Doing sport is both possible and highly recommended for people with asthma! Discover why with pulmonologist Dr Cécile Olivier.
There are several types of asthma: mild intermittent, mild persistent, moderate persistent and severe persistent. No matter the type, exercise can trigger an attack. This is referred to as exercise-induced asthma. This might lead you to think that asthma and exercise aren't compatible. But you'd be wrong! In fact, exercise is strongly recommended for asthmatics.
To explain everything, I had the honour of putting some questions to Dr Cécile Olivier, pulmonologist and asthma specialist at CESAL (Lille sleep research centre).
Dr Olivier: "Sport is recommended for people with asthma just as it is for the general public. It brings both physical and mental benefits. It improves exercise tolerance, which is particularly important for asthmatics."
Dr O: "I not only advise it, I strongly recommend it. In the case of kids, they shouldn't be excused from doing sport. In some cases it might be necessary, but it should be temporary rather than for the entire school year. For more complicated sports, you should adapt the activity to the person's needs, instead of stopping them from doing it in the first place."
Dr O: "The effects aren't actually on the asthma itself, but on the respiratory muscles. Doing regular exercise will increase the capacity of the diaphragm and intercostal muscles. This will make breathing easier, as the muscles will be of better quality.
Exercise also brings psychological benefits, and that applies for any type of chronic illness. It's really beneficial!"
Dr O: "Exercise-induced asthma appears during exercise and manifests as coughing or shortness of breath. These symptoms are caused by the narrowing of the bronchi.
Often, exercise-induced asthma doesn't appear immediately. You have to wait a short while - generally 5 to 10 minutes after starting exercise, or once you've stopped.
It shouldn't be confused with shortness of breath during exercise, which occurs in people who do little physical activity and who are therefore going to get out of breath quickly (unconditioned to exercise). Hence the importance of regular physical activity.
Stopping sport leads to a loss of physical capacity, so you quickly get short of breath. When you start exercising again, it feels hard. But it's worth persevering and finding the most suitable physical activity.
Asthmatics are fully capable of doing sport. The best proof is the existence of high-level athletes with exercise-induced asthma. It doesn't stop them from performing."
Dr O: "If you don't have any allergies or skin problems that are exacerbated by chlorine, swimming is a good choice. It's great for training your lungs and developing your thoracic muscles. Swimming therefore increases lung power."
Dr O: "Strength training is accessible to everyone and can be easily adapted to suit any level of physical ability. The exercises are variable and varied, using weights or just your own bodyweight to improve muscle tone, posture, strength and exercise tolerance through repetition."
We often enjoy sport more when we do it as a group thanks to the feeling of team spirit and shared success.
Basketball is a great example of a sport that asthmatics can do. It involves no more than 5 minutes of effort at a time, doing intervals (repeated 15-second, generally quite intense efforts) in a suitable environment. The fact that it's done indoors leads to fewer asthma attacks than with outdoor sports.
Dr O: "Underwater diving isn't a great sport for people with asthma. It has long been contraindicated and remains something to avoid. Asthma attacks triggered by exercise-induced hyperventilation occur when the airways are cooled down, and this can be caused by inhaling the gas from diving cylinders. It's really the only sport to avoid."
Exercise can cause asthma attacks, but so can allergies.
Dr O: "Of course, if you have allergies, you should avoid environments where there are lots of allergens. For example, if you're allergic to horses or hay, you probably shouldn't do horse riding. The same is true if you have hayfever: avoid running outdoors during the pollen season. You should adapt the sport to your allergies.
In addition, I wouldn't recommend doing outdoor sport if there's a spike in pollution. It's about using common sense."
Dr O: "Running causes more irritation than cycling. Exercise-induced asthma can occur faster in winter; as your breathing rate increases, the cold, dry air can irritate the airways. You breathe more through your mouth in these situations, and less through your nose, which is a humidifier and naturally heats the air. Breathing through the mouth dehydrates the bronchi, leading to constriction of the airways and potentially an asthma attack.
If you exercise in mild weather or indoors, the risk is much lower."
Dr O: "It's well worth warming up before starting your activity. You should get your body and airways ready by doing at least 10 minutes of warm-up. Don't forget to schedule in some recovery time after exercise too.”
What's the best way to warm up before exercise?
Dr O: “When getting into sport, it's important to pick an activity you like, where you're sure to have fun. You might want to do it with someone else for extra motivation, because at the start it might not be very enjoyable and you might be tempted to throw in the towel. To avoid that, it's best to start gradually.”
How can you help friends or family take up exercise?
Dr Olivier also reminds us about the importance of medication:
“Some asthmatics will want to take their inhaler to improve their capacity, make sure they're ready and avoid any attacks during exercise.
You should always keep your inhaler on you and pay attention to the weather conditions (pollen, cold/dry weather, and pollution)."
Dr O: "To improve your breathing capacity, you could try Pilates exercises or the exercises suggested by a breathing and meditation app. This will teach you to control your breathing.
It may also involve holding your breath, and even singing. Singing helps you control your breath to give you better control during attacks."
Dr O: "As you get older, your lung capacity tends to decrease. Your respiratory organs naturally age. But growing older doesn't mean your asthma becomes more severe. On the contrary, you just need to adapt your exercise to your age.
For example, you might want to take up Nordic walking or Pilates, which are very accessible and keep you active without causing any harm.
Qi gong is also a great sport as it's low-impact, trains your breathing and strengthens your muscles.
Cycling, too, is becoming more and more popular thanks to electric bikes, which are great as they keep you exercising for longer! It's important to encourage people to do sport even if they need a helping hand, because it's better to do an assisted activity than to not do anything at all."
“When you're young, you should try to be active to develop your exercise tolerance. It's the job of pulmonologists to support patients by making this physical activity feasible.
The more physical activity you do, the more doctors will be able to adapt your treatment.
Dr O: "Kids absolutely shouldn't be excused from exercise. If necessary, you should adapt the activity to make it physically possible. Don't worry about performance; focus on fun!
Thankfully, sports exemptions are something that's happening less and less. In the past, we'd advise kids not to do sport, but today we know it's beneficial."
We all know that sport is good for us, but it's common to have the odd concern, particularly when it comes to health.
I hope that after reading our chat with Dr Cécile Olivier, you'll feel that all your questions about asthma have been answered.
Many thanks to Dr Olivier for her valuable advice and explanations!