Short and long-term effects of therapeutic exercise in children with bronchiectasis: a multi-centre randomised controlled trial.

The problem

Bronchiectasis is a lung disease characterised by chronic infection in small airways that results in some parts of the lung becoming damaged, scarred and dilated. Children with bronchiectasis experience exacerbations of their condition resulting in frequent hospitalisations and decreased of quality of life.

Guidelines for the treatment and management of bronchiectasis call for regular exercise as a means of improving aerobic fitness and health-related QoL. Moreover, therapeutic exercise may reduce the incidence of acute exacerbations, which is a key predictor of future lung function decline and morbidity. Yet, to date, the short and long-term health benefits resulting from therapeutic exercise have not been investigated in children with bronchiectasis. Hence, RCTs evaluating the efficacy of developmentally-appropriate therapeutic exercise programs for children with bronchiectasis are urgently needed.

The research

Our research team has established that children with bronchiectasis experience significant developmental delays in fundamental movement skills (FMS) and are insufficiently active for health benefit. To address this problem, we have developed a novel, play-based therapeutic exercise program specifically designed to improve movement competence and fitness in children with bronchiectasis, and conducted a pilot RCT in 21 children to evaluate its feasibility and potential efficacy. The program significantly improved FMS proficiency, with a 21% increase in locomotion skills and a 31% increase in object control skills. The program also had a positive effect on fitness (Cohen’s d = 0.5). We are now conducting a fully powered multi-centre RCT to evaluate the efficacy of our therapeutic exercise program with proportion of children with no exacerbations over a 12-month follow-up period as the primary outcome. As secondary outcomes, we will assess the program’s impact on FMS proficiency, physical activity, cardiorespiratory fitness, HR-QoL, and lung function.

The potential outcomes

Our study will be the first of its kind to evaluate the impact of therapeutic exercise on exacerbations, exercise capacity, and quality of life in children with bronchiectasis. Improvements in these outcomes will have an immediate positive impact on physical functioning and future health. BE exacerbation is the only known risk factor for lung function decline in this patient group. Thus, reducing the frequency of exacerbations during childhood through therapeutic exercise may be an important clinical management strategy for preventing future decline in lung function and respiratory morbidity later in life. Furthermore, by enhancing FMS proficiency and increasing children’s perceived and actual competence to engage in a variety of sport and physical activities, the program has strong potential to mitigate the risk of disabling secondary comorbidities such as obesity, anxiety, and depression.