The Breath project (Project Number: 2022-1-PL01-KA220-HED-000089283) has been Co-funded by the European Union. Views and opinions expressed are however those of the author or authors only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System. Neither the European Union nor the entity providing the grant can be held responsible for them.

Acute effects of combined exercise and oscillatory positive expiratory pressure therapy on sputum properties and lung diffusion capacity in cystic fibrosis: a randomized, controlled, crossover trial

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Institution
University of Zurich
Institution Typology
University
Country
Switzerland
Description
Intervention design A single continuous cycling exercise of moderate intensity (experiment A, control condition) versus a combination of interval cycling exercise plus Flutter® (experiment B).
People involved: 15 adults with cystic fibrosis
Obstacles identified: Expiratory flow was not measured during exercise. This is an important indicator to assess whether it was possible to create an expiratory airflow bias, a mechanism that allows the assessment of improvements in mucociliary clearance.
Sustainability: We conclude that the addition of Flutter® to moderate-intensity interval cycling exercise has no measurable effect on the viscoelastic properties of sputum compared to moderate-intensity continuous cycling alone. The greater pulmonary diffusion capacity represents an acute exercise-induced effect that is not maintained after exercise.
Transferability: The approach can be adapted to other respiratory diseases or conditions and in other countries or demographic groups.
Disease
Cystic Fibrosis
Activity level
Medium
Activity Typology
Rehabilitation section-based activities, Home-based activities
Motivation Tools
Not available
Innovation
Regular airway clearance through respiratory physiotherapy and/or exercise is fundamental to lung health in cystic fibrosis (CF). The combination of bicycle exercise and physiotherapy using the Flutter® device on sputum properties has not yet been investigated.
Evaluation System
The properties of sputum (viscoelasticity, yield stress, solids content, ability to mobilize secretions and ease of expelling secretions), the pulmonary diffusion capacity of nitric oxide (DLNO) and carbon monoxide (DLCO) were assessed at rest, during and 45 minutes after exercise (recovery) on 2 consecutive visits. The primary result was the change in sputum viscoelasticity (G', storage modulus; G”, loss modulus) over a wide range of frequencies (0.1-100 rad.s- 1).









No consistent differences were observed between the experiments for G' and G” and other sputum properties, except for the ease with which sputum is expelled during recovery, which favored experiment A. DLNO, DLCO, alveolar volume (VA) and pulmonary capillary blood volume (PCBV) increased during experiment A, while DLCO and PCBV increased during experiment B (all P < 0.05). No differences were found in the absolute changes in pulmonary diffusion capacity and its components in the groups, except a higher VA immediately after exercise, favoring group A (P = 0.032).
Assessment
The additional use of Flutter® in moderate-intensity interval cycling exercise has no measurable effect on the viscoelastic properties of sputum compared to moderate-intensity continuous cycling alone. There was an increase in diffusion capacity.
References
Radtke, T., Böni, L., Bohnacker, P., Maggi-Beba, M., Fischer, P., Kriemler, S., ... & Dressel, H. (2018). Acute effects of combined exercise and oscillatory positive expiratory pressure therapy on sputum properties and lung diffusing capacity in cystic fibrosis: a randomized, controlled, crossover trial. BMC pulmonary medicine, 18, 99

doi.org/10.1186/s12890-018-0661-1" target="_blank">doi.org/10.1186/s12890-018-0661-1
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Diego Cazorla, Universidad de Las Palmas de Gran Canaria - Spain (ES)
Estoy de acuerdo en que la adición de Flutter® al ejercicio de ciclo de intervalos de intensidad moderada no tiene ningún efecto medible en las propiedades viscoelásticas del esputo en comparación con el ciclo continuo de intensidad moderada solo.

Cristian Pérez González, ULPGC - Spain (ES)
Awesome! This explication is perfect to learn about this topic. Thanks!

Bruno Ferreira, ESS - IPS - Portugal (PT)
From a nursing perspective, it reinforces the need for individualized approaches in respiratory care, considering patient response to different techniques. While Flutter® did not significantly enhance sputum properties, the observed increase in diffusion capacity suggests potential benefits of exercise alone. Further research could explore long-term effects and patient-reported outcomes to refine best practices in cystic fibrosis management.