Aug. 30, 2023 -- Asthma is a sneaky foe.
One minute you’re enjoying a walk or a bike ride. You’re breathing easy, your symptoms under control.
The next minute you feel things change. It might start with a cough. Or labored, wheezing breaths. Or tightness in your chest and lungs. They’re all telltale signs of an asthma attack.
“Asthma may appear controlled until someone exercises,” says Maureen George, PhD, a professor of nursing at Columbia University and a spokesperson for the Asthma and Allergy Foundation of America.
But that doesn’t mean exercise should be avoided, she said.
Exercise, in fact, is one of the best ways to reduce asthma symptoms. Research over the past 2 decades has shown that physical activity can help improve lung function and boost quality of life for someone with asthma.
As their fitness improves, asthma patients report better sleep, reduced stress, improved weight control, and more days without symptoms. In some cases, they’re able to cut down their medication doses.
Exercise reduces inflammatory cytokines – small protein molecules that help cells communicate – and increases anti-inflammatory cytokines, according to a 2023 review from researchers in the United Kingdom. That could help calm chronic airway inflammation, easing symptoms of asthma.
A few simple guidelines can help you reap those benefits while staying safe.
Make Sure the First Steps Aren’t the Last Steps
For someone who’s new to exercise, there’s only one way to begin: Carefully.
The Global Initiative for Asthma recommends twice-weekly cardio and strength training.
“You always start low and slow,” says Spencer Nadolsky, DO, a board-certified obesity and lipid specialist and medical director of Sequence, a comprehensive weight management program.
“Low” means light loads in the weight room. “Slow” means short, easy walks.
Many have been put “through the wringer” when starting out, discouraging them from continuing, Nadolsky says. “They were too sore, and it felt more like punishment.”
An even bigger concern is triggering an asthma attack. Take steps to lower the risk. Have your rescue inhaler with you, and keep up on your medications, Nadolsky says.
“A health care professional should be consulted” before you start a new activity or ramp up a program, or anytime asthma interferes with a workout, George says.
If you exercise outside, you need to be aware of the air quality, especially at a time when smoke and particulates from a wildfire in Canada can trigger asthma symptoms in people thousands of miles away.
The harder you work, the higher your “ventilation,” meaning you’re taking more air into your lungs, and potentially more allergens and pollutants.
Temperature and humidity also become risky at the extremes. Cold, dry air can dehydrate and constrict the airways, making it hard to breathe.
How to Choose the Best Type of Exercise
Step one: Be realistic. People with asthma often have less exercise capacity than those who don’t – understandable when shortness of breath is your default setting.
Second, give yourself plenty of time to warm up. A solid warm-up routine – particularly one with a mix of lower- and higher-intensity exercises – may help prevent exercise-induced asthma (bronchoconstriction), a narrowing of the airways during hard physical activity that causes shortness of breath and wheezing.
For example, if you warm up on a treadmill or exercise bike, you could mix in a few short bursts of faster running or cycling, with a couple of minutes of recovery at a slower pace in between.
You can also expand that concept into a full-blown workout.
High-intensity interval training (HIIT) is a promising option for people with asthma. A 2021 study showed that three 20-minute interval workouts a week significantly improved asthma control.
“The benefit of HIIT is that ventilation is able to recover intermittently,” says Carley O’Neill, PhD, an exercise scientist at Acadia University in Nova Scotia and the study’s lead author.
That’s a key difference from conventional cardio, where the constant exertion can evaporate water from the lungs faster than your body can replenish it. “Dehydrating of the airways can, in some, trigger exercise-induced asthma,” O’Neill says.
HIIT, conversely, allows your airways to recover and rehydrate between exercise bouts.
Another recent study found that people with asthma who did HIIT workouts had fewer breathing problems and felt less fatigued, compared to a matched group who did cardio training at a constant pace. (Both types of cardio led to similar improvements in aerobic fitness.)
You can also choose other types of intermittent – or stop-and-go – exercise. Strength training, for example, requires relatively short periods of exertion, with plenty of rest in between.
The One Choice You Don’t Want to Make
While there are lots of good exercise options for someone with asthma, there’s one clearly bad choice, according to George: “Avoiding exercise.”
Being inactive puts you at higher risk for obesity and all the health problems that go with it. And allowing your fitness level to decline makes it much harder to move when you need or want to.
Any choice is better than that one.