Behavior Intervention Can Increase Physical Activity and Improve Asthma Control

Patients with asthma can improve their disease control and sleep quality, while reducing depression and anxiety through a behavior change intervention aimed at increasing their physical activity.

Behavior changes that increase physical activity can improve asthma control and sleep quality while reducing sedentary time and anxiety symptoms among adults with moderate to severe asthma, according to a study in CHEST.

Asthma is a global public health problem that previous research has shown can be improved through supervised exercise. The challenge is that access to programs is limited and when these programs are available, supervised exercise training has just a trivial impact on improving patients’ daily physical activity, the authors noted.

“We therefore hypothesized that a behavior change intervention is needed to increase participation in physical activity, which, in turn, may improve asthma control,” they explained.

The study included 51 patients between the ages of 18 and 60 who had moderate to severe asthma, were clinically stable, and were attending a university hospital for asthma management. To be eligible, they had to engage in less than 150 minutes of moderate to vigorous physical activity (MVPA) weekly and have poorly controlled asthma, as determined by an Asthma Control Questionnaire (ACQ) score of > 1.5, even while receiving optimal medical care.

The patients were randomly assigned to either the intervention group (n = 25) or the control group (n = 26). All patients underwent assessments prior to and after the intervention period. While patients in both groups received usual care and an educational program with information on asthma, instructions about their medication, and other information, patients in the intervention group also underwent a behavior change program. The program was delivered as 40-minute face-to-face counseling sessions once a week for 8 weeks.

The following behavior change techniques were used to increase physical activity:

  • Goal setting
  • Problem solving and action planning
  • Reviewing, monitoring, and providing feedback on behavior
  • Providing information on health consequences
  • Prompts/cues
  • Behavior substitution
  • Habit formation and reversal
  • Environment restructuring
  • Verbal persuasion about capacity

The intervention group also utilized a workbook and a wearable device that provided data that the health professional reviewed weekly.

One patient in the control group and 2 in the intervention group were lost to follow up. Overall, 20 patients in the intervention group completed all 8 sessions and 2 completed 7 sessions. Participants in the groups were similar and on average, they participated in 106 minutes a week of MVPA and spent 63% of their waking hours in sedentary behavior.

After the intervention period, the mean ACQ score in the intervention group improved from 2.8 to 1.6 (P < .001). In comparison, there was no observed change in the ACQ score of the control group. A greater proportion of patients in the control group reported an exacerbation compared with the intervention group (60% vs 26%; P = .04).

While there was no observed change in the daily step count of the control group, the mean daily step count improved from 5283 per day to 9439 in the intervention group. Prior to the intervention period, the participants were considered to be either physically inactive or low active; however, after the intervention, 19 patients improved their step count and were reclassified to being low active (n = 6), somewhat active (n =7), active (n = 3), and high active (n = 30).

The researchers also found improvements in anxiety and depression, as measured by the Hospital Anxiety and Depression Scale, as well as sleep improvements in the intervention group. No patients in the control group reported an improvement in their anxiety symptoms compared with 43% of patients in the intervention group. Only 5% of patients in the control group reported a reduction in depression symptoms, compared with 10% of patients in the intervention group.

“These data suggest that a comprehensive approach to behavior change can potentially be a complementary or alternative strategy to supervised exercise training to improve clinical control in adults with moderate to severe asthma,” the authors concluded.


Freitas PD, Passos NFP, Carvalho-Pinto RM, et al. A behavior change intervention aimed at increasing physical activity improves clinical control in adults with asthma: a randomized controlled trial. Chest. Published online September 12, 2020. doi:10.1016/j.chest.2020.08.2113