Exercise correlates of pulmonary function in paediatric patients with cystic fibrosis

Sara Thompson 1, Jane Schneiderman 1, Donna Wilkes 1, Felix Ratjen 1, Greg D. Wells 1,2 1The Hospital For Sick Children, Toronto, Canada, 2Faculty of Physical Education and Health, University of Toronto, Canada

Introduction
The standard measure of lung health in CF patients is Forced expiratory volume in 1 second (FEV1). Peak aerobic fitness (VO2peak ) has been linked to lung function and has been the traditional fitness assessment in the paediatric population. While aerobic metabolism has been found to be impaired in CF1, it has been suggested that anaerobic fitness and muscle strength and power are affected by CF as well1,2 . However equivocal results have been found in this area of study, and the relationship between these parameters and disease status (FEV1) remains unclear.

Results
FEV1 was significantly correlated to anaerobic fitness (60 Hz) FEV1 was significantly correlated to upper body muscle strength

Conclusions
These results suggest that anaerobic fitness and upper body strength, but not lower body power, may be useful indicators of lung function in children with CF. Interestingly, peak aerobic power was not found to be correlated to lung function in this study. This implies that other parameters of fitness might be better tools for the assessment of physical performance as it relates to lung health in this population.

r=0.66, p=0.01
Peak Peak Pow Pow er er (watt (watt s) s)

r=0.51, p=0.04
Hand grip stren gth (kg)

Implications
Simple fitness tests such as hand grip strength and anaerobic cycle tests may be effective in predicting lung health in clinics that do not have the facility to conduct more technical aerobic fitness tests.
FEV1 (% predicted))

Methods
1. 16 Children between the ages of 7-18 yrs were tested during their regular CF clinic visits as follows: Pulmonary function was measured according to standard spirometric techniques VO2peak was calculated using an electrically braked cycle ergometer Anaerobic capacity for 10- and 30- second trials was measured using an isokinetic cycle ergometer Upper body muscle strength was measured using a handgrip dynamometer and lower body muscle power was assessed by vertical jump height 2. Correlational analyses were performed and all variables were compared to FEV1.

FEV1 (% predicted) FEV1 (% predicted))

FEV1 was not correlated to lower body muscle power

FEV1 was not correlated to maximal aerobic capacity

Physical activity programs that include anaerobic and strength training could be implemented for this population. Including this variety of training could have significant health benefits while avoiding the monotony of exclusively aerobic programs2.

References
r=0.03, p=0.91
Verti cal Jum p (cm)

r=0.27, p=0.33
VO2p
eak

(ml/k g/mi n)

1.Wells, G.D., Wilkes ,D.L., Schneiderman, J.E., Rayner, T., Elmi, M., Selvadurai, H,. Dell, S.D., Noseworthy, M.D., Ratjen, F., Tein, I., Coates, A.L. Skeletal muscle metabolism in cystic fibrosis and primary ciliary dyskinesia. Pediatr Res. 2011 Jan;69(1):40-5. 2.Wilkes, D.L., Schneiderman, J.E., Nguyen, T., Heale, L., Moola, F., Ratjen, F., Coates, A.L., Wells, G.D. Exercise and physical activity in children with cystic fibrosis. Paediatr Respir Rev. 2009 Sep;10(3):105-9. Epub 2009 Jul 21. Review.

3.
FEV1 (% predicted) FEV1 (% predicted)