Pulmonology · Medical Literature
Aerobic training versus behavioural intervention to increase physical activity on clinical control of people with moderate-to-severe asthma: A randomised clinical trial.
Abstract
Aerobic training (AT) or behavioural interventions (BI) to increase physical activity in daily life (PADL) improve clinical control in people with asthma; however, comparisons between these interventions remain poorly known. To compare the effects of AT versus BI on clinical control in people with moderate to severe asthma in the short- and medium-term. This two-arm, randomised, assessor-blinded trial included physically inactive adults with moderate to severe uncontrolled asthma assigned to either an aerobic training group (ATG, n = 27) or a behavioural intervention group (BIG, n = 25). AT was performed on a treadmill (2x/week;45 min/session), and intensity was determined by a cardiopulmonary exercise test (CPET). BI was based on social cognitive theory (1x/week; 90 min/session). At baseline, post-intervention (short-term), and after 4-month follow-up (medium-term) assessments included clinical control (ACQ), quality of life (AQLQ), anxiety and depression symptoms (HADS), and barriers to PADL. Most individuals were women, overweight or obese, with anxiety and depression symptoms, and low quality of life. AT and BI improved clinical control, reaching the minimal clinically important difference (MCID) post-intervention, and maintaining it in follow-up (Δ scores of -1.01 vs. -1.46 and -0.57 vs. -0.94, respectively). Furthermore, both groups achieved the MCID for AQLQ after the interventions and at follow-up (Δ scores of 1.33 vs. 1.40 and 0.97 vs. 0.88, respectively). Both interventions yield similar improvements in clinical control and most outcomes. These results suggest that the choice of intervention should be based on the patient's preferences and the intervention centre's capacity to provide care.
Clinical relevance
In physically inactive adults with moderate-to-severe uncontrolled asthma, does structured aerobic training (AT) produce superior improvement in clinical control compared with a behavioural intervention (BI) targeting physical activity in daily life, in both the short term (post-intervention) and medium term (4-month follow-up)? __SNAPSHOT__ {"studyDesign":"Two-arm, parallel-group, assessor-blinded randomised clinical trial","setting":"University hospital outpatient setting, Brazil (Universidade de São Paulo, São Paulo); based on affiliated protocol publication","sampleSize":"n=52 total (ATG: n=27; BIG: n=25)","population":"Physically inactive adults with moderate-to-severe uncontrolled asthma; predominantly female, overweight or obese, with comorbid anxiety and depression symptoms and low baseline quality of life","intervention":"Aerobic training (AT): treadmill-based, 2 sessions/week, 45 min/session, intensity titrated by cardiopulmonary exercise test (CPET), over an 8-week programme (total contact time 12 hours per protocol)","comparator":"Behavioural intervention (BI): based on social cognitive theory, 1 session/week, 90 min/session, targeting physical activity in daily life (PADL), over 8 weeks (total contact time 12 hours per protocol)","primaryOutcome":"Clinical control of asthma measured by the Asthma Control Questionnaire (ACQ) at post-intervention (short-term) and at 4-month follow-up (medium-term)","followUp":"4 months post-intervention (medium-term assessment); intervention duration approximately 8 weeks","fundingSource":"São Paulo Research Foundation (FAPESP) and National Council for Scientific and Technological Development (CNPq) — government (Brazil); based on affiliated protocol publication"}
Key findings
The abstract states that both AT and BI improved clinical control (ACQ), but the full quantitative data — including absolute mean changes, between-group differences, confidence intervals, p-values, and effect sizes for the primary ACQ outcome at either time point — are not reported in the supplied abstract text, which appears truncated. Secondary outcomes assessed included asthma-related quality of life (AQLQ), anxiety and depression symptoms (HADS), and barriers to physical activity in daily life; results for these are likewise not reported in the supplied text. A 2024 ERS Congress preliminary abstract from the same trial (n=27 at that stage) reported that both groups reached the minimal clinically important difference (MCID) threshold of ≥0.5 points on both the ACQ and AQLQ, and that only AT — not BI — improved peak VO₂; no between-group difference in ACQ or AQLQ was reported. No safety or adverse event data are reported in the supplied abstract. NNT/NNH cannot be calculated from available information.
Practice implications
Based on the abstract as supplied (which is truncated before reporting numerical results), the study appears to find that both aerobic training and behavioural intervention improve asthma clinical control in moderate-to-severe, physically inactive adults, without establishing clear superiority of one modality over the other on the primary ACQ outcome. This interpretation is consistent with the preliminary ERS 2024 data from the same trial. Clinically, this suggests that either intervention may be offered as an adjunct to optimised pharmacotherapy, with AT offering the additional benefit of improved cardiorespiratory fitness (peak VO₂) that BI does not appear to confer. The population studied — predominantly female, overweight or obese, with significant anxiety and depression burden — is clinically representative of a challenging real-world moderate-to-severe asthma phenotype, which adds to generalisability within this demographic. However, patients with mild asthma, those who are not physically inactive at baseline, or those without access to supervised treadmill programmes or structured behavioural programmes were not adequately represented. Because only an abstract (truncated) is available — not the full peer-reviewed article — no definitive conclusions about magnitude of effect, statistical significance, or medium-term durability can be drawn. Practice should not change on the basis of this summary alone; the full publication must be reviewed before clinical adoption. __LIMITATIONS__ Critical limitation of this summary: Only a truncated abstract is available; full quantitative results, statistical analyses, confidence intervals, p-values, and adverse event data are not reported herein and could not be verified.,Small sample size (n=52 total; ATG n=27, BIG n=25), limiting statistical power for between-group comparisons and subgroup analyses.,Assessor blinding but not participant or therapist blinding, introducing potential performance and detection bias for patient-reported outcomes (ACQ, AQLQ, HADS).,Single-centre design at a specialised university asthma clinic in Brazil limits generalisability to primary care, non-specialist, or non-Brazilian settings.,Unequal session frequencies (AT: 2×/week vs. BI: 1×/week) with equal total contact time (12 hours), making it difficult to isolate whether differences are due to modality or session structure.,Predominantly female, overweight/obese sample may limit generalisability to male patients or those with normal BMI.,Four-month medium-term follow-up does not establish long-term durability of effects beyond that window.,All primary and secondary outcomes are patient-reported or questionnaire-based; no spirometric or objective airway inflammation data are reported in the abstract.,Government funding reduces but does not eliminate potential institutional bias; trial conducted within the investigators' own institution.,Intervention intensity was individualised by CPET for AT but group-based for BI, introducing heterogeneity in BI dose-response that may underestimate BI efficacy for some patients. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ Both aerobic training and behavioural intervention targeting physical activity appear to improve clinical asthma control and quality of life in physically inactive adults with moderate-to-severe uncontrolled asthma, without clear superiority of either modality on the primary ACQ outcome; aerobic training additionally improves cardiorespiratory fitness. Because only a truncated abstract is currently available for this trial, clinicians should await the full published manuscript before integrating these findings into practice, but the directional signal supports non-pharmacological exercise-based or behaviour-change adjuncts as complementary strategies in this population.