# Exercise as it relates to Disease/Physical activity and application of breathe technique during exercise effect on young children with cystic fibrosis

This article from 2012 articulates the study of a 6 week physical activity and physiotherapy observed program for young children children suffering from Cystic Fibrosis (also known as CF). This article aims to assess the physiological effects previously studied breathe techniques during exercise for children with CF.

## What is the background to this research ?

Cystic Fibrosis is an incurable genetic disease which causes the body to produce excessive amounts of mucus in the lungs, due to this, individuals effected by CF find it more difficult to breathe due to the mucus blocking airways, as-well as a higher risk of infection due to the mucus in the lungs trapping bacteria without release.
This article assists in filling gaps in pre existing knowledge by bringing studied physiotherapist breathe techniques to assist individuals with CF to clear airways more efficiently and applying this during aerobic exercise when respiratory rate is increased. Thus, this study assists in providing evidence of effectiveness of breathe techniques to support existing studies.
More than 70,000 people are currently living with CF with the life expectancy of these individuals no greater than 38 years. With no current cure the staggering numbers show the severity of the pulmonary disease and the importance of more treatments assessed by studies to assist individuals with coping mechanisms.

## Where is the research from?

The Study was conducted in Hacettepe University Medical Faculty of Child Pulmonary disease. This department in the University located in Turkey is one of the leading resources in pulmonary diseases in Turkey, following the Turkish Paediatric and Respiratory Diseases and Cystic Fibrosis Society.
Three of the four researchers conducting this study are a part of the department of Physiotherapy and Rehabilitation, with the final researcher being apart of the Child Pulmonary Disease Department at the university. Due to this article representing the students PHD research at the university, the standard of this article must be delivered at a high standard. All researchers have experience in the field demonstrated through multiple studies already published in the field go physiotherapy, exercise and respiratory functions in individuals with chronic diseases.
The article was published by the Italian Journal of Paediatrics, this is important to mention as this assists in increasing the validity of the study conducted. The Italian Journal of Paediatrics Provides high-grade research and up to date research in public health and paediatrics. known for its highly commended reputation over an extended period of time (since 1975).

## What kind of research was this?

This study was quantitative research assessing several variables in the relationship to the study question conducted as an uncontrolled longitudinal study.
An uncontrolled longitudinal study is a case series study in which researchers observe the effects of an intervention on the whole cohort with no control group. The results from an intervention are analysed via identical pre and post intervention assessment where the results are compared to draw a conclusion.
This study design is beneficial for this type of intervention as it assists in deciphering the effectiveness of the intervention through the change in results between pre and post intervention assessment. This is valuable for researchers due to CF having a vast range of severities, which, would create more bias if the results of the intervention were compared to a control group.

## What did the research involve?

For the study, 20 children with diagnosed cases of CF aged 8.25 ± 2.77 years contributed in a pre intervention requirement to ensure the individuals capability to exercise with low risk factors. The individuals conducted a max force expiratory volume test (FEV1) and were required to reach 35% or greater capacity to participate in the study. Of the 20 children 4 did not meet the requirement.
16 individuals remained in the study and were subject to a series of pre intervention testing which included;
Pre and Post intervention assessment :
| Testing | Evaluation of testing |
| the Bruce protocol (also referred to as the progressive multilevel treadmill test) | Cardiovascular endurance |
| maximal situp test (amount/ minute) | Abdominal Muscular endurance |
| standing long jump test (cm) | Lower limb power |
| 20 metre sprint (s) | Acceleration |
| Timed 10 step stair climbing test (s) | hand eye coordination |
| series of upper, lower and trunk flexibility tests | flexibility |
| chest circumference (cm) | subcostal, axial and epigastric chest size |
The individuals were then put through a six week training intervention in which participants were to train three times a week. Each session involved a series of breathing techniques administered by physiotherapists whilst assessed at 80% aerobic capacity for 30 minutes on a treadmill. All participants were monitored via regular blood pressure, ECG analysis and heart rate measurements.
At the end of the six week intervention all pre intervention tests were then repeated and data was used in comparison to pre intervention results.
In the instance of evaluating the effects of the six week intervention on the subjects, the use of pre and post testing methodology on all participants whom all have contributed to the intervention deemed a successful approach, however did bring limitations.
The type of research design used in this study may bring forward bias, this can be perceived with the limited range of subjects and no consideration of severity levels of CF between each individual.

## What were the basic results?

The data from the results was analysed through a statistical analysis and data was represented by researchers as a mean ± standard deviation, using a significance level which stated if the p value was greater than 0.05 there was no significant difference between pre and post intervention results and if the p value was less than 0.05 it suggested there was a significant difference observed.
The basic results displayed that in regards to the parameters of physical fitness and chest circumference there was a significant difference observed.
On average, chest circumference increased via 2 cm in all fields, standing long jump showed a 9cm increase, 20 meter sprint time decreased by .81 seconds, 10-step ladder time decreased by 2 seconds and aerobic training capacity during the bruce protocol significantly improved in all parameters (blood pressure, ECG, heart rate).

## What conclusions can we take from this research?

The researchers conclude that with the supervision and prescription of breathe techniques by health professionals during exercise, children with CF will have an increase in physical fitness. Although not mentioned in the conclusion of the article, a greater insight into increase in axilla, subcostal and epigastric chest circumference is essential in the benefit of individuals suffering with CF.
These findings are supported by other research found in the Italian Journal of Paediatrics and specifically by the authors of this article Ugar Ozcelik, due to similar research published via the author which include individuals with CF.

## Practical advice

This type of research design could have been better with a reduced level of bias by implementing a control group to participate in the study. This would give the researchers another aspect to compare results to rather than just comparing pre and post results of the intervention to draw a conclusion.
Considerations such as correct breathing techniques and exercise delivery only from a registered physiotherapist or health professional should be taken into account for individuals with CF. this is due to the high health risk levels that individuals with CF pose when undertaking exercise.

## Further information

For further readings that may interest and benefit individuals with CF and/or the further education and awareness of physical therapies for CF, it would be recommended that the article found at https://www.resmedjournal.com/article/S0954-6111(05)00519-6/fulltext may prove beneficial.
Articles by the Italian Journal of Paediatrics also assist in the further of evidence based information relating to Paediatrics, pulmonary disease and cystic fibrosis.
* 1 2 3 4 5 6 7 8 9 Bulent Elbasan, (2012) Effects of Chest Physiotherapy and Aerobic Exercise Training on Physical fitness in Young Children with Cystic Fibrosis. Italian Journal of Paediatrics.
* ↑ Cystic Fibrosis Foundation, (2021) About Cystic Fibrosis. Congressional Cystic Fibrosis Caucus. Page 1 - About Cystic Fibrosis
* ↑ Cystic Fibrosis Foundation, (2021) Diagnosis and Genetics. Congressional Cystic Fibrosis Caucus. Page 2 – statistics on CF
* ↑ Deniz Dogru, (2020) Cystic Fibrosis in Turkey. The Lancet Respiratory Medicine. Volume 8, Issue 4.
* ↑ Italian Journal of Paediatrics, (2021), About Us. BioMed Central Ltd. Springer Nature
* 1 2 3 Non-randomised Controlled Study (NRS) Designs. (2021), Case series (uncontrolled Longitudinal Study). 2021 The Cochrane Collaboration.
* 1 2 3 Lauren Thomas, (2020), Advantages and disadvantages of longitudinal studies. Scribbr.
* ↑ Department of Psychopharmacology , (2019), the P value and Statistical Significance. US National Library of Medicine, National institutes of health.
* ↑ Ugar Ozcelik, (2018) Reduces anaerobic and aerobic performance in children with pulmonary diseases.
* ↑ Victoria State Government, (2020), Cystic fibrosis (CF). Treatment of Cystic Fibrosis