Effects of an Individualized Exercise Program on Health-related and Skill/Performance-related fitness in CF.

Effects of an Individualized Exercise Program on Health-related and Skill/Performance-related fitness in CF.

Effects of an Individualized and Partially Supervised Exercise Program on Parameters of Physical Fitness, Lung Function, Habitual Physical Activity in Daily Life and Quality of Life in Children, Adolescents and Adults With Cystic Fibrosis.

The aim of this study is to evaluate the effects of a partially supervised exercise program on different aspects of physical fitness, despite VO2peak, lung function, quality of life and sleep quality in children, adolescents and adults with Cystic Fibrosis.

There is growing consensus that exercise in subjects with cystic fibrosis (CF) may yield improvements in measures of physical fitness, lung function and quality of life. In most of the training studies exercise capacity was expressed as peak oxygen uptake (VO2peak), which has been found to be one of the best predictors of survival in subjects with CF. Those subjects with a higher VO2peak related to age and gender specific predicted VO2peak (%pred) have a better prognosis than those with a lower VO2peak (%pred). VO2peak represents the cardiorespiratory endurance is one aspect of physical fitness. Physical fitness may be subdivided into health-related fitness and skill/performance-related fitness. Cardiorespiratory endurance, muscular strength and endurance, body composition and flexibility are often referred to as health-related fitness. Balance, coordination, speed, agility and power are often described as skill/performance related fitness, reflecting the performance aspect of physical fitness. It has been shown, that children and adolescents with a lower skill / performance related fitness are less physical active than those with a higher skill/performance related fitness. This may lead to physically inactive in daily life, less motivation to take part in organized sport and as a consequence to a lower VO2peak. The primary outcome parameters of this study is to evaluate the effects 12-month partially supervised exercise program on 1) health-related fitness (endurance expressed as maximal workload, muscular strength) and skill / performance related fitness (balance, power, agility)and 2) habitual physical activity (steps / day; intensity expressed in METs) in a large group of subjects with CF. Secondary outcome parameters include forced exspiratory volume in 1 second (FEV1), sleep-wake cycle, quality of sleep, quality of life, and exercise related barriers and barrier management in physical exercise. In total 100 subjects with CF 6 year and older will be included. Habitual physical activity and sleep will be recorded by accelerometer before subjects enter the exercise program, and after 6 month and after 12 month. Check-ups, lung function measurement and testing of physical fitness will be performed at baseline, after 6 and 12 month. During the first six month the participants will be contacted by telephone every two weeks. After six month individual counseling by telephone will be stopped. The exercise program is planned as a "low-threshold exercise program "with low barriers to participate. Participants will be asked about their interests and preferences of sports activities to conceive the exercise program together with the participants. Along with counseling participants will be motivated to increase physical activity by at least 10-20 minutes per day. The investigators expect to gain another insight into different aspects of physical fitness, habitual physical activity and sleep from the results of this study. Up to know, there are only a few trails investigated different aspects of physical fitness that means balance, flexibility, power as parameters of health-related fitness and skill/performance-related fitness. The investigators assume that participants with higher values are more physical active than those with lower values and these participants will have a higher cardiorespiratory endurance.

First 6 months supervised exercise program with telephone contact every two weeks Second 6 months exercise program without telephone contact Patients should increase habitual daily physical activity for 10-20 minutes per day 5 times per week Activities were chosen according to the preferences, interests, and severity of disease of the patients Activites should improve endurance, strength, coordination and flexibility Every three month regular vistit at the CF care center (medical examination, lung function, exercise testing, counselling and evaluation of activities by acceleometry and if appropirate adaption of exercise program)

12 months usual routine care and habitual exercise in daily life. At start and after 12 month assessment of habitual exercise with accelerometry (Actigraph GTX3)

The exercise program is planned as a "low-threshold exercise program "with low barriers to participate. Patients will be asked about their interests and preferences of sports activities to conceive the exercise program together with the patients.

Measurement of the time of physical activity in hours/day by accelerometry (ActiGraph GT3X, Penascola, USA)

Measurement of the quality of life by the Cystic Fibrosis Questionnaire Revised (CFQ-R, Quality of life domains: Physical, role/school, vitality, emotion, social, body image, eating, treatment burden, health perceptions. Symptom scales: Weight, respiratory, and digestion)

specific questionnaire (Barrieren und Barrierenmanagementim Prozess der Sportteilnahme, Krämer and Fuchs, Zeitschrift für Gesundheitspsychologie, 18(4), 170-182, 2010)

Measurement of the time of habitual physical activity spend in light intensity (≤ 3METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Change of habitual physical activity spend in moderate to vigorous intensity (3 to 5.9 METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Measurement of the time of habitual physical activity spend in moderate to vigorous intensity (3 to 5.9 METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Change of habitual physical activity spend in vigorous intensity (6 to 8.99 METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Measurement of the time of habitual physical activity spend in vigorous intensity (6 to 8.99 METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Change of habitual physical activity spend in hard intensity (≥ 9 METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Measurement of the time of habitual physical activity spend in hard intensity (≥ 9 METS) in minutes by accelerometry (ActiGraph GT3X, Penascola, USA)

Measurement of heart rate reserve in percent by cycle ergometry (Ergoselect 100p, Ergoline, Bitz, Germany)

Measurement of workload in Watt / kg bodyweight by cycle ergometry (Ergoselect 100p, Ergoline, Bitz, Germany)

Change of maximal exercise capacity expressed as perceived exertion (Borg CR10 Scale) in number of level of exertion

Change of skill / performance related fitness expressed as push-ups in number of repetition in 40 sec.

Measurement of push-ups in number of repetition in 40 sec. with the German motor test (Deutscher Motorik Test, Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, Karlsruhe, Germany) in children and adolescents aged 6-18 years

Change of skill / performance related fitness expressed as standing broad jump in cm in children and adolescents

Measurement of standing broad jump in cm with the German motor test (Deutscher Motorik Test, Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, Karlsruhe, Germany) aged 6-18 years

Measurement of sit-ups in number of repetition in 40 sec. with the German motor test (Deutscher Motorik Test, Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, Karlsruhe, Germany) aged 6-18 years

Change of skill / performance related fitness expressed as balancing backwards number in steps on a wooden beam 6 cm wide and 3 meters long

Measurement of balancing backwards number in steps on a wooden beam 6 cm wide and 3 meters long with the German motor test (Deutscher Motorik Test, Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, Karlsruhe, Germany) aged 6-18 years

Change of skill / performance related fitness expressed as jump sideways in number of repetition in 15 sec.

Measurement of balancing backwards number in jump sideways in number of repetition in 15 sec. with the German motor test (Deutscher Motorik Test, Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, Karlsruhe, Germany) aged 6-18 years

Change of skill / performance related fitness expressed as flexibility in cm in children and adolescents

Measurement of flexibility in cm with the German motor test (Deutscher Motorik Test, Forschungszentrum für den Schulsport und den Sport von Kindern und Jugendlichen, Karlsruhe, Germany) aged 6-18 years

Measurement of one leg stand in sec. as included in the TFR (Test Fitness Rekrutierung, Bundesamt für Sport BASPO, Magglingen, Schweiz) in adults

Measurement of standing broad jump in cm as included in the TFR (Test Fitness Rekrutierung, Bundesamt für Sport BASPO, Magglingen, Schweiz) in adults

Measurement of trunk power in sec. as included in the TFR (Test Fitness Rekrutierung, Bundesamt für Sport BASPO, Magglingen, Schweiz) in adults

Measurement of flexibility in cm as included in the basic motor diagnostics (Motorische Basisdiagnostik, Hrsg. Bös/Wydra/Karisch, 1992) in adults

Change of skill / performance related fitness expressed as circling motion in number of complete performed circles

Measurement of circling motion in number of complete performed circles as included in the basic motor diagnostics (Motorische Basisdiagnostik, Hrsg. Bös/Wydra/Karisch, 1992) in adults

Measurement of the time of hip extension in sec. as included in the basic motor diagnostics (Motorische Basisdiagnostik, Hrsg. Bös/Wydra/Karisch, 1992) in adults

Inclusion Criteria: Confirmed diagnosis of CF Informed consent Exclusion Criteria: Cardiac arrhythmias with exercise Patients with cor pulmonale Colonization with Burkholderia cenocepacia, Methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative (MRGN) pathogens (3 and 4 MRGN) Patients with untreated diabetes

St. Josef-Hospital im Katholischen Klinikum Bochum, Klinik für Kinder und Jugendmedizin, Alexandrinenstrasse 5

Universitätsklinikum Essen, Klinik für Kinderheilkunde III, Pädiatrische Pneumologie und Schlafmedizin, Hufelandstr. 55

Dietz-Terjung S, Gruber W, Sutharsan S, Taube C, Olivier M, Mellies U, Koerner-Rettberg C, Dillenhofer S, Stehling F, Welsner M. Association between habitual physical activity (HPA) and sleep quality in patients with cystic fibrosis. Sleep Breath. 2021 Jun;25(2):609-615. doi: 10.1007/s11325-020-02130-0. Epub 2020 Jul 14.