Regular exercise has been shown to help reduce asthma episodes but exercise can also be a trigger for asthma. You may have had some scary experiences when you were physically active and that has made you a bit hesitant to exercise. Concerns about getting injured or having a heart attack may also come to mind when you think about exercising. These factors play a role in lowering motivation to exercise because your brain does not want you to do something that puts you at risk, even if you know it could help.
The challenge is, when you are not exercising, your body is adapting to being less active, which lowers your ability to be more physically active. This downward spiral of de-conditioning makes asthma symptoms worse and makes it even more challenging to get started with exercising.
If exercising regularly has been a struggle, let’s think about exercising with asthma* in a whole new way. With a body and brain perspective so you can stay motivated to use exercise to help manage asthma symptoms, lowering your chances of exercise triggering asthma and raising your chances of using it long-term to help with asthma control.
Why exercise can cause asthma symptoms
Cardiovascular exercise increases your breathing as your body needs more oxygen to help fuel muscles using the aerobic energy system. This system is the most efficient way to fuel muscles. Your body uses it at rest and at levels of movement that feel light to moderate for you. When your cells do not have enough oxygen or don’t have the equipment to use oxygen to produce energy, it has to rely on the anaerobic system to fuel cells.
This system produces energy without the need for oxygen but it produces more carbon dioxide as a ‘waste product’. It’s this carbon dioxide build-up that causes labored breathing during higher intensities of exercise as your body tries to get rid of the excess. This heavier breathing can lead to dryness in your airways, which causes more tightness in your airways resulting in an asthma episode.
How exercise helps to manage asthma
Studies show that regular cardiovascular exercise gives you more symptom-free days, reduces the severity of asthma symptoms, and improves breathing capacity and thus quality of life. It does this by improving your body’s ability to fuel cells with the aerobic system so you don’t get as short of breath with everyday activities like climbing stairs.
While cardiovascular exercise is the main type that will reduce your asthma symptoms, building strength and mobility are also key ingredients for exercising
well with asthma.
Strength: Strength training exercises have also been shown to improve breathing limitations by conditioning muscles to work more efficiently, with less demand on your breathing system. Strength training is often a more comfortable type of exercise to start with when asthma, or other conditions like pain, limit your ability to do cardiovascular exercise. If you feel very limited by your breathing or muscle fatigue, starting with strength training for a month or two before trying cardiovascular exercise can help your body feel more comfortable doing cardiovascular exercise.
Mobility: When your body feels stiff and balance is a challenge, your risk of injury goes up. When you move less as a result of an injury, stamina levels drop and your breathing becomes more labored with daily activities, increasing the risk for asthma. Regular mobility exercises are a great way to keep your body moving well with less strain and risk of injury, avoiding the downward spiral of deconditioning that often happens with asthma flare-ups, pain, and injury.
Motivation for exercising with asthma
The challenge is that exercise needs to be done regularly to get these benefits because after just three days of not exercising, or 24 hours of bed rest, the body starts to lose the ‘equipment’ needed to use oxygen to fuel cells. That means you need your brain to choose to exercise at least three times a week. This is not likely to happen when exercise brings up fears of not being able to breath!
The brain is hardwired to avoid activities that threaten your sense of safety. When you have an asthma episode when you exercise or are physically active, it triggers a warning in your brain to avoid being physically active. Your logical brain knows that exercising regularly can reduce asthma episodes, but your survival brain does not want you to feel like you cannot get enough breath. This keeps the logical brain and survival brain working against each other and you have to use a lot of willpower to get yourself to exercise consistently.
Since the survival brain will win out, the key to making exercise a habit when you have asthma is knowing how to exercise so you minimize your risk of an asthma episode. As you experience more and more times exercising without asthma, and see how exercise is helping you reduce asthma symptoms in daily life, your survival brain will agree with your logical brain that exercising regularly is a great idea!
How to Exercise Regularly With Asthma
The most important skill here is your ability to listen to and trust your body when you exercise.
Mindfulness is a key skill for doing this. When combined with skills for exercising right, mindfulness can keep you aware of when you are pushing into the zone that can trigger asthma symptoms. When you are exercising with others and trying to keep up, but asthma is holding you back, it is challenging. Mindfulness allows you to respond with kindness, being willing to give your body what it needs rather than pushing through. Using mindfulness with exercise allows you to pay attention, to listen to and trust your body, which improves your ability to exercise at the just-right level to strengthen your body with less chance of asthma getting in the way.
Exercising well means knowing how to adjust exercise intensity so you avoid this uncomfortable level of breathing. This will allow you to stay in the aerobic zone, which is how exercise improves your breathing capacity and helps reduce asthma symptoms. By slowing down as soon as you sense you have reached this threshold for your breathing, you can stay in the sweet spot that conditions your body while avoiding asthma getting in the way. As you build stamina through regular cardiovascular exercise, fewer activities will cause heavy breathing, expanding the activities you can do without triggering an asthma episode.
Tips for preventing an asthma episode with exercise
Help your body avoid an asthma episode with exercise by doing the following:
Warm-up: Avoid a sudden start to exercise by warming up before exercising. When your body temperature rises, your blood releases oxygen with more ease, reducing the work of your lungs during exercise. Warming up also gives your body time to shift more blood flow from your digestive tract to moving muscles. To warm up, move at a light intensity for two to ten minutes, until you feel your body temperature rising, before moving on to more moderate to comfortable challenging intensities.
Cold Temperatures: When exercising in cold temperatures, cover your mouth with a scarf or mask. This warms the air and keeps it moist to avoid that airway drying that can trigger an asthma episode.
Exercising Indoors: Exercise indoors and listen to your body to keep cardiovascular exercise at light to moderate intensity when in:
High pollution areas
Periods of high allergen levels
Mobility Exercises: Choose mobility exercises and possibility light-level strength exercises instead of cardiovascular exercise when asthma is exacerbated or during a respiratory tract infection. Once the infection has cleared up, return to exercise gradually, knowing you probably lost stamina and it will take time to rebuild.
Reduce Stress Levels: Use exercise to reduce stress levels because stress can also trigger asthma symptoms. Using mindfulness skills while exercise help it become a time of reducing stress each day.
Asthma Medication: Ask your doctor about using a fast acting asthma medication 10-15 minutes before exercise that triggers asthma for you. This can help you avoid or minimize an asthma episode during exercise. Use all of your asthma medications as directed.
Other Medical Conditions: Treat other medical conditions that can worsen asthma symptoms, such as gastric reflux.
Progress Gradually: Progress gradually by listening to your body and remembering that your body can adapt to a 10% increase in exercise a week. That means if you are walking for 20 minutes, the following week increase your duration by only 2 minutes!
Restart Smart: If you have had to take time off from one or all types of exercise, know that you probably lost fitness. Restart smart by doing a very low level and duration of exercise during the first week back to ‘test the waters’ and see how much you lost. Listen to your body and use that same 10% rule for progressing back to your previous levels.
Exercise is one of the treatments for asthma that reduces the frequency of symptoms and improves function in daily life and thus quality of life. The key is knowing how to use exercise so it does not cause asthma symptoms and does not cause injury. Use a growth mindset as you chose the right balance of the three types of exercise, listening to and trusting your body to adjust as needed so exercise leaves you feeling better. This way exercise can improve your function, support making it a lasting habit, and keep you out of the downward spiral of inactivity so you can enjoy more of life with less likelihood that asthma will get in the way.
*Important Note: This article provides general information about exercising with asthma. The specifics about how much is enough and the timing of exercise when you have asthma is very individual. Exercising WELL is the way to have a clinical exercise physiologist as part of your asthma care team. Along with your healthcare providers, I can help you decide the way to use exercise to help with asthma control. Click the button below to learn more about Exercising WELL memberships. Schedule a free call with me to answer your specific questions about exercising well with asthma.
Panagiotou M, Koulouris NG, Rovina N. Physical Activity: A Missing Link in Asthma Care. J Clin Med. 2020;9(3):706. Published 2020 Mar 5.
Aggarwal B, Mulgirigama A, Berend N. Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. NPJ Prim Care Respir Med. 2018;28(1):31. Published 2018 Aug 14.