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Radtke T, Kriemler S, Stein L, Karila C, Urquhart DS, Orenstein DM, Lands LC, Schindler C, Eber E, Haile SR, Hebestreit H. Cystic fibrosis related diabetes is not associated with maximal aerobic exercise capacity in cystic fibrosis: a cross-sectional analysis of an international multicenter trial. J Cyst Fibros 2023; 22:31-38. [PMID: 35803884 DOI: 10.1016/j.jcf.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have reported differences in aerobic exercise capacity, expressed as peak oxygen uptake (VO2peak), between people with and without cystic fibrosis (CF) related diabetes (CFRD). However, none of the studies controlled for the potential influence of physical activity on VO2peak. We investigated associations between CFRD and VO2peak following rigorous control for confounders including objectively measured physical activity. METHODS Baseline data from the international multicenter trial ACTIVATE-CF with participants ≥12 years performing up to 4 h per week of vigorous physical activity were used for this project. Multivariable models were computed to study associations between CFRD and VO2peak (mL.min-1) adjusting for a set of pre-defined covariates: age, sex, weight, forced expiratory volume in 1 s (FEV1), breathing reserve index, Pseudomonas aeruginosa infection, and physical activity (aerobic step counts from pedometry). Variables were selected based on their potential confounding effect on the association between VO2peak and CFRD. RESULTS Among 117 randomized individuals, 103 (52% female) had a maximal exercise test and were included in the analysis. Participants with (n = 19) and without (n = 84) CFRD did not differ in FEV1, physical activity, nutritional status, and other clinical characteristics. There were also no differences in VO2peak (mL.min-1 or mL.kg-1.min-1 or% predicted). In the final multivariable model, all pre-defined covariates were significant predictors of VO2peak (mL.min-1), however CFRD [coefficient 82.1, 95% CI -69.5 to 233.8, p = 0.28] was not. CONCLUSIONS This study suggests no meaningful differences in VO2peak between people with and without CFRD given comparable levels of physical activity.
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Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lothar Stein
- Hannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - Chantal Karila
- Service de pneumologie et allergologie pédiatriques - Hôpital Necker Enfants malades - APHP - Université Paris Descartes, Paris, France
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - David M Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA
| | - Larry C Lands
- Montreal Children's Hospital - McGill University Health, Montreal, QC, Canada
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ernst Eber
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Caterini JE, Ratjen F, Barker AR, Williams CA, Rendall K, Schneiderman JE, Wells GD. Exercise intolerance in cystic fibrosis-the role of CFTR modulator therapies. J Cyst Fibros 2021; 21:282-292. [PMID: 34955387 DOI: 10.1016/j.jcf.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/18/2021] [Accepted: 11/20/2021] [Indexed: 12/11/2022]
Abstract
Exercise intolerance is common in people with CF (pwCF), but not universal among all individuals. While associated with disease prognosis, exercise intolerance is not simply a reflection of the degree of lung disease. In people with severe CF, respiratory limitations may contribute more significantly to impaired exercise capacity than in those with mild-moderate CF. At all levels of disease severity, there are peripheral factors e.g., abnormal macro- and micro-vascular function that impair blood flow and reduce oxygen extraction, and mitochondrial defects that diminish metabolic efficiency. We discuss advances in understanding the central and peripheral mechanisms underlying exercise intolerance in pwCF. Exploring both the central and peripheral factors that contribute to exercise intolerance in CF can help inform the development of new therapeutic targets, as well as help define prognostic criteria.
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Affiliation(s)
- Jessica E Caterini
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada; Queen's Medical School, Kingston, ON K7L 3N6, Canada
| | - Felix Ratjen
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada; Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Kate Rendall
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Jane E Schneiderman
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Greg D Wells
- Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada.
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Bernasconi N, Kieninger E, Shaw M, Kurz J, Moeller A, Ratjen F, Rochat I, Stanojevic S, Singer F. CFTR-function and ventilation inhomogeneity in individuals with cystic fibrosis. J Cyst Fibros 2020; 20:641-647. [PMID: 33349584 DOI: 10.1016/j.jcf.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/14/2020] [Accepted: 12/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Increased (abnormal) ventilation inhomogeneity in individuals with mild Cystic Fibrosis (CF) lung disease may become a treatable trait for small-molecule therapeutics improving Cystic Fibrosis Transmembrane Regulator (CFTR) function. The relationship between CFTR function and ventilation inhomogeneity is unknown. We aimed to identify and quantify increased ventilation inhomogeneity in relation to CFTR function. METHODS This was an international, multi-center, cross-sectional study. We collated data from individuals aged 3-25 years with minimal (CFTR-MF) or residual (CFTR-RF) function of a variety of CFTR genotypes and FEV1 ≥ 70% predicted. We measured lung function using nitrogen multiple-breath washout and spirometry. We compared lung clearance index (LCI) and FEV1 between individuals with CFTR-MF vs CFTR-RF using a mixed effects multi-variable linear regression model to account for study differences and a logistic model based on propensity-score matching to adjust for possible confounding. RESULTS We included 141 with CFTR-MF and 35 with CFTR-RF. LCI (> 1.96 z-score) was elevated in 71.6% individuals with CFTR-MF and in 40.0% with CFTR-RF. FEV1 (< -1.96 z-score) was reduced in 11.3% individuals with CFTR-MF and in 5.7% with CFTR-RF. The mean difference (95% CI) of LCI and FEV1 between CFTR-MF and CFTR-RF was 3.71 (1.63 to 5.79) and -0.40 (-0.83 to 0.02) z-score. The LCI differences were similar after adjustment for confounders and in individuals with normal FEV1. CONCLUSION Increased ventilation inhomogeneity is associated with less CFTR function. In individuals with mild CF lung disease, LCI can identify and quantify increased ventilation inhomogeneity, a candidate treatable trait.
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Affiliation(s)
- Nadine Bernasconi
- Division of Respiratory Medicine, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Elisabeth Kieninger
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michelle Shaw
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Johanna Kurz
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Rochat
- Pediatric Pulmonology Unit, Department of Pediatrics, CHUV Lausanne, University Hospital of Lausanne, Switzerland
| | - Sanja Stanojevic
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Florian Singer
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Abstract
This commentary highlights 23 noteworthy publications from 2018, selected by leading scientists in pediatric exercise science. These publications have been deemed as significant or exciting in the field as they (a) reveal a new mechanism, (b) highlight a new measurement tool, (c) discuss a new concept or interpretation/application of an existing concept, or (d) describe a new therapeutic approach or clinical tool in youth. In some cases, findings in adults are highlighted, as they may have important implications in youth. The selected publications span the field of pediatric exercise science, specifically focusing on: aerobic exercise and training; neuromuscular physiology, exercise, and training; endocrinology and exercise; resistance training; physical activity and bone strength; growth, maturation, and exercise; physical activity and cognition; childhood obesity, physical activity, and exercise; pulmonary physiology or diseases, exercise, and training; immunology and exercise; cardiovascular physiology and disease; and physical activity, inactivity, and health.
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Abdelbasset WK, Soliman GS, Elshehawy AA, Alrawaili SM. Exercise capacity and muscle fatiguability alterations following a progressive maximal exercise of lower extremities in children with cystic fibrosis. Afr Health Sci 2018; 18:1236-1242. [PMID: 30766590 PMCID: PMC6354874 DOI: 10.4314/ahs.v18i4.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Impairment of peripheral skeletal muscle function is a common phenomenon in patients with cystic fibrosis (CF) in addition to great clinical connotations, such as lack of exercise tolerance and decrease of health-related quality of life. There is very limited data on the effects of maximal exercise on muscle fatiguability and exercise capacity in children with cystic fibrosis. Objectives The aim of this study was to evaluate the effect of progressive maximal exercise training of the lower extremities on exercise capacity and muscle fatiguability in children with cystic fibrosis. Study design Between June and September 2017, eighteen children aged 8–12 years were recruited in this study. This study had two groups of children; the CF group consisted of nine children (6 males and 3 females) with cystic fibrosis and the control group consisted of nine healthy age matched children (6 males and 3 females). The children underwent a progressive maximal cardiopulmonary exercise cycling test (CPET), muscle fatigue test, and magnetic resonance imaging (MRI) to measure a muscle cross-section area (CSA). Also, pulmonary functions were assessed. Results The findings of this study showed that the CF children had less pulmonary functions, had a less exercise capacity, and had a higher breathing reserve index and oxygen desaturation when compared with healthy children (p<0.05). On the other hand, there was a non-significant difference in muscle fatiguability, muscle cross-section area, and maximal voluntary contraction between the CF and healthy children (p>0.05). Conclusion This study indicates that progressive maximal exercise doesn't affect muscle fatiguability, muscle cross-section area, and maximal voluntary contraction in CF children with moderate respiratory diseases but includes lower exercise capacity. CF children and healthy age matched children have similar responses to maximal exercise in muscle fatiguability, muscle cross-section area, and maximal voluntary contractions but lower exercise capacity in the CF group.
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Affiliation(s)
- Walid K Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Gaber S Soliman
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Qurayyat, Aljouf University, Saudi Arabia
| | - Ahmed A Elshehawy
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Tabuk University, Tabuk, Saudi Arabia
| | - Saud M Alrawaili
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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The Relationship between CFTR Genotype and Exercise Tolerance in Cystic Fibrosis. Ann Am Thorac Soc 2018; 15:166. [DOI: 10.1513/annalsats.201711-860ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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CFTR Genotype and Maximal Exercise Capacity in Cystic Fibrosis: A Cross-sectional Study. Ann Am Thorac Soc 2017; 15:209-216. [PMID: 29140739 DOI: 10.1513/annalsats.201707-570oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Cystic fibrosis transmembrane conductance regulator (CFTR) is expressed in human skeletal muscle cells. Variations of CFTR dysfunction among patients with cystic fibrosis may be an important determinant of maximal exercise capacity in cystic fibrosis. Previous studies on the relationship between CFTR genotype and maximal exercise capacity are scarce and contradictory. OBJECTIVES This study was designed to explore factors influencing maximal exercise capacity, expressed as peak oxygen uptake (V.O2peak), with a specific focus on CFTR genotype in children and adults with cystic fibrosis. METHODS In an international, multicenter, cross-sectional study, we collected data on CFTR genotype and cardiopulmonary exercise tests in patients with cystic fibrosis who were ages 8 years and older. CFTR mutations were classified into functional classes I–V. RESULTS The final analysis included 726 patients (45% females; age range, 8–61 yr; forced expiratory volume in 1 s, 16 to 123% predicted) from 17 cystic fibrosis centers in North America, Europe, Australia, and Asia, all of whom had both valid maximal cardiopulmonary exercise tests and complete CFTR genotype data. Overall, patients exhibited exercise intolerance (V.O2peak, 77.3 ± 19.1% predicted), but values were comparable among different CFTR classes. We did not detect an association between CFTR genotype functional classes I–III and either V.O2peak (percent predicted) (adjusted β = −0.95; 95% CI, −4.18 to 2.29; P = 0.57) or maximum work rate (Wattmax) (adjusted β = −1.38; 95% CI, −5.04 to 2.27; P = 0.46) compared with classes IV–V. Those with at least one copy of a F508del-CFTR mutation and one copy of a class V mutation had a significantly lower V.O2peak (β = −8.24%; 95% CI, −14.53 to −2.99; P = 0.003) and lower Wattmax (adjusted β = −7.59%; 95% CI, −14.21 to −0.95; P = 0.025) than those with two copies of a class II mutation. On the basis of linear regression analysis adjusted for relevant confounders, lung function and body mass index were associated with V.O2peak. CONCLUSIONS CFTR functional genotype class was not associated with maximal exercise capacity in patients with cystic fibrosis overall, but those with at least one copy of a F508del-CFTR mutation and a single class V mutation had lower maximal exercise capacity.
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Dekerlegand RL, Hadjiliadis D, Swisher AK, Parrott JS, Heuer AJ, Myslinski MJ. Clinical Predictors of Inspiratory Muscle Strength in Adults With Stable Cystic Fibrosis: A Pilot Study. Cardiopulm Phys Ther J 2017. [DOI: 10.1097/cpt.0000000000000064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pediatric Exercise Testing: Value and Implications of Peak Oxygen Uptake. CHILDREN-BASEL 2017; 4:children4010006. [PMID: 28125022 PMCID: PMC5296667 DOI: 10.3390/children4010006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/15/2016] [Accepted: 01/17/2017] [Indexed: 01/26/2023]
Abstract
Peak oxygen uptake (peakV˙O2) measured by clinical exercise testing is the benchmark for aerobic fitness. Aerobic fitness, estimated from maximal treadmill exercise, is a predictor of mortality in adults. PeakV˙O2 was shown to predict longevity in patients aged 7–35 years with cystic fibrosis over 25 years ago. A surge of exercise studies in young adults with congenital heart disease over the past decade has revealed significant prognostic information. Three years ago, the first clinical trial in children with pulmonary arterial hypertension used peakV˙O2 as an endpoint that likewise delivered clinically relevant data. Cardiopulmonary exercise testing provides clinicians with biomarkers and clinical outcomes, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response hidden at rest. Momentum from these pioneering observations in multiple disease states should impel clinicians to employ similar methods in other patient populations; e.g., sickle cell disease. Advances in pediatric exercise science will elucidate new pathways that may identify novel biomarkers. Our initial aim of this essay is to highlight the clinical relevance of exercise testing to determine peakV˙O2, and thereby convince clinicians of its merit, stimulating future clinical investigators to broaden the application of exercise testing in pediatrics.
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Abstract
For many years physiotherapy for cystic fibrosis (CF) was synonymous with a daily routine of postural drainage and percussion. Improved longevity and a desire for independence, together with a clearer understanding of the pathophysiology of the disease, has led to the development of many airway clearance techniques. The contribution of ‘chest’ physiotherapy remained unchallenged until recent times when lack of robust evidence and the presentation of asymptomic infants and adults led some physiotherapists to question this traditional approach. As survival increases into the fourth and fifth decade unique complications have evolved and physiotherapy management is challenged with nonrespiratory aspects of treatment. This review will consider the evidence for, and current practice of airway clearance, the value of exercise and the emerging problems of musculoskeletal complications and incontinence.
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Affiliation(s)
- M E Dodd
- Adult Cystic Fibrosis Centre, South Manchester University Hospitals NHS Trust, Manchester, UK.
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Werkman M, Jeneson J, Helders P, Arets B, van der Ent K, Velthuis B, Nievelstein R, Takken T, Hulzebos E. Exercise oxidative skeletal muscle metabolism in adolescents with cystic fibrosis. Exp Physiol 2016; 101:421-31. [PMID: 26707538 PMCID: PMC4925307 DOI: 10.1113/ep085425] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/23/2015] [Indexed: 12/21/2022]
Abstract
NEW FINDINGS What is the central question of this study? Do intrinsic abnormalities in oxygenation and/or muscle oxidative metabolism contribute to exercise intolerance in adolescents with mild cystic fibrosis? What is the main finding and its importance? This study found no evidence that in adolescents with mild cystic fibrosis in a stable clinical state intrinsic abnormalities in skeletal muscle oxidative metabolism seem to play a clinical significant role. Based on these results, we concluded that there is no metabolic constraint to benefit from exercise training. Patients with cystic fibrosis (CF) are reported to have limited exercise capacity. There is no consensus about a possible abnormality in skeletal muscle oxidative metabolism in CF. Our aim was to test the hypothesis that abnormalities in oxygenation and/or muscle oxidative metabolism contribute to exercise intolerance in adolescents with mild CF. Ten adolescents with CF (12-18 years of age; forced expiratory volume in 1 s >80% of predicted; and resting oxygen saturation >94%) and 10 healthy age-matched control (HC) subjects were tested with supine cycle ergometry using near-infrared spectroscopy and (31)P magnetic resonance spectroscopy to study skeletal muscle oxygenation and oxidative metabolism during rest, exercise and recovery. No statistically significant (P > 0.1) differences in peak workload and peak oxygen uptake per kilogram lean body mass were found between CF and HC subjects. No differences were found between CF and HC subjects in bulk changes of quadriceps phosphocreatine (P = 0.550) and inorganic phosphate (P = 0.896) content and pH (P = 0.512) during symptom-limited exercise. Furthermore, we found statistically identical kinetics for phosphocreatine resynthesis during recovery for CF and HC subjects (P = 0.53). No statistically significant difference in peak exercise arbitrary units for total haemoglobin content was found between CF and HC subjects (P = 0.66). The results of this study provide evidence that in patients with mild CF and a stable clinical status (without signs of systemic inflammation and/or chronic Pseudomonas aeruginosa colonization), no intrinsic metabolic constraints and/or abnormalities in oxygenation and/or muscle oxidative metabolism contribute to exercise intolerance.
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Affiliation(s)
- Maarten Werkman
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Jeneson
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul Helders
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bert Arets
- Cystic Fibrosis Center and Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kors van der Ent
- Cystic Fibrosis Center and Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta Velthuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Rutger Nievelstein
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Laboratory, Utrecht, The Netherlands
| | - Erik Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Quon BS, Wilkie SS, Molgat-Seon Y, Schaeffer MR, Ramsook AH, Wilcox PG, Guenette JA. Cardiorespiratory and sensory responses to exercise in adults with mild cystic fibrosis. J Appl Physiol (1985) 2015; 119:1289-96. [PMID: 26429870 DOI: 10.1152/japplphysiol.00692.2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to evaluate cardiorespiratory fitness and reasons for exercise curtailment in a contemporary adult cystic fibrosis (CF) cohort with mild lung disease. Adults with mild CF (n = 19, forced expiratory volume in 1 s = 95 ± 17% predicted) were age-, sex-, ethnicity-, and body mass index-matched to healthy controls (n = 19) and underwent a detailed cardiopulmonary cycle exercise test. While CF subjects had a reduced peak oxygen uptake compared with controls, the values were normal when expressed as %predicted in 14/19 (74%) of subjects. Both groups demonstrated a normal cardiovascular limitation to exercise and stopped exercise primarily because of leg fatigue. Despite not being exercise-limited by respiratory factors, there was some evidence of ventilatory abnormalities as patients with mild CF had increased end-inspiratory lung volumes and reached an inflection/plateau in tidal volume relative to minute ventilation at lower exercise intensities compared with controls. Subjects with CF were not more likely to demonstrate expiratory flow limitation compared with controls and did not have evidence of dynamic hyperinflation during exercise. Despite increased end-inspiratory lung volumes and an earlier tidal volume inflection/plateau, CF subjects did not experience higher levels of dyspnea. In an exploratory analysis, a significant inverse correlation was observed between sweat chloride and peak work rate. Adult CF subjects with relatively well preserved spirometry have normal exercise performance relative to reference values and are primarily limited by nonrespiratory factors. However, ventilatory abnormalities were detected even in this mild CF cohort and should be evaluated in future therapeutic trials focused on disease-modifying therapies in mild CF.
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Affiliation(s)
- Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital
| | - Sabrina S Wilkie
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital
| | - Yannick Molgat-Seon
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, School of Kinesiology, and
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pearce G Wilcox
- Division of Respiratory Medicine, Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Hebestreit H, Arets HG, Aurora P, Boas S, Cerny F, Hulzebos EH, Karila C, Lands LC, Lowman JD, Swisher A, Urquhart DS. Statement on Exercise Testing in Cystic Fibrosis. Respiration 2015; 90:332-51. [DOI: 10.1159/000439057] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022] Open
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Skeletal muscle contractility and fatigability in adults with cystic fibrosis. J Cyst Fibros 2015; 15:e1-8. [PMID: 26033387 DOI: 10.1016/j.jcf.2015.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent discovery of cystic fibrosis transmembrane conductance regulator expression in human skeletal muscle suggests that CF patients may have intrinsic skeletal muscle abnormalities potentially leading to functional impairments. The aim of the present study was to determine whether CF patients with mild to moderate lung disease have altered skeletal muscle contractility and greater muscle fatigability compared to healthy controls. METHODS Thirty adults (15 CF and 15 controls) performed a quadriceps neuromuscular evaluation using single and paired femoral nerve magnetic stimulations. Electromyographic and mechanical parameters during voluntary and magnetically-evoked contractions were recorded at rest, during and after a fatiguing isometric task. Quadriceps cross-sectional area was determined by magnetic resonance imaging. RESULTS Some indexes of muscle contractility tended to be reduced at rest in CF compared to controls (e.g., mechanical response to doublets stimulation at 100 Hz: 74±30 Nm vs. 97±28 Nm, P=0.06) but all tendencies disappeared when expressed relative to quadriceps cross-sectional area (P>0.5 for all parameters). CF and controls had similar alterations in muscle contractility with fatigue, similar endurance and post exercise recovery. CONCLUSIONS We found similar skeletal muscle endurance and fatigability in CF adults and controls and only trends for reduced muscle strength in CF which disappeared when normalized to muscle cross-sectional area. These results indicate small quantitative (reduced muscle mass) rather than qualitative (intrinsic skeletal muscle abnormalities) muscle alterations in CF with mild to moderate lung disease.
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BONGERS BARTC, WERKMAN MAARTENS, ARETS HGM, TAKKEN TIM, HULZEBOS HJ. A Possible Alternative Exercise Test for Youths with Cystic Fibrosis. Med Sci Sports Exerc 2015; 47:485-92. [DOI: 10.1249/mss.0000000000000440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Burtin C, Hebestreit H. Rehabilitation in Patients with Chronic Respiratory Disease Other than Chronic Obstructive Pulmonary Disease: Exercise and Physical Activity Interventions in Cystic Fibrosis and Non-Cystic Fibrosis Bronchiectasis. Respiration 2015; 89:181-9. [DOI: 10.1159/000375170] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bongers BC, Werkman MS, Takken T, Hulzebos EHJ. Ventilatory response to exercise in adolescents with cystic fibrosis and mild-to-moderate airway obstruction. SPRINGERPLUS 2014; 3:696. [PMID: 25512888 PMCID: PMC4254890 DOI: 10.1186/2193-1801-3-696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/14/2014] [Indexed: 02/08/2023]
Abstract
Data regarding the ventilatory response to exercise in adolescents with mild-to-moderate cystic fibrosis (CF) are equivocal. This study aimed to describe the ventilatory response during a progressive cardiopulmonary exercise test (CPET) up to maximal exertion, as well as to assess the adequacy of the ventilatory response for carbon dioxide (CO2) exhalation. Twenty-two adolescents with CF (12 boys and 10 girls; mean ± SD age: 14.3 ± 1.3 years; FEV1: 78.6 ± 17.3% of predicted) performed a maximal CPET. For each patient, data of a sex- and age matched healthy control was included (12 boys and 10 girls; mean ± SD age: 14.3 ± 1.4 years). At different relative exercise intensities of 25%, 50%, 75%, and 100% of peak oxygen uptake (VO2peak), breathing pattern, estimated ventilatory dead space ventilation (VD/VT ratio), minute ventilation (VE) to CO2 production relationship (VE/VCO2-slope), partial end-tidal CO2 tension (PETCO2), and the VE to the work rate (VE/WR) ratio were examined. VO2peak was significantly reduced in CF patients (P = 0.01). We found no differences in breathing pattern between both groups, except for a significantly higher VE at rest and a trend towards a lower VE at peak exercise in patients with CF. Significantly higher values were found for the estimated VD/VT ratio throughout the CPET in CF patients (P < 0.01). VE/VCO2-slope and PETCO2 values differed not between the two groups throughout the CPET. VE/WR ratio values were significantly higher in CF during the entire range of the CPET (P < 0.01). This study found an exaggerated ventilatory response (high VE/WR ratio values), which was adequate for CO2 exhalation (normal VE/VCO2-slope and PETCO2 values) during progressive exercise up to maximal exhaustion in CF patients with mild-to-moderate airway obstruction.
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Affiliation(s)
- Bart C Bongers
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands ; Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten S Werkman
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands ; De Kinderkliniek, Almere, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik H J Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Collaco JM, Blackman SM, Raraigh KS, Morrow CB, Cutting GR, Paranjape SM. Self-reported exercise and longitudinal outcomes in cystic fibrosis: a retrospective cohort study. BMC Pulm Med 2014; 14:159. [PMID: 25287419 PMCID: PMC4195986 DOI: 10.1186/1471-2466-14-159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is characterized by recurrent respiratory infections and progressive lung disease. Whereas exercise may contribute to preserving lung function, its benefit is difficult to ascertain given the selection bias of healthier patients being more predisposed to exercise. Our objective was to examine the role of self-reported exercise with longitudinal lung function and body mass index (BMI) measures in CF. METHODS A total of 1038 subjects with CF were recruited through the U.S. CF Twin-Sibling Study. Questionnaires were used to determine exercise habits. Questionnaires, chart review, and U.S. CF Foundation Patient Registry data were used to track outcomes. RESULTS Within the study sample 75% of subjects self-reported regular exercise. Exercise was associated with an older age of diagnosis (p = 0.002), older age at the time of ascertainment (p < 0.001), and higher baseline FEV1 (p = 0.001), but not CFTR genotype (p = 0.64) or exocrine pancreatic function (p = 0.19). In adjusted mixed models, exercise was associated with both a reduced decline in FEV1 (p < 0.001) and BMI Z-score (p = 0.001) for adults, but not children aged 10-17 years old. CONCLUSIONS In our retrospective study, self-reported exercise was associated with improved longitudinal nutritional and pulmonary outcomes in cystic fibrosis for adults. Although prospective studies are needed to confirm these associations, programs to promote regular exercise among individuals with cystic fibrosis would be beneficial.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, 21287 Baltimore, MD USA
| | - Scott M Blackman
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, 21287 Baltimore, MD USA
| | - Karen S Raraigh
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, 21287 Baltimore, MD USA
| | - Christopher B Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, 21287 Baltimore, MD USA
| | - Garry R Cutting
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, 21287 Baltimore, MD USA
| | - Shruti M Paranjape
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, David M. Rubenstein Building, 200 North Wolfe Street, 21287 Baltimore, MD USA
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Brun J, Roubille C, Le Quellec A, Mercier J. Une nouvelle observation d’intolérance à l’effort avec hypokaliémie chez un porteur sain de la mucoviscidose. Sci Sports 2014. [DOI: 10.1016/j.scispo.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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van de Weert-van Leeuwen PB, Arets HGM, van der Ent CK, Beekman JM. Infection, inflammation and exercise in cystic fibrosis. Respir Res 2013; 14:32. [PMID: 23497303 PMCID: PMC3599254 DOI: 10.1186/1465-9921-14-32] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/17/2013] [Indexed: 01/13/2023] Open
Abstract
Regular exercise is positively associated with health. It has also been suggested to exert anti-inflammatory effects. In healthy subjects, a single exercise session results in immune cell activation, which is characterized by production of immune modulatory peptides (e.g. IL-6, IL-8), a leukocytosis and enhanced immune cell functions. Upon cessation of exercise, immune activation is followed by a tolerizing phase, characterized by a reduced responsiveness of immune cells. Regular exercise of moderate intensity and duration has been shown to exert anti-inflammatory effects and is associated with a reduced disease incidence and viral infection susceptibility. Specific exercise programs may therefore be used to modify the course of chronic inflammatory and infectious diseases such as cystic fibrosis (CF).Patients with CF suffer from severe and chronic pulmonary infections and inflammation, leading to obstructive and restrictive pulmonary disease, exercise intolerance and muscle cachexia. Inflammation is characterized by a hyper-inflammatory phenotype. Patients are encouraged to engage in exercise programs to maintain physical fitness, quality of life, pulmonary function and health.In this review, we present an overview of available literature describing the association between regular exercise, inflammation and infection susceptibility and discuss the implications of these observations for prevention and treatment of inflammation and infection susceptibility in patients with CF.
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Rand S, Prasad SA. Exercise as part of a cystic fibrosis therapeutic routine. Expert Rev Respir Med 2012; 6:341-51; quiz 352. [PMID: 22788948 DOI: 10.1586/ers.12.19] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The role of exercise in cystic fibrosis (CF) is well established, and over the last three decades it has become an important component in the management of all individuals with CF. The role of exercise as a prognostic indicator or therapeutic tool is an important area of research interest in CF care internationally. This article summarizes the currently available evidence regarding exercise capacity in CF, the potential effects of exercise on health outcomes in CF and the challenges faced when trying to incorporate exercise into a CF therapeutic routine, and highlights some methods to facilitate the incorporation of exercise into CF therapeutic routines.
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Affiliation(s)
- Sarah Rand
- Cystic Fibrosis Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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22
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Hughes DC, Day SH, Ahmetov II, Williams AG. Genetics of muscle strength and power: polygenic profile similarity limits skeletal muscle performance. J Sports Sci 2011; 29:1425-34. [PMID: 21867446 DOI: 10.1080/02640414.2011.597773] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Environmental and genetic factors influence muscle function, resulting in large variations in phenotype between individuals. Multiple genetic variants (polygenic in nature) are thought to influence exercise-related phenotypes, yet how the relevant polymorphisms combine to influence muscular strength in individuals and populations is unclear. In this analysis, 22 genetic polymorphisms were identified in the literature that have been associated with muscular strength and power phenotypes. Using typical genotype frequencies, the probability of any given individual possessing an "optimal" polygenic profile was calculated as 0.0003% for the world population. Future identification of additional polymorphisms associated with muscular strength phenotypes would most likely reduce that probability even further. To examine the genetic potential for muscular strength within a human population, a "total genotype score" was generated for each individual within a hypothetical population of one million. The population expressed high similarity in polygenic profile with no individual differing by more than seven genotypes from a typical profile. Therefore, skeletal muscle strength potential within humans appears to be limited by polygenic profile similarity. Future research should aim to replicate more genotype-phenotype associations for muscular strength, because only five common genetic polymorphisms identified to date have positive replicated findings.
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Affiliation(s)
- David C Hughes
- Institute for Performance Research, Manchester Metropolitan University, Crewe, UK.
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23
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Shephard RJ. Lifestyle and the Respiratory Health of Children. Am J Lifestyle Med 2011. [DOI: 10.1177/1559827610378337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article offers a review of the potential influences of personal lifestyle on respiratory health in children, looking at both healthy individuals and those with respiratory disorders. As with many aspects of health, regular physical activity, an appropriate diet, and avoidance of obesity and cigarette smoke all contribute to optimal development of the healthy child. An active lifestyle is associated with greater static and dynamic lung volumes, greater efficiency of the ventilatory process, and an optimization of breathing patterns. The risk of upper respiratory infections is also reduced in those maintaining a moderate level of physical activity. Maternal smoking during pregnancy, as well as active and passive smoking, all have an adverse influence on lung function in the child, the largest effects being on dynamic lung volumes. The risk of developing asthma seems reduced in children who maintain a normal body mass and are physically active. A program of graded physical activity is of therapeutic value in a number of established respiratory conditions, including asthma, cystic fibrosis, and ventilatory impairment from neuromuscular disorders. Exercise carries a slight risk of fatalities from asthma and anaphylactic reactions. In designing an optimal physical activity program, it is also important to guard against the hazards of deep oronasal breathing, including the precipitation of bronchospasm by the inhalation of cold, dry air and pollens; an increased exposure to atmospheric pollutants (reducing and oxidant smog, fine and ultra-fine particulates, and carbon monoxide); and possible long-term dangers from chlorine derivatives in the atmosphere of indoor swimming pools.
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Affiliation(s)
- Roy J. Shephard
- Faculty of Physical Education and Health, University of Toronto, Toronto, ON, Canada,
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24
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McBride MG, Schall JI, Zemel BS, Stallings VA, Ittenbach RF, Paridon SM. Clinical and genetic correlates of exercise performance in young children with cystic fibrosis. Percept Mot Skills 2010; 110:995-1009. [PMID: 20865986 DOI: 10.2466/pms.110.c.995-1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exercise performance in individuals with cystic fibrosis has been shown to be related to the extent of pulmonary dysfunction and undernutrition and genetic profile. The aim of this study was to examine these relationships in young children with cystic fibrosis. The participants were 64 children ages 8 to 11 years (M = 9.3, SD = 0.9) with cystic fibrosis and pancreatic insufficiency recruited from 13 different U.S. cystic fibrosis centers. Assigned to one of three groups by deltaF508 status: deltaF508/deltaF508 homozygous, deltaF508/Other heterozygous, and Other/Other, growth, nutritional and pulmonary status, and exercise performance were measured. Differences in exercise performance, pulmonary function, and nutritional status were not observed among the three groups. However, undernutrition and decreased pulmonary function were associated with measures of exercise performance. These results imply no effect of deltaF508 status on overall functional capacity during preadolescence in children with cystic fibrosis. Rather, the extent of pulmonary disease and undernutrition were associated with functional performance.
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Affiliation(s)
- Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, PA 19104, USA
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25
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Exercise training in children and adolescents with cystic fibrosis: theory into practice. Int J Pediatr 2010; 2010. [PMID: 20886030 PMCID: PMC2945676 DOI: 10.1155/2010/670640] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 05/31/2010] [Accepted: 08/23/2010] [Indexed: 11/17/2022] Open
Abstract
Physical activity and exercise training play an important role in the clinical management of patients with cystic fibrosis (CF). Exercise training is more common and recognized as an essential part of rehabilitation programmes and overall CF care. Regular exercise training is associated with improved aerobic and anaerobic capacity, higher pulmonary function, and enhanced airway mucus clearance. Furthermore, patients with higher aerobic fitness have an improved survival. Aerobic and anaerobic training may have different effects, while the combination of both have been reported to be beneficial in CF. However, exercise training remains underutilised and not always incorporated into routine CF management. We provide an update on aerobic and anaerobic responses to exercise and general training recommendations in children and adolescents with CF. We propose that an active lifestyle and exercise training are an efficacious part of regular CF patient management.
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Karila C, Ravilly S, Gauthier R, Tardif C, Neveu H, Maire J, Ramel S, Cracowski C, Legallais P, Foure H, Halm AM, Saugier J, Bordas G, Loire N, Kirszenbaum M, Dassonville J, Mely L, Wuyam B, Giovannetti P, Ouksel H, Ellaffi M, Denjean A. Activité physique et réentraînement à l’effort du patient atteint de mucoviscidose. Rev Mal Respir 2010; 27:301-13. [DOI: 10.1016/j.rmr.2010.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/03/2010] [Indexed: 11/26/2022]
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Abstract
Exercise is an important aspect of health and development in children. By placing the pulmonary system under stress, exercise testing may reveal subtle dynamic abnormalities that are not apparent on conventional static pulmonary function tests. Furthermore, exercise testing assesses the functional impact of respiratory disease on children. Exercise testing has been used in children with a variety of respiratory diseases such as exercise induced bronchoconstriction, asthma, cystic fibrosis and bronchopulmonary dysplasia to assess the severity of disease as well as response to various interventions. Furthermore, there is good evidence that exercise testing is a useful tool to help determine prognosis in patients with cystic fibrosis. In addition to the clinical utility, exercise testing is also becoming an increasingly important outcome measure in research studies.
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Affiliation(s)
- Oon Hoe Teoh
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney.
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28
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Lack of CFTR in skeletal muscle predisposes to muscle wasting and diaphragm muscle pump failure in cystic fibrosis mice. PLoS Genet 2009; 5:e1000586. [PMID: 19649303 PMCID: PMC2709446 DOI: 10.1371/journal.pgen.1000586] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 07/03/2009] [Indexed: 11/19/2022] Open
Abstract
Cystic fibrosis (CF) patients often have reduced mass and strength of skeletal muscles, including the diaphragm, the primary muscle of respiration. Here we show that lack of the CF transmembrane conductance regulator (CFTR) plays an intrinsic role in skeletal muscle atrophy and dysfunction. In normal murine and human skeletal muscle, CFTR is expressed and co-localized with sarcoplasmic reticulum-associated proteins. CFTR-deficient myotubes exhibit augmented levels of intracellular calcium after KCl-induced depolarization, and exposure to an inflammatory milieu induces excessive NF-kB translocation and cytokine/chemokine gene upregulation. To determine the effects of an inflammatory environment in vivo, sustained pulmonary infection with Pseudomonas aeruginosa was produced, and under these conditions diaphragmatic force-generating capacity is selectively reduced in Cftr(-/-) mice. This is associated with exaggerated pro-inflammatory cytokine expression as well as upregulation of the E3 ubiquitin ligases (MuRF1 and atrogin-1) involved in muscle atrophy. We conclude that an intrinsic alteration of function is linked to the absence of CFTR from skeletal muscle, leading to dysregulated calcium homeostasis, augmented inflammatory/atrophic gene expression signatures, and increased diaphragmatic weakness during pulmonary infection. These findings reveal a previously unrecognized role for CFTR in skeletal muscle function that may have major implications for the pathogenesis of cachexia and respiratory muscle pump failure in CF patients.
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29
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Bray MS, Hagberg JM, Pérusse L, Rankinen T, Roth SM, Wolfarth B, Bouchard C. The human gene map for performance and health-related fitness phenotypes: the 2006-2007 update. Med Sci Sports Exerc 2009; 41:35-73. [PMID: 19123262 DOI: 10.1249/mss.0b013e3181844179] [Citation(s) in RCA: 293] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This update of the human gene map for physical performance and health-related fitness phenotypes covers the research advances reported in 2006 and 2007. The genes and markers with evidence of association or linkage with a performance or a fitness phenotype in sedentary or active people, in responses to acute exercise, or for training-induced adaptations are positioned on the map of all autosomes and sex chromosomes. Negative studies are reviewed, but a gene or a locus must be supported by at least one positive study before being inserted on the map. A brief discussion on the nature of the evidence and on what to look for in assessing human genetic studies of relevance to fitness and performance is offered in the introduction, followed by a review of all studies published in 2006 and 2007. The findings from these new studies are added to the appropriate tables that are designed to serve as the cumulative summary of all publications with positive genetic associations available to date for a given phenotype and study design. The fitness and performance map now includes 214 autosomal gene entries and quantitative trait loci plus seven others on the X chromosome. Moreover, there are 18 mitochondrial genes that have been shown to influence fitness and performance phenotypes. Thus,the map is growing in complexity. Although the map is exhaustive for currently published accounts of genes and exercise associations and linkages, there are undoubtedly many more gene-exercise interaction effects that have not even been considered thus far. Finally, it should be appreciated that most studies reported to date are based on small sample sizes and cannot therefore provide definitive evidence that DNA sequence variants in a given gene are reliably associated with human variation in fitness and performance traits.
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Affiliation(s)
- Molly S Bray
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
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Stevens D, Oades PJ, Armstrong N, Williams CA. Early oxygen uptake recovery following exercise testing in children with chronic chest diseases. Pediatr Pulmonol 2009; 44:480-8. [PMID: 19382220 DOI: 10.1002/ppul.21024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The value of exercise testing as an objective measure of disease severity in patients with chronic chest diseases (CCD) is becoming increasingly recognized. The aim of this study was to investigate changes in oxygen uptake (VO2) during early recovery following maximal cardiopulmonary exercise testing (CPXT) in relation to functional capacity and markers of disease severity. Twenty-seven children with CCD (age 12.7 +/- 3.1 years; 17 female) [19 children with Cystic fibrosis (CF) (age 13.4 +/- 3.1 years; 10 female) and 8 with other stable non-CF chest diseases (NON-CF) (age 11.1 +/- 2.2 years; 7 female)] and 27 healthy controls (age 13.2 +/- 3.3 years; 17 female) underwent CPXT on a cycle ergometer. On-line respiratory gas analysis measured VO2 before and during CPXT to peak VO2) (VO2(peak)), and during the first 10 min of recovery. Early VO2 recovery was quantified by the time (sec) to reach 50% of the VO2 (peak) value. Early VO2 recovery was correlated against spirometry [forced expiratory volume in 1 sec (FEV(1)) and forced expiratory flow between 25% and 75% of the forced vital capacity (FEF(25-75))] and aerobic fitness (VO2)(peak)) as a measure of functional capacity. Disease severity was graded in the CF patients by the Shwachman score (SS). Compared to controls, children with CCD demonstrated a significantly reduced VO2(peak) (P = 0.011), FEV(1) (P < 0.001), FEF(25-75) (P < 0.001), and a significantly prolonged early (VO2) recovery (P = 0.024). In the CF patients the SS was significantly correlated with early VO2 recovery (r = -0.63, P = 0.004), FEV(1) (r = 0.72, P = 0.001), and FEF(25-75) (r = 0.57, P = 0.011). In the children with CCD, FEV(1), FEF(25-75), and BMI were not significantly correlated with VO2(peak) or early VO2 recovery. Lung function does not necessarily reflect aerobic fitness and the ability to recover from exercise in these patients. A significant relationship was found between VO2(peak) and early VO2 recovery (r = -0.39, P = 0.044) in the children with CCD, showing that a greater aerobic fitness corresponded with a faster recovery.
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Affiliation(s)
- D Stevens
- Children's Health and Exercise Research Centre, School of Sport and Health Sciences, University of Exeter, Exeter, Devon, UK
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31
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Rosenthal M, Narang I, Edwards L, Bush A. Non-invasive assessment of exercise performance in children with cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis: is there a CF specific muscle defect? Pediatr Pulmonol 2009; 44:222-30. [PMID: 19206180 DOI: 10.1002/ppul.20899] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Peripheral muscle dysfunction is increasingly recognized as complicating respiratory disease, but this is difficult to measure non-invasively. RESEARCH QUESTION Can skeletal muscle function and efficiency be measured during exercise non-invasively using respiratory mass spectrometry (RMS); and is the known exercise dysfunction in cystic fibrosis (CF) children related in part to a disease specific defect of skeletal muscle, or a non-specific manifestation of chronic airway infection and inflammation. METHODS Calculations of effective pulmonary blood flow and stroke volume, blood oxygen content and oxygen dispatch from the lungs, skeletal muscle oxygen extraction and consumption, anerobic threshold and capacity, and gross, net and work efficiency in 106 controls and 36 children (18 CF) with bronchiectasis, all aged from 8 to 17 years. RESULTS Normal values for control subjects are tabulated. CF and non-CF bronchiectatic subjects had similar physiology, and skeletal muscle abnormalities could not be detected. Reduced oxygen dispatch from the lungs, due to an inability to raise stroke volume, without an increase in functional residual capacity was the major factor in reduced exercise ability. CONCLUSIONS Non-invasive RMS can be used to determine skeletal muscle function in children. The changes observed in CF subjects were very similar to non-CF bronchiectatic subjects and thus a CF specific defect was not demonstrated.
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Abstract
PURPOSE To review the most common field and laboratory exercise tests available for children and adolescents with cystic fibrosis (CF). METHODS Relevant studies for this review were identified by electronic search of Medline and PubMed databases between the years 1958 and 2008. The bibliographies of all accessed publications were also searched. Key descriptors were cystic fibrosis, exercise testing, aerobic fitness, children, and adolescents. RESULTS Five field tests were selected for presentation, including discussion of their strengths and weaknesses. Laboratory tests measuring aerobic and anaerobic responses to exercise in children with CF were also selected for presentation and discussed along with a summary of safety considerations for exercise testing of children with CF. CONCLUSION Exercise testing is regarded an important prognostic tool in CF care. However, despite its beneficial effects, clinical exercise testing seems underused. Clinicians and their staff should encourage patients with CF to be physically active and recommend exercise testing annually.
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Hind K, Truscott JG, Conway SP. Exercise during childhood and adolescence: a prophylaxis against cystic fibrosis-related low bone mineral density? Exercise for bone health in children with cystic fibrosis. J Cyst Fibros 2008; 7:270-276. [PMID: 18378195 DOI: 10.1016/j.jcf.2008.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/01/2008] [Accepted: 02/04/2008] [Indexed: 12/01/2022]
Abstract
Inadequate bone mineral accrual during growth and accelerated bone demineralisation in adulthood are recognised as additional and serious complications for patients with cystic fibrosis (CF). However, little attention has been given to preventative strategies for this population. Inadequate bone accrual during childhood and adolescence, and premature bone loss, lead to a failure to attain an optimal peak bone mass, osteoporosis and fracture in patients with CF. Pharmaceutical treatments may assist in the improvement of bone in patients with CF, but these are usually not preferable for use in children. Evidence indicates that regular, weight-bearing exercise significantly enhances bone accrual in healthy children. This paper reviews the literature concerning the potential for weight-bearing exercise to improve bone mineral accrual in children with CF. All relevant literature since 1979 was obtained and reviewed from the Medline, PubMed, Cochrane and PEDro data base. Evidence concerning the efficacy of exercise for bone health in CF is lacking. There have been no controlled trials investigating the value of weight-bearing exercise for bone accrual in children with CF. As exercise may offer an effective and enjoyable strategy to improve the bone development in children who have CF, exercise should be a high priority for randomised controlled trials in this population.
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Affiliation(s)
- K Hind
- Carnegie Research Institute, Faculty of Sport and Education, Leeds Metropolitan University, Headingley Campus, Leeds, LS6 3QS, UK.
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Serisier DJ, Coates AD, Bowler SD. Effect of Albuterol on Maximal Exercise Capacity in Cystic Fibrosis. Chest 2007; 131:1181-7. [PMID: 17426226 DOI: 10.1378/chest.06-1697] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Inhaled, short-acting beta-adrenergic agonists (SAbetaAs) are widely prescribed in cystic fibrosis (CF) subjects, despite a lack of convincing data for efficacy and the potential for these agents to result in airway instability. We tested the hypothesis that inhaled albuterol would improve maximal exercise performance in CF subjects with airflow obstruction, as a result of acute bronchodilation. METHODS Randomized, double-blind, placebo-controlled crossover study of the effect of inhaled albuterol on maximal exercise performance in 20 stable adult CF patients (mean +/- SD age, 23.3 +/- 6.1 years; FEV(1), 57.65 +/- 17.13% of predicted). RESULTS Ventilatory limitation to exercise was demonstrated in 16 subjects (80%). Significant bronchodilation occurred with exercise alone (end-exercise FEV(1), 2.24 +/- 0.8 L; vs preexercise FEV(1), 2.09 +/- 0.77 L; p < 0.0001), but albuterol resulted in significantly greater exercise-induced bronchodilation than placebo (change in FEV(1), 0.3 +/- 0.15 L vs 0.15 +/- 0.11 L; 95% confidence interval [CI], + 0.07 to + 0.23; p < 0.001). However, there was no difference in maximal workload achieved (albuterol, 158 +/- 46 W; vs placebo, 158 +/- 45 W; 95% CI, - 4.41 to + 4.71; p = 0.95), nor any other measure of exercise performance including maximal oxygen uptake. CONCLUSIONS Despite causing significant acute bronchodilation, inhaled albuterol did not improve maximal exercise performance in ventilatory-limited CF adults, adding to the body of literature that fails to show any clinical benefit of SAbetaAs in CF subjects. The current results provide further evidence to question the widespread use of these agents, although the potential for adrenergic beta-agonists to instead improve submaximal exercise performance merits further investigation.
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Affiliation(s)
- David J Serisier
- DM, Department of Respiratory Medicine, Mater Adult Hospital, South Brisbane, QLD 4101, Australia.
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Rankinen T, Bray MS, Hagberg JM, Pérusse L, Roth SM, Wolfarth B, Bouchard C. The human gene map for performance and health-related fitness phenotypes: the 2005 update. Med Sci Sports Exerc 2007; 38:1863-88. [PMID: 17095919 DOI: 10.1249/01.mss.0000233789.01164.4f] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The current review presents the 2005 update of the human gene map for physical performance and health-related fitness phenotypes. It is based on peer-reviewed papers published by the end of 2005. The genes and markers with evidence of association or linkage with a performance or fitness phenotype in sedentary or active people, in adaptation to acute exercise, or for training-induced changes are positioned on the genetic map of all autosomes and the X chromosome. Negative studies are reviewed, but a gene or locus must be supported by at least one positive study before being inserted on the map. By the end of 2000, in the early version of the gene map, 29 loci were depicted. In contrast, the 2005 human gene map for physical performance and health-related phenotypes includes 165 autosomal gene entries and QTL, plus five others on the X chromosome. Moreover, there are 17 mitochondrial genes in which sequence variants have been shown to influence relevant fitness and performance phenotypes. Thus, the map is growing in complexity. Unfortunately, progress is slow in the field of genetics of fitness and performance, primarily because the number of laboratories and scientists focused on the role of genes and sequence variations in exercise-related traits continues to be quite limited.
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Affiliation(s)
- Tuomo Rankinen
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808-4124, USA
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36
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Abstract
Submaximal endurance cycle ergometer exercise tests are used to measure the efficacy of an exercise intervention, but the repeatability of these tests in patients with cystic fibrosis (CF) has not been established. The purpose of this study was to examine the repeatability of submaximal endurance testing in stable CF. Fifteen adults with CF underwent two submaximal endurance tests carried out over a 7-day period. A subset of six subjects returned 28 days later for a third submaximal endurance test. Workload was set at 80% of maximum workload and exercise was performed to exhaustion. Oxygen consumption, minute ventilation, tidal volume, carbon dioxide output, respiratory rate, heart rate, and oxygen saturation were measured at rest, at end exercise and at four matched times during the submaximal endurance tests (20, 40, 60, and 80% of exercise duration calculated from the first endurance test). Submaximal endurance test time was highly repeatable with no significant learning effect identified on multiple testing. Submaximal endurance exercise time demonstrated a variability of 5.7% which is consistent with high levels of repeatability. Metabolic, ventilatory and cardiac variables were all also highly reproducible between test days. Submaximal endurance testing is repeatable in stable CF, confirming that submaximal endurance tests are a reliable tool for assessment of therapeutic benefit in patients with CF.
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Affiliation(s)
- Sinead C Barry
- Department of Respiratory Medicine and National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Dublin, Ireland.
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Dodd JD, Barry SC, Gallagher CG. Respiratory factors do not limit maximal symptom-limited exercise in patients with mild cystic fibrosis lung disease. Respir Physiol Neurobiol 2006; 152:176-85. [PMID: 16169290 DOI: 10.1016/j.resp.2005.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 08/06/2005] [Accepted: 08/08/2005] [Indexed: 11/29/2022]
Abstract
To evaluate whether respiratory factors limit exercise capacity in patients with mild cystic fibrosis (CF) lung disease (mean FEV(1) = 76 +/- 7.7% predicted) we stressed the respiratory system of seven patients using added dead space (V(D)). Primary outcomes were exercise duration (Ex(dur)) and maximal oxygen uptake (VO(2max)). Dyspnoea/leg-discomfort were assessed at end-exercise. Ex(dur) was identical between control and V(D) studies (520 +/- 152 versus 511 +/ -166 s, p = NS) as was VO(2max)(1.6 +/- 0.5 versus 1.6 +/- 0.6 L/min, p = NS). Significant resting, sub-maximal and maximal workload increases in minute ventilation (V(E)) were detected (70.8 +/- 13.7 versus 79.5 +/- 16.9 L/min, p < 0.05). Analysis of breathing pattern revealed increases in V(E) were attributable to increases in tidal volume (2.0 +/- 0.5 versus 2.2 +/- 0.6 L, p < 0.05) with no change in respiratory frequency. There was no difference in dyspnoea/leg discomfort between tests. The increase in V(E) in response to V(D), with no change in [Exdur/VO(2max) suggests maximal symptom-limited exercise limitation is not primarily limited by respiratory factors in mild CF lung disease. Focused investigation and treatment of non-respiratory factors contributing to exercise limitation may improve exercise rehabilitation in this patient group.
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Affiliation(s)
- Jonathan D Dodd
- Department of Respiratory Medicine and National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Dublin, Ireland.
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38
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Pianosi P, LeBlanc J, Almudevar A. Relationship between FEV1 and peak oxygen uptake in children with cystic fibrosis. Pediatr Pulmonol 2005; 40:324-9. [PMID: 16082708 DOI: 10.1002/ppul.20277] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cross-sectional data do not truly convey the manner in which declining lung function affects peak oxygen uptake (peak VO2) within a given patient with cystic fibrosis. We hypothesized that there would be a concomitant decline in peak VO2 with FEV1 over time. Twenty-eight children aged 8-17 years with cystic fibrosis performed annual ergometer tests over a 5-year period to determine peak VO2 and within-patient predictors of change in peak VO2. Analysis was done using a mixed-effects model. During the study period, the annual decline in FEV1 averaged 2.7% of the predicted value per year. Peak VO2 fell during the observation period in 70% of patients, with an average annualized decline of 1.9 ml x min(-1) x kg(-1). This rate of decline was greater in older children in contrast to younger children, some of whom had an improvement in peak VO2 over the first few years, consistent with growth and maturation. There was no difference in this rate of decline between sexes, but girls started with a slightly lower peak VO2 (37.9 vs. 45.1 ml x min(-1) x kg(-1)). In patients with FEV1 <80% predicted, declining FEV1 was highly correlated with falling peak VO2, whereas it remained stable over 4-5 years in patients whose FEV1 was >80% predicted and remained in that range. We conclude that peak VO2 remains stable or rises slightly over time in younger patients, while it shows a downward trend in older children with CF, particularly once FEV1 falls below 80% predicted. Peak VO2 is correlated with FEV1 during childhood in patients with cystic fibrosis, and both FEV1 and age influence peak VO2.
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Affiliation(s)
- Paul Pianosi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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39
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Clain J, Lehmann-Che J, Duguépéroux I, Arous N, Girodon E, Legendre M, Goossens M, Edelman A, de Braekeleer M, Teulon J, Fanen P. Misprocessing of theCFTRprotein leads to mild cystic fibrosis phenotype. Hum Mutat 2005; 25:360-71. [PMID: 15776432 DOI: 10.1002/humu.20156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cystic fibrosis (CF) is mainly caused by mutations that interfere with the biosynthetic folding of the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel. The aim of this study was to determine the mechanism of dysfunction of a disease-causing mutation associated with variable phenotypes. In order to attain these objectives, we studied the effect of the p.L206W mutation on CFTR protein production and function, and we examined the genotype-phenotype correlation of [p.L206W]+[p.F508del] patients. We showed that p.L206W is a processing (class II) mutation since the CFTR biosynthetic pathway was severely impaired, whereas single-channel measurements indicated ion conductance similar to the wild-type protein. These data raise the larger question of the phenotypic variability of class II mutants, including p.F508del. Since multiple potential partners could modify the processing of the CFTR protein during its course to the cell surface, environmental and other genetic factors might contribute to this variability.
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Affiliation(s)
- Jérôme Clain
- Institut National de la Santé et de la Recherche Médicale (INSERM) U. 468, Hôpital Henri Mondor, Créteil, France
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40
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Abstract
BACKGROUND Single measurements of peak oxygen uptake (VO2) have been shown to predict mortality in patients with cystic fibrosis (CF) although no longitudinal study of serial measurements has been reported in children. A study was undertaken to determine whether the initial, final, or the rate of fall of forced expiratory volume in 1 second (FEV1) or peak VO2 was a better predictor of mortality. METHODS Twenty eight children aged 8-17 years with CF performed annual pulmonary function and maximal exercise tests over a 5 year period to determine FEV1 and peak VO2, magnitude of their change over time, and survival over the subsequent 7-8 years. Analysis was done using Kaplan-Meier curves and Cox proportional hazard model. RESULTS Peak VO2 fell during the observation period in 70% of the patients, with a mean annual decline of 2.1 ml/min/kg. Initial peak VO2 was not predictive of mortality but rate of decline and final peak VO2 of the series were significant predictors. Patients with peak VO2 less than 32 ml/min/kg exhibited a dramatic increase in mortality, in contrast to those whose peak VO2 exceeded 45 ml/min/kg, none of whom died. The first, last, and rate of decline in FEV1 over time were all significant predictors of mortality. CONCLUSIONS Higher peak VO2 is a marker for longer survival in CF patients.
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Affiliation(s)
- P Pianosi
- Department of Pediatrics, Dalhousie University, Halifax, Canada B3J 3G9.
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41
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Hebestreit H, Hebestreit A, Trusen A, Hughson RL. Oxygen Uptake Kinetics Are Slowed in Cystic Fibrosis. Med Sci Sports Exerc 2005; 37:10-7. [PMID: 15632661 DOI: 10.1249/01.mss.0000150065.97657.7b] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE There are conflicting reports on the kinetics of oxygen uptake at the onset of exercise in patients with cystic fibrosis (CF). The objective of the present study was, therefore, to compare oxygen uptake (VO(2) kinetics in patients with CF with those of healthy controls (CON). METHODS Eighteen CF patients (FEV1 37-98% predicted) and 15 CON aged 10-33 yr completed two to four transitions from low-intensity cycling (stage 1, 20 W) to cycling at 1.3-1.4 W.kg(-1) body weight (stage 2). There was no difference between groups in heart rate at stages 1 and 2 or in relative exercise intensity, as expressed as percent VO(2peak) or percentage of ventilatory threshold. However, oxygen saturation (SpO(2)) was lower in the patients with CF during both stages. VO(2) data were interpolated second by second, time-aligned, and averaged. Monoexponential equations were used to describe phase II VO(2) responses. RESULTS Although there were no differences between CF and CON in amplitude (10.9 +/- 1.8 vs 10.2 +/- 1.6 mL O2.W(-1)) of phase II VO(2) response, the time constant tau was significantly prolonged in CF compared with CON (36.8 +/- 13.6 vs 26.4 +/- 9.1 s). When tau was adjusted for the effects of FEV1 or SpO(2) during submaximal exercise, the difference between CF patients and controls disappeared. CONCLUSION VO(2) kinetics are slowed in CF, which may, in part, be attributed to an impairment of oxygen delivery.
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Affiliation(s)
- Helge Hebestreit
- Department of Pediatrics, Julius-Maximilians University, 97080 Würzburg, Germany.
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42
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Rankinen T, Pérusse L, Rauramaa R, Rivera MA, Wolfarth B, Bouchard C. The human gene map for performance and health-related fitness phenotypes: the 2003 update. Med Sci Sports Exerc 2004; 36:1451-69. [PMID: 15354024 DOI: 10.1249/01.mss.0000139902.42385.5f] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review presents the 2003 update of the human gene map for physical performance and health-related fitness phenotypes. It is based on peer-reviewed papers published by the end of 2003 and includes association studies with candidate genes, genome-wide scans with polymorphic markers, and single-gene defects causing exercise intolerance to variable degrees. The genes and markers with evidence of association or linkage with a performance or fitness phenotype in sedentary or active people, in adaptation to acute exercise, or for training-induced changes are positioned on the genetic map of all autosomes and the X chromosome. Negative studies are reviewed but a gene or locus must be supported by at least one positive study before being inserted on the map. By the end of 2000, 29 loci were depicted on the first edition of the map. In contrast, the 2003 human gene map for physical performance and health-related phenotypes includes 109 autosomal gene entries and QTL, plus two on the X chromosome. Moreover, there are 15 mitochondrial genes in which sequence variants have been shown to influence relevant fitness and performance phenotypes.
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Affiliation(s)
- Tuomo Rankinen
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808-4124, USA.
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43
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Silva OBE, Saraiva LCR. Indicações do teste ergométrico em crianças e adolescentes. REV BRAS MED ESPORTE 2004. [DOI: 10.1590/s1517-86922004000500009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O teste ergométrico (TE) é um procedimento de baixo risco e com complicações extremamente raras, principalmente na população pediátrica. Nesta revisão são apresentadas as principais indicações do TE nas crianças e adolescentes (idade até 19 anos), como um método de avaliação diagnóstica, prognóstica e funcional em diversas situações: avaliação da capacidade física, avaliação de sintomas relacionados ao exercício, avaliação de tratamento clínico e cirúrgico em portadores de miocardiopatias, cardiopatias congênitas e valvares, asmáticos e avaliação pré-participação em programas de atividades físicas, entre outras.
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Abstract
Cystic fibrosis (CF) is a life-limiting inherited disorder characterised by pulmonary disease, pancreatic dysfunction and symptoms of malnutrition that are all interrelated with low exercise capacity and poor survival rate. Therapy with growth hormone (GH) may improve the reduced dimensional and functional capacity associated with poor nutritional status and catabolism and therefore improve exercise tolerance, quality of life and survival rate in patients with CF. The literature about GH treatment and its effect on exercise tolerance are rather limited, not always consistent and methodological concerns restrict further analysis. GH treatment may have beneficial effects on both growth and exercise tolerance without serious complications in prepubertal children with CF. The observed dimensional changes of the muscular, cardiovascular and pulmonary system seem to improve aerobic exercise capacity and respiratory and peripheral muscle strength. The physiological background of the observed changes is not yet fully understood, therefore, larger-scale studies with an optimised design are required.
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Affiliation(s)
- Matthias Hütler
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
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45
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Selvadurai HC, Allen J, Sachinwalla T, Macauley J, Blimkie CJ, Van Asperen PP. Muscle Function and Resting Energy Expenditure in Female Athletes with Cystic Fibrosis. Am J Respir Crit Care Med 2003; 168:1476-80. [PMID: 14500260 DOI: 10.1164/rccm.200303-363oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pathophysiology of impaired exercise tolerance in patients with cystic fibrosis (CF) is not completely understood. The objective of this study was to compare exercise ability (at clinical and cellular levels) and resting energy expenditure in female athletes with CF compared with matched control subjects. Sixteen subjects and matched control subjects participated in the study. The girls with CF not only had a significantly greater resting energy expenditure (7.6% higher; p<0.05), their habitual daily activity was also significantly greater than that of control subjects (15% greater; p<0.01). Peak aerobic capacity was similar in both groups. However, peak anaerobic power was 20% less (p<0.05) in girls with CF. The 31P magnetic resonance spectroscopy studies demonstrated that there were no differences between the groups at rest, but at 25% total work output the girls with CF were less acidotic (CF, pH 6.99 [0.06]; control subjects, 6.90 [0.05]) and had a significantly lower inorganic phosphorus-to-phosphocreatine ratio (CF, 0.34 [0.07]; control subjects, 0.41 [0.08]). These differences continued to increase to maximal exercise. This study demonstrates that in spite of normal lung function and good nutritional status, females athletes with CF still had significant deficiencies in some measures of fitness and muscle metabolism compared with healthy athletes.
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Affiliation(s)
- Hiran C Selvadurai
- Department of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, M5G 1X8 Canada.
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46
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Klijn PH, Terheggen-Lagro SW, Van Der Ent CK, Van Der Net J, Kimpen JL, Helders PJ. Anaerobic exercise in pediatric cystic fibrosis. Pediatr Pulmonol 2003; 36:223-9. [PMID: 12910584 DOI: 10.1002/ppul.10337] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Anaerobic fitness is important for daily functioning of children with cystic fibrosis (CF). The aim of this study was to assess the determinants of anaerobic performance in CF. Anaerobic performance was measured in 39 children with CF (mean age, 13.2 +/- 1.8 (SD) years, forced expired volume in 1 sec (FEV(1)) 81.6 +/- 22.1% predicted), using a Wingate anaerobic test. Significant associations were found for peak power (PP) and mean power (MP) with fat-free mass (FFM) body weight, body mass index, maximal isometric muscle force, and aerobic capacity. Pulmonary function was correlated with anaerobic indices when controlled for FFM. Multiple regression analysis indicated that FFM and FEV(1) accounted for 82% and 86% of the variability in PP and MP, respectively. Patients with moderate CF (FEV(1) < 80%), as compared to mild CF (FEV(1) >/= 80%), had higher PP (difference = 85 W, 95% CI = 27-144 W) and MP (difference = 53 W, 95% CI = 42-63 W) at equivalent FFM. Our results indicate that FFM and pulmonary function are important determinants of anaerobic exercise performance in children with CF. With progression of pulmonary disease, anaerobic performance may be enhanced.
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Affiliation(s)
- Peter H Klijn
- Department of Pediatric Physical Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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47
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Pérusse L, Rankinen T, Rauramaa R, Rivera MA, Wolfarth B, Bouchard C. The human gene map for performance and health-related fitness phenotypes: the 2002 update. Med Sci Sports Exerc 2003; 35:1248-64. [PMID: 12900676 DOI: 10.1249/01.mss.0000078938.84161.22] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review presents the 2002 update of the human gene map for physical performance and health-related phenotypes. It is based on peer-reviewed papers published by the end of 2002 and includes association studies with candidate genes, genome-wide scans with polymorphic markers, and single gene defects causing exercise intolerance to variable degrees. The genes and markers with evidence of association or linkage with a performance or fitness phenotype in sedentary or active people, in adaptation to acute exercise, or for training-induced changes are positioned on the genetic map of all autosomes and the X chromosome. Negative studies are reviewed, but a gene or locus must be supported by at least one positive study before being inserted on the map. By the end of 2000, 29 loci were depicted on the map. The 2001 map includes 71 loci on the autosomes and two on the X chromosome. In contrast, the 2002 human gene map for physical performance and health-related phenotypes includes 90 gene entries and QTL, plus two on the X chromosome. To all these loci, one must add 14 mitochondrial genes in which sequence variants have been shown to influence relevant fitness and performance phenotypes.
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Affiliation(s)
- Louis Pérusse
- Department of Preventive Medicine Laval University, Ste-Foy, Québec, Canada
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48
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Tobin MJ. Pediatrics, surfactant, and cystic fibrosis in AJRCCM 2002. Am J Respir Crit Care Med 2003; 167:333-44. [PMID: 12554622 DOI: 10.1164/rccm.2212005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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