Asthma Management Handbook

Physical activity, sport and asthma

Recommendations

Recommend physical training to adults and children with asthma, as part of overall asthma management, for its beneficial effect on quality of life.

How this recommendation was developed

Evidence-based recommendation (Grade A)

Based on systematic literature review 

Clinical question for literature search:

Does planned physical activity (e.g. structured physical activity programs, exercise training/intervention such as swimming, running, cycling) improve asthma outcomes (e.g. lung function, asthma control, quality of life, effect on exercise-induced bronchoconstriction), compared with no planned physical activity (e.g. usual clinical care, treatment regimens that do not included planned physical activity) in children and adults with asthma?

Key evidence considered:

  • Arandelovic et al. 20071
  • Basaran et al. 20062
  • Chandratilleke et al. 20123
  • Onur et al. 20114
  • Shaw and Shaw, 20115
  • Shaw and Shaw, 20116
  • Singh et al. 20127
  • Turner et al. 20118

Advise patients that having asthma does not prevent them doing physical activity, including exercise training.

How this recommendation was developed

Evidence-based recommendation (Grade A)

Based on systematic literature review.

Clinical question for literature search:

Does planned physical activity (e.g. structured physical activity programs, exercise training/intervention such as swimming, running, cycling) improve asthma outcomes (e.g. lung function, asthma control, quality of life, effect on exercise-induced bronchoconstriction), compared with no planned physical activity (e.g. usual clinical care, treatment regimens that do not included planned physical activity) in children and adults with asthma?

Key evidence considered:

  • Chandratilleke et al. 20123
  • Turner et al. 20118

Reassure patients that exercise-induced bronchoconstriction can be managed effectively and should not be a reason to avoid physical activity.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

For adults or children involved in competitive sport, check which asthma medicines are permitted in the sport before prescribing.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Benefits of physical activity (exercise) among people with asthma

Regular, moderately intense physical activity improves cardiopulmonary fitness and quality of life in people with asthma, and is well tolerated, but has no effect on lung function or asthma symptoms.3

These conclusions  are based on a meta-analysis3 of randomised controlled trials clinical trials that involved ‘physical training’, defined as any type of whole-body aerobic exercise lasting at least 20 minutes and undertaken twice a week for a minimum duration of 4 weeks, which included running, cycling, treadmill, swimming, circuit training, pool exercises and step-ups. Various aerobic training programs involved multiple types of activity in a structured program (e.g. supervised warm-up, stretching, aerobic exercise and endurance exercises, followed by cooling down). Some studies involved both supervised and home-based exercises.3

Evidence for specific types of physical activity

There is not enough evidence to recommend one form of physical activity over another in people with asthma.

Current evidence does not support the historical belief that swimming is the preferred form of physical training for people with asthma, but few studies have compared effects of swimming with those of other activities:

  • Swimming appears to improve lung function in children9, 10 and is well tolerated.9
  • Overall, swimming does not appear to improve lung function in adults with asthma;11 but some studies have reported that swimming in non-chlorinated pools improved lung function in adults.1
  • Humid air above the surface of swimming pools might be less likely to trigger asthma than dry air environments. However, repeated chlorine exposure over time is associated with chronic airway injury.10

There is not enough evidence to determine the benefits of other types of exercises, such as tai chi and chi kung (qi gong), in people with asthma.

Safety considerations for physical activity

Airway injury due to cold air, dry air, or air pollutants (including chlorine in indoor pools) is associated with development of exercise-induced bronchoconstriction in elite athletes.12 Cold air, dry air or air pollutants may also trigger asthma symptoms,1314 particularly in athletes.13

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Anti-doping agencies

Australian Sports Anti-Doping Authority

The Australian Sports Anti-Doping Authority (ASADA) is the Australian federal government statutory authority with a mission to protect Australia's sporting integrity through the elimination of doping. 

World Anti-Doping Agency

The World Anti-Doping Agency (WADA) is the international independent anti-doping agency composed of representatives from the Olympic movement and public authorities from around the world. Its mission is to lead a collaborative worldwide campaign for doping-free sport.

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References

  1. Arandelovic M, Stankovic I, Nikolic M. Swimming and persons with mild persistant asthma. ScientificWorldJournal. 2007; 7: 1182-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17704850
  2. Basaran S, Guler-Uysal F, Ergen N, et al. Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma. J Rehabil Med. 2006; 38: 130-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16546771
  3. Chandratilleke MG, Carson KV, Picot J, et al. Physical training for asthma. Cochrane Database Syst Rev. 2012; Issue 5: CD001116. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001116.pub3/full
  4. Onur E, Kabaro, Günay O, et al. The beneficial effects of physical exercise on antioxidant status in asthmatic children. Allergol Immunopathol (Madr). 2011; 39: 90-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21242022
  5. Shaw BS, Shaw I. Pulmonary function and abdominal and thoracic kinematic changes following aerobic and inspiratory resistive diaphragmatic breathing training in asthmatics. Lung. 2011; 189: 131-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21318637
  6. Shaw BS, Shaw I. Static standing posture and pulmonary function in moderate-persistent asthmatics following aerobic and diaphragmatic breathing training. Pak J Med Sci. 2011; 27: 549. Available from: http://www.pjms.com.pk/index.php/pjms/article/viewArticle/1427
  7. Singh S, Soni R, Singh KP, Tandon OP. Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Indian J Physiol Pharmacol. 2012; 56: 63-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23029966
  8. Turner LA, Mickleborough TD, McConnell AK, et al. Effect of inspiratory muscle training on exercise tolerance in asthmatic individuals. Med Sci Sports Exerc. 2011; 43: 2031-2038. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21502887
  9. Beggs S, Foong YC, Le HC, et al. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev. 2013; 4: CD009607. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009607.pub2/full
  10. Wanrooij VH, Willeboordse M, Dompeling E, van de Kant KD. Exercise training in children with asthma: a systematic review. Br J Sports Med. 2013; : . Available from: http://www.ncbi.nlm.nih.gov/pubmed/23525551
  11. Heikkinen SA, Quansah R, Jaakkola JJ, Jaakkola MS. Effects of regular exercise on adult asthma. Eur J Epidemiol. 2012; 27: 397-407. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22531972
  12. Bougault V, Turmel J, St-Laurent J, et al. Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes. Eur Respir J. 2009; 33: 740-746. Available from: http://erj.ersjournals.com/content/33/4/740.long
  13. Koskela HO. Cold air-provoked respiratory symptoms: the mechanisms and management. Int J Circumpolar Health. 2007; 66: 91-100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17515249
  14. Weinmayr G, Romeo E, De Sario M, et al. Short-term effects of PM10 and NO2 on respiratory health among children with asthma or asthma-like symptoms: a systematic review and meta-analysis. Environ Health Perspect. 2010; 118: 449-57. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854719/