Summary of findings 3. Exercise compared with underwater PEP (uPEP; also known as bubble PEP) for people with cystic fibrosis.
| Exercise compared with uPEP for people with cystic fibrosis | ||||||
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Patient or population: children and adults with cystic fibrosis Settings: outpatient Intervention: exercise (cycle ergometer constant effort 1/2 W/kg) 1 x 30‐minute session per week Comparison: uPEP 1 x 30‐minute session per week | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| uPEP | Exercise | |||||
| Pulmonary function: absolute change FEV1 % predicted | This outcome was not measured. | |||||
| Change in VO2 peak during maximal exercise | This outcome was not measured. | |||||
| Quality of life: change in CFQ‐R score | This outcome was not measured. | |||||
| Adverse effects Follow‐up: 2 weeks |
There was no difference between the exercise group and the uPEP group in terms of peak SaO2 (%) or desaturation. |
13 (1 study) | ⊕⊝⊝⊝
very lowa,b |
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| Participant preference: VAS test and a questionnaire to evaluate acceptability of technique to participants Follow‐up: 2 weeks |
The exercise test was perceived by participants as more fatiguing but was also considered more amusing. | 13 (1 study) | ⊕⊝⊝⊝
very lowa,b |
The study gave very limited information on the scale used or the results. We have reported results reported directly from the paper. | ||
| Adherence | This outcome was not measured. | |||||
| Need for extra antibiotics (days) | This outcome was not measured. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CFQ‐R: Cystic Fibrosis Questionnaire ‐ Revised; CI: confidence interval; FEV1: forced expiratory volume in one second; SaO2: arterial oxygen saturation; uPEP: underwater positive expiratory pressure; VAS: visual analogue score; VO2 max: maximal oxygen consumption. | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aDowngraded twice due to high or unclear risk of bias across all domains in this single cross‐over study. bDowngraded once due to imprecision caused by very low participant numbers.