Selected Podcast
Exercise Is Medicine in Cystic Fibrosis
Exercise can improve lung function and have a range of other benefits for cystic fibrosis (CF) patients, but each patient has a unique tolerance for exercise depending on age, condition, and lifestyle. Stefanie Krick, MD, discusses how the complications specific to CF require popular exercises to be modified. She also emphasizes that patients must be monitored closely for changing abilities in each phase of their lives. Multidisciplinary teams that include physical therapists are best suited to help patients with special challenges due to CF make exercise part of their lives safely.
Featuring:
Learn more about Stefanie Krick, MD
Release Date: May 17, 2022
Expiration Date: May 16, 2025
Disclosure Information:
Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education
Katelyn Hiden
Physician Marketing Manager, UAB Health System
The planners have no relevant financial relationships with ineligible companies to disclose.
Faculty:
Stefanie Krick, MD
Assistant Professor, Critical Care Medicine, Pulmonary Critical Care & Pulmonology
Dr. Krick has no financial relationships with ineligible companies to disclose.
There is no commercial support for this activity.
Stefanie Krick, MD
Dr. Krick is an Assistant Professor of Medicine at the University of Alabama at Birmingham (UAB). Following her fellowship training and internships at Jackson Memorial Hospital/University of Miami and Mount Sinai Medical Center, she worked as an assistant professor of medicine at the Miller School of Medicine's Division of Pulmonary and Critical Care Medicine. She has completed training in internal medicine, molecular biology, pulmonary medicine, critical care and vascular medicine.Learn more about Stefanie Krick, MD
Release Date: May 17, 2022
Expiration Date: May 16, 2025
Disclosure Information:
Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education
Katelyn Hiden
Physician Marketing Manager, UAB Health System
The planners have no relevant financial relationships with ineligible companies to disclose.
Faculty:
Stefanie Krick, MD
Assistant Professor, Critical Care Medicine, Pulmonary Critical Care & Pulmonology
Dr. Krick has no financial relationships with ineligible companies to disclose.
There is no commercial support for this activity.
Transcription:
Welcome to UAB MedCast, a continuing education podcast for medical professionals. Providing knowledge that is moving medicine forward. Here's Melanie Cole.
Melanie Cole (Host): Welcome to UAB MedCast. I'm Melanie Cole. And joining me today is Dr. Stefanie Krick. She's a pulmonologist in critical care medicine at UAB Medicine. She's an Assistant Professor and the Associate Director of the UAB Adult Cystic Fibrosis Program. She's here to discuss exercise and cystic fibrosis. Dr. Krick, it's a pleasure to have you join us today. Please discuss the role as we get into this podcast of exercise for cystic fibrosis patients, the benefits for the patient. Tell us a little bit about that.
Dr Stefanie Krick: Thank you very much for having me. And the Cystic Fibrosis Foundation really says that regular physical activity provides benefits well beyond better lung function. They state that keeping fit not only helps lung function, but also helps strengthen the bones, manage diabetes and heart disease and improve your mood.
Looking a little bit closer at that though, there are a lot of studies out there, over 83 when I looked at it, looking at over 480 participants, looking really at the role of exercise. But there are no high quality randomized controlled trials. And these are really the ones we need to better define the role of exercise in cystic fibrosis, because like you said, there are a lot of challenges when it comes to cystic fibrosis.
First of all, most of these patients are weaker because they have a chronic lung disease, they have diabetes, they have weaker bones. So what exercise is really right for them? Do they need a specific exercise prescription? Then kids normally don't participate in school sports, because they are more sick than other kids that don't have cystic fibrosis. And same I think in the adulthood, a lot of them do respiratory therapies about three hours on a daily basis and they have a job, so how can they fit in exercise? And they don't age that much. The life expectancy right now of cystic fibrosis patients is about 50 years. But even when they are 30, 40, they are normally more frail than healthy patients. That also poses certain challenges for doing exercise. They cannot do running or hiking and climbing. They, most of the time, have to really change exercise accordingly. So that makes it very challenging. And I think we need to figure out what is best for them, because exercise is important for them to prolong life and keep lung function high.
Melanie Cole (Host): Well, I certainly agree with you. And as we're talking about how cystic fibrosis affects exercise capacity and tolerance, Dr. Krick, let's break down the different types of exercise as part of a wider management strategy. There's a growing body of evidence that's suggesting that exercise and physical activity certainly can lead to improvements in lung function. And so, if it's helping people with cystic fibrosis benefit from enhanced airway clearance and better mucus clearance, can you speak a little bit to the types of exercise when other providers are listening to this with the breathing benefits and the types of exercise that can really help in this regard?
Dr Stefanie Krick: So I think we want to have a comprehensive exercise regimen. So especially coming to airway clearance, it's actually the moderate to vigorous exercise that will help with lung function and really use the whole vital capacity for them and that helps with airway clearance as well. And as a matter of fact, a lot of our patients that do airway clearances and are physically well, they use this vigorous exercise in addition to help clear more mucus. So it definitely plays an important role, but again, like the clinical trials are missing at this point, it's just really more anecdotal.
Melanie Cole (Host): That's so interesting. Well, it gives you something to really look to for a great research trial. And tell us when you're talking about vigorous and moderate, and we're talking about exercise for airway clearance. What about daily life of cystic fibrosis patients, the mind-body relationship, other types of exercise, yoga, meditation, flexibility, functional training? Tell us how these are all worked in for a real comprehensive program for people living with cystic fibrosis.
Dr Stefanie Krick: Yeah. So I think that's a very good point. Yoga is definitely a very good exercise. It again needs to be modified. And that's I think where it comes to cystic fibrosis patients should be in a cystic fibrosis center and seen by a multidisciplinary team. And this team, most of the time, has an exercise physiologist or a physical therapist as part of that team. And they can also help to find the right exercises, because like you said, yoga in general is very good, especially since you focus on breathing, which will help them overall also with airway clearance. But there are some like downward dog, for example, where they have to lean over, which is sometimes tough for patients who bring up sputum or who have shortness of breath in general. So the yoga program needs to be modified according to what they are able to do. Some of them will have feeding tubes because they are malnourished. That's another thing where some patients might not be able to do exercises for their abdominal muscles the way a normal person would be able to do that. So it's good to have a physical therapist like we have at UAB who is part of our program and helps really finding the right exercises.
Melanie Cole (Host): I think it's so important as you point out that you have patient-specific tailored programs and exercise prescription for these patients. Now, what about red flags, Dr. Krick, exercises to avoid? You just mentioned downward dog and how if someone's bringing up mucus, this could be difficult for them. Tell us any other special considerations. How about sweating? Any red flags that you would like for exercise for people that are living with cystic fibrosis?
Dr Stefanie Krick: I think one thing is they should consult with their specific cystic fibrosis team. Some of our patients are underweight and you don't want to do exercise and lose more weight. So it needs to be discussed with a provider, with a dietician and with your physical therapist, what exercise you can do to gain some lean body mass, some muscle mass and not lose weight or adjust your diet accordingly that you, in general, have a weight gain or maintain your weight. That's I think one thing that is very important to take into consideration.
Regarding exercises, I think that again is very individualized. If someone has a feeding tube, they might be able to do some exercises where another one might not be able to do those exercises. Same is with downward dog. Some might do that and actually it will help them expectorate mucus. So there again, it comes to this individualized exercise, prescription and assessment by a physical therapist.
At UAB, we actually are starting some home-based exercise programs where patients can enroll and can start with us, which is also remotely through telehealth. And this is upcoming for the next two years. If they are interested, they should definitely reach out to us. And I think which will help and also includes some behavioral techniques. How can we sustain exercise? Because I think that's the other big issue, because cystic fibrosis patients that live a normal life with having a job and everything they do, their days are pretty packed. So how do I integrate exercise?
And one other thing I think to consider is Trikafta, the new modulators, the CFTR modulators we are prescribing. They change quality of life significantly. So I think we will find basically it's a revolution, because patients will be able to do more. Some of my patients state now that they actually can run again. So they might actually be able in the future to do exercises they were not able to do before.
Melanie Cole (Host): That's so interesting. So it helps really with exercise tolerance. And you're speaking to other providers, as you wrap up, Dr. Krick, what would you like them to know as far as exercise to recommend it in their clinical practice? And when do you feel it's important that they refer to the specialists at UAB?
Dr Stefanie Krick: I think very important really going through the lifespan. With children with cystic fibrosis, they can do exercise and they should participate in school sports. It's not they are the fragile child and cannot do that, I think it's very important to early on integrate exercise and not hesitate. If they are worried, then refer to specialists at Children's of Alabama or to us. And throughout the lifespan, they should not be afraid to recommend exercise, especially when the patient does not have exacerbations. They should be able to try and really challenge themselves how much they can do and just make it a habit that it is part of the life and I think, with being on modulators, probably integrate it more and more.
Melanie Cole (Host): Thank you so much. And it does take a real multidisciplinary approach. So I really appreciate you speaking to that as well. Thank you for joining us, Dr. Krick. And a physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. Or you can always visit our website at uabmedicine.org/physician.
That concludes this episode of UAB MedCast. For the latest on medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole.
Welcome to UAB MedCast, a continuing education podcast for medical professionals. Providing knowledge that is moving medicine forward. Here's Melanie Cole.
Melanie Cole (Host): Welcome to UAB MedCast. I'm Melanie Cole. And joining me today is Dr. Stefanie Krick. She's a pulmonologist in critical care medicine at UAB Medicine. She's an Assistant Professor and the Associate Director of the UAB Adult Cystic Fibrosis Program. She's here to discuss exercise and cystic fibrosis. Dr. Krick, it's a pleasure to have you join us today. Please discuss the role as we get into this podcast of exercise for cystic fibrosis patients, the benefits for the patient. Tell us a little bit about that.
Dr Stefanie Krick: Thank you very much for having me. And the Cystic Fibrosis Foundation really says that regular physical activity provides benefits well beyond better lung function. They state that keeping fit not only helps lung function, but also helps strengthen the bones, manage diabetes and heart disease and improve your mood.
Looking a little bit closer at that though, there are a lot of studies out there, over 83 when I looked at it, looking at over 480 participants, looking really at the role of exercise. But there are no high quality randomized controlled trials. And these are really the ones we need to better define the role of exercise in cystic fibrosis, because like you said, there are a lot of challenges when it comes to cystic fibrosis.
First of all, most of these patients are weaker because they have a chronic lung disease, they have diabetes, they have weaker bones. So what exercise is really right for them? Do they need a specific exercise prescription? Then kids normally don't participate in school sports, because they are more sick than other kids that don't have cystic fibrosis. And same I think in the adulthood, a lot of them do respiratory therapies about three hours on a daily basis and they have a job, so how can they fit in exercise? And they don't age that much. The life expectancy right now of cystic fibrosis patients is about 50 years. But even when they are 30, 40, they are normally more frail than healthy patients. That also poses certain challenges for doing exercise. They cannot do running or hiking and climbing. They, most of the time, have to really change exercise accordingly. So that makes it very challenging. And I think we need to figure out what is best for them, because exercise is important for them to prolong life and keep lung function high.
Melanie Cole (Host): Well, I certainly agree with you. And as we're talking about how cystic fibrosis affects exercise capacity and tolerance, Dr. Krick, let's break down the different types of exercise as part of a wider management strategy. There's a growing body of evidence that's suggesting that exercise and physical activity certainly can lead to improvements in lung function. And so, if it's helping people with cystic fibrosis benefit from enhanced airway clearance and better mucus clearance, can you speak a little bit to the types of exercise when other providers are listening to this with the breathing benefits and the types of exercise that can really help in this regard?
Dr Stefanie Krick: So I think we want to have a comprehensive exercise regimen. So especially coming to airway clearance, it's actually the moderate to vigorous exercise that will help with lung function and really use the whole vital capacity for them and that helps with airway clearance as well. And as a matter of fact, a lot of our patients that do airway clearances and are physically well, they use this vigorous exercise in addition to help clear more mucus. So it definitely plays an important role, but again, like the clinical trials are missing at this point, it's just really more anecdotal.
Melanie Cole (Host): That's so interesting. Well, it gives you something to really look to for a great research trial. And tell us when you're talking about vigorous and moderate, and we're talking about exercise for airway clearance. What about daily life of cystic fibrosis patients, the mind-body relationship, other types of exercise, yoga, meditation, flexibility, functional training? Tell us how these are all worked in for a real comprehensive program for people living with cystic fibrosis.
Dr Stefanie Krick: Yeah. So I think that's a very good point. Yoga is definitely a very good exercise. It again needs to be modified. And that's I think where it comes to cystic fibrosis patients should be in a cystic fibrosis center and seen by a multidisciplinary team. And this team, most of the time, has an exercise physiologist or a physical therapist as part of that team. And they can also help to find the right exercises, because like you said, yoga in general is very good, especially since you focus on breathing, which will help them overall also with airway clearance. But there are some like downward dog, for example, where they have to lean over, which is sometimes tough for patients who bring up sputum or who have shortness of breath in general. So the yoga program needs to be modified according to what they are able to do. Some of them will have feeding tubes because they are malnourished. That's another thing where some patients might not be able to do exercises for their abdominal muscles the way a normal person would be able to do that. So it's good to have a physical therapist like we have at UAB who is part of our program and helps really finding the right exercises.
Melanie Cole (Host): I think it's so important as you point out that you have patient-specific tailored programs and exercise prescription for these patients. Now, what about red flags, Dr. Krick, exercises to avoid? You just mentioned downward dog and how if someone's bringing up mucus, this could be difficult for them. Tell us any other special considerations. How about sweating? Any red flags that you would like for exercise for people that are living with cystic fibrosis?
Dr Stefanie Krick: I think one thing is they should consult with their specific cystic fibrosis team. Some of our patients are underweight and you don't want to do exercise and lose more weight. So it needs to be discussed with a provider, with a dietician and with your physical therapist, what exercise you can do to gain some lean body mass, some muscle mass and not lose weight or adjust your diet accordingly that you, in general, have a weight gain or maintain your weight. That's I think one thing that is very important to take into consideration.
Regarding exercises, I think that again is very individualized. If someone has a feeding tube, they might be able to do some exercises where another one might not be able to do those exercises. Same is with downward dog. Some might do that and actually it will help them expectorate mucus. So there again, it comes to this individualized exercise, prescription and assessment by a physical therapist.
At UAB, we actually are starting some home-based exercise programs where patients can enroll and can start with us, which is also remotely through telehealth. And this is upcoming for the next two years. If they are interested, they should definitely reach out to us. And I think which will help and also includes some behavioral techniques. How can we sustain exercise? Because I think that's the other big issue, because cystic fibrosis patients that live a normal life with having a job and everything they do, their days are pretty packed. So how do I integrate exercise?
And one other thing I think to consider is Trikafta, the new modulators, the CFTR modulators we are prescribing. They change quality of life significantly. So I think we will find basically it's a revolution, because patients will be able to do more. Some of my patients state now that they actually can run again. So they might actually be able in the future to do exercises they were not able to do before.
Melanie Cole (Host): That's so interesting. So it helps really with exercise tolerance. And you're speaking to other providers, as you wrap up, Dr. Krick, what would you like them to know as far as exercise to recommend it in their clinical practice? And when do you feel it's important that they refer to the specialists at UAB?
Dr Stefanie Krick: I think very important really going through the lifespan. With children with cystic fibrosis, they can do exercise and they should participate in school sports. It's not they are the fragile child and cannot do that, I think it's very important to early on integrate exercise and not hesitate. If they are worried, then refer to specialists at Children's of Alabama or to us. And throughout the lifespan, they should not be afraid to recommend exercise, especially when the patient does not have exacerbations. They should be able to try and really challenge themselves how much they can do and just make it a habit that it is part of the life and I think, with being on modulators, probably integrate it more and more.
Melanie Cole (Host): Thank you so much. And it does take a real multidisciplinary approach. So I really appreciate you speaking to that as well. Thank you for joining us, Dr. Krick. And a physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. Or you can always visit our website at uabmedicine.org/physician.
That concludes this episode of UAB MedCast. For the latest on medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole.