Aerobic training versus behavioural intervention to increase physical activity on clinical control of people with moderate-to-severe asthma: A randomised clinical trial.
Pinheiro D, de Lima F, et al. • Pulmonology • 2026
Both aerobic training and behavioural intervention yield similar improvements in clinical control and most outcomes in people with moderate-to-severe asthma, suggesting that the choice of intervention should be based on the patient's preferences and the intervention centre's capacity to provide care.
Key Findings
Results
Both aerobic training and behavioural intervention improved asthma clinical control to a clinically meaningful degree post-intervention and at 4-month follow-up.
Clinical control was measured using the Asthma Control Questionnaire (ACQ).
ACQ delta scores post-intervention were -1.01 (aerobic training group, ATG) vs. -1.46 (behavioural intervention group, BIG).
ACQ delta scores at 4-month follow-up were -0.57 (ATG) vs. -0.94 (BIG).
Both groups reached the minimal clinically important difference (MCID) for ACQ at both time points.
No statistically significant difference between groups was reported for clinical control.
Results
Both interventions improved quality of life to a clinically meaningful degree post-intervention and at 4-month follow-up.
Quality of life was measured using the Asthma Quality of Life Questionnaire (AQLQ).
AQLQ delta scores post-intervention were 1.33 (ATG) vs. 1.40 (BIG).
AQLQ delta scores at 4-month follow-up were 0.97 (ATG) vs. 0.88 (BIG).
Both groups achieved the MCID for AQLQ after the interventions and at follow-up.
No significant between-group differences were reported for quality of life.
Results
The study population was predominantly women, overweight or obese, with anxiety and depression symptoms and low quality of life at baseline.
Participants were physically inactive adults with moderate-to-severe uncontrolled asthma.
Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS).
Most participants were overweight or obese.
Low quality of life was characteristic of the sample at baseline.
ATG included 27 participants and BIG included 25 participants.
Methods
Aerobic training was performed on a treadmill twice per week with intensity determined by cardiopulmonary exercise testing.
AT sessions were conducted on a treadmill at a frequency of 2 times per week, 45 minutes per session.
Exercise intensity was determined by a cardiopulmonary exercise test (CPET).
The behavioural intervention was based on social cognitive theory, delivered once per week in 90-minute sessions.
The trial was two-arm, randomised, and assessor-blinded.
Results
Both interventions yielded similar improvements across most outcomes, with no significant between-group differences detected.
Outcomes assessed included clinical control (ACQ), quality of life (AQLQ), anxiety and depression symptoms (HADS), and barriers to physical activity in daily life (PADL).
Assessments were conducted at baseline, post-intervention (short-term), and after a 4-month follow-up (medium-term).
The authors concluded that both interventions yield 'similar improvements in clinical control and most outcomes.'
The authors recommended that intervention choice be based on patient preferences and the care centre's capacity.
Results
Improvements in clinical control and quality of life were maintained at 4-month follow-up in both groups.
The MCID for ACQ was maintained at the 4-month follow-up for both ATG (Δ -0.57) and BIG (Δ -0.94).
The MCID for AQLQ was maintained at follow-up for both ATG (Δ 0.97) and BIG (Δ 0.88).
This suggests medium-term durability of both intervention approaches.
Follow-up assessments occurred approximately 4 months after the end of the intervention period.
What This Means
This research suggests that two different types of programs — structured aerobic exercise training and a behavior-change program designed to increase everyday physical activity — can both meaningfully improve asthma control and quality of life in adults with moderate-to-severe uncontrolled asthma. Both groups of participants showed improvements that exceeded the threshold considered clinically meaningful, not just immediately after completing their program but also four months later, suggesting the benefits persisted over time. Importantly, neither approach was clearly superior to the other across the outcomes measured.
The study enrolled 52 physically inactive adults whose asthma was not well controlled. Most were women, overweight or obese, and many had symptoms of anxiety and depression — a profile that reflects the complexity of asthma management in real-world clinical settings. The aerobic training program involved treadmill sessions twice a week with exercise intensity tailored to each person's fitness, while the behavioral intervention focused on motivational strategies based on social cognitive theory and met once a week for longer sessions.
This research suggests that healthcare providers and patients have meaningful flexibility in choosing between these two approaches, since outcomes were comparable. Factors such as patient preference, available resources at a given clinic, and individual circumstances (such as mobility limitations or scheduling constraints) could all reasonably guide the decision. The finding that improvements were maintained four months after the programs ended is particularly encouraging, as it implies the benefits are not merely short-lived.
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Pinheiro D, de Lima F, Cervera V, de Oliveira Y, Dos Santos J, Lunardi A, et al.. (2026). Aerobic training versus behavioural intervention to increase physical activity on clinical control of people with moderate-to-severe asthma: A randomised clinical trial.. Pulmonology. https://doi.org/10.1080/25310429.2026.2684131