Feasibility and implementation of a personalized, web-based exercise intervention for people with cystic fibrosis for 1 year

Abstract

Background: Regular participation in exercise is important for people with cystic fibrosis (CF). Therefore, we implemented a personalized, web-based exercise intervention over the course of one year for people with CF. The aims were to investigate the feasibility of the intervention and to evaluate changes in exercise participation, lung function, and exercise capacity.

Methods: In total, 11/17 participants [aged 12-52 years; FEV₁%pred. 72.3 (SD: 17.3)] were included in the final data analysis. Every week, the participants received an individual training recommendation at the start and uploaded their training report on our website at the end of each week. The number of training minutes and sessions performed were analyzed over 13 four-week training sections. The participation in exercise (physical activity questionnaire), lung function and exercise capacity were assessed at baseline (T0), after 12 weeks (T1) and after 52 weeks (T2).

Results: A training duration of 178 min (SD: 75.5) and 3.3 (SD: 0.89) training sessions could be achieved weekly. In the first four-week training section, the participants performed 137.31 (SD: 95.7) minutes of training, with an increase of 42% in the third training section (195.01, SD: 134.99). Minutes of training reported on the questionnaire increased by 39.7% from T0 (179.38 min, SD: 120.9) to T1 (250.63 min, SD: 124.1) but decreased at T2 (166.88, SD: 155.4). There were slight decreases in lung function (FEV₁ - 3.9%pred.; FVC - 1.9%pred.) and slight increases in exercise capacity (VO_2peak + 1.5 ml/min/kg; six-minute-walk-test-distance + 26 m). Noticeably, five participants experienced deteriorations in their FEV₁ of more than 5% but simultaneously experienced improvements in the parameters of exercise capacity of more than 5% throughout the year.

Conclusions: The web-based concept was feasible for the participants over the course of a year and supported exercise participation. The improvement in exercise capacity due to increased exercise participation over a prolonged period of time, despite a decrease in lung function, should be further investigated. Finally, if integrated into usual care, this approach could facilitate the prescription of regular personalized exercise and promote exercise participation in the daily lives of people with CF.

Keywords: Chronic diseases; Clinical exercise therapy; Exercise prescription; Long-term intervention; Personalized telemedicine.

Fig. 1

Design and overview of the weekly feedback loop between the participants and the sports scientist. Legend. The screen in the middle of the figure shows the design of the website. Part a of the concept illustrates the initial and weekly training analysis and individual training adaptation designed by the sports scientist. Part b represents the combined training options, such as endurance training, strength training and preferred physical activities. The blue hexagon illustrates the third essential part of the program, which was feedback provided by the participants to the sports scientist via an uploaded, hand-written exercise protocol at the end of each week. Based on this protocol, the sports scientist could adapt the training load for the following week

Fig. 2

The decision strategy used to adapt the training load. Legend. After each training session, the participants rated their training session according to the perceived discomfort (0–10) and perceived exertion (0–10). RPD was divided into low (0–3), moderate (4–6) and high (7–10). RPE was also divided into three categories: very light to moderate (0–6), vigorous (7), and hard to maximum effort (8–10). Arrows in the last line illustrate the training load adaptation for each of the nine possible parameter combinations. This decision strategy originated from and the figure is adapted from [18]

Fig. 3

Modified walking test protocol performed on a treadmill during cardiopulmonary exercise testing

Fig. 4

Exercise participation of each participant over the course of the 52 weeks of the intervention. Legend. a illustrates training time (min/week) in combination with performed exercise types and METs for each participant. METs, metabolic equivalents (1 MET = 3.5 male; = 3.15 VO₂ (ml/min/kg)). METs for each exercise type are in accordance with [24]. b Illustrates the mean performed training sessions per week during the intervention. c Shows the active training weeks from the intended 52 week of intervention

Fig. 5

Mean training minutes per four-week training section (95% confidence intervals)

Fig. 6

Mean training sessions per four-week training section (95% confidence intervals)

Fig. 7

Changes in VO_2peak and 6MWTD from T0 to T1 to T2 for each participant. Legend. T0, baseline assessment; T1, assessment after 12 weeks; T2, assessment after 52 weeks; VO_2peak = oxygen ventilation at maximum work rate (ml/min/kg); 6MWTD = six-minute walk test distance (m)

Fig. 8

Changes in FEV_1, and FVC from T0 to T1 to T2 for each participant. Legend. T0, baseline assessment; T1, assessment after 12 weeks; T2, assessment after 52 weeks; FEV₁ = forced expiratory volume in one second (percent predicted); FVC = forced vital capacity (percent predicted)