exercise and asthma

If I Can’t Breathe – Why Should I Exercise?  

by Victoria Phan 

Source: Exercise-Induced Asthma is Common but Controllable 

What is Asthma?

If you’re someone with asthma, you’ve probably tried explaining to others that you feel short of breath, or a tightness in your chest. You’ve also probably realised that your sensitive airways in your lungs tend to react to certain triggers, causing it to ‘flare-up’. Well yes, this happens when the muscles around the airways squeeze tight, swell up, produce more mucous, and then cause the airways to narrow. Essentially, this is what makes it hard to breathe. You’re not alone. One in nine people in Australia have asthma, and it can affect people of all ages¹. Unfortunately, asthma cannot be cured – however the bright side is that with a daily management plan, onset of symptoms can be very well controlled.

 Watch this short Ted Ed video to understand how exactly asthma works.  

Physiological mechanisms aside - how can you control your asthma? 

Tips to Control Your Asthma

Asthma Management Plan 

Ensure you have an action plan - know your triggers and the treatment approaches for appropriate symptom management. It should include information on²: 

• How to administer asthma medicine. 
• What to do during an asthma attack.
• When to call your doctor.
• Emergency contact numbers.

Sports-Related Asthma  

If you have exercise-induced asthma (EIA), you may have noticed that you experience your symptoms during or after exercising. In fact, sports with sustained periods of running or exertion are more likely to trigger this. These include sports like soccer, basketball and long-distance running. Sports that are less likely to trigger EIA symptoms include swimming, walking, biking leisurely, yoga, and hiking. However, don’t let your EIA define you. Prevention if the main goal of therapy for EIA. If you warm up properly, use your medications, knowing your asthma action plan, and avoid certain triggers – this will definitely help you overcome your symptoms. 

Triggers  

Minimise your exposure to triggers. Consider the location of exercise, and how certain places may cultivate certain triggers; such as grass, pollen, pollution etc. Asthma can be divided into two types; allergic or non-allergic. If you have allergic asthma, asthma attacks can be triggered by exposure to environmental allergens such as pollen and dust mites. Non-allergic asthma would be when attacks can be triggered by the weather, stress, smoke and even exercise.   

Image Source: Asthma  - Viral Update 

Heat up the body

It is very important that you do a low intensity warm up prior to exercising, as well as a cool down after your session. While you can experiment to see what works best for you, the American College of Sports Medicine recommends a 10 - 15 minute warm-up prior to activity. You can get the blood circulating around your body by walking, cycling, using the skipping rope … the options are endless!
What about a cool down? Well yes, very similar to your warm-up but in reverse. The goal is to gradually decrease your body temperature, heart rate, and breathing back to normal.
Why is this important or relevant? Studies have suggested that a drop in lung function with exercise can be decreased with a warm-up lasting more than 15 minutes, i.e. better protection from of EIA symptoms. If you have EIA, you probably have airways that are overly sensitive to sudden changes in temperature and humidity – especially if you’re breathing in colder, drier air. 

Medications 

If you only remember one thing from this, remember to have your medication on you at all times. There are three main types of asthmatic medications; preventers, symptom controllers, and relievers. 

Flixotide (preventer), Seretide (a preventer and symptom controller), Spiriva (symptom controller), Ventilin (reliever).

1. PREVENTERS

• Take daily to reduce symptoms and risk of attacks. 
• Work by making airways less sensitive, reduce swelling, and dries up mucous. 
• Most common type are inhaled corticosteroids e.g. Flixotide. 
• Non-steroid tablets and inhalers. 
• Mild to moderate or EIA.

2. SYMPTOM CONTROLLERS 

• Long acting control of symptoms, used in conjunction with preventers. 
• Work by opening up airways and keeps open for 12 hours. 

3. RELIEVERS

• Fast-acting; gives quick relief of asthma symptoms. 
• Relaxes muscles around outside of airways and allows opening.
• Works within minutes, lasts up to 4 hours.
• The asthmatic's bible - carry this around with you and use it whenever you need quick relief from coughs, wheezes, and shortness of breath symptoms. 

Air  

Rapid inhalation of cool air that the body isn’t able to humidify and warm adequately, combined with inhalation of triggering particles (like dust and dirt), may contribute to your symptoms. During strenuous activity, you may tend to breathe through your mouth, allowing cold, dry air directly into the lungs. Air would only then be moistened to 60-70% relative humidity, as opposed to 80-90% humidity with nose-breathing. If you’re working out and it’s cold – wear a mask, or cover your mouth and nose to warm the air. Better yet, move to indoor areas that are well-ventilated and have warm, humidified air.

Why Should You Exercise? 

Ok so we know how to control our symptoms, but why do you need to potentially aggravate these more with exercise? Well, exercise training has been widely linked to health-related benefits and improvements in quality of life. Evidence suggests a strong positive association between exercise training, performance, and fitness in asthmatics³⁻⁷. Essentially, exercise strengthens your heart and lungs. Which means breathing is easier, risk of attacks are reduced, and positive effects on your quality of life. 
We know symptoms can significantly be controlled through medical treatment, or minimising exposure to environmental triggers. Let me paint the picture for you though - exercising is one of the best ways to treat asthma. It exposes the body to a variety of environments, and strengthens it from within. A more robust immune system is developed through increased interaction and activity between the body and its environment. On the other hand, pharmaceuticals may promote the body to become dependent on medications. Extra costs and clingy behaviour? No thanks. 

In pulmonary rehabilitation, exercise is the key component. Standard FITT principles of aerobic exercise prescription can be applied for asthmatics⁸.

FREQUENCY:    3 - 5 days / week. 

   INTENSITY:    Begin with moderate intensity (mildly out of breath - use talk test).

                             Progress according to your tolerance and symptoms. 

              TIME:    Progressively increase to 30 mins. Split it up into bouts of 10 mins - take breaks. 

              TYPE:    Aerobic activity working the large muscles e.g. walking, swimming, cycling. 

Still Not Convinced? Hit up HIIT.

Do you find yourself avoiding exercising, out of fear of triggering an attack? Or maybe you find that you have no time to do regular physical activity? Fortunately, there’s been more and more studies emerging demonstrating the safety of high intensity interval training (HIIT) in asthmatics, which can potentially be a time-efficient, safe, and effective way to improve health. HIIT has been shown to improve pulmonary function in healthy individuals just as well as endurance training, but in a more time-efficient manner⁵⁻⁹. 

Image Source: 30-Minute HIIT Workout  

HIIT uses an interval system of work hard, then recover; alternating between high intensity bursts of work, with short resting periods. For example, 40 second intervals of jump squats, resting for 20 seconds, then repeat. What are some specific benefits of HIIT for asthmatics you ask?

H I I T

ealth-related quality of life enhancements.

Everyone needs regular PA to maintain their health – and so do you. Don’t let your asthma stop you. HIIT has been shown to improve fitness levels of asthmatics, and reduce the need for medication. Feelings of anxiety, ability to cope, and overall quality of life have been found to improve in asthmatics after high intensity exercise³⁻⁵. 

mproves aerobic fitness
↑ VO2 max means a better capacity for aerobic and daily tasks. HIIT has been shown to improve cardio-respiratory performance; enhancing skeletal muscle function with less lactate production and a more effective oxidative metabolism³. This translates to improvements in sports performance and aerobic fitness (run time; speed)⁶.

nterval training results in better asthma control.

Better asthma control seems to relate to a reduction in dyspnoea (shortness of breath), as a result of the opportunity to rest during the recovery intervals⁶.

ime to exhaustion increases.
Exercise tolerance and peak work rates are improved from just two weeks of HIIT⁹. This means that instead of your asthma symptoms preventing you from continuing your exercise, you can push yourself further for longer and harder when you undergo HIIT.

Take Home Message?

There's always a silver lining at the end of the tunnel, so while your asthma may never be cured, it can definitely be controlled down to few to no symptoms. How?  Follow the simple ASTHMA tips.

A  S T H  M A

sthma Management Plan - have one, and know it! 


ports-related - know which sports might trigger your EIA symptoms. 


riggers - dust, cold air, smoking? Minimise your exposure to these. 


eat up the body appropriately through warm-ups and cool-downs before and after exercising.


edications - know which ones are relevant, and carry your reliever with you at all times. 


ir - avoid cold air and breathe through the nose.



HIIT is a time-efficient, well-tolerated and beneficial exercise method, with little to no safety risk for asthmatics. If you are anxious in exacerbating your asthmatic condition with exercise, or feel like you have no time to exercise, a safe and time-efficient routine such as HIIT can help you face these barriers. Not only will it improve your functional capacity to go about your daily life, it can help prevent you from developing more serious conditions strongly associated with inactivity; such as obesity, diabetes and heart disease.

Image Source: Exercising and the Immune System 

References

1. What is asthma? - An Asthma Australia site [Internet]. Asthmaaustralia.org.au. 2017 [cited 25 May 2017]. Available from: https://www.asthmaaustralia.org.au/wa/about-asthma/what-is-asthma

2. Exercise Right for Kids: Asthma - Exercise Right [Internet]. Exercise Right. 2017 [cited 25 May 2017]. Available from: http://exerciseright.com.au/kids-asthma/

3. Satta A. Exercise training in asthma. Journal of Sports Medicine and Physical Fitness. 2000 Dec 1;40(4):277.

4. Lucas SR, Platts-Mills TA. Physical activity and exercise in asthma: relevance to etiology and treatment. Journal of Allergy and Clinical Immunology. 2005 May 31;115(5):928-34.

5. da Silva RA, Rocco PG, Mazzucatto F, Cukier A, Stelmach R, Martins MA, Carvalho CR. (2016) High intensity interval training increases daily life physical activity and quality of life in patients with moderate and severe asthma.

6. da Silva RA, Rocco PG, Mazzucatto F, Cukier A, Stelmach R, Martins MA, Carvalho CR. (2016) High intensity interval training increases the clinical control, aerobic fitness and decreases dyspnea in severe asthmatics.

7. Lucas SR, Platts-Mills TA. Physical activity and exercise in asthma: relevance to etiology and treatment. Journal of Allergy and Clinical Immunology. 2005 May 31;115(5):928-34.

8. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins; 2013 Mar 4.

9. Alyousif ZA. The effects of high intensity interval training (HIIT) on asthmatic adult males. (2014).