Entry for:The Peer Prize for Women in Science 2017
1. Please give a brief summary of your work.
For everyone, being physically active is important for good health. In people with cystic fibrosis (CF) – an inherited, chronic disease particularly affecting the lungs – better fitness is associated with greater longevity. Consequently, exercise programs are often prescribed – but these prove difficult for patients to adhere to. We sought to establish whether being generally active in everyday life related to health and clinical outcomes for adults with CF. We found: i) adults with CF who had low levels of physical activity had greater need for hospitalisation; ii) achieving daily activity targets through concerted periods of activity lasting was associated with better health outcomes; iii) adult females with CF were particularly inactive, and iv) there was more than 40% decline in physical activity following a hospitalisation. Finding new ways to encourage and maintain regular physical activity and exercise in people with CF is important for improved health outcomes.
2. Describe your approach and broader findings.
We undertook a prospective, longitudinal study - the first of its kind to assess physical activity participation measured objectively using accelerometry, conducted exclusively in young adults with CF.
Working closely with clinicians across multiple CF clinics, and recruited young adults with CF well then were in stable respiratory health. Participants undertook assessments of physical activity participation, exercise testing measures, quality of life and respiratory function. Participants were followed over a 12-month period, when assessments were repeated and a record of respiratory exacerbation and need for hospitalization was recorded.
During the followup period, any participant who required admission to hospital completed additional periods of physical activity monitoring at the time of discharge from hospital and one-month following hospital. This time period was of interest as in other groups with chronic respiratory disease, namely older adults with chronic obstructive pulmonary disease (COPD), failure to regain baseline physical activity levels within one month of hospital discharge is associated with increased morbidity and mortality.
We recruited a total of 65 adults with CF and found that while some adults with CF can achieve general population targets for daily physical activity participation, around half do not. Those people who do achieve daily physical activity targets spent less days in hospital over the following 12-months. Of note, most adults with CF accumulate physical activity in multiple short bouts of activity (e.g 1-3 minutes at a time) during the day. Only about one-third of participants performed activity in more concerted periods (of at least 10 minutes), but these individuals had better respiratory function and significantly less need for hospitalisation over the 12-month follow-up. Of interest, adult females with CF were significantly less active than males, and the period following an admission to the hospital was associated with a decline in physical activity participation of over 40%. These findings highlight the need to investigate strategies designed to increase physical activity and exercise participation in this group. Such strategies may need to consider the nature in which physical activity is performed (ie. Short bursts, versus prolonged periods), specifically target females or focus on the period immediately following an admission to hospital.
3. What is the wider contribution, or impact, to your scientific field(s)?
The results of our work were published in 2016 (http://onlinelibrary.wiley.com/store/10.1111/resp.12719/asset/resp12719.pdf?v=1&t=j3cm2l3t&s=7d6c4dace2579db49131545b84a72ba36cdf33d9) in a leading respiratory medicine journal.
This work has informed national clinical practice guidelines for CF. The Physiotherapy for Cystic Fibrosis in Australia and New Zealand clinical practice guideline is the pre-eminent, evidence-based, clinical guide for the physiotherapy management of individuals with Cystic Fibrosis. It forms a part of the teaching curriculum for physiotherapy students, and junior clinicians in the field.
The body of work comprising these studies of physical activity participation in young adults with CF has been highlighted in a Year in Review analysis of key papers in the area of CF and paediatric lung disease, and also led to national television and radio media interviews. In additiona, it has culminated in national and international invited speaker invitations to discuss the importance of physical activity and models of physical activity promotion in adolescents and young adults with CF, including to consumer advocate groups.
A component of this work included the first validation of an accelerometer for the measurement of physical activity in free-living conditions in individuals with cystic fibrosis.
4. Are there any potential ideas you would like to explore to take this research further?
Very few methods have been utilized to promote physical activity participation in young people with CF. I would like to investigate, in a randomized controlled trial, the use of a novel web-based application to promote and support regular physical activity participation in this group using principles of motivational interviewing, self-monitoring and realtime feedback. In pilot data collected during my PhD I established that a web-based program is acceptable to adults with CF in providing motivation and feedback to undertake physical activity. Based on participant feedback we will update the web-platform to be more mobile friendly, accessible as an app and to incorporate more obvious goal setting capabilities.
In parallel, I would like to conduct a qualitative study with adolescents and young adults to identify barriers and facilitators to regular physical activity participation – whilst as clinicians (and researchers) we have ideas about the ways to best deliver and engage our patients in their therapy, at this time the patient perspective regarding what would make it easier to be more physically active has not been sought.
Regular physical activity participation can improve emotional well-being and mood, and reduce symptoms of depression and anxiety. In adolescents and young adults with CF the prevalence of depression is up to 3 times greater than in their well peers. Diagnosis of a depressive disorder has been associated with reduced compliance with therapy, and increased need for hospitalisation and healthcare expenditure.
It is hoped to conduct a longitudinal, repeated measures, cohort study of objectively measured physical activity participation and self-reports of anxiety and depression in young adults with CF over 3 years. This data may help to underpin screening measures, and preventative strategies, for those at risk of future affective illness.
5. Please share a link for researchers to access a relevant publication, data-set, or thesis.
Dr Narelle Cox is an experienced physiotherapist who has worked extensively in paediatric and adult respiratory care. She is currently an NHMRC Early Career Research Fellow at La Trobe University i...