Exercise might be an alternative airway clearance method with other benefits. What this study adds: A session of various whole-body exercises ZD1839 concentration interspersed with expiratory manoeuvres could be an acceptable substitute for a regimen of breathing and manual techniques for airway clearance in children with cystic fibrosis. The effect on sputum clearance is similar, while the immediate effects on lung function and treatment satisfaction are greater. Exercise offers some potential advantages

over other physical airway clearance interventions (van Doorn 2010). In addition to enhancing mucus clearance (Salh et al 1989, Bilton et al 1992), it improves cardiorespiratory fitness (van Doorn 2010), muscle mass, strength, and body image (Sahlberg et al 2008), as well as emotional wellbeing and perceived health (Selvadurai et al 2002, Hebestreit et al 2010). Perhaps most importantly, a recent systematic review examining trials of exercise in children with cystic Libraries Fibrosis concluded that a long-term exercise program may protect against pulmonary function decline (van Doorn 2010). Furthermore, exercise is often more readily accepted by patients, especially the youngest (Moorcroft et al 1998, McIlwaine 2007), than other airway

clearance methods (Bilton et al 1992). This may be because it is a more ‘normal’ activity and because it can be tailored for greater enjoyment (Kuys et al 2011). Although substantial INCB018424 supplier evidence shows that exercise is better than no exercise, fewer trials have been conducted to evaluate the usefulness of acute exercise as a substitute for or

assistance in airway clearance. Most of these trials have studied adults (Bilton et al 1992, Baldwin et al 1994, Salh et al 1989, Lannefors & Wollmer 1992) with fewer studying children (Zach et al 1981, Zach et al 1982, Cerny 1989). However, the trials by Zach and colleagues were not randomised and the trial by Cerny examined the effect of substituting exercise for two of three sessions per day of manual airway clearance techniques in postural drainage positions. These features make it difficult to compare the effects of exercise to those of breathing/manual Bumetanide techniques for airway clearance. Therefore, we sought to compare the effect on airway clearance of exercise and chest physiotherapy in children with stable cystic fibrosis lung disease. The research questions for this study were: 1. Can a session of exercise with incorporated expiratory manoeuvres substitute for a session of breathing techniques for airway clearance in children with cystic fibrosis? A randomised cross-over trial with concealed allocation and intention-to-treat analysis was conducted at the Lyon Paediatric Cystic Fibrosis Centre in France to compare a regimen of exercise combined with expiratory manoeuvres against a control regimen of breathing techniques.