Randomized controlled study of in‐hospital exercise training programs in children with cystic fibrosis

Abstract

The aim of this study was to compare aerobic and resistance training in children with cystic fibrosis (CF) admitted to hospital with an intercurrent pulmonary infection with a control group. The subjects were randomized into three groups on the first day of admission. The fat-free mass (FFM) was calculated, using the skin fold thickness from four sites (biceps, triceps, subscapular, and iliac crest). Pulmonary function tests were performed within 36 hr of admission and repeated on discharge from the hospital, and again at 1 month after discharge. All subjects performed an incremental treadmill exercise test, using a modified Bruce protocol. Lower limb strength was measured using a Cybex dynamometer. An assessment of quality of life was made using the Quality of Well Being Scale, as previously reported. Activity levels were measured using a 7-day activity diary, and subjects also wore an accelerometer on their hips. There were no significant differences between the three groups in terms of disease severity, and length of stay in hospital. Subjects in all three groups received intravenous antibiotics and nutritional supplementation as determined by the physician. Children randomized to the aerobic training group participated in aerobic activities for five sessions, each of 30-min duration, a week. The children randomized to the resistance training group exercised both upper and lower limbs against a graded resistance machine. Subjects in the control group received standard chest physiotherapy. Our study demonstrated that children who received aerobic training had significantly better peak aerobic capacity, activity levels, and quality of life than children who received the resistance training program. Children who received resistance training had better weight gain (total mass, as well as fat-free mass), lung function, and leg strength than children who received aerobic training. A combination of aerobic and resistance training may be the best training program, and future studies to assess optimal training programs for CF patients are indicated.

The Physiotherapist's Use of Exercise in the Management of Young People with Cystic Fibrosis

“…Seven trials using randomised parallel-group design were included, with a total of 231 participants including children and adults. Three studies included children only (Selvadurai et al, 2002;Klijn et al, 2004;Turchetta et al, 2004), and two notable studies included adults and children (Cerny, 1989;Schneiderman-Walker et al, 2000). Overall, these trials showed some evidence of benefits of short-and long-term physical training for people with CF, and this was also the conclusion provided by other reviews in the field (Smidt et al, 2005;Bradley et al, 2006;Shoemaker and Hurt, 2008).…”

“…Importantly, participation in regular physical activity is associated with many holistic benefits, such as improved quality of life and wellbeing (Boas, Danduran, & McColley, 1999;Orenstein, Nixon, Ross, & Kaplan, 1989;Selvadurai et al, 2002). The ICF-CY model facilitates exploration of the impact of exercise intervention on these wider aspects of functioning.…”

“…The ideal elements of exercise programs for this population are presented in the literature, and include: endurance and strength training for the upper and lower limbs; aerobic and anaerobic activities; interval training; weight bearing activities; and flexibility exercises (Webb & Dodd, 2000;Selvadurai et al, 2002;Klijn et al, 2004;Dodd & Prasad, 2005;Bradley et al, 2006;Sahlberg, 2008). As well as addressing the function across these multiple areas, providing a variety of activity types makes it possible to individually tailor the program according to the young person's preferences, thereby improving exercise participation (Klijn et al, 2004).…”

The influence of physical activity on lean mass accrual during adolescence: a longitudinal analysis

“…Previous studies have shown that significant differences have been reported in LBM between athletes and nonathletes (35), changes following exercise (14 -16), and longitudinal studies or exercise training studies of special populations (e.g., cystic fibrosis, Prader-Willi syndrome, etc.) (28,42,44,50). However, few studies have examined the influence of free-living, habitual PA on LBM accrual during adolescence, a critical period of growth affecting body composition and those that have, for the most part, been cross-sectional in design and thus unable to tease out the independent effects of PA from those of growth and maturation (12,21,25).…”

Exercise Performance and Breathing Patterns in Cystic Fibrosis

“…If exercise training including anaerobic exercises can improve muscle strength and muscle size resulting in weight gain remains also under consideration. Further, in terms of quality of life, positive effects towards perceived feasibility have been noted (Turchetta eta l., 2004, Selvadurai et al, 2002, Schneiderman-Walker et al, 2000, Orenstein et al, 1981.…”