Cystic Fibrosis Core Strengthening and Respiratory Exercise Program (CSREP)

Study Design: Phase II clinical trial.

Objective: To determine whether a customized physical therapy exercise intervention titled Core Strengthening and Respiratory Exercise Program (CSREP) clinically improves the following outcome measures for children between the ages of 10 and 21 with cystic fibrosis: pulmonary function, aerobic capacity, rib cage mobility, posture, and core strength, thus warranting more extensive study and development.

Background: Previous research conducted in pediatric populations has focused on the effects of aerobic training, anaerobic training, and strengthening of the extremities on the health of children with cystic fibrosis. However, the disease process of cystic fibrosis secondarily causes impairments in the musculoskeletal and nervous systems. No intervention study aimed at positively impacting these systems has been done to date with children with cystic fibrosis.

Methods: A 6-month CSREP will be customized to meet the specific needs of each participant. During Part I of the program participants will attend weekly CSREP treatments for 4 to 6 weeks; in Part II they will attend monthly CSREP treatments over a five-month period. Each session will last for 45-60 minutes. During these treatments, participants will be given instruction on a daily home exercise program and will receive hands on physical therapy interventions. Handouts with pictures and how-to instructions for assigned exercises will be provided. Participants will be given calendars to track completion of home exercises and level of compliance. During Part II, a researcher will call participants every week in order to encourage compliance with the home exercise program and to provide clarification as needed. All participants will continue to receive regular medical care as well as PT treatments.

A respiratory therapist will perform the pulmonary function tests, a respiratory therapist along with an exercise physiologist will perform the VO2max testing, and a physical therapist will perform the physical therapy evaluation, including assessment of rib cage mobility, core strength, and posture. Another physical therapist as well as a physical therapist assistant will provide the physical therapy treatments, instruct the participants in their home program, and make the weekly phone calls to all participants.

An experience survey will be designed to evaluate both satisfaction on a scale of 1 to 10 and self scoring of outcome measures including: respiratory function, cough strength, activity tolerance, posture, and strength on a three point Likert scale of: 1) Got worse; 2) Stayed the same; and 3) Got better. Additionally, the survey will include a question on the likelihood of continuing with the home program after the study has ended. The survey will be administered at 6 months upon completion of the program.

Relevance: The results of this inquiry as to the viability of the CSREP will prove relevant to the above-mentioned patient outcomes within the cystic fibrosis population. The customized CSREP protocol will provide a non-pharmacological outpatient treatment option that can be completed on an outpatient basis, independently, in the patient's home.