ORCID Profile
0000-0001-6403-2894
Current Organisation
University of Sydney
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Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JPHYS.2015.05.019
Abstract: During an acute exacerbation of cystic fibrosis, is non-invasive ventilation beneficial as an adjunct to the airway clearance regimen? Randomised controlled trial with concealed allocation and intention-to-treat analysis. Forty adults with moderate to severe cystic fibrosis lung disease and who were admitted to hospital for an acute exacerbation. Comprehensive inpatient care (control group) compared to the same care with the addition of non-invasive ventilation during airway clearance treatments from Day 2 of admission until discharge (experimental group). Lung function and subjective symptom severity were measured daily. Fatigue was measured at admission and discharge on the Schwartz Fatigue Scale from 7 (no fatigue) to 63 (worst fatigue) points. Quality of life and exercise capacity were also measured at admission and discharge. Length of admission and time to next hospital admission were recorded. Analysed as the primary outcome, the experimental group had a greater rate of improvement in forced expiratory volume in 1 second (FEV1) than the control group, but this was not statistically significant (MD 0.13% predicted per day, 95% CI -0.03 to 0.28). However, the experimental group had a significantly higher FEV1 at discharge than the control group (MD 4.2% predicted, 95% CI 0.1 to 8.3). The experimental group reported significantly lower levels of fatigue on the Schwartz fatigue scale at discharge than the control group (MD 6 points, 95% CI 1 to 11). There was no significant difference between the experimental and control groups in subjective symptom severity, quality of life, exercise capacity, length of hospital admission or time to next hospital admission. Among people hospitalised for an acute exacerbation of cystic fibrosis, the use of non-invasive ventilation as an adjunct to the airway clearance regimen significantly improves FEV1 and fatigue. ANZCTR 12605000437662.
Publisher: Wiley
Date: 18-04-2016
DOI: 10.1111/RESP.12764
Publisher: Wiley
Date: 05-2020
Publisher: Wiley
Date: 09-10-2015
Publisher: Wiley
Date: 09-02-2018
Publisher: S. Karger AG
Date: 2015
DOI: 10.1159/000439057
Abstract: This statement summarizes the information available on specific exercise test protocols and outcome parameters used in patients with cystic fibrosis (CF) and provides expert consensus recommendations for protocol and performance of exercise tests and basic interpretation of results for clinicians. The conclusions were reached employing consensus meetings and a wide-band Delphi process. Although data on utility are currently limited, standardized exercise testing provides detailed information on physiological health, allows screening for exercise-related adverse reactions and enables exercise counselling. The Godfrey Cycle Ergometer Protocol with monitoring of oxygen saturation and ventilatory gas exchange is recommended for exercise testing in people 10 years and older. Cycle ergometry only with pulse oximetry using the Godfrey protocol or treadmill exercise with pulse oximetry - preferably with measurement of gas exchange - are second best options. Peak oxygen uptake, if assessed, and maximal work rate should be reported as the primary measure of exercise capacity. The final statement was reviewed by the European Cystic Fibrosis society and revised based on the comments received. The document was endorsed by the European Respiratory Society.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.JCF.2015.05.011
Abstract: The aim of this position statement was to inform the choice of physical activity tools for use within CF research and clinical settings. A systematic review of physical activity tools to explore evidence for reliability, validity, and responsiveness. Narrative answers to "four key questions" on motion sensors, questionnaires and diaries were drafted by the core writing team and then discussed at the Exercise Working Group in ECFS Lisbon 2013. Our current position is that activity monitors such as SenseWear or ActiGraph offer informed choices to facilitate a comprehensive assessment of physical activity, and should as a minimum report on dimensions of physical activity including energy expenditure, step count and time spent in different intensities and sedentary time. The DigiWalker pedometer offers an informed choice of a comparatively inexpensive method of obtaining some measurement of physical activity. The HAES represents an informed choice of questionnaire to assess physical activity. There is insufficient data to recommend the use of one diary over another. Future research should focus on providing additional evidence of clinimetric properties of these and new physical activity assessment tools, as well as further exploring the added value of physical activity assessment in CF.
Publisher: European Respiratory Society (ERS)
Date: 21-06-2023
DOI: 10.1183/13993003.00960-2021
Abstract: In people with cystic fibrosis (CF), regular nebulisation of 6% or 7% saline improves lung function however, these concentrations are not always tolerable. Clinically, some CF patients report using lower concentrations of saline to improve tolerability, yet the effects of lower concentrations are unknown. This study therefore aimed to evaluate the relative effectiveness and tolerability of 0.9% versus 3% versus 6% saline nebulised twice daily with an eFlow rapid nebuliser. This was a randomised, blinded, placebo-controlled, parallel-group, multicentre study where subjects inhaled 4 mL of 0.9%, 3% or 6% saline twice daily for 16 weeks. The primary outcome was forced expiratory volume in 1 s. The secondary outcomes were: forced vital capacity (FVC) and forced expiratory flow at 25–75% of FVC quality of life exercise capacity acquisition or loss of bacterial organisms in expectorated sputum tolerability of nebulised saline pulmonary exacerbations and adverse events. 140 participants were randomised to 0.9% (n=47), 3% (n=48) or 6% (n=45) saline. 134 participants (96%) contributed to the intention-to-treat analysis. 3% saline significantly improved lung function and increased the time to first pulmonary exacerbation compared with 0.9% saline but did not improve quality of life. 6% saline had similar benefits to 3% saline but also significantly improved quality of life compared with 3% saline. Only 6% saline delayed the time to intravenous antibiotics for pulmonary exacerbation. Tolerability and adherence were similar. Dilution of 6% saline to 3% maintains the benefits for lung function and exacerbation prevention however, the positive impacts of 6% saline on quality of life and time to i.v. antibiotics for pulmonary exacerbations are lost.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2011
Publisher: BMJ
Date: 30-09-2022
DOI: 10.1136/THORAX-2022-218702
Abstract: Physical activity levels are known to decline following hospitalisation for people with cystic fibrosis (pwCF). However, optimal physical activity promotion strategies are unclear. This study investigated the effect of a web-based application (ActivOnline) in promoting physical activity in young pwCF. Multicentre randomised controlled trial with assessor blinding and qualitative evaluation. People with CF (12–35 years) admitted to hospital for a respiratory cause were eligible and randomised to the 12-week ActivOnline intervention (AO) or usual care (UC). The primary outcome was change in device-based time spent in moderate-to-vigorous physical activity (MVPA) from baseline to post-intervention. Follow-up was at 6 months from hospital discharge when qualitative evaluation was undertaken. 107 participants were randomised to AO (n=52) or UC (n=55). Sixty-three participants (59%) contributed to the intention-to-treat analysis. Mean (SD) age was 21 (6) years (n=46, years). At baseline, physical activity levels were high in both groups (AO 102 (52) vs UC 127 (73) min/day). There was no statistically significant difference in MVPA between groups at either timepoint (post-intervention mean difference (95% CI) −14 mins (−45 to 16)). Uptake of the intervention was low with only 40% (n=21) of participants accessing the web application. A web-based application, including in idualised goal setting, real-time feedback and motivation for behavioural change, was no better than usual care at promoting physical activity in young pwCF following hospital discharge. High levels of baseline physical activity levels in both groups, and limited engagement with the intervention, suggest alternative strategies may be necessary to identify and support young pwCF who would benefit from enhanced physical activity. ACTRN12617001009303, 13 July 13 2017.
Publisher: SAGE Publications
Date: 02-2000
DOI: 10.1191/026921500671430626
Abstract: Objective: The effect of muscle length on strength and dexterity after stroke was investigated. The aim was to determine if poor function at a particular muscle length could be attributed solely to differential weakness at this joint angle or whether an additional problem of differential dexterity exists. Design: This descriptive research study measured elbow flexor and extensor strength as well as dexterity at three elbow joint angles: 30°, 60° and 90° flexion. Dexterity was measured independently of strength. Subjects: Fifteen (seven female, eight male) chronic stroke patients (mean age 67 years) who could actively flex and extend their affected elbow participated. Ten neurologically normal control subjects (mean age 67 years) acted as controls. Main outcome measures: Strength was measured as peak elbow flexor and extensor torque at three angles and dexterity was measured as coherence for slow and fast tracking also at three angles. Results: Dexterity was not affected by muscle length but strength was and this finding was the same for both stroke and controls. While the magnitude of the torque-angle curves was not significantly different between stroke and controls, the shape of torque-angle curves was altered after stroke so that both the elbow flexors ( p 0.05) and extensors ( p 0.05) tested weaker in the testing position where they were shortest. Conclusion: Since there was no differential loss of dexterity, it appears that differential loss of strength, especially in the shortened range, may explain the clinical observation of poorer function at one muscle length than another after stroke. Specific training to strengthen the muscles in these ranges is therefore of clinical importance for rehabilitation.
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.RMED.2009.04.013
Abstract: Determine the SenseWear Pro3 Armband (SWA) accuracy for estimating energy expenditure (EE) and step count during treadmill walking in cystic fibrosis (CF) compared to healthy adults. SWA estimation of EE would be less accurate for CF, than for healthy subjects, due to interference with the SWA skin sensors caused by the high salt concentration in the sweat of CF subjects. 17 CF (mean age 26 yr FEV1 54% predicted) and 17 age-matched control subjects walked slightly faster than their comfortable pace on a treadmill for 20 min, whilst simultaneously wearing the SWA and breathing through an open-circuit indirect calorimetry (IC) system. Subjects' steps were manually counted. Combined EE data from all subjects showed no significant difference in EE measured by IC (6.0+/-3.4 kcal min(-1)) compared to the SWA estimate (6.3+/-2.5 kcal min(-1)), however the SWA significantly overestimated EE at low exercise intensities and underestimated EE at high exercise intensities. Correlations between EE values, estimated by the SWA and measured by IC, were greater than 0.85 (p<0.001) for both the CF and control group. Standard multiple regression showed that diagnosis of CF independently predicted less than 0.1% of the difference between the IC measure of EE and the SWA estimate. The SWA recorded slightly but significantly fewer steps (113+/-12 steps min(-1)) than the manual count (119+/-9 steps min(-1)). Diagnosis of CF had no significant negative impact on the accuracy of the SWA estimate of EE. The SWA provided a reasonably accurate estimate of EE and step count during treadmill walking.
Publisher: BMJ
Date: 20-01-2011
Publisher: Wiley
Date: 11-10-2019
DOI: 10.1111/RESP.13708
Publisher: Wiley
Date: 17-06-2019
DOI: 10.1111/RESP.13604
Abstract: No published studies have examined the long-term effects of non-invasive ventilation (NIV) in cystic fibrosis (CF). Our primary aim was to determine if adults with CF and sleep desaturation were less likely to develop hypercapnia with NIV ± O A prospective, randomized, parallel group study in adult patients with CF and sleep desaturation was conducted, comparing 12 months of NIV ± O A total of 29 patients were randomized to NIV ± O NIV ± O
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12890-019-0942-3
Abstract: Regular participation in physical activity by people with cystic fibrosis (CF) promotes positive clinical and health outcomes including reduced rate of decline in lung function, fewer hospitalizations and greater wellbeing. However adherence to exercise and activity programs is low, in part due to the substantial daily therapy burden for young people with CF. Strict infection control requirements limit the role of group exercise programs that are commonly used in other clinical groups. Investigation of methods to promote physical activity in this group has been limited. The Active Online Physical Activity in Cystic fibrosis Trial (ActionPACT) is an assessor-blinded, multi-centre, randomized controlled trial designed to compare the efficacy of a novel web-based program (ActivOnline) compared to usual care in promoting physical activity participation in adolescents and young adults with CF. Adolescents and young adults with CF will be recruited on discharge from hospital for a respiratory exacerbation. Participants randomized to the intervention group will have access to a web-based physical activity platform for the 12-week intervention period. ActivOnline allows users to track their physical activity, set goals, and self-monitor progress. All participants in both groups will be provided with standardised information regarding general physical activity recommendations for adolescents and young adults. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and at 3-months followup. Healthcare utilization will be assessed at 12 months from intervention completion. The primary outcome is change in moderate-to-vigorous physical activity participation measured objectively by accelerometry. Secondary outcomes include aerobic fitness, health-related quality of life, anxiety and depression and sleep quality. This trial will establish whether a web-based application can improve physical activity participation more effectively than usual care in the period following hospitalization for a respiratory exacerbation. The web-based application under investigation can be made readily and widely available to all in iduals with CF, to support physical activity and exercise participation at a time and location of the user’s choosing, regardless of microbiological status. Clinical trial registered on July 13, 2017 with the Australian and New Zealand Clinical Trials Register at ( ACTRN12617001009303 ).
Publisher: European Respiratory Society (ERS)
Date: 07-03-2019
DOI: 10.1183/13993003.01793-2018
Abstract: Exercise improves mucus clearance in people without lung disease and those with chronic bronchitis. No study has investigated exercise alone for mucus clearance in cystic fibrosis (CF). The aim of this study was to compare the effects of treadmill exercise to resting breathing and airway clearance with positive expiratory pressure (PEP) therapy on mucus clearance in adults with CF. This 3-day randomised, controlled, crossover trial included 14 adults with mild to severe CF lung disease (forced expiratory volume in 1 s % predicted 31–113%). Interventions were 20 min of resting breathing (control), treadmill exercise at 60% of the participant's peak oxygen consumption or PEP therapy (including huffing and coughing). Mucus clearance was measured using the radioaerosol technique and gamma camera imaging. Treadmill exercise improved whole lung mucus clearance compared to resting breathing (mean difference 3%, 95% CI 2–4) however, exercise alone was less effective than PEP therapy (mean difference −7%, 95% CI −6– −8). When comparing treadmill exercise to PEP therapy, there were no significant differences in mucus clearance from the intermediate and peripheral lung regions, but significantly less clearance from the central lung region (likely reflecting the huffing and coughing that was only in PEP therapy). It is recommended that huffing and coughing are included to maximise mucus clearance with exercise.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2017
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/14799731221121670
Abstract: The roles of physical activity (PA) and exercise within the management of cystic fibrosis (CF) are recognised by their inclusion in numerous standards of care and treatment guidelines. However, information is brief, and both PA and exercise as multi-faceted behaviours require extensive stakeholder input when developing and promoting such guidelines. On 30 th June and 1 st July 2021, 39 stakeholders from 11 countries, including researchers, healthcare professionals and patients participated in a virtual conference to agree an evidence-based and informed expert consensus about PA and exercise for people with CF. This consensus presents the agreement across six themes: (i) patient and system centred outcomes, (ii) health benefits, iii) measurement, (iv) prescription, (v) clinical considerations, and (vi) future directions. The consensus was achieved by a stepwise process, involving: (i) written evidence-based synopses (ii) peer critique of synopses (iii) oral presentation to consensus group and peer challenge of revised synopses and (iv) anonymous voting on final proposed synopses for adoption to the consensus statement. The final consensus document includes 24 statements which surpassed the consensus threshold ( % agreement) out of 30 proposed statements. This consensus can be used to support health promotion by relevant stakeholders for people with CF.
Publisher: American Thoracic Society
Date: 02-2018
Publisher: John Wiley & Sons, Ltd
Date: 04-08-2010
Publisher: American Thoracic Society
Date: 15-04-2019
Publisher: BMJ
Date: 29-04-2021
Publisher: Elsevier BV
Date: 03-2016
Publisher: Elsevier BV
Date: 04-2011
Abstract: The physiologic mechanisms by which exercise may clear secretions in subjects with cystic fibrosis (CF) are unknown. The purpose of this study was to compare ventilation, respiratory flow, and sputum properties following treadmill and cycle exercise with resting breathing (referred to as "control"). In 14 adult subjects with CF, ventilation and respiratory flow were measured during 20 min of resting breathing, treadmill exercise, and cycle exercise in a 3-day crossover study. Treadmill and cycle exercise were performed at the work rate equivalent to 60% of the subject's peak oxygen uptake. Ease of expectoration and sputum properties (solids content and mechanical impedance) were measured before and immediately after the interventions and after 20-min recovery. Ease of expectoration improved following exercise. Ventilation and respiratory flow were significantly higher during treadmill and cycle exercise compared with control. Sputum solids content did not change following treadmill or cycle exercise. There was a significantly greater decrease in sputum mechanical impedance following treadmill exercise compared with control, but no significant decrease in sputum mechanical impedance following cycle exercise compared with control. The improvement in ease of expectoration following exercise may have been due to the higher ventilation and respiratory flow. The reductions in sputum mechanical impedance with treadmill exercise may have been due to the trunk oscillations associated with walking. Australian and New Zealand Clinical Trials Registry No. 12605000422628 URL: www.anzctr.org.au.
No related grants have been discovered for Tiffany Dwyer.