Barriers for Sports and Exercise Participation and Corresponding Barrier Management in Cystic Fibrosis

Abstract

Background: Nowadays physical activity (PA)/exercise is an important component of cystic fibrosis (CF) therapy. The aim of the study was to assess the barriers to PA and the barrier management and to explore the effect of supervision on the barriers and barrier management during an exercise program. Methods: In total, 88 people with CF (pwCF) of the ages 6 to 50 years old (mean 24.2 ± 7.9 yrs) participated in the partially supervised 12-month exercise program and filled in a structured and validated questionnaire about barriers to sports and barrier management at baseline. Additionally, 23 pwCF filled in the questionnaire after 6 months and 12 months. The items were clustered into physical and psychosocial barriers and into preventive counter strategies and situational counter strategies and analyzed at baseline and over time. Results: Physical barriers were more relevant than psychosocial barriers and no trend could be seen in the situational and preventive counter strategies. When divided in subgroups, the less active pwCF (<7500 steps/day), more active pwCF (>7500 steps/day), physical barriers, and psychosocial barriers showed no significant differences. However physical barriers showed a tendency to have a higher value in the less active group compared to the more active group (p > 0.05). Stratified by age or FEV1%pred between the subgroups, no differences could be seen regarding barriers and counter strategies. Conclusions: Physical barriers seemed to have a higher priority when it comes to not participating in PA/exercise. Supervision over 6 months during an exercise program did not show a beneficial effect on barriers and barrier management. Besides the motivational aspect of sport counselling, the volitional aspect seemed to be more important to incorporate more PA into daily life. Individual barriers and their concrete counter strategies should be discussed with the patient with CF. Sport counselling is needed permanently and should be part of the CF routine care.

Impact of habitual physical activity and exercise capacity on quality of life in adolescents and adults with cystic fibrosis

“…This suggests that changes in HRQoL over time are an indicator of health status. This is further supported by the fact that physical barriers due to illness have a negative impact on physical activity 46 …”

“…This is further supported by the fact that physical barriers due to illness have a negative impact on physical activity. 46 In addition to physical factors, QoL is also influenced by psychosocial components. The extent to which poor mental health affects physical activity remains unclear.…”

Longitudinal changes in habitual physical activity in adult people with cystic fibrosis in the presence or absence of treatment with elexacaftor/tezacaftor/ivacaftor

“…For example, two of the pwCF without ETI treatment who had participated in previous tests and the CFmobil exercise program reported that the exercise tests (bicycle ergometry and motor performance tests, regular counselling, (Figure 1) motivated them to increase their physical activity (habitual and otherwise). This suggests that regular monitoring of pwCF might be necessary to encourage or sustain motivation to participate in physical activity and exercise (51)(52)(53).…”

“…It should also be noted that factors other than lung function may affect exercise behavior in pwCF. Specifically, personal factors (motivation, energy level, time, illness, pain, dyspnea, confidence in exercising), environmental factors (weather, season, accessibility of training sites) and socio-demographic characteristics (e.g., education, study or occupation) may support or prevent participation in habitual physical activity (51,52). The individual relevance of these factors may change over time, for example with disease severity and age, and may prevent or facilitate the realization of habitual physical activity, especially in the non-ETI group.…”