# Exercise as it relates to Disease/Long-term Exercise Effect on FEV1 in Cystic Fibrosis
### Cystic Fibrosis

Cystic Fibrosis (CF) is a multi-system disease that has the biggest affect on the persons respiratory and digestive system. The disease can be life threatening and their is currently no cure. CF,
* Develops in approximately 1 in 25 children
* Mutation of chromosome 7 during development in the womb
The mutation causes the body to increase production of saliva, sweat, tears and mucus. This also causes the substances to be created thicker than normal causing impairments like
* Increased mucus in lungs causing breathing problems.
* Entrapment of bacteria throughout the body causing infection.
* Digestive enzymes being trapped not allowing food to be digested properly.

#### Diagnosis

CF is developed invitro and needs to be tested for by a medical professional. There are two ways to test for CF
* Heel prick test
* Sweat test
Every child since 1986 has the heel prick test performed when they are born, However, the sweat test is more efficient in testing for CF.

#### Treatment

CF is a life long disease with no cure at the current time, there are however treatment options to help people manage their disease.
* Physiotheraphy
* Enzyme replacement
* Antibiotics
* Nebulisers
* High calorie, high salt and high fat diet
* Exercise

#### Carrier Screening

Today there are more than 1600 different mutations that will lead to CF. For a child to develop CF they need to receive one mutated gene from each parent. If both parents are carriers the child has a
* 1 in 4 chance of receiving both mutated genes (developing CF)
* 1 in 4 chance of not receiving any mutated gene
* 2 in 4 chance of receiving one mutated gene
Carriers will show no symptoms of CF and if there is a history in your family it is encourage you get tested.

## Current Study
### Where Is The Research From?

This study was performed in the Tremli Hospital of Zurich, Switzerland. There was also a parallel study being performed in Germany providing more control findings for the Switzerland research. Of the Switzerland group, six of the eight researchers were associated with various hospitals pediatrics's wings. The European Journal of Cystic Fibrosis published this study after being peer reviewed.

### What Kind Of Research Was It?

This study was a randomised control trial that was registered as a clinical trial at http://www.clinicaltrials.gov (NCTOO231686). Randomised control trials are designed to distribute the participants in an unbiased way between the interventions. It is considered one of the gold standards when designing a study. This study was designed to investigate the effect long term physical exercise had on the forced expiratory volume (FEV1) in patients with CF. Meaning they participants where randomly assigned between 3 groups
* Aerobic Training Program (AT)
* Strength Training Program (ST)
* Control Group (CON)

### What Did The Research Involve?

The study involved 42 participants aged between 16 and 26 recruited from several Swiss CF centres. The inclusion criteria including a diagnosis of CF, an age above 12 years and a FEV1 of at least 35% of predicted value. The participants in the two intervention groups agreed to perform three training sessions a week, with each session lasting between 30 and 45 minutes.

#### Aerobic Training Program

The participants of this program where offered the option of performing their sessions in either a fitness centre or at home one a stationary bike. Both options where offered to the participants free of charge for 12 months. The training sessions included
* Starting the training at 65% of VO2 peak
* Measuring heart rate by heart rate monitor
* Increasing the resistance 10% per month if the participant could pedal at the current level for longer than 30 minutes
Compliance was monitored by the heart rate monitor with monthly visit being made.

#### Strength Training Program

The strength training participants performed their session in a fitness centre that was provided free of charge for 12 months. the strength training participants where
* Assessed prior to starting training.
* Assisted by a fitness instructor at least once a week.
* required to fill out a diary card, recording sessions and loads.
* perform 6 to 9 repetitions with the load being increased by 5% in more than 9 could be performed.

#### Control Group

The control group were offered free access to fitness centres but none of the participants chose to utilise them. The control group were advised to maintain their current activity level for the duration of the study.

### Results

The researchers in this study concluded
* Both aerobic and strength training increased patients FEV1.
* Maximum results happened at the 6th month mark.
* After the sixth months of supervised training the increases found started to drop.
* There were no side effects of the patients performing exercise.

## Conclusions

* This study provided evidence that exercise will increase a CF patients FEV1.
* Both the aerobic and strength interventions provided similar improvements, further study may be needed to address both strength and aerobic training together.
* Nutritional input was not taken into consideration for the study and may have effected measurements of body composition.
* The study was well thought out and was able to be replicated by the other control trail in Germany. This could allow the study to be reapplied to a bigger sample size, as well as modified to include mixed training and nutrition.
* In patients with CF lung function and aerobic capacity are both predictors of health.
* Meeting the recommended exercise amount can improve anyone' s general health.

## Further Information

* http://www.cysticfibrosis.org.au/all/learn/
* https://www.cff.org/What-is-CF/Testing/Sweat-Test/
* http://www.pregnancybirthbaby.org.au/neonatal-screening-test

## References

* ↑ http://www.cysticfibrosis.org.au/all/learn/
* ↑ https://www.childlifesociety.org/what_causes_cf.php
* 1 2 >http://www.cysticfibrosis.org.au/all/learn/
* ↑ T, Radtke et al, (2015). Short-term Effect of Different Physical Exercise–Physiotherapy Combinations on Sputum Production, Oxygen Saturation and Lung Function in Young Patients with Cystic Fibrosis. Journal of Cystic Fibrosis. Volume 14 (1) s27
* ↑ Tiffany J. Dwyer et al, (2016). Effects of Treadmill Exercise Versus Flutter® on Respiratory Flow and Sputum Properties in Adults with Cystic Fibrosis: a Randomised, Controlled, Cross-over Trial. BMC Pulmonary Medicine.
* ↑ Peter H.C. Klijn et al, (2003. Longitudinal Determinants of Peak Aerobic Performance in Children with Cystic Fibrosis. Chest Journal. Volume 124 (6): 2215-2219
* ↑ Helge Hebestriet, Susi Kriemler, Thomas Radtke, (2015). Exercise for all Cystic Fibrosis Patients: is the Evidence Strengthening. Co-pulmonary Medicine. Volume 21 (6) 591-595
* ↑ Susi Kriemler et al, (2013). Effect of Supervised Training on FEV1 in Cystic Fibrosis: A Randomised Controlled Trial. Journal of Cystic Fibrosis. Volume 12, 714- 720
* ↑ Glazerman, S., Levy, D.M., & Myers, D. (2002) Nonexperimental Replications of Social Experiments: A Systematic Review. Mathematica Policy Research discussion paper. 8813-300