Validity and reliability of 6-minute pegboard and ring test in patients with asthma.

OBJECTIVE: The 6-minute pegboard and ring test (6PBRT) is a test of upper-extremity functional capacity designed for and validated in chronic obstructive pulmonary disease. The aim of this study was to evaluate the validity and reliability of the 6PBRT in asthma patients. METHODS: Thirty-four adults (30 women, 4 men) with well-controlled asthma were included. Unsupported upper-extremity exercise capacity was assessed using 6PBRT, maximal arm exercise capacity using an arm ergometer, handgrip strength using a hand dynamometer, activities of daily living with the London Chest Activities of Daily Living Scale (LCADL), Milliken ADL scale (MAS) and health-related quality of life using the Asthma Quality of Life Questionnaire (AQLQ) and Health Assessment Questionnaire Disability Index (HAQ-DI). RESULTS: The 6PBRT showed moderate to excellent test-retest reliability with an intraclass correlation coefficient (ICC) value of 0.872 [95% confidence interval (CI) 0.702-0.941]. The 6PBRT was reproducible according to Bland-Altman analysis, with upper and lower limits of agreement of 53.51 and -25.08 rings moved, respectively. The 6PBRT score was significantly correlated with maximum workload (r = 0.514, p = 0.002) achieved in the arm ergometer test, change in dyspnea during 6PBRT (r = -0.402, p = 0.020), LCADL-self-care (r = -0.364, p = 0.037), MAS total (r = 0.483, p = 0.005), AQLQ-symptom domain (r = 0.420, p = 0.026) and HAQ-DI total scores (r = -0.390, p = 0.025). CONCLUSIONS: The 6PBRT can be used as a valid and reliable test to evaluate functional arm exercise capacity in patients with well-controlled asthma.

Active video gaming in primary ciliary dyskinesia: a randomized controlled trial.

Primary ciliary dyskinesia (PCD) impairs pulmonary function, respiratory and peripheral muscle strength, and exercise capacity. We aimed to investigate the effects of active video games (AVGs) on pulmonary function, respiratory and peripheral muscle strength, exercise capacity, muscle oxygenation (SMO2), physical activity, activities of daily living (ADL), and quality of life (QOL) in PCD. Thirty-two PCD patients were randomly assigned to AVG group (n = 16) and the control group (n = 16). AVG group underwent AVGs using Xbox-Kinect-360 device for 40 min/day, 3 days/week for 8 weeks plus airway clearance techniques (ACT), and the control group was applied ACT only. Pulmonary function, respiratory and quadriceps muscle strength, exercise capacity (6-min walk test [6MWT], incremental shuttle walk test [ISWT]), and ADL (Glittre ADL test) were assessed. SMO2 during ISWT and ADL test was also recorded. Physical activity and QOL (PCD-QOL) were evaluated. Pulmonary function; respiratory and quadriceps muscle strength; 6MWT and ISWT distance; physical activity; ADL performance; SMO2; physical, emotional, and social functioning; treatment burden; and upper and lower symptom parameters of PCD-QOL significantly improved after 8 weeks in the AVG group (p < 0.05). There were no significant differences in measured parameters except emotional function and upper respiratory symptom scores of PCD-QOL in the control group (p > 0.05).    Conclusion: The AVGs positively affect pulmonary (pulmonary function, respiratory muscle strength) and extrapulmonary (peripheral muscle strength, exercise capacity, SMO2, physical activity, ADL, and QOL) characteristics in children with PCD. The AVGs may be added to the pulmonary rehabilitation program as an exercise training modality in patients with PCD.   Trial registration: This study registered at ClinicalTrials.gov with NCT03832491 on February 6, 2019. What is Known: • It is indicated that exercise capacity is increased with traditional exercise-training in a case report of Kartagener Syndrome. What is New: • No randomized controlled study investigated the effects of exercise-training in PCD. • 8-week moderate-intensity active video gaming (AVGs) improves pulmonary and extrapulmonary features in children with PCD. AVGs may be preferable due to being enjoyable, providing visual and audial feedback in the pulmonary rehabilitation programs of PCD.

Physical fitness and activities of daily living in primary ciliary dyskinesia: A retrospective study.

BACKGROUND: Primary ciliary dyskinesia (PCD) is a rare, hereditary, autosomal recessive disorder characterized by recurrent upper and lower respiratory tract infections. This study aimed to compare pulmonary function, respiratory muscle strength, exercise capacity, physical fitness, and activities of daily living (ADLs) retrospectively between patients with PCD and healthy controls. METHODS: Data from 20 patients with PCD and 20 matched, healthy counterparts recorded between July 2015 and January 2017 were analyzed. The data evaluated and recorded included pulmonary function using a portable spirometer, respiratory muscle strength (using a mouth pressure device, exercise capacity using the incremental shuttle walk test,), physical fitness (using the Munich Fitness Test), and ADLs (using the Glittre ADL test). RESULTS: Pulmonary function, respiratory muscle strength, incremental shuttle walk test scores (all parameters), and total Munich Fitness Test scores were lower in the PCD group relative to controls (P < 0.05). The duration to complete the Glittre ADL test was higher in PCD patients than in healthy subjects (P < 0.05). CONCLUSIONS: Pulmonary function, respiratory muscle strength, exercise capacity, physical fitness, and ADL were affected by PCD. Thus, pulmonary rehabilitation regimens should be tailored according to these impacts.

Reliability and validity of the Turkish version of Post-COVID-19 Functional Status Scale

Background/aim: The post-COVID-19 Functional Status (PCFS) has recently been developed for functional outcomes of COVID-19 upon discharge and in long term. The purpose of this study was to investigate the reliability and validity properties of the Turkish version of the PCFS in Turkish post-COVID-19 patients with hospitalized and nonhospitalized during infection. Materials and methods: One hundred participants with post-COVID-19 were included in this cross-sectional study. Test-retest reliability of the Turkish version of PCFS assessed by intraclass correlation coefficient (ICC) and Cronbach's alpha was calculated for internal consistency. For construct validity, correlation coefficients between the Turkish version of PCFS developed by translation-back translation method and modified Medical Research Council (mMRC) dyspnea scale (MMRC), London Chest Activities of Daily Living (LCADL) scale, Barthel Index (BI) were analyzed. Results: For test-retest reliability analysis, ICC ranged between 0.734 and 0.880. The total ICC score was 0.821, indicating excellent reliability. The Cronbach's alpha value of the PCFS test and retest scores were recorded as 0.821 indicating that the scale is quite reliable. The PCFS score was moderately correlated with the mMRC score (r = 0.534, p < 0.001) and weakly correlated with the LCADL self care (r = 0.311, p = 0.002), domestic (r = 0.277, p = 0.005), physical activity (r = 0.342, p < 0.001), leisure subscores (r = 0.434, p < 0.001) and total score (r = 0.399, p < 0.001). Conclusion: The Turkish version of the PCFS scale is reliable scale that reflects activity limitation and functional status after COVID-19. The Turkish version of the PCFS will be a guide for rehabilitation professionals to understand functional limitation after COVID-19 and to direct interventions accordingly to functional status of the patients at discharge and in long term.

Levels of Physical Activity and Physical Fitness in Pediatric Pacemaker Patients: A Cross-Sectional Study.

Children with heart diseases have reduced physical activity (PA) levels relative to their peers, which in turn increases cardiovascular risk. To the best of our knowledge, physical fitness and objectively measured PA levels have not been previously studied in children with pacemakers. We evaluated PA levels and physical fitness in pediatric pacemaker patients compared to their healthy peers. Twenty-eight pediatric patients with pacemakers (15 female, 13 male; mean age 13.43 ± 3.68 years) and 24 healthy subjects (14 female, 10 male; mean age 13.08 ± 3.67 years) were included. Physical fitness was assessed using the Munich Fitness Test (MFT). SenseWear Armband metabolic Holter device was used to record the PA for 7 consecutive days. MFT total and sub-parameter scores were significantly lower in the patient group (p < 0.05). Patients' total and active energy expenditure, PA level, total distance, number of steps, and vigorous PA were significantly lower than those of healthy children (p < 0.05). Sedentary activity and light, moderate, and very vigorous PA durations were similar in both groups (p > 0.05). Duration of mean moderate to vigorous PA was higher than 60 min/day recommended in PA guidelines in both patients and healthy subjects. These results provide initial data on PA and fitness in children with pacemakers and suggest that physical fitness and activity levels in children with pacemakers are lower than in healthy peers. Appropriate exercise programs may improve PA levels in pediatric pacemaker patients. Awareness of the importance of PA should be raised among the parents and families of these children.

High-intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Inspiratory muscle training (IMT) enhances velocity of inspiratory muscle contraction and modifies inspiratory and expiratory time. This study aimed to examine the impact of high-intensity IMT (H-IMT) on exercise capacity in bronchiectasis. METHODS: Forty-five patients were included. Lung function, respiratory muscle strength and endurance, exercise capacity, dyspnoea, fatigue and quality of life (QOL) were evaluated. Patients were randomized into two groups: H-IMT and control groups. Twenty-three patients underwent H-IMT for 8 weeks, using threshold loading with a target workload of maximal inspiratory pressure (MIP) of at least 70%, with 3-min cycles (as 2-min training: 1-min rest intervals) for 21 min. There was a total period of 14 min of loaded breathing and 7 min of recovery. The control group (n = 22) underwent low-intensity IMT at 10% of the initial MIP and was maintained at the same intensity until the end of the training. RESULTS: After training, both MIP and maximal expiratory pressure (MEP) and the incremental shuttle walk distance were increased in the H-IMT group compared with the control group (P < 0.05). There was a significant difference in constant threshold load, time and pressure-time units in the H-IMT group (P < 0.05) but not in the control group (P > 0.05). A significant decrease was found in fatigue in both groups (P < 0.05). The Leicester Cough Questionnaire social score for the H-IMT group decreased significantly after the treatment (P < 0.05). CONCLUSION: The H-IMT increased exercise capacity in patients with non-cystic fibrosis bronchiectasis. It has also positive effects on respiratory muscle strength and endurance, and social aspects of QOL.

Reduced anaerobic and aerobic performance in children with primary ciliary dyskinesia.

Primary ciliary dyskinesia (PCD) restricts lifestyle and increases morbidity. The aim of the study was to investigate anaerobic and aerobic performance in children with PCD and their healthy counterparts. Thirty-one children with PCD and 29 age- and sex-matched healthy subjects were studied. Pulmonary function, hand grip strength (HGS), quadriceps strength (QMS), physical activity, anaerobic capacity (muscle power sprint test), and aerobic performance (modified shuttle walk test (MSWT)) were determined. Pulmonary function, HGS, QMS, mean anaerobic power (MAP), and MSWT distance in PCD were significantly lower than those of healthy subjects (p < 0.05). In PCD, the MAP was significantly correlated with age, FEV1, and the mean kcal for 3 days (p < 0.05), and age was its independent predictor (p < 0.05). The MSWT distance was significantly related to gender and weight (p < 0.05), and gender was selected as its independent predictor (p < 0.05). In healthy controls, the MAP was significantly associated with age, gender, FVC, FEV1, HGS, QMS, and the mean kcal for three days (p < 0.05). The MSWT distance was significantly related to weight and body mass index in healthy group (p < 0.05). CONCLUSION: Anaerobic and aerobic performance is impaired in PCD from the early stages. Age determines anaerobic performance. Gender is the determinant of aerobic performance. Whether skeletal muscle characteristics and sex-related changes in body composition affect anaerobic and aerobic capacity in PCD children warrants further study. What is Known: • Exercise performance is determined by anaerobic and aerobic power. • Few studies have shown that PCD patients have lower aerobic performance which is associated with impaired lung function. What is New: • The present research indicated that both anaerobic and aerobic exercise capacity determined using field testing is impaired in PCD from the early stages. • Anaerobic capacity was found to be independently associated with age in PCD. Higher aerobic performance is independently associated with male gender.

The relationship between lung function, exercise capacity, oxidant and antioxidant response in primary ciliary dyskinesia and cystic fibrosis.

BACKGROUND: There is a need to identify the complex interplay between various physiological mechanisms in primary ciliary dyskinesia (PCD) and cystic fibrosis (CF). The study investigated the interaction between respiratory function, exercise capacity, muscle strength, and inflammatory and oxidant/antioxidant responses in patients with PCD and CF. METHODS: The study included 30 PCD patients, 30 CF patients, and 29 age and sex-matched healthy subjects. Exercise capacity was assessed using the modified shuttle walk test (MSWT). Handgrip strength (HGS) was used to evaluate general muscle strength. Oxidative stress-inflammatory parameters were also assessed. Pulmonary function test was performed by spirometry. Regarding the forced expiratory volume in 1 second (FEV1) z-score, patients with PCD and CF were subdivided into normal, mild, and severe/moderate groups. RESULTS: Forced vital capacity (FVC) z-scores were lower in PCD and CF patients than controls. FEV1, FEV1/FVC, peak expiratory flow (PEF), and forced mid expiratory flow (FEF25-75%) z-scores were lower in PCD than in the other groups. HGS was lower in both mild PCD and normal CF patients relative to the controls. MSWT distance was lower in severe/moderate PCD patients than controls. Catalase (CAT), glutathione S-transferase (GST), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels did not differ significantly among the study groups, but superoxide dismutase (SOD) level in severe/moderate PCD, and glutathione (GSH) level in normal CF were higher than in controls. Interleukin-6 (IL-6) level was higher in patients with normal PCD and CF compared to the controls. IL-1ß level was higher in PCD compared to controls. Additionally, correlations among these parameters were also determined in some patient groups. CONCLUSION: Homeostasis related to respiratory function, aerobic performance, muscle strength, inflammatory response, and oxidant/antioxidant balance were affected in PCD and CF. Evaluating these mechanisms together may contribute to elucidating the pathophysiology of these rare diseases.

Metabolomic, oxidative, and inflammatory responses to acute exercise in chronic obstructive pulmonary disease.

BACKGROUND: There is currently a need to identify metabolomic responses to acute exercise in chronic obstructive pulmonary disease (COPD). OBJECTIVE: We investigated the metabolomic, oxidative, and inflammatory responses to constant (CE) and intermittent (IE) work rate exercises in COPD. METHODS: Sixteen males with COPD performed a symptom-limited incremental cycle exercise test (ICE). Metabolomic, oxidative, and inflammatory responses to CE and IE (based on the performance of ICE) were analyzed in the plasma. RESULTS: Fructose-6-phosphate, 3-phosphoglyceric acid, l-carnitine, and acylcarnitines levels were significantly decreased, whereas alpha-ketoglutaric, malic, 2-hydroxybutyric, and 3-hydroxybutyric acids were increased, after CE and IE (p<0.05). Increases in citric, isocitric, and lactic acids, as well as decreases in pyruvic and oxalic acids, were only present with IE (p<0.05). Isoleucine was decreased after both exercises (p<0.05). We observed an increase in inosine-5'-diphosphate, uric acid, ascorbic acid, and pantothenic acid, as well as a decrease in 5-hydroxymethyluridine, threonic acid, and dehydroascorbic acid, after IE (p<0.05). Catalase, reduced glutathione, and total antioxidant status difference values for both exercises were similar (p>0.05). The change in glutathione peroxidase (GPx) with CE was more significant than that with IE (p = 0.004). The superoxide dismutase change was greater with IE than with CE (p = 0.015). There were no significant changes in inflammatory markers after exercise (p>0.05). CONCLUSION: CE and IE cause isoleucine, l-carnitine, and acylcarnitine levels to decrease, whereas ketone bodies were increased, thus indicating the energy metabolism shift from carbohydrates to amino acid utilization and lipid metabolism in COPD. Compared with CE, IE produces significant changes in more metabolomics in terms of carbohydrates, lipids, amino acids, nucleotides, and vitamins. Acute CE and IE alter circulating GPx levels in COPD.

Upper Extremity Exercise Capacity and Activities of Daily Living in Individuals With Bronchiectasis Versus Healthy Controls.

OBJECTIVE: The purpose of this study was to compare the upper extremity exercise capacity and activities of daily living (ADL) in individuals with bronchiectasis and controls. METHODS: Twenty-four individuals with bronchiectasis and 24 healthy controls were assessed for upper extremity exercise capacity (6-minute pegboard and ring test [6PBRT]) and ADL (Glittre ADL test). Energy expenditure was measured using a wearable metabolic monitor during the Glittre ADL test. RESULTS: The mean [SD] 6PBRT score of individuals with bronchiectasis was significantly lower than the mean score of controls (196.50 [51.75] vs 243.00 [29.76] number of rings). The Glittre ADL test duration was significantly higher in individuals with bronchiectasis compared with controls (3.54 [1.53] vs 2.36 [0.18] minutes), despite similar energy expenditure during the Glittre ADL test between the groups (17.67 [5.28] kcal in individuals with bronchiectasis vs 18.13 [5.71] kcal in controls). The 6PBRT score and the Glittre ADL test duration were negatively correlated in individuals with bronchiectasis (r = -0.694). CONCLUSION: The individuals with bronchiectasis had reduced upper extremity exercise capacity compared with healthy controls. Energy expenditure during ADL was similar between individuals with bronchiectasis and healthy controls, despite lower ADL performance in individuals with bronchiectasis. The upper extremity exercise capacity and ADL are related in individuals with bronchiectasis. Given this relationship, inclusion of upper extremity exercise training in pulmonary rehabilitation programs should be considered. IMPACT: Considering the impairment of upper extremity exercise capacity and ADL in individuals with bronchiectasis highlights the need to tailor preventive strategies and preclude further unfavorable effects. LAY SUMMARY: Bronchiectasis may reduce exercise capacity in your arms and reduce your ability to perform daily living activities. Physical therapists can evaluate your condition and create rehabilitation programs to help manage these impairments.

Validity and Reliability of the Turkish Version of the Nijmegen Questionnaire in Asthma.

OBJECTIVE: The Nijmegen Questionnaire (NQ) enables the assessment and identification of symptoms related to respiratory dysfunction and hyperventilation syndrome. The aim was to investigate the validity of the Turkish version of the NQ in asthmatics. MATERIAL AND METHODS: Fifty-four individuals with asthma were included. Spirometry was performed. Dyspnea was assessed using the modified Borg and modified Medical Research Council scales. Breath-holding time was recorded. End-tidal carbon dioxide was measured using a portable capnograph. Oxygen saturation and heart rate were recorded. Asthma Control Test was used to evaluate the asthma control level. Quality of life was assessed using the Asthma Quality of Life Questionnaire and Nottingham Health Profile. Beck Depression Inventory was used to determine depression. RESULTS: Bartlett's test of sphericity (360.749, df 105, P < .001) and Kaiser-Meyer-Olkin criterion (0.752) for 15-item NQ supported a single-factor model with 36.38% of explained variability through principal component analysis and explanatory factor analysis. For 15-item NQ with this single-factor model, Cronbach's alpha was 0.872, and the test-retest reliability was 0.628. There was a significant negative correlation between NQ and Asthma Control Test (r = -0.448), and Asthma Quality of Life Questionnaire (r = -0.743) and a significant positive association with Beck Depression Inventory (r = 0.477), Nottingham Health Profile-energy (r = 0.370), Nottingham Health Profile-pain (r = 0.313), Nottingham Health Profile-sleep (r = 0.294), and Nottingham Health Profile-physical activity scores (r = 0.406) (P < .05). CONCLUSIONS: The 15-item Turkish version of the NQ is valid and reliable in asthmatics. Individuals with uncontrolled asthma have higher NQ scores than those with well-controlled asthma. NQ is associated with asthma control level, asthma-related quality of life, health profile, and depression.

Gait and functional balance in non-CF bronchiectasis.

BACKGROUND: The decline in ambulatory activities and negative alterations in gait characteristics may impair balance and increase fall risk in obstructive lung diseases. Few studies have evaluated balance and gait parameters in individuals with bronchiectasis. PURPOSE: This study aimed to compare the gait parameters and functional balance in individuals with non-cystic fibrosis (CF) bronchiectasis and healthy subjects. METHODS: This cross-sectional and retrospective study analyzed data from 22 individuals with non-CF bronchiectasis and 32 healthy controls recorded between July 2019 and July 2020. Functional balance was assessed using the Timed Up and Go (TUG) test. Gait parameters were evaluated using the Biodex Gait Trainer. Step cycle (s), gait speed (m/s), the number of steps per minute, and ambulation index were measured for 6 min.Results The TUG time (s) was significantly longer (p = .019, effect size = 0.66), and gait speed (m/s) (p ˂ 0.001, effect size = 2.47), step cycle (s) (p ˂ 0.001, effect size = 2.23), and ambulation index (p ˂ 0.001, effect size = 2.56) were significantly reduced in individuals with non-CF bronchiectasis compared with healthy controls. CONCLUSION: Non-CF bronchiectasis is related to unfavorable changes in gait characteristics, such as slower gait speed and the decreased average step cycle. In addition, impairment in functional balance and mobility exists in a small percentage of adults with non-CF bronchiectasis. In comprehensive pulmonary rehabilitation, balance and gait evaluations should be included to prevent falls in adults with non-CF bronchiectasis.

Daily living activities, exercise capacity, cognition, and balance in COPD patients with and without frailty.

BACKGROUND: Information on the interaction between frailty and chronic obstructive pulmonary disease (COPD) is limited. AIMS: This study aimed to compare activities of daily living (ADL), exercise capacity, balance, and cognition in COPD patients with and without frailty. METHODS: Twenty frail and 28 non-frail COPD patients aged 55 years and over were included. Frailty was determined according to Fried et al. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale. Respiratory and peripheral muscle strength were measured. Functional capacity was assessed using a 6-min walk test (6MWT); ADL performance was evaluated using the Glittre ADL test. The balance was evaluated using the functional reach test (FRT). Cognitive function was assessed using the Montreal Cognitive Evaluation (MoCA) Test. Quality of life was measured using the COPD Assessment Test (CAT). RESULTS: The mMRC and CAT scores were higher in the frail patients as compared with the non-frail patients (p < 0.05). The maximal inspiratory pressure, handgrip strength, 6MWT distance, and FRT score were lower in the frail patients as compared with the non-frail patients (p < 0.05). The duration for the Glittre ADL test was longer in the frail patients than the non-frail patients (p < 0.05). There was no significant difference between MoCA scores between groups (p > 0.05). CONCLUSIONS: Frail COPD patients have increased dyspnea perception, impaired muscle strength, and functional capacity, ADL performance, balance, and quality of life. Whether pulmonary rehabilitation programs for patients with frail COPD need to be adapted with new rehabilitation strategies, including components of frailty, needs further investigation.

Evaluation of exercise capacity using two field tests in patients with metabolic syndrome.

PURPOSE: Field tests are popular for assessing exercise capacity because they are practical and have established validity. The objective of this study was to compare physiological responses and exercise performance of patients with metabolic syndrome in two field tests of exercise capacity. MATERIAL AND METHODS: Forty-seven patients diagnosed with metabolic syndrome participated in this cross-sectional study. Exercise capacity was assessed using incremental shuttle walk test and six-minute walk test. Factors determining exercise capacity and agreement between the two tests were also investigated. RESULTS: Metabolic syndrome patients achieved a significantly greater percentage of predicted maximal heart rate, blood pressure, and longer distance in the incremental shuttle walk test than in the six-minute walk test (p < 0.001). Gender and body mass index explained 48.5% of the variance in six-minute walk test distance (R = 0.697, R2 = 0.485, F(2-46) = 20.737, p < 0.001). Body mass index and fat-free mass explained 55% of the variance in incremental shuttle walk test distance (R = 0.746, R2= 0.557, F(2-46) = 27.623, p < 0.001). CONCLUSIONS: Despite the agreement in the percentages of predicted maximal heart rate during these two field tests, the incremental shuttle walk test may be a better assessment tool than the six-minute walk test because it elicits more pronounced and definitive physiological responses to exercise tolerance in patients with metabolic syndrome.IMPLICATIONS FOR REHABILITATIONThe incremental shuttle walk test can be used to evaluate exercise capacity in metabolic syndrome.The incremental shuttle walk test elicits greater physiological responses than the six-minute walk test.The incremental shuttle walk test may be preferable over the six-minute walk test in investigating exercise capacity.Both tests can guide and assist in the evaluation of this patient population in clinical practice.Body mass index affected distance in both exercise tests.

Physical activity of patients with bronchiectasis compared with healthy counterparts: A cross-sectional study.

BACKGROUND: A few studies have implied that patients with bronchiectasis have a more inactive lifestyle than healthy counterparts do. The main objective of this study was to compare physical activity (PA) levels subjectively and objectively between patients with bronchiectasis and healthy individuals using an accelerometer and a questionnaire. METHODS: The study included 41 patients with bronchiectasis aged 18-65 years and 35 healthy age- and sex-matched control subjects. The PA level was assessed objectively using a multisensorial PA monitor, the SenseWear Armband (SWA), and subjectively with the International Physical Activity Questionnaire (IPAQ). All participants performed the incremental shuttle walk test (ISWT) for the assessment of exercise capacity. Pulmonary function, dyspnea, severity of bronchiectasis, respiratory and peripheral muscle strength, and quality of life were assessed. RESULTS: The pulmonary function test parameters, respiratory and peripheral muscle strength, exercise capacity, step count, moderate- and vigorous-intensity PA duration were significantly lower in patients with bronchiectasis than in the healthy control group (p < 0.05). Sedentary, moderate, vigorous, and total PA duration measured using the SWA were higher than those obtained using the IPAQ (p < 0.05). CONCLUSIONS: Patients with bronchiectasis have a reduced PA level compared with healthy counterparts. The IPAQ (based on the subjective estimation of PA) outcomes differed from the SWA outcomes, reinforcing the necessity for a disease-specific PA questionnaire. IPAQ underestimates the physical activity level compared with objective measurements.

Deviations of body functions and structure, activity limitations, and participation restrictions of the International Classification of Functioning, Disability, and Health model in children with cystic fibrosis and non-cystic fibrosis bronchiectasis.

BACKGROUND: To the best of our knowledge, there is no study in the literature investigating the extrapulmonary outcomes of children with non-cystic fibrosis (CF) bronchiectasis and CF under the framework of the International Classification of Functioning, Disability, and Health (ICF) model. The purpose of the present study is to evaluate the children with CF and non-CF bronchiectasis using the ICF model. MATERIALS AND METHODS: Children with CF, non-CF bronchiectasis, and healthy counterparts were evaluated (20 participants in each group) according to the ICF items in domain b (body functions), domain s (body structures), and domain d (activities and participation). The pulmonary functions, respiratory and peripheral muscle strength tests, and posture analysis were carried out for domain b. For domain d, however, the Glittre-activities of daily living test and Pediatric Outcome Data Collection were used. RESULTS: Muscle strength of shoulder abductors and hip extensors in children with CF was significantly lower than healthy children and adolescents (P < .05). The severity of lateral and posterior postural abnormalities in children with CF and non-CF bronchiectasis was higher than those of healthy children (P < .05). Among the patient groups, global function, sports/physical function, expectations, transfers/basic mobility, and pain/comfort were the most affected participation dimensions (P < .05). CONCLUSIONS: This study highlights the need for comprehensive up-to-date evaluation methods according to the ICF model for understanding rehabilitation requirements in CF and non-CF bronchiectasis in different age groups.

Exercise Capacity and Activities of Daily Living are Related in Patients With Chronic Obstructive Pulmonary Disease.

INTRODUCTION: The knowledge of the relationship between exercise capacity and activities of daily living (ADLs) is important to minimize the negative outcomes in ADLs resulting from reduced exercise capacity in patients with chronic obstructive pulmonary disease (COPD). There is a limited study about the association between exercise capacity and ADLs in patients with COPD. This study aimed to investigate the relationship between maximal exercise capacity and ADLs in patients with GOLD stage II-III COPD. METHODS: Twenty-seven clinically stable GOLD stage II-III COPD patients were included (mean age=58.59±9.63 years and mean FEV1=50.6±13.7%) in this cross-sectional study. Maximal and submaximal exercise capacity were evaluated using an incremental shuttle walk test (ISWT) and 6-min walk test (6MWT), respectively. Activities of daily living were assessed using Glittre-ADL test. RESULTS: The ISWT distance was significantly correlated with Glittre-ADL test time (r=-0.517, p=0.006). There was also a negative correlation between 6MWT distance and Glittre-ADL test time (r=-0.506, p=0.007). CONCLUSION: A moderate relationship was found between maximal exercise capacity and general activities of daily living performance. The reduction in exercise capacity increases the negative influences in ADLs and strengthens our beliefs that exercise interventions in pulmonary rehabilitation could influence activities of daily living positively.

Physiotherapy and Rehabilitation Implementation in Intensive Care Units: A Survey Study.

OBJECTIVES: Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers toward applying physiotherapy in ICUs. MATERIALS AND METHODS: A 54-item survey for determining the characteristics of physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23-52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. RESULTS: The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapist (low level of employment and practice, lack of shift); patient (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. CONCLUSION: The most common interventions were positioning, active, passive, and breathing exercises and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, team, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Aerobic exercise training in Kartagener's syndrome: case report.

Kartagener's syndrome is a rare, autosomal recessive inherited disease, which is characterized by a triad of chronic sinusitis, bronchiectasis, and situs inversus. In this report, we aimed to represent the effect of aerobic exercise training in addition to chest physiotherapy in an outpatient with Kartagener's syndrome. An 18-year-old female diagnosed with Kartagener's syndrome applied with the complaints of productive cough and dyspnea with exertion and attended pulmonary rehabilitation program comprising exercise training in addition to standard treatment. Aerobic exercise training was performed three times weekly at 80% of the peak heart rate, for 8 weeks as supervised sessions. Respiratory physiotherapy and postural exercises were taught to the patient to be performed at home each day of the week. Before and after pulmonary rehabilitation program, incremental shuttle walk test (ISWT) was performed; dyspnea and fatigue were assessed using Borg Scale. Pulmonary function test was evaluated using spirometer. The patient wore activity monitor for 7 consecutive days before and after training. After pulmonary rehabilitation program, 90-m increase in ISWT was observed. We recommend exercise training in patients with Kartagener's syndrome to increase exercise capacity. Further randomized control trial is needed to clarify the effects.

Listening to motivational music while walking elicits more positive affective response in patients with cystic fibrosis.

OBJECTIVE: The purpose of this study was to investigate the effects of motivational and relaxation music on affective responses during exercise in patients with cystic fibrosis (CF). METHODS: Thirty-seven patients with CF performed the 6-min walk test (6MWT) under three experimental conditions: listening to no music, relaxation music, and motivational music. 6-min distance × body weight product (6MWORK) was calculated for each trial. Patients' affective responses during exercise was evaluated with Feeling Scale (FS). The motivational qualities of music were evaluated with the Brunel Music Rating Inventory-2 (BMRI-2). RESULTS: 6MWORK was significantly lower while listening to relaxation music compared to 6MWORK without music (p < 0.05). FS and BMRI-2 scores were significantly higher during 6MWT with motivational music than 6MWT with relaxation music (p < 0.05). CONCLUSIONS: Carefully selected motivational music can lead to positive affective response during exercise and increase the enjoyment of patients from exercises in CF.