How ExACTly does exercise compare as an alternative to traditional airway clearance techniques in people with cystic fibrosis?

I first started working as a physiotherapist in an adult cystic fibrosis (CF) clinic 25 years ago. I am not sure if the first patient I saw questioned me about the relative merits of exercise for airway clearance, but I guarantee that one of the first 20 would have asked something along the lines of, “My lungs feel so much clearer on the days I exercise, do I really have to do chest physio on those days too?” Back then, I could not give them much of an answer, as there were only a handful of small and very short-term studies that compared exercise to traditional airway clearance techniques (ACTs), which we then termed ‘chest physiotherapy’. Collectively, those studies suggested that exercise alone (ie, without encouraged huffing or coughing) was less effective for sputum expectoration than traditional ACTs,1–3 though when huffing or coughing was included with exercise, there were no significant differences.4 5