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Physical Activity and Asthma: The evidence for it and how to get my patients to do it: A Work Group Report of the AAAAI Sports, Exercise, and Fitness Committee
Abstract
Regular physical activity not only improves general health but also can positively impact asthma outcomes, such as control and quality of life. Despite this, many asthma patients do not engage in regular physical activity because they mistakenly believe that they should restrict exercise participation. Health care providers have an opportunity to influence the physical activity levels of their patients during regular office visits. Nonetheless, health care providers often overlook physical activity counseling as an adjunct to pharmacological therapy in asthma patients, and in particular, overlook physical activity counseling. Some providers who acknowledge the benefits of physical activity report being unaware how to approach a conversation with patients about this topic. To address these issues, members of the Sports, Exercise, and Fitness Committee of the American Academy of Allergy, Asthma, and Immunology (AAAAI) performed a focused literature search to identify and evaluate the effects of physical activity in patients with asthma. The purpose of this report is to summarize the evidence for physical activity’s impact on asthma patients’ disease control, pulmonary function, and overall well-being. Several subpopulations of patients with asthma, including children, adolescents, and older adults, are considered individually. In addition, this report offers practical recommendations for clinicians, including how to identify and overcome barriers to counseling, and methods to incorporate physical activity counseling into asthma treatment practice.
... Despite the benefits described, population-based studies have revealed that patients with asthma engage in less PA than those without asthma [16], probably owing to several barriers, including fear of exercise-induced bronchoconstriction [17], a transitory condition that occurs in 40% to 90% of people with asthma and causes airway narrowing during or after exercise [1,17,18]. Several pharmacologic approaches can be adopted to prevent this phenomenon, with bronchodilators representing the mainstay approach [19]. ...
... Despite the benefits described, population-based studies have revealed that patients with asthma engage in less PA than those without asthma [16], probably owing to several barriers, including fear of exercise-induced bronchoconstriction [17], a transitory condition that occurs in 40% to 90% of people with asthma and causes airway narrowing during or after exercise [1,17,18]. Several pharmacologic approaches can be adopted to prevent this phenomenon, with bronchodilators representing the mainstay approach [19]. However, patients suffering from exercise-induced bronchoconstriction may limit or avoid exertion due to symptoms of shortness of breath, cough, wheezing, and chest tightness. ...
(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of PA between individuals with and without asthma. (2) Methods: This study was a cross-sectional, population-based, matched, case–control study using European Health Interview Surveys for Spain (EHISS) for 2014 and 2020. (3) Results: We identified 1262 and 1103 patients with asthma in the 2014 and 2020 EHISS, respectively. The prevalence of PA remained stable (57.2% vs. 55.7%, respectively), while the percentage of persons who reported walking continuously for at least 2 days a week increased from 73.9% to 82.2% (p < 0.001). Male sex, younger age, better self-rated health, and lower body mass index (BMI) were significantly associated with greater PA. From 2014 to 2020, the number of walking days ≥2 increased by 64% (OR1.64 95%CI 1.34–2.00). Asthma was associated with less PA (OR0.87 95%CI 0.47–0.72) and a lower number of walking days ≥2 (OR0.84 95%0.72–0.97). (4) Conclusions: Walking frequency improved over time among people with asthma. Differences in PA were detected by age, sex, self-rated health status, and BMI. Asthma was associated with less LTPA and a lower number of walking days ≥2.
... 2 More recently, researchers have begun to elucidate the important role of physical activity for optimizing asthma control among patients living with this condition-a clinical population that is highly susceptible to adverse environmental conditions (eg, pollution, allergens). 8,9 In light of the global crisis of climate change, this commentary aims to elucidate the major and often unrecognized role of physical activity for highly climate vulnerable clinical populations and to discuss some of the unique challenges that these groups will face in the Anthropocene. ...
... On the other hand, and perhaps ironically, being diagnosed with one or more of these conditions is often in it of itself a reason for reductions in physical activity levels among patients, due to concerns of disease exacerbation episodes, feelings of discomfort while being active, or social norm/ stigma factors. 9 Without a doubt, the bidirectional nature of the links between physical activity and clinical conditions that convey high climate vulnerability makes this a very complex topic. Adding to this complexity is the fact that, despite adverse environmental circumstances (eg, poor air quality due to wildfire emergencies leading to "stay at home" recommendations), members of minoritized, socioeconomically disadvantaged groups often have no choice but to continue with their everyday activities, for economic purposes, 19 which expose them to increased health hazards. ...
... [20] Downloaded from http://journals.lww.com/md-journal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 11/30/2024 A qualified exercise physiologist guided the program, ensuring adherence to recommended exercise prescription guidelines. [28] The training was conducted on a motor-driven, indoor treadmill (HP Cosmos Mercury® Med, Nussdoerf-Traunstien, Germany) and was adapted to accommodate each child's capacity. Initially (i.e., over the first 2 weeks), the training lasted 25 minutes, with a walking pace set at 50% of their HR max . ...
Background
This study evaluates the differential effects of constant-load (CL-AE) and graded (G-AE) aerobic exercise training approaches on cardiopulmonary fitness and functional capacity in obese children with bronchial asthma (BA).
Methods
Seventy-eight obese children with moderate BA (age: 14.14 ± 2.31 years; body mass index: 31.93 ± 1.26 kg/m ² ) were randomly assigned to 3 intervention-based groups: control, CL-AE, or G-AE group (n = 26 in a group). The cardiorespiratory fitness (peak oxygen uptake, minute ventilation [V E ], ventilation-oxygen uptake ratio, stroke volume of oxygen, oxygen/carbon-dioxide exchange ratio, heart rate maximum, and heart rate recovery at one minute) and functional capacity (6-minute walk test and perceived dyspnea and fatigue) were assessed at the baseline and posttreatment.
Results
The G-AE group exhibited more favorable changes in cardiorespiratory fitness [VO 2peak ( P = .03), V E ( P = .021), V E /VO 2 ( P = .032), SVO 2 ( P = .025), O 2 /CO 2 ratio ( P = .004), HR max ( P = .016), HRR 1 ( P = .046)] and functional capacity [6-minute walk test ( P = .021), dyspnea ( P = .041), fatigue ( P = .04)] as compared to the CL-AE group.
Conclusion
The G-AE, compared to CL-AE, appears to be a more potent stimulus for enhancing cardiorespiratory fitness and functional capacity in obese children with BA. Further investigations are, however, required to corroborate the observed effects.
... By improving overall physical activity levels, a greater number of asthma patients may achieve better disease control and reduce their dependence on pharmaceutical treatments. This shift not only enhances health outcomes but also presents economic benefits (Nyenhuis et al., 2022). To maintain or increase activity levels while managing asthma, it is essential to identify triggers for exerciseinduced asthma, take pre-treatment medication 15 to 30 minutes before exercising, and incorporate a proper warm-up and cool-down routine to effectively manage symptoms (American College of Sports Medicine, 2013). ...
Asthma is a chronic inflammatory disease of the airways that affects over 250 million people worldwide and is responsible for approximately 455,000 deaths annually. Characterized by variable expiratory flow and respiratory symptoms such as persistent cough, wheezing, shortness of breath, and chest tightness, asthma can significantly hinder daily activities and quality of life. While pharmacological treatments are essential for managing asthma, non-pharmacological interventions, including physical activity, nutritional changes, and psychological support, play a crucial role in alleviating symptoms and enhancing overall well-being. Aerobic training, in particular, has been shown to provide health benefits that are dose-dependent, improving the quality of life for asthma patients. Despite the potential benefits of physical activity, individuals with asthma may experience exercise-induced bronchoconstriction, which can trigger symptoms during exertion. Historically, patients were advised to avoid exercise; however, recent studies suggest that regular exercise can improve fitness levels and reduce exacerbations in asthmatics. This review highlights the importance of integrating structured physical activity into asthma management strategies for peoples who often face challenges related to obesity and inadequate asthma control. Regular moderate-intensity aerobic exercise can enhance lung function, improve asthma control, oxygen uptake, immune function, antioxidant capacity, and reduce septum eosinophil and fractional exhaled nitric oxide and promote social engagement, making it essential for asthmatics to remain active. Individuals with asthma can participate in exercises like those without the condition, aiming for 20-30 minutes of activity 2-3 days a week. It's important to consult a healthcare provider before starting any exercise program and to use beta-2 agonists if experiencing exercise-induced bronchoconstriction.
... The findings of this study indicate that incorporating information on diet, physical activity, smoke exposure, and screen time into the clinical assessment of asthma in overweight and obese adolescents can provide additional dimensions to the evaluation. Dietary instruction, smoking exposure, screen time controlling and physical activity might be counseled into asthma prevention practice [39]. Moreover, these insights may offer valuable evidence for the development of primary prevention strategies and serve as a reference for public health policy. ...
With the increasing prevalence of overweight and obesity in children and adolescents, to actively prevent the occurrence of asthma in this population is important for reducing the burden of the disease. Lifestyle factors, including diet and exercise, are importance for overweight and obese adolescents, as well as an important modifiable factor affecting airway inflammation and asthma, whether healthy lifestyle was correlated with the risk of asthma in adolescents ≥ 12 years has not been reported. We suspected that there might be correlation between healthy lifestyle behaviors and the risk of asthma in overweight and obese adolescents. This cross-sectional study aimed to explore the association between the adherence to a healthy lifestyle behaviors and the risk of asthma in overweight and obese adolescents based on the data of 945 participants aged between 12–18 years from the National Health and Nutrition Examination Surveys (NHANES). Univariable and multivariable weighted Logistic regression models were applied to evaluate the association between healthy lifestyle behaviors with asthma risk in overweight and obese adolescents. Odds ratio (OR) and 95% confidence interval (CI) were applied as estimates. We found that the risk of asthma was reduced in overweight and obese adolescents with intermediate (OR = 0.40, 95%CI: 0.17–0.94) or good lifestyle behaviors (OR = 0.33, 95%CI: 0.13–0.86) in comparison to those with poor lifestyle behaviors. In summary, intermediate or good lifestyle behaviors was correlated with decreased risk of asthma in overweight and obese adolescents, which might provide a reference for making further prevention strategies for asthma in adolescents.
... In the past 50 years, several studies analyzed the effect of physical activity on childhood asthma [11,[41][42][43][44][45][46][47]. Many studies suggested regular physical activity for asthmatic children [48,49], since it could improve both their physical conditions, their social interactions, and their development as well [50]. Several studies proved that obesity aggravated the severity of asthma and attenuated quality of life [45,[51][52][53], strongly suggesting proper diet and regular physical activity [54]. ...
Physical activity is an especially important part of everyday life for children with chronic diseases. The aim of the study was to show whether asthma is a barrier to physical activity in our society. The correlations between the severity of the disease, body mass index, and physical activity were analyzed, and parents’ opinions on whether children should participate in active sports were assessed. Physical activity of children with asthma was analyzed by questionnaires; 93 parents and their 93 children were involved in the survey. The age of children was 12.6 ± 3.5 years (mean ± SD), 69.9% were boys, 30.1% were girls. A total of 93.4% of the respondents participated in a physical education program and 56.5% also attended sporting activities on a regular basis. In terms of disease severity, 61.2% of the children had mild asthma, 37.6% moderate, and 1.2% severe, and 6.5% of the respondents also stated that their children’s illness had been consistently or frequently limiting their performance concerning their school or home duties over the past four weeks. Of the parents surveyed, 12% felt that physical activity was not appropriate in the context of this disease. We concluded that fear of the consequences of physical activity depends largely on education, which should involve parents, teachers, and coaches.
... Sulphur dioxide (SO2), nitrogen dioxide (NO2), particulate matter of PM10, PM2.5, and an Air Quality Index (AQI) are examples of pollutants that add to the overall level of air pollution and contribute to a harmful environment. These air quality predictions (AQP) are given attention to human health, specifically cardiac diseases, to improve and maximize excellent respiration for persons with asthma, children, the elderly, and some emergency care personnel [3]. Air quality forecasting tools are quickly evolving as the need for pollution measurement grows. ...
Urban air pollution can be reduced via precise air pollutant forecasts.For that, the air quality index (AQI) quantifies air quality.In this manner, accurate and trustworthy air quality index (AQI) estimates are essential for preserving the natural environment and the general population's health. Using the backpropagation (BP) algorithm, this study describes a method for enhancing the performance of neural networks. Using a network optimized with natural swarm intelligence, a novel optimal-hybrid model approachto Nature Swarm Intelligence (NSI), predicting the Air Quality Index (AQI), is possible. This NSI comprises the optimization algorithms Dove Swarm optimization (DSA) and Bat Algorithm (BA), which aim to optimize the weight of the Backpropagation neural network (BPNN) to promote the air quality prediction. The constructed optimal-hybrid modelcaptured the characteristics of the AQI series and produced a more accurate AQI forecast according to exhaustive comparisons using a set of evaluation indicators. Experiments conducted verify the proposed modelis validfor application when attempting to forecast the AQI. This is because it receives a high RMSE, MAPE, Error Absolute total, and Accuracy value from the simulation. This is because the simulation results suggest that the network model could be a good option for actualization, which is why this is the case.
... Accordingly, a 2021 work group report of the American Academy of Allergy, Asthma, and Immunology's Sport, Exercise and Fitness Committee noted that HIIT may be a particularly good option for patients with limited time to pursue physical activity. 3 Prior studies have demonstrated that, like constant-load exercise (CLE), HIIT interventions promote improved health outcomes in patients with asthma. 4 A recent systematic review found that HIIT and a similar type of exercise, sprint interval training, were comparable to other exercise methods in the degree of improvement seen across numerous clinical asthma outcomes. ...
... It is thought that negative experiences of asthmatics related to dyspnea and chest tightness during activity cause fear of movement. Moreover, participating regular physical activity is low in many asthmatics because they mistakenly believe that they should restrict exercise participation [36]. The inclusion of the definition of kinesiophobia into asthma education programs after the first diagnosis could increase awareness and prevent adverse events based on asthma. ...
Kinesiophobia has been studied in musculoskeletal and neurological diseases. The aim of this descriptive study was to assess the level of kinesiophobia in stable asthmatic patients, and to determine whether it is an obstacle to physical activity and quality of life. A total of 62 asthmatic patients and 50 healthy control subjects were assessed using the tampa kinesiophobia scale (TSK) for kinesiophobia, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity levels, and Asthma Quality of Life Questionnaire (AQLQ) for quality of life. A high degree of kinesiophobia was determined in 54.8% of the asthmatic patients. The TSK scores were significantly higher (P < 0.001), and the AQLQ scores were lower in the asthma group than in the control group (P < 0.001). The IPAQ-SF level and AQLQ score were lower (P < 0.001 for both) in the asthmatic group with a high kinesiophobia score. The TSK score was significantly associated with IPAQ-SF score (r = -0.889; P < 0.001) and AQLQ score (r = -0.820; P < 0.001) in asthmatic patients. According to linear regression analysis, kinesiophobia explained 84.40% of QoL and physical activity. Patients with a stable asthma were observed to have a high level of kinesiophobia compared with healthy subjects. High kinesiophobia levels may increase the disease burden by negatively affecting participation in physical activity and quality of life. While developing asthma education programs for asthma patients, it should be remembered that even in the stable period, kinesiophobia can develop. Preventive and therapeutic programs should include precautions to improve quality of life and physical activity against the effects of kinesiophobia.
... It is thought that negative experiences of asthmatics related to dyspnea and chest tightness during activity cause fear of movement. Moreover, participating regular physical activity is low in many asthmatics because they mistakenly believe that they should restrict exercise participation [36]. The inclusion of the definition of kinesiophobia into asthma education programs after the first diagnosis could increase awareness and prevent adverse events based on asthma. ...
GİRİŞ: Astım, değişken ekspiratuvar hava akımı limitasyonuyla birlikte, hırıltı, nefes darlığı, göğüste sıkışma ve öksürük gibi zamanla değişen şiddette solunum semptomları ile tanımlanan genellikle kronik hava yolu inflamasyonu ile karakterize heterojen bir hastalıktır. Bu varyasyonlar, sıklıkla egzersiz, allerjen ya da bir irritasyona maruz kalma, hava durumu değişiklikleri veya viral solunum hastalıkları ile tetiklenir (Karakış, 2018). Astımlı hastalar, bir uyaran sonucu ortaya çıkan hırıltılı solunum, dispne, göğüste sıkışma hissi ve kuru öksürük gibi aralıklı belirtilere sahiptir. Allerjenler, hava kirliliği, gastroözofagiyal reflü, stres ve egzersiz gibi uyaranlar bu belirtilere neden olmaktadır. Tedavi edilemeyen astımlıların %90'ında egzersiz sırasında astım belirtileri ortaya çıkar (Dursun ve ark., 2013). Egzersiz nedeniyle gelişen havayolu daralması astımlıların %40-90'ında görülür, egzersiz yapma yeterliliğini azaltır ve hastalar daha sedanter bir yaşam şeklini tercih ederler. Astımlı hastalarda anksiyete ve depresyon, hareketsizlik, yorgunluk, dispne nedeniyle egzersiz yapmaktan kaçındıkları için düşük fiziksel aktivite düzeyi vardır (Sonbahar, 2015). Aktivite yapabilme yeterliliği ve günlük yaşam aktivitelerini gerçekleştirebilme yaşam kalitesinin bileşenleridir. Yapılan birçok araştırmada kronik akciğer hastalığı olan bireylerde yaşam kalitesinin etkilendiği saptanmıştır. Hastalığa özgü birçok anketle yaşam kalitesi değerlendirilebilir. Astım hastaları yaşam kalitesi açısından birçok alanda gün içerisinde ve gece hastalık belirtileriyle, bozulmuş günlük yaşam aktiviteleri ve azalmış yaşam kalitesi gibi sorunlarla karşılaşırlar. Astım, azalmış yaşam kalitesi ve morbiditeyle ilişkilidir. Astım semptomları okulda ve işte performansı azaltır; öğrenmeyi etkiler ve yaşam kalitesini azaltır. Yapılan çalışmalarda, astımın, yaşam kalitesi, fiziksel, fizyolojik ve sosyal fonksiyon üzerinde negatif etkisi olduğu gösterilmiştir (Sonbahar, 2015). Astımlı hastalarda egzersiz nedeniyle gelişen havayolu obstrüksiyonu fiziksel aktiviteyi azaltır. Bu zamanla hareket korkusu doğurur ve bu da kinezyofobi olarak adlandırılır. Kinezyofobi, kognitif davranışsal kaçınma modeli kapsamında yer alan kaçınma fenomenidir. Semptomlarda kötüleşme veya semptomların meydana gelme ihtimaline karşı hastalar günlük yaşamda aktivitelerinde kısıtlanmaya gidebilmektedirler. Bu da ilerleyen dönemlerde emosyonel sorunlar ve yaşam memnuniyetsizliği ile sonuçlanabilmektedir (Yümin ve ark., 2017). Kinezyofobi özellikle kronik ağrılı olan hastalık süreçlerinde hastaların önceden yapabildikleri fonksiyonlarını tekrar gerçekleştirmek istediklerinde ortaya çıkan bir olgudur (Çıbık 2018). Kontrol altına alınmayan astımlıların %90'ında egzersiz ile astım semptomları oluşur. Bazen de astım atağının tek nedeni egzersiz olabilir (Dursun ve ark., 2013). Astımın semptomları egzersizle ortaya çıkan nefes sıkışması veya öksürük olabilmektedir ve buna da egzersize bağlı astım denilmektedir (Soyluer ve Per, 2013). Egzersize bağlı gelişen solunum sıkıntısı hastanın aktivitesini azaltmakta, kondüsyon düzeyini düşürmekte ve günlük yaşamında da bireyi bağımlı hale getirebilmektedir. Astım hastalarında yapılan bir çalışmada astımlı kişiler, hastalıklarını fiziksel aktiviteye karşı bir engel olarak algıladıklarını ve bu nedenle hareketsizliğe itildiklerini belirtmişlerdir (Kırtay ve Oğuz, 2011).
Introduction:
Asthma is a chronic inflammatory disease of the lower airways that affects more than 260 million people worldwide and has been related to more than 460,000 deaths a year. It is estimated that in 60% of asthma cases, the symptoms are not adequately controlled. The objective of this study was to determine the association between some comorbidities, habits, and health risk behaviors with uncontrolled asthma in a sample of young people with asthma.
Methods:
Through a cross-sectional study, data from 1,078 young people aged 17 to 19 years were analyzed. Information was collected through physical examination, direct questioning, and the application of a self-administered questionnaire.
Results:
In the group of young people with asthma, the prevalence of uncontrolled asthma was 20.6%, of which 53.8% were women, 76.9% suffered from rhinitis, 46.2% were overweight and 23.1% were obese. In the group of young with uncontrolled asthma, gingivitis was detected in 53.8% and alcohol consumption in 84.6%. Logistic regression analysis showed a significant association between allergic rhinitis, gingivitis, carbohydrate intake, alcohol consumption, overweight, and obesity with uncontrolled asthma.
Conclusions:
Parents and members of the health team need to identify on time the risk factors associated with uncontrolled asthma in young people with asthma to limit its development and the negative effects it generates. The results of this study should be used to strengthen programs that promote the comprehensive health of adolescents.
Background: Asthma exhibits varying clinical features in children and adults. However, previous studies have mainly focused on the clinical significance of immunoglobulin E (IgE) in the diagnosis and treatment of asthma, disregarding the characteristics of IgE and its relevant factors.
Objective: This study aimed to gain a better understanding of the differences in the characteristics of IgE between childhood and adulthood allergic asthma (AA).
Methods: Patients with AA from the 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) were divided into 3 groups based on their current age and onset age of AA: childhood AA (Group 1), childhood-onset adult AA (Group 2), and adulthood-onset AA (Group 3). Intragroup analysis and intergroup comparison were carried out, focusing on the characteristics and relevant factors of IgE, as well as the clinical relevance of total IgE (total IgE, tIgE) and allergen-specific IgE (allergen-specific IgE, sIgE).
Results: A total of 424 patients were analyzed, including 187 with childhood AA, 132 with childhood-onset adult AA, and 105 with adulthood-onset AA. The concentration of tIgE was found to be higher in Group 1 (268.0, 118.0–686.0 kU/L) than in Group 2 (224.0, 78.0–494.0 kU/L) and Group 3 (165.0, 74.4–350.5 kU/L). The sensitization rates did not differ between Group 1 and Group 2 but were higher compared with Group 3, particularly for Alternaria-sIgE (50.3% and 46.2% vs 15.2%) and Aspergillus-sIgE (43.9% and 37.1% vs 16.2%). In Group 1, there was a negative correlation between pollen-sIgEs and indoor allergens, but this correlation was not commonly observed in Group 2 and Group 3. On the other hand, in Group 1, environmental chemicals such as phthalates, polyaromatic hydrocarbons, trihalomethanes, and phenols showed a positive correlation with IgE. However, a greater number of chemicals was observed in Group 2 and Group 3, including cotinine, metals, trihalomethanes, phthalates, phenols, and other volatile organic compounds (VOCs). Furthermore, in Group 1, IgE was positively correlated with asthma-related issues such as emergency visits, absenteeism, limited activities, and medication needs. These correlations were less common in Group 2 and Group 3, particularly in Group 3.
Conclusions: There are notable differences in the characteristics and environmental factors of IgE among childhood AA, childhood-onset adult AA, and adulthood-onset AA. Additionally, IgE plays a more significant role in childhood AA due to its higher concentration, fewer relevant environmental chemicals and greater clinical relevance. This may partially explain the age-related features of asthma.
Background:
Asthma is a highly heterogeneous airway disease, and the clinical characteristics of asthma patients with preserved and reduced physical activity are poorly understood.
Objective:
We aimed to investigate the risk factors and clinical phenotypes associated with reduced physical activity in a wide range of patients with asthma.
Methods:
We conducted a prospective observational study of 138 patients with asthma, including patients with asthma without chronic obstructive pulmonary disease (COPD) (n = 104) and asthma-COPD overlap (n = 34), and 42 healthy controls. Physical activity levels were measured for two weeks using a triaxial accelerometer at baseline and one year later.
Results:
Higher eosinophils and body mass index (BMI) were associated with reduced physical activity in patients with asthma without COPD. Cluster analysis of asthma without COPD revealed four asthma phenotypes. We identified a cluster with preserved physical activity (n = 43) that was characterized by good symptom control and lung function and included a high proportion of biologics users (34.9%). Multivariate regression analysis revealed that patients with late-onset eosinophilic (n = 21), high BMI non-eosinophilic (n = 14), and symptom-predominant asthma phenotypes (n = 26) had lower levels of physical activity than controls. Asthma-COPD overlap patients also had significantly lower physical activity levels than controls. Similar trends in physical activity levels were observed in each asthma group at one-year follow-up.
Conclusion:
This study showed the clinical features of asthma patients with preserved and reduced physical activity. Reduced physical activity was observed in various asthma phenotypes and in asthma-COPD overlap.
The One Health approach is a collaborative and interdisciplinary strategy with focal point human, animal, and environmental health interconnections. One Health can support the advanced management of allergic diseases and asthma, as complex, multifactorial diseases driven by interactions between the resilience response to the exposome. According to the One Health concept allergic diseases and asthma arising from exposures to a wide range of allergens, infectious agents and irritants (such as pollutants) occurring indoors and outdoors can be heavily influenced by environmental health (air, water and soil quality) intermingled with animal health. These are currently heavily impacted by climate change, land use, urbanization, migration, overpopulation and many more. Thus, a coordinated response to address the underlying factors that contribute to the development of allergic diseases and asthma needs to focus on environment, human and animal health altogether. Collaborative efforts across multiple sectors, including public health, veterinary medicine, environmental science, and community engagement are thus needed. A wide range of activities, including monitoring and surveillance of environmental and health data, targeted interventions to reduce exposures to allergens and irritants, and research on the underlying mechanisms that drive the development of allergic diseases and asthma are needed to move the field forward. In this consensus document elaborated by the European Academy of Allergy and Clinical Immunology (EAACI) and American Academy of Allergy, Asthma, and Immunology (AAAAI) under the practical allergy (PRACTALL) series, we provide insights into the One Heath approach aiming to provide a framework for addressing the complex and multifactorial nature of allergic diseases and asthma.
The most recent recommendations from the 2020 National Asthma Education and Prevention Program (NAEPP) Update and Global Initiative for Asthma (GINA) 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This workgroup report reviews the current state of the new asthma guideline implementation, presents updated evidence-based therapeutic options with attention to specific patient populations, and addresses barriers to the implementation of these guidelines in minoritized, marginalized, and under resourced communities. Allergists and immunologists can utilize practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the lifespan, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
Walking and cognition are interrelated due to dependence on shared brain regions that include the prefrontal cortex (PFC). Limited literature indicates that asthma is associated with poor mobility in older adults but the mechanisms underlying this relationship are unknown. Therefore, we tested the hypothesis that asthma history was associated with poor gait performance due to limited attention resources and neural inefficiency. Participants, older adults age ≥ 65 years reporting positive (n = 36) and negative (n = 36) history of asthma, walked under single and dual-task conditions with a functional near-infrared-spectroscopy (fNIRS) sensor placed on their forehead to assess task-related changes in PFC oxygenated hemoglobin (HbO2). Results showed that positive asthma history was associated with slower gait and higher fNIRS-derived HbO2 under dual-task walking. These findings suggest that limited attention resources and neural inefficiency underlie the association between asthma and poor walking performance in older adults.
Asthma is a chronic airway inflammatory disease characterized by airway hyperresponsiveness. Regular exercise has positive effects on asthma control state, multiple lung function parameters, cardiopulmonary fitness and mental health of children. However,the insufficient exercise level of asthmatic children is not conducive to asthma disease control and children's growth and development. This expert consensus emphasizes the importance and safety of regular exercise for children with asthma, and provides recommendations for the formulation of exercise prescriptions suitable for asthmatic children in China,which can help improve the ability of clinicians to give exercise consulting and mprove he management level of asthma in China. © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.
Asthma is one of the most common chronic respiratory diseases in children. Regular exercise plays an important role in the long - term management of asthma. Expert consensus on exercise prescription for asthmatic children in China provides scientific suggestions for clinicians to guide children to exercise. In this paper,30 common questions about exercise for children with asthma from clinicians, children and their guardians were covered, in order to eliminate misunderstanding, emphasize the safety and importance of scientific exercise, so that each child could be able o have their own exercise prescription. © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.
Background
National Heart, Lung, and Blood Institute guidelines recommend regular physical activity (PA) for patients with asthma. Health care provider (HCP) counseling represents an effective approach to optimizing patient PA. However, current exercise rates among asthma patients are suboptimal, which suggests that counseling may be improved.
Objective
To understand PA counseling behaviors among HCPs who manage asthma.
Methods
A voluntary 36-item survey assessing self-reported awareness of PA recommendations and current clinical practices was sent to 979 randomly selected HCP members of the American Academy of Allergy, Asthma & Immunology.
Results
The overall response rate was 9.3% (91 of 979). Respondents were physicians (100%) and allergists/immunologists (96%) who reported an average of 18.1 ± 12.3 years in independent practice. Over half (58%) reported personally engaging in 150 min/wk or more of moderate to strenuous PA. Eighty percent of participants were unaware of specific PA guidelines for patients with asthma, yet 66% acknowledged evidence for improved asthma outcomes with moderate exercise. A large majority of respondents believed that patients with asthma (97%) and severe asthma (84%) should pursue exercise. Whereas 90% of respondents support incorporating exercise counseling into asthma care, only 69% regularly counsel asthma patients about PA. Barriers cited included limited time, lack of knowledge regarding how and where to refer patients for exercise, and other medical priorities. Potential facilitators of PA included increasing practitioner education and patient-directed posters in waiting areas.
Conclusions
Health care providers recognized PA as an important component of asthma care but were often unaware of specific guidelines. Promoting PA counseling may require using a time-efficient approach to implement counseling at each asthma patient encounter.
Purpose of review:
Our day-to-day life is saturated with health data that was previously out of reach. Over the last decade, new devices and fitness technology companies are attempting to tap into this data, uncovering a treasure trove of useful information that, when applied correctly, has the potential to revolutionize the way we approach healthcare and chronic conditions like asthma, especially in the wake of the COVID-19 pandemic.
Recent findings:
By harnessing exciting developments in personalization, digitization, wellness, and patient engagement, care providers can improve health outcomes for our patients in a way we have never been able to do in the past. While new technologies to capture individual health metrics are everywhere, how can we use this information to make a real difference in our patients' lives? Navigating the complicated landscape of personal wearable devices, asthma inhaler sensors, and exercise apps can be daunting to even the most tech savvy physician. This manuscript will give you the tools necessary to make lasting changes in your patients' lives by exposing them to a world of usable, affordable, and relatable health technology that resonates with their personal fitness and wellness goals. These tools will be even more important post-COVID-19, as the landscape of clinical outpatient care changes from mainly in-person visits to a greater reliance on telemedicine and remote monitoring.
Minimal clinically important difference (MCID) can be defined as the smallest change or difference in an outcome measure that is perceived as beneficial and would lead to a change in the patient's medical management.
The aim of the current expert consensus report is to provide a “state-of-the-art” review of the currently available literature evidence about MCID for end-points to monitor asthma control, in order to facilitate optimal disease management and identify unmet needs in the field to guide future research.
A series of MCID cut-offs are currently available in literature and validated among populations of asthmatic patients, with most of the evidence focusing on outcomes as patient reported outcomes, lung function and exercise tolerance. On the contrary, only scant and partial data are available for inflammatory biomarkers. These clearly represent the most interesting target for future development in diagnosis and clinical management of asthma, particularly in view of the several biologic drugs in the pipeline, for which regulatory agencies will soon require personalised proof of efficacy and treatment response predictors.
Asthma is the commonest respiratory disease and one of unceasingly increasing prevalence and burden. As such, asthma has attracted a major share or scientific interest and clinical attention. With the various clinical and pathophysiological aspects of asthma having been extensively investigated, the important association between asthma and physical activity remains underappreciated and insufficiently explored. Asthma impacts adversely on physical activity. Likewise, poor physical activity may lead to worse asthma outcomes. This concise clinical review presents the current recommendations for physical activity, discusses the available evidence on physical activity in asthma, and examines the causes of low physical activity in adult asthmatic patients. It also reviews the effect of daily physical activity and exercise training on the pathology and clinical outcomes of asthma. Finally, it summarizes the evidence on interventions targeting physical activity in asthma.
The burden of asthma is particularly notable in adolescents, and is associated with higher rates of prevalence and mortality compared with younger children. One factor contributing to inadequate asthma control in adolescents is poor treatment adherence, with many pediatric studies reporting mean adherence rates of 50% or lower. Identifying the reasons for poor disease control and adherence is essential in order to help improve patient quality of life. In this review, we explore the driving factors behind non-adherence in adolescents with asthma, consider their consequences and suggest possible solutions to ensure better disease control. We examine the impact of appropriate inhaler choice and good inhaler technique on adherence, as well as discuss the importance of selecting the right medication, including the possible role of as-needed inhaled corticosteroids/long-acting β2-agonists vs short-acting β2-agonists, for improving outcomes in patients with mild asthma and poor adherence. Effective patient/healthcare practitioner communication also has a significant role to engage and motivate adolescents to take their medication regularly.
Background:
Sedentary behavior and decreased physical activity are possible risk factors for developing asthma. This longitudinal study investigates the association between physical activity and subsequent asthma. We hypothesize that children with decreased physical activity at early school age, have higher risk of developing asthma.
Methods:
One thousand eight hundred thirty-eight children from the KOALA Birth Cohort Study were analyzed. Children who were born prematurely or with congenital defects/diseases with possible influence on either physical activity or respiratory symptoms were excluded. Physical activity, sedentary behavior, and screen time were measured at age 4 to 5 years by questionnaire and accelerometry in a subgroup (n = 301). Primary outcome was asthma, assessed by repeated ISAAC questionnaires between age 6 and 10. Secondary outcome was lung function measured by spirometry in a subgroup (n = 485, accelerometry subgroup n = 62) (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC] and FEV1/FVC ratio) at age 6 to 7 years.
Results:
Reported physical activity was not associated with reported asthma nor lung function. Accelerometry data showed that daily being 1 hour less physically active was associated with a lower FEV1/FVC (z score β, -0.65; 95% confidence interval, -1.06 to -0.24).
Conclusions:
Physical activity at early school age was not associated with reported asthma development later in life. However, lung function results showed that sedentary activity time was associated with lower FEV1/FVC later in childhood. As this is the first longitudinal study with objectively measured physical activity and lung function, and because the subgroup sample size was small, this result needs replication.
Introduction:
More than 54 million US adults have arthritis, and more than 15 million US adults have chronic obstructive pulmonary disease (COPD). Arthritis and COPD share many risk factors, such as tobacco use, asthma history, and age. The objective of this study was to assess the relationship between self-reported physician-diagnosed COPD and arthritis in the US adult population.
Methods:
We analyzed data from 408,774 respondents aged 18 or older in the 2016 Behavioral Risk Factor Surveillance System to assess the association between self-reported physician-diagnosed COPD and arthritis in the US adult population by using multivariable logistic regression analyses.
Results:
Overall crude prevalence was 6.4% for COPD and 25.2% for arthritis. The prevalence of age-adjusted COPD was higher among respondents with arthritis than among respondents without arthritis (13.7% vs 3.8%, P < .001). The association remained significant among most subgroups (P < .001) particularly among adults aged 18 to 44 (11.5% vs 2.0%) and never smokers (7.6% vs 1.7%). In multivariable logistic regression analyses, arthritis status was significantly associated with COPD status after controlling for sociodemographic characteristics, risk behaviors, and health-related quality of life measures (adjusted prevalence ratio = 1.5, 95% confidence interval, 1.4-1.5, P < .001).
Conclusion:
Our results confirmed that arthritis is associated with a higher prevalence of COPD in the US adult population. Health care providers may assess COPD and arthritis symptoms for earlier detection of each condition and recommend that patients with COPD and/or arthritis participate in pulmonary rehabilitation and self-management education programs such as the Chronic Disease Self-Management Program, the proven benefits of which include increased aerobic activity and reduced shortness of breath, pain, and depression.
Background
Although beneficial for health and well‐being, most children do not achieve recommended levels of physical activity. Evidence for children with asthma is mixed, with symptom severity rarely considered. This paper aimed to address this gap.
Methods
We analyzed cross‐sectional associations between physical activity and parent‐reported asthma symptoms and severity for 6497 UK Millennium Cohort Study 7−year‐old participants (3321, [49%] girls). Primary outcomes were daily moderate‐to‐vigorous physical activity (MVPA, minutes) and proportion of children achieving recommended minimum daily levels of 60 minutes of MVPA. Daily steps, sedentary time, and total activity counts per minute (cpm) were recorded, as were parent‐reported asthma symptoms, medications, and recent hospital admissions. Associations were investigated using quantile (continuous outcomes) and Poisson (binary outcomes) regression, adjusting for demographic, socioeconomic, health, and environmental factors.
Results
Neither asthma status nor severity was associated with MVPA; children recently hospitalized for asthma were less likely to achieve recommended daily MVPA (risk ratio [95% confidence interval [CI]]: 0.67 [0.44, 1.03]). Recent wheeze, current asthma, and severe asthma symptoms were associated with fewer sedentary hours (difference in medians [95% CI]: −0.18 [−0.27, −0.08]; −0.14 [−0.24, −0.05]; −0.15, [−0.28, −0.02], respectively) and hospital admission with lower total activity (−48 cpm [−68, −28]).
Conclusion
Children with asthma are as physically active as their asthma‐free counterparts, while those recently hospitalized for asthma are less active. Qualitative studies are needed to understand the perceptions of children and families about physical activity following hospital admission and to inform support and advice needed to maintain active lifestyles for children with asthma.
Objective:
African American Women (AAW) are disproportionately impacted by both physical inactivity and asthma. The aims of this study were to: 1) understand barriers to physical activity among AAW with asthma; 2) obtain feedback from AAW on an evidence-based walking intervention; and 3) modify the intervention using input from AAW with asthma.
Methods:
Focus groups and interviews were conducted with sedentary AAW with uncontrolled asthma to identify barriers to walking. Women also suggestions for tailoring an existing walking intervention. Qualitative data were coded using domains from the Behavior Change Wheel and guided modifications of the existing walking intervention to tailor the content for sedentary AAW with asthma.
Results:
Six focus groups (2-4 /group) and five interviews were completed. Women (n=20) represented an obese (37 kg/m2 ± 11), middle-aged (46 years ± 15) and low-income population. Barriers to physical activity were mapped to 8 theoretical domains: 1) Limited physical capability; 2) Lack of knowledge; 3) Lack of self-monitoring skills; 4) Complex decision making processes; 5) Lack of areas to walk; 6) Lack of social support; 7) Beliefs about consequences; 8) Beliefs about capability. To target these barriers, the existing walking intervention was modified to include an asthma education session, text messages, monthly group meetings, a walking session and informational materials.
Conclusion:
AAW with asthma reported unique barriers to engaging in physical activity. An assessment of the feasibility, acceptability and efficacy of a modified intervention that addresses these barriers is warranted to address physical inactivity and poor asthma outcomes among AAW with asthma.
Exercise has been found to be an effective treatment for mild to moderate depression. The purpose of this study is to explore the relationship between depression status and weekly exercise in children ages 6 to 17 years stratifying by age and sex using a large nationally representative sample. The study data (n = 65,059) came from the 2011–12 National Survey of Children's Health. Depression categories were current, former, and no history of diagnosed depression. Exercise categories were exercising ≤6 days a week and 7 days a week. Multivariable regression stratified by age and by sex was conducted on the weighted survey data. Among children age 6 to 17, 95.2% were never depressed, 2.1% were formerly depressed, and 2.8% were currently depressed and 28.0% exercised daily. Currently depressed children had 0.75 (95% CI 0.56, 1.00) times and formerly depressed children had 1.09 (95% CI 0.76, 1.57) times the adjusted odds of exercising daily compared to never depressed children. Stratified separately by sex and by age, females and children age 12 to 17 with current depression had 0.63 (95% CI 0.42, 0.94) and 0.48 (95% CI 0.35, 0.66) times the adjusted odds of exercising daily compared to their counterparts with no depression. This study indicates a significant difference in daily exercise habits between currently depressed children age 12 to 17 and females compared to their never depressed counterparts. Healthcare workers should be aware of the possible heightened risk of physical inactivity for depressed female children and children age 12 to 17.
Background
Physical activity (PA) is associated with a diverse range of health benefits. International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits. However, current guidelines are intended for healthy children, and thus may not be applicable to children with a chronic disease. Specifically, the dose of PA and disease specific exercise considerations are not included in these guidelines, leaving such children with few, if any, evidence-based informed suggestions pertaining to PA. Thus, the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases: respiratory, congenital heart, metabolic, systemic inflammatory/autoimmune, and cancer.
Methods
For each disease, we present the pathophysiology of exercise intolerance, summarize the pediatric exercise intervention research, and provide PA suggestions.
Results
Overall, exercise intolerance is prevalent in pediatric chronic disease. PA is important and safe for most children with a chronic disease, however exercise prescription should involve the entire health care team to create an individualized program.
Conclusions
Future research, including a systematic review to create evidence-based guidelines, is needed to better understand the safety and efficacy of exercise among children with chronic disease.
Introduction
Nocturnal worsening of asthma symptoms is a common feature of asthma. Physical exercise training improves general asthma control; however, there is no evidence showing the effects of physical exercise on nocturnal asthma symptoms. Indeed, asthma patients with daytime and nighttime symptoms are physiologically different, and thus the effects of physical exercise on asthma may also be different in these two groups. The objective of this systematic review is to explore the effects of physical exercise on nocturnal asthma symptoms.
Methods
Searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and SPORTdiscus (last search on November 2017). Authors from studies that did not report nocturnal symptoms but used questionnaires and/or diaries were contacted for detailed information. Studies that provided results on nocturnal symptoms before and after physical activity intervention were included. Prevalence of nocturnal symptoms was calculated for each study from the percentage of study participants with nocturnal symptoms before and after intervention.
Results
Eleven studies were included (5 with children and 6 with adults). The prevalence of nocturnal symptoms at baseline ranged from 0% to 63% among children and from 50–73% among adults. In children and adults with nocturnal asthma, aerobic physical exercise reduced the prevalence and frequency of nocturnal symptoms.
Conclusions
Aerobic physical exercise improves nocturnal asthma in children and adults by reducing the prevalence and frequency of nocturnal symptoms. Physical exercise training could be used with conventional treatments to improve quality of life and asthma control in patients with nocturnal worsening of asthma.
Objectives:
Children with comorbid asthma and obesity present with more severe and harder-to-control disease than asthmatic children at healthy weight. Weight loss has been shown to improve asthma symptoms, yet physical activity may be difficult due to exercise-induced bronchospasm. Children with asthma have lower exercise rates than non-asthmatics. The objective of this study was to retrospectively evaluate attrition rates and program outcome measures (Body Mass Index [BMI] and maximum oxygen consumption [VO2max]) among asthmatic and non-asthmatic participants.
Study design:
Clinical data were collected from the Healthy Hearts Program, a 12-week nutrition and activity intervention program for children who are overweight, obese, or at risk for heart disease and other conditions, and used for the study.
Methods:
Intervention data and demographics were obtained from medical records at the Children's Heart Center Nevada. Descriptive statistics, paired t-tests, Cox regression analysis, and analysis of covariance were conducted.
Results:
The mean age of this population (N = 232) was 11 years; 54% were male, 64% were Hispanic, and 37% had asthma. Median time in the program was 9 weeks, and 58% of the population completed the program. Unadjusted analyses showed significant BMI decreases in asthmatic (P = 0.002) and non-asthmatic (P = 0.001) participants and increases in cardiorespiratory function for asthmatic males and females (P = 0.003, P = 0.004) and non-asthmatic males and females (P < 0.001 for both). Asthmatic and non-asthmatic children both had improved exercise intensity (P = 0.033, P < 0.001).
Conclusions:
This program is both beneficial and practical for obese children with asthma for losing weight and improving cardiorespiratory function.
In this research we explore the current state of chronic diseases in the United States, using data from the Centers for Disease Control and Prevention and applying visualization and descriptive analytics techniques. Five main categories of variables are studied, namely chronic disease conditions, behavioral health, mental health, demographics, and overarching conditions. These are analyzed in the context of regions and states within the U.S. to discover possible correlations between variables in several categories. There are widespread variations in the prevalence of diverse chronic diseases, the number of hospitalizations for specific diseases, and the diagnosis and mortality rates for different states. Identifying such correlations is fundamental to developing insights that will help in the creation of targeted management, mitigation, and preventive policies, ultimately minimizing the risks and costs of chronic diseases. As the population ages and individuals suffer from multiple conditions, or comorbidity, it is imperative that the various stakeholders, including the government, non-governmental organizations (NGOs), policy makers, health providers, and society as a whole, address these adverse effects in a timely and efficient manner.
Background:
Behavioral interventions focusing on exercise and healthy diet improve asthma control in obese patients with asthma, but whether these interventions can lead to improvements in nonobese patients remains unclear.
Objectives:
In a randomized, controlled parallel-group design, we studied the effects of an 8-week intervention of either exercise (high-intensity interval training), diet (high protein/low glycemic index), or a combination of the 2, on asthma control and clinical outcomes in nonobese patients with asthma.
Methods:
Nonobese adult patients with asthma (n = 149) were randomized to 1 of 4 groups: an exercise group, a diet group, an exercise + diet group, or a control group. Outcomes included Asthma Control Questionnaire (ACQ) score, asthma-related quality-of-life (Asthma-Related Quality-of-Life Questionnaire [AQLQ]) score, inflammatory cell counts in induced sputum, FEV1, fractional exhaled nitric oxide, and airway hyperresponsiveness (AHR).
Results:
A total of 125 patients completed the study and were included in the data analysis. Patients in the exercise + diet group improved the ACQ score from 1.9 ± 0.7 to 1.0 ± 0.7 and the AQLQ score from 5.2 ± 0.8 to 6.2 ± 0.7, which was statistically significant when compared with changes in the control group (P < .05 and <.01, respectively). The exercise group and the diet group did not improve either the ACQ score or the AQLQ score significantly compared with the control group and there were no significant changes in sputum cell counts, FEV1, fractional exhaled nitric oxide, or AHR within any groups following the intervention period.
Conclusions:
The combination of exercise and diet improves asthma control in nonobese patients, but does not affect AHR or airway inflammation.
Rationale:
Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight-loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated.
Objective:
To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers and lung function.
Methods:
Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program + exercise (WL+E group, n=28) or a weight-loss program + sham (WL+S group, n=27) group, where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL+E group incorporated aerobic and resistance muscle training, whereas the WL+S group incorporated breathing and stretching exercises.
Measurements:
The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength and inflammatory/anti-inflammatory biomarkers.
Main results:
After 3 months, 51 patients were analyzed. Compared with the WL+S group, the WL+E group demonstrated improved clinical control scores (-0.7 [-1.3, -0.3] vs. -0.3 [-0.9, 0.4]; P=0.01) and greater weight-loss (-6.8%±3.5 vs. -3.1%±2.6; P<0.001) and aerobic capacities (3.0 [2.4, 4.0] vs. 0.9 [-0.3, 1.3] mL O2.kg.min-1; P<0.001). These improvements in the WL+E group were also accompanied by improvements in lung function, anti-inflammatory biomarkers and vitamin D levels, as well as reductions in airway and systemic inflammation.
Conclusions:
Adding exercise to a short-term weight-loss program should be considered as a useful strategy to achieving clinical control of asthma in obese patients. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02188940.
Background & aims: We aimed to explore the association between obesity and asthma prevalence, incidence and severity.
Methods: The study included 32,644 adults, 52.6% female, from a representative sample of the 4th Portuguese National Health Survey. The following asthma definitions were used: ever asthma (ever medical doctor asthma diagnosis), current asthma (asthma within the last 12 months), current persistent asthma (required asthma medication within the last 12 months), current severe asthma (attending an emergency department because of asthma within the last 12 months), and incident asthma (asthma diagnosis within the last 12 months). Body mass index was calculated based on self-reported weight and height and categorised according to WHO classification. Logistic regression models adjusted for confounders were performed.
Results: Prevalence of ever asthma was 5.3%, current asthma 3.5%, current persistent asthma 3.0%, current severe asthma 1.4%, and incident asthma 0.2%. Prevalence of obesity was 16%, overweight 37.6%, normal weight 44.6% and underweight 0.2%. Being overweight, obesity class I and II, and obesity class III were associated with an OR (95% CI) with ever asthma 1.22 (1.21–1.24), 1.39 (1.36–1.41), 3.24 (3.08–3.40) respectively; current asthma 1.16 (1.14–1.18), 1.86 (1.82–1.90), 4.73 (4.49–4.98) respectively; current persistent asthma 1.08 (1.06–1.10), 2.06 (2.01–2.10), 5.24 (4.96–5.53), and current severe asthma 1.36 (1.32–1.40), 1.50 (1.45–1.55) and 3.70 (3.46–3.95), respectively. Considering the incidence of asthma, obesity more than quadrupled the odds (OR = 4.46, 95% CI 4.30, 4.62).
Conclusion: Obesity is associated in a dose dependent way with an increase of prevalent and incident asthma, and it seems to increase the odds of a more persistent and severe asthma phenotype independently of socio-demographic determinants, physical activity, and dietary patterns. Our results provide rational for future lifestyle intervention studies for weight reduction in the obesity–asthma phenotype.
Background
Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents. The objectives of our study were to (1) summarize the evidence available on associations between PA and asthma prevalence in children and adolescents and (2) assess the role of PA in new-onset or incident asthma among children and adolescents. Methods
We searched Medline, the Cochrane Library, and Embase and extracted data from original articles that met the inclusion criteria. Summary odds ratios (ORs) and confidence intervals (CIs) were used to express the results of the meta-analysis (forest plot). We explored heterogeneity using funnel plots and the Graphic Appraisal Tool for Epidemiology (GATE). ResultsWe retrieved 1,571 titles and selected 11 articles describing three cohort and eight cross-sectional studies for inclusion. A meta-analysis of the cohort studies revealed a risk of new-onset asthma in children with low PA (OR [95 % CI] 1.32 [0.95; 1.84] [random effects] and 1.35 [1.13; 1.62] [fixed effects]). Three cross-sectional studies identified significant positive associations between childhood asthma or asthma symptoms and low PA. Conclusions
Children and adolescents with low PA levels had an increased risk of new-onset asthma, and some had a higher risk of current asthma/or wheezing; however, there was some heterogeneity among the studies. This review reveals a critical need for future longitudinal assessments of low PA, its mechanisms, and its implications for incident asthma in children. The systematic review was prospectively registered at PROSPERO (registration number: CRD42014013761; available at: http://www.crd.york.ac.uk/PROSPERO [accessed: 24 March 2016]).
Background: Bronchial asthma is a major healthcare problem worldwide. Patients with asthma may show less tolerance to exercise due to worsening symptoms during exercise that may result in reduced physical fitness. Few studies have been conducted on the effects of physical exercise in patients with asthma, particularly on HRQOL as a primary outcome. So, the aim of this study was to evaluate the effects of physical training on HRQOL in adult patients with moderate and severe bronchial asthma.
Patients and methods: A total of 68 patients with moderate and severe asthma were included according to Global Initiative for Asthma (GINA) criteria. All patients were randomized into a physical training group; (N = 38), while another group did not join exercise training (control group; N = 30). Asthma quality of life questionnaire (AQLQ) was measured before, immediately following and 3 months after the intervention period for all included patients. Pulmonary function tests were also done before and immediately after the interventional period.
Results: There were significant improvements in all baseline AQLQ domains, except for environmental exposure domain, immediately following training intervention in the training group and when compared with the control group (p
Rheumatoid arthritis (RA) is an autoimmune disease, which not only affects the joints but can also impact on general well-being and risk for cardiovascular disease. Regular physical activity and exercise in patients with RA have numerous health benefits. Nevertheless, the majority of patients with RA are physically inactive. This indicates that people with RA might experience additional or more severe barriers to physical activity or exercise than the general population. This narrative review provides an overview of perceived barriers, benefits and facilitators of physical activity and exercise in RA. Databases were searched for articles published until September 2014 using the terms 'rheumatoid arthritis', 'physical activity', 'exercise', 'barriers', 'facilitators', 'benefits', 'motivation', 'motivators' and 'enablers'. Similarities were found between disease-specific barriers and benefits of physical activity and exercise, e.g. pain and fatigue are frequently mentioned as barriers, but reductions in pain and fatigue are perceived benefits of physical activity and exercise. Even though exercise does not influence the existence of barriers, physically active patients appear to be more capable of overcoming them. Therefore, exercise programmes should enhance self-efficacy for exercise in order to achieve long-term physical activity and exercise behaviour. Encouragement from health professionals and friends/family are facilitators for physical activity and exercise. There is a need for interventions that support RA patients in overcoming barriers to physical activity and exercise and help sustain this important health behaviour.
The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma.
A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function.
No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05). Although the mean energy expenditure at rest and during exercise training was similar for both groups, the maximum energy expenditure was higher in the VGG.
The present findings strongly suggest that aerobic training promoted by an active video game had a positive impact on children with asthma in terms of clinical control, improvementin their exercise capacity and a reductionin pulmonary inflammation.
Clinicaltrials.gov NCT01438294.
A key aspect for researchers to consider when developing culturally appropriate physical activity (PA) interventions for African American (AA) women are the specific barriers AA women face that limit their participation in PA. Identification and critical examination of these barriers is the first step in developing comprehensive culturally relevant approaches to promote PA and help resolve PA-related health disparities in this underserved population. We conducted a systematic integrative literature review to identify barriers to PA among AA women. Five electronic databases were searched, and forty-two studies (twenty-seven qualitative, fourteen quantitative, one mixed method) published since 1990 (Range 1998-2013) in English language journals met inclusion criteria for review. Barriers were classified as intrapersonal, interpersonal, or environment/community according to their respective level of influence within our social ecological framework. Intrapersonal barriers included: lack of time, knowledge, and motivation; physical appearance concerns; health concerns; monetary cost of exercise facilities; and tiredness/fatigue. Interpersonal barriers included: family/caregiving responsibilities; lack of social support; and lack of a PA partner. Environmental barriers included: safety concerns; lack of facilities; weather concerns; lack of sidewalks; and lack of physically active AA role models. Results provide key leverage points for researchers to consider when developing culturally relevant PA interventions for AA women.
Physical exercise has been shown to improve asthma symptoms, QoL, exercise capacity, bronchial hyperresponsiveness and lung function and is recommended as a supplementary treatment to pharmacotherapy for asthma. Clinicians are well placed to promote physically active lifestyles, but their role and practice towards promoting physically active lifestyles among patients has not been fully investigated. This study was designed to investigate the knowledge, propensity, attitude and practices of clinicians towards the promotion of physical activity among patients with asthma and allergies.
Two hundred and eighty clinicians (mean age; 46 ± 13 years; with a clinical experience of practice for 15 ± 7 years) participated in a global survey. The survey comprised a 29-item questionnaire, which gathered information on attitudes of the clinicians towards promoting physical activity, their knowledge and their beliefs regarding evidence for benefits of physical activity as a supplementary treatment in patients with asthma and allergies.
Almost all respondents were aware of the strong evidence in favor of physical activity for the psychological well-being, weight control, decreased risk of diabetes, ischemic heart disease and arterial hypertension. Evidence for reduction in the risk for developing asthma and for better asthma control were reported by 60.0% and 85.4% of participants, respectively. The majority (85.0%) of clinicians strongly agreed that promoting physical activity is important to health care, although 95.5% considered they required more educational training. Although two thirds of them usually recommended exercise to their asthmatic/allergic patients, only 24.0% reported having previous training on the subject of such counseling. Almost all believed that effective counseling about a healthy diet, exercise and weight management would be easier if the clinician himself/herself was physically fit and healthy.
The results of this global survey indicate that clinicians working in the field of allergy and respiratory diseases are well aware of the evidence supporting the benefits of physical activity for asthma and allergic diseases although they need more training in such counseling. Therefore, concerted efforts are needed towards educating clinicians towards promoting physical activity and weight management, as a supplementary treatment for asthma and allergies.
Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means to improve adherence. A total of 19 studies met the inclusion criteria: 9 focusing on the level of adherence, 6 focusing on effects of poor adherence, and 7 focusing on interventions to improve adherence. Three of the studies focused on more than one of these end points. The mean level of adherence to ICS was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, < 12 y of formal education, and poor communication with the health-care provider, whereas improved adherence was associated with being prescribed fixed-combination therapy (ICS and long-acting β2 agonists). Good adherence was associated with higher FEV1, a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthma-related hospitalizations could be attributed to poor adherence. Most studies have reported an increase in adherence following focused interventions, followed by an improvement in quality of life, symptoms, FEV1, and oral corticosteroid use. However, 2 studies found no difference in health-care utilization, one observed no effect on symptoms, and one observed more symptoms in subjects in the intervention group compared with the control group. Good adherence to ICS in asthma improves outcome but remains low. Interventions to improve adherence show varying results, with most studies reporting an increase in adherence but unfortunately not necessarily an improvement in outcome. Even following successful interventions, adherence remains low. Further research is needed to explore barriers to adherence and interventions for improvement.
Background:
African American (AA) women are disproportionately impacted by both physical inactivity and asthma. Lifestyle physical activity (PA) interventions targeted for AA women with asthma are lacking.
Objective:
Assess the feasibility/acceptability and preliminary effects of a lifestyle PA intervention culturally-tailored for AA women with asthma.
Methods:
AA women (18-70 years old) with uncontrolled asthma (Asthma Control Test <20) were recruited. Outcome assessments at baseline and 24-weeks included measures of: feasibility/acceptability, asthma control, quality of life, health care utilization, PA levels. Participants were randomized to the intervention (asthma education, Fitbit, monthly group sessions, text messages, individual step goals, study manual) or enhanced usual care (EUC; asthma education + Fitbit) group.
Results:
Of the 53 women randomized (EUC=28, Intervention=25), 92% remained in the intervention (23/25), with 76% completing the 24-week outcome assessment. Overall intervention satisfaction (mean score 6.88/7) and their individual components was high at 24-weeks. Mean change in ACQ between groups was not significant at 24-weeks (intervention= -0.41 vs. EUC= 0.03; p=0.08; effect size=-0.38) but approached clinical significance (0.5). At 24-weeks, more women receiving the intervention had controlled asthma compared to EUC (36.84% vs. 9.52%; p=0.04). Clinically significant improvements (0.5) in quality of life were found in intervention group (mean change: intervention=0.58 vs. EUC=0.10; p=0.10) at 24-weeks.
Conclusions:
A culturally-tailored lifestyle PA intervention is feasible, and demonstrates improvements in asthma control and quality of life among AA women with asthma. These preliminary findings support the need for PA lifestyle interventions in urban AA women with asthma. (Clinicaltrials.gov: NCT03265665).
Objective:
To systematically review the evidence on whether having current, ever asthma and asthma control is associated with levels of total, moderate and vigorous physical activity.
Methods:
We searched EMBASE, MEDLINE, and CINAHL databases, limiting searches to English language papers from inception until Oct 2019. We synthesized the evidence comparing levels of total, moderate and vigorous physical activity between adults with and without current asthma or ever asthma by random effects meta-analyses.
Results:
A total of 25 studies were included, with 18 of these included in meta-analyses. A meta-analysis of 4 case-control studies found that adults with current asthma were less active, with 942.12 steps fewer per day, than adults without current asthma (SMD = -0.39, 95%CI: -0.54, -0.24, I2 = 0). Meta-analysis of four-high quality cross-sectional studies found that those with current or ever asthma were more likely to be inactive than those without asthma (binary OR current asthma = 0.85, 95%CI: 0.82, 0.89, I2 = 45.6%, and binary OR ever asthma = 0.83, 0.75, 0.91, I2 = 0, respectively). Meta-analysis, inclusive of all 10 cross-sectional studies with binary ORs, supported this finding. There was also some evidence that adults with current asthma and ever asthma (6 studies with categorical ORs) were less likely to exercise moderately and vigorously, but these meta-analyses were limited by high heterogeneity. No synthesis of the studies considering asthma control was possible.
Conclusion:
Adults with current or ever asthma had lower levels of total, moderate and vigorous physical activity than those without asthma and may be missing out on the health benefits of being physically active. The association between asthma control and physical activity warrants further investigation.
Background
Aerobic training and breathing exercises are interventions that improve asthma control. However, the outcomes of these 2 interventions have not been compared.
Objective
To compare the effects of aerobic training versus breathing exercises on clinical control (primary outcome), quality of life, exercise capacity, and airway inflammation in outpatients with moderate-to-severe asthma.
Methods
Fifty-four asthmatics were randomized into either the aerobic training group (AG, n = 29) or the breathing exercise group (BG, n = 25). Both interventions lasted for 24 sessions (2/week, 40 minutes/session). Asthma clinical control (Asthma Control Questionnaire [ACQ]), quality of life (Asthma Quality of Life Questionnaire), asthma symptom-free days (ASFD), airway inflammation, exercise capacity, psychological distress (Hospital Anxiety and Depression Scale), daily-life physical activity (DLPA), and pulmonary function were evaluated before, immediately after, and 3 months after the intervention.
Results
Both interventions presented similar results regarding the ACQ score, psychological distress, ASFD, DLPA, and airway inflammation (P > .05). However, participants in the AG were 2.6 times more likely to experience clinical improvement at the 3-month follow-up than participants in the BG (P = .02). A greater proportion of participants in the AG also presented a reduction in the number of days without rescue medication use compared with BG (34% vs 8%; P = .04).
Conclusions
Outpatients with moderate-to-severe asthma who participated in aerobic training or breathing exercise programs presented similar results in asthma control, quality of life, asthma symptoms, psychological distress, physical activity, and airway inflammation. However, a greater proportion of participants in the AG presented improvement in asthma control and reduced use of rescue medication.
Objective
To evaluate the effect of aerobic exercise training on asthma control, lung function and airway inflammation in adults with asthma.
Design
Systematic review and meta-analysis (PROSPERO-ID: CRD42019130156)
Methods
Eligibility criteria: Randomised controlled trials investigating the effect of at least 8 weeks of aerobic exercise training on outcomes for asthma control, lung function and airway inflammation in adults with asthma. Information sources: Medline, EMBase, CINAHL, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to 3 April 2019. Risk of bias: Risk of bias was assessed by the “Cochrane Risk of Bias Tool”.
Results
Included studies: We included 11 studies with a total of 543 adults with asthma. Participants' mean age was 36.5 years (range: 22 to 54 years); 74.8% of participants were women and the mean body mass index (BMI) was 27.6 kg·m ⁻² (range: 23.2 to 38.1 kg·m ⁻² ). Interventions had a median duration of 12 weeks (range: 8 to 12 weeks) and included walking, jogging, spinning, treadmill running and other unspecified exercise training programmes. Synthesis of results: Exercise training improved asthma control with a standard mean difference (SMD) of −0.48 (−0.81 to −0.16). Lung function slightly increased with an SMD of −0.36 (−0.72 to 0.00) in favour of exercise training. Exercise training had no apparent effect on markers of airway inflammation [SMD: −0.03 (−0.41 to 0.36)].
Conclusions
In adults with asthma, aerobic exercise training has potential to improve asthma control and lung function but not airway inflammation.
Purpose of review:
Asthma is one of the most common chronic diseases in children and adults in developed countries around the world. Despite international treatment guidelines, poor asthma control remains a frequent problem leading to missed school and work, and emergency room visits and hospitalizations. Many patients with asthma report exercise as a trigger for their asthma, which likely leads to exercise avoidance as a means to control symptoms. Evolving research has suggested that routine exercise may actually help improve some aspects of asthma control. This review discusses the recent research addressing how routine exercise affects important asthma-related outcomes including symptoms, lung function and quality of life.
Recent findings:
Several systematic reviews and meta-analyses have been conducted in recent years, which strongly support the safety of routine exercise in children and adults with asthma. Exercise appears to favor improvements in aerobic fitness, asthma symptoms and quality of life, but results so far are less consistent in demonstrating improvements to lung function and airway hyperresponsiveness.
Summary:
In addition to routine management guidelines, clinicians should recommend for their patients with asthma routine exercise for its general health benefits and likely improvement in asthma symptoms and quality of life.
Purpose of review:
To summarize the recent developments relating to the role of physical activity in improving insulin resistance and metabolic syndrome in children and adolescents.
Recent findings:
The current literature strengthens previous findings on the relationship between physical activity and metabolic health in children; suggests a protective role for physical activity in the setting of obesity; examines population-specific findings; addresses specific effects of different modalities of physical activity in improving health; reveals potential mediators in the relationship between physical activity and metabolic health; and suggests new markers of metabolic health that could potentially be used as outcomes in future physical activity studies.
Summary:
Recent research generally confirms the role of physical activity in decreasing insulin resistance and metabolic syndrome in children and adolescents. However, the current literature is limited by unstandardized research methods and definitions, and also aggregation of different age groups, genders, and weight status. Future research should address these issues to offer targeted physical activity interventions.
Importance
Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.
Objective
To summarize key guidelines in the Physical Activity Guidelines for Americans, 2nd edition (PAG).
Process and Evidence Synthesis
The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. The committee addressed 38 questions and 104 subquestions and graded the evidence based on consistency and quality of the research. Evidence graded as strong or moderate was the basis of the key guidelines. The Department of Health and Human Services (HHS) based the PAG on the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.
Recommendations
The PAG provides information and guidance on the types and amounts of physical activity to improve a variety of health outcomes for multiple population groups. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.
Conclusions and Relevance
The Physical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population.
Objective: Physical education (PE) teachers may be the first to assist students with asthma attacks during PE class. This study explores the PE teachers’ perspectives on in-school asthma management and barriers to physical activity (PA) in children with asthma attending urban elementary schools.
Methods: We conducted qualitative semi-structured interviews with 16 PE teachers from 10 Bronx, NY elementary schools. Interviews were recorded, transcribed and independently coded. Content analysis was used to identify 10 major themes common across interviews which were then categorized into 3 domains.
Results: Three domains were identified: 1) school procedures and policies for asthma management; 2) role of PE teachers in asthma management; and 3) barriers to PA for students. Most PE teachers were unaware of written procedures for acute asthma management and did not receive asthma-specific training. Many PE teachers expressed confidence regarding asthma management. PE teachers identified students with asthma most commonly through communication with students. The PE teachers utilized various methods to manage asthma but all relied on the nurse to handle acute asthma symptoms. Several barriers to PA were determined, including PE teachers’ unawareness of NYS PE requirements, lack of gym facilities, inclement weather, inconsistent PE class time, asthma diagnosis, and having no asthma inhalers at the nurse's office.
Conclusions: PE teachers’ perspectives on asthma management may influence the way asthma is handled at school. The results from this study highlight several barriers that can be targeted in future interventions to improve asthma management.
Obesity is a vast public health problem and both a major risk factor and disease modifier for asthma in children and adults. Obese subjects have increased asthma risk, and obese asthmatic patients have more symptoms, more frequent and severe exacerbations, reduced response to several asthma medications, and decreased quality of life. Obese asthma is a complex syndrome, including different phenotypes of disease that are just beginning to be understood. We examine the epidemiology and characteristics of this syndrome in children and adults, as well as the changes in lung function seen in each age group. We then discuss the better recognized factors and mechanisms involved in disease pathogenesis, focusing particularly on diet and nutrients, the microbiome, inflammatory and metabolic dysregulation, and the genetics/genomics of obese asthma. Finally, we describe current evidence on the effect of weight loss and mention some important future directions for research in the field.
Key words
Asthma; obesity; obese asthma; metabolic syndrome; microbiome
Background:
Physical inactivity and high sedentary time are associated with adverse health outcomes in several diseases. However, their impact in asthma is less clear.
Objective:
We aimed to synthesise the literature characterising physical activity and sedentary time in adults with asthma, to estimate activity levels using meta-analysis, and to evaluate associations between physical activity and sedentary time and the clinical and physiological characteristics of asthma.
Methods:
Articles written in English and addressing the measurement of physical activity or sedentary time in adults ≥18 years old with asthma were identified using four electronic databases. Meta-analysis was used to estimate steps/day in applicable studies.
Results:
There were 42 studies that met the inclusion criteria. Physical activity in asthma was lower compared to controls. The pooled mean (95%CI) steps/day for people with asthma was 8390 (7361, 9419). Physical activity tended to be lower in females compared with males, and in older people with asthma compared with their younger counterparts. Higher levels of physical activity were associated with better measures of lung function, disease control, health status, and health care use. Measures of sedentary time were scarce, and indicated a similar engagement in this behavior between asthma participants and controls. High sedentary time was associated with higher health care use, and poorer lung function, asthma control and exercise capacity.
Conclusions:
People with asthma engage in lower levels of physical activity compared to controls. Higher levels of physical activity may positively impact on asthma clinical outcomes. Sedentary time should be more widely assessed.
Objective:
Physical activity (PA) levels are low in today's youth and may even be lower in those with asthma. Barriers to PA have not been well studied in inner-city, minority children with asthma. We conducted a qualitative study to characterize parental perceptions of barriers to PA and ways to improve PA levels in children with asthma.
Methods:
We used the socio-ecological model (SEM) to inform development of our interview guide. Questions fell into two SEM domains: 1) interpersonal (parent, family) barriers and 2) community (neighborhood, school) barriers. Qualitative semi-structured interviews were conducted with 23 parents (21 mothers, 2 fathers) of inner-city children with asthma (ages 8-10 years) from 10 Bronx, New York (NY) elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. Emerging themes were discussed and agreed upon by investigators.
Results:
Three themes surrounding interpersonal barriers to PA emerged: 1) parental fear of exercise-induced asthma due to lack of child symptom awareness; 2) non-adherence and refusal to take medications; and 3) challenges with asthma management. Four themes around community barriers to PA emerged: 1) lack of trust in school management of asthma; 2) lack of school PA facilities; 3) unsafe neighborhoods, and 4) financial burden of PA.
Conclusions:
Our results indicate a complex multi-level set of barriers to PA in children with asthma. Addressing these barriers by involving stakeholders at the family, school and community levels may improve PA levels in children with asthma.
Unhealthy lifestyle factors such as poor diet quality, sedentary lifestyle, and obesity are associated with negative health consequences in asthma including poor asthma control, impaired quality of life, and greater health care utilization. Lifestyle modification is the cornerstone of behavioral treatments and has been effective in chronic diseases such as atherothrombotic vascular disease and diabetes. There is a critical need for lifestyle interventions in asthma care that address obesity and its intimately linked risk behaviors in terms of poor diet and physical inactivity. We present in this commentary the promising lifestyle interventions emerging in asthma care that target poor diet, physical inactivity and weight loss, the proposed mechanisms of these lifestyle interventions, and the critical need for guideline-concordant lifestyle interventions in asthma care.
Background:
Physical inactivity and sedentary time are distinct behaviors that may be more prevalent in severe asthma, contributing to poor disease outcomes. Physical activity and sedentary time in severe asthma however have not been extensively examined.
Objective:
We aimed to objectively measure physical activity and sedentary time in people with severe asthma compared with age-matched control participants, describing the associations of these behaviors with clinical and biological outcomes. We hypothesized that people with severe asthma would be less active and more sedentary. In addition, more activity and less sedentary time would be associated with better clinical outcomes and markers of systemic and airway inflammation in people with severe asthma.
Methods:
Adults with severe asthma (n = 61) and sex- and age-matched controls (n = 61) underwent measurement of lung function, exercise capacity, asthma control, health status, and airway and systemic inflammation. Physical activity and sedentary time were measured using an accelerometer.
Results:
The severe asthma and control groups were matched in terms of age and sex (32 [53%] females in each group). Individuals with severe asthma accumulated less minutes per day in moderate and higher intensity activity, median (IQR) 21.9 (12.9-36.0) versus 41.7 (29.5-65.2) (P < .0001) and accumulated 2,232 fewer steps per day (P = .0002). However, they engaged in more light-intensity physical activity. No differences were found for sedentary time. In a multivariate regression model, steps per day were strongly and independently associated with better exercise capacity in participants with severe asthma (coefficient, 0.0169; 95% CI, 0.008-0.025; P < .001).
Conclusions:
People with severe asthma perform less moderate and vigorous activity than do controls. Higher levels of activity and lower levels of sedentary time are associated with better exercise capacity, asthma control, and lower levels of systemic inflammation.
Background: Low adherence and poor outcomes provide opportunity for digital coaching to engage patients with uncontrolled asthma in their care to improve outcomes.
Objectives: To examine the impact of a remote digital coaching program on asthma control and patient experience.
Methods: We recruited 51 adults with uncontrolled asthma, denoted by albuterol use of > 2 times per week and/or exacerbations requiring corticosteroids, and applied a 12-week patient-centered remote digital coaching program using a combination of educational pamphlets, symptom trackers, best peak flow establishment, physical activity, and dietary counseling, as well as coaches who implemented emotional enforcement to motivate disease self-management through telephone, text, and email. Baseline and post-intervention measures were quality of life (QOL), spirometry, Asthma Control Test (ACT), Asthma Symptom Utility Index (ASUI), rescue albuterol use, and exacerbation history.
Results: Among 51 patients recruited, 40 completed the study. Eight subjects required assistance reading medical materials. Significant improvements from baseline were observed for PROMIS mental status (p = 0.010), body weight and outpatient exacerbation frequency (p = 0.028). The changes from baseline in ACT (p = 0.005) was statistically significant but did not achieve the pre-specified minimum clinically important difference (MCID). Whereas for ASUI, the MCID and statistical significance were achieved. Spirometry and rescue albuterol use were no different.
Conclusion: A patient-oriented, remote digital coaching program that utilized trained health coaches and digital materials led to statistically significant improvement in mental status, outpatient exacerbations, body weight, and ASUI. Digital coaching programs may improve some outcomes in adults with uncontrolled asthma.
Although healthy lifestyles (HL) offer a number of health benefits, nonadherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits. Behavioral counseling can improve adherence to a HL. However, individuals' motivation for change and resistance to altering unhealthy habits must be considered when developing an effective approach to counseling. In the present article, we review psychological, behavioral, and environmental factors that may promote adherence and contribute to nonadherence. We discuss two established models for counseling, motivational interviewing and the transtheoretical model of behavior change, and provide an example of how these approaches can be used to counsel patients to exercise and increase their levels of physical activity.
Purpose
The association of asthma and overweight in youth is well studied. However, the temporal relationship between asthma and overweight, the strength of their association, and mediating factors involved in this relationship remain unclear. This review investigates the relationship between asthma and overweight in youth, while examining the role of physical activity as a mediator.
Methods
A systematic review of literature was conducted using PubMed and Medline databases. Studies conducted among youth aged 0–18 years, published in English between 2000–2014 were included. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were consulted to evaluate quality of selected citations.
Results
A comprehensive search yielded 143 studies in PubMed and 133 studies in Medline databases. Of these, 75 studies met the eligibility criteria. The review found varying hypotheses regarding the temporal relationship between asthma and overweight in youth; existing evidence supports the mediation of this association by decreased expenditure of energy due to reduced physical activity. Negative self-perception or parental perception of exercise ability due to asthma symptoms secondary to physical exertion was identified as a determinant of physical activity in asthmatic youth.
Conclusions
Physical activity likely mediates the relationship between asthma and overweight in youth. Temporality of this relationship remains unclear.
Objective:
To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity (MVPA) in older adults.
Method:
Inactive older adults (N = 38, 68 ± 7 years old, 71% female) were randomized to 12-week interventions targeting decreased sedentary behavior (Sit Less) or increased MVPA (Get Active). The SenseWear armband was used to objectively assess activity in real time. Assessments included a blinded armband, the Community Health Activites Model Program for Senior (CHAMPS) questionnaire, 400-meter walk, and the Short Physical Performance Battery (SPPB).
Results:
Objectively measured MVPA increased in Get Active (75 ± 22 min/week, p < .001); self-reported MVPA increased in both groups (p < .05). Sedentary behavior did not change in either group (all p > .05). Only the Sit Less group improved the SPPB score (0.5 ± 0.3, p = .046).
Discussion:
Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks. Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed.
Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptomatology and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.
Background and objective:
Earlier studies on the levels of physical activity in asthma patients compared with controls have yielded varying results. We have previously reported that high versus moderate levels of physical activity were associated with higher prevalence of wheezing, especially in females. Here we studied the levels of physical activity in young patients with asthma and healthy subjects and their effect on asthma control.
Methods:
Four hundred eight physician-diagnosed patients with asthma and 118 controls (10-34 years) answered questions concerning frequency and/or duration of physical activity and undertook the Asthma Control Test (ACT), spirometry, methacholine challenges and exhaled nitric oxide measurements.
Results:
Asthma patients were more frequently physically active (P = 0.01) and for longer durations (P = 0.002) than controls. Highly versus moderately physically active patients with asthma had a higher prevalence of not well-controlled asthma (ACT < 20) when physical activity was assessed by frequency (40.6% vs 24.1%, P = 0.001) or duration (39.0% vs 21.7%, P < 0.001). This was only seen in females who had reduced ACT items (P < 0.05). Frequently versus moderately active females had an odds ratio of 4.81 (2.43, 9.51) to have ACT < 20, while no such effect was found in males (OR 1.18 (0.61, 2.30)) and this interaction was statistically significantly associated with gender (P = 0.003). No differences in fraction of exhaled nitric oxide or methacholine reactivity were found between moderately and highly physically active females with asthma.
Conclusion:
Young asthma patients were more active than controls. High levels of physical activity were associated with poor asthma control as judged by the ACT in females, but not in males, and this appears unrelated to airway inflammation or responsiveness.
Background
Little is known about the physical activity patterns among US adults who have asthma.
Methods
Using data for 165,123 respondents of the 2000 Behavioral Risk Factor Surveillance System, we examined leisure-time physical activity.
Results
After adjusting for age, about 30% of participants with current asthma (12,489 participants), 24% with former asthma (4,892 participants), and 27% who never had asthma (147,742 participants) were considered to be inactive (p < 0.001). After adjusting for age, the estimated energy expenditure from leisure-time physical activity was 206 kilocalories (kcal) per week lower among respondents with current asthma than among respondents with former asthma (p < 0.001) and 91 kcal/week lower than respondents who had never had asthma (p < 0.001). About 27% of participants with current asthma, 28% of participants with former asthma, and 28% of participants who had never had asthma were participating in recommended levels of physical activity. Walking was the most frequently reported activity for all three groups (respondents with current asthma, 39%; respondents with former asthma, 39%; and respondents who had never had asthma, 38%. Participants with asthma were less likely to engage in running (p < 0.001), basketball (p = 0.001), golf (p < 0.001), and weightlifting (p = 0.001) but were more likely to use an exercise bicycle (p = 0.035) than were participants without asthma.
Conclusions
Like most US adults, the majority of those with asthma were not meeting the current recommendations for physical activity.
Abstract Engaging in regular physical activity is one of the major determinants of health. Studies have demonstrated the benefits of exercise in the treatment and prevention of most every common medical problem seen today. It is clear that patients who engage in an active and fit way of life, live longer, healthier, and better lives. For these reasons, every patient should be asked about exercise at every visit using an exercise vital sign (EVS) and, when needed, provided with an exercise prescription that encourages them to get 150 minutes or more moderate-to-vigorous physical activity. Physicians have an obligation to assess each patients exercise habits and inform them of the risks of being sedentary. Such an approach is critical to help stem the rising tide of deaths around the world due to noncommunicable diseases, which are so closely associated with a sedentary lifestyle.