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01-01-2019 | Original Article

Exercise testing in patients with cystic fibrosis—importance of ventilatory parameters

Authors: Matthew A. Tucker, Nichole Lee, Paula Rodriguez-Miguelez, Jacob Looney, Reva H. Crandall, Caralee Forseen, Kathleen T. McKie, Ryan A. Harris

Published in: European Journal of Applied Physiology | Issue 1/2019

Abstract

Background

Ventilatory parameters obtained during exercise predict survival in several chronic diseases; however, long-term changes in exercise ventilatory parameters in patients with cystic fibrosis (CF) have yet to be examined and potential differences between sexes in CF are unknown.

Purpose

We sought to examine the change in exercise ventilatory parameters over time in patients with CF and determine if the change is different between sexes.

Methods

Exercise capacity (VO₂ peak) and exercise ventilatory parameters (V_E/VO₂ peak, V_E/VCO₂ peak, and V_E/VCO₂ slope) were determined from a maximal cardio-pulmonary test on a cycle ergometer on two visits separated by 39 ± 16 months in 20 patients with CF (10 female, 10 male).

Results

No differences between sexes were observed at visit 1 (all p > 0.05). Overall, exercise ventilatory parameters significantly (p < 0.05) deteriorated between visits, with no change (p > 0.05) in VO₂ peak. Moreover, compared to males, female patients exhibited greater deteriorations in V_E/VO₂ peak (p = 0.001), V_E/VCO₂ peak (p = 0.002), and V_E/VCO₂ slope (p = 0.016) between visits.

Conclusions

These data in patients with CF indicate that exercise ventilatory parameters decline over time despite no change in VO₂ peak, and female patients exhibit a more rapid deterioration compared to males.

American Thoracic Society (1995) Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med 152(3):1107–1136CrossRef

Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60(6):2020–2027CrossRefPubMed

Cantin A (1995) Cystic fibrosis lung inflammation: early, sustained, and severe. Am J Respir Crit Care Med 151(4):939–941PubMed

Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Earlbaum Associates 2, Hilsdale.

Corey M, Levison H, Crozier D (1976) Five-to seven-year course of pulmonary function in cystic fibrosis 1–3. Am Rev Respir Dis 114(6):1085–1092PubMed

Dodge J, Lewis P, Stanton M, Wilsher J (2007) Cystic fibrosis mortality and survival in the UK: 1947–2003. Eur Respir J 29(3):522–526CrossRefPubMed

Fielding J, Brantley L, Seigler N, McKie KT, Davison GW, Harris RA (2015) Oxygen uptake kinetics and exercise capacity in children with cystic fibrosis. Pediatr Pulmonol 50(7):647–654CrossRefPubMed

FitzSimmons SC (1993) The changing epidemiology of cystic fibrosis. J Pediatr 122(1):1–9CrossRefPubMed

Godfrey S, Davies C, Wozniak E, Barnes CA (1971) Cardio-respiratory response to exercise in normal children. Clin Sci 40(5):419–431CrossRefPubMed

Gratas-Delamarche A, Mercier J, Ramonatxo M, Dassonville J, Prefaut C (1993) Ventilatory response of prepubertal boys and adults to carbon dioxide at rest and during exercise. Eur J Appl Physiol Occup Physiol 66(1):25–30CrossRefPubMed

Gruet M, Troosters T, Verges S (2017) Peripheral muscle abnormalities in cystic fibrosis: etiology, clinical implications and response to therapeutic interventions. J Cystic Fibros 15(5):538–552CrossRef

Guazzi M, De Vita S, Cardano P, Barlera S, Guazzi MD (2003) Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure. Am Heart J 146(3):542–548CrossRefPubMed

Hankinson J, Odencrantz J, Fedan K (1999) Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 159:179–187CrossRefPubMed

Hart N, Polkey MI, Clément A, Boulé M, Moxham J, Lofaso F, Fauroux B (2002) Changes in pulmonary mechanics with increasing disease severity in children and young adults with cystic fibrosis. Am J Respir Crit Care Med 166(1):61–66CrossRefPubMed

Hebestreit H, Kieser S, Rüdiger S, Schenk T, Junge S, Hebestreit A, Ballmann M, Posselt H-G, Kriemler S (2006) Physical activity is independently related to aerobic capacity in cystic fibrosis. Eur Respir J 28(4):734–739CrossRefPubMed

Hebestreit H, Arets HG, Aurora P, Boas S, Cerny F, Hulzebos EH, Karila C, Lands LC, Lowman JD, Swisher A (2015) Statement on exercise testing in cystic fibrosis. Respiration 90(4):332–351CrossRefPubMed

Kleber F, Vietzke G, Wernecke K, Bauer U, Opitz C, Wensel R, Sperfeld A, Gläser S (2000) Impairment of ventilatory efficiency in heart failure. Circulation 101(24):2803–2809CrossRefPubMed

Lands LC, Heigenhauser GJ, Jones NL (1992) Analysis of factors limiting maximal exercise performance in cystic fibrosis. Clin Sci 83(4):391–397CrossRef

MacGowan GA, Murali S (2000) Ventilatory and heart rate responses to exercise: better predictors of heart failure mortality than peak exercise oxygen consumption. Circulation 102(24):e182–e182CrossRefPubMed

MacKenzie T, Gifford AH, Sabadosa KA, Quinton HB, Knapp EA, Goss CH, Marshall BC (2014) Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the cystic fibrosis foundation patient registry. Ann Intern Med 161(4):233–241CrossRefPubMedPubMedCentral

McKone EF, Barry SC, FitzGerald MX, Gallagher CG (2005) Role of arterial hypoxemia and pulmonary mechanics in exercise limitation in adults with cystic fibrosis. J Appl Physiol 99(3):1012–1018CrossRefPubMed

Moorcroft AJ, Dodd ME, Webb AK (1997) Long-term change in exercise capacity, body mass, and pulmonary function in adults with cystic fibrosis. Chest 111(2):338–343CrossRefPubMed

Nixon PA, Orenstein DM, Kelsey SF, Doershuk CF (1992) The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med 327(25):1785–1788CrossRefPubMed

Orenstein DM, Nixon PA (1991) Exercise performance and breathing patterns in cystic fibrosis: male–female differences and influence of resting pulmonary function. Pediatr Pulmonol 10(2):101–105CrossRefPubMed

Penketh A, Wise A, Mearns M, Hodson M, Batten J (1987) Cystic fibrosis in adolescents and adults. Thorax 42(7):526–532CrossRefPubMedPubMedCentral

Philpott J, Houghton K, Luke A (2010) Physical activity recommendations for children with specific chronic health conditions: Juvenile idiopathic arthritis, hemophilia, asthma and cystic fibrosis. Paediatr Child Health 15(4):213–218CrossRefPubMedPubMedCentral

Pianosi P, Hochman J (1996) End-tidal estimates of arterial PCO₂ for cardiac output measurement by CO₂ rebreathing: a study in patients with cystic fibrosis and healthy controls. Pediatr Pulmonol 22(3):154–160CrossRefPubMed

Pianosi P, Wolstein R (1996) Carbon dioxide chemosensitivity and exercise ventilation in healthy children and in children with cystic fibrosis. Pediatr Res 40(3):508CrossRefPubMed

Pianosi P, Leblanc J, Almudevar A (2005) Peak oxygen uptake and mortality in children with cystic fibrosis. Thorax 60(1):50–54CrossRefPubMedPubMedCentral

Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, Enright PL, Hankinson JL, Ip MS, Zheng J (2012) Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J 40(6):1324–1343CrossRefPubMedPubMedCentral

Rosenfeld M, Davis R, FitzSimmons S, Pepe M, Ramsey B (1997) Gender gap in cystic fibrosis mortality. Am J Epidemiol 145(9):794–803CrossRefPubMed

Schneiderman-Walker J, Wilkes D, Strug L, Lands L, Pollock S, Selvadurai H, Hay J, Coates A, Corey M (2005) Sex differences in habitual physical activity and lung function decline in children with cystic fibrosis. J Pediatr 147(3):321–326CrossRefPubMed

Schwaiblmair M, Faul C, von Scheidt W, Berghaus TM (2012) Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension. BMC Pulmon Med 12(1):23CrossRef

Stein R, Selvadurai H, Coates A, Wilkes DL, Schneiderman-Walker J, Corey M (2003) Determination of maximal voluntary ventilation in children with cystic fibrosis. Pediatr Pulmonol 35(6):467–471CrossRefPubMed

Takken T, Bongers BC, van Brussel M, Haapala EA, Hulzebos EH (2017) Cardiopulmonary exercise testing in pediatrics. Ann Am Thorac Soc 14(Supp 1):S123–S128CrossRefPubMed

Thin A, Dodd J, Gallagher C, Fitzgerald M, Mcloughlin P (2004) Effect of respiratory rate on airway deadspace ventilation during exercise in cystic fibrosis. Respir Med 98(11):1063–1070CrossRefPubMed

Troosters T, Langer D, Vrijsen B, Segers J, Wouters K, Janssens W, Gosselink R, Decramer M, Dupont L (2009) Skeletal muscle weakness, exercise tolerance and physical activity in adults with cystic fibrosis. Eur Respir J 33(1):99–106CrossRefPubMed

Tucker MA, Crandall R, Seigler N, Rodriguez-Miguelez P, McKie KT, Forseen C, Thomas J, Harris RA (2017) A single bout of maximal exercise improves lung function in patients with cystic fibrosis. J Cyst Fibros 16(6):752–758CrossRefPubMed

Wasserman K, Hansen J, Sue D, Stringer W, Whipp B (2005) Clinical exercise testing. Principles of exercise testing and interpretation including pathophysiology and clinical applications. Lippincott Williams & Wilkins

Title: Exercise testing in patients with cystic fibrosis—importance of ventilatory parameters
Authors: Matthew A. Tucker
Nichole Lee
Paula Rodriguez-Miguelez
Jacob Looney
Reva H. Crandall
Caralee Forseen
Kathleen T. McKie
Ryan A. Harris
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Applied Physiology / Issue 1/2019
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI: https://doi.org/10.1007/s00421-018-4018-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Exercise testing in patients with cystic fibrosis—importance of ventilatory parameters

Abstract

Background

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusions

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