Conference poster displayed at Clinical Trials Symposium, RD&E Exeter, 5/11/1

Barker, A. R.

Oades, Patrick

Tomlinson, Owen

Williams, Craig A.

RD&E Research Repository

The feasibility of a home-based exercise intervention for the improvement of aerobic function in young cystic fibrosis patients  Owen W. Tomlinson1,2, Alan R. Barker1, Patrick J. Oades2, Craig A. Williams1,2 1Children’s Health & Exercise Research Centre, Sport and Health Sciences, University of Exeter, UK 2Royal Devon & Exeter NHS Foundation Trust Hospital, Wonford, Exeter, UK  METHODS CONCLUSIONS INTRODUCTION CYSTIC FIBROSIS REFERENCES Variables of Interest Contact: Professor Craig Williams (C.A.Williams@exeter.ac.uk) or  Owen Tomlinson (O.W.Tomlinson@exeter.ac.uk) • Cystic fibrosis is a genetically inherited, life-shortening disease.  • There is no cure.  • It is caused by a mutation in the CFTR gene which results in abnormal ion and water transport in and out of the cell.  • This results in a thick, sticky mucus that clogs the airways and digestive tract. • Approximately 10’000 people in the United Kingdom have CF. • Median survival age is 43.5 years4.   • Anthropometric measurements included height, mass and BMI.  • Lung function was assessed with a hand held spirometer, with FVC and FEV1 values normalised5.  • Cardiopulmonary fitness (VO2max) was assessed by a combined  ramp incremental and supra-maximal cycling test  to exhaustion6. Gaseous exchange was measured breath-by-breath and values for VO2, VCO2, VE, Heart Rate and RER were obtained. • Physical activity was objectively assessed using a triaxial GENEA accelerometer mounted on the wrist over four days (two weekdays). Time spent in MVPA (moderate-vigorous activity) and sedentary time  were collected in absolute and relative terms.  • Subjective exercise tolerance was recorded by way of ratings of perceived exertion (RPE) and ratings of perceived dyspnoea  (RPD).  Each patient was assigned a mixed aerobic (AER) and resistance (RES) programme, to take place over a three month period. Participants were allowed free choice in activity selection, but were required to work within a specified HR training zone, based upon initial exercise capacity tests.  • Weeks 1-4: AER; 2/week for 45 minutes at 80% GET. RES; None.  • Weeks 5-6: AER; 3/week for 45 minutes at 40%Δ. RES; chest, arms, back – 10 reps x 2 with theraband • Weeks 7-8: AER; 3/week for 60 minutes at 40%Δ. RES; chest, arms, back – 10 reps x2 with theraband • Weeks 9-12: AER; 3/week for 60 minutes at 60%Δ. RES; chest, arms, back – 20 reps x 2 with theraband Researchers maintained contact with patients on a weekly basis to assess progress and ensure compliance.   Training Programme The results of this feasibility study suggest: • Home-based exercise is a feasible modality of exercise training in children • A mixed aerobic and resistance programme can improve exercise capacity, exercise tolerance and physical activity • Compliance is difficult to ensure and may explain large variances in results The current methods and results will be utilised to inform future randomised control trials in CF  AIM To assess the feasibility of a three-month home-based exercise intervention programme in improving exercise capacity in children with mild-to-moderate CF.  RESULTS Workload Time ~ 10 mins Fig 1. Cardiopulmonary exercise test protocol, as described by Barker et al. (2011)  Three children (2 females; 11.1 ± 0.6 y; 139.2 ±7.3 cm; 33.2 ±0.6 kg) with mild-to-moderate CF (FVC: 81.0 ± 8.9 %; FEV1: 89.8 ± 10.3 %) were recruited from the Royal Devon & Exeter NHS Foundation Trust Hospital. Ethics approval was granted by the local NHS Research Ethics Committee.  40.0045.0050.0055.0060.0065.0070.002527293133353739414345Pre PostGET (% VO2max) VO2 (ml.kg-1.min-1) Fig 2. Changes in maximal cardiopulmonary fitness (solid line) and the gas exchange threshold (dashed line) for each participant. Cardiopulmonary Fitness: • Changes in absolute and relative VO2max were observed between pre- (mean ± SD; 1.27 ± 0.13 L.min-1; 38.07 ± 4.41 ml.kg-1.min-1) and post-training (1.19 ± 0.16; 35.86 ± 6.01). • The gas exchange threshold increased in absolute terms (0.66 ± 0.12 to 0.72 ± 0.11 L.min-1) and as a percentage of VO2max (52.3 ± 6.9 to 60.5 ± 0.9 %). 250300350400450500020406080100120140160Pre PostSedentary Time (mins) MVPA Time (mins) Physical Activity: • The duration of sedentary time decreased by 30.9 ± 25.4 minutes following training          (- 1.15 ±13.10 %). • Light activity increased by 8.3 ±82.1 minutes (+ 2.18 ± 4.48 %). • MVPA decreased by 3.7 ± 59.2 minutes        (-1.33 ± 8.35 %). • Data may be skewed by individual responses and differences in non-wear time of accelerometer. Fig 3. Changes to moderate to vigorous physical activity (solid line) and sedentary time (dashed line) for each participant.  01234567823456789Pre PostRPD RPE Fig 4. Changes to maximal RPE (black) and RPD (grey) for ramp (solid line) and supramaximal (dashed line) exercise during a cardiopulmonary exercise test for each participant. Exercise Tolerance: • RPE showed little change in ramp (6 ± 2 – 6 ± 2) or supramaximal (6 ± 2 – 5 ± 2) exercise. • RPD decreased in both ramp (4 ± 3 – 3 ± 2) and supramaximal (4 ± 2 – 3 ± 1) exercise . • Considered alongside changes in relative peak power (2.82 ± 0.42 – 2.92 ± 0.26 W.kg-1), increased tolerance is suggested. • Exercise training is seen as an essential tool in the management of cystic fibrosis (CF)1. • However, no formal exercise guidelines exist and therefore, prescription of exercise training is under-utilised.  • As exercise is not always possible or practical in the clinical environment, utilisation of the home environment is an important consideration. • Exercise training in the home environment has been shown to have limited improvements in adult patients2 and exercise training has been shown to have some benefits in children3, with the strongest results seen in a clinical setting. • However, it is unclear what effect a home-based, mixed aerobic and resistance training programme may have in children with mild-to-moderate CF.  1. Stevens, D., et al., A survey of exercise testing and training in UK cystic fibrosis clinics. Journal of Cystic Fibrosis, 2010. 9(5): p. 302-306. 2. Rovedder, P.M.E., et al., Exercise programme in patients with cystic fibrosis: A randomized controlled trial. Respiratory Medicine, 2014. 108(8): p. 1134-1140. 3. van Doorn, N., Exercise programs for children with cystic fibrosis: a systematic review of randomized controlled trials. Disability and Rehabilitation, 2010. 32(1): p. 41-9. 4. Cystic Fibrosis Trust, UK Cystic Fibrosis Registry Annual data report 2012. 2013. Available at http://www.cysticfibrosis.org.uk/media/598466/annual-data-report-2013-jul14.pdf 5. Quanjer, P. H., et al., Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. European Respiratory Journal, 2012. 40(6): p. 1324-1343. 6. Barker, A.R., et al., Establishing maximal oxygen uptake in young people during a ramp cycle test to exhaustion. British Journal of Sports Medicine, 2011. 45(6): p. 498-503. The authors would like to thank all patients and their families for their time and dedication to the project. Additional acknowledgements go to the Multi-Disciplinary CF Team at the Royal Devon & Exeter Hospital for their assistance in recruitment and patient contact.  

The feasibility of a home-based exercise intervention for the improvement of aerobic function in young cystic fibrosis patients.

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The feasibility of a home-based exercise intervention for the improvement of aerobic function in young cystic fibrosis patients.

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