Exercise guide
Exercise is part of cystic fibrosis (CF) care, for children and adults. NICE (the National Institute for Health and Care Excellence) recommends an individual exercise programme for everyone with CF: regular activity builds fitness, and moving and huffing help loosen mucus so you can clear it. Running, swimming, cycling, dancing, team sports, trampolining and the gym all count.
Exercise adds to your airway clearance rather than replacing it, and it comes with a few CF-specific precautions: extra fluids and salt in hot weather, keeping apart from other people with CF, and a plan for blood sugar if you have CF-related diabetes.
This guide covers what the research shows, how much to do, a workout that builds in huffing, and the warning signs that need help. Your CF team, physiotherapist and dietitian can tailor all of it to you.
NICE recommends an individual exercise programme for everyone with CF, reviewed regularly, and the NHS says stay as active as possible because it helps clear mucus. In 24 trials with 875 people, 6 months or more of activity improved fitness a little, and harms were rare.
Exercise with huffing helps bring mucus up, but there's no evidence beyond the short term that it can replace airway clearance. Keep the routine your CF physiotherapist gave you, and ask how exercise fits in.
There are no CF-specific targets, so use the general guidelines: for children, an average of at least 60 minutes a day; for adults, 150 minutes a week plus strength exercises on 2 days. Experts recommend some activity at a moderate intensity or harder.
People with CF lose more salt in their sweat, and long or hot sessions can lead to dehydration with low salt levels. Drink more than thirst suggests, and take salt as your CF team advises. This advice comes from guidelines published in 2010 and a small trial from 1999.
The NHS says consider not meeting other people with CF face-to-face, because of the higher risk of catching serious infections from each other. Where you can't avoid being in the same place, such as at school, clinic or sport, a US guideline says keep at least 2 metres apart. Follow your CF centre's rules.
Call 999 for coughing up more than a few spots or streaks of blood, sudden sharp chest pain with breathlessness, chest pain that spreads or comes with feeling sweaty or sick, or heatstroke. For a few streaks of blood, get an urgent GP (general practitioner) appointment, call 111 or contact your CF team.
Cystic fibrosis is "a rare inherited genetic condition that causes breathing and digestive problems". Thick, sticky mucus builds up in the lungs and gut, and sweat is very salty. Babies in the UK are checked for it with the newborn blood spot test. There's no cure, but medicines called cystic fibrosis transmembrane conductance regulator (CFTR) modulators and other treatments help, and "many people diagnosed with the condition today will live well past middle-age".
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Children with CF "have greater sweat-related salt losses", and "Resting energy expenditure is 5% to 25% higher in CF youth". Losing salt can blunt thirst. People with CF-related diabetes still need extra energy and salt, not less.
In 109 people followed for 8 years, 83% of the fittest were alive at the end, against 28% of the least fit, though fitness may partly reflect milder illness. Children with CF are about as active as their peers (20 studies, 785 children).
Most CF exercise trials are small and short, and most took place before CFTR modulators.
In the Cochrane review (24 trials, 875 people), programmes of 6 months or more improved peak fitness by about 1.6 ml/kg/min: a small gain, with moderate certainty.
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"Adverse effects of physical activity appear rare and there is no reason to actively discourage regular physical activity and exercise." International experts agreed that exercise testing is safe at any age or severity.
NICE (2017) tells people that regular exercise improves lung function. The Cochrane review found little or no effect on FEV1 (how much air you can blow out in one second), with low certainty. In the ACTIVATE-CF trial, 117 inactive people aged 12 and over added 3 hours of vigorous activity a week: their fitness rose, but FEV1 at 6 months was slightly better in the comparison group.
In 10 trials with 359 children and teenagers, exercise training improved leg and arm strength and muscle mass (very low quality evidence). International experts agree that strength training improves muscle strength in CF.
In 12 short studies, exercise made mucus easier to bring up and improved mucus clearance, and exercise with huffs worked about as well as airway clearance techniques in the short term. A Cochrane review of 4 trials with 86 people couldn't say whether exercise can replace airway clearance. Experts agreed unanimously that "Exercise with huff or cough improves mucus clearance, however there is no medium- or long-term evidence if exercise can adequately replace airway clearance techniques".
Exercise training didn't worsen nutritional status in children with CF, and strength training increased lean mass (4 studies).
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People with CF are at risk of low bone density and fractures. A year of exercise in 52 children didn't change bone density, though fitness and quality of life improved, and in 2008 there were no controlled trials of weight-bearing exercise for bone in children with CF. Impact and strength exercise build bone in healthy children, so they're sensible.
After a year of elexacaftor/tezacaftor/ivacaftor (Kaftrio in the UK) without an exercise programme, peak fitness rose by 0.6 ml/kg/min in 229 people, "significant, but not clinically relevant". In 56 adults, a 3.5-week exercise programme improved fitness as much with the medicine as without it.
Airway clearance, medicines and CFTR modulators are your CF team's treatment. Airway clearance techniques may increase mucus transport in the short term (low to very low certainty). Exercise adds fitness, strength and easier mucus clearance alongside them.
Exercise loosens mucus. One or two huffs in your rest breaks and after a session help bring it up.
A huff is a breath out through an open mouth, as if steaming up a mirror, that moves mucus up your airways without a full cough. Only do 1 or 2 together, because "repeatedly huffing can make your chest feel tight". The steps below show the full active cycle of breathing techniques (ACBT).
NICE asks CF teams to teach airway clearance, choose a technique with you, and review it regularly. Keep doing your routine, and ask your physiotherapist whether exercise can replace a session on some days (our suggestion).
The Canadian Paediatric Society notes that "Some children cough because of underlying asthma". Use your reliever as your asthma plan says; our asthma guide has more.
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From NHS physiotherapy leaflets (Oxford University Hospitals, 2024, and University Hospitals Birmingham, 2025). Learn it from your CF physiotherapist, who will tell you how often and in which positions. If you use a reliever inhaler first, take it about 10 minutes before.
Doses are starting points, not prescriptions. Plan them with your CF team.
The European Cystic Fibrosis Society says there isn't enough data for CF-specific targets, so the general guidelines are the foundation. Children and young people: an average of at least 60 minutes a day of moderate or vigorous activity, with activities that strengthen muscles and bones 3 times a week. Adults: 150 minutes of moderate activity a week (or 75 of vigorous), plus strength exercises on at least 2 days.
Experts recommend an individual programme "at a moderate intensity or higher". The Canadian Paediatric Society suggests exercise that raises the heart rate to 70% to 80% of its maximum: in practice, hard enough that you can only say a few words at a time, at least some of the time.
Experts agree guidance should cover "hydration, nutrition, exercise intensity and duration", with food and fluids adjusted for active people. NICE asks teams to review your exercise programme regularly, including at your annual review and during hospital stays.
An exercise test helps spot problems and plan your exercise. People with severe CF should have one, to check whether their oxygen level drops.
3 to 5 sessions a week of activity you enjoy, with some harder bursts, plus strength work on 2 days, huffing in the breaks. The cystic fibrosis workout below puts these together.
The active cycle of breathing as your physiotherapist teaches it, then 5 to 10 slow repetitions or breaths of each mobility move to open the chest and ease a stiff upper back (our editorial starting point).
Active cycle of breathing techniques (ACBT) with huffingBeginner · No equipment
3D demoBreath reachBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoDoorway chest openerBeginner · A wall
3D demoWall angelBeginner · A wall
3D demoFoam roller thoracic extensionBeginner · A foam rollerAnything that makes you breathe hard counts. Build to 20 to 30 minutes with some harder bursts, and huff in the breaks (our editorial starting point).
3D demoSkippingBeginner · No equipment
3D demoJumping jackBeginner · No equipment
3D demoBear crawlIntermediate · No equipment
3D demoTreadmill joggingIntermediate · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoIndoor rowing (rowing machine)Beginner · Cardio machine
3D demoStep jack (low-impact jumping jack)Beginner · No equipment2 or 3 sets of 8 to 12, stopping a couple of repetitions short of failure, on 2 days a week (our editorial starting point; experts agree strength training improves muscle strength in CF).
3D demoBodyweight squatBeginner · No equipment
3D demoPush-upIntermediate · No equipment
3D demoKnee push-upBeginner · No equipment
3D demoBand rowBeginner · A band + An anchor point
3D demoGlute bridgeBeginner · No equipment
3D demoDead bugBeginner · No equipment
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoStep-upBeginner · A stepHeel drops and small bounces for bone, building up gradually as each move's guide says, and pelvic floor exercises if you leak when you cough, huff or exercise.
Start with the cystic fibrosis workout, which builds huffing into the breaks. The animal moves session suits younger children, and the asthma warm-up helps if you also have asthma.
A 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 bandFifteen minutes of animal moves, jumps and balance games for children, building the muscle- and bone-strengthening activity they need, with nothing to buy.
15 minBeginner16 movesA wallA 30-minute beginner run-walk session: a brisk walk, then 1-minute jogs with 1-minute walks, building to 3-minute runs over your first three weeks.
30 minBeginner5 movesCardio machine, A wallA 20-minute full-body workout with no equipment: squats, knee push-ups, bridges, lunges and planks.
20 minBeginner10 movesNo equipmentA 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 15-minute warm-up for exercise-induced asthma: easy movement, then short hard bursts that can reduce symptoms in the session that follows, then moving stretches.
15 minBeginner5 movesCardio machine, A wallImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA 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 equipmentFor teenagers and adults who want structure. Huff in the breaks, and keep your airway clearance routine.
A 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginner3 days a weekThree full-body home workouts a week with dumbbells or no equipment at all, plus walks and an 8-week plan to keep progressing.
3 training days35 minBeginner6 days a weekA 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 minBeginnerYour CF team or dietitian will tell you how much salt and fluid you need. This page gives no amounts.
People with CF have very salty sweat. The Canadian Paediatric Society warns that "Prolonged exercise (1.5 h to 3 h) can lead to hyponatremic dehydration": dehydration with low salt levels in the blood. In a trial of 11 young people with CF exercising for 3 hours in the heat, losing salt blunted thirst, and a flavoured drink with more salt helped them drink more and stay hydrated.
Drink before, during and after exercise, more than thirst suggests: the Canadian statement recommends flavoured salty drinks "above thirst levels". A CF-related diabetes guideline advises a "Liberal, high salt diet, especially in warm conditions and/or when exercising". Take salty snacks, drinks or salt tablets as your CF team advises. This advice comes from guidelines published in 2010 and a small trial from 1999.
Heat exhaustion (tiredness, dizziness, a headache, feeling sick, heavy sweating, cramps, a high temperature and great thirst) should improve within 30 minutes of resting somewhere cool and drinking, and the NHS suggests a sports drink or rehydration solution to replace salt. Call 999 for heatstroke: still unwell after 30 minutes; a very high temperature; hot skin that isn't sweating; a fast heartbeat; fast breathing or breathlessness; confusion or poor coordination; a fit; or passing out.
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The NHS says "consider not meeting other people with cystic fibrosis face-to-face", because "there's a higher risk of catching serious infections from another person with the condition". Wash your hands regularly.
Source 2
At school, at clinic or in sport, a US Cystic Fibrosis Foundation guideline says people with CF should keep at least 2 metres (6 feet) apart in all settings, except within the same household. It recommends that only one person with CF goes to an indoor CF event, that pupils with CF aren't in the same room, including for physical education (PE), and that outdoor events are fine at 2 metres apart.
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NICE asks CF services to keep people with CF apart in clinics and hospital, to explain the risk of passing on infections, and to help people connect safely, for example through online support groups. Your CF centre will tell you its own rules.
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Use your own water bottle and towel, and clean shared equipment before and after use. People with CF "can swim in pools or water parks with adequate disinfection (eg, chlorination)", but should avoid hot tubs, whirlpool spas and stagnant water. The guideline also suggests limiting long or repeated exposure to dust from soil, such as from gardening.
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The guideline advises against camps just for people with CF, and says people with CF "are encouraged to participate in camps and sports with non-CF individuals". People with CF who carry MRSA (a bacterium resistant to some antibiotics) needn't be kept off sports teams if they keep up good hand and respiratory hygiene.
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CF-related diabetes (CFRD) affects up to 1 in 2 adults with CF and is checked for every year from age 10. A guideline from the American Diabetes Association and the Cystic Fibrosis Foundation advises "moderate aerobic exercise for at least 150 min per week".
Check your glucose before vigorous activity: you may need extra carbohydrate or a change in insulin, depending on your glucose and how hard and long you'll exercise. You'll need extra carbohydrate during long sessions. Your CF diabetes team sets any changes to insulin.
CFRD doesn't mean eating less: you still need extra energy and salt. People with CF on insulin usually notice hypos normally, but low blood sugar without insulin can happen in CF and is "rarely symptomatic".
The NHS: have "a small glass of fruit juice or sugary fizzy drink, 5 glucose or dextrose tablets, 4 large jelly babies, or 2 tubes of glucose gel", check again after 10 to 15 minutes, then eat something that keeps your blood sugar up for longer. Doing "a lot of exercise without eating more carbohydrate or reducing your insulin dose" is one cause. Our type 1 diabetes guide covers exercise and hypos.
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Low bone density is common in CF. NICE lists the reasons for a bone density scan, such as long-term steroid tablets, frequent courses of antibiotics through a drip, severe lung disease, or a fracture from a minor fall. Weight-bearing, impact and strength exercise are sensible; our osteoporosis guide has the doses if your bones are already thin.
Back pain affected 44% of 489 adults at two UK CF centres in a single week. Posture and chest mobility moves can help (our suggestion), and your CF team should check joint pain, as CF can affect the joints.
Leaking with coughing, huffing or exercise affects 5% to 76% of people with CF across 12 studies, and "commonly limited airway clearance, exercise and/or spirometry". It affects men too. NICE includes it in your CF physiotherapist's assessment: ask about pelvic floor exercises, and see our pelvic floor guide.
A pneumothorax causes "Sudden sharp chest pain that is made worse when taking a deep breath in" and breathlessness. Afterwards, an NHS leaflet advises avoiding extreme exertion, heavy lifting and contact sport until you've been seen in clinic or had your follow-up X-ray, not flying until you've been cleared, and avoiding scuba diving unless you've had an operation to stop it happening again.
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The Canadian Paediatric Society says children with CF "Should absolutely avoid scuba diving". Ask your CF team before any diving.
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Coughing up blood is a known CF complication; the warning signs below say when it's an emergency. Ask your CF team when to restart exercise and airway clearance after a bleed (our suggestion).
Children with CF "With an enlarged spleen or diseased liver should avoid contact or collision sports".
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With a PICC (peripherally inserted central catheter) line for antibiotics, "Vigorous activity such as contact sports may displace the line and should be avoided", and you can't swim. Keep moving otherwise, without restricting your arm.
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People with severe CF should have an exercise test to check whether their oxygen level drops. In hospital, NICE asks for an assessment of your exercise capacity and the facilities to keep exercising, with infection control.
European standards of care stress "the need for a physically active lifestyle and the strict avoidance of all recreational inhalations, including e-cigarettes".
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Schools in England must make sure pupils with medical conditions have "full access to education, including school trips and physical education". Children with CF "Should be encouraged to participate in any physical activity", and the Canadian statement suggests advice from a sports doctor or a children's lung specialist.
An individual healthcare plan can cover drinks and salt, inhalers and airway clearance, toilet breaks, and keeping apart from other pupils with CF, who shouldn't be in the same room, including for PE (our suggestion for what to include).
Don't drive yourself to A&E (accident and emergency).
Ask for an urgent GP (general practitioner) appointment, call NHS 111, or call your CF team's urgent line for:
Stop and rest if you feel dizzy or faint, get chest pain, or become much more breathless than usual, and get help as above if it doesn't settle (our suggestion).
Exercise with huffing helps clear mucus, but "there is no medium- or long-term evidence if exercise can adequately replace airway clearance techniques".
Children with CF "Who cough during exercise should not necessarily stop activity": coughing causes only brief dips in oxygen, and there's "no evidence that this effect causes significant injury". Cough up the mucus and carry on if you feel well.
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They "Should be encouraged to participate in any physical activity", and NICE recommends an exercise programme for everyone with CF.
People with CF "can swim in pools or water parks with adequate disinfection (eg, chlorination)". It's hot tubs, whirlpool spas and stagnant water to avoid.
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Exercise training didn't worsen nutritional status in children with CF, and strength training increased lean mass. Eat and drink more around activity, as your dietitian advises.
It clearly improves fitness and helps clear mucus, but its effect on lung function tests is small or unproven (low-certainty evidence).
A year of elexacaftor/tezacaftor/ivacaftor raised fitness only slightly without training, while an exercise programme worked as well with the medicine as without it.
The NHS says consider not meeting other people with CF face-to-face, because of the higher risk of catching serious infections from each other. Where you can't avoid being in the same place, a US guideline says keep at least 2 metres apart, whatever your sputum test results. Follow your CF centre's rules.
Yes. NICE recommends regular exercise for everyone with CF, and a Cochrane review found that 6 months or more of activity improves fitness, with harms rare. It also helps loosen mucus, though its effect on lung function tests is small or uncertain.
Not on its own. Exercise with huffing helps clear mucus, but there's no evidence beyond the short term that it can replace airway clearance. Keep the routine your CF physiotherapist gave you, and ask how exercise fits in.
A huff is a breath out through an open mouth, as if steaming up a mirror, that moves mucus up your airways without a full cough. It's part of the active cycle of breathing techniques, which your physiotherapist can teach you. Only do 1 or 2 huffs at a time.
Yes: children and adults with CF are encouraged to take part in any physical activity, ideally in teams and camps with people who don't have CF. Avoid contact sport if your spleen is enlarged or your liver is affected, and ask your CF team before any diving: the Canadian paediatric statement says avoid scuba diving altogether.
Yes, in chlorinated pools and water parks. Avoid hot tubs, whirlpool spas and stagnant water, and don't swim with a PICC line in.
People with CF lose much more salt in their sweat, and long or hot sessions can cause dehydration with low salt levels; losing salt can also blunt thirst. Drink more than thirst suggests, and take salty snacks, drinks or tablets as your CF team advises.
It's safest not to. The NHS says consider not meeting other people with CF face-to-face, because of the risk of passing serious infections between you. Where you can't avoid being in the same place, such as at school or sport, a US guideline says keep at least 2 metres apart, and your CF centre will have its own rules.
The same as other children: an average of at least 60 minutes of moderate or vigorous activity a day across the week, with muscle and bone strengthening activities 3 times a week. Running, jumping, swimming, dancing and team games all count.
Aim for at least 150 minutes of moderate activity a week, check your glucose before vigorous exercise, and carry fast-acting sugar. CF-related diabetes doesn't mean eating less: you still need extra energy and salt, as your CF dietitian advises.
Yes. In a Danish study, a year of the medicine on its own raised fitness only slightly, while an exercise programme improved fitness as much in people taking it as in those who weren't.
Yes. Coughing during exercise causes only brief dips in oxygen, and children with CF who cough during exercise don't necessarily need to stop. Huff, clear the mucus and carry on if you feel well.
For a few small spots or streaks, ask for an urgent GP appointment, call 111 or contact your CF team. Call 999 if you cough up more than a few spots or streaks, or blood with difficulty breathing, a very fast heartbeat or chest pain.
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.
