Asthma and Exercise: An Asthma Primer for Personal Trainers
Reading over a new client’s file to see that they have asthma is either something that has happened to you, or something that will happen to you eventually. With 1 in 12 americans, or 8% of the population, living with asthma 1, as a personal trainer, it’s important to understand how this common condition may affect a client who you are working with. People with asthma can—and should!—exercise like everyone else, and having an educated personal trainer can be a huge key to success for a person with asthma who wants to improve their fitness and overall health.
What is asthma?
Asthma is is a chronic (lifelong) lung disease. It may go into periods of dormancy or “remission”, but once you have asthma, you will always have asthma—it cannot technically be outgrown, but the symptoms may disappear for long periods of time for some people.
Asthma causes the bronchioles (small air passages within the lungs) to become swollen when they are exposed to a “trigger”. The muscles surrounding the bronchioles also constrict, further narrowing the airways from being able to pass air through freely. Finally, excess mucus may be created within the lungs as a defense mechanism against the trigger, and further narrow airways.
What are the symptoms of an asthma exacerbation, attack, or flare-up?
When the airways undergo the process above and air passages become narrower, this is called an asthma exacerbation—more commonly called an asthma attack or asthma flare. Ask your client ahead of time what their symptoms are, and how you may need to assist them (they may not need any help in most circumstances!).
Common symptoms of asthma include:
- Wheezing (a whistling sound produced by narrowing airways)
- Chest tightness
- Shortness of breath (dyspnea)
It can be difficult to gauge shortness of breath when a person is exerting themselves. Using Rated Perceived Exertion (RPE) may be a solution for some clients to be able to communicate how hard they feel they are working. For clients with asthma or other lung disease—like most clients—you will probably want them to feel that they are working at a 3 or 4 on an RPE scale of 0 to 10 (with 0 being that they are sitting completely inactive, and 10 being extreme exertion 2. Be sure you feel comfortable using RPE before implementing its use with a client.
Ask your client what symptoms are normal for them when they are not exercising—most clients should be symptom free at baseline. However, for myself, I have a mild cough even at rest. This is something that as a trainer you should be aware of, so you don’t feel that you need to react every time I cough! Clients with more severe asthma may have significant breathlessness at baseline, and this is important to gain an understanding of prior to beginning work with them.
Who gets asthma?
Asthma can develop at any age. While it most commonly develops in childhood, and has a few different peaks of onset in women [LINK], it does not only affect certain populations. Asthma, allergies and eczema (a skin condition causing frequent, itchy rashes and hives in response to various triggers) often coexist, but a person does not have to have either allergies or eczema to have asthma (or the reverse).
What is exercise induced asthma?
Asthma symptoms are triggered by exercise in about 70 to 90% of people with asthma—this is known as exercise induced asthma [EIA] or exercise induced bronchospasm or bronchoconstriction. Some people, however, have no other triggers except exercise! So, while not all people with asthma are triggered by exercise, chances are pretty good that a client with asthma experiences EIA
How should I program for a client with exercise induced asthma?
Most clients with asthma who do not have significantly impacted lung function should be trained with only a few small modifications. They should engage in an extended warm-up and cool-down, both of about fifteen minutes. Clients may benefit from using lower-weight resistance exercises and a higher number of repetitions. For more information, refer to our post on exercise guidelines for people with asthma [LINK]. Most importantly—like all clients—check in with your client who has asthma! They know their disease better than anybody, and know how certain activities may affect their breathing.
Be mindful as well to avoid wearing cologne, perfume, or scented lotions when working with a client with asthma. Be aware of non-exercise asthma triggers the person may have that may be present in your training space—cleaners, dust, fragrances other participants are wearing, humidity, cold air, pollen from indoor plants, for example. It could also be a good idea to do a walk-through with your client during your first meeting or their orientation tour and see what they may notice as a potential problem. Many people with asthma will also have increased asthma symptoms with a cold or other virus, so if they have been sick recently, ensure to check in to see what level of workout they can handle when they return.
Sometimes, clients will take a dose of their rescue medication about 15 minutes prior to working out. In a pre-training meeting, you may wish to ask if they’d like you to check in to ensure they've remembered to take their meds—however, if they say that no reminder is needed… don’t bug them! :)
Most tests will be the same for a client with asthma as any other client. Be aware that asthma medications may increase heart rate, so try to consistently collect this data around the same time after medication has been taken to produce accurate results for trending. If resting heart rate is being measured, it may be worthwhile to have someone record the person’s heart rate upon arrival and prior to the client dosing with asthma medications, or having the client check on their own.
What should I do if my client has an exacerbation?
Learn what your client’s symptoms look like, and if you suspect they are struggling, check in. Ensure they have any rescue medications (inhalers) prescribed with them at the beginning of each session—they do not help if they’re locked up in their locker!
If a client has a sudden onset of cough, shortness of breath preventing them from saying more than 3 or 4 words without taking a breath (determine what is normal for your client), or begin to hold their chest, or sit with their hands on their knees (a common posture used to attempt to increase airflow), insist they stop the activity and sit down—do not leave the person alone at any point.
Taking inhaled medications becomes second nature for most of us, but some clients may want assistance—check on your local legislation on just how much you are able to help. In many cases, a bystander (in this case, yourself) can shake a metered dose inhaler medication, attach the inhaler to a spacer/valved holding chamber device [LINK] if used, and assist as much as needed, with the EXCEPTION of actuating the inhaler (pressing down on the canister to release the medication)—check with your local first aid training centre regarding the protocol in your area. Most, but not all, clients will take two puffs of their rescue medication, and should wait at least 30 seconds between puffs.
Each client will have different care instructions for an asthma exacerbation. Here are general guidelines that you can go over with your client prior to beginning work with them, in the event of an asthma flare:
If the client recovers back to normal within 5-10 minutes and feels able to, they can re-warm-up slowly (for another 10-15 minutes), and continue their workout. Some clients may wish to stop their workout and return another day to complete their session—it simply depends on how they are feeling.
If within 5-10 minutes your client has not improved significantly, they may opt to repeat with a second dose of their rescue inhaler. Observe the client for improvement for another 5-10 minutes, and do not let them return to their workout.
If a client has NO improvement of symptoms within this timeframe OR exhibits any of the following severe symptoms, call for medical help immediately 2:
- Face is pale (sweating is also a sign, but may be difficult to gauge in an exercise environment)
- Wheeze on both inhalation and exhalation
- Inability to stop coughing
- Cannot talk or difficulty talking
- Difficulty walking
- A feeling of panic
If you have any concern, err on the side of caution and call for medical help! If an ambulance is called, it is often acceptable to repeat doses of the rescue medication every 5 minutes until help arrives. Ensure a client who has a severe attack under your observation is cleared by his or her physician before returning to the gym to train.
DO NOT let a client go anywhere alone if they are having issues breathing. Remain calm but in control of the situation. Especially if I have been sick recently or having more symptoms than normal, my own judgement of my symptoms lapses. 99% of the time, a patient knows his or her own body, but I’d rather someone be overcautious if I am showing potentially life-threatening symptoms rather than heed to my potentially poor judgement! In any event, it’s a far better situation to lose a client who’s mad at you for doing the right thing in an emergency, than it is to mis-respond in a potential emergency and it leads to a disaster!
Most of the time, nothing like this will ever happen. But, if it does, you are ready to respond appropriately. Just like we hope you took CPR so you never need to use it, we hope that simply by having this knowledge, you’ll never need to put it into practice! Most importantly, keep your client at the centre of the experience: ask relevant questions to keep them safe, and they’ll trust you if they need to skip or tone down a workout because of their asthma.
And, most importantly: don’t push a client with asthma any less intensely than you would any other client… unless they tell you to!
...And even then, once you’ve developed a rapport with them, try to push them that bit harder than they think they can go—although, that’s an innate ability for most personal trainers and partly what you get paid for, right?
I myself was a physical activity hater until after my diagnosis with asthma! I studied kinesiology in university, but I don’t know everything that is applicable to personal trainers: If you have questions about working with a client with asthma, please leave them below. If I don’t know the answer off hand, I’ll do my best to help you find the information you need to make your client’s experience the best possible!
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