.1651-2227.1984.tb09969.x

Cited by 31 publications

(33 citation statements)

References 6 publications

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“…Several smaller studies have included lactate measurement in the assessment of peak exercise, and have shown that CF subjects do generate a rise in blood lactate on progressive exercise [16][17][18][19]. The present authors found raised lactate levels at peak exercise in CF patients across the full range of pulmonary disease severity, with those in the middle/ moderate group achieving very similar peak concentrations to controls.…”

Section: Discussionsupporting

confidence: 63%

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Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis

Moorcroft¹

2005

European Respiratory Journal

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The purpose of this study was to investigate symptoms, lactate accumulation and limiting factors at peak exercise in cystic fibrosis (CF) patients.In total, 104 CF adults attending an adult CF centre and 27 controls performed progressive cycle ergometry to a symptom-limited maximum. Measurements taken at peak exercise included: heart rate, ventilation, oxygen uptake, carbon dioxide output, oxygen saturation and blood lactate. Symptom scores of perceived breathlessness and muscle effort were recorded using Borg scales.The CF subjects had a lower mean body mass index, forced expiratory volume in one second (FEV1) and peak oxygen uptake than controls. Peak lactate concentrations were very similar to controls (mean¡SD 6.8¡2.0 mmol?L -1 versus 7.4¡1.0 mmol?L -1 ). Symptom scores were no different to controls for either breathlessness (4.5¡2.0 versus 4.3¡1.0) or perceived muscle effort (6.1¡2.0 versus 6.5¡1.0), with higher scores for muscle effort than breathlessness in both groups. In addition, peak ventilation was lower than the predicted maximum, and high peak heart rates were recorded supporting nonpulmonary factors as important in limiting peak exercise. Peak oxygen uptake was correlated with FEV1.Comparison of CF subjects with mild or moderate pulmonary disease and controls revealed similar exercise responses. In contrast, those CF patients with severe lung disease (FEV1 ,40% predicted) had significantly higher breathlessness, lower muscle effort scores, lower peak lactate, lower peak heart rate and a mean ventilation exceeding predicted, thus confirming that ventilation was the major factor limiting exercise.In conclusion, cystic fibrosis subjects have a reduced peak exercise capacity, but their exercise response is similar to controls in generating high blood-lactate concentrations and symptoms of muscle effort in excess of dyspnoea. Nonpulmonary factors influence peak performance more in those without severe disease.

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Section: Discussionsupporting

confidence: 63%

“…However, there is little data concerning lactate accumulation during exercise in CF, although several small studies in subjects with milder disease have shown that lactate accumulation occurs [16][17][18][19]. There is very little information concerning symptom limitation during exercise in CF.…”

mentioning

confidence: 98%

Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis

Moorcroft¹

2005

European Respiratory Journal

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“…There are several potential explanations for why the equation of Corder et al might be inaccurate for use in children with chronic disease. These include delayed gross motor skill development among children with chronic disease, inefficiency of movement from disease complications, increased resting and AEE associated with heart and lung function (Hjeltnes et al, 1984;Knops et al, 1999;Groen et al, 2010), higher HR for a given VO 2 because of deconditioning (Bar-Or and Rowland, 2004) and altered movement patterns to reduce pain (Broström et al, 2007). Each of these would increase HR and EE for a given activity, which may explain why the equation of Corder et al consistently overestimated AEE (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease

et al. 2010

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Background/Objectives: The purpose of this study was to develop an activity energy expenditure (AEE) prediction equation for the Actiheart activity monitor for use in children with chronic disease. Subjects/Methods: In total, 63 children, aged 8-18 years with different types of chronic disease (juvenile arthritis, hemophilia, dermatomyositis, neuromuscular disease, cystic fibrosis or congenital heart disease) participated in an activity testing session, which consisted of a resting protocol, working on the computer, sweeping, hallway walking, steps and treadmill walking at three different speeds. During all activities, actual AEE was measured with indirect calorimetry and the participants wore an Actiheart on the chest. Resting EE and resting heart rate were measured during the resting protocol and heart rate above sleep (HRaS) was calculated. Results: Mixed linear modeling produced the following prediction equation:Estimated AEE ðJ=kg= minÞ ¼ À93:7 þ ð4:8ÂHRaSÞþð0:04ÂAccelerometer CountsÞþð39:8ÂGender ðgirls ¼ 0; boys ¼ 1ÞÞ:This equation results in a nonsignificant mean difference of 2.1 J/kg/min (limits of agreement: À144.2 to 148.4 J/kg/min) for the prediction of AEE from the Actiheart compared with actual AEE. Conclusions: The Actiheart is valid for the use of AEE determination when using the new prediction equation for groups of children with chronic disease. However, the prediction error limits the use of the equation in individual subjects.

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“…In particular, airway dead space is independent from V T , thus in cases of reduction in V T the patient has a greater proportion of dead space for each breath. However, several studies in CF patients with mild or moderate pulmonary disease reported increases in lactate levels [125,126,127,128] and early occurrence of the lactate threshold [127] during incremental exercise, indicating an increase in muscle anaerobic metabolism and suggesting that peak exercise is not limited by ventilation, but rather by nonpulmonary factors that lead to leg fatigue. A relatively low V′ E /MVV at peak exercise and high HR reserve supported this interpretation.…”

Section: Exercise Intolerance In Cystic Fibrosismentioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Functional and Prognostic Evaluation of Patients with Pulmonary Diseases

et al. 2009

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Exercise testing is increasingly utilized to evaluate the level of exercise intolerance in patients with lung and heart diseases. Cardiopulmonary exercise testing (CPET) is considered the gold standard to study a patient’s level of exercise limitation and its causes. The 2 CPET protocols most frequently used in the clinical setting are the maximal incremental and the constant work rate tests. The aim of this review is to focus on the main respiratory diseases for which exercise tolerance is indicated; for example, chronic obstructive pulmonary disease, interstitial lung disease, primary pulmonary hypertension and cystic fibrosis. This review also focuses on the variables/indices that are utilized in the functional and prognostic evaluation. The recognition of abnormal response patterns of ventilatory, cardiac and metabolic limitation to exercise may help in the diagnostic evaluation. In addition, CPET indexes can provide important functional and prognostic information regarding patients with pulmonary disease. Exercise indices, such as peak oxygen uptake (V’O_{2 peak}), ventilatory equivalents for carbon dioxide production (V’_E-/V’CO₂) and arterial oxygen saturation (S_pO₂), have in fact proven to be better predictors of prognosis than lung function measurements obtained at rest. Moreover, useful information on the effects of therapeutic interventions may be obtained by CPET by studying the changes in endurance capacity during high-intensity constant work rate protocols.

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Pulmonary Function and Oxygen Uptake During Exercise in 16 Year Old Boys with Cystic Fibrosis

Cited by 31 publications

References 6 publications

Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis

Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease

Cardiopulmonary Exercise Testing in the Functional and Prognostic Evaluation of Patients with Pulmonary Diseases

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