Web-based physical activity promotion in young people with CF: a randomised controlled trial

Abstract

BackgroundPhysical activity levels are known to decline following hospitalisation for people with cystic fibrosis (pwCF). However, optimal physical activity promotion strategies are unclear. This study investigated the effect of a web-based application (ActivOnline) in promoting physical activity in young pwCF.MethodsMulticentre randomised controlled trial with assessor blinding and qualitative evaluation. People with CF (12–35 years) admitted to hospital for a respiratory cause were eligible and randomised to the 12-week ActivOnline intervention (AO) or usual care (UC). The primary outcome was change in device-based time spent in moderate-to-vigorous physical activity (MVPA) from baseline to post-intervention. Follow-up was at 6 months from hospital discharge when qualitative evaluation was undertaken.Results107 participants were randomised to AO (n=52) or UC (n=55). Sixty-three participants (59%) contributed to the intention-to-treat analysis. Mean (SD) age was 21 (6) years (n=46, <18 years). At baseline, physical activity levels were high in both groups (AO 102 (52) vs UC 127 (73) min/day). There was no statistically significant difference in MVPA between groups at either timepoint (post-intervention mean difference (95% CI) −14 mins (−45 to 16)). Uptake of the intervention was low with only 40% (n=21) of participants accessing the web application.ConclusionA web-based application, including individualised goal setting, real-time feedback and motivation for behavioural change, was no better than usual care at promoting physical activity in young pwCF following hospital discharge. High levels of baseline physical activity levels in both groups, and limited engagement with the intervention, suggest alternative strategies may be necessary to identify and support young pwCF who would benefit from enhanced physical activity.Trial registration numberACTRN12617001009303, 13 July 13 2017.

Role of physical activity and airway clearance therapy in cystic fibrosis: moving forward in a rapidly changing landscape

“…In light of the improvements in the overall health status of pwCF, investigating the role of physical activity and exercise is timely and desired by the CF community 3. Two papers in this issue of Thorax focus on physical activity and exercise in pwCF, respectively, either as a substitute for traditional ACT or as an intervention to promote physical activity 4 5…”

“…In the second paper, Cox et al 5 reported on the effects of a 12-week web-based randomised controlled trial (RCT) using elements of behaviour change theory in pwCF with a 6 months follow-up. Study participants were recruited during hospital admission for a pulmonary exacerbation across eight CF centres in Australia.…”

“…The study by Cox et al 5 is an outcome assessor blinded RCT targeting pwCF admitted for in-hospital treatment of a pulmonary exacerbation. This subgroup of patients has received little attention in physical activity trials so far, although it is a particularly interesting subgroup.…”

“…Future studies have to shed light on the role of PA and exercise as a stand-alone treatment in the care of pwCF. Experiences from RCTs5 12 13 prompts us to think about new strategies aiming to build positive long-term physical activity behaviour. Trials are challenging to conduct, often less attractive for participants (usually 50% chance of being randomised to control group) resulting in selective study samples, and often not reflecting the beneficial effects of regular physical activity on health outcomes seen in observational studies 14 15.…”

“…Trials are challenging to conduct, often less attractive for participants (usually 50% chance of being randomised to control group) resulting in selective study samples, and often not reflecting the beneficial effects of regular physical activity on health outcomes seen in observational studies 14 15. Choice-based interventions, as discussed by Cox et al ,5 or longitudinal studies using harmonised data collection and careful control of confounding factors, could be suitable alternatives to overcome the challenges of classical RCTs. Targeted and individualised physical activity promotion starting in early life and using innovative, patient-centred and technology-based approaches will be a key task for healthcare professionals in the modern era of CF.…”