دانلود مقاله ترجمه شده فیبروز سیستیک در انجام فعالیت بدنی – مجله الزویر

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دانلود رایگان مقاله انگلیسی + خرید ترجمه فارسی
عنوان فارسی مقاله: فعالیت بدنی و تمرین های ورزشی در افراد جوان فیبروز سیستیک: توصیه ها و شواهد جاری
عنوان انگلیسی مقاله: Physical activity and exercise training in young people with cystic fibrosis: Current recommendations and evidence
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مشخصات مقاله انگلیسی (PDF) و ترجمه مقاله (Word)
سال انتشار مقاله  ۲۰۱۳
تعداد صفحات مقاله انگلیسی  ۸ صفحه با فرمت pdf
تعداد صفحات ترجمه مقاله  ۱۸ صفحه با فرمت ورد
رشته های مرتبط  پزشکی ورزشی، تربیت بدنی و علوم بهداشت
مجله  مجله ورزش و علوم بهداشتی (Journal of Sport and Health Science)
دانشگاه   مرکز تحقیقات ورزش و بهداشت کودکان، دانشگاه اکستر، انگلستان(Children’s Health and Exercise Research Centre,University of Exeter, UK)
کلمات کلیدی  فیبروز سیستیک، تمرین های ورزشی، اطفال، فعالیت بدنی، جوانان
شناسه شاپا یا ISSN ISSN ۲۰۹۵-۲۵۴۶
لینک مقاله در سایت مرجع لینک این مقاله در سایت ساینس دایرکت
نشریه الزویر Untitled

 

 

 


بخشی از ترجمه:

 

برخلاف تأیید فعالیت های جسمانی (PA) ، مکمل سلامتی افراد جوان، کودکان دارای معلولیت سطح پایینی از PA را به نمایش می گذارند. در افراد جوان با فیبروز سیستیک (CF) اهمیت تمرینات ورزشی و PA روزانه توسط پزشکان بالینی و تیم های حمایت کننده آنها، تأیید می شود. با این وجود، فقدان دانش مربوط به این توصیه وجود دارد. CF یک نوع اختلال ژنی نفهته است که شش، پانکراس و غدد عرق زا را تحت تأثیر قرار می-دهد. CF بیماری ژنی، کواته کنندة عمر افرادی است که درمانی برای آنها وجود ندارد. در بریتانیای کبیر، CF بیش از ٩٠٠٠ نفر را تحت تأثیر قرار می دهد که ۴٠٠٠ نفرشان زیر ١۶ سال سن دارند. انتظار می رود حدود نصف افراد CF بتوانند بیش از ۴٠ سال زندگی کنند. علاوه بر درمان های داروئی، برنامه های تمرین توان بخشی یک بخش مهم درمان را شکل می دهد. و برنامه های تمرین طولانی مدت، بعنوان استراتژی های درمان مثبت بررسی شدند. اما همه فقدان اطلاعات جزئی تجویز شده هستند.
چدین بررسی و ویرایش فقدان مدارک و شواهد براساس تحقیق در PA و آموزش تمرین در افراد جوان دارای CF را برجسته می کند. اما از یک نیاز بزرگ برای درک نقش تمرین در مداخلات درمانی حمایت می کند.
هدف این بررسی به روز کردن خواننده در مورد سفارشات و توصیه های فعلی و شواهد و مدارک موجود در PA و آموزش تمرین در افراد جوان دارای CF می باشد. این پیشرفت ها، درک ما را از PA و آموزش تمرین در افراد جوان دارای CF می باشد. این پیشرفت ها، درک ما را از PA و آموزش تمرین در کودکان نوجوانان دارای CF بسط و توسعه می دهد و همچنین تحقق آن در مدیریت این بیماری مزمن.


بخشی از مقاله انگلیسی:

 

Abstract Despite the acceptance of physical activity (PA) being integral to a young person’s health, children with disability often exhibit low levels of PA. In young people with cystic fibrosis (CF) the importance of exercise and daily PA is acknowledged by clinicians and their support teams, however, there is a lack of knowledge related to its prescription. CF is a recessive genetic disorder affecting the lung, pancreas and sweat glands. CF is the most common life shortening genetic disease in the Caucasian population for which there is no cure. In the UK, CF affects over 9000 people, with 4000 under 16 years of age. Only about half of the CF population can expect to live beyond 40 years of age. Besides drug therapies, rehabilitative exercise programmes form an important component of treatment and long term exercise programmes are considered positive treatment strategies, but all lack any detailed prescriptive information. Several reviews and editorials have highlighted the lack of evidence based research in PA and exercise training in young people with CF; but advocate a greater need for understanding the role of exercise in therapeutic interventions. The purpose of this review is to update the reader on the current recommendations and evidence in PA and exercise training for young people with CF. These developments have extended our understanding of PA and exercise training in children and adolescents with CF, and its implementation in the management of this chronic disease. Copyright  ۲۰۱۲, Shanghai University of Sport. Production and hosting by Elsevier B.V. All rights reserved. Keywords: Cystic fibrosis; Exercise training; Paediatrics; Physical activity; Young people 1. Introduction Cystic fibrosis (CF) is an autosomal recessive genetic disorder affecting a number of body systems, including the lung, pancreas and sweat glands. The basic defect in CF is a disruption in the CF transmembrane conductance regulator (CFTR).1 The mutated CFTR causes a decrease in chloride ion conductance across the apical membrane of the epithelial cells, resulting in sweat that is high in sodium and chloride levels, and mucus that is abnormally thick and viscous.2 Mucus in the pancreas and gastrointestinal tract results in insufficient secretion of digestive enzymes and malabsorption of nutrients.3 Nutritional deficiencies lead to decreased fat stores and, as a result of protein malnutrition, muscle wasting.4,5 In the lungs the increased viscosity of mucus and its retention causes bronchial obstruction, recurrent or chronic infections, and finally respiratory failure. In more than w95% of all CF patients impaired respiratory function with hypercapnia, chronic hypoxaemia, and exhaustion of the respiratory muscles is the eventual cause of death.6 In addition to the control of chronic infection, airway clearance techniques, such as chest physical therapy and postural drainage, have been conventionally used in the management of CF to release mucus from the airways of the * Corresponding author. E-mail address: c.a.williams@exeter.ac.uk (C.A. Williams) Peer review under responsibility of Shanghai University of Sport. Production and hosting by Elsevier Available online at www.sciencedirect.com Journal of Sport and Health Science 2 (2013) 39e46 www.jshs.org.cn 2095-2546/$ – see front matter Copyright  ۲۰۱۲, Shanghai University of Sport. Production and hosting by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jshs.2012.11.002 lung.7 However exercise is being used more commonly for mucus clearance, with the intention to prevent recurrent lung infection. Moreover, physical activity (PA) and exercise training in CF have been reported to improve or slow down the rate of decline of important prognostic indicators such as lung function and aerobic fitness. Research from our children’s centre, amongst other centres around the world, have shown that children and adolescents with CF have a reduced ability to tolerate exercise.8,9 This has serious implications for their well-being and quality of life (QoL) and limits the opportunities for their involvement in sports and recreational activities. This is critical as aerobic fitness has been shown to be a key predictor of disease prognosis and mortality in patients with CF, independent of factors such as age, sex, lung function, and nutritional status.10 Understanding the efficacy of using exercise training to promote PA, physical fitness, wellbeing, and longevity is therefore critical in young people with CF. However, in a recent survey it was shown that clinicians and their multidisciplinary teams, whilst valuing exercise prescription, knew little about how to implement it in practice.11 In the UK current recommendation by the Cystic Fibrosis Trust12 advocates the use of exercise, but it is poorly and sporadically implemented nationally and lacks detail concerning the most appropriate exercise intensity and duration, and how this can be implemented alongside other aspects of routine clinical support (i.e., nutritional and psychological). The implementation of an improved evidence based exercise prescription programme will, undoubtedly, improve the quality of clinical care and practice.13 Therefore, several key publications highlight the timeliness of this type of work and its potential impact on a national and international stage.14,15 Adherence is a key outcome for the success of any training programme, and is one reason why many studies fail to report significant improvements in physiological and psychological performance. By including a psychosocial element to a training programme, adherence may be improved but this has yet to be tested within the CF population. A recent supervised physiotherapy outpatient exercise programme showed excellent improvements in QoL, reduction in antibiotic days and some improvements in exercise capacity, despite no significant changes in body mass index (BMI).16 Accounting for these factors, researchers will be able to monitor the combined effect of exercise, psychological and nutritional support, and should be able to be precise about the magnitude of the training response. The aim of this review paper is to present the reader with the current recommendations and evidence in PA and exercise training for young people with CF. 2. Recommendations and evidence for PA in young people with CF PA is defined as a behavior trait and subject to multiple extraneous factors.17 In young people with CF the burden of lung disease can impact on PA levels. Indeed, patients with CF attend regular clinic appointments, comply with drug therapy and physiotherapy sessions, and may miss school due to increased illness and/or pulmonary exacerbation. The burden of lung disease may reduce the opportunities to be active on a regular basis, and cause the PA patterns of young CF patients to become irregular. In 2004, recommendations on PA and health for healthy children were re-affirmed by the UK’s Chief Medical Officer.18 These guidelines have since been further reviewed by researchers in the United States who concluded that school children should engage in at least 1 h of moderate to vigorous activity per day, and that activities should be enjoyable and developmentally suitable. More recent updates on the PA guidelines for healthy children in the UK have been issued.19 However, one key point the UK group commented on was the lack of PA data for children with chronic diseases. Therefore, as a minimum when data are being collected on physical fitness of patients with CF, PA data should also be collected. Preferably the PA measurements should include both questionnaire, as well as, more objective measures such as accelerometry. Comprehensive reviews on the measurement and assessment procedures have broadly defined the PA patterns of healthy young people and adults.20,21 However, for children with CF the evidence is less well established. In healthy young people, irrespective of instrument or device to measure PA, similar results have been found. Firstly, boys are more active than girls; secondly, activity declines with age; and thirdly, the relationship between fitness and activity becomes stronger with increasing age. The latter finding is important because it has yet to be conclusively shown that PA is a strong predictor for fitness in healthy young people as it is in adults. Although it has yet to be definitively established in childhood diseases, it is likely that the relationship between fitness and activity is stronger because of the connection between the disease progression and physical function. In adults, the two measurable outcomes, activity and fitness, are linked to morbidity and mortality and the association is even stronger. For children and adolescents with CF, the associations between health, activity, and fitness are important to understand in order to establish how these variables impact on the disease processes. Similarly, CF clinicians and their support teams wish to know and understand more about fitness and PA as these two variables are often used as part of the management and care of their patients.11 In young CF patients it has been shown that maintaining high levels of fitness can have a significant impact on mortality.10 Children with mild to moderate CF can be active but often choose not to be. This is due to a range of reasons, including parental overprotection, fear on the part of the child, lack of understanding of the disease by teachers and healthcare professionals, self or peer imposed social isolation,22 as well as, perceptions of “no time to play”.۲۳ For the CF child it is important to be as active as possible from the beginning of their lives because when the progression of the disease becomes severe, the disease will itself become a direct cause of their hypoactivity. This pattern creates a cycle of ensuing hypoactivity leading to deconditioning within the body systems, leading to further deterioration in physical function that causes further hypoactivity. Therefore, it is imperative that 40 C.A. Williams and D. Stevens exercise and/or PA are utilised as much as possible in the management of the disease. Although the use of exercise will not affect the pathophysiological process of CF, it will bring significant benefits to the CF patient. Longitudinal measures of PA in young people with CF are not common, but one study by Schneiderman-Walker and colleagues24 showed for females 7e17 years of age that those in the two bottom quartiles suffered a more rapid rate of decline in forced expiratory volume in 1 s (FEV1) than girls in the top two quartiles. In boys with CF, there was no significant relationship found between PA and FEV1 decline. It is generally known that healthy boys are more physically active than girls, and this is likely even in young males with CF and might explain poorer survival rates of female CF patients. Other studies have found lower25 and similar26,27 PA levels compared to healthy children. The study by Britto and colleagues26 noted that adolescents with CF did not differ significantly when asked to recall participating in three or more activities a week which made them “sweat or breathe hard”. When adjustments were made by gender and health status, adolescents aged <14 years of age and between 15 and 16 years of age were more likely to participate in activities three times per week compared to adolescents aged >17 years of age. This is not uncommon in normal healthy children, but does suggest that adolescents making the transition to adult care need to be reminded to increase their PA levels. Apart from age effects, Selvadurai and colleagues28 found that, like healthy children, puberty in CF affects the level of PA. When matched with prepubertal controls, boys and girls with CF had similar levels of PA. However, after puberty PA was higher in boys with CF compared to girls, although, interestingly, children with mild CF had higher levels of PA when compared to controls. When the PA of moderate and severe CF was compared to controls, however, PA was lower. These observations no doubt reflect the importance of the management of exercise when the disease progression is minimal compared to the incidental affects of the disease as it progresses more rapidly and hypoactivity is increased. To the best of our knowledge only one study has recommended a more vigorous promotion of PA.25 Using Kriska’s Modifiable Activity Questionnaire (MAQ) to measure habitual activity, in patients with the worst lung disease, vigorous activity was significantly and positively related to peak oxygen uptake ðVO_ 2peakÞ (r ¼ ۰٫۸۳, p < 0.05). Although vigorous activity was less than when compared to healthy controls, Nixon and colleagues25 suggested more vigorous activities should be encouraged for CF patients in order to promote aerobic fitness which may impact on survival rates. Despite PA not being measured objectively, the findings of this study do reflect the interlinked correlates between fitness, PA, and morbidity which become more prominent as the disease progresses from mild to severe status. However, caution must be exhibited when inferring these results at an individual patient level. Ruf and colleagues29 have shown when measuring PA by a variety of questionnaires (Habitual Activity Estimation Scale; 7-day Physical Activity Recall; Lipids Research Clinics Questionnaire), as well as via accelerometry and testing aerobic fitness, that all the questionnaires were unable to generate valid PA data and aerobic fitness on an individual basis. All the associations were, at best, moderate (0.32 < r < 0.56). Thus, using the questionnaires to advise PA programmes for patients with CF would be imprecise and should, at the minimum, be based on objective measures captured through accelerometry. For those clinics unable to afford accelerometers, a recent study published in the Journal of Cystic Fibrosis has reported that less expensive pedometers could be used to indicate significant changes in health status and self reported activity.30 However, further research is required to validate these findings, as 12 of 30 (40%) CF participants had a decrease in their measured step rate when well, compared to when ill (as assessed by the high standard deviation of the mean step rates). In summary, more data are required before PA recommendations for young people with CF can be supported. Whilst the potential benefits of habitual PA and exercise are known, the lack of guidelines and recommendations are holding back many young patients and their families enjoying these benefits. Given the relative inexpensive cost of the many opportunities to increase PA, exercise prescription needs to occupy a more central role in the therapeutic intervention of young CF patients. Therefore, the challenge to researchers is to acquire more evidence based practice of the cost-benefit of PA and exercise interventions


 

دانلود رایگان مقاله انگلیسی + خرید ترجمه فارسی
عنوان فارسی مقاله: فعالیت بدنی و تمرین های ورزشی در افراد جوان فیبروز سیستیک: توصیه ها و شواهد جاری
عنوان انگلیسی مقاله: Physical activity and exercise training in young people with cystic fibrosis: Current recommendations and evidence
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