None listed
Conditions
Brief summary
Physical activity is recognised as an essential component of maintenance of respiratory health in cystic fibrosis (CF), and delivery of exercise education is a critical component of physiotherapy care. Reduced exercise capacity is associated with a decline in respiratory function and survival in people with CF. In both short and long-term studies, regular exercise has been demonstrated to decrease the annual decline in lung function in people with CF. Continued innovative approaches to prompt both exercise and activity participation and adherence at home for adults with cystic fibrosis is required. Group based exercise training is established as the gold standard in people with COPD resulting in reduced symptoms, improved quality of life outcomes, increased exercise capacity, reduced exacerbations and the prevention of hospital exacerbations. The current COVID-19 pandemic has already prompted a shift to ‘virtual’ models of care delivery within CF centres. People with CF are currently, and for the foreseeable future, receiving decreased routine face to face outpatient appointments at hospitals. This current change to care delivery minimises opportunities to offer exercise training for this cohort of patients. Home based tele-rehabilitation group exercise programs have been shown to improve exercise capacity in patients with COPD and other chronic diseases. A systematic review of telehealth in cystic fibrosis highlighted the potential to provide both physical activity and exercise programmes. Exercise sessions of 30 minutes, three times a week over six weeks offered via a virtual platform to children with CF demonstrated participation rates of 85%. The program was found to be a convenient and accessible method of encouraging physical activity and participants reported positive feedback regarding joining a group supervised class. Tomlenson et al ( 2019) examined the feasibility and acceptability of online exercise sessions using telehealth in nine adults with CF to engage patients in individualised exercise programs 2 -3 times a week 20. The participants successfully participated in the classes, rating satisfaction with the virtual training at 9/10, while compliance with sessions was 68%. Whilst these studies suggest that online training is feasible, questions remain regarding the applicability of the outcomes to the cohort of patients provided with care by TPCH Adult Cystic Fibrosis centre (ACFC). The large number of patients receiving care by this centre (over 300) is prohibitive to offering all patients individualised exercise classes. Delivery of 1-on-1 exercise training is labour intensive and expensive. Rapid improvements in survival of people with CF is expected to result in increased demand on physiotherapy services, which will outstrip service capacity. Consequently, alternate, scalable models of delivering exercise training are required.
Interventions
Pulmonary rehab is already a well-established treatment modality for patients with chronic respiratory disease. Traditionally, it has been offered in a face-to-face class environment however due to the risk of cross infection, this cannot occur in a CF population. While there is research supporting the benefits of a pulmonary rehabilitation program virtually, this has not been explored with this demographic of patients.
Subsequently, the aim of this study is to evaluate the feasibly and patient
Pulmonary rehab is already a well-established treatment modality for patients with chronic respiratory disease. Traditionally, it has been offered in a face-to-face class environment however due to the risk of cross infection, this cannot occur in a CF population. While there is research supporting the benefits of a pulmonary rehabilitation program virtually, this has not been explored with this demographic of patients. Subsequently, the aim of this study is to evaluate the feasibly and patient engagement with two models of interactive online exercise classes to deliver and promote exercise in adults with Cystic Fibrosis, and patient perceptions of this intervention. Setup required for the program will require a computer, tablet or mobile device with internet connection. A pilates mat or weights may be required however it will be ensured all participants have access to these prior to commencing the study. The exercise classes in both models will be conducted by the CF physiotherapist. The level of intensity will be monitored by modifed BORG however all patients will be encouraged to self pace during the session based on their own exercise tolerance. The sessions will be 40minutes in length including the warm up and cool down for both exercise models. The duration of the intervention will be 8 weeks with sessions occurring 2x/wkly with a 3rd independent exercise session encouraged. The exercises prescribed to all participants will be standardised however they progressions will be provided for patients for them to choose based on their exercise capacity (eg. sit to stand OR squats OR jump squats). Adherence of the exercise session will be marked on attendance via role call for the traditional model of pulmonary rehab and questionaire for the independent exercise package. The models of interactive exercise that will be used are a virtual exercise class that occurs in real time with 6 patients and 1 physiotherapist via telehealth. The second model of online exercise class will be an independent package where the patients recruited to this model will be provided with videos for exercise sessions that they will complete independently, un-supervised, in their own time
Sponsors
The Prince Charles Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Patients >18 years of age serviced by the ACFC at The Prince Charles Hospital with a diagnosis of gene confirmed cystic fibrosis. - RFT’s 30-70% predicted FEV1
Exclusion criteria
- Severe pulmonary disease (RFT’s <30% FEV1) - Mild pulmonary disease (RFT’s >70% predicted FEV1 ) - Use of domiciliary oxygen therapy - Unable to perform exercise as determined by the medical and/or physiotherapy team - Death is deemed imminent or the patient is actively being palliated - Patients/NOK on patients behalf do not consent to participate
Outcome results
None listed