Safety, feasibility and efficacy of exercise as an airway clearance technique in cystic fibrosis: a randomised pilot feasibility trial.

People with cystic fibrosis often spend significant time each day on airway clearance techniques, and some newer CFTR modulator therapies have raised questions about whether exercise alone might substitute for these routines. This pilot trial asked whether daily exercise, used as the only airway clearance method, is safe and feasible compared with usual care in people already stable on the modulator combination Elexacaftor/Tezacaftor/Ivacaftor. Fifty participants were recruited and 48 randomised over 28 days, with lung function and a measure of ventilation unevenness (lung clearance index) tracked alongside adherence and quality of life.

Recruitment, retention and adherence met the trial's own feasibility targets, and no serious adverse events were reported. Early signals on lung measures leaned in favour of exercise, but the trial was not designed or powered to prove effectiveness. Its main limitation is scale and duration, a small, short pilot, meaning these efficacy signals are preliminary and require confirmation in a larger, longer study.

If you or your child has cystic fibrosis, you'll know how much time daily airway clearance routines can take. This study looked at whether replacing usual airway clearance techniques with daily exercise instead is safe and workable, in people already taking a specific combination modulator medicine.

Researchers followed 48 people over 28 days, comparing those doing exercise-only clearance against those continuing their usual routine. The trial found that recruiting and keeping people in the study, and getting them to stick with the exercise routine, worked well enough to justify a bigger trial. No serious safety concerns came up over the four weeks.

Lung function and a measure of how evenly air moves through the lungs both showed slightly better results in the exercise group, but this was a small, short pilot study, not one designed to prove that exercise clearance actually works better than usual care. So while these early results are encouraging in terms of feasibility, whether exercise can genuinely replace other airway clearance techniques over the longer term is still an open question that needs a larger trial to answer.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This dual-site pilot randomised trial (n=48 randomised, 45 completing) tested exercise as a sole airway clearance technique (ExACT) versus usual care in people with cystic fibrosis aged 10 and over with FEV1 40% predicted or higher, all stable on Elexacaftor/Tezacaftor/Ivacaftor. The primary aim was feasibility, assessed against preset progression criteria: 41% of those approached were randomised, 92% completed the 28-day protocol, and overall adherence was 60%, meeting thresholds for advancing to a definitive trial. Safety and preliminary efficacy signals were secondary.

Lung clearance index (LCI2.5) changed by -0.1 (SD 0.6) with ExACT versus +0.2 (SD 0.8) with usual care, giving a relative difference of 0.97 (95% CI 0.92 to 1.02). FEV1 % predicted changed by +2.1 (SD 6.6) versus -0.8 (SD 5.5), an absolute between-group difference of 3.2 (95% CI -0.6 to 6.9).

Confidence intervals cross the null for both measures, so these should be read as hypothesis-generating rather than confirmatory. Few adverse events occurred, none serious, though the trial was neither large nor long enough to establish safety definitively.

Qualitative and health economic data were also collected but not detailed in the abstract. Overall this supports proceeding to a larger, longer, multisite trial rather than any change in current airway clearance practice.