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Exercise as airway clearance therapy (ExACT) in cystic fibrosis: a UK-based e-Delphi survey of patients, caregivers and health professionals
  1. Zoe Louise Saynor1,2,
  2. Steve Cunningham3,4,
  3. Lisa Morrison5,
  4. Eleanor Main6,
  5. Ioannis Vogiatzis7,
  6. Simon Reid8,
  7. Donald Urquhart4,9
  1. 1 Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
  2. 2 Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
  3. 3 Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  4. 4 Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
  5. 5 West of Scotland Adult CF Unit, Queen Elizabeth University Hospital (The Southern General Hospital), Glasgow, UK
  6. 6 Physiotherapy Section, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
  7. 7 Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
  8. 8 Person with Cystic Fibrosis, Glasgow, UK
  9. 9 Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
  1. Correspondence to Dr Zoe Louise Saynor, University of Portsmouth, Portsmouth, UK, PO1 2ER; zoe.saynor{at}


Replacing traditional airway clearance therapy (tACT) with exercise (ExACT) in people with cystic fibrosis (pwCF) is a top research priority. A UK-based e-Delphi consensus was performed to inform the type(s), duration and intensity of ExACT. The expert panel comprised CF physiotherapists, doctors, pwCF and parents/partners. Exercise ACT was considered to be aerobic activity, of at least 20 min duration and intense enough to elicit deep breathing. Consensus was reached that assessment breaths, coughs and huffs should accompany exercise to remove loose secretions, with support for trials to investigate ExACT versus tACT during times of stable disease but not pulmonary exacerbations.

  • Cystic Fibrosis
  • Exercise
  • Paediatric Lung Disaese

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  • Contributors ZLS, SC, LM, EM, IV, SR and DU substantially contributed to the conception and design of this work. ZLS, SC, LM and DU substantially contributed to the acquisition of data. ZLS, SC, LM, EM, IV, SR and DU substantially contributed to the analysis and interpretation of the data; drafting and revising the work for important intellectual content and final approval of this version of the manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SC and DU have shared last authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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