Publications by authors named "Naciye Vardar Yagli"

46 Publications

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

Ir J Med Sci 2021 May 24. Epub 2021 May 24.

Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Ankara, Turkey.

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.
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http://dx.doi.org/10.1007/s11845-021-02654-8DOI Listing
May 2021

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

J Asthma 2021 May 31:1-9. Epub 2021 May 31.

Faculty of Medicine, Division of Adult Allergy & Clinical Immunology, Hacettepe University, Ankara, Turkey.

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 ( = 0.514,  = 0.002) achieved in the arm ergometer test, change in dyspnea during 6PBRT (r = -0.402,  = 0.020), LCADL-self-care (r = -0.364,  = 0.037), MAS total ( = 0.483,  = 0.005), AQLQ-symptom domain ( = 0.420,  = 0.026) and HAQ-DI total scores (r = -0.390,  = 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.
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http://dx.doi.org/10.1080/02770903.2021.1930040DOI Listing
May 2021

Evaluation of sleep-disordered breathing and its relationship with respiratory parameters in children with mucopolysaccharidosis Type IVA and VI.

Am J Med Genet A 2021 May 7. Epub 2021 May 7.

Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.

The aims of the study were to evaluate the prevalence of sleep-disordered breathing (SDB) by using polysomnography (PSG) in children with MPS IVA and MPS VI who underwent enzyme replacement therapy (ERT) and to analyze the effect on SDB of having upper airway surgery, pulmonary functions, and exercise capacity. A retrospective cross-sectional study was conducted on patients with MPS IVA (n:17) and MPS VI (n:11) aged under 19 years who underwent polysomnography. Descriptive and nonparametric analyses were performed for demographic, PSG, pulmonary function and exercise capacity variables. The frequency of sleep apnea in the study sample was 85.7% (24/28). Four patients (14.3%) had no sleep apnea, 15 (53.6%) had mild, and nine (32.1%) had moderate-to-severe sleep apnea. Two patients (7.1%) had central sleep apnea and 22 had obstructive sleep apnea (OSA) (78.6%). Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were negatively correlated to apnea-hypopnea index (AHI) (r = -0.594, p = .009; r = -0.636, p = .005, respectively). Despite ERT and previous upper airway surgery, the prevalence of OSA was high in patients with MPS IVA-MPS IV, emphasizing the importance of PSG screening for sleep disorders. Pulmonary function tests may be useful for predicting sleep apnea in patients with MPS IVA and MPS VI.
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http://dx.doi.org/10.1002/ajmg.a.62229DOI Listing
May 2021

Health-Promoting Behaviors, Health Literacy, and Levels of Knowledge about Smoking-Related Diseases among Smokers and Non-smokers: A Cross-Sectional Study.

Tuberc Respir Dis (Seoul) 2021 Apr 26;84(2):140-147. Epub 2021 Jan 26.

Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.

Background: For generations, cigarette smoking has presented an important public health concern. This study aimed to compare the health-promoting behavior, exercise capacity, physical activity level, health literacy, and knowledge level of smoking-related diseases between smokers and non-smokers.

Methods: The study included 71 smokers (mean age, 32.69±8.55 years) and 72 non-smokers (mean age, 31.88±9.94 years) between the ages of 20 and 60 years. Assessments included a 6-minute walking test (6MWT), Godin Leisure-Time Physical Activity Questionnaire, Health-Promoting Lifestyle Profile II (HPLP-II), Cardiovascular Risk Factors Knowledge Level Scale (CARRF-KL), Asthma/COPD Awareness Questionnaire, the World Health Organization Quality of Life-Bref questionnaire (WHOQoL-Bref [TR]), and Health Literacy Questionnaire (HLQ).

Results: The results from the study show that the number of coronary artery disease risk factors measured significantly higher among the smoker group members when compared to that of the non-smoker group members (p=0.001). Smokers had significantly lower %6MWT distance than non-smokers (84.83±4.72 and 93.45±7.16, respectively; p<0.05). However, there were no significant differences between the smokers and non-smokers in terms of physical activity, CARRF-KL, HLQ, WHOQoL-Bref, and HPLP-II subscales or total scores (p>0.05). Additionally, while only forty-one smokers (57.7%) were active, 48 of the non-smoker group was active (66.7%).

Conclusion: Smokers suffer greater negative effects to their exercise capacity in comparison to non-smokers. Although smokers and non-smokers have similar levels of health literacy and similar levels of knowledge about cardiovascular disease risk factors and obstructive lung diseases, health professionals could continue to further increase individuals' awareness of smoking-related risk factors and continue to emphasize the importance of physical activity and exercise for protecting cardiopulmonary health.
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http://dx.doi.org/10.4046/trd.2020.0158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010416PMC
April 2021

Comparison of respiratory muscle strength and endurance, maximal oxygen consumption, and fatigue in colorectal cancer survivors with healthy adults.

Support Care Cancer 2021 Jul 3;29(7):3903-3909. Epub 2021 Jan 3.

Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Purpose: This study aimed to evaluate respiratory muscle strength and endurance, maximal oxygen consumption, and fatigue of colorectal cancer (CRC) survivors and compare them with healthy individuals.

Methods: Demographic and clinical characteristics were recorded. Respiratory muscle strength (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)) was measured using an electronic mouth pressure device, and respiratory muscle endurance was assessed using a constant workload protocol with linear workload device. Peak oxygen consumption (VOpeak) was measured using the cardiopulmonary exercise test (CPET) with modified Bruce protocol. Fatigue was assessed using the Brief Fatigue Inventory (BFI).

Results: The patients had similar demographic characteristics (p > 0.05). MEP (cmHO and %predicted) were lower in the CRC group than in healthy controls (p < 0.05). MIP (cmHO and %predicted) and test duration did not differ between the groups (p > 0.05). VOpeak (ml/min and %predicted) and VOpeak/kg (%predicted) were significantly lower in the CRC group (p < 0.05). BFI score differed significantly in the CRC and control groups (p < 0.05).

Conclusion: Respiratory muscle strength, maximal exercise capacity, and fatigue are adversely affected in CRC survivors. Cancer treatment may cause loss of muscle strength and impair energy metabolism and oxygen transmission. These changes can result in decreased exercise capacity and respiratory muscle strength and increased fatigue. Studies examining the effects of different exercise training programs in CRC survivors are needed.
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http://dx.doi.org/10.1007/s00520-020-05963-3DOI Listing
July 2021

Respiratory Dysfunction in Individuals With Thoracic Outlet Syndrome.

J Manipulative Physiol Ther 2020 Jul - Aug;43(6):606-611. Epub 2020 Aug 21.

Department of Thoracic Surgery, Ankara University, Ankara, Turkey.

Objective: The purpose of this study was to compare pulmonary function and respiratory muscle strength and endurance in individuals with thoracic outlet syndrome (TOS) and healthy participants.

Methods: Sixty-two individuals with TOS (mean age 30.81 ± 10.69 years; 10 male, 52 female) and 47 healthy individuals (mean age 30.64 ± 9.16 years; 14 male, 33 female) participated in this study. Pulmonary function testing was performed using a spirometer. Respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]) were measured using a mouth pressure device. Respiratory muscle endurance was tested at 35% MIP and measured as the time in seconds from the start of the test to voluntary exhaustion.

Results: Age distribution and physical characteristics were similar between the groups (P > .05). All pulmonary function parameters except for peak expiratory flow rate were similar in patients with TOS and healthy controls (P > .05). Patients with TOS had significantly lower peak expiratory flow rate, MIP, MIP%, MEP, MEP%, and respiratory muscle endurance compared with controls (P < .05). Forty-six patients with TOS (74.2%) had MIP values below the lower limit of the 95% CI of the control group (97.05-113.88 cmHO), and 53 patients with TOS (85.2%) had MEP values below the lower limit of the 95% CI of the control group (124.74-146.49 cmHO).

Conclusion: Expiratory flow rate and respiratory muscle strength and endurance may be adversely affected in TOS. Trunk muscles perform both postural and breathing functions. Therefore, disruption in one function may negatively affect the other.
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http://dx.doi.org/10.1016/j.jmpt.2019.10.006DOI Listing
May 2021

Sustainable inspiratory pressure and incremental threshold loading for respiratory muscle endurance in chronic obstructive pulmonary disease: A pilot study.

Clin Respir J 2021 Jan 7;15(1):19-25. Epub 2020 Sep 7.

Faculty of Medicine, Department of Chest Medicine, Hacettepe University, Ankara, Turkey.

Introduction: A prolonged mismatch between the demand for respiratory muscle work and the capacity to meet that demand in chronic obstructive pulmonary disease (COPD) can result in symptoms of dyspnea and the development of muscle fatigue.

Objectives: The purpose of this study was to compare two different respiratory muscle endurance assessment methods of sustainable inspiratory pressure (SIP) and incremental threshold loading (ITL) in COPD.

Methods: Thirty-four patients diagnosed with COPD were included in the study. Physical and demographic characteristics of the subjects were recorded. Pulmonary function testing (PFT), modified Medical Research Council (MMRC) dyspnea scale, COPD assessment test, inspiratory and expiratory muscle strength (MIP and MEP, respectively) measurement and six-minute walk test (6MWT) were used to assess subjects. Two different respiratory muscle endurance tests (SIP and ITL) were performed within 48 hours apart, and each test was repeated two times on the same day.

Results: There was no correlation between the SIP and ITL tests (r = 0.069, P = .699). According to the test-retest reliability analysis, both tests were reproducible (ICC = 0.843; P < .001 for SIP, ICC = 0.905; P < .001 for ITL). Finding no differences between repeated tests showed that tests are not affected by learning effect.

Conclusion: The SIP and ITL tests are used for the same purpose but have different characteristics. Regarding the relationship between the other parameters and tests, the ITL is well tolerated and reflects the differences in respiratory muscle endurance better.
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http://dx.doi.org/10.1111/crj.13264DOI Listing
January 2021

The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: A randomized controlled trial.

Heart Lung 2020 Nov - Dec;49(6):940-948. Epub 2020 Aug 13.

Department of Chest Medicine and Sleep Center, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.

Background: Inspiratory muscle training (IMT) and oropharyngeal exercises (OE) have different advantages and disadvantages and a comparison of these modalities has been recommended. The aim of this study was to compare the effects of IMT and OE on important outcomes for patients with OSAS.

Methods: This was a randomized controlled clinical trial. Forty-one clinically stable OSAS patients not receiving CPAP therapy were randomly divided into three groups. Patients in the IMT group (n = 15) trained with a threshold loading device 7 days/week for 12 weeks. Patients in the OE group (n = 14) practiced exercises 5 days/week for 12 weeks. Twelve patients served as control group. Apnea-hypopnea index (AHI), respiratory muscle strength, snoring severity and frequency (Berlin Questionnaire), daytime sleepiness (Epworth Sleepiness Scale; ESS), sleep quality (Pittsburg Sleep Quality Index; PSQI), impact of sleepiness on daily life (Functional Outcomes of Sleep Questionnaire; FOSQ), and fatigue severity (Fatigue Severity Scale; FSS) were evaluated before and after the interventions.

Results: AHI and sleep efficiency did not change significantly in any of the groups. Significant decreases in snoring severity and frequency, FSS and PSQI total scores were found in the IMT and OE groups after the treatments (p < 0.05). There was a significant reduction in neck and waist circumference and significant improvement in respiratory muscle strength (MIP and MEP) in IMT group compared to control group (p < 0.05). The%MEPpred value and FOSQ total score significantly increased and ESS score reduced after the treatment in OE group compared to control group (p < 0.05).

Conclusions: Our results indicate that both OE and IMT rehabilitation interventions are applicable in rehabilitation programs for OSAS patients who do not accept CPAP therapy. Our findings could lead to increase these methods' use among rehabilitation professionals and decrease in cost of CPAP treatment in OSAS.
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http://dx.doi.org/10.1016/j.hrtlng.2020.07.014DOI Listing
March 2021

Visuomotor reaction time and dynamic balance in children with cystic fibrosis and non-cystic fibrosis bronchiectasis: A case-control study.

Pediatr Pulmonol 2020 09 22;55(9):2341-2347. Epub 2020 Jun 22.

Faculty of Medicine, Department of Pediatric Chest Diseases, Hacettepe University, Ankara, Turkey.

Objective: Extrapulmonary involvement such as balance and reaction time is unclear in cystic fibrosis (CF) patients. The aim of this study was to evaluate visuomotor reaction time (VMRT) and dynamic balance in children with CF and non-CF bronchiectasis compared to healthy children.

Design/methods: Demographic and clinical characteristics were recorded. All children were evaluated with pulmonary function test (PFT) using a spirometer, incremental shuttle walk test (ISWT) for exercise capacity, Fitlight Trainer for VMRT, and functional reach test (FRT) for dynamic balance.

Results: Fourteen children with CF (10.71 ± 2.94 years, 7 females), 17 children with non-CF bronchiectasis (12.75 ± 2.81 years, 8 females), and 21 healthy children (11.36 ± 3.28 years, 11 females) were included. Children with CF had longer total VMRT (P = .027), poorer FRT performance (P = .001), and shorter ISWT distances (P = .03) compared to the children with non-CF bronchiectasis and controls. Although total VMRT was longest in the CF group, there was no significant difference in mean VMRT among the CF, non-CF bronchiectasis, and control groups (P > .05).

Conclusion: Dynamic balance and VMRT show greater impairment in children with CF than in children with non-CF bronchiectasis compared to healthy controls. Our findings suggest that VMRT and dynamic balance should be taken into consideration for assessments and exercise programs in pulmonary rehabilitation.
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http://dx.doi.org/10.1002/ppul.24903DOI Listing
September 2020

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

Pediatr Cardiol 2020 Oct 30;41(7):1363-1369. Epub 2020 May 30.

Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

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.
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http://dx.doi.org/10.1007/s00246-020-02384-1DOI Listing
October 2020

Association between 6 min pegboard and ring test and arm performance in GOLD stage II-III patients.

Wien Klin Wochenschr 2021 Jun 25;133(11-12):594-601. Epub 2020 Mar 25.

Faculty of Medicine, Department of Chest Diseases, Hacettepe University, 06230, Sihhiye, Ankara, Turkey.

Background: The 6 min pegboard and ring test (6PBRT) is a valid and reproducible test of unsupported arm exercise endurance. The aim of this study was to determine the associations between the 6PBRT, activities of daily living (ADL) and hemoglobin levels in chronic obstructive pulmonary disease (COPD).

Methods: This study included 40 stable patients with COPD. All participants underwent the 6PBRT, peripheral venous blood sampling, arm ergometer test and the Glittre-ADL and ADL simulation tests for the ADLs performance.

Results: An average 172.51 ± 25.94 rings were moved in 6 min. The number of rings in 6PBRT was significantly positively correlated with the number of cycles in ADL simulation test (r = 0.553, p < 0.001), peak oxygen consumption in arm ergometer (r = 0.381, p = 0.024) and serum hemoglobin level (r = 0.411, p = 0.011).

Conclusion: The number of rings moved in the 6PBRT is associated with ADL simulation test performance that reflects upper extremity ADLs. Therefore, the 6PBRT can be used for estimating limitation in upper extremity ADLs as a simple and quick evaluation in patients with GOLD stage II-III COPD.
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http://dx.doi.org/10.1007/s00508-020-01635-8DOI Listing
June 2021

Validity and Reliability of the Turkish Version of the London Chest Activity of Daily Living Scale in Obstructive Lung Diseases.

Turk Thorac J 2020 03 1;21(2):116-121. Epub 2020 Mar 1.

Department of Chest Medicine, Hacettepe University School of Medicine, Ankara, Turkey.

Objectives: The London Chest Activity of Daily Living Scale (LCADL) is a simple, useful, and comprehensive measure of dyspnea perception in activities of daily living. This study was conducted to determine the validity and reliability of the Turkish version of the LCADL.

Materials And Methods: A total of 64 patients with obstructive lung disease (24 chronic obstructive pulmonary disease, 20 asthma, and 20 bronchiectasis patients) were included. The Turkish LCADL was evaluated for interobserver reliability, test-retest reliability, and criterion validity. Two different observers applied the scale with an interval of 10 minutes to assess interobserver reliability. The second observer applied the scale twice at an interval of 10-15 days to assess test-retest reliability. Criterion validity was assessed using the 6-minute walk test (6MWT), Nottingham Health Profile (NHP), and Saint George Respiratory Questionnaire (SGRQ).

Results: The interobserver reliability of the scale was very high (r=0.985, p<0.050). Cronbach's alpha coefficient for total score was 0.976 and intraclass correlation coefficient was 0.953. These results indicate that the Turkish LCADL has high reliability. The correlation between LCADL and 6MWT was moderate 0.503 (p=0.002). The LCADL total score was weakly correlated with NHP total score (r=0.370, p=0.040) and SGRQ total score (r=0.367, p=0.004).

Conclusion: The Turkish version of the LCADL scale is reliable and valid in obstructive lung disease. The LCADL scale will be beneficial in existing pulmonary rehabilitation programs aiming to improve functional status. We believe that using the Turkish LCADL scale as an outcome measure in pulmonary rehabilitation programs will serve as an indicator of rehabilitation efficacy for individual patients.
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http://dx.doi.org/10.5152/TurkThoracJ.2019.18155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089701PMC
March 2020

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.

Pediatr Pulmonol 2020 05 28;55(5):1207-1216. Epub 2020 Feb 28.

Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

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.
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http://dx.doi.org/10.1002/ppul.24708DOI Listing
May 2020

Acute effects of manual therapy on respiratory parameters in thoracic outlet syndrome.

Turk Gogus Kalp Damar Cerrahisi Derg 2019 Jan 1;27(1):101-106. Epub 2019 Jan 1.

Department of Thoracic Surgery, Medicine Faculty of Ankara University, Ankara, Turkey.

Background: This study aims to investigate the acute effects of manual therapy on pain perception and respiratory parameters in patients with thoracic outlet syndrome.

Methods: The study included 10 patients with thoracic outlet syndrome (1 male, 9 females; mean age 31.3±9.0 years; range, 20 to 43 years). Patients were accepted in a single session of manual therapy involving the cervical spine and thorax. Stretching of scalene, upper trapezius, sternocleidomastoid, rectus abdominis, hip flexor muscles; and mobilization of first rib, cervical and thoracic spine, sacroiliac joints and thorax were applied as manual therapy program. Pain perceptions of upper arm and neck were assessed with visual analog scale. Measurements were performed before and immediately after of a 30-minute session of manual therapy. Pulmonary function testing was performed with a spirometer. Respiratory muscle strength (inspiratory and expiratory muscle strength, maximal inspiratory pressure and maximal expiratory pressure, respectively) was measured. Respiratory muscle endurance was recorded using sustained threshold loading of 35% maximal inspiratory pressure.

Results: There were no significant changes in any pulmonary function parameters or maximal expiratory pressure following manual therapy intervention (p>0.05). However, maximal inspiratory pressure and respiratory muscle endurance improved (p<0.05). Pain perceptions of upper arm and neck reduced after treatment (p<0.05).

Conclusion: A 30-minute single manual therapy session improved inspiratory muscle strength and respiratory muscle endurance but not pulmonary function and expiratory muscle strength in patients with thoracic outlet syndrome. Manual therapy may facilitate functional breathing and support use of primary respiratory muscles more effectively together with rapid pain reduction. The long-term effects of regular manual therapy on respiratory parameters should be investigated after surgical procedures.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2019.17375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021361PMC
January 2019

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

Heart Lung 2020 Jan - Feb;49(1):99-104. Epub 2019 Sep 14.

Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Ankara, Turkey.

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.
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http://dx.doi.org/10.1016/j.hrtlng.2019.09.004DOI Listing
November 2020

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

Disabil Rehabil 2021 Apr 8;43(7):1015-1021. Epub 2019 Aug 8.

Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.

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 ( < 0.001). Gender and body mass index explained 48.5% of the variance in six-minute walk test distance ( = 0.697,  = 0.485,  = 20.737,  < 0.001). Body mass index and fat-free mass explained 55% of the variance in incremental shuttle walk test distance ( = 0.746, = 0.557,  = 27.623,  < 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.
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http://dx.doi.org/10.1080/09638288.2019.1648569DOI Listing
April 2021

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

Arch Bronconeumol (Engl Ed) 2020 Apr 26;56(4):208-213. Epub 2019 Jul 26.

Hacettepe University, Faculty of Medicine, Department of Chest Medicine, Ankara, Turkey.

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 FEV=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.
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http://dx.doi.org/10.1016/j.arbres.2019.06.015DOI Listing
April 2020

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

J Exerc Rehabil 2019 Jun 30;15(3):468-471. Epub 2019 Jun 30.

Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.

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.
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http://dx.doi.org/10.12965/jer.1938144.072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614767PMC
June 2019

Physical activity patterns in children with cerebral palsy and typically developing peers.

Physiother Theory Pract 2021 Jun 12;37(6):710-718. Epub 2019 Jul 12.

Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.

To compare physical activity level between children with cerebral palsy and typically developing peers using accelerometer and activity diary. Twenty children with spastic cerebral palsy Level I and II according to Gross Motor Function Classification System, and 20 healthy age- and sex-matched typically developing peers were included. An activity diary was logged, and each child wore an accelerometer for 4 days, 2 weekdays and 2 weekend days. Total and physical activity energy expenditure assessed using either accelerometer or activity diary was markedly lower in children with spastic cerebral palsy compared to typically developing peers. Moderate and vigorous physical activities and daily total energy expenditure assessed using activity diary were significantly lower in children with cerebral palsy than those of typically developing peers ( < .05). There was a significant relationship between accelerometer and activity diary in total energy expenditure for children with cerebral palsy (r = 0.752, < .001) and typically developing peers (r = 0.732, < .001) and a moderate significant relationship in physical activity energy expenditure for children with cerebral palsy (r = 0.463, = .040). In this study, children with cerebral palsy had lower physical activity levels than their typically developing peers. The activity diary provided detailed information about physical activities and was correlated with accelerometer data. The activity diary could be a valid measure of physical activity levels in children with cerebral palsy.
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http://dx.doi.org/10.1080/09593985.2019.1641863DOI Listing
June 2021

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

Turk Thorac J 2019 04 31;20(2):114-119. Epub 2019 Jan 31.

Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey.

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.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.18107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453635PMC
April 2019

Increased pain sensitivity, postural abnormalities, and functional balance impairment in obstructive lung disease compared to healthy subjects.

Heart Lung 2019 Jul - Aug;48(4):351-355. Epub 2019 Jan 14.

Hacettepe University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey.

Background: Recent reports have identified pain as a comorbidity in obstructive lung diseases, but data regarding pain in certain obstructive lung diseases such as COPD and bronchiectasis vs. healthy controls and differences in pain between these chronic lung diseases are limited.

Objectives: The primary aim of this study was to compare pain sensitivity, postural abnormalities, and functional balance in patients with COPD/bronchiectasis vs. healthy controls. The secondary aim was to evaluate differences in these parameters between two different lung diseases (COPD and bronchiectasis).

Methods: Twenty-nine patients with moderate to severe COPD/bronchiectasis and 31 healthy age/gender-matched individuals participated in the study. Pain sensitivity was assessed with an algometer. Postural abnormalities were analyzed from the lateral and posterior view. Functional balance was evaluated using the Timed Up and Go test (TUG).

Results: Significantly more patients reported pain compared to the healthy controls (89.7% vs. 19.4%, respectively) (p < 0.05). The pressure pain thresholds of the trapezius and deltoid muscles and pain tolerance of the pectoralis major muscle were significantly lower in patients compared to healthy subjects (p < 0.05). Total and posterior posture scores and TUG time were significantly higher in patients compared to the control group (p < 0.05).

Conclusions: This study showed that pain perception, severity, and sensitivity are increased in patients with COPD or bronchiectasis compared to the healthy population. These patients also have more severe postural abnormalities and functional balance impairment than the healthy population.
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http://dx.doi.org/10.1016/j.hrtlng.2018.12.009DOI Listing
March 2020

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

Respirology 2019 03 12;24(3):246-253. Epub 2018 Sep 12.

Faculty of Medicine, Department of Chest Medicine, Hacettepe University, Ankara, Turkey.

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.
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http://dx.doi.org/10.1111/resp.13397DOI Listing
March 2019

The relationship between fear of movement, pain and fatigue severity, dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease.

Disabil Rehabil 2019 09 10;41(18):2159-2163. Epub 2018 Apr 10.

b Faculty of Medicine, Department of Chest Diseases , Hacettepe University , Ankara , Turkey.

Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess levels of kinesiophobia among stable COPD patients and evaluate the relationship between kinesiophobia and pain and fatigue severity, dyspnea level, and comorbidities in this patient group. Thirty-one patients with moderate/severe COPD and thirty-one age- and sex-matched healthy controls participated in the study. All participants were assessed using Visual Analog Scale for pain severity, Fatigue Severity Scale, modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia. Ninety-three percent of the patients with COPD had a high degree of kinesiophobia (Tampa Scale of Kinesiophobia score >37). The modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia scores of patients with COPD was significantly higher than those of healthy subjects ( < 0.001). Tampa Scale of Kinesiophobia score was significantly associated with modified Medical Research Council Dyspnea Scale score ( = 0.676,  < 0.001), Charlson Comorbidity Index score ( = 0.746,  < 0.001) and fatigue severity level ( = 0.524,  = 0.005). Most moderate/severe COPD patients express fear of movement. Kinesiophobia is strongly associated with dyspnea perception, fatigue severity, multisystemic comorbidities in COPD. Further studies are needed to determine the effects of kinesiophobia on the success of pulmonary rehabilitation. Implications for rehabilitation Most of moderate-to-severe chronic obstructive pulmonary disease patients have fear of movement. Increase fear of movement in moderate-severe chronic obstructive pulmonary disease is associated with increased dyspnea perception and fatigue severity and multisystemic comorbidities.
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http://dx.doi.org/10.1080/09638288.2018.1459886DOI Listing
September 2019

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

Eur J Pediatr 2018 May 27;177(5):765-773. Epub 2018 Feb 27.

Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.

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, FEV, 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, FEV, 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.
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http://dx.doi.org/10.1007/s00431-018-3121-2DOI Listing
May 2018

Clinical Determinants of Incremental Shuttle Walk Test in Adults with Bronchiectasis.

Lung 2018 06 12;196(3):343-349. Epub 2018 Feb 12.

Department of Chest Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Introduction: Exercise capacity is impaired in patients with bronchiectasis. Incremental shuttle walk test (ISWT) stresses cardiorespiratory system physiologically to symptom-limited maximal exercise capacity. The purpose of this study was to investigate the clinical determinants of ISWT in adults with non-cystic fibrosis (CF) bronchiectasis.

Methods: Forty-one clinically stable bronchiectasis patients aged 18-72 years (27 females, 14 males) participated in the study. Subjects' demographics and physical characteristics were recorded. Bronchiectasis Severity Index was used to identify disease severity. Pulmonary function test was performed. Dyspnea perception was assessed using the modified Medical Research Council Dyspnea Scale. Maximum inspiratory and expiratory pressures were measured. Peripheral muscle strength using a hand held dynamometer was measured. ISWT was performed to determine exercise capacity. Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Leicester Cough Questionnaire were used to determine fatigue, psychosocial status, and quality of life.

Results: Patients' mean ISWT distance was 469.5 m. The ISWT distance was significantly related with age (r = - 0.472), height (r = 0.469), gender (r = 0.520), FEV (r = 0.651), and FVC (r = 0.545, p < 0.05). Quadriceps muscle strength was higher in males (p = 0.001) as compared to females. Age and gender were identified as independent predictors of the ISWT, explaining 42% of variance in ISWT distance (r = 0.649, r = 0.421, F = 13.794, p < 0.001).

Conclusion: The clinical determinants of ISWT in clinically stable patients with non-CF bronchiectasis are age and gender. Pulmonary function, dyspnea perception, muscle strength, disease severity, fatigue, psychosocial factors, and health-related quality of life seems to have an independent effect on ISWT in this group of patients with bronchiectasis.
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http://dx.doi.org/10.1007/s00408-018-0094-xDOI Listing
June 2018

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

Complement Ther Clin Pract 2016 May 16;23:52-8. Epub 2016 Mar 16.

Hacettepe University, Faculty of Medicine, Department of Biostatistics, 06230, Sihhiye, Ankara, Turkey. Electronic address:

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.
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http://dx.doi.org/10.1016/j.ctcp.2016.03.002DOI Listing
May 2016

Effects of active/passive interventions on pain, anxiety, and quality of life in women with fibromyalgia: Randomized controlled pilot trial.

Women Health 2017 Jan 16;57(1):88-107. Epub 2016 Feb 16.

c Department of Biostatistics, Faculty of Medicine , Hacettepe University , Ankara , Turkey.

The authors of this study compared the effects of pilates exercises and connective tissue massage (CTM) on pain intensity; pain-pressure threshold; and tolerance, anxiety, progress, and health-related quality of life in females with fibromyalgia. It was a pilot, assessor masked, randomized controlled trial conducted between January and August of 2013. Twenty-one women with fibromyalgia were randomly assigned to the pilates exercise program (six of whom did not complete the program), and 22 were randomly assigned to CTM (one of whom did not complete this program). Each group received the assigned intervention three times per week during a 4-week period. The Visual Analogue Scale, algometry, State-Trait Anxiety Inventory, Fibromyalgia Impact Questionnaire, and Nottingham Health Profile were used at baseline and at the end of treatments. Significant improvements were found in both groups for all parameters. However, the scores for pain-pressure threshold were significantly elevated and the symptoms of anxiety were significantly diminished in the exercise group compared to the massage group. Thus, exercise and massage might be used to provide improvements in women with fibromyalgia. The exercise group showed more advantages than the massage group and thus might be preferred for patients with fibromyalgia. However, an adequately powered trial is required to determine this with certainty.
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http://dx.doi.org/10.1080/03630242.2016.1153017DOI Listing
January 2017

Six minute walk test versus incremental shuttle walk test in cystic fibrosis.

Pediatr Int 2016 Sep 28;58(9):887-93. Epub 2016 Apr 28.

Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Although both self-paced and externally paced field tests are widely used in cystic fibrosis (CF), it is still unclear whether they induce clinically relevant and similar cardiorespiratory responses. The aim of this study was therefore to compare the incremental shuttle walk test (ISWT) and 6 min walk test (6MWT), and to determine the factors influencing exercise capacity in CF.

Methods: Fifty clinically stable CF patients were included in the study. Pulmonary function, peripheral and respiratory muscle strength were assessed, anthropometric measurements were recorded, and 6MWT and ISWT carried out.

Results: The CF patients covered significantly more distance in the ISWT than 6MWT (P < 0.001). Heart rate response and dyspnea score at the end of the tests and during the recovery phase were significantly higher in the ISWT compared with the 6MWT (P < 0.05). The 6MWT and ISWT had similar moderate-strong correlations with age, height, weight, pulmonary function, respiratory and peripheral muscle strength (P < 0.05). Forty-nine percent of the variance in 6MWT distance was explained by age and forced expiratory volume in 1 s (FEV1 ; R(2)  = 0.49, F(2-48) = 22.033, P < 0.001). The variables contributing to ISWT distance were FEV1 , inspiratory muscle strength, and body mass index (R(2)  = 0.596, F(3-44) = 20.176, P < 0.001).

Conclusions: The ISWT is a better reflection of exercise tolerance in CF than 6MWT. ISWT is a preferable alternative assessment of exercise tolerance in terms of cardiorespiratory response.
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http://dx.doi.org/10.1111/ped.12919DOI Listing
September 2016

Arm strength training improves activities of daily living and occupational performance in patients with COPD.

Clin Respir J 2017 Nov 22;11(6):820-832. Epub 2015 Dec 22.

Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Sihhiye, Ankara, Turkey.

Objectives: Arm strength training may improve functional performance for patients with chronic obstructive pulmonary disease (COPD). This trial investigated the effects of arm strength training on arm exercise capacity, activities of daily living (ADL) and occupational performance in patients with COPD.

Methods: These was a randomized controlled trial in an outpatient clinic. Forty-two stable patients with COPD were randomly assigned into treatment and control groups. The treatment group underwent an 8-week (23 sessions) arm strength training programme. Both groups completed daily breathing exercises at home. Tests included hand grip strength, arm ergometer test, the Glittre-ADL and ADL Simulation tests and measures included the Milliken ADL Scale (MAS) and the Canadian Occupational Performance Measure (COPM).

Results: Statistically significant increases were detected in hand grip strength and %hand grip strength values, peak arm ergometer workload and the number of ADL simulation test cycles for the treatment group (P < 0.05). Significant decreases were also found in dyspnea and arm fatigue perception during arm ergometer test, and heart rate and dyspnea perception during Glittre-ADL test in the treatment group (P < 0.05). The treatment group also showed significant increases in MAS-house cleaning and laundry and MAS-other activities integrated scores and COPM-performance and satisfaction scores (P < 0.05).

Conclusions: Arm strength training increases peripheral muscle strength, arm exercise capacity, ADL performance and patients' ADL performance satisfaction. Training decreases dyspnea and arm fatigue perception during supported arm exercises, and dyspnea perception during ADL. Arm strength training is a reliable and feasible treatment for COPD patients.
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http://dx.doi.org/10.1111/crj.12422DOI Listing
November 2017