Exploring Exercise as Airway Clearance in Cystic Fibrosis: A Qualitative Study From the ExACT-CF Feasibility Trial.

Chest physiotherapy is the standard way people with cystic fibrosis clear thick mucus from their lungs, but many find it burdensome and time-consuming, which is why researchers have been exploring exercise as an alternative airway clearance approach. The ExACT-CF feasibility trial tested this idea in people with CF who were also on modulator therapy, and this nested qualitative study looked at how participants and healthcare professionals actually experienced the trial and the exercise-based technique. Through interviews with a broad group, including people with CF, parents, healthcare professionals, and some who declined or withdrew, the researchers found that the trial itself and the exercise intervention were broadly acceptable, despite some minor difficulties with recruitment and daily use. Many participants said they would like to use exercise alone or interchangeably with chest physiotherapy, but stressed that stronger clinical evidence is still needed before that becomes routine.

As a qualitative study, this tells us about acceptability and experience rather than whether exercise actually clears mucus as effectively as physiotherapy.

If you or your child has cystic fibrosis, you probably know how much time chest physiotherapy can take out of a day, and how tiring it can feel to keep doing it. Researchers have been asking whether exercise could work as an alternative way to help clear mucus from the lungs, and a feasibility trial called ExACT-CF tested this.

This particular study didn't measure whether exercise cleared mucus as well as physiotherapy, but instead asked people what it was actually like to take part. Researchers talked with people with cystic fibrosis, parents, healthcare professionals, and even a few people who chose not to join or who dropped out. Overall, people found the trial and the exercise-based approach acceptable to try, even though there were some small bumps along the way with things like scheduling and daily routines.

Many liked the idea of using exercise instead of, or alongside, chest physiotherapy, but they were clear that more solid evidence is needed before anyone can be confident it works as well. This study is about experience and acceptability, not proof of effectiveness.

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

This qualitative study addresses a question that sits upstream of clinical effectiveness: is an exercise-based airway clearance approach something people with cystic fibrosis and clinicians find acceptable enough to sustain and evaluate in a larger trial? That question matters because chest physiotherapy adherence is a longstanding challenge, and exercise has been proposed as a more tolerable alternative, but acceptability and feasibility need to be established before effectiveness can be meaningfully tested. Interviews with 32 individuals, including ten people with cystic fibrosis, five parents, twelve healthcare professionals, four decliners, and one participant who withdrew, were analysed using the Framework Method. Two themes emerged: practical lessons about recruitment, randomisation, and daily implementation within the trial, and a preference among participants for using the exercise-based technique (ExACT) either alone or interchangeably with chest physiotherapy, alongside a clear call for robust clinical evidence before wider adoption. The contribution here is to feasibility and implementation, not to treatment effectiveness.

The findings support progressing to a definitive trial but say nothing about whether exercise clears secretions as effectively as chest physiotherapy or affects lung function or exacerbation outcomes. Applicability is also bounded by the qualitative, purposively sampled design, meaning these experiences illuminate barriers and preferences rather than generalisable clinical benefit.