Pilot and Feasibility Study of an Individualized Telehealth Exercise Program for People with Cystic Fibrosis

Background: The Cystic Fibrosis Foundation (CFF) recognizes exercise as a critical part of managing cystic fibrosis (CF). This becomes even more important in the era of highly effective modulator therapy (HEMT) due to many people with cystic fibrosis (pwCF) having decreased symptom burden and a newfound ability to tolerate exercise better. Our single-center pilot study was designed to assess the implementation of a remotely delivered, individualized, and comprehensive exercise program for pwCF. We aimed to determine the feasibility, safety and acceptance of this intervention. Methods: PwCF ≥ 18 years old were recruited and consented at the University of Alabama in Birmingham in 2022 and 2023. Basic fitness was assessed for each participant, and an individualized exercise prescription was prepared for each participant, who was expected to exercise three times weekly on a remote basis with the exercise physiologist for 12 consecutive weeks. Subjects were reassessed at 4 and 7 months for post-exercise evaluation. Patient demographics and clinical parameters, including exacerbation rate, FEV1 percent predicted, 6-min walk test (6MWT), and modified shuttle test (MST) were collected. Questionnaire data from the CFQ-R, PRAISE, and IPAQ were also recorded. The study was registered with ClinicalTrials.gov (NCT04680403) and was submitted on 17 December 2020. Results: Our goal was to enroll 12 participants over the 2-year study period. We were able to recruit nine people for the study, with four participants finishing the program. From the 36 sessions offered over the 12-week program, participants completed an average of 15 sessions. Clinical outcome data was observed, including lung function and exacerbation frequency, but not statistically analyzed due to the small sample size. Conclusions: Implementation of an individualized telehealth-based exercise program for pwCF was well received by participants, safe, and appreciated by the participants. Recruitment and adherence were challenging, which was partially due to the ongoing pandemic. Follow-up studies are needed to assess whether improvements in reducing the amount or supervision of weekly exercise sessions and/or extending the total time might help with adherence.