Enabling Adults With Severe Asthma to Exercise: A Qualitative Examination of the Challenges for Patients and Health Care Professionals

Abstract

Adults living with severe asthma have lower physical activity levels, particularly high intensity physical activity, compared to their healthy peers. Physical inactivity is associated with increased morbidity and mortality. We aimed to understand patient and healthcare professional attitudes to exercise to inform future strategies for the improvement of healthy lifestyle behaviours, including exercise. Participants recruited from a specialist Difficult Asthma Service were interviewed individually, and healthcare professionals (HCPs) from primary care, secondary care and a tertiary centre were invited to attend focus groups. Interviews and focus groups were transcribed verbatim. Thematic analysis was performed on interviews and focus groups separately, followed by an adapted framework analysis to analyse datasets together. Twenty-nine people with severe asthma participated in a semi-structured interview. 51 HCPs took part in 8 focus groups across the East Midlands, UK. Final analysis resulted in 3 major themes: Barriers to exercise and exercise counselling whereby patients and HCPs identified disease and non-disease factors impacting on those living with severe asthma; Attitudes towards HCPsupportfor exercise highlighting education needs for HCPs and preference for supervised exercise programmes; Areas for system improvement insupportingHCPs describing the challenges existing across services that limit patient support. The important role of HCPs in supporting and advising on lifestyle change was identified by patients. Despite a preference for supervised exercise programmes, both patient and HCP barriers existed. To meet patients' varied support needs, improved integration of services is required and HCP skills need extending.