New guidelines endorse exercise as key therapy for asthma
An international task force, led by Dr Oliver Price, has issued recommendations urging healthcare providers to prescribe personalised exercise alongside conventional therapies to optimise asthma care.
The recommendations, backed by compelling evidence of safety and effectiveness, are outlined in a new position paper published in Allergy, the official journal of the European Academy of Allergy and Clinical Immunology (EAACI).
In the paper Dr Oliver Price, Chair of the taskforce and Associate Professor in the Faculty of Biological Sciences, alongside colleagues argues that exercise should be an essential component of asthma care, not a secondary consideration.
The paper, ‘Exercise Recommendations and Practical Considerations for Asthma Management - An EAACI Position Paper’, offers comprehensive recommendations and practical tools for integrating exercise into routine asthma care across the life course. It draws on the expertise of a multidisciplinary task force including allergists, clinical immunologists, pulmonologists, respiratory nurses, human physiologists and exercise scientists from across Europe, North America, and Australasia.
The paper’s key message is that exercise is not only safe for most people living with asthma, but when appropriately prescribed it can improve asthma control, reduce symptoms, enhance quality of life, and potentially reduce the need for medication.
Challenging outdated perceptions
According to the Department of Health and Social Care (DHSC) prevalence data for 2023/24, it is estimated that there were 3,886,879 people over six years of age diagnosed with asthma. This accounts to around 6.5% of the population of England. Globally, over 300 million people are estimated to be affected by asthma – making it one of the most common chronic conditions in both adults and children, and a major cause of avoidable hospital admissions. While pharmacological treatments such as inhaled corticosteroids and bronchodilators remain the cornerstone of asthma therapy, lifestyle interventions, particularly exercise are often overlooked.
Many people with asthma reduce their activity levels due to fear that exercise will exacerbate their symptoms. This is particularly true for those who experience exercise-induced bronchoconstriction (EIB), a condition that causes temporary narrowing of the airways during or after physical exertion. However, as the authors of the paper highlight, with the right preparation and medication plan, EIB can be effectively managed in most cases.
We have strong and growing evidence that exercise is beneficial for people with asthma. Whilst physical activity is endorsed for people with asthma, what has been missing is a practical framework to support personalised exercise prescription. This paper provides evidence-based recommendations to empower healthcare providers to make exercise part of every patient’s asthma management plan.
A prescription for movement
The authors emphasise that exercise should not be viewed as a replacement for medication, but as a complementary therapy that can improve the overall trajectory of disease.
“Exercise has been shown to not only benefit respiratory outcomes in asthma but also comorbidities, or additional medical conditions that frequently coexist with asthma. Meaning that the integration of exercise into asthma management can transform outcomes for people beyond the lungs – improving mood, symptoms of anxiety, sleep, weight, cardiovascular health and physical conditioning” said Professor Vanessa McDonald, EAACI Task Force Member and Professor of Chronic Disease Nursing at the University of Newcastle, Australia.
Importantly, the paper provides guidance on how to minimise risks, such as carrying rescue medication, avoiding pollutants and allergens, and recognising early warning signs of asthma exacerbation.
Evidence-based and person-centred
The recommendations are underpinned by evidence from randomised controlled trials, cohort studies, and systematic reviews. Collectively, these studies show that exercise training has the potential to improve asthma control scores, reduce airway hyperresponsiveness, and lead to measurable improvements in lung function over time.
Beyond the physical benefits, exercise has also been shown to improve psychological resilience, reduce anxiety and depression, and enhance health-related quality of life. This is especially important for adolescents and young adults with asthma, who are at greater risk of disengaging from physical activity during critical developmental years. The task force highlights the need for an individualised approach to exercise prescription. Factors such as asthma severity, comorbidities such as obesity and anxiety, cultural background, and access to safe exercise environments should all be considered.
Image: Figure from the paper showing how exercise training improves asthma-related outcomes and extrapulmonary conditions, as evidenced by recent randomised controlled trials. Visit the paper to view all figures in detail.
Bridging the gap between science and practice
Despite the strength of the evidence, exercise remains underutilised in clinical settings.
The authors point to several reasons for this. Lack of confidence among healthcare professionals, time pressures in primary care, limited training, and the absence of the approach to exercise prescription in asthma guidelines. The position paper calls on healthcare systems, medical societies, and policymakers to revise asthma care pathways and update clinical guidelines to reflect the critical role of exercise prescription in the following ways:
Incorporating exercise advice and support into asthma action plans
The authors recommend developing referral pathways to exercise professionals (such as physiotherapists, pulmonary rehabilitation teams) and embedding exercise prescription training into medical education and continuing professional development.
Just as we routinely assess medication adherence or inhaler technique, we should be asking every patient with asthma about their activity levels and helping them find safe, sustainable ways to move more.
Future research and implementation
The authors also identify key research gaps that need to be addressed in current practice. These include understanding how best to tailor exercise interventions for people with severe or poorly controlled asthma, how to support people in low-resource settings, and how to integrate digital technologies (for example, wearable fitness trackers, telehealth coaching) into care models.
They note that while formal pulmonary rehabilitation programmes are well-established for conditions like COPD, access remains limited for people with asthma in many countries. Scaling up community-based and home-based exercise interventions will be critical for implementation at population level.
A timely opportunity
The timing of the publication is significant, with a call to action to move beyond awareness and into implementation. Health systems across the world are looking for cost-effective strategies to reduce the burden of chronic disease, and exercise interventions offer a high-value, low-risk solution. Aligning asthma management with broader public health goals on physical activity, air quality and mental health could deliver wide-reaching benefits.
Further information
Article by Anu Ekanayake, Research, Innovation and Engagement Officer in the Faculty of Biological Sciences. Photos from University of Leeds.
Exercise Recommendations and Practical Considerations for Asthma Management – An EAACI Position Paper was published in Allergy in May 2025. The authors are Price, O.J., Papadopoulos, N.G., Amérigo, D.A., Backer, V., Bougault, V., Del Giacco, S., Gawlik, R., Eguiluz-Gracia, I., Heffler, E., Janson, C., McDonald, V.M., Moreira, A., Simpson, A. and Bonini, M.
