Winter 2001 - Newsletter

Sports & Exercise

Newsletter Navigation:

Quick Navigation:

   Site Map

   Contact Us

   Sign Our Guest Book

   View Our Guest Book

   Donate to the CFF

Do Patients with Cystic Fibrosis Need to Exercise?

by Charlie Law, M.D. and Jane Burton Keith, PT/OT

Cystic Fibrosis is the most common inherited life-shortening disease among white populations.  The most important clinical aspects of CF are progressive bronchiolar and bronchial obstruction, infection, and fibrosis.  The prognosis for patients with CF has greatly improved over the last few decades with many patients living into their 40's as compared to a median life expectancy of 10 years in 1968.  Much of the improved prognosis can be attributed to improved medical care, but at least part of the improvement is related to patients with CF participating in a healthier, active lifestyle.  Exercise has positive effects on mucus clearance, endurance, fatigue, and development of osteoporosis.  These positive effects lead to an improved overall sense of well being which in turn leads to a more active, healthy lifestyle.

One of the primary management goals in CF patients is removing the purulent secretions from the airways.  Chest physiotherapy is typically the mainstay in doing this.  Forced expiration has also been found to be helpful.  There are also studies that document that regular exercise is helpful in clearing secretions.  Exercise is not as helpful as chest physiotherapy and therefore should not be used as a substitute.

Two of the more common complaints of patients with CF are poor endurance and easy fatigability.  This is especially true later in the disease process when pulmonary function is declining.  Exercise probably does not change specific (FEV1) pulmonary parameters, but it does improve oxygen consumption (endurance).  Oxygen consumption is a measure of how much oxygen you are able to use in a given period of time.  In a study of 93 adolescents and young adults who exercised regularly it was shown that their pulmonary function (measured by FEV1) declined an average of 16% over 5 years.

There is less medical literature to support it, but many authors believe that regular exercise also improves immune function.  This is definitely true in the general population.  In one recent study of 15 children with CF, the immune response to exercise was measured.  At one-hour post exercise, the children with CF had similar response to the non-effected control group.  This should be helpful in the body's fight against infection. 

Another physical benefit of exercise includes enhancing weight gain.  Even though exercise burns calories, it also stimulates the appetite.  So weight loss should not be of concern for those who are already thin.  Also, muscle weighs more than fat, so with a weight-training program, you can tone your muscles, increasing muscle mass and gain weight.  (Strauss, et. al, 1987).

We are beginning to discover more about the problems of Cystic Fibrosis and osteoporosis.  Another benefit of exercise is its role in the fight against osteoporosis.  Physical activity helps to encourage the growth of strong bones.  The more weight-bearing the activity is, the better it is for your bones.  So activities like walking and running are better than swimming or biking, although all are good for overall fitness purposes!

Finally, exercise aids in increasing your overall sense of well-being.  Doctors actually prescribe exercise for their patients with depression because of its mood elevating benefits.  How you feel about yourself emotionally is directly linked to how you feel physically.  Also, being physically fit enables you to keep up with your peers and be involved in social activities.

We've talked to you about why it is important to exercise; now it is time to give you some practical suggestions about exercise.  We have alluded to different types of exercise -- strength training and aerobic.  Strength training is the use of weights to increase strength and muscle mass.  It can be free weights, weight machines, or mat work (like sit-ups, push-ups, etc).  There are different types of strength training protocols designed to increase muscle strength without stressing or causing the muscle harm.  There is also aerobic activity.  Aerobic means "with oxygen."  So any type of activity that increases your heart rate and respiratory rate can be aerobic: walking, running, swimming, cheerleading, jump roping, walking the dog, etc.  It is suggested to perform aerobic activity 3 - 5 times per week, building up to 30 minutes at a time and spending at least 20 minutes at your target heart rate.  Your target heart rate is the ideal heart rate to achieve during exercise; your doctor or PT can help you figure this out).  You should be exercising hard enough to be out of breath, but no so hard that its impossible to carry on a conversation.

One of the most important types of exercise is not really an exercise in itself, but simply living an active lifestyle.  So instead of letting the dog out in the backyard, take him for a walk; instead of getting the mail as you drive in the driveway, walk from the house to get it; instead of waiting for the closest parking place at the mall, park in the back and walk; take the stairs instead of the elevator...you get the idea!

Some keys to a success exercise program are:

• Understanding why exercise is important

• Get involved!

• Make it a social affair

• Set small, manageable goals for yourself, so that you don't become discouraged,

• Keep track of your progress,

• Make exercise fun!  Remember that variety is the spice of life!

All of this should answer the primary question.  Yes, exercise is helpful for all patients with CF.  It not only improves respiratory function, but it also has other far-reaching benefits.  Even if you ore your loved one is on chronic oxygen, requires C-PAP or BiPap -- regular exercise can be helpful.

References:

     Henke, K.G., Regnis, J.A., Bye PT.  Benefits of Continuous Positive Airway Pressure during Exercise in Cystic Fibrosis and Relationship to Disease Severity.  American Review of Respiratory Disease, Vol. 148, 1993.

     Gulmans VAM; DeMeer, K.; Brackel, HLJ; Faber JAJ; Berger R.; Helders PJM.  Outpatient Exercise Training in Children with Cystic Fibrosis: Physiological Effects, Perceived Competence, and Acceptability .  Pediatric Pulmonology, 28: 39-46, 1999.

     Stanghelle, J.K.; Skyberg, D.; Haanaes O.C.  Eight-year Follow Up of Pulmonary Function and Oxygen Uptake During Exercise in 16-year old males with Cystic Fibrosis.  ACTA Paediatrics, Volume 81, 1992.

     Boas, S.R.; Danduran, M.J.; McColley, S.A.; Bearman, K.; O'Gorman, M.R.  Immune Modulation Following Aerobic Exercise in Children with Cystic Fibrosis.  International Journal of Sports Medicine, 2001; 21

     Nixon, P.  Role of Exercise in the Evaluation and Management of Pulmonary Disease in Children and Youth.  Official Journal of the American College of Sports Medicine.

     Bilton, D.; Dodd, M.E.; Abbot, J.V.; Webb, A.K.  The Benefits of Exercise Combined with Physiotherapy in the Treatment of Adults with Cystic Fibrosis.  Respiratory Medicine.  Volume 86, 1992.

     Salh, W,; Bilton, D.; Dodd, M.; Webb, A.K.  Effect of Exercise and Physiotherapy in Aiding Sputum Expectoration in Adults with Cystic Fibrosis.  Thorax, Volume 44, page 1006, 1989.

     Moorcroft, A.J.; Dodd, M.E.; Webb, K.  Long-term Change in Exercise Capacity, Body Mass, and Pulmonary Function in Adults with Cystic Fibrosis.  Chest, Volume 111 and 112, February 1997.

Site Map

Contact Us

Important Information