Description
Intervention design: Over 12-weeks, adults with severe asthma were recruited. Participants were randomised 2:1 to parallel yoga or control groups. All participants received an activity tracker.
The yoga group participated in two supervised 75-min group classes of yoga and mindfulness per week for 16-weeks in a private room during office hours (up to 8 participants/class), in addition to usual care. An accredited yoga practitioner designed and delivered the programme, in collaboration with the investigator team. Classes focused on increasing movement, controlling breath, and meditation to improve mindfulness, and were designed to be suitable regardless of experience, ability and physical limitations. The instructor explained how to perform the exercises, described precautions and encouraged participants to apply the lessons at home. Participants were advised to self-administer salbutamol before sessions to prevent exercise-induced bronchospasm. At their first class participants received an activity tracker (Fitbit Charge 2 [Fitbit, Inc], or pedometer for participants without smartphones) and were encouraged to progressively increase their daily steps according to an algorithm, up to 10,000 steps/day. Participants were also given information sheets (physical activity guidelines, SMART goal-setting, exercise and severe asthma and mindfulness), a printed calendar to track their activity goals, and a BORG Dyspnoea Scale to monitor dyspnoea during physical activity.
The control group received a minimal physical activity goal-setting intervention supported through telephone contact with an exercise physiologist research officer, in addition to usual care. Participants were mailed their activity tracker, the same printed documents as the yoga group, and a workbook to record goals and progress.
People involved: Participants were recruited via the John Hunter Hospital Department of Respiratory and Sleep Medicine’s ambulatory care clinics and research database, and via general/social media advertisement. G1: 15 (yoga) G2: 8 (control); Age: G1: 67 (±9), G2: 68 (±8). The inclusion criteria were: adults (≥ 18 years) with evidence of variable airflow limitation in the last 10 years (bronchodilator response≥ 12% or airway hyper-responsiveness or peak flow diary (variation ≥ 15% or > 50 ml), and severe asthma according to the European Respiratory Society (ERS)/American Thoracic Society (ATS) taskforce definition: asthma requiring high-dose inhaled corticosteroids (> 1000 μgbeclomethasone equivalent ) with a second controller to prevent uncontrolled disease or disease that remains uncontrolled despite therapy.
Identified barriers: Participants entered the study knowing the intervention was a yoga trial, which may have led to selection bias in the type of participants who volunteered. Furthermore, participants knew their group allocation, which may have led to bias in participant response to outcome questionnaires. To reduce these risks, both groups were informed that the effect of this intervention is unknown, and that true equipoise exists.
Sustainability
Transferability: asthma patients in all countries