Information for Other Sports

Asthma UK have produced this guidance for managing asthma whilst exercising

Managing your asthma while exercising

What are the symptoms to look out for when you are active?

When you exercise it's normal for your heart to beat faster and your breathing to be quicker. If you're doing vigorous activity you'll feel out of breath, hot and sweaty.
Make sure you can tell the difference between feeling out of breath through exercising, which is normal, and the symptoms of asthma. Then you can stop and take your reliever if you need to. Ask your doctor or nurse about what symptoms to look out for.
Remember, exercise won't harm your lungs. When you feel short of breath, it's a sign that your body is working harder. If you control your breathing you'll be able to keep going for longer.
When exercising it's normal if:

• you're breathing faster and harder
• your heart is beating faster
• you're feeling hot and sweaty
• you're looking flushed.

Stop exercising if you:

• start coughing/wheezing
• are gasping for air/very short of breath/can't get enough air
• feel tightness in the chest
• have trouble speaking in short sentences
• younger children may complain that their chest or tummy hurts.

You're having an asthma attack if any of these happen:

• your reliever inhaler doesn't help
• your symptoms are getting worse (cough, breathlessness, wheeze or tight chest)
• you're too breathless to speak
• cyanosis (a blue tinge on the skin or lips). This is a sign of lack of oxygen in the blood and means you need urgent medical attention.

 

What to do in an asthma attack

The following guidelines are suitable for both children and adults and are the recommended steps to follow in an asthma attack:

1. Take one to two puffs of your reliever inhaler (usually blue), immediately.
2. Sit down and try to take slow, steady breaths.
3. If you do not start to feel better, take two puffs of your reliever inhaler (one puff at a time) every two minutes. You can take up to ten puffs.
4. If you do not feel better after taking your inhaler as above, or if you are worried at any time, call 999.
5. If an ambulance does not arrive within 10 minutes and you are still feeling unwell, repeat step 3.

If your symptoms improve and you do not need to call 999, you still need to see a doctor or asthma nurse within 24 hours.

 

If exercise triggers your asthma

Exercise can be a trigger for asthma. This can happen to anybody with asthma: children or adults, people who play sports or elite athletes.

 

How does exercise trigger asthma?

It's not known exactly how exercise triggers asthma. When people exercise they breathe faster. This makes it more difficult for the nose and upper airways to warm up and add moisture to the air breathed in, so the air is drier and colder than usual. It's thought that this cold, dry air in the airways triggers the symptoms of asthma.

 

Managing exercise-triggered asthma

Asthma shouldn't stop you doing any type of exercise as long as you:

• see your doctor regularly
• keep your asthma well controlled
• take the right medicine
• slowly build up the amount of exercise you do and the level of intensity, starting with gentle exercise before trying more vigourous activities.

Factors that may trigger asthma when exercising include:

• continuous physical activity
• long distance and cross country running (as this often talks place outside in cold air and without breaks)
• high intensity exercise
• low physical fitness
• cold, dry air
• recent respiratory infection
• some adventure sports or outdoor activities may bring on asthma symptoms. This is more likely to be related to emotional or environmental factors associated with the activity, e.g. excitement, anxiety, stress, weather, pollen count, altitude.
• fitness tests
• dusty equipment
• chlorine in swimming pools.

 

Activities less likely to trigger asthma

Activities that require short bursts of energy alternated with slower paced exercise are less likely to trigger asthma. These include:

• team games such as football, hockey, netball and volleyball

• badminton or table tennis, as they are slower than tennis or squash

• field games, like cricket or rounders
• swimming, as the warm humid air is less likely to trigger asthma, but chlorine used in pools or cold pools may be a trigger for some people
• yoga, Pilates or t'ai chi, provide a workout for both your body and mind. Postures are performed in harmony with breathing techniques. Some people find that breathing techniques are helpful for their asthma. However, don't stop taking your normal asthma medicines unless your doctor or asthma nurse advises you to.
• low-moderate intensity exercise, e.g. walking, cycling, yoga.

 

Asthma that only comes on with exercise

Some people find that they have symtoms of asthma only when they exercise and not at any other time. This is unusual and affects only a small number of people. It is sometimes called exercise-induced asthma.
What would the symptoms be?
The symptoms are the same and include coughing, wheezing, chest tightness and difficulty in breathing. Symptoms usually begin after exercise and worsen about 15 minutes after exercise stops.
If you think you have asthma that comes on only when you exercise let your GP or asthma nurse know. To help you manage your asthma they may ask you to record some peak flow readings during and after exercise.
Asthma brought on by exercise is still treated the same, usually with preventer and reliever inhalers. The good news is that many top athletes have asthma and are still able to complete at a very high level.

Exercise can be divided into three categories, and you should aim to do a combination of all three.

Aerobic activity

Aerobic activity uses all your major muscle groups, is usually rhythmic, and raises your heart rate and makes you breathe quicker.
Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break into a sweat. One way to tell if you're working at a moderate intensity is if you can still talk but you can't sing the words to a song.
Moderate-intensity activities include:

• brisk walking
• gentle swimming
• dancing
• cycling
• jogging.

Vigorous-intensity aerobic activity means you're breathing hard and fast, and your heart rate has gone up quite a bit. If you're working at this level, you won't be able to say more than a few words without pausing for a breath.
Vigorous intensity aerobic activity for most people include:

• fast running  
• aerobics
• swimming fast
• riding a bike fast or on hills
• playing singles tennis
• playing football
• hiking uphill
• energetic dancing, eg Zumba, Ceroc
• martial arts

If you have painful and stiff joints avoid weight-bearing high-impact exercise such as aerobics and running. But even with stiff joints, there are plenty of exercises you can do - such as swimming and some forms of yoga. These put very little stress on weight-bearing joints such as knees and ankles. There are even exercises you can do while sitting in a chair.

Strengthening exercises

As well as aerobic activity, you should also do muscle strengthening exercises. Muscle-strengthening exercises are counted in repetitions and sets. A repetition is one complete movement of an activity, like lifting a weight or doing a sit-up. A set is a group of repetitions. For each activity, try to do 8 to 12 repetitions in each set, eg 8 - 12 sit-ups would be one set.
Try to do at least one set of each muscle-strengthening activity (eg back, chest, abdomen, shoulders, legs and arms). Even better, do two or three sets, with a short break (about one minute) in between.
There are many ways you can strengthen your muscles, whether at home or in the gym. Muscle-strengthening activities include:

• lifting weights
• working with resistance bands
• doing exercises that use your body weight for resistance, such as push-ups or sit-ups
• heavy gardening, such as digging or shovelling
• yoga, Pilates or t'ai chi.

You can do activities that strengthen your muscles on the same day or on different days as your aerobic activity, whatever's best for you.
Some vigorous-intensity aerobic activities provide both aerobic and muscle-strengthening exercise at the same time. Examples include circuit training, aerobic dancing or running. If you use the gym your exercise programme will probably include a combination of aerobic and strengthening exercises.

Stretching

This is an important part of your warm up and cool down, and can help to improve flexibility and range of motion in your joints. This will usually be included in a gym based exercise programe or class. Yoga, Pilates and t'ai chi also involve stretching exercises. Stretching is also something that can also be easily done at home.

 

 

Where can I exercise?

Exercise wherever you feel comfortable. Walking, running and cycling are free and you can enjoy them at any time. Some people prefer to go to a gym or a leisure centre, or even a community centre, which offers a range of activities such as aerobics classes, dance, circuits, yoga, Pilates or other sports.
You may have a local Exercise on Referral scheme. This means your GP can refer you to a nearby gym, where specially qualified instructors run supervised exercise sessions (gym or classes). These are often at a reduced price and are specifically for people who have health conditions. Ask your GP or asthma nurse if there is a scheme in your area.

 

 

Adventure sports

People with asthma may need to take special care when doing adventure sports. It is important that you contact your doctor before undertaking these activities. Always tell the instructor you have asthma and ensure that your reliever is easily accessible. You should mention your asthma on medical insurance, fitness declaration and medical waiver forms; if you don't and something happens you may not be covered.

Scuba-diving

In recent years medical opinion has recognised that people with controlled asthma symptoms can take part in scuba-diving. However, if you have asthma you may have greater problems when scuba-diving because of the triggers to which you are exposed when you dive (cold air, exercise, stress, emotion).
Regulations on scuba-diving by people with asthma vary between countries. It is important that you check the regulations of a particular country before you plan to dive, as some do not allow anyone with asthma to scuba-dive. The British Sub-Aqua Club suggests that those with mild, controlled asthma may dive provided that:

• you do not have asthma that is triggered by cold, exercise, stress or emotion
• your asthma is well controlled
• you have not needed to use a reliever inhaler or had any asthma symptoms in the previous 48 hours
• your peak flow must be within 10% of your best value for at least 48 hours before diving.

You may also be asked to undertake an exercise test.

Mountaineering

The clean air of the mountain environment is ideal for those whose asthma is triggered by pollution. You are unlikely to be troubled by house-dust mites - a very common asthma trigger - as they cannot live at the low temperatures above 'the snow line'.
The mountain environment contains several triggers for people with asthma (cold, dry air and exercise). If you are physically fit with well-controlled asthma and prepare adequately for your trip you should not be restricted in your activity. Always consult your doctor before planning a trip. Medical advice on mountaineering at high altitudes is available from the British Mountaineering Council.

Skiing

Skiing involves many of the same asthma triggers as mountaineering. Cross-country skiing is thought to be a stronger trigger for asthma than downhill skiing or mountaineering.
People with well-controlled asthma should be able to ski safely. You should make sure that your asthma is well controlled before you go. Always take your medicines with you when you ski and discuss your trip with your doctor in advance.

Parachute jumping

Always consult your doctor before planning a parachute jump or skydive. Medical advice on skydiving and parachuting is available from the British Parachute Association. As a general rule you can parachute jump or skydive if:

• your asthma is completely controlled
• cold air does not trigger your asthma
• exercise does not trigger your asthma