Question: Does exercise using a gaming console result in similar cardiovascular demand and energy expenditure as formally prescribed exercise in adults with cystic fibrosis? How do these patients perceive gaming console exercise? Design: Randomised cross-over trial with concealed allocation and intention-to-treat analysis. Participants: 19 adults with cystic fibrosis admitted to hospital for treatment of a pulmonary exacerbation. Intervention: Participants underwent two 15-minute exercise interventions on separate days; one involving a gaming console and one a treadmill or cycle ergometer. Outcome measures: Cardiovascular demand was measured using heart rate and rating of perceived exertion (RPE). Energy expenditure was estimated using a portable activity monitor. Perception (enjoyment, fatigue, workload, effectiveness, feasibility) was rated using a horizontal 10-cm visual analogue scale. Results: There was no significant difference in average heart rate (mean difference 3 beats/min, 95% CI -3 to 9) or energy expenditure (0.1 MET, 95% CI -0.3 to 0.5) between the two interventions. Both interventions provided a 'hard' workout (RPE ~15). Gaming console exercise was rated as more enjoyable (mean difference 2.6 cm, 95% CI 1.6 to 3.6) than formal exercise but they didn't differ significantly in fatigue (-1.0 cm, 95% CI -2.4 to 0.3), perceived effectiveness (-0.4 cm, 95% CI -1.2 to 0.3), or perceived feasibility for inclusion in routine management (0.2 cm, 95% CI -0.7 to 1.1). Conclusion: Gaming console exercise provides a similar cardiovascular demand as traditional exercise modalities. It is feasible that adults with cystic fibrosis could include gaming console exercise in their exercise program. Trial registration: ACTRN12610000861055. [Kuys SS, Hall K, Peasey M, Wood M, Cobb R, Bell SC (2011) Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis: a randomised crossover trial. Journal of Physiotherapy 57: 35-40]