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. 2022 Dec 19:2:64.
doi: 10.3310/nihropenres.13347.1. eCollection 2022.

Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial

Don S Urquhart  1   2 , Steve Cunningham  1   2   3 , Emily Taylor  1   2 , Ioannis Vogiatzis  4 , Lorna Allen  5 , Steff Lewis  6 , Aileen R Neilson  6 , Dia Soilemezi  7 , Naseerah Akooji  6 , Zoe L Saynor  8   9
Affiliations

Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial

Don S Urquhart et al. NIHR Open Res. .

Abstract

Background: Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The 'ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis' trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability.

Methods: Multi-centre, two-arm, randomised (1:1 allocation using minimisation), pilot trial at two sites. Fifty pwCF (≥10 years, FEV 1 >40% predicted, stable on Elexacaftor/Tezacaftor/Ivacaftor (ETI)) will be randomised to an individually-customised ExACT programme (≥once daily aerobic exercise of ≥20-minutes duration at an intensity that elicits deep breathing, with huffs and coughs), or usual care. After baseline assessments, secondary outcomes will be assessed after 28-days, with additional home lung function and exacerbation questionnaires at 7, 14 and 21-days, physical activity and sleep monitoring throughout, and embedded qualitative and health-economic components. Feasibility measures include recruitment, retention, measurement completion, adverse events, interviews exploring the acceptability of trial procedures, and a trial satisfaction questionnaire.

Discussion: Co-designed with the UK CF community, the ExACT-CF pilot trial is the first multi-centre RCT to test the feasibility of recruiting pwCF stable on ETI into a trial investigating ExACT. This pilot trial will inform the feasibility, design, management, likely external validity for progression to a main phase randomised controlled trial.

Registration: Clinicaltrials.gov ( NCT05482048).

Keywords: airway clearance therapy; cystic fibrosis; exercise; feasibility; physical activity; physiotherapy; randomised controlled trial.

Plain language summary

Cystic fibrosis (CF) is the UK’s most common inherited genetic condition and affects > 10,500 people. CF causes problems with the movement of salt and water in the body, resulting in sticky mucus building up, mostly in the lungs and gut. Thick mucus in the airways leads to repeated infections which can damage the lungs. Chest physiotherapy is routinely prescribed to keep pwCF healthy, by loosening and clearing sticky, thick mucus from the airways. However, many find it time-consuming and burdensome. People with CF (pwCF) have asked if doing exercise could have the same effect for clearing mucus. Surveys show that many pwCF have occasionally replaced chest physiotherapy with exercise for airway clearance. We also showed that many pwCF, their families, physiotherapists and doctors in the UK consider that hard exercise with huffs and coughs may be able to clear mucus from the airways. We now need to know if they would be willing to take part in research that asks some to stop chest physiotherapy and do intense exercise with huffs and coughs instead. We will study 50 pwCF (> 10 years old) for 28 days. We will ask half to continue their usual care, and half to stop chest physiotherapy and do exercise that gets them breathing deeply (with huffs and coughs) instead. We will see if people are willing to start and continue with such a study and what they think of the processes. We will also see how stopping chest physiotherapy and replacing it with exercise affects measurements of their lung function. Within the study we will talk with pwCF and members of their CF team to understand their experiences. This information will tell us whether a larger study can answer whether certain forms of exercise can safely be used as an alternative to chest physiotherapy.

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Conflict of interest statement

No competing interests were disclosed.There are no conflicts of interests for to declare for this trial.

Figures

Figure 1.
Figure 1.. The ExACT intervention – guidance on how to undertake an ExACT session and a compendium of suggested ExACT activities.
N.B. The exercise airway clearance therapy intervention to be used in this study was co-developed in collaboration with the UK-based cystic fibrosis community , and further refined with the support from a global group of physiotherapists.
Figure 2.
Figure 2.. SPIRIT overview or enrolment, interventions, and assessments.
N.B. BMI, body mass index; ExACT, exercise as an airway clearance technique; FEV 1, forced expiratory volume in 1 second; FVC, forced vital capacity; LCI, lung clearance index; PA, physical activity.
See this image and copyright information in PMC

References

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