Exercise guide
Bronchiectasis is a long-term condition where the airways in the lungs are widened and damaged, so phlegm builds up and chest infections are more likely. Exercise can't repair the airways, but exercise training helps people walk further and feel better, and moving helps loosen phlegm so a huff can bring it up. If breathlessness holds you back, pulmonary rehabilitation (PR), a course of exercise and education, is recommended, and people with bronchiectasis gain at least as much from it as people with chronic obstructive pulmonary disease (COPD).
Exercise adds to your daily airway clearance; it doesn't replace it. This guide covers how the two fit together, how much and how hard to exercise, what to do around chest infections and flare-ups, exercise classes and infection, and the NHS advice on coughing up blood. It ends with moves you can watch in 3D, a follow-along session with huffs built in, and the warning signs. Your respiratory physiotherapist and team can tailor all of it to you.
A specialist respiratory physiotherapist teaches you breathing techniques to clear phlegm, and the NHS says you'll usually need to do them every day. The 2025 European Respiratory Society (ERS) guideline recommends teaching airway clearance to everyone with bronchiectasis, not only people who cough up a lot.
The British Thoracic Society (BTS) guideline encourages regular exercise with a huff, a forced breath out through an open mouth, to help clear the airways. Exercise loosens phlegm, and NHS Lothian says you may find this is when you bring up the most.
In one 2026 trial of 55 adults in hospital with a flare-up, walking with huffs cleared about as much phlegm as the active cycle of breathing techniques (ACBT). Over the next 6 months, though, the people doing ACBT went longer before their next flare-up. Keep the routine your physiotherapist gave you, and ask how exercise fits around it.
UK and European guidelines recommend PR for people whose breathlessness limits them. In 6 trials with 275 people, exercise training helped people walk further and improved their quality of life, though the evidence is low certainty.
In the trials, the gains had faded within 6 to 12 months of supervised training ending. Aim for 150 minutes of moderate activity a week plus strength work on 2 days, at a level where you're breathless but can still speak.
During a flare-up, follow your self-management plan, step up your airway clearance, and ease off exercise until you feel better (our suggestion for the exercise). For a few small spots or streaks of blood, ask for an urgent GP (general practitioner) appointment or get help from NHS 111. For more than just a few spots or streaks, call 999 or go to A&E (accident and emergency).
In bronchiectasis, inflammation damages the airways and they become wider than usual, so phlegm (mucus) builds up and bacteria can get trapped. It can't usually be cured, but treatment helps manage it. A Cambridge NHS leaflet describes the cycle: more mucus that's harder to clear leads to more infections, more inflammation and more damage, which is why clearing phlegm every day matters.
The main symptoms are a cough that doesn't go away, coughing up a lot of phlegm (clear, white, yellow or green) and frequent chest infections. Others include wheezing, breathlessness, noisy breathing, feeling very tired, coughing up blood and chest pain. Around 3 in 4 people cough up phlegm every day; some bring up little or none, which is sometimes called dry bronchiectasis.
About 212,000 people in the UK have bronchiectasis, around 1 in 200 adults. It's more common in women, and more likely to be diagnosed over the age of 70. A GP practice of 15,000 people might care for about 70 people with it, and UK records show it became more common every year from 2004 to 2013.
In around 4 in 10 people no clear cause is found. Known causes include a severe past infection such as pneumonia, tuberculosis, measles, whooping cough or COVID-19, immune problems, rheumatoid arthritis and inflammatory bowel disease. It's common to have bronchiectasis with asthma or COPD, and the BTS asks doctors to look for it in people with COPD who have frequent flare-ups and a germ called Pseudomonas in their phlegm, and in people with rheumatoid arthritis who have a lasting chesty cough or repeated chest infections.
A flare-up (exacerbation) is when your symptoms get worse than your usual ups and downs: more coughing or phlegm, a change in its colour or thickness, more breathlessness or tiredness, and sometimes a fever, blood in your phlegm or a sharp pain in your chest when you breathe. Most are caused by bacterial infections, and colds, flu, COVID-19 and air pollution can set them off. Your team may give you antibiotics to keep at home, called a rescue pack.
Treatment includes daily airway clearance taught by a specialist physiotherapist, sometimes with a hand-held device or a salt-water nebuliser first, PR if breathlessness is a problem, antibiotics for chest infections, inhalers for some people, and vaccines. If you get more than 3 chest infections a year, a specialist may suggest long-term antibiotics. You'll have check-ups at least once a year.
Some people lose weight without meaning to, for example because eating makes them breathless or shopping and cooking are hard, and being underweight raises the risk of infections. Carrying extra weight can make breathlessness worse. If you need help with your weight, your GP may be able to refer you to a dietitian.
Breathlessness, tiredness, a lower capacity for exercise and weaker muscles are common in bronchiectasis. Exercise makes you breathe harder and faster, which may help move phlegm up the airways, and keeping active helps with breathlessness. A Cambridge NHS leaflet adds that staying strong makes it easier to cope when you have an infection.
Most trials in bronchiectasis are small and short, so the certainty of the evidence is low. Medicines, not exercise, carry the evidence for preventing and treating flare-ups.
The 2025 ERS guideline strongly recommends teaching airway clearance to everyone with bronchiectasis, while rating the evidence as very low certainty. The BTS guideline offers ACBT or an oscillating positive expiratory pressure (PEP) device, a hand-held device you breathe out through. In 7 small trials (105 people), airway clearance appeared safe and may help clear phlegm and improve symptoms and quality of life. A 2023 ERS review of 30 trials found more phlegm cleared, less impact from coughing and fewer flare-ups.
A 2021 Cochrane review found 6 trials with 275 people, mostly 6 to 8 weeks of supervised and home training. Exercise training added about 87 metres to a shuttle walk test (4 trials, 161 people) and improved quality of life by more than the smallest change people notice (3 trials, 160 people), both from low-certainty evidence. It didn't change cough-related quality of life, anxiety or depression.
Source 8
In a trial of 85 people, 8 weeks of twice-weekly supervised training added about 62 metres to a shuttle walk and 41 metres to a 6-minute walk, and eased breathlessness and tiredness, but the walking gains had gone by 6 and 12 months. In a home programme for 63 people, three sessions a week of stepping and resistance band exercises for 8 weeks improved walking and quality of life, with nothing left at 6 months. The message from every trial is the same: keep exercising after the course ends.
In the trial of 85 people, those who trained had fewer flare-ups over the following year (a median of 1 against 2) and went longer before their first one (8 months against 6). It's a single trial, so treat it as a promising sign rather than a settled finding.
In this trial, 55 adults in hospital with a flare-up did ACBT, used an oscillating PEP device, or walked for 10 minutes three times a day at 3 to 5 out of 10 for breathlessness, huffing after each walk. Walking with huffs and ACBT cleared similar amounts of phlegm and both improved quality of life in hospital, while the device changed little. Over the next 6 months, the ACBT group went longer before their next flare-up (158 days against 118), but 20 people dropped out and the authors urge caution.
In a pilot trial of 27 people, starting PR straight after a course of antibiotics for a flare-up made no clear difference to walking or to the time until the next flare-up; both groups improved. The BTS lists rehab after a hospital stay as a question for research, so unlike COPD there's no evidence-based start date.
In a UK study, 213 people with bronchiectasis finished PR as often as 213 matched people with COPD (74%) and improved their shuttle walk as much (70 metres against 63), though tiredness improved less.
Source 25
The BTS says to consider breathing-muscle (inspiratory muscle) training alongside PR to help keep the gains. In the one trial behind this, with 32 people, it added nothing by the end of training, but the gains lasted 3 months longer. Ask your physiotherapist before buying a trainer.
Antibiotics for chest infections, long-term antibiotics for people with frequent flare-ups, and the other treatments your team chooses are what prevent and treat flare-ups. Exercise adds fitness, easier breathing and a better quality of life alongside them, never instead of them.
Airway clearance is best taught by a specialist respiratory physiotherapist, who finds the technique that suits you: breathing techniques such as ACBT, sometimes with a hand-held device. Fewer than half of people with bronchiectasis in Europe have been shown how to do it. If you've never been taught, or it isn't clearing your chest, ask your GP or respiratory team for a referral.
The BTS suggests at least 10 minutes and up to 30, then carrying on until you've done two clear huffs or coughs or you start to tire. An Oxford NHS leaflet suggests once or twice a day when you're well, with an extra or longer session when you're unwell; NHS Lothian calls twice a day a good starting point, and more often during an infection. Your physiotherapist sets yours.
Exercise loosens phlegm, so build a huff into your rest breaks: one or two huffs together, no more, because huffing again and again can make your chest feel tight. If you hear crackles, cough the phlegm into a tissue or pot. Keep tissues and a lidded pot to hand (our suggestion).
Many people find their chest is most productive during or just after exercise, so doing your airway clearance straight after a walk can make use of that (our suggestion). Your physiotherapist will tell you the order that works for you.
One NHS trust's leaflet says to take treatments that loosen phlegm, such as a saline nebuliser, before your airway clearance, to use your reliever inhaler first if you feel wheezy or tight, and to take nebulised antibiotics and steroid inhalers afterwards. Your own team's plan comes first.
Source 15
Drinking regularly through the day stops phlegm becoming thick and sticky, so it's easier to cough up. Water is best.
From the Oxford University Hospitals NHS physiotherapy leaflet (2024). Learn it from your respiratory physiotherapist, who will tell you how often and in which positions to do it, and may suggest a hand-held device instead.
ACBT: once or twice a day for about 10 to 15 minutes or until your chest feels clear, more when you're unwell (the move page's dose); it has no 3D demo, so follow its written steps. Slow breathing is the closest move to breathing control: keep it gentle, with no holds. Pursed-lip breathing is optional: Asthma + Lung UK teaches it for breathlessness, so try it and keep it if it helps.
The BTS guideline says to offer PR to anyone whose breathlessness limits them, including people who only get breathless when hurrying on the flat or walking up a slight hill, and to explain to everyone with bronchiectasis why an exercise programme matters. The European guideline strongly recommends it for breathlessness or reduced exercise capacity, and the 2026 BTS quality standard names bronchiectasis among the conditions that should be offered PR, with a start within 90 days of referral.
PR is a course of exercise and education run by physiotherapists and other trained staff, usually two group sessions a week for 6 to 8 weeks. The BTS quality standard sets a minimum of 6 weeks of twice-weekly supervised sessions, with a third session each week that can be done at home. For bronchiectasis, the course should also cover topics such as airway clearance.
Ask your GP, practice nurse or respiratory team to refer you. The European guideline's authors say PR is underused and many people who are referred don't go, so if getting to classes would be hard, say so when you're referred (our suggestion).
There's no evidence-based start date for PR after a bronchiectasis flare-up, unlike COPD. Once you've recovered, ask about a referral if breathlessness is limiting you (our suggestion).
The gains fade within 6 to 12 months if you stop, so keep up the walking and strength work at home, and ask about a maintenance class or another course if you slip back (our suggestion).
Doses are starting points, not prescriptions. Your physiotherapist or PR team can tailor them.
Aim for at least 150 minutes of moderate activity a week, about 20 minutes a day, and strength exercises on at least 2 days. If you're 65 or over, be active every day and add balance and flexibility work on 2 days too. Build up gradually from what you can do now.
Getting out of breath is normal. NHS Lothian says being breathless but still able to speak is a good sign you're working at the right level. Asthma + Lung UK's talk test agrees: if you need to stop for breath partway through a short sentence, that's about right; if you can only say one word at a time, slow down.
Our editorial starting point: walk or cycle on most days, starting with what you can manage, even 5 minutes, and adding a few minutes a week towards 20 to 30 minutes. Add strength work on 2 days: 1 to 2 sets of 8 to 12 slow repetitions of 4 to 6 moves, breathing out on the effort. Huff once or twice in your rest breaks and after the session.
If you like structure, the 2026 trial's routine was a 10-minute walk three times a day at 3 to 5 out of 10 for breathlessness, with huffs at the end of each walk. It was tested in one trial, during hospital flare-ups, so ask your physiotherapist before using it in place of any part of your routine.
Breathing control, breathing out as you make an effort, pacing your breathing with your steps and resting in a comfortable position all help you recover, and our COPD guide shows them. If you have a reliever inhaler, carry it and use it as your plan says.
Asthma + Lung UK lists brisk walking, jogging or running, swimming, cycling, tennis and football among the activities that get your heart rate up with a lung condition. Build up gradually. We found no bronchiectasis guidance on swimming pools; if anything brings on coughing or wheezing, tell your team.
Source 32
It's common to have bronchiectasis with asthma or COPD, so our COPD and asthma guides apply too.
Source 1
Breathless but able to speak. Build towards 20 to 30 minutes on most days (our editorial starting point), with a huff or two in your rest breaks. Do the step-up a minute at a time on the bottom stair, with the rail in reach.
On 2 days a week: 1 to 2 sets of 8 to 12 of each, breathing out on the effort (our editorial starting point). A light band or tins of food are enough to start.
For comfort when coughing leaves your chest and upper back stiff; no study shows they clear phlegm. Breath reach is 5 breaths, thoracic rotation 6 each side and the open book 8 to 10 slow openings each side (the move pages' doses); hold the doorway stretch for 30 seconds each side (our editorial starting point).
Coughing more or bringing up more phlegm, phlegm that's darker, thicker or stickier, feeling more breathless or tired than usual, a temperature, chest pain or blood in your phlegm can all mean a flare-up. Treating it quickly helps prevent further damage to your lungs.
Your plan may include giving a phlegm sample, taking antibiotics, sometimes from a rescue pack at home, and doing your airway clearance more often or for longer.
Our suggestion: rest from structured exercise while you feel unwell or have a temperature, but keep moving gently around the house and keep up your airway clearance. In one trial, gentle walking with huffs was used in hospital during flare-ups, so it's reasonable if your team agrees.
Source 7
Our suggestion: once your symptoms are back near your usual, restart with shorter, easier sessions and build up over 1 to 2 weeks. If you were in hospital, ask about PR when you've recovered.
Source 24
Stop exercising and follow the NHS advice in the warning signs below: coughing up blood always needs checking. If bleeding keeps happening, the BTS says your respiratory physiotherapist should review which airway clearance technique you use. Ask your team before going back to hard exercise (our suggestion).
The BTS guideline says people with bronchiectasis don't routinely need to be separated from each other because of the germs found in their phlegm, though good infection control and the local rules of your class or clinic still apply. This rests on expert opinion rather than trials, and the BTS has asked for research into infection in group exercise.
Source 4
People with cystic fibrosis (CF) are advised to keep apart from each other, as our CF guide explains. Bronchiectasis that isn't caused by CF has its own guidelines, and they don't ask for this. Where a class or facility is shared with people who have CF, the CF infection rules take priority, and if you have CF yourself, follow the CF guide.
Source 4
Wash your hands regularly, try to stay away from people with infections such as colds and flu, and have your flu, pneumococcal and COVID-19 vaccines as your GP recommends. In a class, use your own water bottle and towel, wipe shared equipment, keep tissues and a lidded pot for phlegm, and stay at home if you have a new infection (our suggestions).
Source 1
Coughing puts extra pressure on your bladder and pelvic floor, so some people leak when they cough or laugh. Asthma + Lung UK points to pelvic floor exercises and the help health professionals can give, so mention it to your GP or physiotherapist. Our pelvic floor guide shows how to find the right muscles.
Source 6
Start with 8 slow holds of up to 10 seconds and 8 quick squeezes, 3 times a day, and build towards 10 of each (the move page's dose).
The bronchiectasis workout builds huffs and airway clearance into a 35-minute session. The COPD session suits days when breathlessness is the main limit: add a huff in its recovery breaks. The cystic fibrosis workout is harder, for fitter people, and its salt and keeping-apart tips are for CF only.
A 35-minute home session for bronchiectasis: easy walking rounds with a huff in each break, five strength moves, then your airway clearance.
35 minBeginner13 movesCardio machine, A bench or boxA 25-minute home session for COPD: marching and light strength work, with pursed-lip and paced breathing and rests in a recovery position when you need them.
25 minBeginner12 movesA bench or box, A wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA 35-minute session for teenagers and adults with cystic fibrosis: cardio rounds with huffs in the breaks, simple strength, then breathing to clear your chest.
35 minBeginner13 movesCardio machine, A bandFor weekly structure: build more slowly than the plan if you need to, and ease off during flare-ups.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginnerThis is general information, not a diagnosis: your own team knows your condition, so use the contact numbers they gave you. In the US, call 911 where this page says 999.
Don't drive yourself to A&E: ask someone to drive you or call 999 for an ambulance, and bring any medicines you take.
Asthma + Lung UK adds these to its 999 list for bronchiectasis flare-ups:
Source 12
Stop and get advice from your healthcare professional if you get any of these. If you cough up blood while exercising, stop and follow the advice above.
Source 32
Our suggestion: skip structured exercise if you have a temperature or feel unwell with a chest infection, if you've coughed up blood and haven't had advice yet, or if you're more breathless than usual. Keep doing your airway clearance, more often if your plan says so.
Exercise with a huff helps bring phlegm up, and the BTS encourages it, but both the UK and European guidelines put airway clearance first. In the one trial that compared them, during hospital flare-ups, walking with huffs matched ACBT in hospital, but people using ACBT went longer before their next flare-up.
The 2025 European guideline recommends teaching airway clearance to everyone with bronchiectasis, not only people with a productive cough, and Asthma + Lung UK says it can help some people with dry bronchiectasis.
The BTS guideline, the European guideline and the BTS quality standard all include bronchiectasis. In a UK study, people with bronchiectasis did as well in PR as matched people with COPD.
The BTS says separating people by what grows in their phlegm isn't routinely needed, with good hygiene and local rules. CF rules apply where facilities are shared with people who have CF. The advice rests on expert opinion rather than trials.
Source 4
Exercise loosens phlegm, and NHS Lothian says you may find this is when you're most productive: huff, clear it into a tissue and carry on if you feel well. Blood is different: stop and follow the NHS advice.
In the trials, the gains had gone 6 to 12 months after supervised training stopped. Keep exercising after the course.
Yes. Exercise training helps people with bronchiectasis walk further and improves quality of life, and moving helps loosen phlegm so it's easier to clear. The NHS says to exercise regularly to stay fit and help clear your lungs, and your care team can give you advice.
Walking or cycling at a pace where you're breathless but can still speak, plus strength exercises for your arms and legs on 2 days a week: the mix used in trials and in pulmonary rehab. A huff or two in your rest breaks helps bring phlegm up. Choose what you'll keep doing.
Not on its own. Exercise with huffing helps, but UK and European guidelines put airway clearance first, and in the one trial that compared them, people using the active cycle of breathing went longer before their next flare-up. Keep your routine, and ask your physiotherapist how exercise fits around it.
The active cycle of breathing techniques: breathing control, 3 to 5 deep breaths and one or two huffs, repeated until your chest feels clear. A respiratory physiotherapist should teach you, and may suggest a hand-held device instead. Breathing control, and pursed-lip breathing if it suits you, can help when you're breathless.
Usually every day: once or twice a day when you're well, and more often when you're unwell. The British Thoracic Society suggests sessions of at least 10 and up to 30 minutes, carrying on until you get two clear huffs or coughs or start to tire. Your physiotherapist sets your routine.
Yes. Pulmonary rehab is a course of exercise and education, usually two sessions a week for 6 to 8 weeks, and UK and European guidelines recommend it for people with bronchiectasis whose breathlessness limits them. Ask your GP, practice nurse or respiratory team to refer you.
Follow your self-management plan, step up your airway clearance and rest from structured exercise while you feel unwell, but keep moving gently. Restart with shorter, easier sessions once your symptoms are back near your usual. In one hospital trial, walking with huffs was safe during a flare-up and helped clear phlegm.
Stop exercising. For a few small spots, flecks or streaks, or blood in your phlegm, ask for an urgent GP appointment or get help from NHS 111. Call 999 if you cough up more than just a few spots or streaks, or cough up blood with difficulty breathing, a very fast heartbeat or pain in your chest or upper back.
Yes. The British Thoracic Society says people with bronchiectasis don't routinely need to be kept apart because of what grows in their phlegm, but good hygiene and the class's own rules apply. If you have cystic fibrosis, or the class includes people who do, the cystic fibrosis rules apply instead.
Yes. Walking is at the heart of most programmes, and in a hospital trial during flare-ups, three 10-minute walks a day with huffs after each cleared about as much phlegm as a breathing technique. Build towards 150 minutes of activity a week at your own pace.
Asthma + Lung UK lists running and swimming among activities people with lung conditions can do, building up gradually. We found no bronchiectasis-specific advice on swimming pools. If an activity brings on coughing or wheezing, tell your team.
Yes. Coughing puts pressure on your pelvic floor, and pelvic floor exercises can help. Our pelvic floor guide shows how, and your GP or physiotherapist can help too.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
