Original Article|Articles in Press

Steps Ahead: Optimising physical activity in adults with cystic fibrosis: A pilot randomised trial using wearable technology, goal setting and text message feedback

Published:November 16, 2022DOI:


      • A randomised pilot trial amongst adults with Cystic Fibrosis
      • Intervention consisted of wearable technology, goal setting and text message feedback
      • Active comparator group wore wearable technology only
      • Physical activity increased for both groups
      • Text messages based on collaborative goal setting showed significantly greater improvements



      Regular participation in physical activity (PA) is encouraged for people with Cystic Fibrosis (CF). This study aimed to assess the effectiveness of an intervention using wearable technology, goal setting and text message feedback on PA and health outcomes in people with CF.


      This was a pilot randomised trial conducted at University Hospital Limerick. Participants were randomly assigned to the intervention (INT) or active comparator (AC). The 12-week intervention consisted of wearable technology (Fitbit Charge 2) which was remotely monitored, and participants set step count goals. Participants were sent a one-way text message once a week over 12 weeks to positively reinforce and encourage PA participation. The AC group received the wearable technology alone. Follow up was assessed at 24 weeks. Outcomes assessed were PA, aerobic capacity, lung function, sleep, quality of life and wellbeing.


      Step count increased significantly for the INT group over 12 weeks when compared to the AC group (p=0.019). The INT group had a 28% week-to-week percentage change (Weeks 1-12), while the AC group reduced by 1%, p=0.023. Within group changes demonstrated that VO2 peak (ml/kg/min) significantly increased for the INT group at 12 weeks (24.4 ±7.65 to 26.13 ±7.79, p=0.003) but not at 24 weeks (24.45 ±7.05, p=0.776). There were no significant differences observed for VO2 peak (ml/kg/min) for the AC group. There was no significant effect on lung function, sleep, well-being, or quality of life for either group.


      A personalised PA intervention using wearable technology, goal setting and text message feedback increased PA and aerobic capacity in people with CF. Integration of this intervention into usual care may encourage regular PA participation for people with CF.


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        • Boyle MP.
        Adult cystic fibrosis.
        JAMA. 2007; 298: 1787-1793
        • Castellani C
        • Duff AJ
        • Bell SC
        • Heijerman HG
        • Munck A
        • Ratjen F
        • et al.
        ECFS best practice guidelines: the 2018 revision.
        J Cyst Fibros. 2018;
        • Radtke T
        • Nevitt SJ
        • Hebestreit H
        • Kriemler S.
        Physical exercise training for cystic fibrosis.
        Cochrane Database System Rev. 2017;
        • Williams CA
        • Stevens D.
        Physical activity and exercise training in young people with cystic fibrosis: current recommendations and evidence.
        J Sport Health Sci. 2013; 2: 39-46
        • Cox NS
        • Alison JA
        • Holland AE.
        Interventions for promoting physical activity in people with cystic fibrosis.
        Cochrane Database System Rev. 2013;
        • Shilts MK
        • Horowitz M
        • Townsend MS.
        Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature.
        Am J Health Promot. 2004; 19: 81-93
        • Conn VS
        • Hafdahl AR
        • Brown SA
        • Brown LM.
        Meta-analysis of patient education interventions to increase physical activity among chronically ill adults.
        Patient Educ Couns. 2008; 70: 157-172
        • Cox NS
        • Alison JA
        • Rasekaba T
        • Holland AE.
        Telehealth in cystic fibrosis: a systematic review.
        J Telemed Telecare. 2012; 18: 72-78
        • Ringeval M
        • Wagner G
        • Denford J
        • Paré G
        • Kitsiou S.
        Fitbit-based interventions for healthy lifestyle outcomes: systematic review and meta-analysis.
        J Med Internet Res. 2020; 22: e23954
        • Tudor-Locke C
        • Bassett DR.
        How many steps/day are enough?.
        Sport Med. 2004; 34: 1-8
        • Feehan LM
        • Geldman J
        • Sayre EC
        • Park C
        • Ezzat AM
        • Yoo JY
        • et al.
        Accuracy of Fitbit devices: Systematic review and narrative syntheses of quantitative data.
        JMIR mHealth and uHealth. 2018; 6
        • Chia GLC
        • Anderson A
        • McLean LA.
        Behavior change techniques incorporated in fitness trackers: content analysis.
        JMIR mHealth and uHealth. 2019; 7: e12768
        • Shelley J
        • Fairclough SJ
        • Knowles ZR
        • Southern KW
        • McCormack P
        • Dawson EA
        • et al.
        A formative study exploring perceptions of physical activity and physical activity monitoring among children and young people with cystic fibrosis and health care professionals.
        BMC Pediatrics. 2018; 18: 335
        • Tagliente I
        • Solvoll T
        • De Cecco CN
        • Murgia F
        • Bella S.
        Which indicators for measuring the daily physical activity? An overview on the challenges and technology limits for telehealth applications.
        Technol Health Care. 2016; 24: 665-672
        • Curran M
        • Tierney A
        • Button B
        • Collins L
        • Kennedy L
        • McDonnell C
        • et al.
        The effectiveness of exercise interventions to increase physical activity in cystic fibrosis: a systematic review.
        J Cyst Fibros. 2021;
        • Cox NS
        • Alison JA
        • Button BM
        • Wilson JW
        • Holland AE.
        Feasibility and acceptability of an internet-based program to promote physical activity in adults with cystic fibrosis.
        Respir Care. 2015; 60: 422-429
        • Swisher AK
        • Moffett K.
        The effect of coaching on physical activity and quality of life in children and adolescents with cystic fibrosis: a quality improvement pilot study.
        Internet J Allied Health Sci Pract. 2010; 8: 8
        • Schulz KF
        • Altman DG
        • Moher D.
        CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.
        BMC Med. 2010; 8: 18
      1. Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, et al. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology [version 3; peer review: 2]. 2020.

        • Chan A-W
        • Tetzlaff JM
        • Altman DG
        • Laupacis A
        • Gøtzsche PC
        • Krleža-Jerić K
        • et al.
        SPIRIT 2013 statement: defining standard protocol items for clinical trials.
        Ann Intern Med. 2013; 158: 200-207
        • Savi D
        • Di Paolo M
        • Simmonds N
        • Onorati P
        • Internullo M
        • Quattrucci S
        • et al.
        Relationship between daily physical activity and aerobic fitness in adults with cystic fibrosis.
        BMC Pulmon Med. 2015; 15: 1-9
        • Ranu H
        • Wilde M
        • Madden B.
        Pulmonary function tests.
        Ulster Med J. 2011; 80: 84
        • Adams MA
        • Sallis JF
        • Norman GJ
        • Hovell MF
        • Hekler EB
        • Perata E.
        An adaptive physical activity intervention for overweight adults: a randomized controlled trial.
        PLoS One. 2013; 8: e82901
        • Strath SJ
        • Swartz AM
        • Parker SJ
        • Miller NE
        • Grimm EK
        • Cashin SE.
        A pilot randomized controlled trial evaluating motivationally matched pedometer feedback to increase physical activity behavior in older adults.
        J Phys Activ Health. 2011; 8: S267-SS74
        • Hurling R
        • Catt M
        • De Boni M
        • Fairley BW
        • Hurst T
        • Murray P
        • et al.
        Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial.
        J Med Internet Res. 2007; 9
        • Bravata DM
        • Smith-Spangler C
        • Sundaram V
        • Gienger AL
        • Lin N
        • Lewis R
        • et al.
        Using pedometers to increase physical activity and improve health: a systematic review.
        JAMA. 2007; 298: 2296-2304
        • Haskell WL
        • Lee I-M
        • Pate RR
        • Powell KE
        • Blair SN
        • Franklin BA
        • et al.
        Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
        Circulation. 2007; 116: 1081
        • Hebestreit H
        • Kieser S
        • Rüdiger S
        • Schenk T
        • Junge S
        • Hebestreit A
        • et al.
        Physical activity is independently related to aerobic capacity in cystic fibrosis.
        Eur Respir J. 2006; 28: 734-739
        • Curran M
        • Tierney AC
        • Button B
        • Collins L
        • Kennedy L
        • McDonnell C
        • et al.
        Physical activity and sedentary behavior in adults with cystic fibrosis: association with aerobic capacity, lung function, sleep, well-being, and quality of life.
        Respir Care. 2021;
        • Hebestreit H
        • Kieser S
        • Junge S
        • Ballmann M
        • Hebestreit A
        • Schindler C
        • et al.
        Long-term effects of a partially supervised conditioning programme in cystic fibrosis.
        Eur Respir J. 2010; 35: 578-583
        • Selvadurai HC
        • Blimkie C
        • Meyers N
        • Mellis C
        • Cooper P
        • Van Asperen P
        Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis.
        Pediatr Pulmonol. 2002; 33: 194-200
        • Tuzin BJ
        • Mulvihill MM
        • Kilbourn KM
        • Bertran DA
        • Buono M
        • Hovell MF
        • et al.
        Increasing physical activity of children with cystic fibrosis: a home-based family intervention.
        Pediatric Exerc Sci. 1998; 10: 57-68
        • Hebestreit H
        • Kriemler S
        • Schindler C
        • Stein L
        • Karila C
        • Urquhart DS
        • et al.
        Effects of a partially supervised conditioning program in cystic fibrosis: an International Multicenter Randomized Controlled Trial (ACTIVATE-CF).
        Am J Respir Crit Care Med. 2021;
        • Lahav Y
        • Goldstein N
        • Gepner Y.
        Comparison of body composition assessment across body mass index categories by two multifrequency bioelectrical impedance analysis devices and dual-energy X-ray absorptiometry in clinical settings.
        Eur J Clin Nutr. 2021; 75: 1275-1282
        • Schneiderman-Walker J
        • Pollock SL
        • Corey M
        • Wilkes DD
        • Canny GJ
        • Pedder L
        • et al.
        A randomized controlled trial of a 3-year home exercise program in cystic fibrosis.
        J Pediatr. 2000; 136: 304-310