Short and long-term effects of a play-based therapeutic exercise programme in children with non-cystic fibrosis...

To determine whether an 8-week, play-based therapeutic exercise program increases the proportion of children with bronchiectasis who remain exacerbation-free over 12-months. Secondary objectives were to assess effects on time of exacerbations, fundamental movement skill (FMS) proficiency, moderate-to-vigorous physical activity (MVPA), aerobic fitness, perceived movement competence, and health-related quality of life (HRQoL).

Multi-site, observer-blinded, parallel-group randomised controlled trial.

Children aged 4 to 13-years with bronchiectasis, were randomised 1:1 to intervention or waitlist control. The 8-week intervention comprised weekly 60-minute group sessions in community venues, incorporating play-based activities targeting FMS and aerobic fitness, alongside a twice-weekly home program. Primary and secondary outcomes were assessed at baseline, immediately post-intervention, and at 6- and 12-months. Analyses used intention-to-treat with multiple imputation for missing data.

Forty-seven children (mean age = 7.3 years ± SD 2.4) were randomised. At 12-months, the estimated odds of remaining exacerbation-free over 12 months were higher in the intervention group than in the control group (OR 1.51, 95% CI 0.32-7.5), although the association was not statistically significant. Median time to first exacerbation was longer in the intervention participants than controls (175 vs 82 days, p = 0.38). Daily MVPA increased significantly post-intervention (+16.8 min/day; p = 0.011) but was unsustained at 6- and 12-month follow-up. No significant group differences were observed for FMS, aerobic fitness, perceived competence, or HRQoL.

A developmentally appropriate, play-based therapeutic exercise program was associated with short-term increases in daily physical activity and clinically relevant reductions in exacerbation frequency were suggested, although estimates were imprecise and not statistically significant. Therapeutic exercise as a potential adjunct to routine care warrants further investigation in adequately powered trials.