Results
Four distinct physical activity profiles were identified among children with asthma using person-centered profile modeling.
- Study recruited 243 children with asthma aged 6-17 years from respiratory outpatient clinics of two tertiary hospitals in Zhejiang Province, China between March 2024 and February 2025
- Profiles were named Fearful Avoiders (14.4%), Unsupported Potentials (15.6%), Struggling Strivers (21.4%), and Supported Thrivers (48.6%)
- Profiles differed on measures of physical activity, asthma control, breathlessness-related fear, perceived physical competence, and parental activity support
- An explanatory sequential mixed-methods design was used, combining quantitative profile modeling with qualitative semi-structured interviews
Results
Profile 1, Fearful Avoiders (14.4%), showed the lowest physical activity levels, poorest asthma control, highest symptom fear, and lowest perceived physical competence.
- This profile represented 14.4% of the 243-child sample
- Qualitative findings from child-parent dyad interviews suggested 'a self-reinforcing cycle of fear, avoidance, and reduced confidence'
- 4 child-parent dyads from this profile were selected for semi-structured interviews conducted between June and September 2025
- This profile had the most unfavorable combination of psychological and behavioral outcomes among the four profiles
Results
Profile 2, Unsupported Potentials (15.6%), showed predominantly moderate activity and the lowest parental support, with predominantly partial asthma control.
- This profile represented 15.6% of the sample
- Qualitative interviews suggested that 'symptom stability was often interpreted as good enough, leading families to disengage from active lifestyle support'
- Despite having predominantly partial asthma control, families in this profile were not actively engaged in supporting physical activity
- 4 child-parent dyads from this profile were selected for qualitative interviews
Results
Profile 3, Struggling Strivers (21.4%), maintained moderate activity despite elevated symptom fear and intermediate psychosocial outcomes, often under external pressure rather than genuine confidence.
- This profile represented 21.4% of the sample
- Qualitative data suggested that 'activity was often sustained under peer and family pressure rather than through genuine confidence'
- This profile illustrates that similar activity levels to other profiles may reflect very different underlying mechanisms
- Elevated symptom fear coexisted with continued moderate physical activity engagement
Results
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.
- This was the largest profile, representing nearly half (48.6%) of the sample
- This profile had the most favorable combination across all measured dimensions including physical activity, asthma control, breathlessness-related fear, perceived physical competence, and parental support
- This profile represented an adaptive self-management pattern as distinguished from the fear-driven or disengaged patterns seen in other profiles
- 4 child-parent dyads from this profile were selected for qualitative interviews
Results
External validation confirmed significant between-profile differences in depression, anxiety, quality of life, and exercise adherence.
- All between-profile differences in depression, anxiety, quality of life, and exercise adherence were statistically significant (all p < .001)
- These variables were used as external validators to support the clinical relevance of the profiles
- Significant differences across all four external validators support that the profiles represent clinically meaningful distinctions
- The validation reinforces that the profiles capture real differences in child health outcomes beyond the variables used to construct them
Discussion
Similar levels of physical activity among children with asthma may reflect very different underlying mechanisms including disengagement, fear-driven persistence, or adaptive self-management.
- The study used joint display analysis to integrate quantitative patterns with lived experiences from 16 child-parent dyads (4 per profile)
- Qualitative interviews revealed that moderate activity in Profile 2 (Unsupported Potentials) was driven by disengagement, while moderate activity in Profile 3 (Struggling Strivers) was driven by external pressure
- This finding challenges approaches that assess physical activity in pediatric asthma based on activity level or disease severity alone
- The authors conclude that 'physical activity participation in children with asthma appears to be shaped by interacting physiological, psychological, and family processes rather than by disease severity alone'
Results
Parental support was identified as a key differentiating factor across physical activity profiles in children with asthma.
- Parental activity support was one of the core measures used to construct profiles alongside physical activity, asthma control, breathlessness-related fear, and perceived physical competence
- The Unsupported Potentials profile had the lowest parental support among all profiles
- The Supported Thrivers profile had the greatest parental support and the most favorable outcomes
- Qualitative interviews with child-parent dyads were used to explore family processes underlying each profile