Impact of exercise on Vo₂peak and Fev₁ in cystic fibrosis: a systematic review
DOI:
https://doi.org/10.47197/retos.v74.117144Keywords:
Cystic fibrosis , physical exercise, +VO₂peak, FEV₁, aerobic capacity, quality lifeAbstract
Introduction: Cystic fibrosis (CF) is a multisystem genetic disease characterized by thick secretions, progressive pulmonary damage, and functional decline. Among the main prognostic indicators are maximal oxygen uptake (VO₂peak) and forced expiratory volume in one second (FEV₁). Although physical exercise is recommended by clinical guidelines as part of comprehensive CF management, uncertainty remains regarding its objective impact, particularly on pulmonary function.
Objectives: To evaluate, through a systematic review of randomized controlled trials (RCTs) published since 2017, the effects of physical exercise on VO₂peak and FEV₁ in individuals with CF.
Methods: The PRISMA 2020 guidelines were followed. Included RCTs involved participants of any age diagnosed with CF, comparing exercise programs (aerobic, resistance, or combined) with standard care. Studies had to report pre- and post-intervention measures of VO₂peak and/or FEV₁. The literature search was updated through May 2025. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated using the GRADE approach.
Results: A total of 13 RCTs were included (n = 392; ages 6 to 40 years). Most studies reported significant improvements in VO₂peak (increases of 5 to 15%) in the intervention groups. In contrast, no clinically meaningful changes in FEV₁ were observed. One multicenter study (ACTIVATE-CF) reported a transient FEV₁ improvement in the control group at six months.
Conclusions: Physical exercise consistently improves aerobic capacity in individuals with CF but does not produce significant changes in pulmonary function (FEV₁) in the short term.
References
Alexiou, C., Ward, L., Hume, E., Armstrong, M., Wilkinson, M., & Vogiatzis, I. (2021). Effect of interval versus continuous training on physiological responses in patients with chronic respiratory di-seases: A systematic review and meta-analysis. Chronic Respiratory Disease, 18, 14799731211041506. https://doi.org/10.1177/14799731211041506
Beaudoin, M., Radtke, T., Kriemler, S., et al. (2017). Combined aerobic and resistance exercise training improves physical fitness in adults with cystic fibrosis. Journal of Cystic Fibrosis, 16(5), 563–570. https://doi.org/10.1016/j.jcf.2017.04.008
Bell, S. C., Mall, M. A., Gutierrez, H., Macek, M., Madge, S., Davies, J. C., ... & Ratjen, F. (2023). The future of cystic fibrosis care: A global perspective. Nature Reviews Disease Primers, 9(1), 10. https://doi.org/10.1038/s41572-022-00444-1
Bowhay, A. R., Hoo, Z. H., Gardner, B., & Wildman, M. J. (2023). Digital interventions to promote physi-cal activity in people with cystic fibrosis: A systematic review. Journal of Cystic Fibrosis, 22(2), 196–204. https://doi.org/10.1016/j.jcf.2022.07.015
Burchill, L. J., Lee, A. L., Wilson, J. W., & Holland, A. E. (2022). The effects of exercise training on aerobic capacity in people with cystic fibrosis: A systematic review and meta-analysis. Chest, 162(2), 394–405. https://doi.org/10.1016/j.chest.2022.02.027
Cai, H., Xu, R., Fang, L., & Li, H. (2024). Inspiratory muscle training in children with cystic fibrosis: A systematic review and meta-analysis. BMC Pediatrics, 24, 127. https://doi.org/10.1186/s12887-024-04726-x
Cox, N. S., Holland, A. E., Rasekaba, T., & Wilson, J. W. (2021). Predictors of survival in adults with cystic fibrosis: Aerobic fitness, physical activity, and body mass index. European Respiratory Journal, 58(6), 2100372. https://doi.org/10.1183/13993003.00372-2021
Cochrane Cystic Fibrosis and Genetic Disorders Group. (2019). Physical training for cystic fibrosis. Cochrane Database of Systematic Reviews, 2019(11), CD001882. https://doi.org/10.1002/14651858.CD001882.pub4
Cox, N. S., Radtke, T., Hebestreit, H., & Holland, A. E. (2023). Physical activity and exercise in cystic fibrosis: Current perspectives and future directions. Journal of Cystic Fibrosis, 22(S1), S33–S41. https://doi.org/10.1016/j.jcf.2023.01.004
Cruz, J., Radtke, T., & Hebestreit, H. (2021). VO₂peak in cystic fibrosis: Clinical relevance and determinants. Pediatric Pulmonology, 56(2), 381–388. https://doi.org/10.1002/ppul.25252
Cochrane Cystic Fibrosis and Genetic Disorders Group. (2019). Physical training for cystic fibrosis. Co-chrane Database of Systematic Reviews, 2019(11), CD001882. https://doi.org/10.1002/14651858.CD001882.pub4
Cystic Fibrosis Foundation (CFF). (2023). Clinical practice guidelines for exercise in cystic fibrosis. Re-cuperado de https://www.cff.org
Curran, M., Tierney, A. C., Collins, L., Kennedy, L., McDonnell, C., Jurascheck, A. J., Sheikhi, A., Walsh, C., Button, B., Casserly, B., & Cahalan, R. (2023). Steps Ahead: Optimising physical activity in adults with cystic fibrosis: A pilot randomised trial using wearable technology, goal setting and text message feedback. Journal of Cystic Fibrosis, 22(3), 570–576. https://doi.org/10.1016/j.jcf.2022.11.002
Donadio, M. V. F., Heinzmann-Filho, J. P., Vendrusculo, F. M., Fronza, F. C., Lemes, L. C., Lanza, F. C., & Hommerding, P. X. (2022). Is exercise and electrostimulation effective in improving muscle strength and cardiorespiratory fitness in children with cystic fibrosis and mild-to-moderate pulmonary impairment? Respiratory Medicine, 193, 106752. https://doi.org/10.1016/S0954-6111(22)00063-4
European Cystic Fibrosis Society (ECFS). (2022). Exercise and physical activity in cystic fibrosis. Recu-perado de https://www.ecfs.eu
García-Pérez-de-Sevilla, G., Castro-Sánchez, A. M., Moreno-Lorenzo, C., Matarán-Peñarrocha, G. A., & Valenza, M. C. (2022). Exercise training in children and adults with cystic fibrosis: A systematic review and meta-analysis. Disability and Rehabilitation, 44(24), 7182–7194. https://doi.org/10.1080/09638288.2021.1991847
Green, D. J., Hopman, M. T. E., Padilla, J., Laughlin, M. H., & Thijssen, D. H. J. (2017). Vascular adaptation to exercise in humans: Role of hemodynamic stimuli. Physiological Reviews, 97(2), 495–528. https://doi.org/10.1152/physrev.00014.2016
Gomes-Neto, M., Silva, C. M., Conceição, C. S., Carvalho, V. O., & Brito, C. J. (2021). Effects of inspiratory muscle training on respiratory function, functional capacity, and quality of life in patients with cystic fibrosis: A systematic review. Physiotherapy Theory and Practice, 37(11), 1242–1253. https://doi.org/10.1080/09593985.2020.1746705
Gupta, S., Mukherjee, A., Lodha, R., Kabra, M., Deepak, K. K., Khadgawat, R., Talwar, A., & Kabra, S. K. (2019). Effects of exercise intervention program on bone mineral accretion in children and adolescents with cystic fibrosis: A randomized controlled trial. Indian Journal of Pediatrics, 86(11), 987–994. https://doi.org/10.1007/s12098-019-03019-x
Gruber, W., Orenstein, D. M., Braumann, K. M., & Beneke, R. (2014). Interval exercise training in cystic fibrosis: Effects on exercise capacity in severely affected adults. Journal of Cystic Fibrosis, 13(1), 86–91. https://doi.org/10.1016/j.jcf.2013.06.005
Gruber, W., Stehling, F., Blosch, C., Dillenhoefer, S., Olivier, M., Koerner-Rettberg, C., ... & Welsner, M. (2022). Effects of a long-term monitored exercise program on aerobic fitness in a small group of children with cystic fibrosis. International Journal of Environmental Research and Public Health, 19(13), 7923. https://doi.org/10.3390/ijerph19137923
Gruet, M., Saynor, Z. L., Urquhart, D. S., & Radtke, T. (2022). Rethinking physical exercise training in the modern era of cystic fibrosis: A step towards optimising short-term efficacy and long-term en-gagement. Journal of Cystic Fibrosis, 21(1), 16–23. https://doi.org/10.1016/j.jcf.2021.08.004
Hebestreit, H., Arets, H. G. M., Aurora, P., Boas, S., & de Jong, W. (2019). Clinical exercise testing in cystic fibrosis: Test selection and interpretation. Journal of Cystic Fibrosis, 18(Suppl 2), S59–S66. https://doi.org/10.1016/j.jcf.2019.08.006
Hebestreit, H., Hulzebos, E. H., Schneiderman, J. E., & Latzin, P. (2022). ACTIVATE-CF study: Long-term effects of physical activity on cystic fibrosis. American Journal of Respiratory and Critical Care Medicine, 205(6), 734–744. https://doi.org/10.1164/rccm.202108-1795OC
Hebestreit, H., Sauer-Heilborn, A., Schindler, M., Kriemler, S., & Radtke, T. (2022). ACTIVATE-CF: A ran-domized clinical trial of a personalized physical activity intervention in cystic fibrosis. The Lan-cet Respiratory Medicine, 10(6), 550–560. https://doi.org/10.1016/S2213-2600(21)00485-3
Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2022). Cochrane handbook for systematic reviews of interventions (Version 6.3, updated February 2022). Cochrane. https://training.cochrane.org/handbook
Hommerding, P. X., Baptista, R. R., Makarewicz, G. T., Schindel, C. S., Donadio, M. V. F., Pinto, L. A., & Ma-rostica, P. J. (2015). Effects of an educational intervention on physical activity for children and adolescents with cystic fibrosis: A randomized controlled trial. Respiratory Care, 60(1), 81–87. https://doi.org/10.4187/respcare.02578
Jones, A. M., & Carter, H. (2000). The effect of endurance training on parameters of aerobic fitness. Sports Medicine, 29(6), 373–386. https://doi.org/10.2165/00007256-200029060-00001
Kaltsakas, G., Latsios, G., & Tzanakis, N. (2021). Inspiratory vs expiratory muscle training in cystic fi-brosis: A crossover randomized controlled trial. Respiratory Physiology & Neurobiology, 288, 103645. https://doi.org/10.1016/j.resp.2021.103645
LaRosa, C., Sawicki, G. S., Tantisira, K. G., Chua, K., Christofferson, C., Chan, W., ... & Gruber, M. (2020). High-intensity interval training improves aerobic fitness in adolescents with cystic fibrosis. Journal of Cystic Fibrosis, 19(5), 707–714. https://doi.org/10.1016/j.jcf.2020.02.007
Murillo, B. R., Pérez-Cortés, M. J., López-Campos, J. L., & Rodríguez-Hermosa, J. L. (2025). Rehabilitation interventions in people with cystic fibrosis: A systematic review and meta-analysis. Journal of Clinical Medicine, 14(3), 543. https://doi.org/10.3390/jcm14030543
O’Sullivan, B. P., & Freedman, S. D. (2009). Cystic fibrosis. The Lancet, 373(9678), 1891–1904. https://doi.org/10.1016/S0140-6736(09)60327-5
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Radtke, T., Hebestreit, H., & Kriemler, S. (2021). Exercise and physical activity in cystic fibrosis: State of the art. Current Opinion in Pulmonary Medicine, 27(6), 515–522. https://doi.org/10.1097/MCP.0000000000000827
Radtke, T., Nevitt, S. J., Hebestreit, H., & Kriemler, S. (2022). Physical exercise training for cystic fibrosis. Cochrane Database of Systematic Reviews, 2022(11), CD002768. https://doi.org/10.1002/14651858.CD002768.pub5
Radtke, T., Nevitt, S. J., Hebestreit, H., & Kriemler, S. (2015). Physical exercise training for cystic fibrosis. Cochrane Database of Systematic Reviews, 6, CD002768. https://doi.org/10.1002/14651858.CD002768.pub4
Reuveny, R., DiMenna, F. J., Gunaratnam, C., Arad, A. D., McElvaney, G. N., Susta, D., Peled, M., & Moyna, N. M. (2020). High-intensity interval training accelerates oxygen uptake kinetics and improves exercise tolerance for individuals with cystic fibrosis. BMC Sports Science, Medicine & Rehabilitation, 12, 9. https://doi.org/10.1186/s13102-020-0159-z
Savant, A. P. (2025). Cystic fibrosis year in review 2024. Pediatric Pulmonology, 60(8), e71222. https://doi.org/10.1002/ppul.71222
Sarac, D. C., Bayraktar, D., Ozer Kaya, D., Ozdemir, S., Kilinc, F., Arslan, I. E., & Ones, K. (2024). The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial. Pediatric Pulmonology, 59(3), 562–573. https://doi.org/10.1002/ppul.26783
Selvadurai, H. C., Blimkie, C. J., Meyers, N., Mellis, C. M., Cooper, P. J., & Van Asperen, P. P. (2002). Ran-domized controlled study of in-hospital exercise training programs in children with cystic fi-brosis. Pediatric Pulmonology, 33(3), 194–200. https://doi.org/10.1002/ppul.10015
Sawyer, A., Cavalheri, V., Jenkins, S., Wood, J., Cecins, N., Bear, N., Singh, B., Gucciardi, D., & Hill, K. (2020). High-intensity interval training is effective at increasing exercise endurance capacity and is well tolerated by adults with cystic fibrosis. Journal of Clinical Medicine, 9(10), 3098. https://doi.org/10.3390/jcm9103098
Stanojevic, S., Graham, B. L., Cooper, B. G., Thompson, B. R., Carter, K. W., Abramson, M. J., & Stocks, J. (2017). Global Lung Function Initiative reference values for spirometry. European Respiratory Journal, 50(6), 1700583. https://doi.org/10.1183/13993003.00583-2017
Stephenson, A. L., Sykes, J., Stanojevic, S., & Lands, L. C. (2022). Longitudinal trends in lung function and survival in the era of CFTR modulators. Thorax, 77(5), 429–437. https://doi.org/10.1136/thoraxjnl-2021-217647
Swisher, A. K., Hebestreit, H., & Allemann, Y. (2021). Barriers to exercise in cystic fibrosis: Patient and clinician perspectives. Journal of Cystic Fibrosis, 20(1), 24–29. https://doi.org/10.1016/j.jcf.2020.08.006
Stevens, D., Oades, P. J., Armstrong, N., Williams, C. A., & Rayner, C. (2020). A systematic review of exer-cise training in cystic fibrosis: A focus on aerobic capacity and lung function. Sports Medicine, 50(6), 1173–1191. https://doi.org/10.1007/s40279-020-01277-y
Swisher, A. K., Hebestreit, H., Mejia-Downs, A., Lowman, J. D., Gruber, W., Nippins, M., & Schneiderman, J. E. (2015). Exercise and habitual physical activity for people with cystic fibrosis: Expert consen-sus, evidence-based guide for advising patients. Cardiopulmonary Physical Therapy Journal, 26(4), 85–98. https://doi.org/10.1097/CPT.0000000000000016
Troosters, T., Radtke, T., & Cox, N. (2022). Physical activity as a prognostic marker in cystic fibrosis: Observational insights and clinical implications. Respiratory Medicine, 197, 106826. https://doi.org/10.1016/j.rmed.2022.106826
Thorel, J. B., Guillot, M., Reychler, G., & Payen, V. (2022). Effects of physical exercise programs on mus-cle strength and physical performance in people with cystic fibrosis: A systematic review and meta-analysis. Physiotherapy Research International, 27(3), e1942. https://doi.org/10.1002/pri.1942
Westerdahl, E., Andersson, H., & Holmgren, A. (2022). VO₂peak as a mortality predictor in cystic fibro-sis: A systematic review and meta-analysis. Respiratory Medicine, 190, 106709. https://doi.org/10.1016/j.rmed.2021.106709
Zainuldin, R., Mackey, M. G., Alison, J. A., & Hill, K. (2020). Home-based exercise training for people with cystic fibrosis. Cochrane Database of Systematic Reviews, 11, CD012398. https://doi.org/10.1002/14651858.CD012398.pub2
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