ABSTRACT
Background: Physical activity has been shown to have a positive impact on cystic fibrosis (CF) symptoms and slows decline in lung function. Additionally, moderate-intensity activities have been shown to improve sputum expectoration and oxygen saturation in children with CF, improving symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children with CF. Method(s): This pre-post pilot study included participants aged 6 to 21 who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020 and November 2021. Garmin vivosmart 4 wrist-based activity trackers were issued, and baseline datawere tracked and analyzed for the first 2 study days. Pre-goal number of steps was defined as average number of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal settingwere defined as average number of steps taken on study day 3 and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means, and standard deviations. Outpatient data were collected for 3 months to observe adherence to goals after discharge. Result(s): Eight participants aged 6 to 18 completed the study. Hospital length of stay ranged from 4 to 14 days. Participants took an average of 1508 +/- 1078 steps before goal setting, which increased to an average of 3704 +/- 1555 steps after the intervention. Step goals were met 56% of the time, although these data were highly variable. During the first week after hospital discharge, participants took an average of 6303 +/- 1786 steps per day (Figure 1).(Figure Presented) Figure 1. During the intervention, patients met their step goal 56% of the time, although this was highly variable. Two patients met their goal 100% of the time (9- year-old boy, 7-year-old girl), two met it 0% of the time (18-year-old boy, 17-year-old girl), one met it 44% of the time (6-year-old boy), and the remaining three met it 67% of the time (10-year-old girl, 17-year-old girl, 14-year-old boy). Conclusion(s): This intervention shows promise, with daily number of steps doubling from baseline during the intervention period. There was great variability among participants, suggesting that the approach helps some more than others. Enrollment was initially planned for 20 patients, but the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data were analyzed for only the first week after discharge because of poor adherence to wearing the device. Although our results showa positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long-term benefits of intervention.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Purpose of Study Cystic Fibrosis (CF) is a progressive, genetic disease that affects over 30,000 individuals across the nation and results in decreased functionality of the lungs. Physical activity has a positive impact on the symptoms of CF and works to slow the decline in lung function. Additionally, activities with moderate intensity have been shown to improve sputum expectoration and oxygen saturation in children with CF. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children and young adults with CF. Methods Used This prospective study included participants 6- 21 years of age who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020-May 2021. Study enrollment occurred no more than 48 hours after hospital admission. Garmin vivosmart® 4 wrist-based activity trackers were issued and baseline data were tracked and analyzed for the first 2 study days. Pre-goal steps were defined as the average of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participant. Steps after goal setting were defined as the average of steps taken on study day 3 and beyond, excluding day of discharge. Data were collected from the electronic medical record and the activity tracker web-based profile and included the following: daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means and standard deviations. Summary of Results Six patients, aged 6-18 years, completed the study. Mean baseline FEV1for study participants was 66% predicted (range 38 to 92%). Hospital length of stay ranged from 4-14 days. Participants took an average of 1772 ± 1011 steps before goal setting. This increased to an average of 3741 ± 1780 steps after goal setting. Overall, step goals were met 52% (Range 0-100%) of the time. Conclusions This intervention shows promise, as daily steps doubled from baseline during the intervention period. There was great variability among the participants, suggesting the device may help some people much more than others. Enrollment was initially planned for 20 patients;however, the SARS-CoV-2 pandemic and consequent changes to CF therapy drastically reduced hospitalizations during the study period. Though our results show a positive impact of increased physical activity following goal implementation, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include having a larger sample size, conducting a multi-center study to increase population diversity, and implementing a longer follow- up period to better assess long term benefits of intervention.
ABSTRACT
Purpose of Study For the 2020-21 academic year, the impact of the coronavirus disease 19 (COVID-19) pandemic on residency programs nationwide not only included decreased connectivity between residents, but also decreased involvement in communities. When restrictions were lifted, we anticipated resident engagement would be slow to return to normal. In response, our Pediatric Chief Resident organized monthly community involvement opportunities to promote engagement, and community service. The purpose of this quality improvement (QI) project was to increase resident engagement in the community through volunteer opportunities. Methods Used The goal for this QI project was to achieve 75% resident engagement in community-centered activities in a twelve-month period. To achieve this, the Chief Resident collaborated with community partners to plan monthly community- oriented activities. A total of twenty-five pediatric residents were invited to participate in these events on a voluntary basis. Participation in each event was documented and used to follow overall resident engagement over time. Cycle 1 consisted of 3 identical events in a 3-month period, which took place at a local farmers' market as a public health initiative to educate families in the community about summer safety. Cycle 2 incorporated other opportunities to accommodate varying interests and schedules. These options included a Teddy Bear Clinic at a local park and a clothing drive for children attending a local summer camp for children who have experienced burns. Cycle 3, which is ongoing, includes new activities as well as a resident sign-up to provide a more formal invitation and commitment to participate. Summary of Results Prior to Cycle 1, some residents volunteered in the community on their own volition, but as a residency program, participation in formally organized community service activities was scarce. In Cycle 1, 4/25 (16%) of residents engaged;one PGY2, two PGY3, and the chief resident. With the incorporation of different activities in Cycle 2, resident engagement increased to 9/25 (36%). The same residents who participated in Cycle 1 also participated in Cycle 2, with the addition of two PGY1, two more PGY2, and one more PGY3. Offering a variety of service opportunities has proven to increase resident engagement. Cycle 3 is currently ongoing. Conclusions Community service restores the connectivity between residents and the surrounding community we serve. Our program's resident engagement in the community is improving over time as more opportunities are offered. The goal of 75% resident participation has not yet been reached, but ideas for future community service activities are emerging. Realizing residents have different strengths and motivations has emphasized the importance of offering new activities that are appealing to residents who have yet to participate. Our hope is the overall success of this QI project will result in perpetual community involvement.