BELLARMINE UNIVERSITY, LOUISVILLE, KY

Cystic FibrosisExercise, and Quality of Life

Presented by: John Hardy, Adam Hooten, Andrew Stethen, and Cody Russell

http://med.stanford.edu/ism/2010/february/cystic-fibrosis-0208.html http://app1.unmc.edu/publicaffairs/todaysite/sitefiles/today_full.cfm?match=1503

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Becky Foster(Adam Hooten’s Aunt)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

P.I.C.O

P.- Adults with cystic fibrosis

I.- Physical activity

C.- Inactivity

O.- Decreased hospitalizations and exacerbations

http://blog.prashantgorule.com/wp-content/uploads/2011/12/Albert-Einstein-pic.png

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Cystic Fibrosis

-”inherited disease of the secretory glands”-National Heart, Lung, and Blood Institute

-Organs mainly affected:-Lungs-Pancreas-Liver-Intestines-Sinuses-Sex organs

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BELLARMINE UNIVERSITY, LOUISVILLE, KY

Other Names For Cystic Fibrosis:

-Cystic Fibrosis of the pancreas

-Fibrocystic disease of the pancreas

-Mucoviscidosis

-Mucoviscidosis of the pancreas

-Pancreas fibrocystic disease

-Pancreatic cystic fibrosis

Andrew Simmons

Nathan Charles

http://www.zimbio.com/pictures/Pn8gQIz6yw0/Super+14+Rd+8+Western+Force+v+Stormers/

ZsYbhPuhZJe/Nathan+Charles

http://wwewallpaper4u.blogspot.com/2011/11/wwe-umaga-wallpaper.html

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Cystic Fibrosis

• Epidemiology:– Highest among Caucasians of Northern Europe

descent.

• Signs and Symptoms-– Variable

• Diagnosis-– Series of tests:

Fraser Brown

http://tutongkita.blogspot.com/2010/05/kerajaan-baru-uk-dalom-gambar.html

BELLARMINE UNIVERSITY, LOUISVILLE, KY

P.I.C.O

P.- Adults with cystic fibrosis

I.- Physical activity

C.- Inactivity

O.- Decreased hospitalizations and exacerbationshttp://discovermagazine.com/2013/september/14-doorway-to-a-cure

BELLARMINE UNIVERSITY, LOUISVILLE, KY

• Results-QOL is proven directly correlated with hospitalizations and exacerbation.

• Conclusion: -QOL assessments are clinically feasible and practical to monitor in regards to CF

Goldbeck 2006

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Sahlberg 2008

• Results:-Max HR remained unchanged

-Max workload and maximal VO2 improved significantly.

• Conclusions: -Endurance training alone improved cardio-pulmonary function

BELLARMINE UNIVERSITY, LOUISVILLE, KY

• Results:-Intervention group reported significant increase in sports activities

-No difference between groups with reported infections

-Significant intervention effect on peak VO2

-No significant effect on the QOL scale

• Conclusion: -No long term significant changes in the QOL

Hebestreit 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

• Results:-Significant increases in PWC, VC, TLC, Pimax, SPimax

-Decrease in anxiety and depression

• Conclusion:-IMT program resulted in significant benefits for CF pts

Enright 2004

BELLARMINE UNIVERSITY, LOUISVILLE, KY

• Results: -Significantly increased VO2 Max

-Showed no significant change in QOL except the scores in the domain of treatment burden and emotional functioning

-No significant difference in QOL between exercise group and questionnaire group.

• Conclusion:-Significantly increased VO2 Max

-Could not demonstrate improvement in QOL.

Schmidt 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Bradley 2006

• Results:-Evidence supports different types of training including: resistance and aerobic conditioning.

• Conclusions:-No intervention proven superior to others

-Interventions should be used in conjunction with aerobic exercise

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Abbott 2008

• Results: -69% of the original participants completed the follow up.

-Higher QOL was associated with better survival.

-Pain and physical functioning domains were statistically significant.

• Conclusions: -The CFQOL questionnaire is a valid predictor of survival in patients with CF.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Direct Effect

Indirect Effect

No Effect

Inconclusive

0 0.5 1 1.5 2 2.5

Do PT Interventions Positively Affect QOL?

Number of Articles-Graphical depiction of article findings. (Abbot, Bradley, Enright, Goldbeck, Hebestriet, Sahlberg, Schmidt)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Summary of Findings

• Exacerbations and living circumstances significantly impact QOL.

• Physical functioning and pain are important predictors of survival QOL.

• Aerobic conditioning can improve cardiovascular function and

psychosocial status.

• Little evidenced to support long-term improvements in QOL through exercise and or other PT interventions.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

• Best intervention is conflicting.– Aerobic Conditioning

• Exercise indirectly affects QOL. – Exacerbations = +QOL

• Holistic approach needed to produce long-term affects on QOL.– Physical and psychosocial domains.

Conclusions/Discussion

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References

• Abbott J, Hart A, Morton A, Dey P, Conway S, Webb A. Can health-related quality of life predict survival in adults with cystic fibrosis?. American Journal Of Respiratory And Critical Care Medicine. 2009;179(1):54-58. Available from: MEDLINE, Ipswich, MA. Published January 2009. Accessed September 26, 2013.

• Bradley J, Moran F, Elborn S. Evidence for physical therapies in cystic fibrosis: An overview of five Cochrane systematic reviews. Respiratory Medicine. 2006;100(2): 191-201. http://www.sciencedirect.com/science/article/pii/S0954611105005196. Published February 2006. Accessed September 26, 2013.

• Enright S, Chatham K, Ionescu A, Unnithan V, Shale D. Inspiratory Muscle Training Improves Lung Function and Exercise Capacity in Adults With Cystic Fibrosis. Chest. 2004;126(2):405-411. Available from: Academic Search Premier, Ipswich, MA. Published August 2004. Accessed September 26, 2013.

• Goldbeck L, Zerrer S, Schmitz T. Monitoring quality of life in outpatients with cystic fibrosis: feasibility and longitudinal results. Journal Of Cystic Fibrosis: Official Journal Of The European Cystic Fibrosis Society. 2007;6(3):171-178. Available from: MEDLINE, Ipswich, MA. Published May 2007. Accessed September 26, 2013.

• Hebestreit H, Kieser S, Kriemler S, et al. Long-term effects of a partially supervised conditioning programme in cystic fibrosis. The European Respiratory Journal. 2010;35(3):578-583. Available from: MEDLINE, Ipswich, MA. Published March 2010. Accessed September 26, 2013.

• Sahlberg M, Eriksson B, Sixt R, Strandvik B. Cardiopulmonary Data in Response to 6 Months of Training in Physically Active Adult Patients with Classic Cystic Fibrosis. Respiration. 2008;76(4):413-420. Available from: Academic Search Premier, Ipswich, MA. Published November 2008. Accessed September 26, 2013.

• Schmidt A, Jacobsen U, Oluf Schiøtz P, et al. Exercise and quality of life in patients with cystic fibrosis: A 12-week intervention study. Physiotherapy Theory And Practice. 2011;27(8):548-556. Available from: MEDLINE, Ipswich, MA. Published November 2011. Accessed September 26, 2013.