The Effects of Core Stabilization Exercises on Respiratory Muscle Strength, Respiratory Functions, and Postural Control in Children With Hearing Loss: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the effects of core stabilization training on respiratory muscle strength, respiratory functions, and postural control in children with hearing loss. DESIGN: We conducted a randomized controlled trial at Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation. Thirty children with hearing loss who were diagnosed with prelingual sensorineural hearing loss were randomly allocated to the study (n = 15, 12.20 ± 1.69 years) and control (n = 15, 11.87 ± 2.20 years) groups. Core stabilization training protocol was performed by the study group for 8 weeks, 5 days/week, whereas the control group received no training. The primary outcome measure was respiratory muscle strength. The secondary outcome measures were: spirometry, postural control tests on Biodex Balance System, and Balance Error Scoring System (BESS). Exercise adherence was recorded via a diary for home sessions. Outcomes were assessed at baseline and the end of the 8 weeks. RESULTS: In the study group, a significant improvement was observed in force vital capacity, peak expiratory flow of the spirometry test, maximum inspiratory pressure/expiratory pressure (MEP) of the respiratory muscle strength test; postural stability test except "anterior/posterior stability index", limits of stability test except "backward" and "forward/right", all parameters of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) test except "eyes closed firm surface" of the Biodex Balance System, and total score of BESS. Group × time interaction was found in MEP, "overall" stability index in postural stability test, "overall," "left," and "backward left" of limits of stability test, all parameters of the mCTSIB, and BESS total. CONCLUSIONS: Core stabilization exercises were effective in improving respiratory muscle strength, spirometry, and postural control in children with hearing loss.

Effects of inspiratory muscle training on respiratory muscle strength, respiratory function and functional capacity in adolescents with idiopathic scoliosis : A randomized, controlled trial.

BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) may impair respiratory dynamics and affect the performance of inspiratory and expiratory muscles. The benefit of inspiratory muscle training (IMT) is not well investigated in AIS. We aimed to investigate the effects of IMT on respiratory muscle strength, respiratory function and functional capacity in adolescents with mild to moderate AIS. METHODS: Thirty-six adolescents were randomized into control or IMT groups. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were measured by spirometry; respiratory muscle strength by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); and functional capacity by 6-min walk test (6MWT) before and after the 8-week-long home-based exercise program. Both groups received conventional exercise program including diaphragmatic breathing exercises, resistive local expansion exercise on the collapsed areas in concave sides of scoliosis, spinal stabilization, strengthening of interscapular muscles and stretching exercises. IMT group also trained with Threshold IMT device for 15 minutes, twice a day for 8 weeks at the intensity of 30% of initial MIP value in addition to conventional exercise program. RESULTS: FEV1, PEF, MIP, MEP and 6MWT distance significantly improved in both groups. IMT group also showed significant improvement in FVC. The increases in FVC, MIP, MEP and 6MWT distance of IMT group were significantly higher compared to control group. CONCLUSION: IMT is found to be beneficial for patients with AIS for achieving further improvements in respiratory function, respiratory muscle strength and functional capacity compared to conventional exercise program alone.

Validity and reliability of the Turkish version of breathlessness beliefs questionnaire.

BACKGROUND: Dyspnea is often the main symptom that limits exercise; however, the vicious cycle of dyspnea limiting exercise participation is also an important contributor to the reduced exercise capacity. OBJECTIVE: The aim of our study was to investigate the reliability and validity of Turkish Breathlessness Beliefs Questionnaire (BBQ) in patients with Chronic Obstructive Pulmonary Diseases (COPD). METHODS: Seventy-seven COPD patients were included in the study. Sociodemographic and physical characteristics were recorded. Turkish version of BBQ, Saint George Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) were applied. Second evaluation of BBQ was conducted via telephone calls with no drop-outs. Reliability of the questionnaire was explored by calculating the internal consistency and test-retest analysis. Construct validity was assessed calculating correlation coefficients of BBQ with HADS and SGRQ scores. Known group validity was also explored. RESULTS: Cronbach alpha coefficients for total score of BBQ were 0.78, indicating that the questionnaire has 'good' internal consistency. Initial and test-retest BBQ total scores were 41.42 ± 6.47 and 41.18 ± 6.24, respectively. Intra-class correlation coefficients (ICC2,1) values of BBQ and its sub-scales varied between 0.973 and 0.983, indicating strong test-retest reliability. Correlation coefficient between BBQ total and SGRQ-Activity (0.619) was highest among the variables of interest, followed by BBQ total and SGRQ total (0.611). There was a significant correlation between BBQ total and HADS (0.390). One-way analysis of variance revealed that BBQ total and BBQ-Activity Avoidance scores were significantly differ in disease stages. CONCLUSION: Turkish version of BBQ was found to be a valid and reliable tool for measuring dysfunctional beliefs related to the dyspnea in patients with COPD.

Effects of creative dance on functional capacity, pulmonary function, balance, and cognition in COPD patients: A randomized controlled trial.

BACKGROUND: Exercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Creative dance can be an innovative approach as effective as traditional exercise training. OBJECTIVES: This study aimed to investigate effect of creative dance-based exercise (CDE) training on functional capacity, postural stability and balance, pulmonary and cognitive functions, respiratory and peripheral muscle strength in COPD patients. METHODS: Twenty-four patients with COPD were randomly allocated to either "chest physiotherapy and home-based walking program" (PT) or "CDE alongside home-based chest physiotherapy group" (PT+CDE). Both groups performed chest PT program twice a day for 5 days per week for 8 weeks. PT+CDE group received CDE training 2 days a week for 8 weeks. Primary outcome was six minute walk test (6MWT). Secondary outcomes were postural stability and balance, pulmonary function, maximum inspiratory (MIP) and expiratory (MEP) pressure, peripheral muscle strength, Montreal Cognitive Assessment (MoCA), COPD Assessment Test (CAT), and BODE index. Outcome measures were assessed at baseline and after 8 weeks of training. RESULTS: Both groups showed statistically significant improvements in 6MWT distance, MIP, MEP, MoCA score, CAT, and BODE index (p < 0.05). Only with CDE training was achieved improvements in postural stability and balance scores, pulmonary function, and peripheral muscle strength (p < 0.05). The improvements in 6 MWT distance, MEP, MoCA score, and CAT were greater in PT+CDE group (p < 0.05). CONCLUSION: Use of creative dance training in addition to home-based chest PT program was more effective than chest PT program regarding primary and secondary outcomes in COPD patients.

Do handgrip strength and dexterity predict respiratory function in neuromuscular disease?

BACKGROUND: Neuromuscular diseases are acquired or inherited diseases that affect the function of the muscles in our body, including respiratory muscles. OBJECTIVE: We aimed to discover more cost-effective and practical tools to predict respiratory function status, which causes serious problems with patients with neuromuscular disease. METHODS: The Vignos and Brooke Upper Extremity Functional Scales were used to evaluate functional status for patient recruitment. The handgrip strength and dexterity of patients were measured using a dynamometer and nine-hole peg test. Respiratory function parameters: forced vital capacity, forced expiratory volume in one second, and peak expiratory flow were evaluated using spirometry. RESULTS: The mean age of the 30 patients was 11.5 ± 3.79 years old. Significant relationships were found between nine-hole-peg-test scores and respiratory function parameters on both sides. Significant correlations were found between both handgrip strength and respiratory function parameters (p < 0.05). In the linear regression analysis, it was seen that the forced expiratory volume in 1 second, and peak expiratory flow values could be explained in different percentages (p < 0.05). CONCLUSIONS: Handgrip strength and dexterity measurements can be used as indicators for estimating respiratory function parameters in terms of cost and accessibility, although it is known that they will not replace respiratory function tests.

ANTECEDENTES: As doenças neuromusculares são doenças adquiridas ou hereditárias que afetam a função dos músculos do nosso corpo, incluindo os músculos respiratórios. OBJETIVO: Nosso objetivo foi descobrir ferramentas mais práticas e econômicas para prever o estado da função respiratória, que causa sérios problemas em pacientes com doença neuromuscular. MéTODOS: As Escalas Funcionais da Extremidade Superior de Vignos e Brooke foram utilizadas para avaliar o estado funcional para recrutamento de pacientes. A força de preensão manual e a destreza dos pacientes foram medidas por meio de um dinamômetro e do teste de nove buracos. Os parâmetros da função respiratória: capacidade vital forçada, volume expiratório forçado no primeiro segundo e pico de fluxo expiratório foram avaliados por meio da espirometria. RESULTADOS: A média de idade dos 30 pacientes foi de 11,5 ± 3,79 anos. Relações significativas foram encontradas entre as pontuações do teste de nove buracos e os parâmetros da função respiratória em ambos os lados. Correlações significativas foram encontradas entre a força de preensão manual e os parâmetros da função respiratória (p < 0,05). Na análise de regressão linear, observou-se que o volume expiratório forçado no primeiro segundo e os valores de pico de fluxo expiratório puderam ser explicados em diferentes percentuais (p < 0,05). CONCLUSõES: As medidas de força de preensão manual e destreza podem ser utilizadas como indicadores para estimar parâmetros da função respiratória em termos de custo e acessibilidade, embora se saiba que não substituirão os testes de função respiratória.

Do handgrip strength and dexterity predict respiratory function in neuromuscular disease? / A força de preensão manual e a destreza predizem a função respiratória em doenças neuromusculares?

Abstract Background Neuromuscular diseases are acquired or inherited diseases that affect the function of the muscles in our body, including respiratory muscles. Objective We aimed to discover more cost-effective and practical tools to predict respiratory function status, which causes serious problems with patients with neuromuscular disease. Methods The Vignos and Brooke Upper Extremity Functional Scales were used to evaluate functional status for patient recruitment. The handgrip strength and dexterity of patients were measured using a dynamometer and nine-hole peg test. Respiratory function parameters: forced vital capacity, forced expiratory volume in one second, and peak expiratory flow were evaluated using spirometry. Results The mean age of the 30 patients was 11.5 ± 3.79 years old. Significant relationships were found between nine-hole-peg-test scores and respiratory function parameters on both sides. Significant correlations were found between both handgrip strength and respiratory function parameters (p< 0.05). In the linear regression analysis, it was seen that the forced expiratory volume in 1 second, and peak expiratory flow values could be explained in different percentages (p< 0.05). Conclusions Handgrip strength and dexterity measurements can be used as indicators for estimating respiratory function parameters in terms of cost and accessibility, although it is known that they will not replace respiratory function tests.

Resumo Antecedentes As doenças neuromusculares são doenças adquiridas ou hereditárias que afetam a função dos músculos do nosso corpo, incluindo os músculos respiratórios. Objetivo Nosso objetivo foi descobrir ferramentas mais práticas e econômicas para prever o estado da função respiratória, que causa sérios problemas em pacientes com doença neuromuscular. Métodos As Escalas Funcionais da Extremidade Superior de Vignos e Brooke foram utilizadas para avaliar o estado funcional para recrutamento de pacientes. A força de preensão manual e a destreza dos pacientes foram medidas por meio de um dinamômetro e do teste de nove buracos. Os parâmetros da função respiratória: capacidade vital forçada, volume expiratório forçado no primeiro segundo e pico de fluxo expiratório foram avaliados por meio da espirometria. Resultados A média de idade dos 30 pacientes foi de 11,5 ± 3,79 anos. Relações significativas foram encontradas entre as pontuações do teste de nove buracos e os parâmetros da função respiratória em ambos os lados. Correlações significativas foram encontradas entre a força de preensão manual e os parâmetros da função respiratória (p< 0,05). Na análise de regressão linear, observou-se que o volume expiratório forçado no primeiro segundo e os valores de pico de fluxo expiratório puderam ser explicados em diferentes percentuais (p< 0,05). Conclusões As medidas de força de preensão manual e destreza podem ser utilizadas como indicadores para estimar parâmetros da função respiratória em termos de custo e acessibilidade, embora se saiba que não substituirão os testes de função respiratória.

Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis.

OBJECTIVE: The main objective was to assess the relationship between inter-recti distance (IRD) and abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with Diastasis Recti Abdominis (DRA). Additionally, the secondary purpose of the study is to investigate the independent predictors of IRD in women with DRA. STUDY DESIGN: Fifty-one women who were diagnosed with DRA participated to the study. IRD assessment with a caliper, abdominal muscle endurance test, Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), maximum inspiratory and expiratory pressure (MIP and MEP, respectively) tests, Clinical Test of Sensory Integration of Balance (m-CTSIB) under eyes open on a firm surface (EOFS), eyes closed on a firm surface (ECFS), eyes open on a foam surface (EOFoS), and eyes closed on a foam surface (ECFoS) conditions, and Limits of Stability (LOS) tests were performed for all subjects. Pearson or Spearman correlation analyses were used to determine the relationship between IRD and static abdominal flexion endurance test, PFDI-20, MIP and MEP, m-CTSIB, and LOS scores depending on the distribution properties of the data. Additionally, linear regression analysis was utilized for analyzing the independent predictors of IRD among the age, BMI, parity, time since last birth, birth weight, weight gains last pregnancy, and mode of delivery. RESULTS: IRD had correlations with Colorectal-Anal Distress score of PFDI-20 (r = -0.317, p = 0.03) and EOFS, ECFS, EOFoS, ECFoS and composite score of m-CTSIB (r = 0.356, p = 0.01; r = 0.337, p = 0.02, r = 0.279, p = 0.04; r = 0.265, p = 0.04; r = 0.413, p = 0.004, respectively) and LOS scores (r = 0.422, p = 0.003). Increased IRD did not influence abdominal muscle endurance and respiratory muscle strength in women with DRA (p < 0.05). Age, BMI, time since last birth, weight gains last pregnancy, and mode of delivery were not determined as the factors that influence IRD in women with DRA (p < 0.05). CONCLUSION: We concluded that increased IRD is associated with worse postural control, but better colorectal functions in women with DRA. Additionally, IRD does not show a clear association with abdominal muscle endurance, pelvic floor functions, and respiratory muscle strength. According to our results, postural stability assessments may perform in the physiotherapeutic management of women with DRA.

Video game-based exercise in children and adolescents with non-cystic fibrosis bronchiectasis: A randomized comparative study of aerobic and breathing exercises.

BACKGROUND: Video game-based systems have been proposed to improve effectiveness and compliance with exercise training in children and adolescents with noncystic fibrosis bronchiectasis (NCFB). This study aimed to investigate the effects of aerobic and breathing video game-based exercises (VGE) on pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance in children and adolescents with NCFB. METHOD: Thirty-nine children and adolescents aged between 8 and 18 years with NCFB were randomly allocated into three groups as "home-based chest physiotherapy group" (CP), "aerobic VGE given in addition to home-based chest physiotherapy group" (CP + aerobic VGE), and "breathing VGE given in addition to home-based chest physiotherapy group" (CP + breathing VGE). All three groups performed chest physiotherapy program twice a day for 7 days per week for 8 weeks. Pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance were assessed at baseline and after 8 weeks of training. RESULTS: The improvement in maximum expiratory pressure and balance scores were significantly higher in both CP + aerobic and CP + breathing VGE groups. The significant improvement in maximum inspiratory pressure was greater in the CP + breathing VGE group. The changes in peripheral muscle strength and functional capacity were significantly higher in the CP + aerobic VGE group. CONCLUSIONS: The present study showed that aerobic VGE provides additional benefits in improving peripheral muscle strength and functional capacity, while breathing VGE provides further increase in improving respiratory muscle strength. In addition, both aerobic and breathing VGE were effective in improving balance, but they were not superior to each other.

Does the effect of comprehensive respiratory physiotherapy home-program differ in children with cystic fibrosis and non-cystic fibrosis bronchiectasis?

Bronchiectasis is a form of airway damage as a consequence of endobronchial infection and inflammation and may be present in different diseases. The underlying aetiologies include both cystic fibrosis (CF) and a group of non-cystic fibrosis diseases (NCFB) such as immunodeficiency, primary ciliary dyskinesia, or severe pulmonary infection. Although children with CF and non-cystic fibrosis bronchiectasis (NCFB) have many similar clinical features, their responses to exercise may be different. The aim of this study was to compare the efficacy of a comprehensive respiratory physiotherapy (CRP) home-program in children with CF and NCFB. Thirty children with CF and thirty children with NCFB were included in the study. Both groups performed the CRP home-program twice daily for 8 weeks. Pulmonary function, exercise capacity, and respiratory and peripheral muscle strength were assessed at baseline and after 8 weeks of training. Both groups experienced significant improvements in pulmonary function, exercise capacity, and respiratory and peripheral muscle strength (p < 0.001). Maximum expiratory pressure, exercise capacity, and peripheral muscle strength were further improved in NCFB group compared to CF (p < 0.05); however, there was a great variability in the improvements for each variable. CONCLUSION: CRP is beneficial both for children with CF and NCFB and adherence to the program was high in both groups. WHAT IS KNOWN: • Different physiotherapy approaches in the management of non-cystic fibrosis bronchiectasis have been based on the experience gained from the research studies performed in cystic fibrosis. • Although having similar pathophysiology, these two diseases show variation in some pulmonary and extrapulmonary features. WHAT IS NEW: • The respiratory muscle strength and the efficacy of comprehensive respiratory physiotherapy have been compared for the first time in children with cystic fibrosis and non-cystic fibrosis bronchiectasis. • Comprehensive respiratory physiotherapy provides higher increases in children with non-cystic fibrosis bronchiectasis in exercise capacity and expiratory and peripheral muscle strength; however, there was a great variability in these improvements. Nevertheless, it can be concluded that both groups significantly benefited from the CRP program.

Evaluation of postural control in children with increased femoral anteversion.

BACKGROUND: Femoral anteversion is defined as the angular difference between the axis of the femoral neck and the transcondylar axis of the knee and the most common cause of an in-toe gait in children. RESEARCH QUESTION: Does increased femoral anteversion (IFA) adversely affect postural stability and balance in healthy children? METHODS: Sixteen children with IFA aged 10-15 years and an age-matched control group of 16 children who were growing typically were included. Postural stability (PS), limits of stability (LoS), and the modified clinical test of sensory integration of balance (mCTSIB) were used to evaluate postural control by "Biodex Balance System® (BBS)" and Balance Error Scoring System (BESS), which is a visual observation of instability in 3 stance positions under 6 different conditions, were performed for all cases. SPSS v.20 program was used for data analysis. Independent Samples T-test or Mann Whitney U test were used for between-group comparisons depending on the distribution properties of the data. The significance level was set at p < 0.05. RESULTS: A significant difference was found between the groups for overall and anterior/posterior stability index in PS (p < 0.05), all parameters of LoS (p < 0.05) and mCTSIB (p < 0.05). Also there was a significant difference between the BESS firm surface (p = 0.007), BESS foam surface (p < 0.001), and total surface scores (p < 0.001). SIGNIFICANCE: The results indicate that the children with IFA were significantly more unstable in all parameters of BBS and BESS when compared to their healthy peers. This shows that postural stability and balance are impaired in healthy children with IFA. To the extent of our knowledge, this study is the first to examine the postural control problems associated with IFA in healthy children.

Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation.

BACKGROUND: Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fibrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed. AIMS: We aimed to provide cut-off values for two frequently used field tests to be able to objectively interpret symptom burden in atrial fibrillation. METHODS: One hundred twenty-five patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classified as "asymptomatic", and those with EHRA 2-4 as "symptomatic". Cut-off values of 6MWT and 30 s-STST for discriminating between these patients were calculated. RESULTS: The optimal cut-off value was "450 m" for 6MWT (sensitivity: 0.71; specificity of 0.79) and "11 repetitions" for 30 s-STST (sensitivity 0.77; specificity of 0.70). Area under ROC curve was 0.75 for both tests (p < 0.001). Discriminative properties of the two tests were similar, and they were significantly correlated (r = 0.58; p < 0.001). Subgroup analysis revealed patients below cut-off values also had worse outcomes in SF-36, IPAQ-SF, and spirometry. CONCLUSIONS: In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-off values may help identifying patients who may require adjustments in their routine treatment or who may benefit from additional rehabilitative approaches.

Walking training augments the effects of expiratory muscle training in Parkinson's disease.

OBJECTIVES: To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease. MATERIALS & METHODS: Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W + RMT, n = 15) and the RMT (n = 15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15 min of inspiratory muscle training and 15 min of expiratory muscle training in both groups, and 15 min of walking training in the W + RMT group in addition to RMT, twice per day, 5 days/week, for a total of 8 weeks at home. Training intensity was adjusted once per week for the groups at the hospital. RESULTS: Respiratory muscle strength and 6-min walking distance were significantly increased (p = .001), and UPDRS-III scores were significantly improved (W + RMT: p = .008 and RMT: p = .01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W + RMT group than in the RMT group (p = .007). CONCLUSION: Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Effects of Inspiratory Muscle and Balance Training in Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial.

The aim of the study was to investigate the effects of inspiratory muscle and balance training on pulmonary function, respiratory muscle strength (RMS), functional capacity, and balance in children with hemiplegic cerebral palsy (CP). Thirty children with hemiplegic CP (Gross Motor Function Classification System I-II) included in this study. The control group (n = 15) underwent conventional physiotherapy rehabilitation program (CPRP) that included balance exercises, and the training group's (n = 15) program included inspiratory muscle training (IMT) in addition to CPRP for 8 weeks. The outcome measures were pulmonary function test, RMS measurement, the six-minute walk test (6MWT), and balance tests. There were no significant differences in the score changes of pulmonary function, balance, and 6MWT distance between groups (p > .05), whereas maximum inspiratory and expiratory pressure further increased in the training group (p > .05). RMS assessment and the identification of children who need it, and adding IMT to CPRP will contribute greatly to the rehabilitative approach of children with CP.

Atrial Fibrillation Impact Questionnaire (AFImpact): Validity and reliability of the Turkish version.

OBJECTIVE: Guidelines recommend measuring and addressing health-related quality of life in the management of atrial fibrillation (AF); however, a disease-specific questionnaire is lacking for the Turkish language. Our aim was to translate and adapt the Atrial Fibrillation Impact Questionnaire (AFImpact) into Turkish and to explore its psychometric properties. METHODS: This cross-sectional study was conducted in two phases, including the translation and cultural adaptation of AFImpact into Turkish language and the analysis of psychometric properties of the translated questionnaire. 98 patients diagnosed with AF were evaluated using the Turkish version of AFImpact, Short Form-36 (SF-36) and Pittsburg Sleep Quality Index (PSQI). Reliability, validity, and factor structure of the Turkish version of AFImpact was explored. RESULTS: Cronbach's alpha coefficients for vitality, emotional distress, and sleep domains of AFImpact was 0.956, 0.955, and 0.819, respectively, indicating good-to-excellent internal consistency. No significant difference was detected between the initial and retest scores, and intraclass correlation coefficients of each domain varied between 0.991 and 0.996, indicating excellent test-retest reliability. Each domain of AFImpact highly correlated with similar domains of SF-36 and PSQI, having correlation coefficients between -0.484 and -0.699. AFImpact was able to discriminate between the patients in different functional classes, confirming know-groups validity. Factor analysis revealed AFImpact had the same factorial structure as the original questionnaire. CONCLUSION: The Turkish version of AFImpact is a valid and reliable questionnaire for evaluating health-related quality of life in patients with AF.

Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: A randomized controlled trial.

BACKGROUND: The major symptom of chronic obstructive pulmonary disease (COPD) is dyspnea, which causes dyspnea-related kinesiophobia resulting in avoidance of activities associated with dyspnea or compensation by reducing the rate of activity. The aim of this study was to assess dyspnea-related kinesiophobia and determine the effect of inspiratory muscle training (IMT) on dyspnea-related kinesiophobia in COPD. METHODS: Forty COPD subjects were randomly allocated to either the IMT or sham group. Both groups' maximal inspiratory pressure (MIP) was assessed weekly. All patients were instructed to perform the training exercises for 15 min twice a day, 5 days a week for a total of 8 weeks. In the IMT group, intensity was set at 30% of MIP and adjusted according to weekly MIP value. In the sham group, intensity remained constant at 15% of initial MIP. Pulmonary function test (PFT), respiratory muscle strength, 6-min walk test (6 MWT), Breathlessness Beliefs Questionnaire (BBQ), Modified Medical Research Council scale (MMRC), modified Borg scale, Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT) were assessed before and after the intervention. RESULTS: BBQ scores ranged from 18 to 51, with mean values in the IMT and sham groups of 39.80 ± 7.62 and 43.00 ± 6.58, respectively. When between-group differences of all outcome scores were compared, there was a statistically significant improvement in the IMT group than in the sham group (p < 0.05). After IMT, statistically significant decreases in BBQ and modified Borg scores were observed in within groups (p ≤ 0.001). These decreases were significantly greater in the IMT group (p ≤ 0.001). MMRC decreased significantly only in the IMT group (p < 0.001). There was a statistically significant increase in PFT values in the IMT group (p = 0.007-0.045), but no difference in the sham group (p = 0.129-0.886). Both groups showed statistically significant improvement in respiratory muscle strength, 6 MWT distance, and CAT score after 8 weeks (p < 0.05). All HADS and SGRQ scores decreased significantly in the IMT group (p < 0.001), whereas only the SGRQ activity score decreased significantly in the sham group (p = 0.017). CONCLUSIONS: Our study provides data on the presence and level of dyspnea-related kinesiophobia in COPD patients. All patients had BBQ scores higher than 11, indicating dyspnea-related kinesiophobia. IMT reduced BBQ score and improved respiratory function, and exercise capacity. Our results also support the other known benefits of IMT such as reduced dyspnea and symptom perception, decreased anxiety and depression, and improved quality of life.

Sit-to-stand test in children with bronchiectasis: Does it measure functional exercise capacity?

BACKGROUND: Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests. METHODS: Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO2 and dyspnea responses to tests were recorded. RESULTS: Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT (r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls (r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65±5.28 vs 26.55±3.56 repetitions) and 6MWT (538±85 vs 596±54 m) were significantly lower in BE group compared to healthy controls (p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE (p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference (p = 0.466), indicating both tests had similar discriminative properties. CONCLUSIONS: 30s-STST is found to be a valid alternative measurement for functional exercise capacity in children with BE.

Do pulmonary and extrapulmonary features differ among cystic fibrosis, primary ciliary dyskinesia, and healthy children?

BACKGROUND: Primary ciliary dyskinesia (PCD) is generally likened to cystic fibrosis (CF) due to similarities in impaired mucociliary clearance and some other symptoms. The aim of our study was to investigate pulmonary and extrapulmonary characteristics of children with CF and PCD since no studies have addressed respiratory muscle strength in children with PCD and to compare the results to those obtained from healthy age-matched controls. METHODS: Pulmonary and extrapulmonary characteristics were assessed by 6-min walk test, spirometry, maximum inspiratory and expiratory pressure measurements, and knee extensor strength test in the children with CF, PCD, and healthy controls. RESULTS: Children with PCD and CF had similar PFT results, except forced expiratory flow between 25% and 75% of vital capacity (FEF25-75 ) which was lower in PCD (p = .04). Maximum inspiratory pressure (MIP) value was lower in the children with CF compared with the healthy controls (p = .016), MEP value of the children with PCD was worse than those with CF and healthy controls (p = .013 and p = .013), respectively. 6-min walk test (6MWT) distance of the children with CF was lower than their healthy counterparts (p = .003). Knee extensor muscle strength differed among the children with PCD, CF, and healthy control groups, but post hoc test failed to show statistical significance (p = .010). CONCLUSION: Children with CF and PCD had some impairments in pulmonary functions, respiratory muscle strength, functional capacity, and peripheral muscle strength compared with healthy children. However, the unique characteristics of each disease should be considered during physiotherapy assessment and treatment. The clinicians may especially focus on the respiratory and peripheral muscle strength of the children with PCD.

Effects of inspiratory muscle training on postural stability, pulmonary function and functional capacity in children with cystic fibrosis: A randomised controlled trial.

BACKGROUND: Previous research has found conflictive results regarding the benefits of inspiratory muscle training (IMT) for cystic fibrosis (CF) patients. Also, involvement of postural stability is a rising concern in chronic lung diseases but its role in CF patients is poorly understood. Our aim was to investigate the effects of IMT in CF patients as well as analysing the factors which may be related to postural stability. METHODS: Thirty-six children aged between 8 and 18 years with CF were randomly allocated to either "comprehensive chest PT" group (PT) or "IMT alongside comprehensive chest PT" group (PT+IMT). Both groups trained for 8 weeks. Dynamic and static postural stability tests on Biodex Balance system®, spirometry, respiratory muscle strength and 6-min walk distance (6MWD) was assessed at baseline and after 8 weeks of training. Determinants of postural stability was also analysed on baseline values. RESULTS: Maximum expiratory pressure (MEP) was found to be an independent predictor for overall limits of stability (LOS) score explaining %26 of variance (R = 0.514, p = 0.003). Overall LOS score, FVC, FEV1, peak expiratory flow, MEP and 6MWD significantly improved in both groups, with no significant differences between groups. Maximum inspiratory pressure (MIP) also improved in both groups but the magnitude of improvement in MIP was greater in PT+IMT group (38 cmH2O vs 13 cmH2O; p < 0.001). CONCLUSIONS: Combining IMT with chest PT failed to provide further improvements, except for MIP, suggesting that a comprehensive chest PT program may be individually effective in improving overall LOS score, spirometry, respiratory muscle strength and 6MWD. TRIAL REGISTRATION: www.ClinicalTrials.gov; registration number: NCT03375684.

The relationship of sit-to-stand tests with 6-minute walk test in healthy young adults.

The aim of this study was to evaluate the timed sit-to-stand (STS) test performances of healthy young adults and to investigate the relationship of timed STS tests with 6-minute walk test (6MWT). A cross-sectional study was performed. A total of 40 healthy volunteers (mean age: 21.7 ±â€Š1.2 years) were evaluated with 10, 30, and 60 seconds STS tests and 6MWT. Fatigue and shortness of breath were rated using Borg category-ratio scale (CR10) before and after each test. Weekly energy expenditures of volunteers were calculated using International Physical Activity Questionnaire. 30 and 60 seconds STS tests were moderately (r = 0.611 and r = 0.647, respectively) (P < .001) and 10 seconds STS test was weakly (r = 0.344) (P = .028) correlated with 6MWT. Among correlations of each STS test with 6MWT, none of them was statistically stronger to one another (P > .05). Borg fatigue scores after 10, 30, and 60 seconds STS tests were weakly correlated with fatigue score after 6MWT (r = 0.321, r = 0.378, and r = 0.405, respectively) (P < .05). Weekly energy expenditure (MET-min/week) was moderately correlated with 10, 30, and 60 seconds STS tests and 6MWT (r = 0.533, r = 0.598, r = 0.598, and r = 0.547, respectively) (P < .001). Considering the statistically significant relationship between timed STS tests and 6MWT, any of the timed STS tests may be used for a quick and alternative measurement of physical performance and functional capacity in healthy young adults.

Relationship of respiratory muscle strength, pulmonary function, and functional capacity with quality of life in patients with atrial fibrillation.

Objective To examine the relationship of pulmonary parameters and functional capacity with quality of life (QoL) in patients with atrial fibrillation (AF). Methods Thirty-six patients with chronic AF were included in this cross-sectional study. QoL was assessed with the Medical Outcomes Survey 36-item Short Form (SF-36) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Respiratory muscle strength and pulmonary function were also measured. Functional capacity was assessed with the 6-min walk test (6MWT). The Borg CR10 Scale was used to determine the resting dyspnea and fatigue levels. Results The SF-36 physical component summary score was correlated with the maximum inspiratory pressure (r = 0.517), maximum expiratory pressure (r = 0.391), 6MWT distance (r = 0.542), resting Borg dyspnea score (r = -0.692), and resting Borg fatigue score (r = -0.727). The MLHFQ total score was correlated with the maximum inspiratory pressure (r = -0.542), maximum expiratory pressure (r = -0.384), 6MWT distance (r = -0.535), resting Borg dyspnea score (r = 0.641), and resting Borg fatigue score (r = 0.703). The resting Borg fatigue score was the significant independent predictor of the SF-36 physical component score and the MLHFQ total score. Conclusion Respiratory muscle strength, functional capacity measured with the 6MWT, and resting symptoms including dyspnea and fatigue may have an impact on QoL in patients with AF.