Yassine Trabelsi

Spirometric Reference Values in Tunisian Children

Background: In Tunisia, there are no normal values of pulmonary function for healthy Tunisian children. Objectives: The purpose of this study was to set reference values for spirometric lung function in Tunisian children and to compare these results with other data sets. Methods: Spirometric values were measured with a Minato portable spirometer in 1,114 asymptomatic, nonsmoking Tunisian children (581 boys and 533 girls) 6–16 years of age. Natural logarithmic values of lung function and standing height were used in the final regression model. Results: Prediction equations for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC × 100, maximum mid expiratory flow (MMEF 25–75%) and peak expiratory flow (PEF) for both sexes are presented with standing height as the dependent variable. Our data show a significant increase in lung function with standing height in both sexes. Comparing our results with recent data, values of FVC and FEV1 in both sexes in the present study are close to those in European, white US and Asian children, whereas our values are higher than the Libyan ones. Conclusions: Healthy Tunisian children showed similar spirometric reference values compared to European, white US and Asian children. Thus, these standards of lung function could also be used in Tunisia.

Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects

Background: The six-minute walking distance (6MWD) test has demonstrated validity and reliability to assess changes in functional capacity following pulmonary rehabilitation in patients with chronic obstructive lung disease. However, no attempt has been made to establish an iterative measurement of 6MWD during the overall period of pulmonary rehabilitation. Therefore, the aim of this study was to evaluate the impact of a twelve-week rehabilitation program on the iterative weekly measurement of 6MWD in chronic obstructive pulmonary disease (COPD) patients and healthy subjects. Methods: Twenty-six patients with COPD and nine age-matched healthy subjects were studied. Measurements were taken at baseline and after twelve weeks except for the 6MWD. The exercise measurements included a six-minute walking test (6MWT) and an incremental exercise test. Oxygen saturation, heart rate, and dyspnea will be monitored during all these tests. Results: At baseline there were significant differences between groups, except in age, body mass index, and oxygen saturation. After 12 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. The 6MWD, peak oxygen uptake V̇O2peak and anaerobic threshold increased significantly after training in both groups (P < 0.01). The averaged trace of the 6MWD of patients with COPD and healthy subjects was followed-up respectively by a logarithmic and linear fitting. 6MWD showed a plateau after eight weeks in patients with COPD, however, it increased continually overall in healthy subjects. Conclusion: Both patients with COPD and healthy subjects demonstrated functional responses to training but with somewhat different patterns in quality of the improvement of the 6MWD.

Factors affecting the development of lung function in Tunisian children.

We undertook to evaluate the impacts of morphology at birth, physical activity, anthropometric, socioeconomic and environmental factors on lung function in healthy Tunisian children. Pulmonary function parameters were measured with a Minato portable spirometer in a randomized population of 756 healthy children (388 males and 368 females) aged between 6 and 16. The morphology at birth, the gestational age, the physical activity, the socioeconomic status, the type of habitation, and the environmental factors were all assessed by a standard questionnaire. Using univariate analysis, we found that: (1) morphometric parameters (height, weight, maximal inspiratory, and expiratory perimeter), as well as sex were highly associated with pulmonary function parameters; (2) Height at birth showed strong significant relations with FVC, FEV1, and FEV1/FVC; (3) lung function parameters were influenced by physical training of our children, socioeconomic status, indoor pollution, and passive smoking; and (4) we did not observe any association between the gestational age and the weight at their birth and lung function parameters. Using a general linear model analysis, morphometric parameters, age, sex, type of heating, and maximal inspiratory and expiratory perimeters had significant relation with respiratory parameters. In our population of healthy Tunisian children, the main predictive factors of the pulmonary development were the morphological factors such as height, weight, maximal inspiratory, and expiratory thoracic perimeter, sex and age, and the environmental conditions such as type of heating but not morphology at birth, physical activity, or socioeconomic status. Am. J.Hum. Biol., 2008.

Spirometric values in Tunisian children: relationship with pubertal status.

Background: Little is known about the effect of pubertal stages on lung function parameters in Tunisian children. Aim: The purpose of this study is to determine the relationship between lung function and pubertal stage in Tunisian children using anthropometric parameters. Subjects and methods: Pulmonary function parameters were measured with a Minato portable spirometer in 684 healthy Tunisian children (351 males and 333 females) aged between 8 and 16. The pubertal status was assessed for males and females according to the Tanner Method. Results: A large variation was observed in the distribution of childrens age and height by pubertal stages in both sexes. Height increased with age and pubertal stage in both males and females. The results also showed a significant increase in parameters of lung function (FVC, FEV1, PEF, MEF50 and MMEF25–75) with pubertal stage in Tunisian children. The analysis of covariance adjusting for anthropometric parameters showed that pubertal status had a significant independent effect on some pulmonary function parameters in both sexes. Conclusion: The results indicated that the parameters of pulmonary function for healthy Tunisian school children increased with age, height and pubertal stage. The present study has indicated that the use of only one morphological parameter such as height is not sufficient, but the pubertal status could be taken into account to standardize the lung function.

The relative contributions of anthropometric variables to vertical jumping ability and leg power in Tunisian children.

Aouichaoui, C, Trabelsi, Y, Bouhlel, E, Tabka, Z, Dogui, M, Richalet, JP, and Bouchez Buvry, A. The relative contributions of anthropometric variables to vertical jumping ability and leg power in Tunisian children. J Strength Cond Res 26(3): 777–788, 2012—The purpose of this study was to examine the relative contributions of anthropometric variables to vertical jumping ability and leg power and to establish reference values of vertical jumping parameters in athletic Tunisian children aged 7–13 years in both sexes. Three hundred and ninety-one athletic Tunisian children (208 boys and 183 girls) aged 7–13 years were randomly selected to participate in our study. They were asked to perform squat jumps and countermovement jumps. Jump heights and leg power were simultaneously provided by the optojump device. Full and stepwise regression models were calculated to identify which anthropometric parameters significantly contributed to performance variables. The multiple regressions showed that age, weight, standing height and fat-free mass were the predictors of jumping performance. The results may help in verifying the effectiveness of a specific training program and detecting highly talented athletes.

Effect of 6 Months of Balance Training During Pulmonary Rehabilitation in Patients With COPD.

PURPOSE: Balance impairment is recognized as an important issue for patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the effect of balance training as part of pulmonary rehabilitation (PR) on balance in COPD patients. METHODS: Patients were randomly assigned to an intervention or usual care group. The intervention group underwent balance training 3 times a week for 6 months in addition to the standard PR. The control group received 6 months of the standard PR program only. Balance was assessed by the Timed Up and Go (TUG), Tinetti, Berg Balance Scale (BBS), and the Unipodal Stance (UST) tests. Balance confidence was rated using the ABC scale. Exercise tolerance was determined using a 6-Minute Walk Test. RESULTS: Following the completion of PR, the intervention group showed improvement in all balance measures. Only TUG, ABC, and UST scores were improved in the usual care group (P < .05). Results demonstrated significant between-group differences in TUG, Tinetti, BBS, and ABC scores (P < .01) and UST score (P < .05). CONCLUSIONS: Balance training incorporated into a standard PR program significantly improves scores on balance tests in COPD patients.

Effect of rehabilitation program on endocrinological parameters in patients with COPD and in healthy subjects.

Abstract Background: Skeletal muscle wasting commonly occurs in patients with chronic obstructive pulmonary disease (COPD) and has been associated with the presence of systemic inflammation and endocrinological disturbance. The aim of this study is to analyze the effect of rehabilitation program on the balance of anabolic versus catabolic hormone in patients with COPD and in healthy subjects. Methods: Nineteen patients with COPD and 16 age-matched healthy subjects undertooked exercise training 3 days/week for 8 weeks. Before and after the training program the concentration of growth hormone (GH), Insulin-Like Growth Factor-1 (IGF-1), Insulin-like Growth Factor-Binding Protein 3 (IGF-BP3), testosterone and cortisol in serum were determined. The exercise measurements included a 6-Minute Walking Test (6MWT). Results: After 8 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. Growth hormone, Insulin-like Growth Factor-1 and Insulin-like Growth Factor-Binding Protein 3 increased significantly after rehabilitation training (p < 0.01). The rehabilitation program improves the testosterone/cortisol ratio (T/C ratio) in both groups. There is a significant improvement in the 6-Minute Walking distance (6MWD) in both groups (p < 0.01). Dyspnea and heart rate at rest and at the peak of the 6-Minute Walking Test (6MWT) decreased significantly after training program (p < 0.01). Conclusion: Pulmonary rehabilitation induces an improvement of the anabolic process and reduces proteine distruction by the modifications in endocrinological factors regulating skeletal muscle in patients with COPD.

Reference values of vertical jumping performances in healthy Tunisian adolescent

Abstract Background: The assessment of normal values of muscle strength can be determined for the health outcome of adolescents, especially those who are living in a developing country. Aims: The purpose of this study is to identify the relationship between anthropometric variables and vertical jumping performances. The jump height and the average of power were measured to establish reference values of vertical jumping parameters in Tunisian healthy adolescents aged 13–19 in both sexes. Subjects and methods: Five hundred and twenty-five school adolescents (242 males and 283 females) were randomly selected to participate in this study. Maximum height and average of power reached in countermovement jump and squat jump were provided by an Optojump device. Full and stepwise regression models were used to identify which anthropometric parameters significantly contributed to performance variables. Results: All anthropometric parameters increased with age. Reference values and multiple prediction equations of vertical jump parameters were set based on a large sample of healthy Tunisian adolescents. The multiple regressions showed that age, mass, sitting height, waist size, fat-free mass and leg muscle volume for boys and mass for girls were the best predictors of jumping performances. Conclusion: This study provides normative data for jumping performances in Tunisian healthy adolescents aged 13–19 in both sexes. The percentiles values are calculated to estimate the levels of adolescents with high or low jumping performances.

Minimal Detectable Change for Balance Measurements in Patients With COPD.

PURPOSE: The purpose of this study was to determine the reliability and minimal detectable change (MDC) of various outcome measures that are potentially suitable for evaluating postural control in individuals with chronic obstructive pulmonary disease (COPD). METHODS: This was a test-retest reliability study. Participants with COPD were asked to complete 5 balance assessments, separated by 1 week. The assessments included Timed Up and Go (TUG) Test, Unipodal Stance Test (UST), Tinetti Test, Berg Balance Scale (BBS), and the Activities Balance Confidence (ABC) scale. Test-retest reliability using intraclass correlation coefficients and MDC values were calculated for each assessment. RESULTS: All 5 outcome measures were found to have excellent test-retest reliability (r > 0.90). The MDC95 values were 3.01 seconds and 4.03 seconds for the TUG Test and the UST, respectively; 3.23 points and 3.46 points for the Tinetti Test and the BBS, respectively; and 8.25% for the ABC scale. CONCLUSION: The TUG, UST, BBS, the Tinetti Test, and the ABC scale are reliable outcome measures for use with people with COPD, recognizing that individual variability of performance is high. Minimal detectable change scores at the 95% CI can be used to assess change in performance over time and the impact of interventions in this population.

Balance Training in Pulmonary Rehabilitation: EFFECTS ON PSYCHOSOCIAL OUTCOMES.

PURPOSE: Balance impairment in chronic obstructive pulmonary disease (COPD) is associated with a worsening of quality of life (QOL) as related with fatigue perception, depression, and anxiety. The aim of this study was to examine the effect of balance training included in pulmonary rehabilitation (PR) on QOL, fatigue perception, depression, and anxiety in patients with COPD. METHODS: Patients were assigned randomly to an intervention or PR-only group. The intervention group underwent balance training 3 times a week for 6 months concurrently with PR. The PR-only group received 6 months of the standard PR program. Quality of life was assessed at the beginning and at the end of the program using the St. Georges Respiratory Questionnaire, fatigue using the Multidimensional Fatigue Inventory, and anxiety and depression using the Hospital Anxiety and Depression Scale. Exercise tolerance was determined from the 6-minute walk test. RESULTS: After the 6 months of the intervention or PR-only, both the intervention (n = 32) and PR-only (n = 30) groups improved their QOL (activity, impact, and total) with a significant intergroup difference (P < .05) after PR. General fatigue, physical fatigue, and reduced activity decreased in both groups with an intergroup difference (P < .05). Anxiety decreased significantly in both groups with a greater change in the intervention group (P < .01). Only the intervention group had an improved depression score at the end of 6 months. CONCLUSIONS: Balance training added to PR improved health-related QOL, fatigue, and mental health in patients with COPD.