Laurie J Smith1, Helen Marshall2, Jody Bray2, Martin Wildman3, Noreen West4, Alex Horsley5, Jim M Wild6. 1. POLARIS group, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK. 2. POLARIS group, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK. 3. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 4. Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK. 5. POLARIS group, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Respiratory Research Group, Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK. 6. POLARIS group, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK. Electronic address: j.m.wild@sheffield.ac.uk.
Abstract
BACKGROUND: The importance of exercise in the management of people with CF is well recognised, yet the effect of exercise on lung function is not well understood. FEV1 is insensitive to the detection of small changes in lung function. Ventilation MRI and LCI are both more sensitive to mild lung disease than FEV1 and may be better suited to assess the effects of exercise. Here we assessed the short-term effects of maximal exercise on the distribution of ventilation using ventilation MRI and LCI. METHODS: Patients with CF and a range of lung disease were assessed. Baseline LCI and ventilation MRI was followed by a maximal cardio-pulmonary exercise test (CPET). Repeated ventilation MRI was performed within 30 minutes of exercise termination, followed by LCI and finally by FEV1. RESULTS: 13 patients were recruited and completed all assessments. Mean (SD) age was 25 (10) years and mean (SD) FEV1 z-score was -1.8 (1.7). Mean LCI at baseline was 8.2, mean ventilation defect percentage on MRI (VDP) was 7.3%. All patients performed maximal CPET. Post-exercise, there was a visible change in lung ventilation in 85% of patients, including two patients with increased ventilation heterogeneity post-CPET who had normal FEV1. VDP and LCI were significantly reduced post-exercise (p < 0.05) and 45% of patients had a significant change in VDP. CONCLUSIONS: Acute maximal exercise directly affects the distribution of ventilation on ventilation MRI in patients with CF. This suggests that exercise is beneficial in CF and that ventilation MRI is suitable to assess airway clearance efficacy.
BACKGROUND: The importance of exercise in the management of people with CF is well recognised, yet the effect of exercise on lung function is not well understood. FEV1 is insensitive to the detection of small changes in lung function. Ventilation MRI and LCI are both more sensitive to mild lung disease than FEV1 and may be better suited to assess the effects of exercise. Here we assessed the short-term effects of maximal exercise on the distribution of ventilation using ventilation MRI and LCI. METHODS: Patients with CF and a range of lung disease were assessed. Baseline LCI and ventilation MRI was followed by a maximal cardio-pulmonary exercise test (CPET). Repeated ventilation MRI was performed within 30 minutes of exercise termination, followed by LCI and finally by FEV1. RESULTS: 13 patients were recruited and completed all assessments. Mean (SD) age was 25 (10) years and mean (SD) FEV1 z-score was -1.8 (1.7). Mean LCI at baseline was 8.2, mean ventilation defect percentage on MRI (VDP) was 7.3%. All patients performed maximal CPET. Post-exercise, there was a visible change in lung ventilation in 85% of patients, including two patients with increased ventilation heterogeneity post-CPET who had normal FEV1. VDP and LCI were significantly reduced post-exercise (p < 0.05) and 45% of patients had a significant change in VDP. CONCLUSIONS: Acute maximal exercise directly affects the distribution of ventilation on ventilation MRI in patients with CF. This suggests that exercise is beneficial in CF and that ventilation MRI is suitable to assess airway clearance efficacy.
Authors: Neil J Stewart; Laurie J Smith; Ho-Fung Chan; James A Eaden; Smitha Rajaram; Andrew J Swift; Nicholas D Weatherley; Alberto Biancardi; Guilhem J Collier; David Hughes; Gill Klafkowski; Christopher S Johns; Noreen West; Kelechi Ugonna; Stephen M Bianchi; Rod Lawson; Ian Sabroe; Helen Marshall; Jim M Wild Journal: Br J Radiol Date: 2021-06-09 Impact factor: 3.629
Authors: Alex R Horsley; John Belcher; Katie Bayfield; Brooke Bianco; Steve Cunningham; Catherine Fullwood; Andrew Jones; Anna Shawcross; Jaclyn A Smith; Anirban Maitra; Francis J Gilchrist Journal: Thorax Date: 2021-07-22 Impact factor: 9.139