Q&A: Recommending physical activity to patients with asthma

Although national guidelines recommend physical activity in people with asthma, few of these patients receive counseling from their health care providers, according to a study that was to be presented at the American Academy of Asthma, Allergy & Immunology Annual Meeting.

The meeting was canceled because of concerns about COVID-19, the disease caused by the novel coronavirus.

The study, which was conducted at a single urban, minority-serving academic university hospital, evaluated responses from 75 health care providers — both primary care physicians and asthma specialists — who participated in a 10-item survey.

Researchers found that 40.67% of PCPs said they were unsure of the evidence recommending physical activity in people with asthma compared with 25% of asthma specialists.

They also discovered that of the PCPs who did recommend physical activity, 60% recommended it only sometimes.

Among PCPs, 26.67% reported that time was a barrier to recommending physical activity, and another 26.67% reported that forgetting to educate was a barrier. Researchers also found that other barriers among health care providers included lack of training on physical activity education and considerations of other comorbidities in patients with asthma.

Sharmilee Marie Nyenhuis, MD, an associate professor of medicine in the division of pulmonology, critical care, sleep and allergy at the University of Illinois at Chicago, spoke with Healio Primary Care about the importance of physical activity in people with asthma and what kinds of activities PCPs can recommend to these patients. – by Erin Michael

Q: What are the current physical activity recommendations for people with asthma?

A: Both the National Heart, Lung, and Blood Institute guidelines for the management of asthma (EPR-3) and the Global Initiative For Asthma encourages people with asthma to engage in regular physical activity for its general health benefits. The U.S. physical activity guidelines recommend that all adults — even those with chronic medical conditions — should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity, if they are able.

Q: Why is it important for patients with asthma to regularly exercise?

A: It is important for patients with asthma to engage in regular physical activity for its general health benefits, including weight maintenance, better sleep quality, reduced anxiety and lower risk of cardiovascular disease, diabetes and many types of cancer to name a few. Specifically, for asthma, it has been shown to improve cardiopulmonary fitness and asthma-related quality of life.

Q: What are some examples of physical activities physicians can recommend to patients with asthma? What activities should they avoid?

A: Some activities such as running, cycling and basketball may be more likely to cause asthma symptoms with exercise. Activities such as resistance training, baseball, walking, jogging and swimming may be better tolerated by patient with asthma.

Q: Time and forgetting to educate were the most common reasons for not recommending physical activity. What is your advice to physicians who struggle to overcome these barriers?

A: We are actively exploring the best ways to help care providers for patients with asthma overcome the barriers to recommending physical activity. Recent research shows that using prompts and cues and restructuring the physical environment may enable providers to remember to educate and manage time to deliver brief behavior change interventions. My advice to providers would be to think about how you could use your existing staff or even patients to help provide prompts and cues to trigger a discussion on physical activity. This might include adding exercise as a vital sign during check in or putting posters in the waiting area, reminding patients to discuss exercise with their provider.

Q: What efforts are needed to ensure physicians are recommending physical activity for patients with asthma?

A: Several efforts, such as education, resource development and additional research, are needed to increase the number of health care providers recommending physical activity to their asthma patients. Education efforts such as CME activities, podcasts or guideline development may help providers learn how and what types of physical activity they should recommend to their asthma patients. Developing resources that can be easily printed and given to patients with asthma may help health care providers deliver physical activity recommendations. Finally, obtaining evidence on the best practices to deliver physical activity recommendations in both high- and low-resource settings and across specialties will lead to wider dissemination and implementation among providers.

References:

Carson KV, et al. Cochrane Database Syst Rev. 2013;doi:10.1002/14651858.CD001116.pub4.

Nyenhuis SM, et al. Abstract 352. Presented at: American Academy of Asthma, Allergy & Immunology Annual Meeting; March 13-16, 2020 (meeting canceled).

Disclosure: Nyenhuis reports no relevant financial disclosures.