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Airway clearance physiotherapy improves ventilatory dynamics during exercise in patients with cystic fibrosis: a pilot study
  1. Fernanda Maria Vendrusculo1,2,
  2. Zoe Johnstone1,
  3. Elaine Dhouieb1,
  4. Márcio V F Donadio2,
  5. Steven Cunningham1,
  6. Donald S Urquhart1
  1. 1 Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2 Laboratory of Pediatric Physical Activity, Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
  1. Correspondence to Dr Donald S Urquhart, Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK; don.urquhart{at}


Background Airflow limitation and dynamic hyperinflation may limit exercise capacity in patients with cystic fibrosis (CF). The aim was to investigate whether the undertaking of airway clearance physiotherapy (ACT) prior to cardiopulmonary exercise testing (CPET) results in improvements in exercise capacity.

Methods A prospective randomised, cross-over pilot study was performed in children aged >9 years. Spirometry, plethysmography and CPET were performed on two separate occasions—one test with ACT prior to CPET and the other without.

Results 12 patients with CF were included in the study with a mean (SD) age of 12.83 (1.85) years. No significant difference in peak oxygen uptake (VO2) was found between the tests. However, lower minute ventilation (VE) and ventilatory equivalents (VEVO2 and VEVCO2) at ventilatory threshold (VT) were noted when ACT was undertaken prior to CPET. The mean(SD) VE (L/min) at VT was 26.67 (5.49) vs 28.92 (6.3) (p=0.05), VEVO2 (L/min) at VT was 24.5 (1.75) vs 26.05 (2.5) (p=0.03) and VEVCO2 (L/min) at VT was 26.58 (2.41) vs 27.98 (2.11) (p=0.03).

Conclusions These pilot data suggest that ACT prior to exercise may lead to improved ventilatory dynamics during exercise in individuals with CF.

  • cystic fibrosis
  • exercise physiology
  • physical therapy
  • exercise test
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  • Contributors DSU devised the idea for the project. DSU, FMV, ZJ, ED and SC developed study protocol. FMV and ZJ undertook the study. DSU, MVFD and SC supervised the project, edited and co-wrote the manuscript with FMV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval NRES Committee North West—Lancaster REC 14/NW/1270.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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