A systematic review of physical activity guidelines for adults with cardio-respiratory diseases: Stepping towards evidence-based recommendations.

ObjectivesPhysical activity benefits for adults with cardio-respiratory diseases are well established, and evidence-based recommendations are essential for healthcare professionals. This study systematically reviewed existing recommendations on physical activity for adults with cardio-respiratory diseases, specifically chronic obstructive pulmonary disease, asthma, and heart failure, focusing on the frequency, intensity, time and type (FITT).Data SourcesWe searched OVID MEDLINE, EMBASE, CINAHL, and grey literature for guidelines and related documents. The comprehensive search was conducted in July 2025 and subsequently updated through March 2026. Two authors independently screened guidelines, extracted FITT components, and documented disease-specific precautions. Disagreements were resolved with a third author. The AGREE II instrument assessed methodological quality for identified CPGs. Recommendations were categorised based on the FITT framework.ResultsWe included 29 guidelines, of which 14 were classified as Clinical Practice Guideline and assessed with AGREE II. Among the 14 guidelines, 7 demonstrated high quality, 6 were moderate, and 1 was low quality. Most guidelines recommended at least 150 minutes of moderate aerobic activity per week. Adaptive recommendations primarily addressed exacerbations and symptom management.ConclusionWhile aerobic physical activity was consistently recommended, disease-specific guidance and adherence to FITT principles were limited. Significant gaps were noted in methodological quality, particularly in stakeholder involvement and applicability. To enhance usability, guidelines should standardise recommendations for type, duration, intensity, and frequency, incorporating evidence grading system.