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Barriers and facilitators to physical activity among children, adolescents, and young adults with cystic fibrosis: a systematic review and thematic synthesis of qualitative research
  1. Sarah Denford1,
  2. Samantha van Beurden1,
  3. Paul O'Halloran2,
  4. Craig Anthony Williams1
  1. 1Children's Health & Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
  2. 2School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
  1. Correspondence to Dr Sarah Denford; s.denford{at}


Objectives Physical activity is widely recommended in the treatment and management of cystic fibrosis (CF). Despite the numerous physical and psychological benefits, many young people with CF are not achieving the recommended levels of physical activity. The aim of this systematic review was to identify and synthesise available qualitative investigations exploring the motives for, barriers to and facilitators of physical activity among young people with CF.

Methods The following six electronic databases were systematically searched: Applied Social Sciences Index and Abstracts (ASSIA), CINAH, EMBASE, MEDLINE, MEDLINE-in-process, PsycINFO up to August 2019. Keywords were used to identify qualitative research that explored engagement in physical activity among young people with CF. Titles and abstracts were screened by two independent reviewers, and potentially relevant articles were retrieved in full. Articles were eligible for inclusion if they employed any qualitative method and recruited participants under the age of 24 years with CF. Risk of bias of included studies was assessed via the Critical Appraisal Skills Programme. Results were synthesised using a thematic approach.

Results Seven studies met our inclusion criteria and were included in the review. Overall, studies were of moderate to high quality. Thematic synthesis identified nine main themes that encompass motives for, barriers to and facilitators of physical activity among young people with CF. These were (1) Perceptions of physical activity. (2) Value attributed to physical activity. (3) Social influences. (4) Competing priorities. (5) Fluctuating health. (6) Normality. (7) Control beliefs. (8) Coping strategies. (9) Availability of facilities. Previous reviews have been unable to identify intervention characteristics that influence physical activity behaviour.

Conclusions This review provides detailed information on the physical (biological—clinical), psychological, social and environmental influences on physical activity behaviour, thus providing numerous targets for future interventions. This in turn could facilitate promotion of physical activity among young people with CF.

  • qualitative research
  • respiratory medicine (see thoracic medicine)
  • sports medicine
  • cystic fibrosis
  • paediatric thoracic medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors This study was designed by SD with considerable input from SvB, CAW and PO. Studies were identified by SD with inputs from colleagues with expertise in systematic reviewing. Data were extracted and analysed by SD and SvB with inputs from PO and CAW. The manuscript was prepared by SD with considerable input from SvB, CAW and PO. All authors approved the final manuscript prior to publication.

  • Funding This work was supported by the Cystic Fibrosis Trust Strategic Research Centre: grant number 008 and Vertex Pharmaceuticals Circle of Care Award. The funders had no involvement in the research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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