SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Respiratory Physiology and Pathophysiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1548382
This article is part of the Research TopicAdaptations and Responses to Respiratory InterventionsView all 4 articles
The effects of exercise based on adherence to ACSM recommendations on pulmonary function and quality of life in adults with asthma: a systematic review and meta-analysis
Provisionally accepted
- 1Department of Respiratory and Critical Care Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
- 2Department of Neurobiology, Hebei Medical University, Shijiazhuang, China
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Background: Adherence to ACSM exercise guidelines is linked to improved clinical outcomes in asthma patients, yet its effects on pulmonary function and QOL remain unclear. This study aims to comprehensively assess the impact of ACSM-based exercise adherence on lung function and patientreported QOL in adults with asthma.Methods: A systematic search of Cochrane, Web of Science, Embase, and PubMed was conducted to review a meta-analysis on exercise regimens with tailored prescriptions for symptomatic bronchial asthma patients. Eligible randomized controlled trials comparing exercise interventions to nonintervention were selected and analyzed using SMD and 95% CI. Study quality was assessed using the revised Cochrane Risk of Bias tool, while Egger's regression and Begg's test evaluated publication bias. Studies were classified based on adherence to ACSM guidelines, and subgroup analyses employed a random-effects model where appropriate to enhance result reliability and interpretability.Results: A total of 18 studies were included, with 9 classified as high adherence to ACSM guidelines and 9 as low/uncertain adherence. Standardized mean difference (SMD) ratios indicated superior outcomes in the high adherence group across four key measures. For FEV1, SMD was 0.55 (95% CI: 0.02, 1.08) in the high adherence group and 0.43 (95% CI: 0.01, 0.86) in the low/uncertain adherence group. FVC values were 0.72 (95% CI: 0.02, 1.42) and 0.64 (95% CI: 0.18, 1.11), respectively. The FEV1/FVC ratio was 0.19 (95% CI: -0.30, 0.69) versus 0.16 (95% CI: -0.95, 1.28). QOL scores demonstrated the most pronounced difference, with SMD at 0.85 (95% CI: 0.39, 1.32) for high adherence and 0.07 (95% CI: -0.22, 0.37) for low/uncertain adherence.This meta-analysis revealed that exercise interventions with high adherence to ACSM guidelines led to greater changes in QOL scores among asthma patients. While the high-adherence group outperformed the low/uncertain-adherence group in FEV₁ and FVC, subgroup analysis failed to establish a significant difference. The modest impact on FEV₁/FVC was likely influenced by substantial heterogeneity, potentially introducing bias in effect size estimation. Furthermore, the limited number of RCTs and small sample sizes may have undermined statistical power and result reliability.
Keywords: bronchial asthma1, health related quality of life2, Exercise intervention3, ACSM exercise recommendations4, respiratory function5
Received: 19 Dec 2024; Accepted: 23 Apr 2025.
Copyright: © 2025 Li, Zhao, Wei, Wu and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wuzhuang Sun, Department of Respiratory and Critical Care Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
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