Effect of physical activity on pulmonary function and quality of life in asthma patients: a systematic review and...

Physical activity is increasingly recognized as a non-pharmacological adjunct in asthma management, yet existing systematic reviews are limited by single-modality scope, narrow age ranges, and inconsistent operationalization of pulmonary function outcomes. We comprehensively evaluated the effects of physical activity on pulmonary function and quality of life in patients with asthma across a broad age range and multiple exercise modalities.

We systematically searched PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, and CNKI up to April 25, 2026, for randomized controlled trials (RCTs) of structured physical activity interventions ( ≥ 6 weeks) in asthma. The primary outcome was forced expiratory volume in 1 s as a percentage of predicted value (FEV₁% predicted); secondary outcomes were FVC% predicted, PEF% predicted, PEF (L/s), FEV₁ (L), FVC (L), and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Random-effects meta-analyses used the restricted maximum likelihood estimator. Heterogeneity was explored via subgroup analyses and meta-regression. Risk of bias was assessed with Cochrane RoB 2 and certainty of evidence with GRADE.

Twenty-two RCTs (n = 1,280) were included. Physical activity significantly improved FEV₁% predicted (MD = 5.79, 95% CI: 1.89-9.69; I ² = 89.16%), PEF (L/s) (MD = 0.47, 95% CI: 0.08-0.85), FVC (L) (MD = 0.55, 95% CI: 0.25-0.84), and PAQLQ (MD = 1.13, 95% CI: 0.45-1.81), but not FVC% predicted, PEF% predicted, or FEV₁ (L). Meta-regression did not identify intervention duration, weekly frequency, session duration, or intervention type as significant moderators for either FEV₁% predicted or FVC% predicted (all P > 0.20). Egger's test and trim-and-fill indicated no significant publication bias. Certainty of evidence was low for FEV₁% predicted and very low for FVC% predicted, PEF% predicted, and PAQLQ.

Physical activity is associated with improved FEV₁% predicted and PAQLQ in patients with asthma, but overall certainty is low, mainly due to risk of bias and heterogeneity. The systematic discordance between predicted-value and absolute-unit scales across pulmonary function outcomes highlights the need for standardized outcome reporting in future trials.