Disability and Rehabilitation YR: 2010 VL: 32 NO: 1 PG: 41-49

Studies in English; RCT; subjects diagnosed as having CF; children or adolescents aged 6–18 years; exercise training intervention lasting at least 2 weeks. A control group had to be present.

Schneiderman-Walker 2000; Selvadurai 2002; Klijn 2004; Orenstein 2004

4 RCT: Schneiderman-Walker et al. (control=36; aerobic=36); Selvadurai et al. (control=21; aerobic=21, resistance=22); Klijn et al. (control=9; anaerobic=11); Orenstein et al. (control=26; stregth=30)

exercise intervention

pulmonary function (FEV1; FVC) and fitness outcomes (VO2; leg strength; peak power)

Four RCTs were included (n=212, range 20 to 72). All studies met criteria for randomisation, allocation concealment, baseline comparability and reporting of effect estimates, drop-outs and intervention details. Eligibility criteria and compliance rate were reported in three RCTs each. Blinding and ITT analysis were reported in two RCTs each.Pulmonary function (four RCTs): One RCT found that FEV1% was significantly improved from baseline by short-term aerobic exercise (p<0.05) and resistance training (p<0.01); function significantly decreased in controls (p<0.05). The other three RCTs had longer follow-up and none reported statistically significant findings for FEV1%. One RCT of aerobic exercise reported a significantly smaller decline in FVC over long-term follow-up in the intervention group than in controls (p value not reported). Other findings for FVC (one short-term RCT) were not statistically significant.Fitness (four RCTs): Both relevant RCTs (one short term and one long term) reported significantly improvement from baseline in leg strength in one or more intervention group (p≤0.03); improvements lasted up to 12 months (one RCT). Findings for aerobic fitness were inconsistent (four RCTs). Exercise training was associated with significant improvement from baseline in one intervention group of one short-term RCT (p<0.01) and with significant deterioration from baseline in one intervention group of one long-term RCT (p<0.01). Anaerobic fitness was significantly improved in the intervention group compared to controls (p<0.0001) in the only RCT that reported this outcome (short term).

The review concluded that both aerobic exercise and strength training may benefit pulmonary function, aerobic fitness and strength among children with cystic fibrosis. Factors that limited the review included the small amount of evidence available and inconsistencies between studies. Therefore, the author's conclusions may require cautious interpretation. Both aerobic exercise and strength training may benefit pulmonary function, aerobic fitness and strength among children with cystic fibrosis. - The author stated that children with mild to severe cystic fibrosis may benefit from exercise training, especially in an in-patient setting. Both short-term and long-term strength programmes were effective, even in prepubertal children. - The author stated that research was needed into the most effective exercise programme for children with cystic fibrosis. Research needed to include which exercise modalities (or combinations) and what intensity, duration and dose of exercise were most effective. The author recommended research (RCTs included) of home-delivered exercise, strength training and anaerobic exercise that reported outcomes such as quality of life, need for chest physiotherapy, recurrent infection rate, nutritional status and physiological end points.