Hindawi Publishing Corporation International Journal of Pediatrics Volume 2010, Article ID 670640, 7 pages doi:10.1155/2010/670640 Review Article Exercise Training in Children and Adolescents with Cystic Fibrosis: Theory into Practice Craig A. Williams,1 Christian Benden,2 Daniel Stevens,1 and Thomas Radtke1, 2 1 Children’s Health and Exercise Research Centre, School of Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, UK 2 Division of Pulmonary Medicine, University Hospital Zurich, 8091 Zurich, Switzerland Correspondence should be addressed to Craig A. Williams, c.a.williams@exeter.ac.uk Received 19 January 2010; Revised 31 May 2010; Accepted 23 August 2010 Academic Editor: Patricia A. Nixon Copyright © 2010 Craig A. Williams et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Physical activity and exercise training play an important role in the clinical management of patients with cystic ﬁbrosis (CF). Exercise training is more common and recognized as an essential part of rehabilitation programmes and overall CF care. Regular exercise training is associated with improved aerobic and anaerobic capacity, higher pulmonary function, and enhanced airway mucus clearance. Furthermore, patients with higher aerobic ﬁtness have an improved survival. Aerobic and anaerobic training may have diﬀerent eﬀects, while the combination of both have been reported to be beneﬁcial in CF. However, exercise training remains underutilised and not always incorporated into routine CF management. We provide an update on aerobic and anaerobic responses to exercise and general training recommendations in children and adolescents with CF. We propose that an active lifestyle and exercise training are an eﬃcacious part of regular CF patient management. 1. Introduction Physical activity and exercise training have become increas- ingly important and widely accepted as part of therapy and rehabilitation programmes in cystic ﬁbrosis (CF) man- agement. Physical activity refers to any body movement produced by the skeletal muscles and occurs in a vari- ety of forms (i.e., free play, exercise, organised sports), resulting in a substantial increase in energy expenditure [1]. Exercise training, however, can be deﬁned as regu- lar participation in vigorous physical activity to improve physical performance or cardiovascular function or muscle strength or any combination of these three [2]. Prior to initiation of any exercise training, detailed exercise testing is recommended, not only to monitor disease progression, but also to detect exercise-induced limitations and therefore to provide the patients with safe training recommenda- tions [3, 4]. Ideally, exercise training should complement current therapies in CF patient healthcare. In previous reports, however, it has emerged that clinicians lack speciﬁc recommendations to instruct their patients appropriately [5, 6]. Several studies report beneﬁcial eﬀects of exercise train- ing on cardiopulmonary ﬁtness (CPF) in patients with CF [7–11]. CPF pertains to the functions of both the heart and the pulmonary system, usually expressed as peak oxygen consumption (peak V˙ O2), the most reliable and reproducible measure of CPF following maximal exercise testing [12]. Recently, Bradley and Moran examined the eﬀectiveness of exercise training in CF using a systematic Cochrane review [13]. Seven randomised controlled trials with a total number of 231 participants were included, investigating the eﬀects of diﬀerent types of training (aerobic versus anaerobic training, anaerobic training, aerobic training, and the combination of both). The authors conclude that exercise training is an important part of CF care; however, there are insuﬃcient numbers of studies published to date to document the beneﬁts of exercise training for people with CF. Nevertheless, the authors state that there is no evidence to actively discourage exercise training [13]. In 2009 Wilkes et al. underlined the importance of exercise and habitual physical activity in children with CF [14]. In particular, Wilkes et al. highlighted that education of health care providers and implementing exercise in clinical practice are needed [14].