# The 2025 European Cystic Fibrosis Society position statement on physical activity assessment in cystic fibrosis

## TL;DR

This paper updates guidelines for measuring physical activity in cystic fibrosis patients, emphasizing device-based metrics and validated questionnaires.

## Contribution

The paper provides updated, evidence-based recommendations for assessing physical activity in cystic fibrosis clinical practice and research.

## Key findings

- Device-based metrics should include time spent in different activity intensity categories and sedentary/sleep time.
- Data resolution should be at least 1 second to accurately categorize physical activity patterns.
- Validated questionnaires and diaries can supplement device-based assessments but serve different purposes.

## Abstract

Recent advances in the measurement of physical activity have significantly enhanced the analyses and interpretation in relation to health and well-being. Thus, we sought to revise and expand the 2015 position statement on the measurement of physical activity and provide guidance to clinicians and researchers for measuring physical activity in cystic fibrosis (CF) clinical practice and research.

This study was registered with the International Prospective Register of Systematic Review (PROSPERO) database (CRD42022292165). Three databases (Medline, Embase and Cumulative Index to Nursing and Allied Health Literature) were searched for studies investigating the measurement of physical activity and sedentary time in people with CF irrespective of age or duration. The Quality Assessment for Diverse Studies was used to assess methodological concern. A mixed-methods framework synthesis was used to extract, map, chart, categorise and aggregate study findings.

In total, 7439 potentially relevant publications were identified. Following screening of titles and abstracts, 422 full texts were retrieved and assessed for eligibility, with 90 studies included. There was considerable variation in the methods of assessment, data processing and analytical interpretation of data.

It is recommended that device-based physical activity metrics are presented as time spent in different intensity categories (e.g., light, moderate and vigorous) and to include sedentary and sleep time. For data analysis, the data resolution should be at least 1 s (minimum 30 Hz) to enable clinical teams to obtain representative categorisation of patients’ physical activity patterns. Validated questionnaires (e.g., the Habitual Activity Estimation Scale) offer additional opportunities to assess physical activity, whilst diaries can add context but should be viewed as secondary outcome measurements.

Device-based and validated physical activity questionnaires are recommended, inclusive of measuring sedentary and sleep time, to assess the importance of physical activity to the health and well-being of people with cystic fibrosis.
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