Effects of Exercise on Nutritional Status in People with Cystic Fibrosis: A Systematic Review

Abstract

Background: Physical exercise is an important part of regular care for people with cystic fibrosis (CF). It is unknown whether such exercise has beneficial or detrimental effects on nutritional status (body composition). Thus, the objective of this review was to evaluate the effect of exercise on measures of nutritional status in children and adults with CF. Methods: Standardized reporting guidelines for systematic reviews were followed and the protocol was prospectively registered. Multiple databases were utilized (e.g., PubMed, Scopus, and CINHAL). Two reviewers independently reviewed titles/abstracts and then the full text for selected studies. Results: In total, 924 articles were originally identified; data were extracted from 4 eligible studies. These four studies included only children; pulmonary function ranged from severe to normal, and the majority of participants were at or below their recommended weight. Exercise training did not worsen nutritional status in any study; two studies that included resistance exercise reported an increase in fat-free mass. Three of the four studies also reported increased aerobic capacity and/or muscle strength. Conclusions: Exercise training can produce positive physiologic changes in children with CF without impairing their nutritional status. In fact, resistance exercise can help improve body mass. Much less is known about how exercise may affect adults or those who are overweight.

Update on the management of vitamins and minerals in cystic fibrosis

“…2 The role of registered dietitians is pivotal in the multidisciplinary CF team, and common nutrition interventions include individualized nutrition counseling utilizing weight, body mass index, and/or body composition to frame recommendations; exercise/activity to promote optimal body composition; pancreatic enzyme replacement therapy (PERT) for individuals with exocrine pancreatic insufficiency (EPI); and appropriate micronutrient supplementation. [3][4][5] The CFF 2020 Registry data revealed approximately 40% of patients with CF required oral nutrition supplements and 10% received enteral nutrition. 2 The nutrition state of individuals with CF has significantly improved and is mainly attributed to early CF diagnosis through newborn screening, use of effective enteric-coated pancreatic enzymes, optimization of fat-soluble vitamin supplementation, implementation of systematic quality-improvement interventions, and availability of newer CF-targeted therapies such as the highly effective modulators (HEMs).…”

“…The Cystic Fibrosis Foundation (CFF) Registry data are released annually, and the latest data for the year 2020, published in 2021, showed a predicted median reported survival of approximately 50 years 2 . The role of registered dietitians is pivotal in the multidisciplinary CF team, and common nutrition interventions include individualized nutrition counseling utilizing weight, body mass index, and/or body composition to frame recommendations; exercise/activity to promote optimal body composition; pancreatic enzyme replacement therapy (PERT) for individuals with exocrine pancreatic insufficiency (EPI); and appropriate micronutrient supplementation 3–5 . The CFF 2020 Registry data revealed approximately 40% of patients with CF required oral nutrition supplements and 10% received enteral nutrition 2…”

Current and Future Therapeutic Approaches of Exocrine Pancreatic Insufficiency in Children with Cystic Fibrosis in the Era of Personalized Medicine

“…Lower values for fat free mass were associated with decreased pulmonary function and undernutrition. Also, pulmonary chronic infection, a characteristic of this disease has been linked to decreased fat free mass [ 41 , 42 ]. The predictive value of body composition for clinical outcomes of CF patients is still undefined [ 43 ].…”

Evolving nutritional needs, obesity, and overweight status in cystic fibrosis

“…Encouragingly, familiar tools we have long used remain beneficial. Exercise continues to provide positive physiologic benefit in the absence of nutritional losses, with particular benefit from resistance-based exercise [38]. Impacts of exercise in overweight or obese people with CF is an area for future investigation.…”