***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 
    ***DOCUMENTATION*** 
    ***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 To compare the short-term effects of postural drainage with clapping ( PD ) and autogenic drainage ( AD ) on oxygen saturation , pulmonary function , and sputum recovery , we studied ten patients with cystic fibrosis ( CF ) r and omly treated with PD or AD on separate days .  Pulse oximetry was monitored and sputum was collected during and for 1 h following each treatment . Pulmonary function was measured before and then 1 , 15 , and 60 min after each treatment . There was no significant difference in the amount of sputum recovered with AD ( 14.0 + /- 3.5 g ) vs PD ( 10.4 + /- 3.0 g ) and no significant differences in pulmonary function occurred . Oxygen saturation during PD fell from 93.3 + /- 0.7 % to 91.2 + /- 0.8 % ( p < 0.01 ) and required 15 min following treatment to return to baseline . Oxygen saturation did not fall during AD and increased to 94.5 + /- 0.7 % by 1 h following treatment ( baseline , 93.3 + /- 0.8 % ; p < 0.01 ) . We conclude that AD is less likely to produce oxygen desaturation and may be better tolerated by patients with CF , while producing similar benefits in sputum clearance 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 Little information is available about the effects of inspiratory muscle training in patients with cystic fibrosis ( CF ) . In this study the effects of inspiratory-threshold loading in patients with CF on strength and endurance of the inspiratory muscles , pulmonary function , exercise capacity , dyspnoea and fatigue were evaluated . Sixteen patients were assigned to one of two groups using the minimization method : eight patients in the training group and eight patients in the control group . The training was performed using an inspiratory-threshold loading device . Patients were instructed to use the threshold trainer 20 min a day , 5 days a week for 6 weeks . Patients in the training group trained at inspiratory threshold loads up to 40 % of maximal static inspiratory pressure ( Pimax ) and patients in the control group got ' sham ' training at a load of 10 % of Pimax . No significant differences were found among the two groups in gender , age , weight , height , pulmonary function , exercise capacity , inspiratory-muscle strength and inspiratory-muscle endurance before starting the training programme . Mean ( SD ) age in the control group was 19 ( 5.5 ) years , mean ( SD ) age in the training group was 17 ( 5.2 ) years .  Mean FEV1 in both groups was 70 % predicted , mean inspiratory-muscle strength in both groups was above 100 % predicted . All patients except one , assigned to the training group , completed the programme . After 6 weeks of training , mean inspiratory-muscle endurance ( % Pimax ) in the control group increased from 50 % to 54 % ( P = 0.197 ) ; in the training group mean inspiratory muscle endurance ( % Pimax ) increased from 49 % to 66 % ( P = 0.003 ) . Statistical analysis showed that the change in inspiratory-muscle endurance ( % Pimax ) in the training group was significantly higher than in the control group ( P = 0.012 ) . After training , in the training group there was a tendency of improvement in Pimax with an increase from 105 to 123 % predicted , which just fell short of statistical significance ( P = 0.064 ) . After training no significant differences were found in changes from baseline in pulmonary function , exercise capacity , dyspnoea and fatigue . It is concluded that low-intensity inspiratory-threshold loading at 40 % of Pimax was sufficient to elicit an increased inspiratory-muscle endurance in patients with CF The Flutter VRP1 ( Flutter ) is cl aim ed to increase the clearance of excess bronchial secretions and to improve lung function and oxygenation , but these cl aims were based on computer models , laboratory assisted experiments and uncontrolled clinical trials . A prospect i ve r and omized clinical trial was undertaken , in subjects with cystic fibrosis , using the active cycle of breathing techniques as the ' gold st and ard ' . The cl aims could not be substantiated and the possibility of sputum retention was of concern when the Flutter was used as significantly more sputum ( P < 0.001 ) was cleared with the active cycle of breathing techniques alone . There were no significant changes in lung function or oxygenation 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 OBJECTIVE The aim of the present study was to investigate the efficacy of two frequently used physiotherapies ( PTs ) for the removal of bronchial secretions in cystic fibrosis ( CF ) lung disease :  autogenic drainage ( AD ) and the Flutter ( Desitin in Germany ) . AD is believed to improve mucus clearance from peripheral to central airways due to airway caliber changes in combination with a special breathing technique . The Flutter is an easy-to-use physiotherapy device based on oscillations of a steel ball during expiration through a pipe-type device . MATERIAL S AND METHODS To evaluate the acute and chronic physiotherapy effects of these two techniques , 14 CF patients underwent either twice daily AD or Flutter treatment for 4 consecutive weeks in a r and omized crossover design . Prior to each therapy interval , for a 1-week wash-out period , no PT was administered , but patients continued regular medication . At the beginning and end of each 4-week interval , pulmonary function was measured before and after an acute 30-min therapy . At the end of the PT session , sputum was collected , weighed , and deep frozen until analyzed . The viscoelasticity of the sputum was evaluated using a magnetic microrheometer . RESULTS No significant changes were noted for FVC , FEV1 , or sputum volume throughout the study . Sputum viscoelasticity ( rigidity index ) , however , was significantly lower ( p<0.01 ) after therapy with the Flutter in comparison with AD , predicting improvements in mucociliary and cough clearability of the secretions . In a companion in vitro experiment , oscillations generated by passing humidified air over CF sputum lining an acrylic tube connected to a Flutter de-ice were found to decrease sputum elasticity , as measured by a filancemeter . These findings suggest that applied oscillations are capable of decreasing mucus viscoelasticity within the airways at frequencies and amplitudes achievable with the Flutter device , and provide direct evidence that PT can reduce the viscoelasticity of sputum 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 
    Output:
    
There are no ACTs demonstrated to be superior to others , so the prescription of ACTs should be individualized .
Aerobic exercise is recommended as an adjunctive therapy for airway clearance and for its additional benefits to overall health