Background
Higher levels of physical activity have been associated with better asthma clinical
control.
Research Question
Does a behavior change intervention aimed at increasing physical activity change asthma
clinical control, physical activity, sedentary time, health-related quality of life
(HRQoL), and anxiety and depression symptoms?
Study Design and Methods
This single-blind, randomized controlled trial included participants who were allocated
to an intervention group (IG) or to a control group (CG). Both groups received usual
care and disease-specific education. Participants in the IG also underwent an 8-week
behavior change intervention aimed at increasing physical activity. Prior to and following
the intervention period, measures were made of asthma clinical control (Asthma Control
Questionnaire [ACQ]), physical activity, sedentary time and sleep quality (ActiGraph),
HRQoL (Asthma Quality of Life Questionnaire), and anxiety and depression symptoms
(Hospital Anxiety and Depression Scale). Data on asthma exacerbations were recorded
12 months prior to and throughout the intervention period.
Results
Fifty-one participants were included (CG, n = 26; IG, n = 25). On completion of the
intervention period, compared with the CG, those in the IG exhibited improvements
in asthma control (mean difference [95% CI] in ACQ score, –0.8 [–1.1 to –0.4]); in
daily step count, 3,605 [1,937 to 8,867] steps/d; in sleep efficiency, 9.2% [–7.1% to
21.9%]; and a reduction in sedentary time, –1.1 [–2.9 to –0.6] h/d). No between-group
difference in HRQoL was observed. The percentage of participants who experienced exacerbations
during the intervention period was 27% in the IG vs 60% in the CG (P = .04). The change in time spent in moderate-intensity physical activity was inversely
associated with change in ACQ (r = –0.60). Compared with the CG, a higher percentage of participants in the IG reported
a reduction in anxiety symptoms (43% vs 0%; P < .02).
Interpretation
In adults with moderate to severe asthma, a comprehensive behavior change intervention
that increased physical activity also produced improvements in asthma clinical control,
sedentary time, sleep quality, and anxiety symptoms.
Clinical Trial Registration
ClinicalTrials.gov; No.: NCT03705702; URL: www.clinicaltrials.gov.
Key Words
Abbreviations:
ACQ (Asthma Control Questionnaire), ANOVA (analysis of variance), AQLQ (Asthma-related Quality of Life Questionnaire), CG (control group), HADS (Hospital Anxiety and Depression Scale), IG (intervention group), LABA (long-acting B2-agonist), MD (mean between-group difference), MVPA (moderate to vigorous intensity physical activity), NNT (number-needed-to-treat), RCT (randomized controlled trial)To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to CHESTAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global Strategy for Asthma Management and Prevention.National Institutes of Health/National Heart, Lung and Blood Institute of Health, Bethesda, MD2019www.ginasthma.orgDate accessed: October 1, 2019
- Asthma Global prevalence.https://www.who.intDate accessed: November 24, 2019
- A systematic review of associations of physical activity and sedentary time with asthma outcomes.J Allergy Clin Immunol Pract. 2018; 6: 1968-1981.e2
- Physical training for asthma.Cochrane Database Syst Rev. 2013; 9: CD001116
- Exercise is associated with improved asthma control in adults.Eur Respir J. 2011; 37: 318-323
- Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial.Thorax. 2015; 70: 732-739
- The effects of exercise training in a weight loss lifestyle intervention on asthma control, quality of life and psychosocial symptoms in adult obese asthmatics: protocol of a randomized controlled trial.BMC Pulm Med. 2015; 15: 124
- Effects of aerobic training on psychosocial morbidity and symptoms in patients with asthma: a randomized clinical trial.Chest. 2010; 138: 331-337
- Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis.Chron Respir Dis. 2012; 9: 17-26
- Self-Efficacy: The Exercise of Control.Freeman, New York, NY1997
- The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.Ann Behav Med. 2013; 46: 81-95
- Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review.Intern Med J. 2019; 49: 1209-1220
- Global Strategy for Asthma Management and Prevention.National Institutes of Health/National Heart, Lung and Blood Institute of Health, Bethesda, MD2017www.ginasthma.orgDate accessed: August 16, 2017
- American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.Med Sci Sports Exerc. 2011; 43: 1334-1359
- Identifying 'well-controlled' and 'not well-controlled' asthma using the Asthma Control Questionnaire.Respir Med. 2006; 100: 616-621
- Effects of a behaviour change intervention aimed at increasing physical activity on clinical control of adults with asthma: study protocol for a randomised controlled trial.BMC Sports Sci Med Rehabil. 2019; 11: 16
- Protocol registration and results system/behavioral intervention to increase physical activity in patients with asthma. NCT03705702. ClinicalTrials.gov.National Institutes of Health, Bethesda, MD2018 (Updated April 15, 2020)
- Exercise prescription for other clinical populations.(American College of Sports Medicine)ACSM's Guidelines for Exercise Testing and Prescription. 8th ed. Lippincott Williams & Wilkins, Philadelphia, PA2009: 226-272
- The role of physician counseling in improving adherence to physical activity among the general population.Sao Paulo Med J. 2007; 125: 115-121
- An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice.Am J Respir Crit Care Med. 2009; 180: 59-99
- Conducting accelerometer-based activity assessments in field-based research.Med Sci Sports Exerc. 2005; 37: S531-S543
- How many steps/day are enough? Preliminary pedometer indices for public health.Sports Med. 2004; 34: 1-8
- Validation of a simplified quality-of-life questionnaire for socioeconomically deprived asthma patients.J Asthma. 2005; 42: 41-44
- The Hospital Anxiety and Depression Scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD [in Portuguese].Rev Saude Publica. 1995; 29: 355-363
- Stature, recumbent length and weight.in: Lohman T.G. Roche A.F. Martorell R. Anthropometric Standardization Reference Manual. Human Kinetics, Champaign, IL1988: 3-8
- Distribution and correlates of waist-to-hip ratio in black adults: the Pitt County Study.Am J Epidemiol. 1992; 135: 678-684
- Minimal important difference for the asthma control questionnaire.Am J Respir Crit Care Med. 2001; 163
- Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation.JAMA. 2001; 285: 1992-1995
- The role of exercise in a weight-loss program on clinical control in obese adults with asthma. A randomized controlled trial.Am J Respir Crit Care Med. 2017; 195: 32-42
- Exercise improves physical activity and comorbidities in obese adults with asthma.Med Sci Sports Exerc. 2018; 50: 1367-1376
- Effects of an unsupervised pedometer-based physical activity program on daily steps of adults with moderate to severe asthma: a randomized controlled trial.J Sports Sci. 2018; 36: 1186-1193
- Increasing physical activity in patients with asthma through positive affect and self-affirmation: a randomized trial.Arch Intern Med. 2012; 172: 337-343
- Effects of weight loss on asthma control in obese patients with severe asthma.Eur Respir J. 2014; 43: 1368-1377
- Short-term effects of aerobic training in the clinical management of moderate to severe asthma in children.Thorax. 1999; 54: 202-206
- Treatable traits can be identified in a severe asthma registry and predict future exacerbations.Respirology. 2019; 24: 37-47
- Obesity and exercise habits of asthmatic patients.Ann Allergy Asthma Immunol. 2008; 101: 488-494
Freitas PD, Xavier RF, McDonald VM, et al. Identification of asthma phenotypes based on extrapulmonary treatable traits [published online ahead of print July 30, 2020]. Eur Respir J. https://doi.org/10.1183/13993003.00240-2020.
- Clinical characteristics and possible phenotypes of an adult severe asthma population.Respir Med. 2012; 106: 47-56
- Maintenance of physical activity and sedentary behavior change, and physical activity and sedentary behavior change after an abridged intervention: secondary outcomes from the ACTIVATE trial.Cancer. 2019; 125: 2856-2860
Article Info
Publication History
Published online: September 12, 2020
Footnotes
FUNDING/SUPPORT: The study was supported by Grant 2016/17093-0 from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and by Grant 311443/2014-1 from the Ministerio da Ciencia, Tecnologia e Inovação-Conselho Nacional de Pesquisa. Grant CNPq 311443/2014-1 supports the scholarship of C. R. F. C. as well as the patient's transport and equipment. Grant FAPESP 2016/17093-0 supports the Postdoctoral Research Scholarship of P. D. F. V. C. is supported by the Cancer Council of Western Australia Postdoctoral Research Fellowship.
Identification
Copyright
© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
