(124) CF-FIT: Cystic Fibrosis Fitness During Inpatient Treatment

Background: Physical activity has been shown to have a positive impact on CF symptoms and works to slow the decline in lung function. Additionally, activities with moderate intensity have been shown to improve sputum expectoration and oxygen saturation in children with CF, resulting in improvement in symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized pediatric patients with CF.

Methods: This pre-post pilot study included participants 6-21 years of age who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020-November 2021. Garmin Vivosmart® 4 wrist-based activity trackers were issued, and baseline data were tracked and analyzed for the first two study days. Pre-goal steps were defined as the average of steps taken on those two days. On study day three, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal setting were defined as the average of steps taken on study day three and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included: daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means and standard deviations. Furthermore, outpatient data was also collected for 3 months in an effort to observe adherence to goals post-discharge.

Results: Eight participants, ages 6-18 years, completed the study. Hospital length of stay ranged from 4-14 days. Participants took an average of 1508 ± 1078 steps before goal setting. This increased to an average of 3704 ± 1555 steps post-intervention. Overall, step goals were met 56% of the time, and this data was highly variable. During the first week after hospital discharge, participants took an average of 6303 ± 1786 steps per day.

Conclusions: This intervention shows promise, as daily steps doubled from baseline during the intervention period. There was great variability among the participants, suggesting the approach may help some more than others. Enrollment was initially planned for 20 patients; however, the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data was analyzed for only the first week post-discharge due to poor adherence in wearing the device. Though our results show a positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long term benefits of intervention.

Acknowledgements: This work was supported by the Cystic Fibrosis Foundation Student Traineeship Grant [Award #IFIKHA19H0]

References: [1] Wilkes, et al. Paediatric Respiratory Reviews. 2009;10(3):105-109 DOI:10.1016/j.prrv.2009.04.001