As a physiotherapist with a special interest in CF and over 20 years’ experience one of the most common questions I get asked is, “What exercise should I be doing? Or what is the best exercise for my child?” This is both a simple but complex question.

My simple standard answer is always, “Whatever exercise you enjoy!” The reason behind this is quite simply, if you enjoy something you will do it and more importantly you will want to do it. Some people might love swimming while others running. I cannot tell someone who hates to run that that is what they should be doing. I know full well that it will all start with good intentions but soon fizzle out. So, rather focus on something that you love, and the rest will follow.

However, exercise in CF is not as simple as that answer. Extensive research into the effect of exercise training and physical activity in the healthy child has demonstrated physiological and quality of life benefits. Guidelines for exercise testing, prescription and training for healthy children are also well documented. However, by comparison, there is much less evidence demonstrating that children with CF achieve the same level of benefits as their healthy peers, and guidelines for exercise are still being developed. Current guidelines for the physiotherapy management of children and adults with CF suggest that regular exercise and physical activity be prescribed in conjunction with airway clearance therapy (ACT) and inhalation therapy. The rationale is that exercise may enhance sputum clearance, improve, or maintain lung function, reduce breathlessness, increase aerobic capacity, and muscle strength, improve bone health and ultimately quality of life. Regular adherence to exercise and ACT is variable in both adults and children, with time required to complete ACT, nutritional status and progression of the disease the key factors that influence exercise capacity, and willingness to participate in any form of exercise or physical activity- hence my reasoning for doing an exercise that you enjoy.

Endurance training has been found to be the most popular intervention and is effective at increasing lung function and improving breathlessness and quality of life, while strength training improves muscle strength and size, and weight gain. In seeing this when looking at any exercise prescription one needs to include both endurance and strength training. These should always be monitored by a professional and individualised.

Studies at Great Ormond Street Children’s hospital have shown that “Supervised and in-patient programs for children with CF produced the most improvements in exercise parameters, with less dramatic effects noted in part-supervised or unsupervised programs.” When they started their Frequent Flyer programme, which allows those that spend a fair amount of time in hospital per annum on IV’s to start exercising with a trainer at their local gym (for free) they found a 25% reduction in IV antibiotic usage, quality of life improvements and maintenance of lung function and growth (in children) Feedback from both children and parents was very encouraging, with families reporting that their children had been able to spend more time at home and school and experienced less of a dip in their general quality of health. Children reported they were now able to exercise at the same level or sometimes even higher than their peers. These programs present an interesting new model of physiotherapy care focused on incorporating structured, supervised exercise programs into children’s CF management.

In South-Africa this management of structured supervised exercise is unfortunately not free so my advice would be to see someone who has knowledge of exercise prescriptions in CF on an ad hoc basis who can help with home programmes and tailor it accordingly. This exercise prescription should incorporate three core components: exercise testing, exercise prescription and exercise training. This person is also someone who the individual will be held accountable to and therefore will hopefully stick to the programme.

So, in summary, exercise is medicine! Make it a lifelong commitment and reap the rewards!

Susan Naude

B.Sc. Physio. Pr 0089044

(With thanks to Sean Ledger, Founder of the Great Ormond Street Frequent Flyer Programme.)

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