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Can exercise replace chest physiotherapy? Early data from study published
What is the study?
The ExACT-CF study is trying to see if different types of exercise could be used as an alternative to chest physiotherapy, reducing the treatment burden on people with CF, and ensuring it is a safe and effective option instead of traditional airway clearance techniques.
It is co-led by Dr Don Urquhart (Royal Hospital for Children and Young People and University of Edinburgh) and Dr Zoe Saynor (University of Southampton and University Hospitals Southampton NHS Foundation Trust) and co-developed with people affected by CF and healthcare professionals.
Who took part?
Fifty people with CF aged 10-58 years took part. Half continued their usual chest physiotherapy and exercised as they wanted. The other half stopped chest physiotherapy and instead did the ExACT (Exercise as an Airway Clearance Technique). This was at least 20 minutes of moderate-to-vigorous intensity exercise combined with huffs and coughs.
What are the results?
The initial results showed that the ExACT method could be as safe and effective as chest physiotherapy over 28 days, with lung function improving in the ExACT group. A larger, longer trial is needed however, to check exactly how safe and effective this is as a long-term alternative.
Most people said that they would prefer to use the ExACT intervention in future, either alone or alongside chest physiotherapy.
Why do people with CF need to do physiotherapy?
Physiotherapy is a crucial part of the daily treatment regime which helps to keep people with cystic fibrosis fit and healthy. It can be used for airway clearance, sinus management, back and continence problems, staying fit and much more.
You can find out more about cystic fibrosis physiotherapy here
What is airway clearance?
People with CF have thick, sticky mucus in their lungs which is difficult to remove. Airway clearance helps to stop this from building up and blocking airways. This then helps to stop bacteria that get stuck in the mucus from causing an infection.
What type of physiotherapy someone with CF does, and how often they do it, will be different for everyone. It will be adapted to suit individuals and CF physiotherapists will work with patients to find the best routine.
How did the study work with the CF community?
We’re so proud of this team effort and grateful to the amazing people with CF who make it possible. This study not only pushes science forward but also tackles priorities set by the CF community. We’re excited to keep driving this work to support people with CF to live active, fulfilling lives - and, where possible, to ease their treatment burden.
Dr Zoe Saynor
The study had input from the Trust’s community Involvement group at a very early stage, and regular feedback as they developed their successful funding application.
The researchers knew that there was a big variation in what people think of as ‘exercise’ and there were also lots of different ways that people with CF do their physiotherapy. After speaking to them in a focus group, members of the CF community helped the research team design a consensus survey, known as a Delphi survey, to agree on the types of exercise that could be compared to physiotherapy. This allowed the team to devise the ExACT intervention.
“Other people’s stories really inspire me. It was interesting to hear about other people’s experience of exercise and physio. What someone else said about their physio really resonated with me. It made me think ‘oh, it isn’t only me then’. I find being involved in research really rewarding, and it’s a lot of fun meeting other people. It’s a nice feeling to see the results, knowing that you had a part it in, that your ideas and comments have been taken into account” said Tonia who has CF and has been involved in shaping this study
We would really like to thank all of the participants and families who took part for their commitment to the ExACT-CF trial, and for giving us the privilege of working with them on this study.
Dr Don Urquhart
Does this mean I can stop my chest physiotherapy?
No, the study published in Thorax was a feasibility trial, with the aim of helping to gain the insights needed to plan a larger, longer trial. A larger trial would gather the evidence required to assess the safety and effectiveness of exercise as an alternative to physiotherapy, and if successful, could support its integration into CF care.
If you have any questions about your physiotherapy talk to your CF team.