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

Abstract

Background: Exercise is recommended in guidelines for asthma management and has beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma. Despite this, physical activity levels in patients with difficult asthma are often impaired. Understanding the barriers to exercise in people with difficult asthma is crucial for increasing their activity, and in implementing successful, disease modifying, and holistic approaches to improve their health. Methods: 62 Patients within the WATCH Difficult Asthma Cohort (Southampton, UK) completed an Exercise Therapy Burden Questionnaire (ETBQ). The results were analyzed with contemporaneous asthma-related data to determine relationships between perceived exercise barriers and asthma and comorbidity characteristics Results: Patients were reflective of a difficult asthma cohort, 66% were female, and 63% were atopic. They had a high BMI (median [inter-quartile range]) of 29.3 [25.5-36.2], age of 53.5 [38.75, 65.25], impaired spirometry with FEV1 73% predicted [59.5, 86.6%] and FEV/FVC ratio of 72 [56.5, 78.0] and poor symptom control, as defined by an Asthma Control Questionnaire (ACQ6) result of 2.4 [1.28, 3.2]. A high perceived barriers to exercise score was significantly correlated with increased asthma symptoms (r = 0.452, p < 0.0001), anxiety (r = 0.375, p = 0.005) and depression (r = 0.363, p = 0.008), poor quality of life (r = 0.345, p = 0.015) and number of rescue oral steroid courses in the past 12 months (r = 0.257, p = 0.048). Lung function, blood eosinophil count, FeNO, Njimegen and SNOT22 scores, BMI and hospitalisations in the previous year were not related to exercise perceptions. Conclusion: In difficult asthma, perceived barriers to exercise are related to symptom burden and psychological morbidity. Therefore, exercise interventions combined with psychological input such as CBT to restructure thought processes around these perceived barriers may be useful in facilitating adoption of exercise.

Physical activity and childhood asthma control: Mediation and moderation role of body mass index

“…However, such finding seemed to be inconsistent with a prior study that examined the association between BMI, exercise, and lung function among asthmatic adolescents and reported no association between PA capacity and FEV 1 for those with obesity 38 . The reasons for this discrepancy may be that FEV 1 and asthma control are two different indicators and seem to have discordant association with PA as reported in previous studies 39,40 . Additionally, exercise capacity is a reflection of maximal oxygen consumption and physical limitation, 41 while PA level represented lifestyle inclination.…”

Exercise Training Induces a Shift in Extracellular Redox Status with Alterations in the Pulmonary and Systemic Redox Landscape in Asthma

“…The stability of body mass index provides some reassurance that these changes are not merely a result of reduced adiposity-driven inflammation. Demonstration of the disease-modifying benefits of exercise in asthma should go a long way in increasing uptake in patients with greater perceived barriers to activity [ 46 ]. There is support for our findings from work in other chronic inflammatory diseases, summarised in a review that suggests exercise interventions exert antioxidant effects [ 47 ].…”

Physical Activity and Life Quality in Patients with Asthma and Osteoarthritis

“…However, asthmatic patients are often afraid to engage in physical activity. Analysis of psychological barriers that interfered with active lifestyles in patients with asthma showed that a high level of psychological barriers was significantly correlated with increased asthma symptoms, anxiety and depression, low quality of life and amount of oral glucocorticosteroids used in the last 12 months [17]. Asthmatic patients are especially avoidant when it comes to a vigorous activity as it is associated with exercise-induced bronchoconstriction [18].…”