Exercise and Cystic Fibrosis

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By ACCORDANT HEALTH SERVICES

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If you have CF, exercise is very good for you. It makes you breathe deeply, which helps move the mucus in your lungs. Exercise makes your breathing muscles stronger. Most everyone with CF should exercise. Even if your CF is severe, you should talk to your doctor about exercise.

Brisk Exercise
Children with CF are as active as other children. But they often do less brisk types of exercise than other children. An exercise is brisk if it makes you sweat and breathe hard. This is true even if their lung function and nutrition are good. Some children may not take part in brisk exercise because they know their parents, teachers, or coaches are concerned about them. This may cause children to doubt their own ability to do strong exercise. Parents, teachers, and health care team members should allow both boys and girls to be as active as possible. They should support brisk exercise because it could actually help children live longer. Girls often have less lung function than boys do, so they may gain even more from brisk exercise.

One study found that teenagers with mild to moderate lung disease could safely raise the time they spent doing brisk exercise. In this study, each teen had an exercise plan that was made just for them. A physical therapist can design a personal exercise program for anyone with CF. The therapist will decide what to include based on the severity of the person's CF, their fitness level, and the kinds of exercise they like to do.

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People with CF need two kinds of brisk exercise. They need endurance exercise, such as swimming, running, cycling, or taking aerobics classes. They also need strength training exercise, such as lifting weights, to benefit the upper and lower body.

Many people do not want to start an exercise program. This is very natural and not special to CF. But if exercise can be made fun more people will do it. What interests the person with CF? Make sure that person is involved in deciding what is done and how it is done. Build up slowly.

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Replacing Salt, Fluids, and Calories
During brisk exercise, it is easy for people with CF to get dehydrated. Because of CF, you lose more salt than other people when you sweat. To make up for this, replace both salt and fluids when you are active. Drink between 6 and 12 ounces of fluid every 20 to 30 minutes while exercising. Avoid drinks that contain caffeine. They increase fluid loss. Water and sports drinks are better choices. Sports drinks contain both salt and carbohydrates. The extra carbohydrates help keep blood sugar up. There is not enough salt in sports drinks to replace the all the salt you lose during exercise. Salty snacks are needed too. Potato chips and pretzels are good choices. Keep in mind that exercise also burns calories. Do not forget to replace the calories you lose through exercise. An extra snack or two can help.

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Exercise and ACTs
No matter what type of ACT (airway clearance technique) you use, exercise can make it more effective. By itself, exercise is not a method of airway clearance. But when exercise is added to another ACT, more mucus is removed from the airways. It also slows down the process that makes lung function get worse over time. This is why exercise is now seen as a way to help manage CF. Exercise is a CF treatment that is also a normal part of many healthy people's lives. Exercising helps adults and children with CF feel that they are just like their friends.

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Other Benefits of Exercise
People with CF also get:

• Stronger bones. Bones get stronger and denser when they are made to hold, or bear, weight. Weight bearing exercise includes activities such as walking, lifting weights, climbing stairs, dancing, and playing soccer. Building bone though brisk exercise is important because people with CF are more likely to get brittle bones. If you already have brittle bones, do not do high-impact exercises or those that make you bend, flex, or lift something heavy. Ask your doctor which activities are safe for you.
• Better blood sugar control. If you have CFRD (cystic fibrosis-related diabetes) exercise may reduce the amount of insulin you need to take. Exercise may also improve your overall blood sugar control.
• A better body image. Body image may improve as a person with CF builds muscles through exercise.

Regular, brisk exercise also:

• Helps lower blood pressure.
• Strengthens your heart.
• Increases good cholesterol and lowers bad cholesterol.
• Helps reduce your risk for:
  • Heart disease
  • Colon cancer
  • Breast cancer
  • Stroke
• Makes the muscles around your joints stronger. This reduces strain on the joints and helps protect them.
• Helps you relax. Reduces tension, irritability, and stress.
• Reduces fatigue.
• Eases depression and anxiety. Exercise releases endorphins, the body's natural "feel good" chemicals.
• Helps you sleep better at night.

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When Not to Exercise
When you have certain problems, you should not exercise until your doctor says it's OK. But after the problem gets better you should start to exercise again. Times when it is good to put off exercise are:

• When a lung infection is getting worse (acute pulmonary exacerbation)
• During a bout of painful joints
• When you feel that you cannot get enough air (breathlessness)
• After having a baby by C-section
• If you have a blockage in your bowel
• If you have pneumothorax (air in the chest or flattened lung)
• If you are coughing up a lot of blood
• After you have just had surgery
• When you have a fever

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References

Cystic Fibrosis Foundation Web site. http://www.cff.org/LivingWithCF/AtSchool/TeachersGuide/. Accessed July 9, 2008.

Turcios NL. Cystic fibrosis: an overview. J Clin Gastroenterol. 2005;39(4):307-317.

Gumery L, Dodd M, Parker A, Prasad A, Pryor J, Kennedy N, eds. Clinical Guidelines for the Physiotherapy Management of Cystic Fibrosis. Bromley, United Kingdom: Cystic Fibrosis Trust; 2002.

Nixon, PA, Orenstein DM, Kelsey SF. Habitual physical activity in children and adolescents with cystic fibrosis. Med Sci Sports Exerc. 2001 Jan;33(1):30-5.

Baker CF, Wideman L. Attitudes toward physical activity in adolescents with cystic fibrosis: sex differences after training: a pilot study. J Pediatr Nurs. 2006 Jun;21(3):197-210.

Cystic Fibrosis Foundation. Nutrition: School, Enzymes, and Sports for the Child with Cystic Fibrosis. Bethesda, MD: Cystic Fibrosis Foundation; 2002.

Johns Hopkins Cystic Fibrosis Center Web site. http://www.hopkinscf.org/teens/living/keeping_nutri_exer.html. Accessed July 23, 2008.

McIlwaine M. Chest physical therapy, breathing techniques and exercise in children with CF. Paediatr Respir Rev. 2007 Mar;8(1):8-16.

Yankaskas JR, Marshall BC, Sufian B, Simon RH, Rodman D. Cystic fibrosis adult care: consensus conference report. Chest. 2004;125(1)(suppl 1):1S-39S.

Mayo Clinic Web site. Link from http://www.nlm.nih.gov/medlineplus/exerciseandphysicalfitness.html. Accessed April 30, 2008.

Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nccdphp/dnpa/physical/everyone/index.htm. Reviewed March 24, 2008. Updated April 10, 2008. Accessed April 30, 2008.

Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nccdphp/dnpa/physical/everyone/health/index.htm. Reviewed March 24, 2008. Updated March 26, 2008. Accessed April 28, 2008.

Lorig K, Fries JF. Exercise for fitness and better living. In: The Arthritis Helpbook. 6th ed. Cambridge, MA: Da Capo Press; 2006:133-191.

Mayo Clinic Web site. http://www.mayoclinic.com/health/depression-and-exercise/MH00043. Accessed April 30, 2008.

Centers for Disease Control and Prevention Web http://www.cdc.gov/nccdphp/dnpa/physical/everyone/get_active/index.htm. Reviewed March 24, 2008. Updated March 24, 2008. Accessed April 28, 2008.

Last Modified Date: March 19, 2009 © Accordant Health Services, a CVS/Caremark company.  All rights reserved.
This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team.
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