P217 exercise as airway clearance therapy (ExACT) in cystic fibrosis: a UK-based e-Delphi survey of patients, caregivers and health professionals

Saynor, Z., Cunningham, S., Morrison, L., Main, E., Reid, S. and Urquhart, D. (2022) P217 exercise as airway clearance therapy (ExACT) in cystic fibrosis: a UK-based e-Delphi survey of patients, caregivers and health professionals. Journal of Cystic Fibrosis, 21 (Suppl. 1), [S127]. (doi:10.1016/S1569-1993(22)00546-X).

Abstract

Background: establishing whether exercise could replace traditional airway clearance therapy (ACT) in people with cystic fibrosis (pwCF) is a top research priority. We aimed to gauge consensus amongst United Kingdom key stakeholders on whether exercise can be used for ACT and develop consensus on the type, duration and intensity of exercise considered equivalent to ACT.

Methods: our panel comprised CF physiotherapists and doctors, adults with CF and parents/partners of pwCF. Using e-Delphi methodology, respondents ranked agreement on a 9-point Likert scale with statements relating to exercise ACT. Consensus was defined as >70% agreement (scores 7–9).

Results: eighty-three participants completed Round 1, with 60 (72%) completing all three rounds: fifteen (25%) pwCF, 24 (40%) physiotherapists, 11 (18%) doctors, and 10 (17%) parents/partners. 75% (63/83) considered exercise could be potentially be equivalent to ACT. 88% (52/60) would participate in a clinical trial to answer the question and 89% (74/83) would adopt exercise for ACT if supported by trial evidence. Exercise ACT wasconsidered to be aerobic activity, of 21–30 minutes duration (modal average), and an intensity that elicits deep breathing (90%, 60/67). Assessment breaths and coughs and huffs (during and/or after exercise) should accompany exercise to remove loose secretions (80%, 48/60), however, it should be noted the physiotherapy subgroup had significantly higher agreement with this statement than other groups. Traditional ACT is considered to remain integral to care during an exacerbation (73%, 44/60).

Conclusions: our panel support the research priority ‘exercise as a substitute for traditional ACT’. The consensus recommended exercise considered equivalent to traditional ACT and may serve as a reference for developing new ACT strategies and also enable clinical trials to investigate the safety of substituting such exercise for traditional ACT in pwCF.

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Contributors

Author: Z. Saynor

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