title: Effects of a supervised, outpatient exercise and physiotherapy programme in children with cystic fibrosis.
abstract: Previous work suggests benefit from outpatient exercise and physiotherapy in children with cystic fibrosis (CF), namely improved exercise capacity and lung function measures, as well reduced intravenous (IV) antibiotic needs. Our study aim was to investigate the effect of a year-long supervised outpatient exercise and physiotherapy programme in children with CF. Subjects with CF aged ≥10 years who had received ≥4 courses of IV antibiotics in 2009 were enrolled and seen fortnightly for supervised exercise and physiotherapy throughout 2010. In addition, they were expected to exercise three times weekly, and if unwell complete additional physiotherapy sessions extra to usual chest physiotherapy. Assessments of exercise capacity using the Modified Shuttle Test (MST) and quality of life (QOL; CFQ-UK) were recorded at baseline and after 1 year. Regular spirometry was performed before and throughout the study. Data were collected on IV antibiotic days. 12 subjects (6 female) were enrolled with mean (95% CI) age of 13.3 (11.8-14.6) years at study entry. A significant reduction in IV antibiotic days from 60 (56-64) days in 2009 to 50 (44-56) in 2010 (P = 0.02) was noted, along with improved MST distance (m) [735 (603-867) vs. 943 (725-1,161), P = 0.04] and level attained [9.4 (8.4-10.5) vs. 11.1 (9.6-12.6), P = 0.04]. Significant improvements in CFQ-UK scores for physical [59 (47-72) vs. 83 (74-92), P = 0.001], emotional [63 (55-72) vs. 84 (74-93), P < 0.001], treatment [41 (30-51) vs. 61 (48-73), P = 0.002], and respiratory [54 (42-66) vs. 76 (70-82), P = 0.002] domains were noted. The mean (95% CI) rate of change of FEV(1) was -4 (-18, +10)% in 2009, but was +6 (-2, +13)% in 2010, although this did not reach statistical significance. Supervised, outpatient exercise and physiotherapy are associated with improvements in QOL and exercise tolerance, a reduction in IV antibiotic days, and a trend towards reducing lung function decline in children with CF. The cost of IV antibiotics was reduced by £66,384 ($104,000) in 2010 when compared with 2009. Such cost-benefit may have implications for workforce planning and service provision.
authors.affiliation: Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, UK. don.urquhart@luht.scot.nhs.uk
authors.forename: Donald
authors.initials: D
authors.lastname: Urquhart
authors.forename: Zoe
authors.initials: Z
authors.lastname: Sell
authors.forename: Elaine
authors.initials: E
authors.lastname: Dhouieb
authors.forename: Gillian
authors.initials: G
authors.lastname: Bell
authors.forename: Sarah
authors.initials: S
authors.lastname: Oliver
authors.forename: Ryan
authors.initials: R
authors.lastname: Black
authors.forename: Matthew
authors.initials: M
authors.lastname: Tallis
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D003550:Cystic Fibrosis / Q000191:economics / Q000534:rehabilitation*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012138:Respiratory Therapy / Q000379:methods; D013147:Spirometry; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents