Abstract
BackgroundExercise 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.Methods62 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 characteristicsResultsPatients 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.ConclusionIn 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.
Highlights
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
In this paper we present the perceived barriers to exercise in patients with difficult asthma in a group recruited from the Wessex Asthma Cohort of Difficult Asthma (WATCH)
The only significant differences between the Exercise Therapy Burden Questionnaire (ETBQ) group and the overall WATCH cohort were that the cohort as a whole had a higher mean [95% confidence interval] use of rescue oral corticosteroids (OCS) (3.60 [3.24, 3.96] vs 1.93 [1.24, 2.62], p < 0.0001), a higher rate of hospitalisation in the previous 12 months (0.76 [0.59, 0.93] vs 0.24 [0.01, 0.47], p = 0.0025), a lower Fractional Exhaled Nitrogen Oxide (FeNO) (31.1 [27.5, 34.8] vs 48.55 [16.5, 80.6], p = 0.03) and a higher Hospital Anxiety and Depression Score (HADS)-D score (5.4 [5.0, 5.8] vs 4 [0.1, 5.0], p = 0.04)
Summary
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. 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]. Patients with difficult and severe asthma comprise only 5–10% of all patients with asthma [6, 7] They are disproportionately more likely to demonstrate poorly controlled symptoms and inflammation on optimised treatment regimens. Understanding of the barriers to exercise is crucial in increasing activity in patients with difficult asthma, and in implementing a successful exercise training programme to improve their health outcomes [13, 14]
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