Role of arterial hypoxemia and pulmonary mechanics in exercise limitation in adults with cystic fibrosis

McKone, Edward F.; Barry, Sinead; FitzGerald, M. X.; Gallagher, Charles G.

doi:10.1152/japplphysiol.00475.2004

Cited by 29 publications

(23 citation statements)

References 38 publications

(68 reference statements)

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“…Other factors are higher RR with lower tidal volume, hypoxemia, and poor ventilation. (20)(21)(22) In a study involving 188 healthy children between 6 and 12 years of age, the mean 6MWD was shorter than that achieved by our control group for the first 6MWT (579.4 ± 68.1 m vs. 610.3 ± 53.4 m) and the second 6MWT (569.2 ± 83.4 m vs. 616.2 ± 58.0 m). (8) However, our study included adolescents and young adults, with different anthropometric characteristics.…”

Section: Discussionmentioning

confidence: 53%

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Desempenho funcional de pacientes com fibrose cística e indivíduos saudáveis no teste de caminhada de seis minutos

Pereira

Ribeiro

et al. 2011

J. bras. pneumol.

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Objective: To compare patients with cystic fibrosis and healthy individuals in terms of their functional performance on the six-minute walk test (6MWT). Methods: A prospective, cross-sectional study involving healthy individuals and patients with cystic fibrosis treated at a referral university hospital in the city of Campinas, Brazil. The 6MWT was administered in accordance with the American Thoracic Society guidelines, and it was repeated after a 30-min rest period. For all of the participants, RR, HR, SpO 2 , and Borg scale scores were obtained. For the cystic fibrosis patients, nutritional status and spirometric values were determined. Patients with pulmonary exacerbation were excluded. Spearman's correlation coefficient and repeated measures ANOVA were used. Results: The cystic fibrosis group comprised 55 patients, and the control group comprised 185 healthy individuals. The mean ages were 12.2 ± 4.3 and 11.3 ± 4.3 years, respectively. The six-minute walk distance (6MWD) was significantly shorter in the cystic fibrosis group than in the control group for both tests (547.2 ± 80.6 m vs. 610.3 ± 53.4 m for the first and 552.2 ± 82.1 m vs. 616.2 ± 58.0 m for the second; p < 0.0001 for both). The 6MWD correlated with age, weight, and height only in the cystic fibrosis group. During the tests, SpO 2 remained stable, whereas HR and RR increased. Conclusions: In our sample, functional performance on the 6MWT was poorer among the cystic fibrosis patients than among the healthy controls in the same age bracket, and we found immediate repetition of the test to be unadvisable.Keywords: Cystic fibrosis; Exercise tolerance; Dyspnea. ResumoObjetivo: Comparar pacientes com fibrose cística e indivíduos saudáveis quanto ao desempenho funcional no teste de caminhada de seis minutos (TC6). Métodos: Estudo transversal e prospectivo, com indivíduos saudáveis e com fibrose cística de um hospital universitário de referência na cidade de Campinas (SP). O TC6 foi aplicado de acordo com as normas da American Thoracic Society e repetido após 30 min de repouso. Foram determinados FR, FC, SpO 2 e escore da escala de Borg em todos os participantes, assim como o status nutricional e valores espirométricos para os pacientes com fibrose cística. Excluíram-se pacientes em exacerbação pulmonar. Foram utilizados coeficientes de correlação de Spearman e ANOVA para medidas repetidas. Resultados: Foram incluídos 55 pacientes no grupo fibrose cística e 185 indivíduos saudáveis no grupo controle, com médias de idade de 12,2 ± 4,3 anos e 11,3 ± 4,3 anos, respectivamente. A distância percorrida no TC6 (DTC6) foi significativamente menor no grupo fibrose cística que no grupo controle em ambos os testes (547,2 ± 80,6 m vs. 610,3 ± 53,4 m no primeiro e 552,2 ± 82,1 m vs. 616,2 ± 58,0 m no segundo; p < 0,0001 para ambos). A DTC6 se correlacionou com idade, peso e altura somente no grupo fibrose cística. A SpO 2 manteve-se estável durante o teste, com aumento da FC e da FR. Conclusões: Nesta amostra, os pacientes com fibrose cística apresentaram u...

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Section: Discussionmentioning

confidence: 53%

“…More vigorous exercise and severe forms of COPD can cause major reductions in SpO 2 and reduced exercise tolerance. (22,24) The self-reported sensation of dyspnea was greater in the control group than in the CF group. Healthy children might not have the ability to measure dyspnea, because this condition is unknown in their experience.…”

Section: Discussionmentioning

confidence: 90%

Desempenho funcional de pacientes com fibrose cística e indivíduos saudáveis no teste de caminhada de seis minutos

Pereira

Ribeiro

et al. 2011

J. bras. pneumol.

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“…We concluded that ventilatory limitation may be a predisposing factor for developing oxygen desaturation at peak exercise. McKone et al 13 showed that adding dead-space volume and supplemental oxygen can increase peak exercise ventilation and improve maximal exercise capacity in adult CF patients. It is unclear whether or not oxygen supplementation can be advised as a therapeutic measure in training and rehabilitation protocols for children with CF and ventilatory limitation on CPET.…”

Section: Discussionmentioning

confidence: 99%

“…Hypoxemia results from a combination of factors such as intrapulmonary shunting, ventilation-perfusion mismatch, elevated venous admixture, and alveolar hypoventilation. 13 The primary objective of this study was to evaluate whether or not children with CF and ventilatory limitation associated with static hyperinflation are more likely to have decreased exercise capacity than CF patients without ventilatory limitation. We also evaluated whether ventilatory limitation is a predisposing risk factor for development of arterial hypoxemia during incremental exercise.…”

Section: Introductionmentioning

confidence: 99%

Static Hyperinflation Is Associated With Decreased Peak Exercise Performance in Children With Cystic Fibrosis

et al. 2013

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BACKGROUND:We evaluated the exercise capacity of children with cystic fibrosis to determine whether ventilatory limitation associated with static hyperinflation is related with decreased exercise capacity, thus predisposing these children to arterial hypoxemia during progressive exercise. METHODS: Thirty-seven children, ages 8 -17 years, underwent spirometry, body plethysmography, and cardiopulmonary exercise testing after arterial catheter placement. According to the ratio of residual volume to total lung capacity (RV/TLC), the subjects were categorized as either with (RV/TLC > 30%) or without static hyperinflation (RV/TLC < 30%). RESULTS: Children with static hyperinflation showed lower values of maximum load per kilogram (% predicted) (P ‫؍‬ .01), which was aggravated by ventilatory limitation (FEV 1 < 80% of predicted, peak oxygen consumption [% predicted] < 85%, and breathing reserve index > 0.7). Subjects with ventilatory limitation had significantly lower oxygen saturation (P ‫؍‬ .04) and hypoxemia (P ‫؍‬ .03) than did subjects without ventilatory limitation. CONCLUSIONS: In children with cystic fibrosis, static hyperinflation and ventilatory limitation are associated with decrease in exercise performance, oxygen saturation, and P aO 2 during maximum cardiopulmonary exercise testing. All children with cystic fibrosis who exhibit static hyperinflation and ventilatory limitation may require S aO 2 monitoring during progressive exercise.

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“…Simpler and cheaper tests such as the 6MWT have been used to assess tolerance to exercise in adult patients with CF, and the distance achieved in the walking test allows an estimation of individual response to incremental maximal exercise. Several conditions have been linked to the limited exercise capacity in adults with CF, including the deterioration of pulmonary function, peripheral muscle weakness, and malnutrition 31 . Moreover, the role of body balance as one of the main domains of functional capacity is recognized.…”

Section: Variablesmentioning

confidence: 99%

Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis

Penafortes¹,

Guimarães²,

Moço³

et al. 2013

Braz. J. Phys. Ther.

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| Background: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. Objective: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. Method: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). Results: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=-0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. Conclusions: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition.Keywords: cystic fibrosis; rehabilitation; respiratory function tests; postural balance; psychomotor performance; nutrition assessment. HOW TO CITE THIS ARTICLEPenafortes JTS, Guimarães FS, Ribeiro Moço VJ, Almeida VP, Menezes SLS, Lopes AJ. Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis. Braz J Phys Ther. 2013 Sept-Oct; 17(5):450-457. http://dx

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Role of arterial hypoxemia and pulmonary mechanics in exercise limitation in adults with cystic fibrosis

Cited by 29 publications

References 38 publications

Desempenho funcional de pacientes com fibrose cística e indivíduos saudáveis no teste de caminhada de seis minutos

Desempenho funcional de pacientes com fibrose cística e indivíduos saudáveis no teste de caminhada de seis minutos

Static Hyperinflation Is Associated With Decreased Peak Exercise Performance in Children With Cystic Fibrosis

Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis

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