Discussion
CF, fatigue, anxiety, 1RM quadriceps, 1RM shoulder abductors, depression
DISEASE
This randomized clinical trial evaluated the effects of an early rehabilitation program (aerobic and muscle strength training) on lung function, muscle strength, inflammatory markers, and quality of life in adult CF patients hospitalized for pulmonary exacerbation. Patients showed significant improvement in the Borg score for leg fatigue at rest, muscle strength variables (1RM biceps, 1RM triceps, 1RM shoulder flexors, 1RM shoulder abductors, 1RM quadriceps, and 1RM hamstrings), and CFQ-R domains (emotional functioning, physical functioning, social functioning, and treatment burden) after the rehabilitation program.Studies on the effects of exercise during hospitalization in CF patients are scarce in the literature (A recently published systematic review (In the present study, the exercise group showed improved QoL in the CFQ-R domains (emotional functioning, physical functioning, social functioning, and treatment burden). Adolescents and adults with CF have lower QoL and high rates of depression and anxiety (In this study, the distance covered in the 6MWT did not significantly differ between groups. The 6MWT was selected as the main outcome assessment due to the critical condition of the patients. The exercise group did not differ from the control group, although it showed greater increments in the 6MWT result (57 Using the cardiopulmonary exercise test, which is considered the gold standard for assessing the interaction of cardiovascular, respiratory, and metabolic systems (There was a significant improvement in arm and leg muscle strength in the exercise group despite the short training period. Several studies have observed changes in muscle strength in CF patients after a training period (Our exercise rehabilitation program did not change any of the inflammatory markers analyzed. On the other hand, another study demonstrated that physical activity modulates IL-6 and TNF- levels in patients with CF (The clinical findings of the present study suggest that even supervised physical exercises performed in a short period of time and in an adverse situation of disease exacerbation can have positive impacts on muscle strength, fatigue, and quality of life.This study had some limitations. First, due to technical impediments, it was not possible to reach the minimum sample size calculated for the main outcome, which could have underestimated the real impact of early rehabilitation in this group. In addition, the study was conducted at a single center. Furthermore, early rehabilitation was performed only during hospitalization and the outcome assessment time was short (14 days). Prolonged rehabilitation after hospital discharge and a longer time until outcome evaluation could shed more light on the subject. Moreover, it is not yet fully understood or established which form and intensity of aerobic and muscle strength training provide the maximum benefits for these patients.In conclusion, the early rehabilitation program significantly improved the muscle strength, resting fatigue, and QoL in adult patients with CF.