Mental Health of CF Patients Declines With Lung Function, Irrespective of Exercise

People with more severe cystic fibrosis-causing gene mutations tend to have poorer mental health as they age, an effect mediated entirely by their worsening lung health, according to a recent analysis.

While exercise was seen to improve the mental health of these patients, it was effective only if it improved physical health. This suggests that cystic fibrosis (CF) care needs to adopt an integrated approach, with well-tailored exercise programs and access to psychological support as key steps to lower the psychological impact of the disease.

The study,  “Associations between genetics, medical status, physical exercise and psychological well-being in adults with cystic fibrosis,” was published in the journal BMJ Open Respiratory Research.

As more CF patients reach adult age, the burden of the disease and treatment on their psychological well-being may become heavy. Few studies, however, have examined the complex interactions between gene mutations, lung health, quality of life, medication, and psychiatric diseases such as anxiety and depression.

Researchers at Karolinska Institutet in Sweden recruited 68 adult CF patients, and divided the patients into two groups depending on the severity of their CFTR mutation. Those with two copies of a Class I or Class II mutation, or one copy each of two different Class I and II mutations, were rated as severe. Patients were evaluated with tools measuring quality of life, depression and anxiety.

The team also created a score of the patients’ disease severity using spirometry measures (FEV1% predicted), body mass index (BMI), antibody levels, and physical working capacity.

Once the team had all data available, they used an advanced statistical analysis to explore the effect of the mutation, and then also analyze the effect of exercise on the patients’ well-being.

While levels of depression and anxiety were no different in the entire group than what is seen in the general population, the team noted that in patients with more severe disease mutations — and consequently, more severe disease — mental health worsened with age. However, this was largely a consequence of their deteriorating health.

Doing the same type of analysis with exercise, they saw that exercise had no impact on psychological health by itself. Only if it improved lung health did psychological well-being increase with exercise.