Increasing daily steps is as effective at controlling moderate to severe asthma as supervised treadmill training, according to University of Sao Paulo researchers.
The study found that both physical activity strategies improve overall quality of life, relieve symptoms of anxiety and depression, and maintain medium term control over the disease. These findings provide doctors and patients with more flexible and accessible non-pharmacological treatment options.
Asthma is a chronic inflammatory disorder of the respiratory airways that causes recurring episodes of wheezing, coughing, chest tightness, and breathing difficulty. The University of Sao Paulo, located in Brazil, is South America's largest public university and a premier center for medical research.
The investigation originated from the doctoral research of physiotherapist David Halen Araujo Pinheiro, who is currently a postdoctoral researcher at the Laboratory of Investigation in Physical Therapy and Exercise at the Hospital das Clinicas of the University of Sao Paulo Medical School. His work was supported by a research grant from the Sao Paulo Research Foundation.
The Hospital das Clinicas serves as the primary teaching hospital complex for the university's medical faculty in Sao Paulo. Pinheiro noted that a previous study demonstrated that asthma patients who walk at least 7,500 steps per day already achieve significantly improved clinical control of their condition.
Participant recruitment and selection criteria
Researchers initially invited 480 patients to participate in the project, with 52 individuals successfully joining the trial following a thorough screening process. The active intervention phase lasted two months, with a final follow-up evaluation conducted four months after the intervention ended.
To qualify for the trial, volunteers were required to have a confirmed diagnosis of moderate to severe uncontrolled asthma and be physically inactive, defined as engaging in less than 150 minutes of physical activity per week prior to the study. Participants also had to be receiving ongoing medical treatment for at least six months, remain clinically stable without sudden symptom worsenings in the previous 30 days, and be non-smokers between the ages of 18 and 65.
The majority of the enrolled volunteers were women who were classified as overweight or suffering from grade 1 obesity. In addition to low self-reported quality of life, most participants exhibited active symptoms of anxiety and depression at the start of the study.
Exercise program design and evaluation methods
Prior to starting the active interventions, participants attended an in-person educational lecture covering topics such as the pathophysiology of asthma, proper medication techniques, and the health benefits of regular exercise. Volunteers were then randomly assigned by draw to one of two groups for an eight-week program.
The first group attended the Hospital das Clinicas twice a week for 45-minute treadmill aerobic training sessions under direct professional supervision. The second group visited the hospital once per week for sessions lasting up to 90 minutes, receiving counseling, guidance, and encouragement to increase daily physical activity through walking and weekly goal setting. Members of the behavioral group were equipped with smartwatches to track their daily step totals during the trial.
Researchers evaluated physical activity levels, clinical asthma control, quality of life, and depression and anxiety symptoms at three distinct stages: baseline before the study, immediately post-intervention at eight weeks, and during the follow-up four months later. Each assessment phase lasted seven days and seven nights, during which volunteers wore an accelerometer on their waist by day to count steps and another on their wrist at night to measure sleep quality.
Asthma symptom improvements and step count data
Volunteers in both study groups experienced a reduction in respiratory symptoms and successfully maintained those clinical benefits four months after the formal interventions concluded. Pinheiro stated that both approaches proved beneficial in improving disease control, noting that neither intervention demonstrated superiority over the other.
Pinheiro explained that while supervised aerobic treadmill training requires dedicated gym apparatus and staff supervision, simple daily walking allows patients to control asthma symptoms while gaining additional health benefits such as improved quality of life and reduced anxiety and depression.
Following the two-month intervention, researchers intentionally refrained from contacting participants for four months before scheduling the follow-up evaluation. Pinheiro stated that this step was taken to avoid influencing the volunteers and to observe how they managed their daily lives independently.
During the four-month follow-up assessment, several participants from the aerobic training group reported joining a gym to continue using treadmills, whereas patients from the behavioral group maintained regular daily walking routines. However, not all volunteers sustained their physical activity, with weather variation cited as the primary reason for stopping exercise.
Daily step counts increased in both groups post-intervention and declined slightly at follow-up, though totals in both groups remained above initial baseline levels. In the aerobic training group, daily steps increased by an average of 1,537 steps above baseline after two months, dropping to an average gain of 983 steps per day above baseline at the four-month mark.
In the behavioral intervention group, daily steps increased by an average of 1,126 steps above baseline immediately after the two-month program. Four months later, the daily step count increase stood at an average of 996 steps above baseline.
Pinheiro described it as an interesting finding that after four months, the step count increase recorded by the behavioral walking group was slightly higher than that of the aerobic training group.
