Cystic fibrosis related diabetes is not associated with maximal aerobic exercise capacity in cystic fibrosis: a cross-sectional analysis of an international multicenter trial

Thomas Radtke; Susi Kriemler; Lothar Stein; Chantal Karila; Don S Urquhart; David M Orenstein; Larry C Lands; Christian Schindler; Ernst Eber; Sarah R Haile; Helge Hebestreit; ACTIVATE-CF Study Working Group

doi:10.1016/j.jcf.2022.06.012

Cystic fibrosis related diabetes is not associated with maximal aerobic exercise capacity in cystic fibrosis: a cross-sectional analysis of an international multicenter trial

J Cyst Fibros. 2023 Jan;22(1):31-38. doi: 10.1016/j.jcf.2022.06.012. Epub 2022 Jul 6.

Authors

Collaborators

ACTIVATE-CF Study Working Group:
Ernst Eber¹¹, Marlies Wagner¹¹, Helmut Ellemunter¹², Larry C Lands¹³, Nancy Alarie¹³, Chantal Karila¹⁴, Clotilde Simon¹⁵, Anne Faucou¹⁶, Laurent Mely¹⁷, Bruno Ravaninjatovo¹⁸, Anne Prevotat¹⁹, Helge Hebestreit²⁰, Jonathan Schaeff²⁰, Lothar Stein²¹, Cordula Koerner-Rettberg²², Jutta Hammermann²³, Christina Smaczny²⁴, Inka Held²⁵, Sibylle Junge²⁶, Oliver Nitsche²⁷, Rainald Fischer²⁸, Jörg Große-Onnebrink²⁹, Anne Wesner³⁰, Andreas Hector³¹, Alexandra Hebestreit³², Susi Kriemler³³, Christian Schindler³⁴, Thomas Radtke³³, Christian Benden³⁵, Carmen Casaulta³⁶, Reta Fischer³⁷, Alexander Möller³⁸, Erik Hulzebos³⁹, Marcella Burghard³⁹, Don S Urquhart⁴⁰, Sarah Blacklock⁴⁰, Debbie Miller⁴⁰, Zoe Johnstone⁴⁰, David M Orenstein⁴¹, John D Lowman⁴²

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. Electronic address: thomas.radtke@uzh.ch.
² Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
³ Hannover Medical School, Institute of Sports Medicine, Hannover, Germany.
⁴ Service de pneumologie et allergologie pédiatriques - Hôpital Necker Enfants malades - APHP - Université Paris Descartes, Paris, France.
⁵ Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK.
⁶ Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA.
⁷ Montreal Children's Hospital - McGill University Health, Montreal, QC, Canada.
⁸ Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
⁹ Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
¹⁰ Paediatric Department, University Hospitals Würzburg, Germany.
¹¹ Medical University of Graz, Graz, Austria.
¹² University Hospital Innsbruck, Innsbruck, Austria.
¹³ McGill University Health Centre, Montreal, Quebec, Canada.
¹⁴ Université Paris Descartes, Paris, France.
¹⁵ Unité Recherche Clinique Cochin Necker, Paris, France.
¹⁶ Unité de Recherche Clinique Cochin Necker, Paris, France.
¹⁷ Hôpital Renée Sabran, Giens, Hyères, France.
¹⁸ CHR, Reims, France.
¹⁹ CHRU, Hôpital Calmette, Lille, France.
²⁰ University Hospitals Würzburg, Würzburg, Germany.
²¹ Medical School Hannover, Hannover, Germany.
²² University Children's Hospital of Ruhr University Bochum at St Josef-Hospital, Bochum, Germany, Germany.
²³ University Hospital of Dresden, Dresden, Germany.
²⁴ Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
²⁵ CF Zentrum Altona, Hamburg, Germany.
²⁶ Hannover Medical School, Pediatric Pneumology, Allergology and Neonatology, Hannover, Germany.
²⁷ Johannes Gutenberg-Universität Mainz, Mainz, Germany.
²⁸ Praxis für Lungenheilkunde, München-Pasing, Germany.
²⁹ University Hospital Münster, Münster, Germany.
³⁰ Klinikum Stuttgart, Olgahospital, Stuttgart, Germany.
³¹ University of Tübingen, Tübingen, Germany.
³² Christiane Herzog-Zentrum, Universitätsklinikum Würzburg, Germany.
³³ University of Zurich, Zurich, Switzerland.
³⁴ University of Basel, Basel, Switzerland.
³⁵ University Hospital Zurich, Zurich, Switzerland.
³⁶ University Children's Hospital Bern, Bern, Switzerland.
³⁷ Quartier Bleu, Lindenhospital Bern, Switzerland.
³⁸ University Children's Hospital Zurich, Zurich, Switzerland.
³⁹ University Medical Center Utrecht, Utrecht, The Netherlands.
⁴⁰ Royal Hospital for Children and Young People, Edinburgh, UK.
⁴¹ Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA.
⁴² University of Alabama at Birmingham, Birmingham, Alabama, USA.

PMID: 35803884
DOI: 10.1016/j.jcf.2022.06.012

Abstract

Background: Previous studies have reported differences in aerobic exercise capacity, expressed as peak oxygen uptake (VO_2peak), between people with and without cystic fibrosis (CF) related diabetes (CFRD). However, none of the studies controlled for the potential influence of physical activity on VO_2peak. We investigated associations between CFRD and VO_2peak following rigorous control for confounders including objectively measured physical activity.

Methods: Baseline data from the international multicenter trial ACTIVATE-CF with participants ≥12 years performing up to 4 h per week of vigorous physical activity were used for this project. Multivariable models were computed to study associations between CFRD and VO_2peak (mL.min^-1) adjusting for a set of pre-defined covariates: age, sex, weight, forced expiratory volume in 1 s (FEV₁), breathing reserve index, Pseudomonas aeruginosa infection, and physical activity (aerobic step counts from pedometry). Variables were selected based on their potential confounding effect on the association between VO_2peak and CFRD.

Results: Among 117 randomized individuals, 103 (52% female) had a maximal exercise test and were included in the analysis. Participants with (n = 19) and without (n = 84) CFRD did not differ in FEV₁, physical activity, nutritional status, and other clinical characteristics. There were also no differences in VO_2peak (mL.min^-1 or mL.kg^-1.min^-1 or% predicted). In the final multivariable model, all pre-defined covariates were significant predictors of VO_2peak (mL.min^-1), however CFRD [coefficient 82.1, 95% CI -69.5 to 233.8, p = 0.28] was not.

Conclusions: This study suggests no meaningful differences in VO_2peak between people with and without CFRD given comparable levels of physical activity.

Keywords: Cystic fibrosis related diabetes; Dysglycaemia; Exercise capacity; Peak oxygen uptake; Physical activity.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Cystic Fibrosis* / complications
Diabetes Mellitus*
Exercise
Exercise Test
Female
Humans
Male