Exploring exercise as airway clearance in cystic fibrosis: a qualitative study from the ExACT-CF feasibility trial

Abstract

Question: cystic fibrosis (CF) affects > 11,300 people in the UK and is characterized by thick, sticky mucus in the lungs, leading to recurrent infections, inflammation, and progressive respiratory decline. Chest physiotherapy remains a cornerstone of airway clearance; however, many people with CF (pwCF) find it burdensome and time-consuming. Exercise has been proposed as a potentially effective and more acceptable alternative. The ExACT-CF feasibility trial evaluated the use of exercise as an airway clearance technique in pwCF on modulator therapy.

Methods: this nested qualitative study explored the experiences of participants and healthcare professionals involved in the ExACT-CF trial, alongside broader perspectives on airway clearance, to inform future research and clinical practice. Purposively sampled semi-structured interviews were conducted with 32 individuals: ten pwCF, five parents, twelve healthcare professionals, four decliners, and one participant who withdrew. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using “The Framework Method.”. 

Results: two primary themes emerged. Theme 1 reflected experiences and lessons learned from the trial, including reported barriers and facilitators around recruitment, randomization, and daily implementation. Despite some minor difficulties, trial participation, processes, and the intervention itself were broadly acceptable. Theme 2 highlighted a preference for using ExACT alone or interchangeably with chest physiotherapy. Participants emphasized the need for robust clinical evidence to guide use. 

Answer: this study highlights the acceptability of both the ExACT-CF trial processes and the use of this exercise-based airway clearance technique. Findings support progression to a definitive trial and further exzploration of patient-centered, flexible approaches to airway clearance in CF. 

Trial registration: NCT02429180.

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