Increasing Daily Steps Matches Aerobic Training for Asthma Control in Randomized Trial

A behavioral program designed to increase daily physical activity improved clinical asthma control as effectively as supervised aerobic treadmill training among physically inactive adults with uncontrolled moderate-to-severe asthma, according to results of a randomized clinical trial published in Pulmonology. Both strategies also improved asthma-related quality of life and reduced anxiety and depression symptoms, with most benefits maintained 16 weeks after the programs ended.^1,2

According to lead investigator David Halen Araújo Pinheiro, PT, MSc, a physical therapist and postdoctoral fellow at the University of São Paulo Medical School in Brazil, both interventions improved disease control, and "neither strategy outperformed the other." The study authors concluded that the choice should rest on patient preference and the care center's capacity, as aerobic training requires equipment and supervision.^1-3

Physical Activity as Adjunctive Asthma Therapy

The Global Initiative for Asthma (GINA) recognizes pulmonary rehabilitation, including aerobic training and efforts to increase physical activity, as a nonpharmacologic strategy for asthma control. A previous 8-week behavioral intervention improved asthma control, anxiety symptoms, and sleep quality in adults with moderate-to-severe asthma.^1,4

Exercise intensity may also matter. In a separate trial published in The Journal of Allergy and Clinical Immunology: In Practice, moderate-intensity aerobic training produced statistically and clinically significant improvements in asthma quality of life and Asthma Control Questionnaire (ACQ) scores compared with control, whereas vigorous-intensity training improvements were statistically, but not clinically, significant.⁵

Until this trial, the 2 approaches had never been compared head-to-head.^1,4

Trial Design

Of 480 patients assessed for eligibility, 52 were randomly assigned to an aerobic training group (n = 27) or a behavioral intervention group (n = 25) at a tertiary university hospital in São Paulo between May 2022 and August 2025. Eligible participants were aged 18 to 65 years, physically inactive (less than 150 minutes of moderate-to-vigorous activity per week), had uncontrolled asthma (Asthma Control Questionnaire [ACQ] score of at least 1.5), had received treatment for at least 6 months, were clinically stable, and were not current smokers.¹

After a 90-minute asthma education session, the aerobic group completed supervised 45-minute treadmill sessions twice weekly, with intensity set by cardiopulmonary exercise testing. The behavioral group attended weekly individual sessions of up to 90 minutes using motivational interviewing, feedback, and goal setting, and participants wore a smartwatch that vibrated when they reached their step goal or had been sedentary for 60 minutes. Both programs lasted 8 weeks, and pharmacologic treatment was maintained throughout.¹

Blinded assessors measured outcomes at baseline, after the intervention, and 16 weeks later. Completion rates were 89% in the aerobic group and 96% in the behavioral group.¹

Key Findings

Both groups reduced ACQ scores beyond the minimal clinically important difference (MCID) of 0.5 points, with no significant between-group differences. Scores fell by 1.01 points with aerobic training and 1.46 points with the behavioral intervention after 8 weeks and remained 0.57 and 0.94 points below baseline, respectively, at follow-up. Asthma Quality of Life Questionnaire (AQLQ) scores rose by 1.33 and 1.40 points after the intervention and stayed 0.97 and 0.88 points above baseline at follow-up.¹

After the intervention, 88% of behavioral participants and 78% of aerobic participants reached the ACQ MCID, as did 64% and 63%, respectively, at follow-up. Both groups also increased moderate-to-vigorous physical activity and improved anxiety and depression symptoms, though neither intervention changed sleep quality or body composition. The large effect size for asthma control held at follow-up only in the behavioral group, declining to medium in the aerobic group.¹

During the program, smartwatch-recorded steps in the behavioral group climbed from 5185 to 7848 per day. At follow-up, many aerobic participants reported joining a gym, while many behavioral participants kept walking as part of their routines; weather changes were the most cited reason for stopping.^1,2

Implications for Pharmacists

Most participants were using high-dose inhaled corticosteroids, and both interventions were delivered on top of maintained pharmacologic treatment.¹ Pinheiro emphasized that exercise complements, rather than replaces, GINA-recommended therapy.² Pharmacists, who frequently counsel patients on inhaler technique and adherence, may be well positioned to reinforce that message while encouraging gradual, goal-based increases in daily walking.

REFERENCES

1. Pinheiro DHA, de Lima FF, Cervera VZ, et al. Aerobic training versus behavioural intervention to increase physical activity on clinical control of people with moderate-to-severe asthma: a randomised clinical trial. Pulmonology. 2026;32(1):2684131. doi:10.1080/25310429.2026.2684131

2. Increasing daily steps is as effective as aerobic exercise in managing asthma. News release. EurekAlert! September 2, 2026. Accessed October 2, 2026. https://www.eurekalert.org/news-releases/1142528

3. Pradhan S. Commentary on 'Aerobic training versus behavioural intervention to increase physical activity on clinical control of people with moderate-to-severe asthma: a randomised clinical trial.’ Pulmonology. 2026;32(1). doi:10.1080/25310429.2026.2692324

4. Araujo Pinheiro DH, Silva RAD, Lunardi AC, et al. Effects of aerobic training versus behavioral intervention to increase physical activity for disease control in patients with asthma: protocol for a randomized trial. JMIR Res Protoc. 2025;14:e78603. doi:10.2196/78603

5. Valkenborghs S, Wood L, Callister R, et al. Effects of moderate- versus vigorous-intensity exercise training on asthma outcomes in adults. J Allergy Clin Immunol Pract. 2024. Accessed October 2, 2026. https://www.jaci-inpractice.org/article/S2213-2198(24)00638-X/fulltext