Frequent Flyer patients with cystic fibrosis spend less time in hospital and more at the gym
Children with moderate to severe cystic fibrosis (CF) enrolled on a programme offering physiotherapy, dietary support and personal training sessions at their local gym, were found to spend less time in hospital receiving antibiotics, as well as boosting their exercise capacity. The pilot study, published in the Journal of Cystic Fibrosis, estimated that the programme also saved around £7,000 per patient per year at Great Ormond Street Hospital (GOSH).
CF, a life-threatening condition, affects the lungs and digestive system by clogging them with thick mucus. Children with CF often have to stay in hospital for a few weeks at a time to receive intravenous (IV) antibiotics. The 12-month pilot Frequent Flyer Programme, so named because the children spend so much time in hospital, aimed to reduce the need for children and young people with CF to be admitted to hospital, allowing them to spend more time at home and at school.
Fourteen children and young people (aged 4-15) who had spent more than 40 days in hospital receiving intravenous antibiotics in the year prior to the study starting were followed. Free access to their local gym was arranged, where a specialist physiotherapist provided weekly supervised, personal training sessions along with a regular review of their home physiotherapy regimen. A specialist dietitian provided regular nutritional support and education.
Gym sessions included high intensity interval training using cardiovascular training equipment (such as treadmills or bikes) interspersed with periods of recovery. Strength, core-conditioning and stretching components were also included. Children exercised for 30-60 minutes per session, depending on their health. In addition, they were encouraged to exercise independently and to actively participate in school sports for an extra two hours a week. Participants were monitored over the course of the year in terms of their exercise capacity, lung function, growth, appetite, and food intake and absorption.
The study resulted in a 21% reduction in the total number of days patients received IV antibiotic treatment at GOSH, from 619 days in the preceding year to 478 in the pilot year, along with a 20% reduction in home IV antibiotic treatment from 304 to 243 days collectively for all patients.
The children also showed a significant increase in their exercise capacity, which was determined by measuring their maximum oxygen uptake and the distance they walked or ran during exercise testing. Peak oxygen uptake increased by 13 per cent, and the researchers also saw a significant increase in the distance walked or run.
A handful of children struggled to maintain steady growth as a result of exercising more, and when necessary the dietitian prescribed additional calorie supplements to meet their higher energy needs. No significant increase in lung function was measured within the year, although in some children lung function was found to be more stable. Exercise capacity has been previously shown help to maintain or increase lung function in the longer term.
Overall, the study estimated a mean cost saving per patient of £13,700, where the average cost per patient was £60,200 before the study compared to £46,500 in the pilot year. After factoring in the set-up costs for the programme, plus estimated annual gym memberships, the average cost per patient would be £53,100, suggesting an overall cost saving of £7,100 per patient.
Sean Ledger, GOSH Specialist Physiotherapist and lead author of the study, said: “This was a small-scale trial with promising results, and we have now launched a larger randomised controlled trial, called INSPIRE-CF, to validate the results and recruit more children onto our tailored fitness programme. As with all these schemes, it is important to carefully monitor growth and body composition in children who regularly exercise, as greater energy demands may affect their body mass index (BMI).”
“If our positive results could be replicated in other hospitals across the UK, the implications for cost savings to the NHS, along with improving the quality of life for children living with cystic fibrosis, would be extensive.”
Tom, 15, from St Albans was one of the first patients to enrol on the programme.
After being diagnosed with CF at six weeks old, Tom struggled to gain weight and had a bad cough. He began visiting GOSH bimonthly as an outpatient until he was four. Tom then developed an infection and was admitted for two weeks to receive IV antibiotics. By the time Tom was nine, he was spending two to three weeks in hospital every few months for antibiotic treatment.
Currently, in order to protect his lungs Tom uses a chest physiotherapy technique twice a day to clear his chest of mucous. In addition, he must adhere to a strict regime of oral and nebulised antibiotics. A nebulised mucous-thinning drug is taken daily to help clear his airways. Enzyme medication is taken to aid food digestion, as CF also affects the digestive system.
Tom’s mum Karen says:
“Having a child with CF has a huge impact on the whole family. When it became clear that Tom needed more frequent inpatient stays, the effect on family life was quite considerable. It became a struggle to maintain my career and most importantly, to divide my time between Tom and my elder daughter of school age. Tom’s schooling was also affected, as more and more time was spent away from school whilst in hospital.”
“However, since Tom joined the Frequent Flyer Programme, the difference to his health and to family life has been enormous. Hospital admissions have been reduced considerably and Tom has realised the importance of staying fit and healthy to help manage his CF. Tom is an active member of a football team and is a regular visitor to his local gym. There is no better reward for Tom’s efforts than to see him as active as his friends.”
“Overall, we have been delighted with the Frequent Flyer Programme and very much hope that other children will be able to benefit from such schemes.”
“A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV-antibiotic requirements in children with moderate-severe cystic fibrosis”,
Sean Ledger et al.
Journal of Cystic Fibrosis.