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Tomlinson OW, Barker AR, Fulford J, Wilson P, Shelley J, Oades PJ, Williams CA. Skeletal muscle contributions to reduced fitness in cystic fibrosis youth. Front Pediatr 2023; 11:1211547. [PMID: 37388288 PMCID: PMC10300555 DOI: 10.3389/fped.2023.1211547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
Background Increased maximal oxygen uptake (V̇O2max) is beneficial in children with cystic fibrosis (CF) but remains lower compared to healthy peers. Intrinsic metabolic deficiencies within skeletal muscle (muscle "quality") and skeletal muscle size (muscle "quantity") are both proposed as potential causes for the lower V̇O2max, although exact mechanisms remain unknown. This study utilises gold-standard methodologies to control for the residual effects of muscle size from V̇O2max to address this "quality" vs. "quantity" debate. Methods Fourteen children (7 CF vs. 7 age- and sex-matched controls) were recruited. Parameters of muscle size - muscle cross-sectional area (mCSA) and thigh muscle volume (TMV) were derived from magnetic resonance imaging, and V̇O2max obtained via cardiopulmonary exercise testing. Allometric scaling removed residual effects of muscle size, and independent samples t-tests and effect sizes (ES) identified differences between groups in V̇O2max, once mCSA and TMV were controlled for. Results V̇O2max was shown to be lower in the CF group, relative to controls, with large ES being identified when allometrically scaled to mCSA (ES = 1.76) and TMV (ES = 0.92). Reduced peak work rate was also identified in the CF group when allometrically controlled for mCSA (ES = 1.18) and TMV (ES = 0.45). Conclusions A lower V̇O2max was still observed in children with CF after allometrically scaling for muscle size, suggesting reduced muscle "quality" in CF (as muscle "quantity" is fully controlled for). This observation likely reflects intrinsic metabolic defects within CF skeletal muscle.
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Affiliation(s)
- Owen William Tomlinson
- Children’s Health and Exercise Research Centre, Public Health and Sports Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Alan Robert Barker
- Children’s Health and Exercise Research Centre, Public Health and Sports Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Jonathan Fulford
- Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Paul Wilson
- Children’s Health and Exercise Research Centre, Public Health and Sports Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - James Shelley
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Patrick John Oades
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Craig Anthony Williams
- Children’s Health and Exercise Research Centre, Public Health and Sports Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
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Uslu NZ, Kocakaya D, Olgun Yıldızeli Ş, Eryüksel E, Keniş Coşkun Ö, Cimşit C, Karaketir ŞG, Ceyhan B. Relationship of muscle thickness, strength, and diaphragm function in adults with cystic fibrosis. Turk J Phys Med Rehabil 2023; 69:200-206. [PMID: 37671376 PMCID: PMC10475901 DOI: 10.5606/tftrd.2023.10361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/01/2022] [Indexed: 09/07/2023] Open
Abstract
Objectives This study aimed to evaluate the muscle thickness, strength, and diaphragmatic function and relate them with clinical findings. Patients and methods The cross-sectional study was conducted with 54 participants (27 males, 27 females; mean age; 24.5±5.3 years; range, 18 to 45 years) between January 2017 and October 2017. Of the participants, 31 were adult CF patients, and 23 were age-and sex-matched controls. Patient demographics, 6-min walk distance, body mass index (BMI), and fat-free mass index (FFMI) were evaluated. Each patient underwent pulmonary function tests. Quadriceps femoris thickness and diaphragm thickening fraction were assessed by ultrasonography. Upper extremity strength was measured with a handheld dynamometer. Results There was no difference between the patients' and controls' BMI (p=0.052). However, patients' FFMI was lower than the controls' (p=0.010). The FFMI correlated with pulmonary function tests. Patients' both right and left quadriceps femoris muscles were thinner than the controls (p=0.001 and p=0.001, respectively). Patients with pancreatic insufficiency had thinner muscles than patients without pancreatic insufficiency. The control group had a stronger handgrip than CF patients (33.5±10.1 vs. 24.5±9.2 kg, p=0.003). Conclusion Peripheral muscle wasting and weakness and lower functional capacity are highly prevalent in CF patients.
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Affiliation(s)
- Nazlı Zeynep Uslu
- Pulmonary Medicine, Marmara University Medical Faculty, Istanbul, Türkiye
| | - Derya Kocakaya
- Pulmonary Medicine, Marmara University Medical Faculty, Istanbul, Türkiye
| | | | - Emel Eryüksel
- Pulmonary Medicine, Marmara University Medical Faculty, Istanbul, Türkiye
| | - Özge Keniş Coşkun
- Department of Physical Medicine and Rehabilitation, Marmara University Medical Faculty, Istanbul, Türkiye
| | - Canan Cimşit
- Department of Radiology, Marmara University Medical Faculty, Istanbul, Türkiye
| | | | - Berrin Ceyhan
- Pulmonary Medicine, Marmara University Medical Faculty, Istanbul, Türkiye
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Effects of Exercise Training on Peripheral Muscle Strength in Children and Adolescents with Cystic Fibrosis: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10122520. [PMID: 36554044 PMCID: PMC9778003 DOI: 10.3390/healthcare10122520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results.
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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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Ruf K, Badran A, Siauw C, Haubitz I, Schlegel PG, Hebestreit H, Härtel C, Wiegering V. Does allogeneic stem cell transplantation in survivors of pediatric leukemia impact regular physical activity, pulmonary function, and exercise capacity? Mol Cell Pediatr 2021; 8:16. [PMID: 34738228 PMCID: PMC8569121 DOI: 10.1186/s40348-021-00127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has improved survival in high-risk childhood leukemia but is associated with long-term sequelae such as impaired pulmonary function and reduced exercise capacity impacting quality of life. METHODS A convenience sample of 17 patients after allo-HSCT (HSCT-12 male, age 15.7±6.7 years, time after HSCT 5.3±2.8 years) underwent pulmonary function testing, echocardiography, and an incremental exercise test on a bike. Physical activity and health-related quality of life were assessed by questionnaires (7-day physical activity recall, PEDS-QL). Seventeen healthy age- and gender-matched controls served as control group (CG) for results of pulmonary function and exercise testing. RESULTS HSCT showed reduced pulmonary function (HSCT vs. CG: FEV1 90.5±14.0 vs. 108.0±8.7%pred; FVC 88.4±19.3 vs. 107.6±6.9%pred, DLCO 75.3±23.6 vs. 104.9±12.8%pred) and exercise capacity (VO2peak 89±30.8%pred, CG 98±17.5%pred; Wmax 84±21.7%pred, CG 115±22.8%pred), but no relevant cardiac dysfunction and a good quality of life (PEDS-QL mean overall score 83.3±10.7). Differences in peak oxygen uptake between groups were mostly explained by 5 adolescent patients who underwent total body irradiation for conditioning. They showed significantly reduced diffusion capacity and reduced peak oxygen uptake. Patients reported a mean time of inactivity of 777±159min/day, moderate activity of 110±107 min/day, hard activity of 35±36 min/day, and very hard activity of 23±22 min/day. A higher amount of inactivity was associated with a lower peak oxygen uptake (correlation coefficient tau -0.48, p=0.023). CONCLUSIONS This pilot study shows that although patients after allo-HSCT reported a good quality of life, regular physical activity and exercise capacity are reduced in survivors of stem cell transplantation, especially in adolescents who are treated with total body irradiation for conditioning. Factors hindering regular physical activity need to be identified and exercise counseling should be part of follow-up visits in these patients.
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Affiliation(s)
- Katharina Ruf
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany.
| | - Alaa Badran
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Céline Siauw
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Imme Haubitz
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Paul-Gerhardt Schlegel
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Helge Hebestreit
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Christoph Härtel
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Verena Wiegering
- University Children's Hospital, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
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Magal M, Liette NC, Crowley SK, Hoffman JR, Thomas KS. Sex-Based Performance Responses to an Acute Sprint Interval Cycling Training Session in Collegiate Athletes. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2021; 92:469-476. [PMID: 32589514 DOI: 10.1080/02701367.2020.1751026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
There are limited data pertaining to the effects of sex on sprint interval cycling (SIC) training session performance. Purpose: We investigated sex-based differences on sprint interval cycling (SIC) performance in collegiate soccer players. Methods: Twelve men and twelve women completed two identical lab trials, 7-14 days apart. The first lab session served as familiarization, "dry run," trial. Reported data were collected and analyzed during the second, "testing" SIC training trial. Each SIC training session was comprised of a warm-up, at 50 revolutions per min (RPM) with no resistance, and six repeated 30-s Wingate Anaerobic Tests (WAnT) separated by a 4-min recovery period between each sprint. Results: Significant (P ≤ .05) sex differences were observed in peak power (PP), peak power relative to body mass (RPP), mean power (MP), mean power relative to body mass (RMP) but not in peak power relative to fat free mass (FFMPP). When WAnT bouts 2-6 were expressed as %Δ of WAnT1, there were no significant (P > .05) differences between the sexes across all performance variables. Further, Cohen's d statistics demonstrated only trivial and small effect size between the groups. Average HR and RPE were not significantly (P > .05) different between the sexes. Correlational analysis revealed a significant (P ≤ .05) relationship between FFM, and PP and MP. Conclusion: Although overall performance may be affected by a number of physiological mechanisms, the results of the current study indicate that differences between men and women soccer players performing SIC training, are likely attributed to differences in body composition.
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