Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Dec 13;2013(12):CD009448.
doi: 10.1002/14651858.CD009448.pub2.

Interventions for promoting physical activity in people with cystic fibrosis

Narelle S Cox  1 , Jennifer A Alison, Anne E Holland
Affiliations
Meta-Analysis

Interventions for promoting physical activity in people with cystic fibrosis

Narelle S Cox et al. Cochrane Database Syst Rev. .

Abstract

Background: In individuals with cystic fibrosis there are no established targets for participation in physical activity, nor have any ideal strategies to promote participation in physical activity been identified

Objectives: To evaluate the effect of treatment to increase participation in physical activity in people with cystic fibrosis.

Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register using the terms 'physiotherapy and exercise'.Date of the most recent search: 05 December 2013.Additionally, we conducted searches of the electronic databases MEDLINE, CINAHL (Ebscohost), PsycINFO (OvidSP) and the Physiotherapy Evidence Database (PEDro). We also searched for potentially relevant, completed but unpublished studies, on several clinical trials registers.Date of the most recent searches: 10 September 2012.

Selection criteria: All randomised and quasi-randomised controlled studies which investigated strategies designed to promote increased participation in daily physical activity for individuals with cystic fibrosis.

Data collection and analysis: Two authors independently selected studies for inclusion, assessed the risk of bias and extracted data. Any disagreements were resolved by discussion and consensus, or in arbitration with a third author.

Main results: Four studies (199 participants) met the inclusion criteria and were predominantly conducted in children with cystic fibrosis. Only one study had a combined cohort of adult and paediatric participants. The description of study methods was inadequate to assess the risk of bias, particularly with regard to blinding of assessors and selective reporting. One study was conducted in an inpatient setting with follow up in the outpatient setting; while the remaining three studies were conducted in individuals with stable respiratory disease in the outpatient setting. All included studies used exercise training to promote participation in physical activity, with the duration of the intervention period ranging from 18 days to three years. No improvement in physical activity participation was reported with any intervention period less than or equal to six months. Improvements in physical activity participation were only seen where follow up occurred beyond 12 months. There was no significant impact on quality of life from any of the intervention strategies.

Authors' conclusions: Although participation in physical activity is generally regarded as beneficial for people with cystic fibrosis, there is a lack of evidence regarding strategies to promote the uptake and the continued participation in physical activity for this population. This review provides very limited evidence that activity counselling and exercise advice, undertaken over at least six months, to engage in a home exercise programme may result in improved physical activity participation in people with cystic fibrosis. Further research is needed to determine the effect of strategies such as health coaching or telemedicine applications, in promoting the uptake and adherence to regular participation in physical activity. In addition, establishing the ideal duration of any interventions that promote physical activity, including exercise training programmes, will be important in addressing issues relating to participation in physical activity for people with cystic fibrosis.

PubMed Disclaimer

Conflict of interest statement

Narelle Cox has received a PhD stipend from the National Health and Medical Research Council (NH&MRC), Australia. This review forms a part of those PhD studies. The NH&MRC will not interfere with the independence of the authors in regard to the conduct of the review and will not delay or prevent publication of the review.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Supervised exercise training compared to no intervention, Outcome 1: Participation in physical activity (MJ/day)
1.2
1.2. Analysis
Comparison 1: Supervised exercise training compared to no intervention, Outcome 2: Change in quality of life
1.3
1.3. Analysis
Comparison 1: Supervised exercise training compared to no intervention, Outcome 3: Change in exercise capacity (ml/kg/min)
1.4
1.4. Analysis
Comparison 1: Supervised exercise training compared to no intervention, Outcome 4: Change in FEV1 (% predicted)
1.5
1.5. Analysis
Comparison 1: Supervised exercise training compared to no intervention, Outcome 5: Change in FVC (% predicted)
1.6
1.6. Analysis
Comparison 1: Supervised exercise training compared to no intervention, Outcome 6: Change in fat‐free mass (kg)
2.1
2.1. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 1: Annual rate of change in exercise capacity (ml/kg/min) (follow up > 6 months)
2.2
2.2. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 2: Annual rate of decline FEV1 (% predicted) (follow up > 6 months)
2.3
2.3. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 3: Change in FEV1 (% predicted)
2.4
2.4. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 4: Annual rate of decline FVC (% predicted) (follow up > 6 months)
2.5
2.5. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 5: Annual rate of decline FEF25-75 (% predicted) (follow up > 6 months)
2.6
2.6. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 6: Change in lean body mass (kg)
2.7
2.7. Analysis
Comparison 2: Unsupervised exercise training compared to no intervention, Outcome 7: Change in skin fold measure (mm)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Hebestreit 2010 {published and unpublished data}
    1. Hebestreit H, Kieser S, Junge S, Ballmann M, Hebestreit A, Schindler C, et al.Long-term effects of a partially supervised conditioning programme in cystic fibrosis. European Respiratory Journal 2010;35(3):578-83. - PubMed
Klijn 2004 {published data only (unpublished sought but not used)}
    1. Klijn PH, Oudshoorn A, Ent CK, Net J, Kimpen JL, Helders PJ.Effects of anaerobic training in children with cystic fibrosis: a randomized controlled study. Chest 2004;125(4):1299-305. 5500100000002558 - PubMed
Schneiderman‐Walker 2000 {published data only (unpublished sought but not used)}
    1. Reisman JJ, Schneiderman-Walker J, Corey M, Wilkes D, Pedder L, Levison H, et al.The role of an organized exercise program in cystic fibrosis - a three year study [abstract]. Pediatric Pulmonology 1995;Suppl 12:261. 5500100000001555
    1. Schneiderman-Walker J, Pollock SL, Corey M, Wilkes DD, Canny GJ, Pedder L, et al.A randomized controlled trial of a 3-year home exercise program in cystic fibrosis. Journal of Pediatrics 2000;136(3):304-10. - PubMed
Selvadurai 2002 {published data only (unpublished sought but not used)}
    1. Selvadurai HC, Blimkie CJ, Meyers N, Mellis CM, Cooper PJ, Van Asperen PP.Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis. Pediatric Pulmonology 2002;33(3):194-200. - PubMed
    1. Selvadurai HC, Van Asperen PP, Cooper PJ, Mellis CM, Blimkie CJ.A randomised controlled study of in-hospital exercise training programs in children with cystic fibrosis (CF) [abstract]. Pediatric Pulmonology 1999;Suppl 19:287-8. - PubMed

References to studies excluded from this review

Bernard 2004 {published data only}
    1. Bernard RS and Cohen LL.Increasing adherence to cystic fibrosis treatment: A systematic review of behavioral techniques. Pediatric Pulmonology 2004;37(1):8-16. - PubMed
Gulmans 1999 {published data only}
    1. Gulmans VAM, Meer K, Brackel HJL, Faber JAJ, Berger R, Helders PJM.Outpatient exercise training in children with cystic fibrosis: Physiological effects, perceived competence and acceptability. Pediatric Pulmonology 1999;28:39-46. - PubMed
Hind 2008 {published data only}
    1. Hind K, Truscott JG, Conway SP.Exercise during childhood and adolescence: a prophylaxis against cystic fibrosis-related low bone mineral density? Exercise for bone health in children with cystic fibrosis. Journal of Cystic Fibrosis 2008;7(4):270-6. - PubMed
Kuys 2011 {published data only}
    1. Hall K, Peasey M, Wood M, Cobb R, Bell SC, Kuys S.The effects of Nintendo Wii® exercise training in adults with cystic fibrosis [abstract]. Journal of Cystic Fibrosis 2010;9(Suppl 1):S71, Abstract no: 275.
    1. Kuys SS, Hall K, Peasey M, Wood M, Cobb R, Bell SC.Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis: a randomised crossover trial. Journal of Physiotherapy 2011;57(1):35-40. - PubMed
Moorcroft 2004 {published data only}
    1. Dodd ME, Moorcroft AJ, Webb AK.Improved fitness and decreased symptoms of muscle fatigue for upper and lower body following an individualised unsupervised home exercise training programme in adults with cystic fibrosis [abstract]. Pediatric Pulmonology 1998;Suppl 17:347.
    1. Moorcroft AJ, Dodd ME, Morris J, Webb AK.Individualised unsupervised exercise training in adults with cystic fibrosis: a 1 year randomised controlled trial. Thorax 2004;59(12):1074-80. - PMC - PubMed
    1. Moorcroft AJ, Dodd ME, Webb AK.Individualised home exercise training in cystic fibrosis - a one-year trial [abstract]. In: Proceedings of the 13th International Cystic Fibrosis Congress. 2000:153.
Orenstein 1981 {published data only}
    1. Orenstein DM, Franklin BA, Doershuk CF, Hellerstein HK, Germann KJ, Horowitz JG, et al.Exercise conditioning and cardiopulmonary fitness in cystic fibrosis. The effects of a three-month supervised running program. Chest 1981;80(4):392-8. - PubMed
Petrovic 2013 {published data only}
    1. Petrovic M, Kaluza I, Pohl W.Effects of individualised aerobic exercise training in adults with cystic fibrosis: A 4 year controlled trial [abstract]. Journal of Cystic Fibrosis 2013;12 Suppl 1:S28, Abstract no: WS14.4. 5500100000011658
Sosa 2012 {published data only}
    1. Sosa ES, Groeneveld IR, Gonzalez-Saiz L, Lopez-Mojares LM, Villa-Asensi JR, Barrio Gonzalez MI, et al.Intrahospital weight and aerobic training in children with cystic fibrosis: A randomized controlled trial. Medicine and science in sports and exercise 2012;44(1):2-11. - PubMed
Swisher 2010 {published data only}
    1. Swisher AK, Moffett K.The effect of coaching on physical activity and quality of life in children and adolescents with cystic fibrosis: a quality improvement pilot study. http://ijahsp.nova.edu/articles/Vol8Num2/pdf/swisher.pdf (The Internet Journal of Allied Helath Sciences and Practice) (accessed 16 November 2012).
Tunzin 1998 {published data only}
    1. Tuzin BJ, Mulvihill MM, Kilbourn KM, Bertran DA, Buono M, Hovell MF, et al.Increasing physical activity of children with cystic fibrosis: a home-based family intervention. Pediatric Exercise Science 1998;10(1):57-68.
van Doorn 2010 {published data only}
    1. Doorn N.Exercise programs for children with cystic fibrosis: a systematic review of randomized controlled trials. Disability and Rehabilitation 2010;32(1):41-9. - PubMed

References to studies awaiting assessment

Alarie 2013 {published data only}
    1. Alarie N, Agnew LL, McIlwaine MP, Ratjen F, Davidson GF, Milner R, et al.Evaluation of physical activity using the habitual activity estimation scale (HAES) questionnaire in a multicenter study [abstract]. Journal of Cystic Fibrosis 2013;12 Suppl 1:S28, Abstract no: WS14.1. 5500100000011657
Marostica 2012 {published data only}
    1. Marostica PJ, Hommerding P, Makarewicz G, Baptista R, Donadio MV.Efficacy of an educational intervention of physical activity for children and adolescents with cystic fibrosis [abstract]. Journal of Cystic Fibrosis 2012;11 Suppl 1:S36. - PubMed

Additional references

ABS 2012
    1. Australian Bureau of Statistics.Australian Health Survey: First Results 2011-2012. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.001main+feature... (accessed 28 November 2013).
Andersen 1998
    1. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M.Relationship of physical activity and television watching with body weight and level of fatness among children. JAMA 1998;279(12):938-42. - PubMed
Bradley 2008
    1. Bradley JM, Moran F.Physical training for cystic fibrosis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No: CD002768. [DOI: 10.1002/14651858.CD002768.pub2] - DOI - PubMed
Bradley 2010
    1. Bradley JM, Kent L, Elborn JS, O'Neill B.Motion sensors for monitoring physical activity in cystic fibrosis: what is the next step? Physical Therapy Reviews 2010;15(3):197-203.
Brodie 2005
    1. Brodie DA, Inoue A.Motivational interviewing to promote physical activity for people with chronic heart failure. Journal of Advanced Nursing 2005;50(5):518-27. - PubMed
Casparen 1985
    1. Casparen CJ, Powell KE, Christenson GM.Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports 1985;100(2):126-31. - PMC - PubMed
CDC 2011
    1. US Department of Health and Human Services Centers for Disease Control and Prevention.Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase Physical Activity in the Community. http://www.cdc.gov/obesity/downloads/PA_2011_WEB.pdf (accessed 28 November 2013).
Clanchy 2011
    1. Clanchy KM, Tweedy SM, Boyd R.Measurement of habitual physical activity performance in adolescents with cerebral palsy: a systematic review. Developmental Medicine and Child Neurology 2011;53(6):499-505. - PubMed
Conn 2008
    1. Conn VS, Hafdahl AR, Brown SA, Brown LM.Meta-analysis of patient education intervention to increase physical activity among chronically ill adults. Patient Education and Counselling 2008;70:157-72. - PMC - PubMed
Dwyer 2011
    1. Dwyer TJ, Alison JA, McKeough ZJ, Daviskas E, Bye PTP.Effects of exercise on respiratory flow and sputum properties in patients with cystic fibrosis. Chest 2011;139(4):870-7. - PubMed
Eakin 2007
    1. Eakin EG, Lawler SP, Vandelanotte C, Owen N.Telephone Interventions for Physical Activity and Dietary Behavior Change: A systematic review. American Journal of Preventative Medicine 2007;32(5):419-34. - PubMed
Foster 2005
    1. Foster C, Hillsdon M, Thorogood M.Interventions for promoting physical activity. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No: CD003180. [DOI: 10.1002/14651858.CD003180.pub2] - DOI - PMC - PubMed
Haskell 2007
    1. Haskell WL, Lee I-M, Pate RR, Powel KE, Blair SN, Franklin BA, et al.Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise 2007;39(8):1423-34. - PubMed
Hebestreit 2006
    1. Hebestreit H, Kieser S, Rüdiger S, Schenk T, Junge S, Hebestreit A, et al.Physical activity is independently related to aerobic capacity in cystic fibrosis. European Respiratory Journal 2006;28(4):734-9. - PubMed
Henry 2003
    1. Henry B, Aussage P, Grosskopf C, Goehers JM.Development of the Cystic Fibrosis Questionnaire (CFQ) for Assessing Quality of Life in Pediatric and Adult Patients. Quality of Life Research 2003;12(1):63-76. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors).Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Kahn 2002
    1. Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, et al.The effectiveness of interventions to increase physical activity: A systematic review. American Journal of Preventive Medicine 2002;22(4 Suppl):73-107. - PubMed
Koch 1993
    1. Koch C, Høiby N.Pathogenesis of cystic fibrosis. Lancet 1993;341(8852):1065-9. - PubMed
Lacasse 2006
    1. Lacasse Y, Goldstein R, Lasserson TJ, Martin S.Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No: CD003793. [DOI: 10.1002/14651858.CD003793.pub2] - DOI - PubMed
Marcus 2000
    1. Marcus BH, Forsyth LH, Stone EJ, Dubbert PM, McKenzie TL, Dunn AL, et al.Physical activity behavior change: issues in adoption and maintenance. Health Psychology 2000;19(1 Suppl):32-41. - PubMed
Moy 2012
    1. Moy ML, Weston NA, Wilson EJ, Hess ML, Richardson CR.A pilot study of an Internet walking program and pedometer in COPD. Respiratory Medicine 2012;106(9):1342-50. - PubMed
Nguyen 2009
    1. Nguyen HQ, Gill DP, Wolpin S, Steele BG, Benditt JO.Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD. International Journal of Chronic Obstructive Pulmonary Disease 2009;4:301-13. - PMC - PubMed
Pate 1995
    1. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al.Physical Activity and Public Health. JAMA 1995;273(5):402-7. - PubMed
Quittner 2009
    1. Quittner AL, Modi AC, Wainwright C, Otto K, Kirihara J, Montgomery AB.Determination of the Minimal Clinically Important Difference Scores for the Cystic Fibrosis Questionnaire-Revised Respiratory Symptom Scale in Two Populations of Patients With Cystic Fibrosis and Chronic Pseudomonas aeruginosa Airway Infection. Chest 2009;135(6):1610-8. - PMC - PubMed
RevMan 2011 [Computer program]
    1. Review Manager (RevMan).Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Rimmer 2004
    1. Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J.Physical activity participation among persons with disabilities: Barriers and facilitators. American Journal of Preventive Medicine 2004;26(5):419-25. - PubMed
Saiman 2004
    1. Saiman L, Seigel J.Infection control in cystic fibrosis. Clinical Microbiology Reviews 2004;17(1):57-71. - PMC - PubMed
Schmidt 2009
    1. Schmidt A, Wenninger K, Niemann N, Wahn U, Staab D.Health-related quality of life in children with cystic fibrosis: validation of the German CFQ-R. Health and Quality of Life Outcomes 2009;7:97-106. - PMC - PubMed
Schneiderman‐Walker 2005
    1. Schneiderman-Walker J, Wilkes DL, Strug L, Lands LC, Pollock SL, Selvadurai HC, et al.Sex differences in habitual physical activity and lung function decline in children with cystic fibrosis. Journal of Pediatrics 2005;147(3):321-6. - PubMed
Thompson 2003
    1. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK.Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Arteriosclerosis, Thrombosis, and Vascular Biology 2003;23(8):e42-e49.
Troosters 2009
    1. Troosters T, Langer D, Vrijsen B, Segers J, Wouters K, Janssens W, et al.Skeletal muscle weakness, exercise tolerance and physical activity in adults with cystic fibrosis. European Respiratory Journal 2009;33(1):99-106. - PubMed
Trost 2005
    1. Trost SG, McIver KL, Pate RR.Conducting Accelerometer-Based ActivityAssessments in Field-Based Research. Medicine and Science in Sports and Exercise 2005;37(11 Suppl):S531-S543. - PubMed
Vandelanotte 2007
    1. Vandelanotte C, Spathonis KM, Eakin EG, Owen N.Website-Delivered Physical Activity Interventions. American Journal of Prevenative Medicine 2007;33(1):54-64. - PubMed
van Sluijs 2007
    1. Sluijs EMF, McMinn AM, Griffin SJ.Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ 2007;335(7622):703-7. - PMC - PubMed
Wenninger 2003
    1. Wenninger K, Aussage P, Wahn U, Staab D, German CFQ study group.The revised German Cystic Fibrosis Questionnaire: validation of a disease-specific health-related quality of life instrument. Quality of Life Research 2003;12(1):77-85. - PubMed
WHO 2010
    1. WHO.Global recommendations for physical activity and health. Geneva: WHO Library Cataloguing-in-Publication Data, 2010. [ISBN: 978 924159 9979]
Yankaskas 2004
    1. Yankaskas JR, Marshall BC, Sufian B, Simon RH, Rodman D.Cystic fibrosis adult care. Consensus conference report. Chest 2004;125(Suppl 1):1-39. - PubMed

Publication types