Exercise Testing in Laryngectomized Patients | 217 9 Materials and Methods Participants Ten subjects were included, using convenience sampling from the outpatient pool of the department of Head-and-Neck Oncology and Surgery at the Netherlands Cancer Institute. All had undergone a total laryngectomy (TL) and were at least six months postoperative. Inclusion criteria were: fully independent in activities of daily living (ADL), and regular self-reported participation in moderate-intensity leisure physical activities (>30 minutes), three or more times a week. A history of cardiac problems22 (such as unstable angina, arrhythmias, myocardial infarction, syncope), and active oncological disease were exclusion criteria. All patients were daily HME users (Provox® Life™, Home or Go, Atos Medical AB, Hörby, Sweden). HMEs All subjects were tested twice to allow comparison of exercise capacity and performance between HMEs with different resistance properties. Patients used their regular HME, which could be either the Provox® Life™ Home or Go, in one of the tests, and a lower resistance HME: the Provox® Life™ Energy HME (Atos Medical AB), specifically developed for use during physical activity, in the other. HME specifications for resistance and moisture loss of each of the HMEs used in the study can be seen in table 1. Table 1. HME Specifications* Flow Resistance Moisture Loss Energy HME 0.15 hPa 23.0 mg/l Go HME 0.30 hPa 22.5 mg/l Home HME 0.60 hPa 19.5 mg/l *This technical data comes from the instructions of use of the products. Flow resistance is measured as 30L/min*(Pa) 3D-printed connector for CPET To replace the regular facial masks used for breathing gas analysis, an in-house 3D printed adapter was developed, which can be connected to the adhesive baseplate in front of the tracheostoma, with the HME in place. The connector was designed in such a way the HME is not visible to the patient once placed and closed, enabling blinding during testing. The breathing-gas-analysis was corrected for the additional dead space of the connector (78,68 ml). Picture 1 gives an overview of the connector and where the HME is placed in the connector. The connector is made out of polyamide 12 (Oceanz PA12)23 and can be cleaned by washing it with water and soap and rinsing it with disinfectant (70% alcohol).
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