Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis

Abstract

| Background: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. Objective: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. Method: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). Results: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=-0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. Conclusions: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition.Keywords: cystic fibrosis; rehabilitation; respiratory function tests; postural balance; psychomotor performance; nutrition assessment. HOW TO CITE THIS ARTICLEPenafortes JTS, Guimarães FS, Ribeiro Moço VJ, Almeida VP, Menezes SLS, Lopes AJ. Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis. Braz J Phys Ther. 2013 Sept-Oct; 17(5):450-457. http://dx

The Role of Multidetector Computed Tomography and the Forced Oscillation Technique in Assessing Lung Damage in Adults With Cystic Fibrosis

“…First, we evaluated a relatively small number of adults with CF; however, it is worth emphasizing that, in addition to the fact that CF is a rare condition, an adult population with CF has only emerged in recent decades in light of increased survival rates due to improvements in the therapeutic arsenal and respiratory physiotherapy. 1 Second, the patient and control groups were not statistically paired for body mass index because weight matching was hampered by the fact that CF commonly causes a state of malnutrition due to pancreatic impairment and malabsorption syndrome 47 ; however, weight does not influence the parameters of the PFTs because it is not a factor in the reference equations that model pulmonary function. 12 Finally, quantitative analysis of the airways through lungvolume quantification using multidetector CT could have been important in the correlation studies, especially in relation to the parameters provided by the forced oscillation technique.…”

The involvement of musculoskeletal system and its influence on postural stability in children and young adults with cystic fibrosis

“…The pathologies involving any of these systems end up disrupting the postural stability. There are two studies investigating this relationship in fourteen adult patients with CF [ 13 , 14 ]. The exact functional implications of this spine involvement are not defined clearly, and the data showing the involvement of postural stability and its relationship to musculoskeletal health is scarce.…”

Visuomotor reaction time and dynamic balance in children with cystic fibrosis and non‐cystic fibrosis bronchiectasis: A case‐control study

“…As these balance tests are based on patients' performance, test outcomes are expected to differ between children and adults with CF due to factors such as body composition, age, gender, duration of disease, and musculoskeletal system involvement. Penafortes et al 7 also reported that impaired balance was mainly associated with body composition in adults with CF. The present study included an age‐, BMI‐, gender‐homogeneous CF group, but disease‐related symptoms such as dyspnea, fatigue, or leg fatigue were not recorded during FRT.…”

“…Postural control involves asynchronous activity of the somatosensory, vestibular, and visual systems and is essential for the body to maintain balance during daily activities 8 . Balance impairment in adults with CF was reported to occur mainly in the anterior‐posterior direction and was associated with nutrition, inspiratory muscle strength, and pulmonary diffusion capacity 7 . In addition, postural control may be adversely affected by skeletal muscle dysfunction, advanced age, supplemental oxygen requirement, and physical inactivity in chronic obstructive pulmonary disease (COPD) 6 .…”