Exercise as it relates to Disease/Anaerobic training for children with cystic fibrosis

What is the background to this research?
Cystic Fibrosis is a disease which primarily affects the lungs and digestive system. It is caused by a malfunction in the exocrine system which is responsible for producing mucus, saliva, and sweat. Cystic Fibrosis causes an excessive build-up of thick and sticky mucus in the lungs, airways and digestive system. This mucus causes impairment of the pancreas and traps bacteria in the lungs and airways which leads to reoccurring infection leading to further damage of the lungs and airways. Generally, the main cause of death for people with Cystic Fibrosis is lung failure. Cystic Fibrosis affects about 1 in every 2500 babies born in Australia and it is caused when both parents of the affected child carry the cystic fibrosis gene. For infants born with cystic fibrosis, the mean age of death is 50 years old so it is extremely important to find an effective rehabilitation scheme that is effective from a young age.

Where is the research from?
This study was conducted by six researchers from the University Medical Centre at the Wilhelmina Children’s Hospital in Ultrecht in the Netherlands. It was published in the Chest Journal: Official Publication of the American College of Chest Physicians in April 2004 in Volume 125, number 4.

What kind of research was this?
This research was a single-blind, randomised, controlled study, which involved recruitment of 23 subjects between the ages of 9 and 18 years old. The research used multiple testing methods including, physical tests and questionnaires.

What did the research involve?
This research involved 23 children between the ages of 9 and 18 with stable clinical conditions and subjecting them to either the training group, a seven week anaerobic testing program or the control group, continuing their normal daily tasks and physiotherapy regime. The training program involved training 2 times per week with sessions lasting between 30 and 45 minutes. Children were encouraged to exercise at maximal levels during the training. Both groups took baseline tests before and after the seven week trial period. The tests taken included anthropometrical assessments, including height, weight and BMI (Body Mass Index), pulmonary function tests which measured the subject’s lung capacity and strength, quality of life which was measured with a questionnaire, and anaerobic fitness tests which were measured using the Wingate Anaerobic Test. The subjects were then re-evaluated after a 12 week follow-up period.

What were the basic results?
The results of this study showed that the training group, who were subjected to anaerobic training for seven weeks displayed improvements in both aerobic and anaerobic performance. They showed an improvement of 1.5 mL/kg/min for their VO2 peak with an improvement of 4.7% predicted VO2 max. They also showed an improvement in peak power and mean power per kilogram of body weight (10.9% and 10.1%).The control group showed a significant deterioration in aerobic performance with a VO2 peak per kilogram of body weight of -1.5%.

How did the researchers interpret the results?
The researchers established that the training group did not have any significant differences between the control group in terms of their body composition, pulmonary function, peripheral muscle force, and habitual physical activity after the training period. They did however see improvements in both anaerobic performance, aerobic performance and health related quality of life. After the 12 week follow-up period, the observed a decrease to pre-training levels in most testing parameters excluding anaerobic performance and health related quality of life.

What conclusions should be taken away from this research?
The conclusions that can be drawn from this research are that aerobic training in children with cystic fibrosis can in fact improve both anaerobic performance, aerobic performance as well as improving a child’s overall health related quality of life. Furthermore, the anaerobic performance and quality of life standards were maintained after a 12 week follow-up period, indicating that anaerobic training could be an important method of rehabilitating children with cystic fibrosis.

What are the implications of this research?
The main implications of this are that prior to this research, anaerobic training had received little to no attention compared to that of aerobic training. Daily living tasks use a mixture of anaerobic and aerobic fitness, so it is important to train both, especially for someone with cystic fibrosis. Exercise is essential for the ongoing rehabilitation of children with cystic fibrosis. A study showed that anaerobic energy stores may in fact be very similar in people with cystic fibrosis as normal people. This could be a good indication that it may be easier for individuals to train anaerobically, and as shown in this study, improve their anaerobic and aerobic performance, as well as their health related quality of life.

This research could be improved by having larger test groups as well as subjecting adults to the test as well. It can also be seen from the research that the subjects thoroughly enjoyed the exercise, which led to low withdrawal rates and maximal improvements from the tests. If this study were to be replicated with adults, the exercise program would again need to be enjoyable for the adults in order to see maximum improvement. If the anaerobic training program was to be used over a longer period of time, variation of exercise would be extremely important to maintain the individual’s interest and motivation.