Exercise and Cystic Fibrosis
Exercising is recommended as part of achieving and maintaining a healthy lifestyle. Exercise is encouraged for patients with cystic fibrosis (CF) to promote the formation of muscle, improve energy, and positive benefits on lung function. Before beginning an exercise regimen be sure to check in with your CF doctor to make sure that the activity is appropriate for you.
Exercise can be classified into two categories, aerobic and anaerobic. Aerobic activity refers to exercises that are performed at moderate to low intensity for longer periods of time. For example, running, walking, swimming, or hiking would be considered aerobic activity. Anaerobic activity refers to exercises that are performed at moderate to high intensity for short periods of time. Weight lifting, strength training, and running sprints are examples of anaerobic exercises. Another way to think about these two forms of exercise is aerobic activity typically builds endurance and anaerobic activity builds muscle mass or strength. When exercising, the lungs work to oxygenate the blood and the heart works to pump the oxygenated blood to the muscles that are performing the activity. The heart and lungs are muscles and can be strengthened through routine exercise. Many people with cystic fibrosis comment that aerobic exercise helps them cough and expectorate sputum, although check with you CF MD if you are considering exercise instead of a chest physiotherapy (CPT) regimen.
It is important to remember physical activity, in any form, burns calories. For patients with cystic fibrosis it may already be a struggle to gain weight and following an exercise routine can make this goal even more challenging, so be sure to properly fuel the body before and after exercising. Consider eating a small snack 30 to 60 minutes before exercising, especially if you haven’t eaten a meal in the past 1 to 2 hours, this way the body will have some nutrients it can use for fuel. It is equally important to refuel after exercising to make sure that no additional weight is loss and the muscles have enough nutrients to rebuild.
Before exercising, the snack or meal can be slightly higher in carbohydrates as this is the easiest form of fuel for the body to metabolize. After exercising it is a good idea to have a mixed snack that includes some protein, fat, and carbohydrates. Your body will use the protein to repair and preserve muscle tissue, the carbohydrates to replenish its energy stores, and the additional fat to create satiety and additional fuel for energy stores. Some examples of post-workout snacks would include chocolate milk smoothie with fruit and protein powder, a sandwich and cheese, yogurt and trail mix or granola, or a nutrition supplement drink (i.e. Ensure, Boost, Carnation Instant Breakfast, etc.).
If you live in a place that gets very hot in the summer months be mindful to stay well hydrated when exercising. When exercising, the body’s way of cooling itself off is to produce sweat; so it is important to replenish the water lost by drinking water or sports beverages during and after exercise. Consider carrying a water bottle with you if you are planning on exercising for more than 30 minutes to stay well hydrated. For people who have CF, it is also important to also monitor salt intake due to increased losses of salt in the sweat. During summer months, active individuals may benefit from consuming sports drinks that have added salt (or add a salt packet to the beverage) and eating salty snacks after exercising as part of refueling. During summer months you may want to consider exercising in the early morning or later evening when the temperature may be cooler or at an indoor facility with air conditioning.
For patients with CF, exercise is important to promote muscle mass formation, improve wellbeing, and increase energy levels. Pick an exercise or activity you enjoy doing so that it becomes a desirable part of your weekly or daily routine. Be sure to check in with your CF team before starting a new exercise regimen to make sure it is appropriate for you.
Probiotics are defined by Food and Agriculture Organization (FAO) and World Health Organization (WHO) as live microorganisms, which when administered in adequate amounts confer a health benefit on the host. Over the past several years probiotics have increased in popularity and research has been conducted for possible health benefits.
Research within the field of probiotics has discovered potential benefits of probiotics for symptom management during illness and improvements in immune function. It has been noted that probiotics in the gut have positive immune benefits for a person by: helping to create an inhospitable environment for pathogens, competing for physical space with pathogens, and enhancing the intestinal barrier. The well-documented benefits of probiotics are related to: improving digestion, managing constipation, reducing antibiotic-associated diarrhea, aiding in Clostridium difficile (C. Diff) infections, improving immune function, and improving the ability to digest lactose for lactose intolerant individuals. Management of diarrhea and “re-culturing the gut” are the more common reasons that individuals start taking probiotics. According to the World Gastroenterology Organization Practice Guidelines for Probiotics, certain strains of bacteria have been shown to have positive effects depending on the problem. For example, bacteria strains found to help with management of digestion include: L. reuteri ATCC 55730, L. rhamnosus GG, L. casei DN-114 001, and Saccharomyces cerevisiae (boulardii). For treatment of antibiotic-associated diarrhea the most commonly studied strains are S. boulardii or L. rhamnosus GG. The strains found to have benefits for immune support include: B. lactis, L. reuteri, L. rhamnosus GG, and L. casei.
Most products that contain live, active cultures will have strains listed on the label but not necessarily dosing, or quantity of cultures, per serving size. One thing to be mindful of is labeling of dietary supplements are not federally regulated; therefore the term “probiotics” is not protected and there is no oversight to ensure efficacy, potency, or consistency among products. According to the Food and Drug Administration (FDA), probiotics are not intended to treat, diagnosis, cure, or alleviate symptoms of disease. Health claims regarding probiotics supplements in relation to decreasing the risk of a disease or health condition are also not approved by the FDA. Structure-function health claims can be approved by the FDA if there is extensive research to demonstrate the connection between probiotics and their effect on the structure or function of humans which is where most of the research is being conducted.
The mostly commonly supplemented bacterial strains found in the supermarket or health store are Lactobacillus (acidophilus) and Bifidobacterium, as well as some yeast strains including Saccharomyces cerevisiae, E. coli, and Bacillus species. The majority of food items that contain probiotics are dairy products such as DanActive, Yo-Plus, Yakult, and Activia; as well as fortified beverages all which contain live, active cultures. Probiotics can also be found freeze dried in capsule and tablet forms such as Florastor, Align, Bacid, and Culturelle. The category or strength of a probiotic supplement depends on how many live (or freeze dried) active cultures it contains. Dosing is written as colony-forming units (CFUs). Food grade probiotic supplements can be found in yogurts, kefir, some fortified dairy products and juices and may not specifically list CFU’s on the label. Pharmaceutical grade probiotics often contain high concentrations of cultures with specific dosing per capsule listed. Be sure to read the label for what cultures the supplement contains as different strains have different studied benefits and this may effect what supplement is appropriate to take.
Your CF team may prescribe probiotics supplements during times of illness. Consult with your team if you have questions about probiotic supplements ordered for you or if you want to start a probiotic supplement regimen at home for appropriate recommendations.