Evaluating a telehealth exercise model of care for adults with Cystic Fibrosis: A feasibility randomised controlled trial

Participants randomised to the intervention group will be allocated to the new telehealth model of care. In this model of care, participants will be given a choice of participating in either an independent exercise program with weekly check in sessions from a physiotherapist (Option A) or a live supervised group exercise program (Option B). The duration of both intervention groups will be 12 weeks. Participants in both intervention groups will be provided with an exercise diary and asked to record their exercise participation throughout the program. Participants will also have access to a peer support messaging group for the duration of the 12-week program. Option A: Independent Exercise program with weekly check in sessions - Participants will attend an Initial telehealth video session (at baseline, week 0) with a physiotherapist who will discuss the participant's exercise preferences and set initial goals. The physiotherapist will provide the participant with an individually tailored exercise program based on their exercise preferences and goals during this initial session. -The individually tailored exercise program will include a combination of cardiovascular exercise (eg. walking, jogging, or cycling) and strength or flexibility training exercises. The exercise training intensity for each participant will be individualised to each participant based on the current CF exercise guidelines which recommend that people with CF should exercise to approximately 75% of their maximum heart rate. The maximum heart rate recorded during the participant's exercise test completed during initial participant assessment (at baseline, week 0) will be used to calculate 75% of the participant's maximum heart rate. The participant's will be educated on how to manually take their own heart rate during exercise (via peripheral pulse rate) or they may choose to use a wearable exercise tracker device if they already own one. - The telehealth video sessions will be conducted via the Alfred Hospital Health Direct platform which participants may have some experience using for their usual Cystic Fibrosis (CF) outpatient care. The participant will be sent a link to access this platform via text message or email. - Weekly check in sessions will be provided to the participant by a CF Physiotherapist via telephone call, text messaging, or email based on the participant’s preference. The purpose of these check ins will be to review the participant’s progress with their exercise program and adjust exercise prescription if required on an individual basis. - Participants can also request an individual telehealth video review with the physiotherapist at any time during the program to review their exercise program. Option B: Live supervised telehealth group exercise program - Participants will attend a live supervised telehealth group exercise program via Zoom two times per week run by a CF Physiotherapist. - The Alfred Hospital Zoom account will be used for this group. - Each participant will complete their own individual, tailored exercise program during the telehealth sessions after a shared group warm up. The exercise program will be tailored to the individual participant based on their exercise preferences and goals which will be discussed with the participant at their baseline assessment (week 0) in person. - Each session will be sixty minutes in duration, with participants completing approximately 50 minutes of exercise training including warm up (10 minutes), individual strength training program (30 minutes) and stretching exercises (10 minutes), and 10 minutes of optional peer support at the end of the session. - Participants will be able to choose the timing of the exercise session that best suits their schedule and lifestyle from a selection of options. There will be options for day time and evening sessions. - During the session the physiotherapist will record the participant’s exercise program in an exercise recording sheet and monitor them using modified BORG shortness of breath (SOB) and rate of perceived exertion (RPE) scales. - Additional information such as heart rate and Spo2 may be collected if participants have access to this information such as their own wearable fitness tracker device or portable oximeter. - The exercise recording sheet will be recorded in the patient’s electronic medical record. Exercise Diary: All participants in the intervention group will be asked to complete an exercise diary for the duration of the 12-week telehealth exercise intervention. Participants will be given an exercise diary based on the exercise intervention that they select. Participants will be asked to record their exercise participation in symptoms including any adverse events related to exercise participation. The exercise diary will be personalised to the individual participant based on the participant's preferences identified in the initial assessment and individual exercise prescription. All participants will be asked to record the amount of cardiovascular exercise completed each day, and completions of other exercises (eg. individual strength or flexibility training exercises). They will also be asked to record their shortness of breath using a modified BORG scale and their rate of perceived exertion using RPE scales. Additional information such as heart rate and Spo2 may be collected if participants have access to this information such as their own wearable fitness tracker or portable oximeter. Peer Support Group: - Participants in the intervention group will be given the option to sign up for an online peer support messaging group. This is a key component of the telehealth model of care that was requested by participants during the previous focus group study. - This group will be a private group in Microsoft Teams and will be moderated by the student investigator. - A private channel will be created by the student investigator using an Alfred Health log in on Microsoft Teams. - Participants will only be able to join this team through individual email invitations from the student investigator. - The privacy settings will be set up in Microsoft teams to ensure that participants are unable to invite other people to join the peer support group. - Participants will be able to create “posts” and reply to each other within the Microsoft Teams group. - Participants will be able to delete their own posts, but will not be able to delete posts from other participants. The student investigator will moderate the peer support group and have the ability to delete all participant posts if required.