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. 2025 May 15:16:1548382.
doi: 10.3389/fphys.2025.1548382. eCollection 2025.

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

Jinhan Li  1 , Jianxu Zhao  2 , Jiahao Wei  1 , Baofa Wu  1 , Wuzhuang Sun  1
Affiliations

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

Jinhan Li et al. Front Physiol. .

Abstract

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 patient-reported 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 non-intervention 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. For 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.

Conclusion: 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.

Systematic review registration: identifier CRD42024553618.

Keywords: ACSM exercise recommendations; bronchial asthma; exercise intervention; health related quality of life; respiratory function.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA study flow diagram.
FIGURE 2
FIGURE 2
Risk of bias summary: The review author’s judgement of the risk of bias of each included study.
FIGURE 3
FIGURE 3
(A) Forest plot for meta-analyses of the effect of exercise on FEV1 in individuals of asthma. (B) Funnel plot containing FEV1 study.
FIGURE 4
FIGURE 4
Forest plot for meta-analyses of the effect of exercise on FEV1 in individuals with asthma.
FIGURE 5
FIGURE 5
(A) Forest plot for meta-analyses of the effect of exercise on FEC in individuals with asthma. (B) Funnel plot containing FVC study.
FIGURE 6
FIGURE 6
(A) Forest plot for meta-analyses of the effect of exercise on FEV1/FVC in individuals with asthma. (B) Funnel plot containing FEV1/FVC study.
FIGURE 7
FIGURE 7
Forest plot for meta-analyses of the effect of exercise on FEV1/FVC in individuals with asthma.
FIGURE 8
FIGURE 8
(A) Forest plot for meta-analyses of the effect of exercise on quality of life scores in individuals with asthma. (B) Funnel plot containing QOL study.
FIGURE 9
FIGURE 9
Forest plot for meta-analyses of the effect of exercise on QOL in individuals with asthma.
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