As medicine marches forward in increasingly unexplored territory, a significant number of physicians are advocating for a return to basics and the rediscovery of treatment modalities that are accessible to individuals in most parts of the world.
In cystic fibrosis, physicians and physiotherapists alike are once again highlighting the benefits of physical activity and exercise training. Studies have shown time and again that lifestyle-related behavior plays a significant role in the quality of life and prognosis of patients with this disease.
Physical fitness has traditionally been prescribed as a method to increase cardiorespiratory fitness, which is severely lacking in patients with cystic fibrosis. Thick secretions often clog up the lungs, and patients typically have to undergo recurrent chest physiotherapy to optimize their respiratory ability.
Granted, morbidity in cystic fibrosis tends to discourage patients from overt physical activity, since it can be extremely exhausting. In addition to decreased mucociliary clearance in the lungs, patients with cystic fibrosis are also vulnerable to bronchiectasis, pulmonary hypertension, and heart failure. The respiratory tract is particularly vulnerable to bacterial infections, which can cause further lung damage if left untreated.
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One of the challenges of being a physician is to empathize with the struggles of our patients, but at the same time encourage them to form healthy habits that may improve their prognosis. This task is considerably easier if there is research that backs this up.
Patients’ Perception of Physical Activity
A study recently conducted by Burnett and colleagues and published in Respiratory Care sought to investigate common attitudes toward exercise training among patients with cystic fibrosis.
“Declining levels of exercise leads to low cardiorespiratory fitness, which is a strong, independent predictor of mortality in patients with [cystic fibrosis],” Burnett et al wrote. “As a result, exercise training has become a commonly accepted form of treatment for patients with [cystic fibrosis].”
They recruited adult patients with cystic fibrosis (n=46) and conducted structured interviews to gather their thoughts on the importance of physical activity. Participants were also asked to fill in questionnaires on their levels of physical activity and their perceptions of it.
The results indicate that 84% of participants engage in moderate physical activity, with most respondents preferring walking. Around 65% of patients view physical activity as vital for their health. However, common barriers to exercise include low energy, poor health, and a lack of self-discipline.
This study indicates that most patients with cystic fibrosis engage in what they term as “moderate physical activity.” A minority of patients actively participate in vigorous exercise.
“Motivating patients with [cystic fibrosis] to engage in more vigorous physical activity may provide a stimulus that improves clinical outcomes and potentially survival,” Burnett et al suggested.
Effects on Health Parameters
A separate study conducted by Radtke and colleagues and published in Paediatric Respiratory Reviews complements the paper written by Burnett et al. In their study, Radtke and colleagues sought to understand the effects of physical activity on various health parameters.
They studied patients with cystic fibrosis recruited in the Cochrane Cystic Fibrosis and Genetic Disorder Group Trials Register. In addition, they also included data from 2 ongoing clinical trial registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform.
The research team discovered that physical activity likely had a positive effect on exercise capacity compared to individuals who performed no physical activity. However, they did not find any evidence suggesting that physical activity impacted lung function or health-related quality of life scores.
“Further high‐quality and sufficiently‐sized studies are needed to comprehensively assess the benefits of physical activity and exercise in people with [cystic fibrosis], particularly in the new era of [cystic fibrosis] medicine,” Radtke et al wrote.
Nevertheless, this study contains some arguments in favor of physical activity, even if its beneficial health effects may not be apparent at first glance. First, the purpose of physical activity is not only improving lung capacity; it is also an opportunity for individuals to improve their mental health and be a part of a community of other like-minded individuals who are committed to their physical well-being. The benefits of this are intangible.
Second, physical activity does not result in any notable adverse effects, meaning that there is no good reason why patients should not engage in it. In addition, physical activity has been shown to improve other parameters of health, making patients stronger and better positioned to experience better clinical outcomes.
Read more about cystic fibrosis treatment
There are good reasons why physicians are always advised to invite patients to participate in some form of physical activity; it helps them escape the increasingly sedentary lifestyle of modern times and allows them to make use of their muscles and joints in a positive way. In addition, studies have made clear that endorphins are released during periods of physical activity.
In conclusion, patients with cystic fibrosis should be encouraged to participate in some form of physical activity; if they complain of feeling easily tired, just a simple jog will do. As a society that is moving toward remote work, we are increasingly at risk of the downsides of a sedentary lifestyle. Physicians should encourage patients to keep moving—and improve their quality of life in turn.
Burnett DM, Barry AN, Mermis JD. Physical activity level and perception of exercise in cystic fibrosis. Respir Care. 2020;65(4):500-506. doi:10.4187/respcare.07193
Radtke T, Smith S, Nevitt SJ, Hebestreit H, Kriemler S. Physical activity and exercise training in cystic fibrosis. Paediatr Respir Rev. 2022;S1526-0542(22)00050-1. doi:10.1016/j.prrv.2022.08.001