Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis.

BACKGROUND: Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients' preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery. METHODS: We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348. RESULTS: 13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb. CONCLUSIONS: Our results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (<10 m) should be referred to formal cardiopulmonary exercise testing.

Effect of Fatigue on Functional Stability of the Knee: Particularities of Female Handball Players.

The risk of anterior cruciate ligament injury in female handball players is high. Fatigue of active stabilizers and increases in joint laxity are often mentioned in the literature as causal factors. However, no studies have been carried out on this population. Our objective is to determine the effect of muscle fatigue on active and passive knee stability in female handball players. This prospective study assessed tibiofemoral joint laxity, as well as hamstring and quadriceps strength, before (Tinitial), during and 3 min after (Tfinal) an isokinetic fatigue protocol (25 repetitions of knee flexion / extension at 180°.s-1). Laxity values (slope of the displacement-load curve and anterior tibial translation) were measured using a GNRB-Rotab® arthrometer; torque values were measured at specific joint angles and peak muscle torque using an isokinetic dynamometer. Nineteen women (20.9±2.4 years, 62.0±4.9 kg, 166±5 cm) were included. Normalized peak torque decreased significantly between the first three and last three repetitions of the fatigue protocol (p<0.0001, ES=3.2 and 3.2). Slope of the displacement-load curve and anterior tibial translation, functional and conventional ratios did not change significantly between Tinitial and Tfinal. Active and passive markers of knee stability were not altered by a fatigue protocol in female handball players, suggesting these players have a large capacity for recovery. These results suggest that muscle strengthening to prevent ACL injury in female handball players may be inappropriate.Level of evidence: Level 2b, Prospective Cohort.

Oxygen uptake kinetics during treadmill walking in adolescents with clinically stable cystic fibrosis.

BACKGROUND: Oxygen uptake (V̇O2) kinetics have been shown to be slowed in adolescents with cystic fibrosis (CF) during heavy-intensity cycling and maximal exercise testing. OBJECTIVES: This study investigated V̇O2 kinetics in adolescents with CF compared to control adolescents (CON) during a treadmill-walking exercise. METHODS: Eight adolescents with CF and mild-to-moderate pulmonary obstruction (5 girls; 13.1 ± 2.5 years; FEV1 67.8 ± 21.4%) and 18 CON adolescents (10 girls; 13.8 ± 1.8 years) were recruited. Pulmonary gas exchange and ventilation were measured during a single transition of 10 min of treadmill walking and a 5 min seated recovery period. Participant's walking speed was determined during a one-minute self-paced walking task along a 50-m corridor. A six-parameter, non-linear regression model was used to describe the changes in V̇O2 function during the treadmill walking and recovery, with monoexponential curve fitting used to describe the mean response time (MRT1) at the onset of exercise, and the half-life (T1/2V̇O2) at the offset of exercise. V̇O2 baseline and amplitude, minute ventilation and respiratory equivalents were recorded. RESULTS: V̇O2 kinetics were slower in CF group compared to CON group during the treadmill walking with a greater MRT1 (32 ± 14 s vs 21 ± 16 s; p = .04, effect size = 0.75). The T1/2V̇O2 was prolonged during recovery in CF group compared to CON group (86 ± 24 s vs 56 ± 22 s; p = .04, effect size = 1.31). The mean VE/V̇CO2 during exercise was the only parameter significantly greater in CF group compared to CON group (32.9 ± 2.3 vs 29.0 ± 2.4; p < .01, effect size = 1.66). CONCLUSION: V̇O2 kinetics were found to be slowed in adolescents with CF during treadmill walking.

Effects of Exercise Training on Peripheral Muscle Strength in Children and Adolescents with Cystic Fibrosis: A Meta-Analysis.

Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results.