# Exercise as it relates to Disease/The effects of exercise on patients with Cystic Fibrosis

This is a critique of a paper discussing the effects of a 3 year home exercise program for those with Cystic Fibrosis. Paper - 'A randomized controlled trial of a 3-year home exercise program in cystic fibrosis'

## What is the background to this research?
##### Cystic Fibrosis

Cystic Fibrosis (CF) is among one of the most common life threatening genetic disorders in the world. CF affects approximately 30,000 Americans, with about 1 in 2500 Australian babies born with the condition. The disorder mainly affects the respiratory and digestive system due to the malfunction in the exocrine system, which is responsible for the production of saliva, sweat, tears and mucus. With an increased level of mucus, an individual suffering from CF has a heightened chance of infection due to bacteria and pathogens becoming trapped within the respiratory or digestive track. Currently, there is no cure for CF. There are however, numerous strategies to help with the symptoms. These strategies include chest physiotherapy, exercise and supplementation.

##### Chest Physiotherapy

There are many techniques of chest physiotherapy for patients with CF, some of these techniques include;
Postural Drainage - involves positioning the patient in a way that allows gravity to assist with drainage, while clapping on the chest wall.
Flutter Device - the Flutter Device is a small, hand held device which involves the patient exhaling through said device, resulting in oscillations which assist in loosening mucus in the respiratory track .

##### Exercise

Exercise can assist in managing the symptoms of CF by; improving the respiratory muscles, and therefor ability to discharge mucus, by increasing body mass, and by increasing an individuals overall quality of life.

##### Supplements

In addition to respiratory issues, patients with cystic fibrosis also suffer from a variety of gastrointestinal problems. As a result, patients with CF have to regularly take pancreatic enzyme supplements to assist with food digestion.

## Where is the research from?

This research was conducted at The University of Toronto, in Canada, and at the Respiratory Unit at Our Lady's Hospital for Sick Children in Dublin, Ireland.

## What kind of research was this?

This research was a Randomized Controlled Trial. Randomized Controlled Trials have been shown to be an effective technique to examine the effects of a treatment, and therefore is well suited for this study .

## What did the research involve?
#### Aim

The aim of this research was to determine if a long-term, home exercise program could effect a change in pulmonary function, for sufferers of CF. Additionally, the researchers aimed to develop and implement a home exercise regime that was a realistic component of current long term treatments, and if the recommended amount of exercise was enough to effect a change in exercise tolerance.

#### Method

This researched involved 72 patients, aged between 7 and 19 years, suffering from mild to moderate CF. Computerized random number assignment was used to evenly allocate patients to either an exercise group, or a control group. Each patient of the control group was instructed to participate in a minimum of 20 minutes of their favored exercise, at least 3 times per week, with each session containing a 5 minute warm up as well as a 5 minute cool down. The exercise group were taught to how to monitor their pulse while exercising and instructed to train at a target heart rate of 70% to 80% of their maximal.
Both groups completed a maximal incremental cycling test at the begging, and at yearly intervals. Heart rate, arterial oxygen saturation, inspired minute ventilation, mixed expired oxygen and respiratory rate were all monitored. Blood pressure was taken before hand, at rest, and immediately post exercise.
Both groups were required to record their daily physical activity in a diary.
At the completion of the study, both groups completed a questionnaire to evaluate their attitude towards physical activity, as well as their perceived feasibility of a regular exercise program.

## What were the basic results?

This study found that the 3 year exercise program slowed the rate of decline in pulmonary function when compared to the control group, who displayed similar rates of decline to control groups in previous studies.
Both groups displayed an increase of Wmax and VO2max over the three years, with the exercise group displaying larger improvements.
The questionnaire revealed that following this exercise program was feasible to maintain over the 3 year period.

## What conclusions can we take from this research?

The main conclusion drawn from this study is that a long-term, unsupervised program is realistic, and has the ability to positively influence pulmonary function, and thus, improvements in exercise tolerance for patients suffering from CF.

## Practical advice

Past studies have found the positive correlation between exercise and health in patience suffering with CF. As displayed in this study, exercise can reduce the decline of pulmonary function and therefore, it is important for CF sufferers to maintain a regular exercise routine. Exercise has also been shown the ease the symptoms related to CF, increase muscle strength and body mass, and improve the patients quality of life. Therefore, a regular exercise routine involving, both resistance and aerobic training, should be recommended for sufferers of CF.

## Further information/resources

For further information regarding Cystic Fibrosis; follow the links below.
Cystic Fibrosis Federation Australia
Cystic Fibrosis American Foundation

## References

* 1 2 3 4 5 6 7 8 9 10 11 Schneiderman-Walker, J., Pollock, S. L., Corey, M., Wilkes, D. D., Canny, G. J., Pedder, L., & Reisman, J. J. (2000). A randomized controlled trial of a 3-year home exercise program in cystic fibrosis. The Journal of pediatrics, 136(3), 304-310.
* 1 2 Cutting, G. R. (2005). Modifier genetics: cystic fibrosis. Annu. Rev. Genomics Hum. Genet., 6, 237-260.
* 1 2 Cystic Fibrosis Federation Australia. Available at:https://www.cysticfibrosis.org.au/
* ↑ App, E. M., Kieselmann, R., Reinhardt, D., Lindemann, H., Dasgupta, B., King, M., & Brand, P. (1998). Sputum rheology changes in cystic fibrosis lung disease following two different types of physiotherapy: flutter vs autogenic drainage. Chest, 114(1), 171-177.
* ↑ Gondor, M., Nixon, P. A., Mutich, R., Rebovich, P., & Orenstein, D. M. (1999). Comparison of Flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation. Pediatric pulmonology, 28(4), 255-260.
* 1 2 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)
* ↑ Borowitz, D. S., Grand, R. J., & Durie, P. R. (1995). Use of pancreatic enzyme supplements for patients with cystic fibrosis in the context of fibrosing colonopathy. The Journal of pediatrics, 127(5), 681-684.
* ↑ Sibbald, B., & Roland, M. (1998). Understanding controlled trials. Why are randomised controlled trials important?. BMJ: British Medical Journal, 316(7126), 201.