Introduction: We have previously reported the controversies of exercise referral to community gyms and the risks of cross infection for patients with different microbiological groups (MG) [1]. As per MACFU guidelines each individual is informed if another patient attends the same gym and specific attendance times arranged to avoid direct contact. The aim of the study was to determine if cross infection occurred between patients with different MG referred to the same gym. Methods: We surveyed the records of 41 referrals made over a 3 year period (2003 2005). Data was collected for MG and groups of patients attending the same gym. Attendance ratings and changes to microbiological grouping including strain typing were recorded. Results: 23 females and 18 males were referred. Mean (range) BMI 22.4 (14 38.3), FEV1 2.38 (0.85 4.4)l/rain. The MG consisted of 16 sporadic Pseudomonas aeruginosa (Pa), 13 transmissible Pa, 9 non-Pa, 2 Burkholderia cenocepacia, and 1 Burkholderia gladioli. Three pairs (6 patients), mean (range) BMI 21.95 (19.4 29.2) FEV12.3 (1.65 3.3) were referred with different MG's to 3 different venues. Pair 1: sporadic Pa and transmissible Pa. Pair 2: non-Pa and transmissible Pa; and pair 3: non-Pa and sporadic Pa. 5 of the 6 were classed as regular attenders (>1 visit per week) and 1 a poor attender. All patients reported lapses in attendance related to ill health or busy social/work spells for periods up to 2 months. None of the pairs attending the same venue changed microbiological group as a result of attendance at their exercise facility. Conclusion: Routine microbiological surveillance and negotiation of attendance times have prevented cross infection in patients with different MG's attending the same gym.

Background: Urinary incontinence (UI) is a newly recognised problem in cystic fibrosis. Whilst prevalence is well documented, there are no reports of assessment and treatment of the problem. Methods: A previous study reports the prevalence of UI in women with CF to be 51/75 (68%). Nineteen women subsequently requested help for the problem and were referred to a physiotherapist specialising in women's health. A digital assessment was performed to measure pelvic floor muscle strength and endurance. An individualised programme of pelvic floor muscle exercises (PFME) was taught based on the assessment. A questionnaire addressed issues of assessment and treatment. Results: 12 women were assessed. The median (range) age, FEV1% predicted and BMI were 20.9 (19.3–46.1) years, 45.9 (14.8–82.7) and 20.5 (16.1–26.0), respectively. The median strength of the pelvic floor muscle was moderate (Oxford Scale grade 3) with a hold time (endurance) of 5 s. At reassessment (median time 13.1 weeks), there was an improvement in endurance (P=0.04), with no change in strength. This was supported by a subjective improvement in symptoms. Patients found the exercises were difficult to perform, difficult to fit into their treatment programme and adherence was poor. Conclusions: PFME are effective at improving endurance and reducing leakage over the short-term. Women are reluctant to be assessed and the CF team should provide support and encouragement with treatment. Long-term outcome and the mechanisms of UI in this group of patients need further evaluation.

Cystic fibrosis is an inherited disease characterised by the production of infected secretions, and it requires lifelong daily treatment by airway clearance. We knew that some women attending our clinic for adults with cystic fibrosis leaked urine when performing airway clearance or spirometry, but they were dismissive during discussion and were rarely forthcoming about the problem. This study was designed to determine the prevalence of urinary incontinence in women with cystic fibrosis, to establish the importance of the problem as perceived by the patients, and to identify those women who wanted help.