Tuesday, March 25, 2008

Nutrition, Exercise and Well Being

Lungs aren’t the only organs affected by the thick, sticky mucus that cystic fibrosis produces. The pancreas, an exocrine gland that normally secretes digestive enzymes necessary to absorb nutrients from food, can be coated with mucus as well. In fact, nearly 85% of CF patients demonstrate pancreatic insufficiency before age 10. This can lead to issues of malabsorption and malnutrition due to the body’s inability to break down fats, carbohydrates and protein before they pass into the intestinal system.

Nutrition and Calories

In order to remedy this problem, many CF patients are prescribed digestive enzyme supplements to help the body better absorb the vitamins and minerals that are present in the diet. However, digestive enzymes are only part of the solution. A person with CF needs to incorporate more calories into their diet than other healthy people the same age. Important ways that you can help your child with CF grow healthy and strong include providing good overall nutrition along with extra fat and calories as well as prescribed enzymes.

Table 1. Caloric Intake Ranges Based on Age Group and Activity

It is important for everyone with CF to combine good nutrition with appropriate exercise. One of the challenges that await school-aged children upon returning to the classroom is that eating habits may need to change. For example, a child who has been able to “graze” frequently during the day may have trouble adjusting to the pre-determined eating schedule set by the school or classroom.

Another problem that may indirectly affect CF students is the obesity epidemic. Many schools are adopting low-calorie, low-fat meal programs in an attempt to address the alarming rise in the number of overweight and obese children. If your child is participating in a school lunch program, be sure that the meal offers the appropriate amount of calories for your child’s age and activity level.

On school days, offer your child or young adult a large, balanced breakfast. Meals that include complex carbohydrates (e.g. whole grain toast) take longer for the body to break down and provide energy for a longer period of time. You the school nurse, who in turn may speak with your child’s teacher or the school administration, to permit additional snack breaks as necessary.

Correlating Nutrition and Lung Health

The need for adequate nutrition cannot be stressed enough. The Cystic Fibrosis Foundation (CFF) has identified a correlation between nutritional health and lung health. Studies have shown that patients with better Body Mass Index (BMI) values for their age, height, and weight, typically perform better on pulmonary function tests. Many CF physicians stress the importance of patients reaching healthy weight and BMI goals before age 6 in order to reduce the likelihood of hospitalizations due to pulmonary exacerbations.

Certain sports related activities, such as running and jumping, generate vibrations in the chest cavity which may stimulate coughing. Coughing should never be suppressed, because it is how the body rids itself of infection-prone mucus in the lungs. Getting the body moving acts as a natural form of chest physiotherapy.

Exercise is also an effective way to prevent infection and inflammation of the lungs. Scientific studies have demonstrated that physical exercise is just as important as chest physiotherapy. Any sort of activity that forces the respiration rate to increase will naturally strengthen the muscles used to cough. Strong back, chest, and abdominal muscles that are well toned from exercise can make coughing easier and less exhausting. Aerobic (oxygen using) and cardio-pulmonary exercise is particularly important for people with CF. As the heart rate increases, the rate of blood flow increases, thereby delivering vital oxygen throughout the body.

Although it may be tempting for parents of students with CF to want their child to opt-out of physical education class, this is not a good idea. The school nurse should speak with coaches and PE teachers about the importance of exercise and its benefit to the student with CF. Students with CF should be encouraged to participate as much as they are able in sports or other fitness activities. If outdoor activity aggravates allergy symptoms, look for other ways to encourage rigorous cardio-pulmonary activity.

Community classes in martial arts, dance, or gymnastics may be an alternative. Another option is to have your student enroll in the school’s band or orchestra. Wind instruments such as the clarinet, trombone, trumpet or French horn are excellent for improving and maintaining lung function. This can also open the doors to scholarship opportunities when your student is ready to apply for college.

The combination of nutrition and exercise can lead to lasting benefits for all ages of those with cystic fibrosis. Many CF Team Clinics have nutritionists and/or dietitians on staff to help determine the best way to incorporate adequate nutrition and exercise into the busy lives of CF patients and their care givers.

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