The Exeter Activity Unlimited statement on physical activity and exercise for cystic fibrosis: methodology and results of an international, multidisciplinary, evidence-driven expert consensus

Craig A Williams^{1

2}, Alan R Barker¹, Sarah Denford^{3

4

5}, Samantha B van Beurden⁶, Mayara S Bianchim⁷, Jessica E Caterini^{8

9}, Narelle S Cox^{10

11}, Kelly A Mackintosh¹², Melitta A McNarry¹², Sarah Rand¹³, Jane E Schneiderman^{14

15}, Greg D Wells⁸, Peter Anderson¹⁶, Daniel Beever¹⁷, Z Beverley¹⁸, Ronan Buckley¹⁹, Brenda Button^{20

21}, Adam J Causer²², Máire Curran^{23

24

25}, Tiffany J Dwyer^{26

27}, Warren Gordon¹⁶, Mathieu Gruet²⁸, Ryan A Harris²⁹, Elpis Hatziagorou³⁰, H J Erik Hulzebos³¹, Asterios Kampouras^{30

32}, Lisa Morrison³³, Marietta N Cámara^{34

35}, Clare M Reilly¹⁹, Abbey Sawyer^{36

37}, Zoe L Saynor³⁸, James Shelley¹², Grace Spencer³⁹, Gemma E Stanford^{18

40}, Don S Urquhart^{41

42}, Rachel Young⁴³, Owen W Tomlinson^{1

2}; Youth Activity Unlimited – A Strategic Research Centre of the UK Cystic Fibrosis Trust

Affiliations

¹ Children's Health and Exercise Research Centre, Sport and Health Science, 3286University of Exeter, Exeter, UK.
² Royal Devon and Exeter NHS Foundation Trust Hospital, Exeter, UK.
³ 1980Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol, Bristol, UK.
⁴ Population Health Sciences, Bristol Medical School, 1980University of Bristol, Bristol, UK.
⁵ School of Psychological Science, 1980University of Bristol, Bristol, UK.
⁶ College of Medicine and Health, 3286University of Exeter, Exeter, UK.
⁷ 7622University of Stirling, NMAHP Research Unit, University of Stirling, Stirling, UK.
⁸ Translational Medicine, The Hospital for Sick Children, Toronto, Canada.
⁹ School of Medicine, Queen's University, Kingston, Canada.
¹⁰ Respiratory Research @ Alfred, Department of Immunology and Pathology, 2541Monash University, Melbourne, Australia.
¹¹ Institute for Breathing and Sleep, Melbourne, Australia.
¹² Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, 7759Swansea University, Swansea, UK.
¹³ Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK.
¹⁴ Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.
¹⁵ Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
¹⁶ 59842Royal Hospital for Children, Glasgow, UK.
¹⁷ School of Health and Related Research, University of Sheffield, Sheffield, UK.
¹⁸ Adult Cystic Fibrosis Unit, 4964Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, London, UK.
¹⁹ National Referral Centre for Adult Cystic Fibrosis, St Vincent's University Hospital, Dublin, Republic Of Ireland.
²⁰ Faculty of Medicine Nursing and Health Sciences, 2541Monash University, Melbourne, Australia.
²¹ Department of Respiratory Medicine, 5392Alfred Health, Melbourne, Australia.
²² Department for Health, 1555University of Bath, Bath, UK.
²³ School of Allied Health, 8808University of Limerick, Limerick, Republic Of Ireland.
²⁴ University Hospital Limerick, Limerick, Republic Of Ireland.
²⁵ Health Research Institute, 8808University of Limerick, Limerick, Republic Of Ireland.
²⁶ Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
²⁷ Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.
²⁸ 27017University of Toulon, IAPS Laboratory, Toulon, France.
²⁹ Georgia Prevention Institute, Department of Medicine, 1421Augusta University, Augusta GA, United States Of America.
³⁰ Paediatric Pulmonology and CF Unit, 3rd Paediatric Department, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece.
³¹ Department of Pediatrics, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
³² Paediatric Department, 424 General Military Hospital, Thessaloniki, Greece.
³³ West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, Glasgow, UK.
³⁴ Hospital Carlos Van Buren, Department of Pediatrics, Division of Pulmonary, Cystic Fibrosis & Home Mechanical Ventilation, Valparaíso, Chile.
³⁵ School of Medicine & Postgraduate, Department of Pediatrics, 28068Universidad de Valparaíso, Viña del Mar, Chile.
³⁶ Department of Physiotherapy, University of Melbourne, Parkville, Australia.
³⁷ Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia.
³⁸ School of Sport, Health and Exercise Science, Faculty of Science and Health, 6697University of Portsmouth, Portsmouth, UK.
³⁹ 1555Department of Psychology University of Bath, Bath, UK.
⁴⁰ National Heart and Lung Institute, Imperial College, London, UK.
⁴¹ Department of Paediatric Respiratory and Sleep Medicine, 59842Royal Hospital for Children and Young People, Edinburgh, UK.
⁴² Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
⁴³ All Wales Adult Cystic Fibrosis Centre, 97605University Hospital Llandough, Llandough, UK.

PMID: 36068015
PMCID: PMC9459449
DOI: 10.1177/14799731221121670

The Exeter Activity Unlimited statement on physical activity and exercise for cystic fibrosis: methodology and results of an international, multidisciplinary, evidence-driven expert consensus

Craig A Williams et al. Chron Respir Dis. 2022 Jan-Dec.

. 2022 Jan-Dec:19:14799731221121670.

doi: 10.1177/14799731221121670.

Authors

Affiliations

¹ Children's Health and Exercise Research Centre, Sport and Health Science, 3286University of Exeter, Exeter, UK.
² Royal Devon and Exeter NHS Foundation Trust Hospital, Exeter, UK.
³ 1980Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol, Bristol, UK.
⁴ Population Health Sciences, Bristol Medical School, 1980University of Bristol, Bristol, UK.
⁵ School of Psychological Science, 1980University of Bristol, Bristol, UK.
⁶ College of Medicine and Health, 3286University of Exeter, Exeter, UK.
⁷ 7622University of Stirling, NMAHP Research Unit, University of Stirling, Stirling, UK.
⁸ Translational Medicine, The Hospital for Sick Children, Toronto, Canada.
⁹ School of Medicine, Queen's University, Kingston, Canada.
¹⁰ Respiratory Research @ Alfred, Department of Immunology and Pathology, 2541Monash University, Melbourne, Australia.
¹¹ Institute for Breathing and Sleep, Melbourne, Australia.
¹² Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, 7759Swansea University, Swansea, UK.
¹³ Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK.
¹⁴ Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.
¹⁵ Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
¹⁶ 59842Royal Hospital for Children, Glasgow, UK.
¹⁷ School of Health and Related Research, University of Sheffield, Sheffield, UK.
¹⁸ Adult Cystic Fibrosis Unit, 4964Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, London, UK.
¹⁹ National Referral Centre for Adult Cystic Fibrosis, St Vincent's University Hospital, Dublin, Republic Of Ireland.
²⁰ Faculty of Medicine Nursing and Health Sciences, 2541Monash University, Melbourne, Australia.
²¹ Department of Respiratory Medicine, 5392Alfred Health, Melbourne, Australia.
²² Department for Health, 1555University of Bath, Bath, UK.
²³ School of Allied Health, 8808University of Limerick, Limerick, Republic Of Ireland.
²⁴ University Hospital Limerick, Limerick, Republic Of Ireland.
²⁵ Health Research Institute, 8808University of Limerick, Limerick, Republic Of Ireland.
²⁶ Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
²⁷ Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.
²⁸ 27017University of Toulon, IAPS Laboratory, Toulon, France.
²⁹ Georgia Prevention Institute, Department of Medicine, 1421Augusta University, Augusta GA, United States Of America.
³⁰ Paediatric Pulmonology and CF Unit, 3rd Paediatric Department, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece.
³¹ Department of Pediatrics, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
³² Paediatric Department, 424 General Military Hospital, Thessaloniki, Greece.
³³ West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, Glasgow, UK.
³⁴ Hospital Carlos Van Buren, Department of Pediatrics, Division of Pulmonary, Cystic Fibrosis & Home Mechanical Ventilation, Valparaíso, Chile.
³⁵ School of Medicine & Postgraduate, Department of Pediatrics, 28068Universidad de Valparaíso, Viña del Mar, Chile.
³⁶ Department of Physiotherapy, University of Melbourne, Parkville, Australia.
³⁷ Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia.
³⁸ School of Sport, Health and Exercise Science, Faculty of Science and Health, 6697University of Portsmouth, Portsmouth, UK.
³⁹ 1555Department of Psychology University of Bath, Bath, UK.
⁴⁰ National Heart and Lung Institute, Imperial College, London, UK.
⁴¹ Department of Paediatric Respiratory and Sleep Medicine, 59842Royal Hospital for Children and Young People, Edinburgh, UK.
⁴² Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
⁴³ All Wales Adult Cystic Fibrosis Centre, 97605University Hospital Llandough, Llandough, UK.

PMID: 36068015
PMCID: PMC9459449
DOI: 10.1177/14799731221121670

Abstract

Background: The roles of physical activity (PA) and exercise within the management of cystic fibrosis (CF) are recognised by their inclusion in numerous standards of care and treatment guidelines. However, information is brief, and both PA and exercise as multi-faceted behaviours require extensive stakeholder input when developing and promoting such guidelines.

Method: On 30^th June and 1^st July 2021, 39 stakeholders from 11 countries, including researchers, healthcare professionals and patients participated in a virtual conference to agree an evidence-based and informed expert consensus about PA and exercise for people with CF. This consensus presents the agreement across six themes: (i) patient and system centred outcomes, (ii) health benefits, iii) measurement, (iv) prescription, (v) clinical considerations, and (vi) future directions. The consensus was achieved by a stepwise process, involving: (i) written evidence-based synopses; (ii) peer critique of synopses; (iii) oral presentation to consensus group and peer challenge of revised synopses; and (iv) anonymous voting on final proposed synopses for adoption to the consensus statement.

Results: The final consensus document includes 24 statements which surpassed the consensus threshold (>80% agreement) out of 30 proposed statements.

Conclusion: This consensus can be used to support health promotion by relevant stakeholders for people with CF.

Keywords: clinical practice; health; lifestyle; respiratory disease.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Flowchart detailing process involved in establishing consensus document. ACPCF, Association of Chartered Physiotherapists in Cystic Fibrosis; ACSM, American College of Sports Medicine; CDC, Centre for Disease Control; CF, cystic fibrosis; ECFS, European Cystic Fibrosis Society; NICE, National Institute for Health and Care Excellence; PPI, public and patient involvement; SRC, Strategic Research Centre.

See this image and copyright information in PMC

References

1. Bell SC, Mall MA, Gutierrez H, et al. The future of cystic fibrosis care: A global perspective . Lancet Respir Med, 2020. 8(1): p. 65–124. - PMC - PubMed
1. Farrell PM, Rosenstein BJ, White TB, et al. Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report . J Pediatr, 2008. 153(2): p. S4–S14. - PMC - PubMed
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The Exeter Activity Unlimited statement on physical activity and exercise for cystic fibrosis: methodology and results of an international, multidisciplinary, evidence-driven expert consensus

Affiliations

The Exeter Activity Unlimited statement on physical activity and exercise for cystic fibrosis: methodology and results of an international, multidisciplinary, evidence-driven expert consensus

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical