Abstract
BackgroundRegular airway clearance by chest physiotherapy and/or exercise is critical to lung health in cystic fibrosis (CF). Combination of cycling exercise and chest physiotherapy using the Flutter® device on sputum properties has not yet been investigated.MethodsThis prospective, randomized crossover study compared a single bout of continuous cycling exercise at moderate intensity (experiment A, control condition) vs a combination of interval cycling exercise plus Flutter® (experiment B). Sputum properties (viscoelasticity, yield stress, solids content, spinnability, and ease of sputum expectoration), pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were assessed at rest, directly and 45 min post-exercise (recovery) at 2 consecutive visits. Primary outcome was change in sputum viscoelasticity (G’, storage modulus; G”, loss modulus) over a broad frequency range (0.1–100 rad.s− 1).Results15 adults with CF (FEV1range 24–94% predicted) completed all experiments. No consistent differences between experiments were observed for G’ and G” and other sputum properties, except for ease of sputum expectoration during recovery favoring experiment A. DLNO, DLCO, alveolar volume (VA) and pulmonary capillary blood volume (Vcap) increased during experiment A, while DLCO and Vcap increased during experiment B (all P < 0.05). We found no differences in absolute changes in pulmonary diffusing capacity and its components between experiments, except a higher VA immediately post-exercise favoring experiment A (P = 0.032).ConclusionsThe additional use of the Flutter® to moderate intensity interval cycling exercise has no measurable effect on the viscoelastic properties of sputum compared to moderate intensity continuous cycling alone. Elevations in diffusing capacity represent an acute exercise-induced effect not sustained post-exercise.Trial registrationClinicalTrials.gov; No.: NCT02750722; URL: clinical.trials.gov; Registration date: April 25th, 2016.
Highlights
Regular airway clearance by chest physiotherapy and/or exercise is critical to lung health in cystic fibrosis (CF)
Sputum rheological properties and exercise In the present study, we found no differences in sputum viscoelasticity between the two experimental conditions, rejecting our initial hypothesis
One could argue that the chosen exercise mode in our study was not sufficient to improve viscoelastic properties of sputum in our patients and/or that the magnitude of effect from Flutter® was not large enough to produce greater changes in sputum viscoelastic properties compared to cycling alone
Summary
Regular airway clearance by chest physiotherapy and/or exercise is critical to lung health in cystic fibrosis (CF). Combination of cycling exercise and chest physiotherapy using the Flutter® device on sputum properties has not yet been investigated. Regular airway clearance is of critical importance to lung health in CF. Exercise and chest physiotherapy are accepted airway clearance techniques (ACT’s) in CF, belonging to the current top ten research priorities [2]. There are a number of different ACT’s such as the active cycle of breathing technique, high-frequency chest wall oscillations, positive expiratory pressure (PEP) and oscillatory PEP. Oscillatory PEP with the Flutter® is effective compared to other ACT’s [3] and has been shown to favorably alter respiratory flow [4], to increase sputum expectoration [5] and to reduce sputum viscoelasticity [6, 7] in CF
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