Low exercise among children with asthma: a culture of over protection? A qualitative study of experiences and beliefs

Abstract

Background: Research shows that children are insufficiently active in most affluent societies. Although children with asthma may particularly benefit from physical activity, they are less active than their peers. Aim: To explore the reasons for low physical activity levels among children with asthma and to identify strategies to improve activity. Design of study: A qualitative study using in-depth interviews and focus groups. Setting: Six GP practices, a Paediatric Respiratory Unit, and four schools in Tayside, Scotland. Method: Purposive sampling identified 30 children with asthma, their parents (n = 38) and school staff (n = 28), who were interviewed or took part in focus groups. Data were examined using constant comparative analysis. Results: The lower level of activity among children with asthma was supported by a climate of fear among parents and teachers about what was safe and possible for the child. Restrictions were imposed because of perceived dangers of exercising in the presence of 'triggers'. Physical activity was regarded as a threat to be managed rather than something beneficial. Teachers found it difficult to distinguish between children who were physically incapable of exercise due to asthma and those who were unmotivated. GPs were unknowingly drawn into the controversy by children and parents who cite medical advice to sanction exemption from exercise. Conclusion: GPs and asthma nurses need to provide clear management plans explaining what is appropriate and safe in terms of exercise on a child-by-child basis, to counter the considerable misunderstanding and disagreement among children, parents, and teachers

Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma

“…The same study also reported that 37% of mothers reported that exercise was dangerous for children with asthma, but there was no evidence of an association between the severity of the child's asthma and his or her physical activity. Qualitative data from Scotland have shown that many parents and school staff were very anxious about children with asthma being physically active, and that physical activity was perceived as a threat to asthma control 24. Thus, there is a clear need to communicate to parents and school staff that physical activity is possible for children with asthma and the challenge.…”

“…Qualitative data from Scotland have shown that many parents and school staff were very anxious about children with asthma being physically active, and that physical activity was perceived as a threat to asthma control. 24 Thus, there is a clear need to communicate to parents and school staff that physical activity is possible for children with asthma and the challenge. The challenge is to build on current efforts to find more effective, easier to implement and sustain ways of helping this group to be more active more often.…”

A nested case–control study: personal, social and environmental correlates of vigorous physical activity in adolescents with asthma

“…Older subjects seems less sensible of parental support (19). Concerning parental restrictions to PA by fear of breathlessness in children and adolescents with asthma (15,16), one may also expect the association to be negative. Lack of negative significant association of parental support may thereby be interpreted as satisfactory.…”

“…Furthermore, van Gent et al (10) did not found lower level of VPA based on both self-reports and objective recordings, and neither did Nystad (11) at any level of exercise frequency or exercise hours a week in asthma based on self-reports. Even though asthma control and severity are associated with level of PA (1,6,7), and that increased intensity and exercise load is associated with bronchoconstriction (12), there is also evidence that psychosocial and socio-demographical factors and knowledge/competence are important for level of physical activity in children and adolescents with asthma (1,(13)(14)(15)(16)(17)(18). Parents observing shortness of breath in their child may lead them to restrain their children from exertion (14), with subsequent increasing fear of breathlessness followed by personal or parental restrictions (15,16).…”

The exercise prescription

“…The first is about asthmatic school children in Dundee, and their own, their parents', and their teachers' perceptions of their ability to take part in physical activity. 3 From this paper it is clear that there are many false limiting beliefs among these children about their asthma, some of which arise from what we as doctors have told them. Is this another example of a way in which doctors can create iatrogenic harm?…”