Defining a role for exercise training in the management of asthma

Abstract

<jats:p>The prevalence of asthma remains high worldwide, with increasing awareness of the morbidity and mortality from asthma in low-income countries. In the UK, despite the development of biological treatments, many patients remain suboptimally controlled, and mortality rates have been static for decades. Therefore, new approaches are needed to treat asthma that are scalable at minimal cost. Exercise immunology is an expanding field, and there is growing evidence that exercise can modulate inflammatory and immune processes in asthma. Whilst exercise is encouraged in current treatment guidelines, there are no specific recommendations as to the intensity, frequency or duration of exercise exposure. Despite national and international guidance to increase exercise, patients with asthma are less likely to engage in physical activity. This review explores the disease modifying benefit of exercise in asthma. We also review the domains in which exercise exerts positive clinical effects in asthma, including the effects of exercise on symptom scores, quality of life, psychosocial health, and in the obese asthma phenotype. Finally, we review the barriers to exercise in asthma, given the benefits it confers. A better understanding of the mechanisms through which exercise exerts its positive effects in asthma may provide more accurate prescription of exercise training programmes as part of broader asthma management, with the potential of identification of new drug targets.</jats:p>

The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research

“…Although some intervention studies of exercise as a diseasemodulating treatment have suggested clinical improvements for obese and non-obese patients with asthma, and exercise is encouraged in current treatment guidelines, there are no specific recommendations as to the intensity, frequency or duration of exercise exposure. This research is urgently needed so that more specific physical activity recommendations can be developed for children and adults with asthma [78][79][80].…”

Patient perceived barriers to exercise and their clinical associations in difficult asthma

“…Therefore, our results which show that a higher barrier to exercise correlates with a lower QoL score are not unexpected. Exercise is, however, known to improve health related QoL in asthma [4,23] and therefore interventions to address this paradox need investigating.…”

“…Exercise is recommended in national and international guidelines for asthma management [1][2][3] and appears to have beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma [4]. Despite this, physical activity levels in patients with severe asthma have been demonstrated to be impaired [5].…”

Cytomegalovirus Infection Impairs the Mobilization of Tissue-Resident Innate Lymphoid Cells into the Peripheral Blood Compartment in Response to Acute Exercise

“…The increased amount of catecholamines, such as norepinephrine or epinephrine, in response to moderate-to-high-intensity exercise is well documented [ 1 , 3 ] and is likely to bind to β2-adrenergic receptors on the ILC2 cells, which would inhibit their activity. This promising result could further explain the known positive effects of aerobic exercise on reducing asthma symptoms [ 37 ]. We also found that CMV infection history was associated with dampened ILC mobilization following acute exercise in healthy young adults.…”