Interventions that promote physical activity could improve symptoms and quality of life for people with asthma, although these interventions may face barriers to success, according to a review published in Journal of Health Psychology.
“Engaging in regular physical activity is associated with better measures of lung function, disease control, health status and use of health care services,” author Leanne Tyson, PhD, postgraduate researcher at Norwich Medical School at University of East Anglia in Norwich, England, told Healio.
Leanne Tyson
“Despite this, people with asthma engage in less physical activity and are more sedentary than people without asthma. Consequently, there is a need to develop interventions that promote physical activity within the asthma population, but no reviews to date have examined the effectiveness of interventions that have been developed and their components,” Tyson said.
The study’s methodology
The researchers examined 25 studies involving 1,840 participants with varying degrees of asthma. The 21 unique physical activity interventions reported in these studies primarily included aerobics, strength or resistance training, yoga and walking. High-intensity interval training, indoor circuit training and aquatic training also were used.
Participants typically were asked to engage in these activities two or three times a week for 30 to 60 minutes. Most of these interventions were delivered by a combination of providers face-to-face individually and within groups.
Ten of the 25 studies involving eight unique interventions showed significant improvements in relevant behavioral and/or health outcomes, the researchers wrote.
Of the 10 studies that assessed physical activity as an outcome, four found significant positive between-group effects, and four found significant positive within-group effects. Also, participants in one study increased daily step count by approximately 2,000 steps.
Two of the three studies examining sedentary behavior indicated a significant within-group decrease in time spent sedentary. Five of the 16 studies examining quality of life found evidence of a significant positive within-group effect, and five found significant positive between-group effects.
Four of the 12 studies exploring asthma control reported significant positive within-group effects, and two reported significant between-group effects. In the 11 studies including asthma symptoms, four found significant positive within-group effects, and four reported a significant positive between-group effect.
Finally, two of the eight studies that assessed medication usage as an outcome found within-group evidence of a significant reduction in the use of rescue inhalers among its intervention group.
The ways these interventions are presented can have a significant impact on their success, the researchers wrote, involving specific behavior change techniques. The researchers identified 25 of such techniques, with an average of nine per intervention.
The unique effective interventions included 20 of these behavior change techniques. The most common interventions included “action planning” (100%), “goal setting (behavior)” (100%), “instructions on how to plan the behavior” (89%) and “demonstration of behavior” (89%).
Recommendations for interventions
Setting a specific and detailed plan on when, where and how to perform a behavior and providing instructions increases self-efficacy and physical activity, the researchers wrote, as low self-efficacy and negative beliefs about capabilities are major barriers.
“We showed that interventions aimed at promoting physical activity in adults diagnosed with asthma were successful and improved quality of life and asthma symptoms in the short term,” Tyson said.
“However, they would not have overcome patient-reported barriers to physical activity, as they still required patients to travel and were not suitable for those with additional health conditions,” she continued.
The researchers determined which evidence-based behavior change techniques were not extracted from the interventions and recommend techniques to include in future interventions to improve outcomes as well, Tyson said.
Also, Tyson continued, health care providers can be crucial in encouraging patients to be physically active in providing information on how they can do so safely, as such support facilitates physical activity.
“In terms of developing future interventions, incorporating behavior change techniques that promote self-regulation and sustained motivation, as well as considering patient-reported barriers, could improve outcomes in the long term,” Tyson said.
The researchers highlighted the potential use of digital interventions such as video conferencing and fitness trackers, which Tyson called “notably absent” from the studies that were reviewed.
“This is important now more than ever, as patients have not been able to attend face-to-face support during the COVID-19 pandemic, and services will likely become overwhelmed,” she said. “Therefore, alternative interventions and methods of delivery need to be considered.”
The researchers continue to study how these interventions can be improved.
“We have been conducting interviews and focus groups with adults diagnosed with asthma to understand more about the barriers and facilitators to physical activity, as well as identifying key content and components to include in a [mobile health (mHealth)] intervention,” Tyson said.
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PERSPECTIVE
Justin C. Greiwe, MD, FACAAI, FAAAAI
Although it is not surprising that an increase in physical activity would benefit patients who suffer from asthma, this study by Tyson and colleagues aimed to examine the effectiveness of interventions that promote physical activity and identify the specific behavior change techniques used.
The authors performed a comprehensive systematic review looking at the literature published in this area dating back to 1990. After identifying 3,685 citations, the authors identified 25 studies that met a predetermined set of inclusion criteria.
The authors were restricted to a narrative review, as a meta-analysis could not be performed due to differences in study designs, methodologic quality, specific interventions used and patient populations enrolled in the selected studies.
Barriers to physical activity in adult asthma have been well-described in the literature and include low self-efficacy and negative beliefs about the ability to be active. This review attempts to understand which interventions and behavior change techniques can help overcome these barriers while promoting physical activity in asthmatics.
“Action planning” and “goal setting” were the most used behavior change techniques in effective interventions. However, due to the study design, the authors were unable to identify specific behavior change techniques that showed promise of effectiveness.
The authors provide examples of evidence-based BCTs that have been shown in other studies to increase the likelihood of interventions being effective, including “practical social support” and “self-monitoring of outcomes of behavior,” but admit that these interventions were lacking in the studies included in this systematic review.
Based on the data presented, exercise interventions only had transient effects on physical activity levels, quality of life and sedentary behavior and had no overall objective improvement in the patient’s asthma control or medication usage.
The authors suggest digital interventions could help address barriers to long-term compliance, citing improved accessibility and convenience compared with traditional in-person care. This recommendation should be considered the authors’ expert opinion because the data lacked a significant number of digital interventions to analyze.
From this review, it is clear that physical activity interventions have the potential to benefit adults with asthma, but further research is required to identify ways to sustain these behaviors. This will require well-designed randomized trials that incorporate digital-physical activity intervention technologies and evidence-based behavior change techniques that sustain motivation and improve adherence.Justin C. Greiwe, MD, FACAAI, FAAAAIPartner, Bernstein Allergy Group Inc.Clinical assistant professor of medicine, University of CincinnatiMember, American College of Allergy, Asthma and Immunology
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