# Exercise as it relates to Disease/Which is more beneficial, physical exercise or chest physiotherapy for those with Cystic Fibrosis?
## Background - What is Cystic Fibrosis?

Cystic Fibrosis is rated the most common, life threatening, genetic disorder and effects the respiratory system, the digestive system and the reproductive system. Cystic Fibrosis patients will experience an excess of thick, sticky mucus being secreted due to a malfunction of their exocrine system. This results in difficulty breathing due to a build up of mucus on the lungs, as well as enzyme replacements in order to digest food effectvely. The symptoms of Cystic Fibrosis include;
* Persistent cough
* Difficulty breathing
* Impaired exercise ability
* Poor appetite
Cystic Fibrosis is generally treated a number of ways which include;
* Physiotherapy
* Enzyme replacement
* Aerosol inhalers
* Salt and vitamin supplements
* Diet
* Exercise
Chest Physiotherapy
Chest physiotherapy for those with Cystic Fibrosis involves various techniques such as, postural drainage, percussion, chest shaking, huffing, directed coughing, as well as mechanical devices to help clear mucus off the lungs and airways. This is important as it will assist with respiratory function and therefore quality of life.

## Where is this research from?

This study was conducted at the University Children's Hospital, Graz, and Pediatric Department in Stolzape, Austria.

## What kind of research was this?

This was a cohort study, comparing the effects of physical activity on a group of children with cystic fibrosis, who prior to commencement, were only undertaking chest physiotherapy, with their end results after 17 days of regular physical activity, and then observing the reversibility effects eight weeks post program.

## What was involved in this research?

This study involved six male and six female children with a median age of 10.5 years who were attending the Cystic Fibrosis clinic at the University Children's Hospital, Graz. Over a seventeen day period, the twelve children were required to cease any aerosol inhalation and chest physiotherapy and participate in an exercise/physical activity program which involved; one hour of swimming and diving twice a day, 2.5 kilometer jog four times a day, hiking, and recreational activities such as gymnastics, skipping, mini golf, soccer and table tennis. Ventilatory status was measured one day before the beginning of the program, one day post program and finally, eight weeks later

## Basic results

The results of this study found a gradual increase in performance and endurance amongst the children. This led to an across the board increase in ventilation, with the children's coughing and mucus on the lungs gradually decreasing after the fifth day. This decrease in mucus on the lungs reduces the rate of coughing, and can also lead to the individual no longer requiring chest physiotherapy.
Limitations:
The training program had to be adjusted to suit the capabilities of the majority of the children. This resulted in the older, fitter children not being as challenged,and the younger participating to a lessor extent, which would have therefore effected the results as the maximal benefits were not viewed across the board. Furthermore, the training program proved too strenuous for the youngest of the children who ceased the training program after the forth day, and returned to her normal inhalation-physiotherapy. This led to only ten of the twelve children's results being recorded. A more specific training program focused on each individual and their fitness levels may have proven to produce greater results.

## Conclusion

The authors concluded that a regular, effective, physical exercise routine may be a substitute for the inhalation chest physiotherapy for some children suffering from Cystic Fibrosis. However this is greatly affected by the fitness level of the individual as exercise tolerance can be limited in people with Cystic Fibrosis, which could result in physical exertion being more risky than beneficial. A combination of the two may prove the most effective, and as physical fitness increases, the reliance on chest physiotherapy can decrease.

## Practical advice

Regular physical exercise is highly recommended for those with Cystic Fibrosis. Moderate to high intensity physical activity can be an effective method of clearing the airways of built up mucus as well as improving the recruitment of respiratory skeletal muscle. Swimming appears to be one of the more effective forms of exercise in achieving this goal. Exercise may be a useful substitute for chest physiotherapy, however it should not be replaced immediately. Those with Cystic Fibrosis find it difficult to breath, and an excess of physical activity may result in loss of breath and a lack of oxygen saturation. Therefore exercise programs should be tailored to the individual, and intensity, and time exercising should be increased along with the individuals fitness level. During this time, chest physiotherapy should be continued to assist with the clearing of the respiratory pathways until breathing has improved to a level where this physiotherapy is no longer required, and physical activity can be solely relied on. Once the individual has reached the point where chest physiotherapy is no longer required, physical activity must be maintained to ensure all adaptations are maintained, and reduce the effects of reversibility.
It may also prove beneficial for a resistance training program to be included along side of an aerobic training program. This is due to resistance training having a strong relationship with improving lung function and weight gain in individuals with Cystic Fibrosis. This improvement would therefore further increase the individuals quality of life, and decrease their need for chest physiotherapy.

## Further reading

What is Cystic Fibrosis?
Cystic Fibrosis Federation Australia
Better Health Channel
Cystic Fibrosis American Foundation
How exercise can improve Cystic Fibrosis
In Hospital Study
Adherence to Exercise

## References

* 1 2 3 4 Better Health
* 1 2 Cystic Fibrosis Australia
* ↑ Elbasan B, Tunali N, Duzgun I, Ozcelik U. Effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis. Italian journal of pediatrics. 2012;38:2.
* ↑ van der Schans, C.P., Prasad, A. and Main, E., 2000. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. The Cochrane Library.
* 1 2 3 4 5 6 7 Zach M, Oberwaldner B, Häusler F. Cystic fibrosis: physical exercise versus chest physiotherapy. Archives of Disease in Childhood. 1982;57:587-589.
* ↑ Selvadurai, H.C., Blimkie, C.J., Meyers, N., Mellis, C.M., Cooper, P.J. and Van Asperen, P.P., 2002. Randomized controlled study of in‐hospital exercise training programs in children with cystic fibrosis. Pediatric pulmonology, 33(3), pp.194-200.