Physical Activity, Exercise and Asthma

Physical Activity, Exercise and Asthma

The human body is built to move. Physical activity and exercise deliver stronger muscles and bones, psychological well-being, chronic disease prevention and management, and they aid in reducing obesity. There is evidence obesity increases risk of asthma or complicates the condition further. Environmental allergens. such as house dust mites are common triggers for asthmatics. Asthmatics who exercise regularly have shown decreased specific IgE levels to house dust mite allergens (Haahtela et al., 2013).

Large scale, and long term epidemiological studies dating back to 1950s, from a study of obese bus drivers in London, England (Morris, 1952) and more recently at the Cooper Institute in Dallas, Texas have reported vast amounts of evidence for the benefits of regular physical activity and exercise and human health or lack thereof (Lee et al., 2005; Blair et al.,2001).

Exercise is anti-inflammatory. Sedentary behavior increases the inflammatory burden, and regular exercise reduces low-grade systemic inflammation (Bruunsgaard, 2005). People who follow recommended and established guidelines have less heart disease, stroke, cancer, diabetes, arthritis, COPD, asthma, stress, anxiety, depression, lower blood pressure, and reduced obesity. Data also shows that sufferers of these conditions that exercise regularly respond to treatment better, and in many cases, reverse their disease, independent of medications compared to non-exercisers.

When healthcare providers are surveyed, 85% agree that physical activity has benefits for patients suffering from chronic diseases. When asked specifically about asthma prevention or control, only half the respondents believe physical activity has benefits, yet the majority report no evidence for patients to reduce or improve allergic rhinitis. However in the same survey, 48% indicate that exercise compliance would be higher when linked to the patient’s disease itself. These contradictory findings elevate the need for a greater awareness of the benefits of physical activity for health care providers. From this same research, 95% responded that providers need more training in assisting patients with preventative care. They also report that if health care providers themselves participate in regular physical activity or exercise, they would more likely or be better prepared to discuss exercise and physical activity with their patients. About two thirds of these providers also responded, that if they appear fit, and had a healthy weight, their patients are likely to perceive their advice as more credible (Moreira et al., 2014).

Definitions

Movement - any musculoskeletal activity of a person
Physical activity - any musculoskeletal activity that involves significant movement of body or limbs
Exercise - a type of physical activity defined as planned, structured and repetitive bodily movement done to improve or maintain physical fitness

Physical activity can be thought of as any form of movement performed throughout the day, including cognitively-planned incidental activity such as taking the stairs instead of the elevator, walking or biking to the store instead of driving, or parking further away in the parking lot to the destination, to get a few extra steps for example. Whereas exercise is defined as a specific amount of time set aside for moderate to vigorous activity, such as going to the gym, a brisk walk or bike ride, taking a yoga class, a tennis game or swimming laps at the pool.

The Office of Disease Prevention and Health Promotion published the Physical Activity Guidelines for Americans (2008). These guidelines report the amount of physical activity and exercise children, adults (see below), older adults and special needs populations, should aim to achieve and maintain for health benefits.

Key Guidelines for Adults – recommendations from the Office of Disease Prevention and Health Promotion.

• All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.

• For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.

• For additional and more extensive health benefits, adults should increase their aerobic physical activity to 300 minutes (five hours) a week of moderate intensity, or 150 minutes a week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity. Additional health benefits are gained by engaging in physical activity beyond this amount.

• Adults should also do muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on two or more days a week, as these activities provide additional health benefits.

The Australian Guidelines on Physical Activity have added an interesting psychological consideration to their national guidelines. The first recommendation is to think of movement as an opportunity not an inconvenience and secondly to be active every day in as many ways as possible. These recommendations are asking the individual to be more mindful of their daily accumulated physical activity levels and reduce  their sedentary behaviors (National Physical Activity Guidelines, Aust Gov Press, Canberra, 2005).

Healthcare providers have a crucial role, given the trusted and respected position their patients hold in them, to tailor their discussions about pre-existing conditions, and how other lifestyle factors such as physical activity and exercise can benefit their condition in almost all cases. There are two initial questions for healthcare providers to ask their patients who aren’t getting enough regular physical activity or exercise for health benefits:

1) On a scale of 1-10, how important is it for you to perform regular physical activity or exercise?

2) On the same scale of 1-10, how confident are you that you could commence regular physical activity or exercise?

For the first question, if they answer less than five, the healthcare provider needs to start with counseling the patient on the health benefits the patient will receive, the disease specific benefits, the quality of life benefits, and the economic benefits, (i.e. less medication requirements, less doctor visits, less hospital visits) for their regular participation.

If the patient answers less than five for the second question, then in this case, the provider needs to suggest tips, tactics and recommendations to build-up their confidence. Suggest ways to achieve more incidental activity, a specific exercise class at a community health center, find a personal trainer, or a friend that exercises.

The healthcare provider should also assist with developing short term measurable and attainable goals, such as using the pedometer in their smart phone or Fitbit, and aim to add 500-1,000 more steps a day to the what the patient did on average for the last seven days. Ask the patient to write it down in a log book or download an app to their phone to help monitor their progress.

Dr Garry Egger, author of the Australian Physical Activity Guidelines (2005), in his recent text book ‘Lifestyle Medicine’ (Egger et al, 2011) presented an adaption of the Australian Guidelines for physicians to use as a prescription form (see below) for clinical use, encouraging patients to include physical activity and exercise into their treatment plans.

It appears it’s never too late to commence regular physical activity to receive overall health benefits. Researchers have commenced exercise programs in nursing homes with residents in their eighties and nineties, these studies show that even after long-term sedentary behavior, subjects reported quality of life improvements after only a matter of weeks through planned exercise classes lead by the researchers in the participant’s nursing homes (Fiatarone-Singh, 2002).

In summary, it cannot be overstated enough, physical activity and exercise is an especially important means for primary, secondary and tertiary prevention of disease for children, adults and older adults, and physicians and health care providers are in esteemed positons to influence the importance of physical activity and exercise for all of their patients, and therefore should lead by example and achieve the minimum weekly physical activity and exercise guidelines themselves.

References

Blair SN, Cheng V, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports & Ex 2001;33(6: Suppl 2):S379-399.

Bruunsgaard H. Physical activity and modulation of systemic low-level inflammation. J Leukoc Biol. 2005 Oct;78(4):819-35. Epub 2005 Jul 20.

Egger G, Binns A, Rossner S. (Eds) Lifestyle Medicine: Managing disease of lifestyle in the 21st Century (2e) McGraw-Hill, Sydney, 2011.

Fiatarone-Singh M.A. Exercise comes of age: Rationale and recommendations for ageriatric exercise prescription. J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:262–282. doi: 10.1093/gerona/57.5.M262.

Haahtela T, Holgate S, Pawankar R, et al. The biodiversity hypothesis and allergic disease: World Allergy Organization position statement. World Allergy Organization Journal. 2013;6:3.

Lee s, Kuk JL, Katzmarzyk PT, Blair SN, Church TS, Ross R. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Diab Care 2005;28(4):895-901.

Moreira et al. A World Allergy Organization international survey on physical activity as a treatment option for asthma and allergies. World Allergy Organization Journal 2014 7:34.

Morris JN, Heady JA, Raffle PA. Coronary disease and physical activity of work (part 2). Lancet 1953;265:1111-1120.

National Health & Medical Research Council (NH&MRC). National Physical Activity Guidelines, Aust Gov Press, Canberra, 2005. (www.health.gov.au/internet/wcms/Publishing.nsf/Content/).

Physical Activity Guidelines for Americans Summary 2008. Office of Disease Prevention and Health Promotion. https://health.gov/paguidelines/guidelines/summary.aspx. Accessed 12.3.16.