Skip to main content
SpringerLink
Log in

Exercise performance and quality of life in children with cystic fibrosis and mildly impaired lung function: relation with antibiotic treatments and hospitalization

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This study evaluates the impact of antibiotic treatments and hospitalization on exercise performance and health-related quality of life (QOL) in children with mild cystic fibrosis (CF) lung disease. Forty-seven children between 7 and 17 years with mild CF underwent a maximal exercise test including spiro-ergometry and filled out a QOL-questionnaire (PedsQL™). Amount of antibiotic treatments (AB) and hospitalization days in the last 3 years were reviewed. FEV1% was mildly decreased (91.7 ± 17.9 L/min, p = 0.02). Maximal oxygen consumption (VO2max), test duration and anaerobic threshold were lower compared to a control population (VO2max% 94 ± 15 vs 103 ± 13, p = 0.009). FEV1% correlated with AB and hospitalization episodes in the last year and 3 years before testing, VO2max% only correlated with AB in the last 3 years. Domains of school functioning and emotional functioning were low. Children with higher VO2max% and less AB in the last 3 years had better physical health. Physical health and school functioning were negatively correlated with hospitalization days in the last year.

Conclusion: Patients with mild CF lung disease have good exercise performance although still lower than the normal population. VO2max% is affected by number of antibiotic treatments over a longer period. There is an impact of hospitalization days on quality of life.

What is Known:

• Children with CF have lower exercise performance; there is an association between hospitalization frequency and exercise performance

• Quality of life is diminished in children with CF and influenced by respiratory infections

What is New:

• Even patients with mild CF lung disease have lower maximal exercise performance (VO 2 max) and a lower anaerobic threshold; VO 2 max is lower in children who had more antibiotic treatments in the last 3 years

• School and emotional functioning are diminished in children with mild CF lung disease; hospitalization is negatively correlated with school functioning and physical functioning

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AB:

Amount of antibiotic treatments

BPM:

Beats per minute

BR:

Breathing reserve, (MVV-VE)/MVV

CF:

Cystic fibrosis

CPET:

Cardiopulmonary exercise test

FEV1%:

Forced expiratory volume in 1 s, expressed as percentage of predicted value

HR-QOL:

Health-related quality of life

load%:

Percentage of the predicted load reached by the patient

MVV:

Maximal voluntary ventilation

QOL:

Quality of life

RER:

Respiratory exchange ratio: VCO2/VO2

VAT:

Ventilatory anaerobic threshold

VAT%:

Ventilatory anaerobic threshold, expressed as % of maximal oxygen consumption

VE:

Maximum exercise ventilation

VO2max:

Maximal oxygen consumption

VO2max%:

Percentage of the predicted maximal oxygen consumption reached by the patient

References

  1. Armstrong N, Welsman JR (1994) Assessment and interpretation of aerobic fitness in children and adolescents. Exerc Sport Sci Rev 22:435–476

    Article  CAS  PubMed  Google Scholar 

  2. Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60:2020–2027

    CAS  PubMed  Google Scholar 

  3. Bodnar R, Kadar L, Holics K, Ujhelyi R, Kovacs L, Bolbas K, Szekely G, Gyurkovits K, Solyom E, Meszaros A (2014) Factors influencing quality of life and disease severity in Hungarian children and young adults with cystic fibrosis. Ital J Pediatr 40:50. https://doi.org/10.1186/1824-7288-40-50

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bongers BC, Hulzebos EH, Van Brussel M, Takken T (2014) Pediatric norms for cardiovascular exercise testing. Proefschriftmaken B.V., Utrecht

  5. Britto MT, Kotagal UR, Hornung RW, Atherton HD, Tsevat J, Wilmott RW (2002) Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis. Chest 121:64–72

    Article  PubMed  Google Scholar 

  6. Habib A-RR, Manji J, Wilcox PG, Javer AR, Buxton JA, Quon BS (2015) A systematic review of factors associated with health-related quality of life in adolescents and adults with cystic fibrosis. Ann Am Thorac Soc 12:420–428. https://doi.org/10.1513/AnnalsATS.201408-393OC

    Article  PubMed  Google Scholar 

  7. Hebestreit H, Arets HGM, Aurora P, Boas S, Cerny F, Hulzebos EHJ, Karila C, Lands LC, Lowman JD, Swisher A, Urquhart DS, European Cystic Fibrosis Exercise Working Group (2015) Statement on Exercise Testing in Cystic Fibrosis. Respiration 90:332–351. https://doi.org/10.1159/000439057

    Article  PubMed  Google Scholar 

  8. Hebestreit H, Schmid K, Kieser S, Junge S, Ballmann M, Roth K, Hebestreit A, Schenk T, Schindler C, Posselt H-G, Kriemler S (2014) Quality of life is associated with physical activity and fitness in cystic fibrosis. BMC Pulm Med 14:26. https://doi.org/10.1186/1471-2466-14-26

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hulzebos HJ, Werkman MS, van Brussel M, Takken T (2012) Towards an individualized protocol for workload increments in cardiopulmonary exercise testing in children and adolescents with cystic fibrosis. J Cyst Fibros 11:550–554. https://doi.org/10.1016/j.jcf.2012.05.004

    Article  CAS  PubMed  Google Scholar 

  10. Hurley MN, McKeever TM, Prayle AP, Fogarty AW, Smyth AR (2014) Rate of improvement of CF life expectancy exceeds that of general population—observational death registration study. J Cyst Fibros 13:410–415. https://doi.org/10.1016/j.jcf.2013.12.002

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kianifar H-R, Bakhshoodeh B, Hebrani P, Behdani F (2013) Qulaity of life in cystic fibrosis children. Iran J Pediatr 23:149–153

    PubMed  PubMed Central  Google Scholar 

  12. Klijn PH, Terheggen-Lagro SW, van der Ent CK, van der Net J, Kimpen JL, Helders PJ (2003) Anaerobic exercise in pediatric cystic fibrosis. Pediatr Pulmonol 36:223–229. https://doi.org/10.1002/ppul.10337

    Article  PubMed  Google Scholar 

  13. Liou TG, Adler FR, Cahill BC, FitzSimmons SC, Huang D, Hibbs JR, Marshall BC (2001) Survival effect of lung transplantation among patients with cystic fibrosis. JAMA 286:2683–2689. https://doi.org/10.1001/jama.286.21.2683

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Milani RV, Lavie CJ, Mehra MR, Ventura HO (2006) Understanding the basics of cardiopulmonary exercise testing. Mayo Clin Proc 81:1603–1611. https://doi.org/10.4065/81.12.1603

    Article  PubMed  Google Scholar 

  15. Myers J, Walsh D, Buchanan N, Froelicher VF (1989) Can maximal cardiopulmonary capacity be recognized by a plateau in oxygen uptake? Chest 96:1312–1316

    Article  CAS  PubMed  Google Scholar 

  16. Nguyen S, Leroy S, Cracowski C, Perez T, Valette M, Neviere R, Aguilaniu B, Wallaert B (2010) Prognostic value of clinical exercise testing in adult patients with cystic fibrosis. Rev Mal Respir 27:219–225. https://doi.org/10.1016/j.rmr.2010.01.009

    Article  CAS  PubMed  Google Scholar 

  17. Nixon PA (1996) Role of exercise in the evaluation and management of pulmonary disease in children and youth. Med Sci Sports Exerc 28:414–420

    Article  CAS  PubMed  Google Scholar 

  18. Nixon PA, Orenstein DM, Kelsey SF, Doershuk CF (1992) The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med 327:1785–1788. https://doi.org/10.1056/NEJM199212173272504

    Article  CAS  PubMed  Google Scholar 

  19. Pérez M, Groeneveld IF, Santana-Sosa E, Fiuza-Luces C, Gonzalez-Saiz L, Villa-Asensi JR, López-Mojares LM, Rubio M, Lucia A (2014) Aerobic fitness is associated with lower risk of hospitalization in children with cystic fibrosis. Pediatr Pulmonol 49:641–649. https://doi.org/10.1002/ppul.22878

    Article  PubMed  Google Scholar 

  20. Radtke T, Stevens D, Benden C, Williams CA (2009) Clinical exercise testing in children and adolescents with cystic fibrosis. Pediatr Phys Ther 21:275–281. https://doi.org/10.1097/PEP.0b013e3181b15445

    Article  PubMed  Google Scholar 

  21. Ratjen FA (2009) Cystic fibrosis: pathogenesis and future treatment strategies. Respir Care 54:595–605

    Article  PubMed  Google Scholar 

  22. Sanders DB, Bittner RCL, Rosenfeld M, Redding GJ, Goss CH (2011) Pulmonary exacerbations are associated with subsequent FEV1 decline in both adults and children with cystic fibrosis. Pediatr Pulmonol 46:393–400. https://doi.org/10.1002/ppul.21374

    Article  PubMed  Google Scholar 

  23. Sanders DB, Hoffman LR, Emerson J, Gibson RL, Rosenfeld M, Redding GJ, Goss CH (2010) Return of FEV1 after pulmonary exacerbation in children with cystic fibrosis. Pediatr Pulmonol 45:127–134. https://doi.org/10.1002/ppul.21117

    Article  PubMed  Google Scholar 

  24. Savi D, Simmonds N, Di Paolo M, Quattrucci S, Palange P, Banya W, Hopkinson NS, Bilton D (2015) Relationship between pulmonary exacerbations and daily physical activity in adults with cystic fibrosis. BMC Pulm Med 15:151. https://doi.org/10.1186/s12890-015-0151-7

    Article  PubMed  PubMed Central  Google Scholar 

  25. Slieker MG, Uiterwaal CSPM, Sinaasappel M, Heijerman HGM, van der Laag J, van der Ent CK (2005) Birth prevalence and survival in cystic fibrosis: a national cohort study in the Netherlands. Chest 128:2309–2315. https://doi.org/10.1378/chest.128.4.2309

    Article  PubMed  Google Scholar 

  26. Stevens D, Oades PJ, Armstrong N, Williams CA (2010) A survey of exercise testing and training in UK cystic fibrosis clinics. J Cyst Fibros 9:302–306. https://doi.org/10.1016/j.jcf.2010.03.004

    Article  CAS  PubMed  Google Scholar 

  27. Stickland MK, Butcher SJ, Marciniuk DD, Bhutani M (2012) Assessing exercise limitation using cardiopulmonary exercise testing. Pulm Med 2012:824091–824013. https://doi.org/10.1155/2012/824091

    Article  PubMed  PubMed Central  Google Scholar 

  28. Thomas C, Mitchell P, O’Rourke P, Wainwright C (2006) Quality-of-life in children and adolescents with cystic fibrosis managed in both regional outreach and cystic fibrosis center settings in Queensland. J Pediatr 148:508–516. https://doi.org/10.1016/j.jpeds.2005.11.040

    Article  PubMed  Google Scholar 

  29. van de Weert-van Leeuwen PB, Hulzebos HJ, Werkman MS, Michel S, Vijftigschild LAW, van Meegen MA, van der Ent CK, Beekman JM, Arets HGM (2014) Chronic inflammation and infection associate with a lower exercise training response in cystic fibrosis adolescents. Respir Med 108:445–452. https://doi.org/10.1016/j.rmed.2013.08.012

    Article  PubMed  Google Scholar 

  30. van de Weert-van Leeuwen PB, Slieker MG, Hulzebos HJ, Kruitwagen CLJJ, van der Ent CK, Arets HGM (2012) Chronic infection and inflammation affect exercise capacity in cystic fibrosis. Eur Respir J 39:893–898. https://doi.org/10.1183/09031936.00086211

    Article  PubMed  Google Scholar 

  31. Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812

    Article  CAS  PubMed  Google Scholar 

  32. Wasserman K (2012) Principles of Exercise Testing and Interpretation. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  33. Wieboldt J, Atallah L, Kelly JL, Shrikrishna D, Gyi KM, Lo B, Yang GZ, Bilton D, Polkey MI, Hopkinson NS (2012) Effect of acute exacerbations on skeletal muscle strength and physical activity in cystic fibrosis. J Cyst Fibros 11:209–215. https://doi.org/10.1016/j.jcf.2011.12.001

    Article  PubMed  Google Scholar 

  34. Wilkes DL, Schneiderman JE, Nguyen T, Heale L, Moola F, Ratjen F, Coates AL, Wells GD (2009) Exercise and physical activity in children with cystic fibrosis. Paediatr Respir Rev 10:105–109. https://doi.org/10.1016/j.prrv.2009.04.001

    Article  PubMed  Google Scholar 

  35. Zapletal A (1990) Lung function testing in the assessment of lung involvement in cystic fibrosis. Acta Univ Carol Med (Praha) 36:183–194

    CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the CF centre Ghent University Hospital and Mrs. Ann Raman, Mrs. Marleen Vanderkerken and Mrs. Ann Carton for their support.

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Kristof Vandekerckhove, Michiel Keyzer, Jasper Cornette, Ilse Coomans & Daniel De Wolf

  2. Department of Paediatric Pulmonology, Ghent University Belgium, Ghent, Belgium

    Filip Pyl, Frans De Baets, Petra Schelstraete, Filomeen Haerynck & Sabine Van Daele

  3. Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium

    Jan Boone

Authors
  1. Kristof Vandekerckhove
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michiel Keyzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jasper Cornette
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilse Coomans
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Filip Pyl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frans De Baets
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Petra Schelstraete
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Filomeen Haerynck
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel De Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sabine Van Daele
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jan Boone
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

K.V. participated in the research design, performance of the research, data analysis and writing of the article. J.B., J.C., M.K. and S.V. participated in the data analysis, performance of the research and writing of the article. I.C. and F.P. participated in the performance of the research and data analysis. J.B. participated in the data analysis and writing of the article. F.H., F.D., P.S. and D.D. participated in the writing of the article.

Corresponding author

Correspondence to Kristof Vandekerckhove.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Peter de Winter

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vandekerckhove, K., Keyzer, M., Cornette, J. et al. Exercise performance and quality of life in children with cystic fibrosis and mildly impaired lung function: relation with antibiotic treatments and hospitalization. Eur J Pediatr 176, 1689–1696 (2017). https://doi.org/10.1007/s00431-017-3024-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-017-3024-7

Keywords

Search

Navigation