New expert recommendations redefine exercise as therapy for children with asthma

Asthma is one of the most common chronic respiratory diseases among children, affecting nearly 475 million globally. For decades, exercise was discouraged due to the risk of triggering wheezing and breathlessness, known as exercise-induced bronchoconstriction (EIB). This avoidance has led to lower fitness levels, obesity, and poorer mental health outcomes. Yet, modern studies reveal that structured exercise improves pulmonary capacity, reduces inflammation, and boosts overall quality of life when symptoms are well controlled. Despite these findings, many parents and clinicians remain hesitant to recommend exercise. Based on these challenges, there is a need to develop evidence-based guidance on safe and effective exercise programs for children with asthma.

New evidence-based exercise recommendations for children with asthma (DOI: 10.1007/s12519-025-00976-6) have been developed by a multidisciplinary panel of 17 experts led by the National Clinical Research Center for Child Health and the Children's Hospital, Zhejiang University School of Medicine and published in the World Journal of Pediatrics in October 2025. Drawing on international literature and expert consensus, the study provides detailed guidance on exercise safety, types, intensity, and monitoring. The recommendations aim to help healthcare professionals and caregivers design individualized exercise programs that promote lung health, prevent EIB, and enhance both physical and psychological well-being among pediatric patients.

The multidisciplinary team conducted an extensive literature review across eight major databases, identifying 64 studies that met inclusion criteria. Using the Oxford Centre for Evidence-Based Medicine (OCEBM) framework and Delphi expert voting, the team developed recommendations across nine domains, including exercise safety, prescription design, environmental considerations, and monitoring. Key findings indicate that moderate aerobic exercise 3-5 times per week—such as walking, cycling, or swimming—can safely enhance cardiopulmonary function and reduce asthma symptoms. Resistance training twice weekly helps counteract muscle loss associated with corticosteroid use, while flexibility training improves respiratory muscle compliance. The guidelines emphasize individualized plans based on asthma control level, fitness status, and environmental quality (optimal temperature 20-24 °C; humidity above 40%).

Importantly, wearable devices and home spirometry are recommended for real-time monitoring of lung function and exercise intensity. The authors highlight that well-controlled asthma should not limit children's physical activity; rather, exercise is a crucial component of rehabilitation and prevention. Regular follow-ups and gradual progression ensure safety and sustained benefits.

Exercise should be viewed not as a risk but as a therapeutic tool for children with asthma. With proper control and individualized plans, most children can safely engage in physical activity that strengthens their bodies and minds. Our recommendations provide clinicians and families with the scientific framework to transform exercise into an integral part of asthma care—promoting not only lung health but also confidence, social participation, and psychological resilience."

Prof. Zhi-Min Chen, one of the corresponding authors of the study

These recommendations mark a shift from restriction to empowerment in pediatric asthma care. By integrating exercise into routine management, healthcare providers can reduce medication reliance, prevent obesity, and enhance children's long-term physical and mental health. The study also encourages the use of smart health devices and digital monitoring tools to track symptoms and activity, making precision exercise prescriptions feasible in daily life. Future research will focus on refining intensity parameters and exploring the long-term impact of combined aerobic and resistance training, paving the way for holistic asthma management centered on movement and well-being.