Association between lung function, physical activity level and postural evaluation variables in adult patients with cystic fibrosis

Jaw and neck muscle activity during chewing and craniocervical dysfunction index in children, adolescents, and adults with and without cystic fibrosis: a comparative analysis

OBJECTIVE

To compare masticatory muscle activity between people with cystic fibrosis (pwCF) and healthy controls and to verify whether craniocervical dysfunction is associated with the presence of CF.

METHODS

Fifty-six participants were assessed and divided into pwCF and healthy control (HC) groups, each one composed of 13 children and adolescents at 9 (SD 3) years old and 15 adults at 25 (SD 6) years old. Craniocervical Dysfunction Index assessed symptoms of dysfunction and cervical spine mobility. Electromyography was used to evaluate the jaw and neck muscle activity during chewing.

RESULTS

Muscle activity during chewing was not statistically different between groups. Prevalence of craniocervical dysfunction was 75% for pwCF vs 64% for healthy controls. Individuals with CF are 1.53 [1.260, 1.870] times more likely to have reduced cervical mobility compared to healthy controls (p = 0.000).

CONCLUSION

These results reinforce the need for musculoskeletal disorders treatment in the management of pwCF.

Longitudinal changes in the 6-minute walk test and the Glittre-activities of daily living test in adults with cystic fibrosis

With the increasing use of highly effective modulator therapy (HEMT) in adults with cystic fibrosis (awCF), it is necessary to determine the evolution of the most dynamic physiological markers of this disease, such as the 6-minute walk test (6MWT) and the Glittre-activities of daily living test (TGlittre). The present study aimed to evaluate the 1-year changes in the 6- minute walking distance (6MWD), TGlittre time, and quality of life (QoL) in awCF before the initiation of HEMT and to determine the impact of habitual physical activity (HPA) and chest physiotherapy (CP). This longitudinal study enrolled 24 awCF who completed the 6MWT and TGlittre. Pulmonary function tests, handgrip strength (HGS), and the Cystic Fibrosis Questionnaire-Revised (CFQ-R) were conducted. Measurements were collected at baseline (T1) and 1 year later (T2). The median body mass index increased between T1 and T2 [19.8 (18-24) vs. 21.4 (19-24) kg/m2, p=0.038]. TGlittre time decreased both in relation to the absolute values [3.10 (2.52-3.39) vs. 2.40 (2.00-3.00) minutes, p=0.001] and in relation to the predicted values [127 (116-150) vs. 108 (102-140) % predicted, p=0.001]. Although there was no increase in 6MWD relative to the predicted values, it increased relative to the absolute values [545 (463-654) vs. 617 (540-658) meters, p=0.041]. In relation to the group that did not engage in HPA, individuals who had HPA showed an increase in HGS between T1 and T2 [7.1 (0-20) vs. 0 (-12-3) kgf, p=0.031]. In relation to the group that did not undergo CP, individuals undergoing CP showed an increase in the 'treatment burden'-CFQ-R between T1 and T2 [16.1 (-3-18) vs. -11.2 (-28-1) points, p=0.049]. In conclusion, awCF performed better on TGlittre than on 6MWT. They experienced an improvement in body composition. HPA was correlated with peripheral muscle strength, as were CP and QoL.

Clinimetric properties of field exercise tests in cystic fibrosis: a systematic review

OBJECTIVES

Accurate measurement of exercise capacity is an important prognostic indicator for people with cystic fibrosis (pwCF); however, gold-standard, cardiopulmonary exercise tests are commonly unavailable. This review systematically describes the clinimetric properties of field exercise tests for pwCF.

METHODS

A systematic review was undertaken for studies reporting field exercise tests in pwCF. Four electronic databases were searched for studies published from 1990 to January 2024. Where available, clinimetric properties reported included reliability, validity, responsiveness and interpretability.

RESULTS

4041 studies were identified with 153 eligible for inclusion. 10 different field exercise tests were described, including six walk/run tests (incremental shuttle walk test (ISWT), modified shuttle test-15 levels (MST-15), MST-25 levels (MST-25), 20-m shuttle test, 6-min walk test (6MWT) and 12-min walk test (12MWT)), three step tests (3-min step test (3MST), incremental step test and Alfred step test (A-STEP)) and the 1-min sit-to-stand test (1STS). Reliability was found for the ISWT, MST-15, 6MWT, 1STS and 3MST (intraclass correlation coefficients >0.80). The ISWT, MST-15 and 6MWT were found to be valid (concurrent and discriminate). Responsiveness was supported for the 6MWT only. Four tests (MST-15, 6MWT, 3MST and 1STS) demonstrated ceiling effects.

CONCLUSION

This review supports the reliability, validity and responsiveness of the 6MWT in pwCF. The ISWT and MST-15 were found to be valid. The 1STS is reliable and feasible, but its utility is limited by ceiling effects. The 3MST, MST-25, 20-m shuttle test, incremental step test, A-STEP and 12MWT require further investigations of their clinimetric properties.

Physical activity level and sedentary behavior in patients with bronchiectasis: A systematic review of outcome measures and determinants

BACKGROUND

Changes in respiratory functions negatively affect the physical activity (PA) levels of patients with bronchiectasis. Therefore, detecting the most frequently used assessments of PA is essential as determining related factors and improving PA. This review study aimed to investigate the PA levels, compare levels with the recommended PA guidelines, determine the outcome measurements of PA and examine the determinants related to PA in patients with bronchiectasis.

METHOD

This review was conducted using databases of MEDLINE, Web of Science, and PEDro. The searched terms were the variations of the words "bronchiectasis" and "physical activity". Full texts of cross-sectional studies and clinical trials were included. Two authors independently screened the studies for inclusion.

RESULT

The initial search identified 494 studies. A hundred articles were selected for full-text review. Following the application of the eligibility process, 15 articles were included. Twelve studies used activity monitors and five studies used questionnaires. The studies that used activity monitors presented daily step counts. The mean number of steps ranged between 4657 and 9164 for adult patients. It was approximately 5350 steps/day in older patients. One study investigated children's PA level reported 8229 steps/day. The functional exercise capacity, dyspnea, FEV1 and, quality of life as related determinants with PA have been reported in the studies.

CONCLUSION

PA levels of patients with non-cystic fibrosis bronchiectasis were lower than the recommended levels. The objective measurements were frequently used in PA assessment. In further studies, it is needed to investigate the related determinants of PA in patients.

Physical activity and its correlates in people with cystic fibrosis: a systematic review

Cystic fibrosis (CF) is a life-shortening genetic disease, affecting multiple life domains including physical activity (PA). Although higher PA levels are associated with multiple health benefits, little insight exists on the PA level of people with CF (PwCF) compared to healthy peers. Evidence on the influencing factors (i.e. correlates) of PA in this clinical population is scarce, but essential to fully understand their PA behaviour. Therefore, the present review aims to provide an overview of the PA level of PwCF compared to healthy peers, and the correlates of PA in PwCF. A systematic search of three databases resulted in 46 included studies. Analysis of 16 studies showed that the CF population is equally active compared to healthy peers, but there is a trend towards less high-intensity PA in youths with CF. Furthermore, PA is positively associated with quality of life, lung function, (maximal) exercise capacity, bone mineral density and quadriceps force. Also, PA was lower on weekdays compared to weekend days and lower when experiencing pulmonary exacerbations. More high-quality research is required in PwCF, particularly longitudinal studies that further explore the correlates of PA, with PA investigated as a primary outcome and measured objectively.

Association between habitual physical activity (HPA) and sleep quality in patients with cystic fibrosis

PURPOSE

Sleep disturbances and poor sleep quality are known to be present in patients with CF. Regular physical activity plays an important role in the treatment of CF patients due to its positive influence on progression of disease and quality of life. The aim of this work is to create a home-based sleep and activity profile and to investigate the influence of habitual physical activity (HPA) on sleep quality in children, adolescents, and adults with CF.

METHODS

A total of 109 CF patients (64 male, mean age 22.7 ± 12.0 years; mean ppFEV1 63.0 ± 26.7) were equipped with an actigraph for a home-based collection of data on sleep and activity over 4 weeks.

RESULTS

Age, FEV1, and BMI affect sleep and activity in CF patients. Especially younger age and higher FEV1 show a great influence on certain aspects of sleep (SE, TST, TIB, WASO, # of awakenings) and activity and its different intensities. General HPA does not affect sleep, but there is a strong correlation between times spent in vigorous to very vigorous intensities and better sleep quality.

CONCLUSION

Besides younger age and higher FEV1, daily activity in higher intensities influences sleeping behavior of CF patients in a positive way. Patients with poor sleep quality and sleep disturbances possibly benefit from an intensification of physical activity in the home environment. TRAIL REGISTRATION: number: 14-6117-BO (University Duisburg-Essen) and NCT03518697 (clinical trials).

"Test-retest reliability and minimal detectable change in TGlittre-P test in children and adolescents with cystic fibrosis"

OBJECTIVE

to provide test-retest reliability for the TGlittre-P in children and adolescents with cystic fibrosis (CFG) and healthy controls (HCG), to establish the minimal detectable change for time in TGlittre-P and comparing the performance in the TGlittre-P test between these populations.

METHOD

A cross-sectional study evaluated 36 children and adolescents aged 6 to 13. Anthropometric and spirometric evaluation was performed, as well as, on the same day, two TGlittre-P tests with a 30-minute interval between them.

RESULTS

TGlittre-P time test-retest reliability was excellent for both groups (CFG: intraclass correlation coefficient [ICC] = 0.849, p < 0.001 and HCG: ICC = 0.913, p < 0.001). As concerning absolute reliability, the time spent presented a small variability with a standard error of measurement of 8.4 s (s) to CFG and 5.3 s to HCG. The minimal detectable change at 95% confidence level (MDC95) was 23.2 s and 14.6 s, respectively. There was no difference between the groups regarding performance in the TGlittre-P test (CFG 179.1 s ± 25.7 s vs. HCG 174.7 s ± 22.3 s) p = 0.589.

CONCLUSION

The TGlittre-P is a reliable tool in children and adolescents with CF and healthy controls. The TGlittre-P appears not to be sensitive enough to discriminate a group of children and adolescents with mild cystic fibrosis from healthy counterparts.IMPLICATIONS FOR REHABILITATIONTGlittre-P is a multitasking test that has been used to assess the functional capacity of children and adolescents with chronic diseases.TGlittre-P has excellent reliability in children and adolescents with and without CF.TGlittre-P differences time greater than 12% could indicate changes in the functional capacity of children and adolescents with CF.Other functional capacity tests may be preferred to detect continuous increases in functional capacity through rehabilitation or training, whether children and adolescents obtain performance values close to 100% of predicted.

Association between lung function, thoracoabdominal mobility and posture in cystic fibrosis: pilot study

Abstract Introduction: Deterioration of lung function is the main cause of mortality in cystic fibrosis (CF), so it is essential to study different related factors. Objective: To assess the association of pulmonary function with thoracoabdominal mobility and postural alignment in individuals with CF. Method: A cross-sectional study was performed in individuals with CF (8-17 years). Pulmonary function was assessed by spirometry. Thoracoabdominal mobility and postural alignment were evaluated by photogrammetry using the Postural Assessment Software (PAS/Sapo). Pearson correlation coefficient analysis was performed, and p < 0.05 was considered significant. Results: The following spirometric variables showed a decrease compared to predicted values: FEV1, FEV1/FVC, PEF and FEF25-75%. Postural assessment showed alterations in head horizontal alignment (HHA; 2.71 ± 2.23o), acromion horizontal alignment (AHA; 1.33 ± 1.35o), anterior superior iliac spine (ASIS) horizontal alignment (ASISHA; 1.11 ± 0.89o), angle between acromia and ASIS (AAASIS; 0.89 ± 0.39o), scapula horizontal asymmetry - T3 (SHAT3; 16.95 ± 12.03%), and asymmetry of the projection of the center of gravity within the base of support in the frontal (11.45 ± 8.10%) and sagittal (48.98 ± 18.55%) planes. A strong positive correlation was found between pulmonary function and thoracoabdominal mobility in the variables anteroposterior mobility of the upper chest (APMUC) and FVC (r = 0.818, p = 0.024), APMUC and FEV1 (r = 0.874, p = 0.010), and APMUC and FEF25-75% (r = 0.797, p = 0.032). A strong negative correlation was detected between FEV1/FVC and AHA (r = -0.761, p = 0.047). Conclusion: Our study showed in CF a reduction in pulmonary function, strong positive correlation between APMUC and pulmonary function, high prevalence of kyphoscoliosis and strong negative correlation between AHA and pulmonary function.

The Effect of Pulmonary Rehabilitation on the Physical Activity Level and General Clinical Status of Patients with Bronchiectasis

OBJECTIVES

We aimed to investigate the effects of pulmonary rehabilitation (PR) on the level of physical activity (PA) and the general clinical status in adult patients with non-cystic fibrosis bronchiectasis.

MATERIALS AND METHODS

The patients were included prospectively in the study and followed a home-based PR program for 2 months comprising breathing exercises, training in chest hygiene techniques, peripheral muscle strengthening training, and self-walking. The outcomes measurements were the following: 6-minute walking distance, pulmonary function test, peripheral and respiratory muscle strength measurements, International Physical Activity Questionnaire (IPAQ), Saint George Respiratory Questionnaire, and modified Medical Research Council dyspnea scores.

RESULTS

Of the total 25 patients included in the study, six were excluded due to follow-up and adherence problems. A comparison of the outcome measures recorded before and after PR showed statistically significant improvements in the IPAQ total (p=0.015) and walking scores (p=0.011). While the proportion of patients in the low PA category was 73% (n=14) prior to PR, this rate decreased to 42% (n=8) post-PR. The proportion of patients in the moderate PA category was 26% (n=5) prior to PR and increased to 52% (n=10) post-PR. While positive improvements were seen in all clinically monitored parameters, aside from spirometric values, these changes did not reach a statistically significant level.

CONCLUSION

The majority of patients with bronchiectasis have a low level of PA. PR ensures positive improvements in the level of PA and general physical clinical status of such patients.