Feasibility and acceptability of establishing virtual exercise classes for cystic fibrosis (CF) patients

Background: CFTR modulators have led to improvements in CF outcomes, including FEV1, exacerbation frequency and body mass index (BMI). Despite positive outcomes, modulators have brought new challenges – particularly elevated BMI. For many, weight gain has been due to increased fat rather than muscle mass, making exercise a high priority. Exercise has always been an integral part of CF management. However, the COVID-19 pandemic has made it harder for patients to access exercise. This presented a service need to set up a platform where patients could safely exercise at home with support from a known physiotherapist. Objectives: To assess the feasibility and acceptability of a physiotherapyled online group exercise class for CF patients. Methods: In this pilot study, high and low intensity virtual exercise classes were delivered twice weekly over four weeks. Eight participants were recruited;five completed the study. The primary outcomes were (1) feasibility, assessed by means, resources and time needed to deliver the intervention and (2) acceptability, assessed by qualitative interviews with participants. FEV1, BMI, 60STS and psychosocial outcomes were also monitored. Results: Time, resources and equipment were all adequate to deliver the intervention within the service. Positive themes from interviews included: (1) Impact on health: improved fitness, (2) Motivation to exercise: feeling encouraged, supported and accountable, and (3) Convenience: saved time, money and ease of exercising at home. Some challenges patients reported were space, technical issues with equipment and missing face-to-face interaction. Conclusion: Virtual exercise classes for patients with CF are both feasible and acceptable, with patients reporting a positive impact on their fitness levels as well as reduced travel burden. Patients also stated that classes delivered by a familiar physiotherapist motivated them to exercise and instilled confidence that the exercises were safe and effective.Background: CFTR modulators have led to improvements in CF outcomes, including FEV1, exacerbation frequency and body mass index (BMI). Despite positive outcomes, modulators have brought new challenges – particularly elevated BMI. For many, weight gain has been due to increased fat rather than muscle mass, making exercise a high priority. Exercise has always been an integral part of CF management. However, the COVID-19 pandemic has made it harder for patients to access exercise. This presented a service need to set up a platform where patients could safely exercise at home with support from a known physiotherapist. Objectives: To assess the feasibility and acceptability of a physiotherapyled online group exercise class for CF patients. Methods: In this pilot study, high and low intensity virtual exercise classes were delivered twice weekly over four weeks. Eight participants were recruited;five completed the study. The primary outcomes were (1) feasibility, assessed by means, resources and time needed to deliver the intervention and (2) acceptability, assessed by qualitative interviews with participants. FEV1, BMI, 60STS and psychosocial outcomes were also monitored. Results: Time, resources and equipment were all adequate to deliver the intervention within the service. Positive themes from interviews included: (1) Impact on health: improved fitness, (2) Motivation to exercise: feeling encouraged, supported and accountable, and (3) Convenience: saved time, money and ease of exercising at home. Some challenges patients reported were space, technical issues with equipment and missing face-to-face interaction. Conclusion: Virtual exercise classes for patients with CF are both feasible and acceptable, with patients reporting a positive impact on their fitness levels as well as reduced travel burden. Patients also stated that classes delivered by a familiar physiotherapist motivated them to exercise and instilled confidence that the exercises were safe and effective.

Remote delivery of care to people with cystic Fibrosis during covid-19 shielding is not Detrimental to patient outcomes

Introduction and Objectives Intensive surveillance of lung function (FEV1), body weight and airway microbiology is central to good cystic fibrosis (CF) care. National standards recommend people with CF (pwCF) are reviewed at least three monthly by specialist multidisciplinary teams. COVID-19 'shielding' precautions, set to protect clinically extremely vulnerable people, terminated all but essential face-to-face clinical contact for over four months. Many pwCF remain apprehensive as restrictions ease. The King's Adult CF Unit delivers care to 250 pwCF across south-east England. We discuss the immediate service changes in response to COVID-19, and the effect on patient outcomes of limited clinician review. Methods At the start of shielding the entire patient cohort was reviewed and grouped as stable or of concern. Telephone and/or video clinics were implemented, and patients identified as high risk were prioritised for remote self-monitoring (FEV1 with Bluetooth home spirometers, weight, postal sputum samples). Home visits or ward reviews, by specialist nurses or physiotherapists, were arranged if clinically essential. We undertook a cohort review of consecutive patients emerging from shielding to compare clinical parameters before and after lockdown. Results Since shielding ended, 24 consecutive patients (see table 1) have been reviewed, at a median (IQR) of 167 (155, 180) days after pre-COVID assessments. At review, 2 patients had a clinically significant fall in lung function (10%), however no statistical difference in FEV1, weight or BMI (n=21) was seen overall following shielding when compared to measurements immediately (29 (21, 46) days) before lockdown (ppFEV10.0 (-0.1, 0.1), BMI 0.5 (-1.0, 1.6)). 11 (45.8%) patients sent sputum samples, 1 identified a clinically insignificant new microorganism. 13 (54%) patients required treatment for pulmonary exacerbations, 8 (33.3%) with intravenous, 5 (20.8%) with oral antibiotics. Conclusions Unpredicted changes to CF care delivery at our centre was not detrimental to patient outcomes. In this cohort, key CF clinical indices remained stable over a short period of shielding, supporting safe remote delivery of care. Modulator therapies likely contributed to the stability in lung function seen.

P123 Remote delivery of care to people with cystic fibrosis during COVID-19 shielding is not detrimental to patient outcomes

P123 Table 1Baseline characteristics and lung function pre- and post- shielding. Data presented as mean ± SD, or median (IQR). *At start of shieldingAge, years* 28 (22, 30) Male, n (%) 10 (41.7) CFTR modulator therapy, n (%)* Ivacaftor 1 (4.2) Lumacaftor/ivacaftor 1 (4.2) Tezacaftor/ivacaftor 10 (41.7) Best measurements in last year FEV1 percent predicted,% 70.8 (23.4) Body mass index (kg/m2) 28.0 (3.6) Patients identified as ‘high risk’*, n (%) 5 (20.8) Pre- and post- shielding FEV1 percent predicted,% 67.2 (27.3) 66.9 (26.3) Weight, kg (n=21) 66.0 (15.1) 66.9 (12.9) Body mass index, kg/m2 (n=21) 23.3 (3.8) 24.0 (3.5) ConclusionsUnpredicted changes to CF care delivery at our centre was not detrimental to patient outcomes. In this cohort, key CF clinical indices remained stable over a short period of shielding, supporting safe remote delivery of care. Modulator therapies likely contributed to the stability in lung function seen.