Digital coaching increases asthma control and quality of life

Digital coaching increases asthma control and quality of life

A randomized study shows that while online coaching doesn't keep people with asthma active long-term, it can still lead to significant improvements in motivation, symptom control and quality of life.

Study: Short- and medium-term effectiveness of an online physical activity behavior change intervention in adults with asthma. Photo credit: New Africa/Shutterstock.com

In a recent study published inScientific reportsResearchers examined the effectiveness of a behavioral intervention in reducing sedentary behavior and increasing physical activity in asthmatics.

They found that the intervention did not produce major long-term improvements in participants' sitting behavior or physical activity compared to asthma education alone. However, in the short term, it was associated with improvements in exercise motivation, perceived competence, asthma control, and asthma-related quality of life, suggesting that more participants experienced significant benefits, even if mean group scores were not significantly different.

Why inactivity and sedentary time worsen asthma outcomes

Adults with asthma are generally less physically active and spend longer periods of time sitting, both of which are associated with worse asthma outcomes such as reduced lung function, poorer symptom control, and increased shortness of breath.

Regular physical activity has been shown to improve asthma control and symptoms and is recommended by physicians as part of non-pharmacological asthma treatment. However, increasing and maintaining physical activity in people with asthma remains a challenge. Behavior change theories suggest that successful interventions should go beyond education and consider psychological needs, motivation, and self-regulation. Although behavioral change interventions for asthma have shown promise, most studies have been conducted face-to-face and remote approaches remain poorly understood.

Given the increasing use of telemedicine, particularly following the coronavirus disease 2019 (COVID-19) pandemic, online interventions may provide a convenient and scalable approach to promoting physical activity among asthmatics.

Testing an online behavior change program versus education

This single-blind, multicenter, randomized, controlled trial recruited adults aged 18 to 60 years with stable asthma who were insufficiently physically active. Participants were assessed at baseline, immediately after a 12-week intervention, and again at a 6-month follow-up. All participants received an online training program that addressed asthma management and provided information on sedentary behavior and physical activity. The intervention group also received a structured online behavior change program delivered by a trained physical therapist.

This program combined strategies from established behavior change models and included weekly individual sessions, four group sessions, goal setting using an activity monitor, and a workbook to support self-monitoring. Sedentary behavior and physical activity were quantified using accelerometers. Secondary endpoints included asthma control, asthma-related quality of life, motivation to exercise, and psychological needs for exercise, assessed using validated questionnaires. Statistical analyzes included linear mixed models to compare changes between groups over time.

Short-term increases in motivation without permanent changes in activity

A total of 51 adults with stable asthma were included in the analysis and randomly assigned to the intervention group (n = 25) or the control group (n = 26). At baseline, there were no significant differences between the two groups in demographic characteristics, asthma severity, lung function, physical activity, sedentary time, or psychosocial measures. No significant differences were observed between groups in objectively measured sedentary behavior or physical activity after the intervention or at six months.

However, over the 12-week intervention period, participants in the intervention group gradually increased their average daily step count, with averages increasing from about 6,500 steps at the start of the program to over 10,500 steps in the final week. These improvements were not sustained after the intervention and activity monitoring ended.

In terms of psychological outcomes, participants in the intervention group reported significantly higher perceived competence in training and higher levels of identified, autonomous motivation immediately after the program compared to the control group. Within-group analyzes showed short-term improvements in autonomy, competence, relatedness, and overall self-determination in the intervention group, while the control group showed more limited motivational changes. These psychological benefits did not persist at the six-month follow-up.

Asthma control values ​​did not differ significantly between groups at any time point. Nevertheless, a greater proportion of participants in the intervention group achieved clinically meaningful improvement in asthma control immediately after the intervention, and their mean asthma control scores remained below the threshold for uncontrolled asthma at follow-up, a finding that was considered clinically relevant despite the lack of statistical significance.

Although overall quality of life scores did not differ significantly between groups, a significantly larger proportion of intervention participants achieved clinically meaningful improvements, particularly in symptom-related domains, with these benefits lasting up to six months. Improvements in asthma control were moderately correlated with improvements in asthma-related quality of life.

Digital coaching improves symptoms without maintaining activity

This study found that adding an online behavior change intervention to asthma education did not result in sustained improvements in physical activity or reductions in sedentary behavior beyond the effects of education alone. However, the intervention was associated with short-term improvements in exercise motivation, perceived competence, and clinically meaningful gains in asthma control and asthma-related quality of life, while longer-term benefits were limited to symptom-related quality of life.

The lack of sustained behavior change may be due to reduced motivation after removal of activity monitors, fundamental misclassification of physical activity levels, or the influence of education alone on both groups. The authors also note that behavior change strategies alone may not be sufficient without complementary approaches such as structured exercise training.

Strengths include objective measurement of physical activity, theory-based intervention design, use of a widely accessible online platform, and recruitment from multiple centers. Limitations include the modest sample size, lack of stage-specific adjustment, and lack of structured exercise training.

Although the intervention did not change long-term activity behavior, it demonstrated overall clinically relevant but not statistically significant benefits on quality of life and asthma control, supporting the potential value of theory-based online approaches as an adjunct to asthma treatment, particularly when combined with more intensive or face-to-face interventions shown to be effective in previous studies.

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