# Exercise as it relates to Disease/Aerobic Capacities vs. Resistance Training in Children with Cystic Fibrosis

This is a critique of a paper discussing the effects of exercise in children with Cystic Fibrosis. Paper: Selvadurai et al. 'Randomized controlled study of in-hospital exercise training programs in children with Cystic Fibrosis'

## What Is Cystic Fibrosis?

Cystic Fibrosis (CF) is rated the most common life-threatening genetic disease in Australia. It largely affects the respiratory and digestive system due to the malfunction in the exocrine system, which is mainly responsible for the production of saliva, sweat, tears and mucus. The increased production of mucus elevates the individual’s chances of infection as the bacteria and pathogens become trapped in the respiratory or digestive track. At the current time, there is no cure for an affected individual suffering cystic fibrosis. Although there are numerous strategies to help with the symptoms, including chest physiotherapy and regular exercise, that if implemented correctly, will have great effects on the signs and symptoms of CF. There are numerous signs and symptoms related to CF, some include:
* Nasal congestion
* Wheezing
* Suppressed appetite
* Asthma-like symptoms

## Where Is The Research From?

This study was conducted at Royal Alexandra Hospital for Children, New South Wales, in conjunction with Department of Paediatrics and Child Health, University of Sydney, New South Wales.

## What Kind Of Research Was This?

This study was a randomised control trial that investigated the effect of aerobic training, resistance training and no physical activity (control group) in children suffering from CF. The randomised control trial is considered a level two research method by the National Health and Medical Research Council (NHMRC), and is also the most appropriate design for clinical trials. This means that the results from this study provide sound evidence for the correlation of exercise and children suffering from CF.

## What did the research involve?

The experiment focused on 66 children that had been admitted to hospital for the treatment of an infectious pulmonary exacerbation. All subjects were between ages 8 –16 and were all of the same risk factor. The program saw the patients randomly selected into three groups; aerobic training, resistance training and control group. At the onset of the experiment all subjects had their weight and height taken as well as free-fatty mass. Pulmonary function tests were recorded within 36hrs of admission, they were repeated on discharge from the hospital, and then again 1 month after discharge. Subjects were then prescribed their exercise and tested further depending on their specific group. These tests were taken in order to ascertain the full results of the study. The prescribed amount of exercise for each group are as follows:
* Aerobic Training was performed 5 times a week for 30 minutes, either on a non motorised treadmill or stationary bike. Subjects were instructed to exercise at 70% of their peak heart rate, which was re-tested every 5 days by performing a maximal exercise test.
* The resistance training group also participated in exercise 5 times a week, although this group participated in upper and lower body exercises. The subjects performed 5 sets of 10 reps on a nonoisokinetic resistance machine, set at 70% of their maximal subjective resistance which was tested every 5 days.
* Participants in the control group did not attend sessions, although did receive standard chest physiotherapy.
At the completion of the study all subjects were re-tested for pulmonary function and strength, at discharge and again 1 month after discharge.

## What were the basic results?
#### The main findings

The study showed aerobic training and resistance training improved different parameters of assessment in children with Cystic Fibrosis. The improvements that were seen, were found to be maintained for around a month after discharge from hospital. Overall, both training programs had better outcomes than the control group.

#### Other findings

From the result of the study the aerobic training group showed significant improvements in peak aerobic capacity, FEV1, quality of life and body mass. The resistance training group produced significant changes in FEV1, lower limb strength and body mass. The control group also showed improvements in FEV1 and body mass. No significant changes or improvements were seen from admission to discharge in the subjects FVC in any of the three groups. When comparing the results form all groups there was a slight decrease in peak aerobic capacity and lower limb strength in the control group at the time of discharge, although this reduction was not statistically significant. After discharge from hospital, the aerobic training group were seen to continue to improve aerobic fitness, even with the lack of supervision. Subjects in the control group were also seen to improve aerobic fitness as well as muscular strength one month after discharge. The study did not over emphasise results from the experiment, although showed that both aerobic and resistance training can help to improve symptoms of Cystic Fibrosis.

## What conclusions can we take from this research?

This study has provided a strong hypothesis that reflects both aerobic and resistance training can improve and ease symptoms in children suffering from cystic fibrosis. It has also shown that regular chest therapy for patients does not have the same effect as physical activity combined with chest therapy. Subjects would benefit more so if they were able to participate in both therapy and exercise. Further studies relating to CF and exercise show an ease from symptoms in both adults and children.

## Practical Advice

The research relates to real-world implications for children suffering from CF to increase their overall aerobic fitness and muscular strength. For best results individuals should look at participating in physical activity and resistance training as well as receiving nutritional advice. Individuals should also be participating in regular chest physiotherapy to ease symptoms. Before partaking in this, it is advised that individuals seek professional advise and receive a program or supervision when training. With correct application of this advise individuals should see improvements in their overall wellbeing.

## Further reading

For further information regarding the effects of exercise on individuals suffering from Cystic Fibrosis; click on the links below.
Cystic Fibrosis Federation Australia
Cystic Fibrosis American Foundation

## References

* 1 2 3 4 5 6 7 8 H Selvadurai, C Blimkie, N Meyers, C Mellis, P Cooper, P Van Asperen. Randomized Controlled Study of In-Hospital Exercise Training Programs in Children With Cystic Fibrosis. Pedistric Pulmonology 33: 194-200 (2002)
* 1 2 3 Cystic Fibrosis Australia. About Cystic Fibrosis [internet]. Available from:http://www.cysticfibrosis.org.au/all/learn/
* 1 2 Radtke T, Nolan SJ, Hebestreit H, Kriemler S. Physical exercise training for cystic fibrosis. Paediatric Respiratory Reviews. 2016;19:42-5
* ↑ Better Health Channel. Cystic Fibrosis (CF) [internet]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cystic-fibrosis-cf
* ↑ National health and Medical Research Council. (2009). NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. NHMRC. Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
* ↑ Craig A Williams & Daniel Stevens. 2013. Physical Activity and Exercise Training in young people with Cystic Fibrosis. Vol 2, no 2.
* ↑ G Wolfgang, D Oernstein, K Braumann, R Beneke. 2014. Physical activity and exercise training in young people with cystic fibrosis: Current recommendations and evidence. Journal of Cystic Fibrosis
* ↑ Craig A Williams, C Benden, D Stevens & T Radtke. Exercise Training in Children and Adolescents with Cystic Fibrosis: Theory into Practice. Vol 13, no 1, pp 68-91. 2010.
* ↑ 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.