New guidance gives practical advice on exercise testing in CF

Cystic fibrosis

By Selina Wellbelove

5 Sep 2023

New guidance on the use of exercise assessments for patients with cystic fibrosis in clinical practice has been developed by a team of more than 60 multidisciplinary experts from Australia and around the world.

It is hoped that the guidelines, which were 10 years in the making, will standardise and improve practice on exercise testing in CF patients, according to a European Cystic Fibrosis Society Exercise Working Group that includes Dr Brenda Button (PhD) from Institute for Breathing and Sleep, Austin Hospital and the University of Melbourne.

“Exercise is becoming increasingly important in CF and exercise tests give a good overview of health,” said co-author Dr Don Urquhart, a Consultant in Paediatric Respiratory Medicine at the Royal Hospital for Children and Young People, and Deputy Coordinator of the Working Group, told the limbic.

“We hope that these guidelines will help improve confidence and understanding by having everyone undertake tests in a standardised manner … For example, if you decide to do a maximum workload test on a bike in Edinburgh it should be done in the same way as in Brisbane”, he said.

The study authors highlighted “clear evidence” of the benefit of exercise testing in all patients with CF for monitoring disease progression and response to intervention as well as in developing personalised exercise programmes, particularly amid the advent of CFTR modulators and increasing patient survival.

However, while the majority of specialist CF clinics in the UK offer some patients some exercise testing and training advice, current practice falls well short of the recommendation that every patient with CF should be offered an exercise test at least once a year, they noted.

“Our goal is that all people with CF of an appropriate age have access to regular exercise testing to better understand their health and be given individualised exercise advice,” said lead author Dr Zoe Saynor, School of Sport, Health & Exercise Science at the University of Portsmouth.

Practical advice

The new guidelines, published in European Respiratory Review, not only offer practical advice on which tests to use but also highlight those that should be decommissioned as they are no longer deemed relevant for patients with CF, such as the 3-minute step test.

Cardiopulmonary exercise testing (CPET) was highlighted as the ‘gold standard’ for aerobic exercise performance, “offering understanding of fitness levels and exercise-limiting factors, whilst opening up avenues for exercise counselling and the derivation of individualised training programmes,” according to the paper.

However, other tests have also been recommended for when there is a lack of resource of expertise, such as the maximum workload testing without gas exchange, Dr Urquhart said.

Also of note, the availability of supplementary file containing standardised operating procedures (SOPs) for each test, provided as part of the paper, “allows interested healthcare professionals to build experience with a chosen test to aid longitudinal patient evaluation,” he added.

Read the guidelines in full here

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