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ePS04.9 Evaluation of 6 Minutes Walking Test in CF patients before and after lung transplant
Oral Presentations / Journal of Cystic Fibrosis 15 (2016) S1–S50
36% of the control group. With regard to strategies to decrease barriers 75% of CF patients “think about the advantage of sport” compared to 82% in the control group. Conclusion: Physical barriers were more important for healthy than for CF patients. Despite time consuming treatment CF patients do not regard “stress” more often as barrier than healthy volunteers. Concerning the barrier management the acute strategy to “think about the advantage of exercise” is important for both groups while others differ. The challenge for the individualized activity program is therefore to develop individual strategies to decrease barriers and identify facilitators to promote physical activity for CF patients. ePS04.7 A survey of activity levels and sedentary time in adult CF patients A.R. Morris1 , N.P. Hilton1 , J. Greenwood1 , M.J. Ledson1 , M.J. Walshaw1 . 1 Liverpool Heart & Chest Hospital, Liverpool, United Kingdom Introduction: Physical activity and exercise are widely agreed to be beneficial to the health and well-being of cystic fibrosis patients and are an important part of the CF care package. This study investigated the physical activity status and sedentary behaviour of a population of adult cystic fibrosis patients. Method: Physical activity was reported in 141 patients via the World Health Organisation Global Physical Activity Questionnaire. We also performed a concomitant sub-maximal exercise capacity assessment by recording treadmill maximal steady state. Current pulmonary function and BMI were also noted. Results: Results showed that 62% of the sample group were failing to meet the minimal recommended requirement of 600MET-minutes/ week of moderate to vigorous physical activity. There was a weak relationship between physical activity levels and exercise capacity (r = 0.4, p < 0.05) but there was no relationship between activity levels and either pulmonary function, BMI or age. Observation of sedentary time showed the majority of patients spending around half of their waking hours in sedentary behaviours with 21% spending in excess of 10 hours per day sitting or reclining. 7% of patients reported being sedentary for half of their waking hours or more, despite meeting minimal activity guidelines through exercising. Conclusion: The message to increase activity levels is still an important one and many patients are still at risk of a low-activity lifestyle. Reducing sedentary behaviour is important to avoid the problem of the ‘active couch potato’ – patients who are meeting activity guidelines but who are then spending an excessive amount of their time in sedentary behaviours. ePS04.8 Daily physical activity and peripheral muscle force in adults with cystic fibrosis compared with controls F. Pyl1 , F. De Baets1 , D. Declercq1 , P. Calders2 , S. Bernaert2 , S. Van Biervliet1 . 1 University Hospital Gent, Gent, Belgium; 2 University Gent, Gent, Belgium Objectives: Physical activity (PA) and peripheral muscle force (PMF) is important in chronic diseases. It is not clear whether adults with CF have the same level of PA and PMF as healthy peers. This study evaluates the level of PA and PMF in adults with CF and their relation with FEV1, BMI and 6 minutes walking distance (6MWD). Methods: 35 CF patients (FEV1 64.6%, IQR 52–85; age 26 y, IQR 22–33; BMI 20.7, IQR 20–23.2) and 35 healthy age- and BMI-matched controls wore the Sensewear® armband for 5 consecutive days to measure daily PA. PA level was expressed as the average time spent/day in moderate PA (MPA, 4.8–7.2 METs) and vigorous PA (VPA, >7.2 METs). They performed a quadriceps force test (QF), handgrip force test (HGF) and a 6MWD. Results: There was no difference in PA (MPA: 30 IQR 20–86 vs 40 IQR 21–61.5 min; VPA: 16 IQR 3–33 vs 10 IQR 1.5–16.5 min). For controls + CF (TG) there was an inverse relation between PA and age (p = 0.009). In the TG and in the CF group, QF was correlated with 6MWD (p = 0.009 and p = 0.031 resp.). On the other hand no relation was found between PA and PMF. Except for HGF right (p = 0.014) PMF was comparable between both groups. 6MWD was significantly lower in the CF group (p = 0.001). PMF in CF but not in controls was correlated with BMI (BMI vs QF
S45
p = 0.036; BMI vs HGF p = 0.001). BMI was also correlated with FEV1 (p = 0.031). Conclusion: The studied CF population had the same level of PA and PMF as their healthy peers. FEV1 didn’t seem to determine PA nor PMF. Despite this finding, submaximal exercise capacity (6MWD) in CF is impaired. Nutritional status seems essential in maintaining PMF in adults with CF. ePS04.9 Evaluation of 6 Minutes Walking Test in CF patients before and after lung transplant A. Meschi1 , S. Tomezzoli1 , C. Tartali1 , G. Tridello1 , A. Borruso1 , M. Ocampo Barao1 , C. Vassanelli1 . 1 Azienda Ospedaliera Universitaria Integrata Verona, Cystic Fibrosis Center, Verona, Italy The 6 Minutes Walking Test (6MWT) is a field test that evaluates exercise capacity, assessing prognosis and response to treatment in different respiratory diseases. Some studies showed changes in the 6 Minutes Walking Distance (6MWD), muscle strength and exercise capacity before and 1 year after lung transplant (LTX). Objectives: To describe the change of the 6MWD post-LTX in CF patients. Methods: A retrospective analysis was performed on 6MWT data collected in the clinical evaluation of LTX recipients between 2000 and 2015. 6MWTs were executed in the year prior LTX and every year after LTX. A complete follow-up consisted in tests collected at baseline (≤12 mths pre-LTX) and at 2 post-LTX time-points (between 12–24 and between 24–48 mths). Non parametric paired tests were applied to detect possible changes, considering statistically significant a p < 0.05. A difference of 30 metres was considered clinically relevant. Results: 19 patients (9M, 10F, median age 24 y, range 10–44 y) with a complete follow-up were selected. An improvement of the 6MWD was observed, with an average increment of 71 m (SD 97, p < 0.01) at 12–24 mths and of 86 m (SD 93, p < 0.01) at 24–48 mths. The comparisons of post-LTX values with the baseline resulted both clinically relevant and statistically significant. Conclusion: Our results suggest that the 6MWT could be a clinical tool for a global evaluation of CF LTX patients. This study shows that the 6MWD has improved and mantained till 48 mths. Further analysis are needed to investigate the variables that correlate with the improvement of 6MWT performance. ePS04.10 Evaluation of exercise performance with Godfrey cycle protocol: experience of the cystic fibrosis (CF) center of Milan F. Carta1 , S. Gambazza1 , A. Brivio1 , E. Caverni1 , M. Foa` 1 , A. Lopopolo1 , D. Brusa1 , C. Colombo1 . 1 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy Standardized exercise is part of the regular assessment of patients with CF. Protocols using cycle-ergometer or treadmill are strongly preferred to field tests, particularly in subjects with mild-to-moderate lung disease. Objectives: To evaluate exercise tolerance in patients regularly followedup at CF centre. Methods: After reviewing the literature and feasibility of different exercise testing, we adopted the Godfrey cycle protocol by November 2014 as routinary assessment. Informed consent and test operator procedure were thus realized. Data are displayed as mean(sd). Results: Sixty-seven patients (36 female) with CF have performed the Godfrey test so far. Mean age was 20.6 (4.8) yrs (range 12.6 to 36.9 yrs) with a FEV1 of 71.5 (30.3)% pred. (19% had FEV1 <40%pred); 7 were on oxygen therapy. The estimated VO2 was 2.46 (0.63) L/min, HRpeak was 166.5(15.6) beats/min, Wmax was 122.3(48.61) Watt and power/weight ratio was 2.47 (0.62) W/kg; 35.8% performed a maximal test, mainly due to maximal BORG CR10 Dyspnea and/or Muscle Fatigue rating (62%). 6% of the whole sample showed a normal response to exercise. The average time needed for the test was 10m 16(150)s and 10 to 16 minutes for patients training and setting arrangement. No adverse event occurred. Conclusion: When ventilatory gas analysis is not available and facilities lack space, the Godfrey protocol gives a plethora of information about physical functioning and also potential reasons for exercise limitation
36% of the control group. With regard to strategies to decrease barriers 75% of CF patients “think about the advantage of sport” compared to 82% in the control group. Conclusion: Physical barriers were more important for healthy than for CF patients. Despite time consuming treatment CF patients do not regard “stress” more often as barrier than healthy volunteers. Concerning the barrier management the acute strategy to “think about the advantage of exercise” is important for both groups while others differ. The challenge for the individualized activity program is therefore to develop individual strategies to decrease barriers and identify facilitators to promote physical activity for CF patients. ePS04.7 A survey of activity levels and sedentary time in adult CF patients A.R. Morris1 , N.P. Hilton1 , J. Greenwood1 , M.J. Ledson1 , M.J. Walshaw1 . 1 Liverpool Heart & Chest Hospital, Liverpool, United Kingdom Introduction: Physical activity and exercise are widely agreed to be beneficial to the health and well-being of cystic fibrosis patients and are an important part of the CF care package. This study investigated the physical activity status and sedentary behaviour of a population of adult cystic fibrosis patients. Method: Physical activity was reported in 141 patients via the World Health Organisation Global Physical Activity Questionnaire. We also performed a concomitant sub-maximal exercise capacity assessment by recording treadmill maximal steady state. Current pulmonary function and BMI were also noted. Results: Results showed that 62% of the sample group were failing to meet the minimal recommended requirement of 600MET-minutes/ week of moderate to vigorous physical activity. There was a weak relationship between physical activity levels and exercise capacity (r = 0.4, p < 0.05) but there was no relationship between activity levels and either pulmonary function, BMI or age. Observation of sedentary time showed the majority of patients spending around half of their waking hours in sedentary behaviours with 21% spending in excess of 10 hours per day sitting or reclining. 7% of patients reported being sedentary for half of their waking hours or more, despite meeting minimal activity guidelines through exercising. Conclusion: The message to increase activity levels is still an important one and many patients are still at risk of a low-activity lifestyle. Reducing sedentary behaviour is important to avoid the problem of the ‘active couch potato’ – patients who are meeting activity guidelines but who are then spending an excessive amount of their time in sedentary behaviours. ePS04.8 Daily physical activity and peripheral muscle force in adults with cystic fibrosis compared with controls F. Pyl1 , F. De Baets1 , D. Declercq1 , P. Calders2 , S. Bernaert2 , S. Van Biervliet1 . 1 University Hospital Gent, Gent, Belgium; 2 University Gent, Gent, Belgium Objectives: Physical activity (PA) and peripheral muscle force (PMF) is important in chronic diseases. It is not clear whether adults with CF have the same level of PA and PMF as healthy peers. This study evaluates the level of PA and PMF in adults with CF and their relation with FEV1, BMI and 6 minutes walking distance (6MWD). Methods: 35 CF patients (FEV1 64.6%, IQR 52–85; age 26 y, IQR 22–33; BMI 20.7, IQR 20–23.2) and 35 healthy age- and BMI-matched controls wore the Sensewear® armband for 5 consecutive days to measure daily PA. PA level was expressed as the average time spent/day in moderate PA (MPA, 4.8–7.2 METs) and vigorous PA (VPA, >7.2 METs). They performed a quadriceps force test (QF), handgrip force test (HGF) and a 6MWD. Results: There was no difference in PA (MPA: 30 IQR 20–86 vs 40 IQR 21–61.5 min; VPA: 16 IQR 3–33 vs 10 IQR 1.5–16.5 min). For controls + CF (TG) there was an inverse relation between PA and age (p = 0.009). In the TG and in the CF group, QF was correlated with 6MWD (p = 0.009 and p = 0.031 resp.). On the other hand no relation was found between PA and PMF. Except for HGF right (p = 0.014) PMF was comparable between both groups. 6MWD was significantly lower in the CF group (p = 0.001). PMF in CF but not in controls was correlated with BMI (BMI vs QF
S45
p = 0.036; BMI vs HGF p = 0.001). BMI was also correlated with FEV1 (p = 0.031). Conclusion: The studied CF population had the same level of PA and PMF as their healthy peers. FEV1 didn’t seem to determine PA nor PMF. Despite this finding, submaximal exercise capacity (6MWD) in CF is impaired. Nutritional status seems essential in maintaining PMF in adults with CF. ePS04.9 Evaluation of 6 Minutes Walking Test in CF patients before and after lung transplant A. Meschi1 , S. Tomezzoli1 , C. Tartali1 , G. Tridello1 , A. Borruso1 , M. Ocampo Barao1 , C. Vassanelli1 . 1 Azienda Ospedaliera Universitaria Integrata Verona, Cystic Fibrosis Center, Verona, Italy The 6 Minutes Walking Test (6MWT) is a field test that evaluates exercise capacity, assessing prognosis and response to treatment in different respiratory diseases. Some studies showed changes in the 6 Minutes Walking Distance (6MWD), muscle strength and exercise capacity before and 1 year after lung transplant (LTX). Objectives: To describe the change of the 6MWD post-LTX in CF patients. Methods: A retrospective analysis was performed on 6MWT data collected in the clinical evaluation of LTX recipients between 2000 and 2015. 6MWTs were executed in the year prior LTX and every year after LTX. A complete follow-up consisted in tests collected at baseline (≤12 mths pre-LTX) and at 2 post-LTX time-points (between 12–24 and between 24–48 mths). Non parametric paired tests were applied to detect possible changes, considering statistically significant a p < 0.05. A difference of 30 metres was considered clinically relevant. Results: 19 patients (9M, 10F, median age 24 y, range 10–44 y) with a complete follow-up were selected. An improvement of the 6MWD was observed, with an average increment of 71 m (SD 97, p < 0.01) at 12–24 mths and of 86 m (SD 93, p < 0.01) at 24–48 mths. The comparisons of post-LTX values with the baseline resulted both clinically relevant and statistically significant. Conclusion: Our results suggest that the 6MWT could be a clinical tool for a global evaluation of CF LTX patients. This study shows that the 6MWD has improved and mantained till 48 mths. Further analysis are needed to investigate the variables that correlate with the improvement of 6MWT performance. ePS04.10 Evaluation of exercise performance with Godfrey cycle protocol: experience of the cystic fibrosis (CF) center of Milan F. Carta1 , S. Gambazza1 , A. Brivio1 , E. Caverni1 , M. Foa` 1 , A. Lopopolo1 , D. Brusa1 , C. Colombo1 . 1 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy Standardized exercise is part of the regular assessment of patients with CF. Protocols using cycle-ergometer or treadmill are strongly preferred to field tests, particularly in subjects with mild-to-moderate lung disease. Objectives: To evaluate exercise tolerance in patients regularly followedup at CF centre. Methods: After reviewing the literature and feasibility of different exercise testing, we adopted the Godfrey cycle protocol by November 2014 as routinary assessment. Informed consent and test operator procedure were thus realized. Data are displayed as mean(sd). Results: Sixty-seven patients (36 female) with CF have performed the Godfrey test so far. Mean age was 20.6 (4.8) yrs (range 12.6 to 36.9 yrs) with a FEV1 of 71.5 (30.3)% pred. (19% had FEV1 <40%pred); 7 were on oxygen therapy. The estimated VO2 was 2.46 (0.63) L/min, HRpeak was 166.5(15.6) beats/min, Wmax was 122.3(48.61) Watt and power/weight ratio was 2.47 (0.62) W/kg; 35.8% performed a maximal test, mainly due to maximal BORG CR10 Dyspnea and/or Muscle Fatigue rating (62%). 6% of the whole sample showed a normal response to exercise. The average time needed for the test was 10m 16(150)s and 10 to 16 minutes for patients training and setting arrangement. No adverse event occurred. Conclusion: When ventilatory gas analysis is not available and facilities lack space, the Godfrey protocol gives a plethora of information about physical functioning and also potential reasons for exercise limitation