The effect of air pollution on asthma sufferers
Physical activity is good for people with asthma. It improves lung function, supports the immune system and helps keep people’s weight down, cutting the risk of an asthma attack. However, since some people with asthma find that exercise triggers their symptoms, they may feel apprehensive about getting started.
Patient's sports survey
In Patient's recent survey of 281 healthcare professionals, the medical community was somewhat divided in what sports they'd recommend to people with asthma. The most recommended activities were yoga and Pilates (recommended by 60% of doctors), archery and shooting (recommended by 51%) and cycling (recommended by 49%). Conversely, the least recommended activities were all competitive sports - squash (22%), hockey (21%) and rugby (18%).
Exercising with asthma
This rather complex picture reflects the nuances involved in exercising with asthma. While there are many upsides to staying fit, it is essential that the condition is properly managed and you have a good awareness of your personal triggers.
"If people are looking after their asthma well, and their symptoms are under control, they should be able to enjoy any type of exercise, whether that's swimming, running or even competitive sport," says Dr Andy Whittamore, Asthma UK's clinical lead and a practising GP. "If a person's asthma is not under control, they're new to exercise or haven't done any in a while, it might be best to start with less intense aerobic activities such as yoga or walking."
Clearly, recommendations will vary depending on your personal circumstances. For instance, swimming (recommended by 45% of doctors) is often beneficial, as the warm, moist air around swimming pools is generally good for sensitive airways. On the other hand, some people find that the chlorine used in pools can be a trigger.
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According to the widely used SIGN/BTS guidelines, for most people with asthma, symptoms brought on by exercise are an indication that overall control is poor or at least inadequate. This means your medication, including 'preventer' inhalers, should be reviewed. However, some people have few or no symptoms except when they exercise. For them, the guidelines recommend taking a dose of 'reliever' inhaler immediately before exercise to keep the airways open and prevent symptoms from coming on.
On a similar note, running (recommended by just 29% of doctors), is excellent for overall fitness, and there are a number of world-class athletes, such as Paula Radcliffe and Jo Pavey, who have found asthma to be no impediment. However, it is imperative to warm up and cool down thoroughly, and to carry your reliever inhaler with you at all times.
"Cold weather can irritate sensitive airways, so you could try exercising indoors over winter or consider doing less vigorous exercise on cold days," says Dr Whittamore. "There are also likely to be other asthma triggers that people come into contact with, such as pollen."
If you haven't exercised in a while, or your asthma is severe, it may be preferable to start with a more moderate activity. It perhaps is no coincidence that the survey leaders, yoga and Pilates, are usually conducted indoors, emphasise controlled breathing and can be taken at your own level of intensity.
Lynne Robinson, founder and director of Body Control Pilates and author of The Pilates Bible and Pilates for Life, points out that Joseph Pilates himself (the founder of Pilates) suffered from asthma as a child.
"That is probably why teaching efficient breathing is central to our method," she says. "You are taught lateral thoracic breathing to maximise the efficiency of the breath. You also learn how to coordinate your breath with your movements. This, coupled with the relaxation element of classes, makes it ideal for asthmatics helping them learn how to stay calm and breathe deeply during an attack."
The key message is that, provided you are feeling well generally and are taking your preventer medicines as prescribed, there is really no stopping you from enjoying your physical activity of choice. In a survey by Asthma UK, 37% of people with asthma said that exercising made them happier and healthier overall. Among parents who had children with asthma, 83% said exercise was good for helping their child feel more confident about their condition.
However, if you are having difficulty exercising because of asthma, it's important to speak with your GP or asthma nurse, who can assess your treatment. They will help you develop an up-to-date written asthma action plan that details what you should do if your symptoms are getting worse.
"It's a good idea for people to take a photo of this on their phone so they always have a copy when they’re out and about," says Dr Whittamore. "If you have symptoms when you exercise, stop, take your reliever inhaler and wait until you feel better before starting again."