Towards an individualized protocol for workload increments in cardiopulmonary exercise testing in children and adolescents with cystic fibrosis

AbstractBackgroundThere is no single optimal exercise testing protocol for children and adolescents with cystic fibrosis (CF) that differs widely in age and disease status. The aim of this study was to develop a CF-specific, individualized approach to determine workload increments for a cycle ergometry testing protocol.MethodsA total of 409 assessments consisting of maximal exercise data, anthropometric parameters, and lung function measures from 160 children and adolescents with CF were examined. 90% of the database was analyzed with backward linear regression with peak workload (Wpeak) as the dependent variable. Afterwards, we [1] used the remaining 10% of the database (model validation group) to validate the model's capacity to predict Wpeak and [2] validated the protocol's ability to provide a maximal effort within a 10±2minute time frame in 14 adolescents with CF who were tested using this new protocol (protocol validation group).ResultsNo significant differences were seen in Wpeak and predicted Wpeak in the model validation group or in the protocol validation group. Eight of 14 adolescents with CF in the protocol validation group performed a maximal effort, and seven of them terminated the test within the 10±2minute time frame. Backward linear regression analysis resulted in the following equation: Wpeak (W)=−142.865+2.998×Age (years)−19.206×Sex (0=male; 1=female)+1.328×Height (cm)+23.362×FEV1 (L) (R=.89; R2=.79; SEE=21). Bland–Altman analysis showed no systematic bias between the actual and predicted Wpeak.ConclusionWe developed a CF-specific linear regression model to predict peak workload based on standard measures of anthropometry and FEV1, which could be used to calculate individualized workload increments for a cycle ergometry testing protocol

Позиционирование изображений фотошаблонов в системах автоматизированного оптического контроля

Разработана система автоматизированного оптического позиционирования фотошаблонов интегральных схем, которая имеет высокие показатели помехоустойчивости и точности

MRI-based screening for metabolic insufficiency of leg muscle during aerobic exercise in Cystic Fibrosis

There is evidence for mitochondrial dysfunction in various tissues in Cystic Fibrosis (CF) including muscle. Among others, a slow rate of high-energy phosphate resynthesis following exercise involving single limb muscle activity was found in human CF using in vivo 31P magnetic resonance spectroscopy (MRS). This raises the question whether this outcome would be ameliorated versus exacerbated if instead an exercise regime is used that puts a significant cardiopulmonary load on the body as in running or bicycling. This is of interest because exercise therapy is commonly prescribed in CF. To investigate this matter, ten pediatric CF patients (age 12–16 years) and healthy peers performed two ramp exercise tests to volitional exhaustion using a bicycle ergometer fit for use inside a MR scanner. Endurance, VO2max and heart rate were determined in the exercise laboratory. Quadriceps muscle energy-and acid/base balance during exercise and recovery were measured on a separate day using MR imaging-based 31P MRS. This study brings together for the first time this powerful biomedical imaging platform and whole body exercise testing in the clinical setting of human CF

Coping with paediatric illness: Child’s play? Exploring the effectiveness of a play- and sports-based cognitive behavioural programme for children with chronic health conditions

Little is known about how play affects the development of children with a chronic condition. Studying play poses major methodological challenges in measuring differences in play behaviour, which results in a relative scarcity of research on this subject. This pilot study seeks to provide novel directions for research in this area. The effectiveness of a play- and sports-based cognitive behavioural programme for children (8–12 years) with a chronic condition was studied. The children and parents completed a battery of measurement tools before and after the programme. Moreover, the application of automated computer analyses of behaviour was piloted. Behaviour (Child Behavior Checklist) seemed to be positively affected by the programme. An increase in psychological well-being was observed (KIDSCREEN). Perceived competence (Self-Perception Profile for Children) and actual motor competence (Canadian Agility and Movement Skill Assessment) did not show any positive trends. These results of 13 participants suggest that children might learn to better cope with their illness by stimulating play behaviour. For the analysis of the effectiveness of programmes like this, we therefore propose to focus on measuring behaviour and quality of life. In addition, pilot measurements showed that automated analysis of play can provide important insights into the participation of children

Preoperative respiratory physical therapy in cardiac surgery

Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in the postoperative period. Moreover, anesthesia and analgesia affect respiratory function during and after the surgical intervention, causing changes in lung volume, diaphragmatic dysfunction, respiratory muscle strength, pattern of ventilation, and gas exchange, and in the response to carbon dioxide and oxygen concentrations. As a consequence of these changes, patients undergoing cardiac surgery have an increased risk of postoperative pulmonary complications (PPCs), which lead to increased postoperative morbidity and mortality, increased use of medical resources, longer hospital stay, and increased health care costs. The incidence of PPCs varies between 20% and 95% in cardiac surgery, depending in part on the criteria used to define PPCs and on the diagnostic techniques used to document them. As a result of the generally high incidence of these complications (including mortality) and the high costs of hospitalization, efforts have been made during the last decade to identify those patients who have a higher chance of developing such complications, and to find ways to prevent their development. Considerable effort has been put into preventing and treating PPCs, but there is no consensus on the most appropriate or effective remedy. Controversy exists concerning the possible overuse and abuse of many of the therapeutic modalities commonly used for the prevention and treatment PPCs. A few experimental studies have demonstrated that preoperative physical therapy (e.g. pulmonary rehabilitation) in cardiac surgery has advantages over postoperative physical therapy alone. The effects of these programs, however, in decreasing the incidence of PPCs and in identifying those patients who might derive the most benefit, i.e. all patients or only high-risk patients, have not been proven indisputably. So, the aim of our project was to answer these three basic questions: [1] Is preoperative physical therapy effective in preventing PPCs after cardiac surgery? [2] What type of preoperative physical therapy is effective in preventing PPCs after cardiac surgery? [3] Which patients benefit the most from this intervention? The studies described in this thesis demonstrate that it is possible to stratify preoperatively, patients according to their risk of developing PPCs, especially pneumonia, after CABG. We found that preventive physical therapy, including IMT, given to patients at high risk of PPCs before CABG decreased the incidence of PPCs (e.g. atelectasis and pneumonia) significantly and shortened the duration of mechanical ventilation and postoperative hospitalization. Our program is safe and well tolerated and should be implemented in regular care for these patients as soon as possible. In the future, it is expected that more fragile patients will undergo CABG, and in these patients preoperative physical therapy, including IMT, may be needed to help reduce the incidence of PPCs

A systematic approach to interpreting the cardiopulmonary exercise test in pediatrics

The use of cardiopulmonary exercise testing in pediatrics provides critical insights into potential physiological causes of unexplained exercise-related complaints or symptoms, as well as specific pathophysiological patterns based on physiological responses or abnormalities. Clinical interpretation of the results of a cardiopulmonary exercise test in pediatrics requires specific knowledge with regard to pathophysiological responses and interpretative strategies that can be adapted to address concerns specific to the child’s medical condition or disability. In this review, the authors outline the 7-step interpretative approach that they apply in their outpatient clinic for diagnostic, prognostic, and evaluative purposes. This approach allows the pediatric clinician to interpret cardiopulmonary exercise testing results in a systematic order to support their physiological reasoning and clinical decision making

Reference values for cardiopulmonary exercise testing in healthy subjects:: an updated systematic review

Introduction: Reference values for cardiopulmonary exercise testing (CPET) parameters provide the comparative basis for answering important questions concerning the normalcy of exercise responses in patients, and significantly impacts the clinical decision-making process. Areas covered: The aim of this study was to provide an updated systematic review of the literature on reference values for CPET parameters in healthy subjects across the life span. A systematic search in MEDLINE, Embase, and PEDro databases were performed for articles describing reference values for CPET published between March 2014 and February 2019. Expert opinion: Compared to the review published in 2014, more data have been published in the last five years compared to the 35 years before. However, there is still a lot of progress to be made. Quality can be further improved by performing a power analysis, a good quality assurance of equipment and methodologies, and by validating the developed reference equation in an independent (sub)sample. Methodological quality of future studies can be further improved by measuring and reporting the level of physical activity, by reporting values for different racial groups within a cohort as well as by the exclusion of smokers in the sample studied. Normal reference ranges should be well defined in consensus statements

Feasibility and preliminary effectiveness of preoperative therapeutic exercise in patients with cancer: a pragmatic study.

The aim of this pilot study is to determine the feasibility and preliminary effectiveness of an individually designed preoperative therapeutic exercise program (PreTEP), in patients recently diagnosed with cancer and awaiting elective surgery. The purpose is to improve their physical fitness levels during this waiting period with the intention of decreasing postoperative morbidity. A preexperimental pilot study was performed at the University Medical Center Utrecht, The Netherlands. Thirty-nine patients diagnosed with cancer, scheduled for elective abdominal/thoracic surgery, were referred to a multidisciplinary preoperative screening. Fifteen patients (38%) participated in PreTEP. Participants were satisfied and motivated during the period of training (on average 5 weeks) in which they attended 84% of the sessions. Cardiorespiratory fitness (A strand-test) and muscle strength (Handheld Dynamometry) increased significantly, from 25 to 33 mL/kg/min, respectively (p<0.01; 95% confidence interval [CI]=-0.011 to -0.004) and from 894 Newton (N) to 961N (p<0.01; 95% CI=-94.53 to -39.0). No adverse events occurred during the training period. PreTEP was shown to be feasible, safe, and well-tolerated and appreciated by participants. Despite the relatively short period of training, physical fitness improved in all participants