Aerobic Exercise-Based Pulmonary Rehabilitation for Bronchial Asthma in Pediatrics: A Systematic Review

Bronchial asthma is a prevalent chronic condition in children, often leading to exercise intolerance and diminished quality of life despite pharmacological management. Aerobic exercise-based pulmonary rehabilitation (PR) has emerged as a promising adjunct therapy. This systematic review aims to critically evaluate the effects of aerobic exercise-based PR on pulmonary function, asthma control, exercise capacity, and quality of life in children with bronchial asthma. A systematic search was conducted across five electronic databases (PubMed, Scopus, Embase, Web of Science, and ClinicalTrials) for randomized controlled trials (RCTs) published from 2015 to 2025. Studies involving children (≤18 years) with asthma that compared aerobic exercise-based interventions against a control were included. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 (ROB 2) tool. A narrative synthesis was undertaken due to heterogeneity in interventions and outcomes. Eight RCTs with a total of 435 participants were included. The findings revealed inconsistent effects on spirometric parameters [forced expiratory volume in one second (FEV₁), forced vital capacity (FVC)], with three studies showing significant improvements and others reporting no significant change. In contrast, interventions consistently demonstrated significant benefits in asthma control/symptoms, quality of life, and cardiorespiratory fitness (e.g., VO₂max, 6-minute walk test). Various modalities, including yoga, conventional aerobic exercise, and inspiratory muscle training, were effective. The overall risk of bias was low for seven of the eight included studies. Aerobic exercise-based pulmonary rehabilitation is a safe and effective adjunct to standard care in pediatric asthma, conferring significant and consistent improvements in asthma control, quality of life, and physical fitness, even in the absence of uniform changes in lung function. These findings support the integration of structured exercise programs into comprehensive asthma management plans for children. However, the heterogeneity in exercise interventions and outcome measurements across the included studies should be considered when interpreting these findings.