Effectiveness of rehabilitation interventions in adults with moderate-to-severe asthma: an extended systematic review

INTRODUCTION: Physical deconditioning is common in adults with moderate-to-severe asthma, negatively affecting respiratory function, disease control and quality of life (QoL). Pulmonary rehabilitation may improve both functional and psychological outcomes. OBJECTIVE: This systematic review aimed to evaluate the effectiveness of rehabilitative interventions in moderate-to-severe asthma and to assess the methodological quality of the included studies. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, PEDro, SCOPUS, and Web of Science following PRISMA guidelines. Eligible designs included randomized controlled trials (RCTs), quasi-experimental and observational studies. Risk of bias was assessed using PEDro scale and Risk of bias-2 (RoB2) for RCTs, ROBINS-E/ROBINS-I for non-randomized and observational studies. RESULTS: Thirteen studies (n. 1094 participants) were included. Outcome measures comprised Lung Function, Six-Minute Walking Test (6MWT), Asthma Quality of Life Questionnaire (AQLQ), and Asthma Control Questionnaire (ACQ). Aerobic training combined with breathing techniques improved exercise tolerance (6MWT: 39.62 m; 95% CI 18 to 123 m) and QoL; Inspiratory muscle training (IMT) showed additional functional benefits. Overall methodological quality ranged from low to moderate, with limitations related to heterogeneity and small sample sizes. CONCLUSION: Aerobic training with breathing techniques appears beneficial for moderate-to-severe asthma. Further high-quality, large-scale RCTs are needed to confirm these findings. PROSPERO REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD420251024215.