Patient perceived barriers to exercise and their clinical associations in difficult asthma

Abstract

Background: Exercise is recommended in guidelines for asthma management and has beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma. Despite this, physical activity levels in patients with difficult asthma are often impaired. Understanding the barriers to exercise in people with difficult asthma is crucial for increasing their activity, and in implementing successful, disease modifying, and holistic approaches to improve their health.

Methods: 62 Patients within the WATCH Difficult Asthma Cohort (Southampton, UK) completed an Exercise Therapy Burden Questionnaire (ETBQ). The results were analyzed with contemporaneous asthma-related data to determine relationships between perceived exercise barriers and asthma and comorbidity characteristics.

Results: Patients were reflective of a difficult asthma cohort, 66% were female, and 63% were atopic. They had a high BMI (median [inter-quartile range]) of 29.3 [25.5-36.2], age of 53.5 [38.75, 65.25], impaired spirometry with FEV1 73% predicted [59.5, 86.6%] and FEV/FVC ratio of 72 [56.5, 78.0] and poor symptom control, as defined by an Asthma Control Questionnaire (ACQ6) result of 2.4 [1.28, 3.2]. A high perceived barriers to exercise score was significantly correlated with increased asthma symptoms (r = 0.452, p < 0.0001), anxiety (r = 0.375, p = 0.005) and depression (r = 0.363, p = 0.008), poor quality of life (r = 0.345, p = 0.015) and number of rescue oral steroid courses in the past 12 months (r = 0.257, p = 0.048). Lung function, blood eosinophil count, FeNO, Njimegen and SNOT22 scores, BMI and hospitalisations in the previous year were not related to exercise perceptions.

Conclusion: In difficult asthma, perceived barriers to exercise are related to symptom burden and psychological morbidity. Therefore, exercise interventions combined with psychological input such as CBT to restructure thought processes around these perceived barriers may be useful in facilitating adoption of exercise.

Keywords: Asthma; barriers; exercise; psychology.

Conflict of interest statement

Competing interestsK.S reports grants from AstraZeneca, grants from Asthma UK, outside the submitted work. T. W reports personal fees and other from MyMHealth, grants from Innovate UK, grants from GSK, grants and personal fees from AstraZeneca, grants and personal fees from Synairgen and personal fees from BI, outside the submitted work. A. F, D. H, C. N, H. M, A. A, D. K, L. P, M. H, HM. H, A. W and R. K report no potential conflicts of interest.

© The Author(s) 2020.

Figures

Fig. 1

Q1 (The exercise causes me pain): results for comparison using Kruskal Wallis Test to compare ETBQ scores for question 1 when grouped by BMI category (mdn and IQR), with significantly higher scores noticed in those overweight (p = 0.017)

Fig. 2

Q6 (Exercising reminds me of my condition)-: Independent samples Median Test results for comparison of ETBQ scores for question 6 when grouped by age at diagnosis (mdn and IQR), with significant differences in the age 6–11 group (p = 0.03)

Fig. 3

Correlation between symptom scores (ACQ6, Fig. 4a) and rescue OCS (Fig. 4b) as assessed by Spearman Rank Correlation with r and p values

Fig. 4

ETBQ and psychological comorbidity for anxiety and depression (HADS total, Fig. 5a), anxiety (HADSA, Fig. 5b), depression (HADSD, Fig. 5c), as assessed by Spearman Rank Correlation with r and p values

Fig. 5

ETBQ and Quality of Life Scores for SGRQ total (6A), impacts (6B) and symptoms (6C), and EQ-5D5L heath today 6D, and EQ-5D-5 L Index (6E as assessed by Spearman correlation, with r and p value