Prediction of peak oxygen uptake using the modified shuttle test — Methodological concerns and implications for clinical practice

This is the author accepted manuscrip

Exercise capacity following a percutaneous endoscopic gastrostomy in a young female with cystic fibrosis: a case report

This is the final version of the article. Available from the publisher via the DOI in this record.Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.Cystic fibrosis (CF) is a genetic condition affecting the respiratory and gastrointestinal systems, with patients experiencing problems maintaining weight, especially during rapid growth periods such as puberty. The aim of this case report was to monitor the effect of gastrostomy insertion and implementation of overnight supplemental feeding upon clinical outcomes, including body mass index (BMI), lung function (FEV1), and exercise-related variables (maximal oxygen uptake [VO2max] and ventilatory efficiency [VE/VO2]) in an 11-year-old female with CF. Combined incremental and supramaximal exercise testing to exhaustion was performed at four time points: 3 months prior to the procedure (T1), 2 days prior to (T2), 4 months (T3), and 1 year following the procedure (T4). Improvements following gastrostomy insertion were observed at the 1 year follow-up with regards to BMI (+20%); whereas absolute VO2max remained stable and lung function fluctuated throughout the period of observation. Declines in function with regards to body weight relative VO2max (−16.3%) and oxygen uptake efficiency (+7.5%) were observed during this period. This case report is the first to consider exercise-related clinical outcomes in assessing the effect of implementing gastrostomy feeding in CF. The varied direction and magnitude of the associations between variables shows that further investigations are required

Normal reference values for aerobic fitness in cystic fibrosis: a scoping review

This is the final version. Available on open access from BMJ publishing Group via the DOI in this recordData availability statement: All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.Objective The importance of aerobic fitness (VO2peak) in cystic fibrosis (CF) is well established, and regular exercise testing is recommended. To standardise VO2peak, a ‘percentage of predicted’ (%pred) derived from normative reference values (NRV), as promoted by the 2015 European Cystic Fibrosis Society Exercise Working Group (ECFS EWG), can be reported. However, the NRVs used in CF and their relative frequency is unknown. Method A scoping review was performed via systematic database searches (PubMed, Embase, Web of Science, SciELO, EBSCO) and forward citation searches for studies that include people with CF and report VO2peak as %pred. Studies were screened using Covidence, and data related to patient demographics, testing modality and reference equations were extracted. Additional analyses were performed on studies published in 2016–2021, following the ECFS EWG statement in 2015. Results A total of 170 studies were identified, dating from 1984 to 2022, representing 6831 patients with CF, citing 34 NRV. Most studies (154/170) used cycle ergometry, 15/170 used treadmills, and the remainder used alternative, combination or undeclared modalities. In total, 61/170 failed to declare the NRV used. There were 61 studies published since the ECFS EWG statement, whereby 18/61 used the suggested NRV. Conclusion There is a wide discrepancy in NRV used in the CF literature base to describe VO2peak as %pred, with few studies using NRV from the ECFS EWG statement. This high variance compromises the interpretation and comparison of studies while leaving them susceptible to misinterpretation and limiting replication. Standardisation and alignment of reporting of VO2peak values are urgently needed.Canon Medical Systems UK LtdUniversity of Exete

Validity and reliability concerns associated with cardiopulmonary exercise testing young people with cystic fibrosis

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Letter to the Edito

Interpreting (and misclassifying) fitness – what do we really mean by ‘normal’?

This is the author accepted manuscrip

Promotion of exercise in the management of cystic fibrosis - summary of national meetings

This is the final version. Available from the publisher via the DOI in this recordRationale, aims and objectives: Physical activity (PA) and exercise are important in maintaining and improving health and wellbeing in people with cystic fibrosis (CF) and measures of exercise capacity are useful outcomes in monitoring disease progression. The roles and responsibilities of CF multi-disciplinary team (MDT) members in supporting PA and exercise have yet to be fully defined. This communication reports on national meetings of CF MDT staff whose interest is to improve and standardise person-centered exercise provision and testing as part of routine CF care. We also introduce the role of the physiotherapy technician in supporting PA interventions. Meetings: The two meetings covered a range of presentations, discussions and workshops, focusing on the role of exercise and PA in CF management. Forty people from 15 NHS Hospital Trusts and 3 universities were asked to provide feedback via a questionnaire. Results: The common roles and responsibilities of clinical staff involved in exercise testing and prescription are described, with a wide range of duties identified. In addition, physiotherapists were reported as the main MDT member responsible for exercise provision. The majority of teams reported discussing exercise at every clinical visit (57%) and felt confident in discussing exercise with patients (67%). Conclusions: While this report highlights the current provision of exercise in CF MDTs, it also provides insight into the resources MDTs may require in order to enhance the profile of exercise within CF services, including enhanced training, guidelines and standardised clinical roles.Royal Devon & Exeter NHS Foundation TrustUniversity of Exeter Open Innovation Link Fun

Cardiopulmonary responses to maximal aerobic exercise in patients with cystic fibrosis (article)

This is the final version. Available from Public Library of Science via the DOI in this record.The dataset associated with this article is located in ORE at: https://doi.org/10.24378/exe.1105Cystic fibrosis (CF) is a debilitating chronic condition, which requires complex and expensive disease management. Exercise has now been recognised as a critical factor in improving health and quality of life in patients with CF. Hence, cardiopulmonary exercise testing (CPET) is used to determine aerobic fitness of young patients as part of the clinical management of CF. However, at present there is a lack of conclusive evidence for one limiting system of aerobic fitness for CF patients at individual patient level. Here, we perform detailed data analysis that allows us to identify important systems-level factors that affect aerobic fitness. We use patients’ data and principal component analysis to confirm the dependence of CPET performance on variables associated with ventilation and metabolic rates of oxygen consumption. We find that the time at which participants cross the gas exchange threshold (GET) is well correlated with their overall performance. Furthermore, we propose a predictive modelling framework that captures the relationship between ventilatory dynamics, lung capacity and function and performance in CPET within a group of children and adolescents with CF. Specifically, we show that using Gaussian processes (GP) we can predict GET at the individual patient level with reasonable accuracy given the small sample size of the available group of patients. We conclude by presenting an example and future perspectives for improving and extending the proposed framework. The modelling and analysis have the potential to pave the way to designing personalised exercise programmes that are tailored to specific individual needs relative to patient’s treatment therapies.Wellcome TrustEngineering and Physical Sciences Research Counci

The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials

This is the final version. Available on open access from Taylor & Francis via the DOI in this recordPURPOSE: Cerebral palsy (CP) is the commonest motor disability affecting children. This study reviewed the evidence for virtual reality (VR) intervention compared with conventional physiotherapy in upper limb function of children with CP. METHODS: Searches were undertaken in MEDLINE, EMBASE, PEDro, CENTRAL, Web of Science, CINAHL, ERIC, ICTRP, EU-CTR, ClinicalTrials.gov and EThOS databases. Only randomised-controlled trials (RCTs) were included. Two reviewers independently screened the search results, assessed full-text articles, extracted data and appraised the methodological quality by using the Cochrane collaboration's risk of bias (RoB2) tool. Albatross plots were used to synthesise the data. RESULTS: Seven RCTs, examining motor function in a total of 202 children with CP, included. Four trials used the Quality of Upper Extremity Skills Test (QUEST) as an outcome measure, and three trials used grip strength. These outcome measures were utilised to develop two Albatross plots. Data from the plots showed contradictory findings of the included studies. CONCLUSIONS: The effect of VR in the upper limb rehabilitation of children with CP remains unclear. All included studies used commercial non-immersive VR games. Future high-quality clinical research is needed to explore the extent to which non-immersive and immersive VR is feasible and effective with children and adolescents.IMPLICATIONS FOR REHABILITATIONThe current evidence supporting the use of VR as a rehabilitative tool is weak and uncertain.The current use of VR relies only on commercial non-immersive VR (off-shelf) games, which are not adjustable to meet the demands and goals of therapy programmes.Future research is needed to study the therapeutic feasibility of immersive VR with children and adolescents.Ministry of Education, Saudi Arabi

Feasibility of cardiopulmonary exercise testing in idiopathic pulmonary fibrosis

This is the author accepted manuscript. The final version is available from BMJ Publishing Group via the DOI in this recordBritish Thoracic Society Winter Meeting 2018, London, UK, 5-7 December 2018Introduction Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease of irreversible declining lung function. Reductions in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) are the common clinical endpoints for prognostic monitoring and assessing treatment outcomes. The use of cardiopulmonary exercise testing (CPET) in IPF remains largely unexplored. Objectives To explore the feasibility of CPET as a clinical measure in IPF and identify associations with established clinical variables. Methods Seventeen patients with IPF were approached, and fifteen (88%) were recruited (13 male, 68.1±7.5 years). Incremental exercise testing to exhaustion was undertaken via electronically braked cycle ergometer. Variables included: peak oxygen consumption (VO2peak), peak work rate (WRpeak), nadir SpO2, ventilatory drive (VE/VCO2), alongside standard clinical pulmonary function tests of FVC and DLCO. Pearson’s correlation coefficients established relationships between variables. Results One participant was excluded (high baseline systolic blood pressure). Eight out of fourteen (57%) participants reached volitional exhaustion. Five CPETs were terminated early due to desaturation (SpO2 <88%) and one to an exercise-induced right bundle branch block (recovery within minutes of ceasing exercise). Mean (±SD) pulmonary and exercise results were: FVC, 84.9%±17.0%; DLCO, 56.5%±11.4%; VO2peak, 1.4±0.4 L.min-1, 16.5±5.5 mL.kg-1.min-1; WRpeak, 104±42 W; SpO2, 90±3%; VE/VCO2, 27.1±6.4. Significant correlations were identified between: FVC and SpO2 (r=0.58, p=0.032), DLCO and VE/VCO2 (r=0.81, p<0.001) and WRpeak (r=0.58, p=0.03). Body-mass relative VO2peak held moderate, but not significant relationships with FVC (r=0.44, p=0.11) and DLCO (r=0.53, p=0.51). Conclusions Initial findings from this study have found CPET to be acceptable to patients with IPF and potentially feasible as a testing measure. Preliminary results identified common exercise desaturation, suggesting less conservative SpO2 termination criteria (e.g. 80% cut-off) could be considered. Although exercise parameters held limited relationships with FVC and DLCO, results from VO2peak identifies potential additional and dynamic prognostic information and warrants further investigation.Royal Devon & Exeter Hospita

Validity of the Supramaximal Test to Verify Maximal Oxygen Uptake in Children and Adolescents

This is the author accepted manuscript. The final version is available from Human Kinetics via the DOI in this record.Purpose: This study had 2 objectives: (1) to examine whether the validity of the supramaximal verification test for maximal oxygen uptake ( formula presented ) differs in children and adolescents when stratified for sex, body mass, and cardiorespiratory fitness and (2) to assess sensitivity and specificity of primary and secondary objective criteria from the incremental test to verify formula presented . Methods: In total, 128 children and adolescents (76 male and 52 females; age: 9.3-17.4 y) performed a ramp-incremental test to exhaustion on a cycle ergometer followed by a supramaximal test to verify formula presented . Results: Supramaximal tests verified formula presented in 88% of participants. Group incremental test peak formula presented was greater than the supramaximal test (2.27 [0.65] L·min-1 and 2.17 [0.63] L·min-1; P  .18). Supramaximal test time to exhaustion predicted supramaximal test formula presented verification (P = .04). Primary and secondary objective criteria had insufficient sensitivity (7.1%-24.1%) and specificity (50%-100%) to verify formula presented . Conclusion: The utility of supramaximal testing to verify formula presented is not affected by sex, body mass, or cardiorespiratory fitness status. Supramaximal testing should replace secondary objective criteria to verify formula presented