Letter to the Editor: Validity and reliability concerns associated with cardiopulmonary exercise testing young people with cystic fibrosis. Response to: Statement on Exercise Testing in Cystic Fibrosis (Hebestreit et al., 2015 Respiration 90(4):332-51)

This letter has been submitted for publication in RespirationAccepted manuscript (12 month embargo

Oxygen uptake efficiency slope is not a valid submaximal measure of aerobic capacity in paediatric cystic fibrosis patients

Conference poster displayed at the Clinical Trials Symposium, RD&E Exeter, 5/11/15

Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial [version 1; peer review: awaiting peer review]

Background: Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The ‘ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis’ trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability. Methods: Multi-centre, two-arm, randomised (1:1 allocation using minimisation), pilot trial at two sites. Fifty pwCF (≥10 years, FEV1 >40% predicted, stable on Elexacaftor/Tezacaftor/Ivacaftor (ETI)) will be randomised to an individually-customised ExACT programme (≥once daily aerobic exercise of ≥20-minutes duration at an intensity that elicits deep breathing, with huffs and coughs), or usual care. After baseline assessments, secondary outcomes will be assessed after 28-days, with additional home lung function and exacerbation questionnaires at 7, 14 and 21-days, physical activity and sleep monitoring throughout, and embedded qualitative and health-economic components. Feasibility measures include recruitment, retention, measurement completion, adverse events, interviews exploring the acceptability of trial procedures, and a trial satisfaction questionnaire. Discussion: Co-designed with the UK CF community, the ExACT-CF pilot trial is the first multi-centre RCT to test the feasibility of recruiting pwCF stable on ETI into a trial investigating ExACT. This pilot trial will inform the feasibility, design, management, likely external validity for progression to a main phase randomised controlled trial. Registration: Clinicaltrials.gov (NCT05482048)

Aerobic Function and Muscle Deoxygenation Dynamics during Ramp Exercise in Children

PURPOSE:To characterise changes in deoxyhemoglobin ([HHb]) response dynamics in boys and girls during ramp incremental exercise to investigate whether the reduced peak oxygen uptake (peakV˙O2) in girls is associated with a poorer matching of muscle O2 delivery to muscle O2 utilisation, as evidenced by a more rapid increase in [HHb].METHODS:52 children (31 boys, 9.9 ± 0.6 years, 1.38 ± 0.07 m, 31.70 ± 5.78 kg) completed ramp incremental exercise on a cycle ergometer during which pulmonary gas exchange and muscle oxygenation parameters were measured.RESULTS:When muscle [HHb] was expressed against absolute work rate and V˙O2, girls had an earlier change in [HHb] as evidenced by the lower c/d parameter (Girls: 54 ± 20 W vs Boys: 67 ± 19 W, P=0.023; Girls: 0.82 ± 0.28 L·min vs. Boys: 0.95 ± 0.19 L·min, P=0.055) and plateau (Girls: 85 ± 12 W vs. Boys: 99 ± 18 W, P=0.031; Girls: 1.02 ± 0.25 L·min vs. Boys: 1.22 ± 0.28 L·min, P=0.014). However, when expressed against relative work-rate or V˙O2, there were no sex differences in [HHb] response dynamics (all P>0.20). Significant correlations were observed between absolute and fat-free mass normalised peak V˙O2 and the HHb c/d and plateau parameters when expressed against absolute work-rate or V˙O2. Furthermore, when entered into a multiple regression model, the [HHb] plateau against absolute V˙O2 contributed 12% of the variance in peak V˙O2 after adjusting for fat-free mass, gas exchange threshold, and body fatness (model R =0.81, P<0.001).CONCLUSION:The sex-difference in peak V˙O2 in 9-10 year old children is, in part, related to sex-specific changes in muscle O2 extraction dynamics during incremental exercise

Resistance through realism : Youth subculture films in 1970s (and 1980s) Britain

This document is the Accepted Manuscript version of the following article: Nathaniel Weiner, ‘Resistance through realism: Youth subculture films in 1970s (and 1980s) Britain’. The final, definitive version of this paper has been published in European Journal of Cultural Studies, November 2015, DOI: https://doi.org/10.1177/1367549415603376. Published by SAGE Publishing.Film scholars have argued that the British social realist films of the late 1950s and early 1960s reflect the concerns articulated by British cultural studies during the same period. This article looks at how the social realist films of the 1970s and early 1980s similarly reflect the concerns of British cultural studies scholarship produced by the University of Birmingham’s Centre for Contemporary Cultural Studies during the 1970s. It argues that the Centre for Contemporary Cultural Studies’ approach to stylised working-class youth subcultures is echoed in the portrayal of youth subcultures in the social realist films Pressure (1976), Bloody Kids (1979), Babylon (1980) and Made in Britain (1982). This article explores the ways in which these films show us both the strengths and weaknesses of the Centre for Contemporary Cultural Studies’ work on subcultures.Peer reviewe

Physical activity, mental health and wellbeing of adults within and during the easing of COVID-19 restrictions, in the United Kingdom and New Zealand

Physical activity (PA) participation was substantially reduced at the start of the COVID-19 pandemic. The purpose of this study was to assess the association between PA, mental health, and wellbeing during and following the easing of COVID-19 restrictions in the United Kingdom (UK) and New Zealand (NZ). In this study, 3363 adults completed online surveys within 2–6 weeks of initial COVID-19 restrictions (April/May 2020) and once restrictions to human movement had been eased. Outcome measures included the International Physical Activity Questionnaire Short-Form, Depression Anxiety and Stress Scale-9 (mental health) and World Health Organisation-5 Wellbeing Index. There were no differences in PA, mental health or wellbeing between timepoints (p > 0.05). Individuals engaging in moderate or high volume of PA had significantly better mental health (−1.1 and −1.7 units, respectively) and wellbeing (11.4 and 18.6 units, respectively) than individuals who engaged in low PA (p < 0.001). Mental health was better once COVID-19 restrictions were eased (p < 0.001). NZ had better mental health and wellbeing than the UK (p < 0.001). Participation in moderate-to-high volumes of PA was associated with better mental health and wellbeing, both during and following periods of COVID-19 containment, compared to participation in low volumes of PA. Where applicable, during the current or future pandemic(s), moderate-to-high volumes of PA should be encouraged

The Exeter Activity Unlimited statement on physical activity and exercise for cystic fibrosis: methodology and results of an international, multidisciplinary, evidence-driven expert consensus

This is the final version. Available on open access from SAGE Publications via the DOI in this recordData availability statement: All results are presented within the manuscript and supplementary files.BACKGROUND: The roles of physical activity (PA) and exercise within the management of cystic fibrosis (CF) are recognised by their inclusion in numerous standards of care and treatment guidelines. However, information is brief, and both PA and exercise as multi-faceted behaviours require extensive stakeholder input when developing and promoting such guidelines. METHOD: On 30th June and 1st July 2021, 39 stakeholders from 11 countries, including researchers, healthcare professionals and patients participated in a virtual conference to agree an evidence-based and informed expert consensus about PA and exercise for people with CF. This consensus presents the agreement across six themes: (i) patient and system centred outcomes, (ii) health benefits, iii) measurement, (iv) prescription, (v) clinical considerations, and (vi) future directions. The consensus was achieved by a stepwise process, involving: (i) written evidence-based synopses; (ii) peer critique of synopses; (iii) oral presentation to consensus group and peer challenge of revised synopses; and (iv) anonymous voting on final proposed synopses for adoption to the consensus statement. RESULTS: The final consensus document includes 24 statements which surpassed the consensus threshold (>80% agreement) out of 30 proposed statements. CONCLUSION: This consensus can be used to support health promotion by relevant stakeholders for people with CF.Cystic Fibrosis Trus

The effects of dietary w-3 fatty acids on serum lipids and haemostasis in man

SIGLEAvailable from British Library Document Supply Centre- DSC:DX184287 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

long-term effect of dietary supplementation with fish lipid concentrate on serum lipids, bleeding time, platelets and angina. Atherosclerosis

Summary The effect of a fish lipid concentrate rich in eicosapentaenoic acid was studied in 107 subjects for periods up to 2 years. Ninety-two had heart disease or hyperlipidaemia and 15 had no history of heart disease. Serum triglyceride levels were rapidly reduced, cholesterol fell more slowly but high density lipoprotein (HDL) cholesterol was increased. Bleeding time increased significantly and the consumption of glyceryl trinitrate (GTN) tablets decreased together with a reduction in anginal attacks. The data are consistent with a reduction in hepatic triglyceride synthesis rather than an increased rate of triglyceride clearance. Total and HDL cholesterol changes are suggestive of an enhanced removal of cholesterol from the tissues. Increased bleeding time and changes in GTN consumption are consistent with decreased platelet aggregation