Asthma

Asthma is an airway condition in which narrowing, swelling and mucus production cause episodes of coughing, wheezing, shortness of breath and chest tightness.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 573.} Cold air, viral infections, stress, tobacco smoke, allergens and exercise can trigger symptoms.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 573.}

Between 60% and 90% of clients with diagnosed asthma experience acute airway narrowing after starting activity, called exercise-induced bronchoconstriction (EIB).^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 573.} EIB usually begins 2 to 5 minutes into exercise, peaks around 10 minutes and clears about an hour after exercise stops.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 573.} A late phase can follow 1 to 6 hours after exercise.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.} ACSM finds exercise training well tolerated and safe in clients with stable asthma.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 581.}

In practice

• Ask to see the client’s written asthma action plan.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.} If there isn’t one, encourage the client’s health care provider to write one.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.} Refer medication questions to the prescribing physician.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.}
• Use a 10 to 15 minute variable-intensity warm-up and a cooldown to lower EIB risk.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.} ACSM cites strong recommendations for the same warm-up length to create a “refractory period” in which EIB is less likely.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 581.}
• Postpone sessions in extreme temperature and humidity, and monitor breathing after the workout ends.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.}
• Rate breathlessness on a 0 to 10 dyspnea scale and keep aerobic work around 3 to 4.^{2Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 574.} Untrained clients may initially tolerate low-resistance, high-repetition work more easily: 2 to 4 sets of 10 to 15 reps with rest intervals of 3 to 4 minutes.^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 575.}