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

Abstract

Introduction/AimPhysical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity (PA) in reducing the risk of these outcomes, little is known about optimal interventions for increasing PA in those with severe disease. This systematic review and meta-analysis evaluates the effectiveness of interventions in increasing PA in severe asthma.MethodsMedline, CINAHL, EMBASE, PubMed, Informit, SPORTDiscus and Cochrane databases were searched up to September 2021 for PA-based intervention studies that assessed PA outcomes (e.g. steps·day−1, time spent undertaking PA) in adults with severe asthma. Data on asthma-related (e.g. asthma control) and health-related outcomes (e.g. HRQoL) were assessed as secondary outcomes. The Revised Cochrane ROB tool was used to assess risk of bias. Random-effects meta-analyses synthesised data where possible. PROSPERO ID: CRD42021210968ResultsFour RCTs (all 12-weeks in duration) including 176 adults with moderate-to-severe asthma were included. An increase in PA was reported with a moderate-vigorous intensity aerobic and resistance training intervention (steps·day−1 and time spent undertaking PA), and an unsupervised pedometer-based intervention (steps·day−1). Meta-analyses showed that PA interventions had an overall positive effect on steps·day−1 (MD=1588, 95% CI:399, 2778; p=0.009, I2=23), asthma control (MD=-0.65, 95% CI: −0.95, −0.35; p<0.0001, I2=0%), and HRQoL (MD=0.56, 95% CI:0.10,1.01; p=0.02, I2=16%) compared to control.ConclusionWhile there is some evidence supporting the effectiveness of interventions in improving PA in adults with severe asthma, higher-quality, large-scale studies of longer duration are needed to determine the optimal intervention.

Evaluation of physical activity before and after respiratory rehabilitation in normal weight individuals with asthma: a feasibility study

“…However, even after adjustment each 1-unit increase in BMI was associated with a small significant decrease in average minutes/day of moderate to vigorous activity (−2.2; 95% confidence interval −3.6 to −0.3; p = 0.03). The improvement in the number of steps is lower in normal-weight individuals with asthma compared to overweight or obese severe people with asthma, as reported by McLoughlin et al ( 13 ).…”

“…Freitas et al confirmed that a comprehensive PR program, including a weight loss program and exercise training, improves PA in moderately to severely obese adults with asthma ( 12 ). The results of a recent systematic review revealed some evidence supporting the effectiveness of different supervised or unsupervised interventions, such as walking, running, cycling, low-intensity exercise (i.e., yoga), improving PA in adults with severe asthma ( 13 ).…”

Effects of physical activity on lung function and quality of life in asthmatic children: An updated systematic review and meta-analysis

“…Consequently, after assessing the children's condition, physicians should advise them to exercise as much as possible according to an appropriate exercise prescription ( 49 ). We noted that some recent studies found improvement in asthma symptoms and quality of life with PA in adults with severe asthma ( 50 , 51 ), but there were no studies on children yet because of the possible ethical risks.…”

Key Considerations When Addressing Physical Inactivity and Sedentary Behaviour in People with Asthma

“…Three systematic reviews were included to address Aim 3 [ 54 , 55 , 56 ], of which two included meta-analyses and one was a Cochrane review. Tyson et al [ 56 ] included 10 studies that reported on intervention effects on physical activity, while three studies also included sedentary behaviour as an outcome.…”