title: Long-term effects of a partially supervised conditioning programme in cystic fibrosis Physical activity levels of patients with cystic fibrosis hospitalised with an acute respiratory exacerbation. Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis: prevalence and associated factors Effects of anaerobic training in children with cystic fibrosis: a randomized controlled study. Effect of supervised training on FEV1 in cystic fibrosis: a randomised controlled trial. Reliability and validity of the habitual activity estimation scale (HAES) in patients with cystic fibrosis. Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis. Exercise conditioning and cardiopulmonary fitness in cystic fibrosis. The effects of a three-month supervised running program.
abstract: Little is known about the long-term persistence of positive effects induced by a physical conditioning programme in cystic fibrosis . Therefore , this study determined the effects of a 6-month conditioning programme on peak oxygen uptake ( primary outcome ) and other markers of fitness , physical activity , anthropometry , lung function and quality of life ( secondary outcomes ) , 18 and 24 months after the programme was initiated . Patients with cystic fibrosis aged 12–40 yrs were r and omly assigned to an  intervention ( n = 23 ) and a  control ( n = 15 ) group . The intervention group consented to add 3 h of sports per week for ≥6 months to their previous activities . Controls were asked to maintain their level of activity for 12 months . Patients were seen at baseline and after 3 , 6 , 12 , 18 and 24 months . There was no significant difference between groups at baseline . The intervention induced positive effects on peak oxygen uptake ( difference in changes from baseline to the 18- and 24-month assessment s between groups : 3.72±1.23 mL·min−1·kg−1 ; p<0.01 ) , maximal workload ( 0.37±0.11 W·kg−1 ; p<0.01 ) , vigorous physical activity ( 1.63±0.82 h·week−1 ; p<0.05 ) , forced vital capacity ( 6.06±2.87 % predicted ; p<0.05 ) and perceived health ( 9.89±4.72 ; p<0.05 ) . A home-based partially supervised physical conditioning programme  can improve physical fitness , lung function and perceived health long after the intervention has ended BACKGROUND The  physical activity  levels of adult patients with cystic fibrosis hospitalised for an acute respiratory exacerbation is unknown . METHODS A prospect i ve observational study was undertaken . Physical activity levels were measured for a 24-h period using an activity monitor ( SenseWear ( ® ) Pro 3 ) during hospitalisation for an acute respiratory exacerbation and one month post-discharge . Measures of exercise tolerance and muscle strength were also recorded . RESULTS Twenty-four patients completed the study . Most outcomes significantly increased from hospitalisation to one month post-discharge . Time spent doing physical activity ( ≥3 METs ) increased from a mean ± SD of 95 ± 58 to 209 ± 111 min . CONCLUSIONS Hospitalisation for an acute respiratory exacerbation was associated with less time spent  performing physical activity compared to one month post-discharge . Physical activity levels were higher than anticipated , even during hospitalisation , suggesting an increased metabolic rate may have contributed to the physical activity levels documented . Activity level definitions for moderate intensity exercise that are based on higher MET levels seemed more appropriate in this patient setting . CLINICAL TRIAL REGISTRY Australian New Zeal and Clinical Trials Registry Number : ACTRN12610000595011 BACKGROUND Patients with cystic fibrosis ( CF ) have many risk factors for reduced bone mineral density ( BMD ) . The aim of this study was to determine the prevalence of osteoporosis and osteopenia in a large cross section of patients and to identify risk factors . METHODS All patients attending the regional centre were invited to participate in the study . Bone mineral density was measured at the lumbar spine , femoral neck , and for total body with a Lunar DPX-L densitometer . Multiple indices of disease severity were investigated , and liver and thyroid function , blood calcium , phosphate , 25-OH vitamin D , follicle stimulating and luteinising hormone , oestradiol , and testosterone levels were measured . Patients completed a four day prospect i ve dietary diary . Exercise was assessed by a seven day activity recall question naire .  Sexual development and treatment histories were obtained . The relationship between all these variables and BMD measurements was analysed . RESULTS Sixty six percent of 114 patients assessed had osteopenia or osteoporosis . The Shwachman-Kulczycki ( SK ) clinical score ( higher score = less severe disease ) correlated significantly with BMD at the lumbar spine and femoral neck , and with total body BMD ( p<0.001 ) . There was a predicted increase of 0.0032 g/cm2 in lumbar spine BMD for every unit increase in the SK score . Oral steroid use was significantly associated with reduced BMD at the lumbar spine ( p = 0.017 ) and femoral neck ( p = 0.027 ) . CONCLUSIONS Osteopenia and osteoporosis are common findings in a heterogeneous population of adults with CF . Patients at most risk are those with severe disease and those who have used corticosteroids BACKGROUND Children 's physical activity patterns are characterized by short-term anaerobic activities . Anaerobic exercise performance in children with cystic fibrosis ( CF ) has received little attention compared to aerobic performance . This study investigated the effects of anaerobic training in children with CF . DESIGN AND METHODS Twenty patients were r and omly assigned to the training group ( TG ) [ 11 patients ; mean ( + /- SD ) age , 13.6 + /- 1.3 years ; mean FEV(1 ) , 75.2 + /- 20.7 % predicted ] or the control group ( CG ) [ 9 patients ; mean age , 14.2 + /- 2.1 years ; FEV(1 ) , 82.1 + /- 19.1 % predicted ] . The TG trained 2 days per week for 12 weeks , with each session lasting 30 to 45 min . The training program consisted of anaerobic activities lasting 20 to 30 s. The control subjects were asked not to change their normal daily activities . Body composition , pulmonary function , peripheral muscle force , habitual physical activity , aerobic and anaerobic exercise performance , and quality of life were reevaluated at the end of the training program , and again after a 12-week follow-up period . RESULTS Patients in the TG significantly improved their anaerobic performance , aerobic performance , and quality of life . No significant changes were seen in other parameters , and no improvements were found in CG . After the follow-up period , only anaerobic performance and quality of life in TG were significantly higher compared to pretraining values . CONCLUSIONS Anaerobic training has measurable effects on aerobic performance ( although not sustained ) , anaerobic performance , and health-related quality of life in children with CF . Therefore , anaerobic training could be an important component of therapeutic programs for CF patients BACKGROUND Long-term exercise interventions have been shown to improve vital capacity in cystic fibrosis ( CF ) . Yet , no data are available indicating positive effects of long-term exercise training on FEV1 . METHODS 39 Swiss patients with CF were r and omly divided into strength training ( ST , n=12 ) , endurance training ( AT , n=17 ) and controls ( CON(CH ) , n=10 ) , and also compared with age-matched Swiss ( n=35 ) and German ( n=701 ) CF registry data . A partially supervised training of 3 × 30 min/week for 6 months took place with measurements at baseline and after 3 , 6 , 12 and 24 months . Primary outcome was FEV1 at 6 months . RESULTS FEV1 increased significantly in both training groups compared with CON(CH ) ( AT:+5.8±0.95 , ST:+7.4±2.5 , CON(CH):-11.5±2.7 % predicted , p<0.001 ) and both registry groups at 6 months . At 24 months , changes in favour of the training groups persisted marginally compared with CONCH , but not compared with registry data . CONCLUSIONS A partially supervised training over 6 months improved FEV1 but effects were basically gone 18 months off training . Regular long-term training should be promoted as essential part of treatment in CF PURPOSE To underst and potential benefits of exercise in the cystic fibrosis ( CF ) population , there needs to be accurate methods to quantify it . The Habitual Activity Estimation Scale ( HAES ) question naire has been shown to be a feasible tool to measure physical activity however the reliability and validity have yet to be determined in the CF population . METHODS Fourteen ( seven male , seven female ) patients aged 16.2 + /- 4.2 years with CF participated in this study . Participants were clinical ly stable at the time of the study and participating in their habitual physical activity . To assess reliability , patients completed the HAES and a vali date d 3-day activity diary , and wore an ActiGraph Accelerometer for two consecutive weeks .  Validity was assessed by comparing the activity results of each of the three instruments over a single week time period . RESULTS ICC estimates of reliability for the HAES , diary , and  accelerometer  were 0.72 ( P < 0.0001 ) , 0.76 ( P < 0.0001 ) , 0.63 ( P < 0.0001 ) , respectively . Validity analysis indicated that there were significant relationships between the participants ' activity results as estimated by the HAES , diary and  accelerometer .  Further , significant relationships were detected between activity measures when broken into morning , afternoon , or evening periods , and between measures from weekday or weekend days . There were also significant relationships among the three instruments when recording different activity levels ( somewhat inactive , somewhat active , and very active ) . CONCLUSION The findings of this study suggest that the HAES question naire is a reliable and valid instrument that can be used to assess activities of varying intensity in patients with CF 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 r and omized 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 r and omized to the aerobic training group participated in aerobic activities for five sessions , each of 30-min duration , a week . The children r and omized to the resistance training group exercised both upper and lower limbs against a grade d resistance machine . Subjects in the control group received st and ard 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 Exercise intolerance is common in cystic fibrosis ( CF ) . We examined the effects of a supervised three-month running program on exercise tolerance , pulmonary function , cardiorespiratory fitness ( peak oxygen consumption ) , and respiratory muscle endurance in CF patients . We studied 31 patients , 21 exercise and ten control , aged 10 to 30 years , with pulmonary involvement ranging from mild to severe . The exercise and control groups were not significantly different with respect to age , sex , pulmonary function , exercise tolerance , or cardiorespiratory fitness . After three months of physical conditioning , the exercise group had significantly increased exercise tolerance and peak oxygen consumption and significantly lower heart rates for submaximal work loads , while the nonexercising ( control ) group was unchanged in all these variables . The FEV1 decreased significantly in the control group . There were no other significant changes in pulmonary function in either the control or exercise group . Respiratory muscle endurance increased significantly in the exercise patients , and did not change in the control patients . There were no adverse effects of the program . The data suggest that a supervised running program can increase CF patients '  exercise tolerance and cardiorespiratory fitness , perhaps in part by increasing respiratory muscle tolerance . The effects of a much longer program deserve study
target: The DigiWalker pedometer offers an informed choice of a comparatively inexpensive method of obtaining some measurement of physical activity .
  The HAES represents an informed choice of question naire to assess physical activity .
  There is insufficient data to recommend the use of one diary over another .
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