Muscles Oxygenation During Exercise in Fibrosing Interstitial Lung Diseases
Condition: Lung Diseases, Interstitial; Exercise, Compulsive; Oxygen Deficiency
MeSH terms: Lung Diseases; Lung Diseases, Interstitial; Hypoxia; Compulsive Exercise
Study type: Observational

Summary: 
      The type of this study is an observational prospective study. It will be done to determine
      the oxygenation status of the intercostal muscles and quadriceps femoris muscle during
      exercise in patients with fibrosing lung and to examine its relationship with exercise
      capacity, respiratory functions and respiratory muscle strength. The main questions that the
      study aims to answer are:

        -  Question 1: Do changes in muscle oxygenation during exercise affect respiratory
           functions in patients with Fibrosing Lung?

        -  Question 2: Do changes in muscle oxygenation during exercise affect exercise capacity in
           patients with Fibrosing Lung?

      Participants; demographic information such as age, height, weight will be questioned.
      Respiratory functions will be evaluated with a desktop spirometer, peripheral muscle strength
      measurement will be evaluated with a digital myometer, and functional capacity will be
      evaluated with a 6-minute walk test (6MWT). The Moxy device, which is a non-invasive
      near-infrared spectroscopy (NIRS), will be attached to the upper leg (the vastus lateralis of
      the quadriceps muscle) and the rib (intercostal muscles) with a silk patch, and the
      oxygenation of the muscles here will be measured during the 6-minute walking test. In
      addition, fatigue status will be evaluated with the Modified Borg Scale.
    

Detailed description: 
      Interstitial Lung Disease (ILD); It constitutes a heterogeneous group of approximately 200
      diseases with acute or chronic course that affect the lung diffusely and cause varying
      degrees of inflammation, fibrosis and structural deterioration in the lung parenchyma.
      Clinical features of ILD include exercise-induced dyspnea, exercise-induced hypoxemia,
      progressive skeletal muscle weakness, and impaired exercise tolerance. The main symptoms of
      fibrosis are progressive decreases in forced vital capacity (FVC) and diffusing capacity of
      the lung for carbon monoxide (DLCO). Restriction of pulmonary ventilation leads to
      respiratory failure, which is exacerbated by capillary destruction and decreased alveolar
      blood flow resulting from hypoxic vasoconstriction.

      Exercise intolerance is a key feature of ILD and is usually associated with significant
      dyspnea on exertion. Exercise limitation in ILD is related to altered respiratory mechanics,
      impaired gas exchange, and circulatory limitation. Evidence suggests that pulmonary
      rehabilitation can provide significant benefits in patients with ILD. Daily use of
      corticosteroids for >1 year significantly reduces muscle function in patients with chronic
      respiratory disease. Muscle size, strength, and functional outcomes were evaluated in ILD
      patients. Decreased quadriceps strength and endurance were seen in patients with fibrotic
      idiopathic interstitial pneumonia compared to healthy controls. Compared to the upper
      extremity, more atrophy and weakness were found in the lower extremity muscles. Therefore,
      exercise training is a critical component of pulmonary rehabilitation. The effect of exercise
      on blood oxygenation has been little studied in ILD patients, and the few data available in
      the literature are conflicting.

      In the studies conducted, there are studies stating that there is a positive improvement in
      blood biochemistry as a result of an acute exercise, as well as a change with chronic
      exercises. An important goal of hemodynamic monitoring is the early detection of inadequate
      tissue perfusion and oxygenation. The use of simple, non-invasive monitoring techniques has
      the advantage of facilitating earlier initiation of therapy. Near-infrared spectroscopy
      (NIRS) is a noninvasive measurement instrument that does not impair skin integrity, allowing
      the measurement of muscle hemoglobin-oxygen saturation (StO2) during exercise. There are few
      studies in the literature where muscle oxygenation was measured with the NIRS device.
      According to the results of our literature review, our study will be the first study to
      examine muscle oxygenation in fibrosing lung patients.
    

Intervention name(s): NIRS device usage during 6MWT; Peripheral Muscle Strength Measurement; Pulmonary Function Test
Intervention type(s): Other; Other; Other
Intervention description(s): It will be performed by placing a traffic cone as the sign of the turning point in a straight 30 meter long corridor, after patients have rested for a sufficient time (> 30 minutes) by sitting in a chair. Participants will be asked to walk as fast as possible but without running along the corridor within 6 minutes. Before and after the test, the patient's fatigue and dyspnea conditions will be questioned using the Modified Borg Scale and blood pressure using a digital sphygmomanometer, and saturation and pulse measurement will be evaluated using finger pulse oximetry before, during and after the test. During the 6-minute walk test, the muscle oxygenation of the patients and the amount of muscle oxygen will be measured using Moxy (Fortiori Design LLC, Minnesota, USA) brand NIRS technology. During the walking test, the change in intramuscular oxygenation will be monitored and recorded with the company's software program.; The muscle strength of shoulder flexors, abductors, elbow flexors, hip flexors, abductors, and knee extensors will be evaluated using a Lafayette® 01165 model electronic hand dynamometer. The force measurement will be repeated 3 times and it will be requested to maintain muscle strength against the dynamometer for at least 5 seconds in each trial. The best value out of 3 test results will be recorded; Pulmonary Function Test (PFT) with desktop type spirometry for FVC (Forced Vital Capacity), Forced expiratory flow rate (FEV1), FEV1/FVC.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The sample of the study will consist of male and female patients between the ages of 18-75
        who have been diagnosed with Fibrosing Lung Disease (Interstitial Lung Disease) in Istanbul
        Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital.
      
Keywords: Oxygen Consumption; Interstitial Lung Diseases; Exercise