Tailored profiles of physical activity in children with asthma: Insights from a mixed methods study.

BACKGROUND

Physical activity participation among children with asthma is highly variable and cannot be explained by disease severity alone. Understanding distinct patterns of activity engagement and their underlying mechanisms may help inform more tailored support strategies.

OBJECTIVE

To identify distinct physical activity profiles in children with asthma and to explore the lived experiences and family processes underlying these profiles using a mixed-methods design.

METHODS

An explanatory sequential mixed-methods study was conducted in two phases. In the quantitative phase, 243 children with asthma aged 6-17 years were consecutively recruited between March 2024 and February 2025 from respiratory outpatient clinics of two tertiary hospitals in Zhejiang Province, China. Measures assessed physical activity, asthma control, breathlessness-related fear, perceived physical competence, and parental activity support. Person-centered profile modeling was used to identify distinct profiles. In the qualitative phase, 16 child-parent dyads (4 per profile) were purposively selected for semi-structured interviews between June and September 2025. Joint display analysis was used to integrate quantitative patterns with lived experiences.

RESULTS

Four distinct profiles were identified. Profile 1, Fearful Avoiders (14.4%), showed the lowest activity, poorest asthma control, highest symptom fear, and lowest physical competence; qualitative findings suggested a self-reinforcing cycle of fear, avoidance, and reduced confidence. Profile 2, Unsupported Potentials (15.6%), showed predominantly moderate activity, the lowest parental support, and predominantly partial asthma control; interviews suggested that symptom stability was often interpreted as "good enough," leading families to disengage from active lifestyle support. Profile 3, Struggling Strivers (21.4%), maintained moderate activity despite elevated symptom fear and intermediate psychosocial outcomes; qualitative data suggested that activity was often sustained under peer and family pressure rather than through genuine confidence. Profile 4, Supported Thrivers (48.6%), demonstrated the most favorable pattern, with higher activity, better asthma control, lower fear, stronger perceived competence, and greater parental support. External validation supported the clinical relevance of the profiles, with significant between-profile differences in depression, anxiety, quality of life, and exercise adherence (all p < .001).

CONCLUSION

Physical activity participation in children with asthma appears to be shaped by interacting physiological, psychological, and family processes rather than by disease severity alone. Similar activity levels may reflect very different underlying mechanisms, including disengagement, fear-driven persistence, or adaptive self-management. These findings suggest that support for physical activity in pediatric asthma may need to be tailored to profile-specific behavioral and family mechanisms.