Targeting behaviour to increase physical activity levels and improve sedentary behaviour in a severe asthma population

Asthma is a disease that is prevalent and manageable, however, a proportion of people with asthma have severe disease, meaning that it is not controlled despite optimal pharmacotherapy, or requires high-dose treatment to remain controlled (2). People with severe asthma have a high disease burden that impacts their quality of life and the healthcare system (3, 4). This burden continues even with advances in pharmacotherapy options for people with severe asthma (5, 6). More research is needed to improve the quality of life of people with severe asthma, particularly to identify effective non-pharmacological interventions. Strategies that optimise movement behaviours may be one potential approach. Recent research has demonstrated overall health- and asthma-related benefits of movement, and that people with asthma are at risk of engaging in low amounts of physical activity and high amounts of sedentary behaviour (7-11). It is important to consider physical activity and sedentary behaviour as two distinct behaviours, with their own independent health risk factors and required targeted approaches to achieve changes (12, 13). There is existing evidence to support interventions that lead to improvements in physical activity levels in people with severe asthma, although it is unknown if these changes lead to long-term maintenance of behaviour (14). Sedentary behaviour is an emerging research field and has not been widely investigated in a severe asthma population, particularly not as a separate construct from physical activity. Shifting the focus to addressing sedentary behaviour may be an attainable starting point for a progressed increase in physical activity participation and overall movement behaviours. To date, and our knowledge, no studies have explored the effects of a sedentary behaviour focused intervention in severe asthma. Existing interventions focus on increasing moderate-to-vigorous intensity physical activity (MVPA), with limited research available on the effectiveness of these interventions for reducing sedentary behaviour in people with severe asthma (14). Achieving changes in movement behaviours for people with severe asthma, necessitates the implementation of approaches that overcome disease-specific challenges that people with severe asthma face (14).