A feasibility randomised controlled trial of Novel Activity Management in severe ASthma-Tailored Exercise (NAMASTE): yoga and mindfulness

Abstract

Background Physical inactivity is common in severe asthma and associated with poor health outcomes. New approaches are needed to address physical inactivity in this group. Objective To examine whether yoga and mindfulness improves health-related quality of life (HRQoL) compared with a minimal active control group and collect feasibility data to inform future studies. Methods Over 12-weeks, adults with severe asthma were recruited. Participants were randomised 2:1 to parallel yoga or control groups. All participants received an activity tracker. The yoga group received tailored group classes twice a week for 16-weeks with a qualified yoga instructor. The control group set activity goals with a research officer and received eight progress calls. Outcomes were assessed at 16-weeks. Primary outcome was St George’s Respiratory Questionnaire (SGRQ). Secondary outcomes included asthma control, physical activity, breathlessness, and inflammation. Face-to-face qualitative interviews were conducted to determine acceptability. Results There were 15 participants randomised to yoga (mean 67 years; 60% female) and 9 to control (68 years; 56% female). Planned comparisons indicated the yoga group had greater SGRQ improvement than the control group. There was little change in secondary outcomes. Moderate-vigorous activity increased substantially in the control group. Participants found the intervention acceptable; key barriers and facilitators were social connection, the setting, addressing breathing and asthma symptoms, changing their mindset, and the intersection of different elements. Conclusion A yoga and mindfulness intervention was feasible, acceptable to patients and improved HRQoL. The findings will inform design of much needed future research into physical activity interventions for severe asthma. World Health Organization International Clinical Trials Registry Platform The study was registered under the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 26th of November 2018, Trial ID ACTRN12618001914257.

Increasing physical activity in severe asthma: a systematic review and meta-analysis

“…There is evidence that breathing exercises improve both symptom management and ventilatory control 37 , which may subsequently increase an individual's confidence in undertaking PA. Indeed, in a study by Hiles et al, individuals with severe asthma reported increased confidence and motivation to be active after receiving a yoga and mindfulness intervention which focused on controlling breathing, increasing movement and meditation 38 . No increases in PA were reported following this intervention however, which the authors suggest may have been due to the participants prioritising relaxation activities or displacing more active exercise with the low-intensity yoga 38 .…”

“…Indeed, in a study by Hiles et al, individuals with severe asthma reported increased confidence and motivation to be active after receiving a yoga and mindfulness intervention which focused on controlling breathing, increasing movement and meditation 38 . No increases in PA were reported following this intervention however, which the authors suggest may have been due to the participants prioritising relaxation activities or displacing more active exercise with the low-intensity yoga 38 . Further studies are needed to explore the benefits of aerobic training for increasing PA in this population, with breathing exercises a potentially important intervention component to include.…”

“…Overall, the four RCTs involved 176 physically inactive adults with moderate-to-severe asthma (sample size ranged from [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. No studies included participants with severe asthma only.…”

Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma

“…Resistance exercise was investigated in 14 (36%) studies37,39,48,49,51,52,56–58,60,62,63,68,69,76,77 and consisted of free weight (n = 5),39,51,52,60,76 elastic resistance band (n = 2),48,77 and body-weight resistance (n = 1)56 exercises (often performed in a circuit37,48,51,56) targeting major muscle groups 37,39,49,52,57,58,60,62,63,68,69. Breathing/stretching exercise was investigated in 12 (31%) studies,21,37,39,41,43,49,52,54,68,69,72–74,77 of which six investigated yogic breathing/stretching exercises 21,41,43,68,69,72–74. Three studies described pursed-lip breathing, diaphragmatic breathing, and thoracic expansion exercises,39,52,54 while inspiratory resistive breathing,54 incentive spirometer breathing exercises,77 and an inspiratory muscle training device75 were investigated in one study each.…”

“…37,39,49,52,57,58,60,62,63,68,69 Breathing/stretching exercise was investigated in 12 (31%) studies, 21,37,39,41,43,49,52,54,68,69,[72][73][74]77 of which six investigated yogic breathing/stretching exercises. 21,41,43,68,69,[72][73][74] Three studies described pursed-lip breathing, diaphragmatic breathing, and thoracic expansion exercises, 39,52,54 while inspiratory resistive breathing, 54 incentive spirometer breathing exercises, 77 and an inspiratory muscle training device 75 were investigated in one study each. Details of the breathing exercises were not reported in one (3%) study.…”