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Published on: August 24, 2019
Effects of a therapeutic exercise program in children with non-cystic fibrosis bronchiectasis: A pilot randomized
Barbara Joschtel1, Sjaan R Gomersall1,2, Sean Tweedy1
1School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
Insights
This pilot study shows that a play-based therapeutic exercise program significantly improved fundamental movement skills in children with bronchiectasis. The program also positively impacted fitness and quality of life.
Area of Science:
- Pediatric Pulmonology
- Pediatric Physical Therapy
- Exercise Science
Background:
- Randomized controlled trials (RCTs) on therapeutic exercise for pediatric bronchiectasis are lacking.
- This pilot RCT evaluated a play-based exercise program for children with bronchiectasis.
- Secondary outcomes included cardiorespiratory fitness, perceived competence, and health-related quality of life (HR-QoL).
Purpose of the Study:
- To assess the impact of a play-based therapeutic exercise program on fundamental movement skill (FMS) proficiency in children with bronchiectasis.
- To examine secondary effects on cardiorespiratory fitness, perceived competence, and HR-QoL.
Main Methods:
- A 7-week, play-based therapeutic exercise program was implemented.
- Participants (children with bronchiectasis) were randomized into an exercise group (n=11) or a wait-list control group (n=10).
- Assessments included FMS (TGMD-2), cardiorespiratory fitness (%ΔHR), perceived competence (Harter's scale), and HR-QoL (PedsQL).
Main Results:
- Significant improvements in locomotor and object control skills were observed in the exercise group (p=0.01).
- The exercise group showed a 6% point decline in %ΔHR, compared to a 0.9% point decline in controls.
- Small positive effects were noted for competence perceptions (Cohen's d=0.2) and HR-QoL (Cohen's d=0.3).
Conclusions:
- A play-based therapeutic exercise program demonstrates preliminary efficacy in improving FMS and fitness in children with bronchiectasis.
- The findings support the need for larger RCTs to confirm efficacy in children with bronchiectasis and other chronic respiratory conditions.
Background:
In the absence of randomized controlled trials (RCTs) on the benefits of therapeutic exercise programs involving children with bronchiectasis, we undertook a pilot RCT to evaluate the effects of a play-based therapeutic exercise program on fundamental movement skill (FMS) proficiency. The effects of the program on cardiorespiratory fitness, perceived competence, and health-related quality of life (HR-QoL) were examined as secondary outcomes.
Methods:
Children [median (IQR) age: 6.8 (5.3-8.8) years] with bronchiectasis unrelated to cystic fibrosis were randomized to a 7-week therapeutic exercise program (n = 11) or wait-list control (n = 10). The exercise program comprised 7 × 60-min weekly sessions and was supplemented by a home-based program 2-days/week. Participants were assessed on: FMS (locomotor and object control skills) using the Test of Gross Motor Development 2nd Edition (TGMD-2); cardiovascular fitness by calculating the percent change in heart rate (%ΔHR) from rest to completion of the first stage of a submaximal treadmill test; perceived competence using Harter's athletic competence subscale; and QoL with the PedsQL.
Results:
Significant group by time interactions were observed for locomotor and object control skills. Children completing the therapeutic exercise program exhibited significant improvements in both locomotor (pre 29.0 ± 2.0, post 35.2 ± 2.2, p = 0.01) and object control (pre 27.0 ± 2.0, post 35.5 ± 2.2, p = 0.01) skills, with no significant change in controls (pre 31.6 ± 2.1, post 31.8 ± 2.3 and pre 31.0 ± 2.1, post 32.3 ± 2.3, respectively). Among children completing the program, %ΔHR declined by 6% points, while %ΔHR declined only marginally among controls (0.9% points), but the group by time interaction was not statistically significant. The program had a small positive impact on competence perceptions (Cohen's d = 0.2) and HR-QoL (Cohen's d = 0.3).
Conclusion:
This pilot RCT provides preliminary evidence for the efficacy of a play-based therapeutic exercise program to improve proficiency in FMS and fitness in children with bronchiectasis. The results are sufficiently positive to warrant conducting a larger RCT testing the efficacy of the exercise program in children with bronchiectasis and/or other chronic respiratory conditions.
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