***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: We studied the acute effects of 4 different chest physical therapy regimens using a r and omised cross-over design in 14 patients with cystic fibrosis . Treatment A consisted of postural drainage , percussion and vibration ; treatment B of postural drainage and periodic application of a face mask with positive expiratory pressure ( PEP ) ; treatment C of PEP in the sitting position ; treatment D of the forced expiration technique in the sitting position . In terms of sputum expectorated , treatments B and C were superior to treatment D and especially to treatment A ( p less than 0.05 ) . Skin oxygen tension , PSO2 was monitored continuously during and for 35 min after treatment . A substantial and prolonged decay in PSO2 was observed during treatment A , quite different from other patterns seen . During and even following treatment C , an increase in PSO2 was noted . PEP was well accepted by the patients , who preferred treatment C , and we suggest it is incorporated in chest physical therapy regimens if the therapeutic objective is to increase expectoration The use of a positive expiratory pressure ( PEP ) mask was compared with postural drainage in the treatment of 10 patients with cystic fibrosis . The patients were allocated r and omly in a crossover fashion to the two regimens and evaluated initially by a physiotherapist and over a 4 week treatment period by use of a diary card . There was no significant difference in sputum production or change in lung function between each technique as assessed by the physiotherapist . Diary card evaluation also failed to demonstrate a difference in sputum production , symptom score or peak expiratory flow rate between the 4 week treatment periods . It was concluded that PEP mask therapy is an acceptable and effective alternative to postural drainage in interval therapy of patients with cystic fibrosis , although the patients have tended to revert to postural drainage during acute exacerbations We studied the effectiveness of some of the components of a physiotherapy regimen on the removal of mucus from the lungs of 6 subjects with cystic fibrosis . On 5 r and omized study days , after inhalation of a 99mTc-human serum albumin aerosol to label primarily the large airways , the removal of lung radioactivity was measured during 40 min of ( a ) spontaneous cough while at rest ( control ) , ( b ) postural drainage , ( c ) postural drainage plus mechanical percussion , ( d ) combined maneuvers ( postural drainage , deep breathing with vibrations , and percussion ) administered by a physiotherapist , ( e ) directed vigorous cough . Measurements continued for an additional 2 h of quiet rest . Compared with the control day , all forms of intervention significantly improved the removal of mucus : cough ( p less than 0.005 ) ,  physiotherapy maneuvers ( 0.005 less than or equal to p less than 0.01 ) ,  postural drainage  ( p less than 0.05 ) , and  postural drainage plus percussion  ( p less than 0.01 ) . However , there was no significant difference between regimented cough alone and therapist-administered combined maneuvers , nor between  postural drainage  alone and with  mechanical percussion . We conclude that in cystic fibrosis , vigorous , regimented cough sessions may be as effective as therapist-administered physiotherapy in removing pulmonary secretions .  Postural drainage , although better than the control maneuver , was not as effective as cough and was not enhanced by mechanical percussion . Frequent , vigorous self-directed cough sessions are potentially as useful as more complex measures for effective bronchial toilet Fourteen patients with cystic fibrosis were trained in 2 self-administered chest physiotherapy ( PT ) techniques : high-pressure PEP-mask physiotherapy ( PEP ) , and autogenic drainage ( AD ) . They then visited the clinic on 5 consecutive days , and , in a r and om order , performed 1 of the following : PEP , AD , PEP followed by AD ( PEP-AD ) , AD followed by PEP ( AD-PEP ) , and , no PT except for spontaneous coughing . Lung function was measured repeatedly before , during , and after PT ;  time needed for and sputum produced by each form of PT was recorded . PEP produced the highest amount of sputum , followed by PEP-AD , AD-PEP , and AD ; all 4 forms of PT produced significantly more sputum than coughing . Lung function improved significantly after PEP , AD , and PEP-AD , but PEP-induced changes did not exceed those after AD . Within the investigated group , the PEP-induced lung function improvement per milliliter of sputum produced was significantly lower for those patients with airway hyperreactivity . The fact that the highest sputum yield with PEP was not reflected in higher PEP-effected lung function changes might thus be explained by PEP-induced bronchospasm in patients with airway hyperreactivity .  PEP  clears more sputum than AD or combined techniques ; patients with airway hyperreactivity , however , should either prefer AD or should take a bronchodilator premedication before PEP BACKGROUND Children 's physical activity patterns are characterized by short-term anaerobic activities . Anaerobic exercise performance in children with cystic fibrosis ( CF ) has received little attention compared to aerobic performance . This study investigated the effects of anaerobic training in children with CF . DESIGN AND METHODS Twenty patients were r and omly assigned to the training group ( TG ) [ 11 patients ; mean ( + /- SD ) age , 13.6 + /- 1.3 years ; mean FEV(1 ) , 75.2 + /- 20.7 % predicted ] or the control group ( CG ) [ 9 patients ; mean age , 14.2 + /- 2.1 years ; FEV(1 ) , 82.1 + /- 19.1 % predicted ] . The TG trained 2 days per week for 12 weeks , with each session lasting 30 to 45 min . The training program consisted of anaerobic activities lasting 20 to 30 s. The control subjects were asked not to change their normal daily activities . Body composition , pulmonary function , peripheral muscle force , habitual physical activity , aerobic and anaerobic exercise performance , and quality of life were reevaluated at the end of the training program , and again after a 12-week follow-up period . RESULTS Patients in the TG significantly improved their anaerobic performance , aerobic performance , and quality of life . No significant changes were seen in other parameters , and no improvements were found in CG . After the follow-up period , only anaerobic performance and quality of life in TG were significantly higher compared to pretraining values . CONCLUSIONS Anaerobic training has measurable effects on aerobic performance ( although not sustained ) , anaerobic performance , and health-related quality of life in children with CF . Therefore , anaerobic training could be an important component of therapeutic programs for CF patients Bronchial hygiene therapy is a st and ard part of the treatment of patients with cystic fibrosis ( CF ) . Coughing alone promotes sputum expectoration and is probably the primary effective component of st and ard bronchial hygiene therapy . The purpose of this study was to determine whether substituting regular exercise , which also promotes coughing , for two of three daily bronchial hygiene treatments would affect the expected improvements in pulmonary function and exercise response in hospitalized patients with CF . Seventeen patients with CF hospitalized ( means length of stay = 13.0 + /- 2.6 days ) for an acute exacerbation of their pulmonary disease participated in the study . The patients were r and omly assigned to either a group that participated in two cycle ergometer exercise sessions and one bronchial hygiene treatment session per day ( EX Group [ n = 9 ] ) or a group that participated in three bronchial hygiene treatment sessions per day ( PD Group [ n = 8 ] ) . Pulmonary functions and responses to a progressive , incremental cycle ergometer exercise test were measured on admission and before discharge . Bronchial hygiene therapy consisted of postural drainage , in six positions , with chest percussion and vibration . Therapeutic exercise was of moderate intensity and was individually adjusted based on the patient 's heart rate and arterial oxygen saturation response to the admission exercise test . Coughing was encouraged during and after all treatments . Pulmonary function and exercise response were significantly improved over the period of hospitalization in both groups ; the improvements were the same in the two groups . These results indicate that , in some hospitalized patients with CF , exercise therapy may be substituted for at least part of the st and ard protocol of bronchial hygiene therapy Recently , the flutter was introduced as a new device to improve sputum expectoration . Preliminary data suggested a significant improvement in expectoration and lung function during flutter treatment in patients with cystic fibrosis ( CF ) . The aim of the present study was to compare the effects of the flutter and the positive expiratory pressure ( PEP ) mask on symptoms and lung function in children with CF . In a crossover r and omized study 22 patients with CF ( mean age 12 yrs , range 7 - 17 yrs ) performed physiotherapy using either the flutter or the PEP mask twice a day during two treatment periods of 2 weeks , separated by a one week wash-out period , in a r and om sequence . Lung function parameters ( peak expiratory flow , forced vital capacity ( FVC ) , forced expiratory volume in one second , maximal midexpiratory flow , maximal expiratory flow at 25 % of FVC , thoracic gas volume , total lung capacity , residual volume/total lung capacity , airway resistance and specific airway conductance ) and changes in transcutaneous oxygen haemoglobin saturation were assessed before and after the first supervised session and at the end of each treatment period . Throughout the study peak flow was measured and symptoms were scored daily . No significant changes in any lung function parameter occurred after a single session or after 2 weeks of physiotherapy with either method . There was no difference in acceptability and subjective efficacy . In conclusion , any superiority of the flutter over the positive expiratory pressure mask technique for expectoration could not be confirmed during 2 weeks of daily treatment in children with cystic fibrosis . Both methods are well accepted by children and do not change lung function . Long-term comparison of both methods , including expectoration measurements , seems to be required for further evaluation of the potential success of physiotherapy in cystic fibrosis Background : Chest physiotherapy is essential to the management of cystic fibrosis ( CF ) . However , respiratory muscle fatigue and oxygen desaturation during treatment have been reported . The aim of this study was to determine whether non-invasive ventilation ( NIV ) during chest physiotherapy could prevent these adverse effects in adults with exacerbations of CF . Methods : Twenty six patients of mean ( SD ) age 27 ( 6 ) years and forced expiratory volume in 1 second ( FEV1 ) 34 (12)% predicted completed a r and omised crossover trial comparing st and ard treatment ( active cycle of breathing technique , ACBT ) with ACBT + NIV .  Respiratory muscle strength ( PImax , PEmax ) , spirometric parameters , and dyspnoea were measured before and after treatment . Pulse oximetry ( Spo2 ) was recorded during treatment . Sputum production during treatment and 4 and 24 hours after treatment was evaluated . Results : There was a significant reduction in PImax following st and ard treatment that was correlated with baseline PImax ( r=0.73 , p<0.001 ) . PImax was maintained following NIV ( mean difference from st and ard treatment 9.04 cm H2O , 95 % confidence interval ( CI ) 4.25 to 13.83 cm H2O , p=0.006 ) . A significant increase in PEmax was observed following the NIV session ( 8.04 cm H2O , 95 % CI 0.61 to 15.46 cm H2O , p=0.02 ) . The proportion of treatment time with Spo2 ⩽90 % was correlated with FEV1 ( r=−0.65 , p<0.001  ) . NIV improved mean Spo2 ( p<0.001 ) and reduced dyspnoea ( p=0.02 ) . There were no differences in FEV1 , forced vital capacity ( FVC ) or sputum weight , but FEF25–75 increased following NIV ( p=0.006 ) . Conclusion : Reduced inspiratory muscle strength and oxygen desaturation during chest physiotherapy are associated with inspiratory muscle weakness and severity of lung disease in adults with exacerbations of CF . Addition of NIV improves inspiratory muscle function , oxygen saturation and small airway function and reduces dyspnoea Impaired mucociliary clearance due to defective ion and water transport and the effects of chronic airway infections lead to stasis of secretions and progressive pulmonary damage in patients with cystic fibrosis ( CF ) . Methods to improve removal of tenacious lung secretions in CF patients contribute to slowing the decline in respiratory function . We have evaluated an intrapulmonary percussive ventilator ( IPV ) , which is a device design ed to enhance airway clearance and preserve lung function . A previous pilot study by us had determined that the device was acceptable to patients and is safe . We undertook a 6 month parallel comparative trial of the IPV versus st and ard , manual chest physiotherapy in 16 CF children and adults . No significant differences in spirometric measures , numbers of hospitalizations , use of oral or IV antibiotics , or anthropometric measurements were detected between the st and ard aerosol/chest physiotherapy group and the IPV group over the duration of the trial . Patient acceptance , as determined by participant survey , was good . The device appeared to be safe and durable . It was concluded that the IPV is as effective as st and ard aerosol and chest physiotherapy in preserving lung function and anthropometric measures , and there was no difference in the use of antibiotics and hospitalizations We studied 
    Output:
    
RESULTS Review 1 provides some evidence from short-term trials of the benefit of airway clearance over no airway clearance in improved mucus transport but no definitive evidence from long-term trials to support the efficacy of airway clearance over no airway clearance ; review 2 provides some evidence that conventional chest physiotherapy ( CCPT ) is at least as effective as other forms of airway clearance , but that patients may have a preference for self-administered treatments over CCPT ; review 3 provides some evidence that positive expiratory pressure ( PEP ) is at least as effective as other forms of airway clearance ; review 4 provides some evidence to support the use of  non-invasive ventilation during airway clearance in patients with moderate to severe disease who have difficulty clearing sputum ; review 5 provides some evidence of the benefits of different types of physical training .
CONCLUSION The Cochrane systematic review s summarised in this paper provide some evidence to support the inclusion of physical therapies in the care-management plan of CF .