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How to train clients with Asthma

Hadyn Luke posted this on Tuesday 8th of July 2014 Hadyn Luke 08/07/2014

Tags: Special populations


Personal trainers and fitness instructors working with clients who have asthma, the subject of this blog, should be aware of the causes and effects of the condition.

In some cases the client will have been referred to the personal trainer by the medical profession, but in other cases they may simply attend a fitness class.

What is asthma?

Asthma is an obstructive pulmonary disease in which inflamed airways prevent airflow to different levels.

Unlike other COPD (chronic obstructive pulmonary disease) conditions, asthma is episodic and reversible, either of its own accord or following treatment.

While most people with asthma can find ways to control it and live with the symptoms, there can be fatalities. The Royal College of Physicians National Review of Asthma Deaths states that: “It is not clear why the number of deaths per year from asthma in the UK have not reduced significantly from around 1,200 for many years, even though it is widely accepted that there are preventable factors in 90% of deaths.”

How common is asthma?

The Asthma Audit of 2001 found that more than five million people in the UK have asthma; however the true number is thought to be higher as many people live with the symptoms without informing their doctor.

What triggers asthma?

Asthma has a range of different causes, from allergens to triggers such as certain proteins in food.

These include (but are not restricted to):

  • Dust mites
  • Cigarette smoke
  • Tree and grass pollen
  • Exhaust fumes
  • Perfume
  • Colds and chest infections can exacerbate asthma, as can stress and worry.
  • Common food and drink that trigger asthma attacks include nuts, shellfish and alcohol.

Because asthma can also be brought on by exercise, fitness instructors should take additional care to monitor clients who have asthma.

What happens during an asthma attack?

Once the allergic response is triggered, the asthmatic will experience bronchoconstriction, a contraction of the airway’s smooth muscle

This is followed by the swelling of the mucous glands found in the lining of the airways, which stimulates the secretion of mucous.

The individual will feel short of breath, their chest will feel tight and they may find themselves wheezing, coughing and struggling to exhale.

Exercise induced asthma (EIA)

If an asthma attack is caused by exercise, for example while working in the gym with a personal trainer, the client will usually find symptoms start around five to 15 minutes after they have stopped exercising, although symptoms can begin for up to 30 minutes after the end of a gym session.

The cause of EIA is thought to be the loss of heat or water from the airways, especially if the client is in an environment where they are breathing in dry or cold air.

Because EIA does not involve inflammation and mucous production, the symptoms usually resolve themselves and don’t continue for as long as they would after some other asthma triggers.

What preparation should a fitness professional carry out?

A personal trainer or fitness instructor training clients with asthma should check how the client is feeling before starting each session. They should also ensure that the client has brought along any bronchial dilators they use.

As asthma is often an exercise referral condition, the personal trainer should be cleared to work at Level 3 and familiar with the symptoms and causes of asthma.

However, gym instructors may have people in their classes who bring an inhaler without letting the instructor know they have asthma. Different gyms and sports clubs have different rules about exercising with asthma.

Exercise adaptations for asthma

A personal trainer working with clients who have asthma should understand what adaptations to make to the exercise routine.

Exercise recommendations are to keep at low to moderate intensity. With asthmatic clients, a personal trainer should make sure they are enjoying the exercise rather than trying to challenge them, as this is more likely to help the client stick with it.

Walking, cycling and swimming (unless a client reacts to chlorine) are all beneficial, as well as low resistance weight training and exercises that improve flexibility. Exercise that mostly focuses on the upper body, such as rowing, is best avoided.

The aim is to help the client manage and maintain their current fitness levels and gently advance if they feel that they can. If a client is struggling, the fitness professional should look at ways of making the exercise more manageable, rather than pushing the client to perform.

A client with asthma may need to do an extended warm up as it can take longer for their heart rate and breathing patterns to become more relaxed and controlled.

Interval training can also be beneficial as a short burst of less than two minutes seems to be not long enough to provoke EIA (see our blogs on How a personal trainer can use interval training and Interval training to motivate a client and progress fitness.

The benefits of exercising for those with asthma.

Many people with asthma might avoid exercise because it makes them out of breath, which causes them to panic.

However, the rationale for exercise is that a fitness instructor can help the client to retrain their breathing patterns. The more a client gets used to being out of breath, the less anxious they will feel when it happens.

Not only will this help them when they are exercising, but it will also bring the same benefit if they find themselves out of breath in other situations, for example running for a bus.

Also be aware of…

If a client is wheezing when they arrive at the gym, or particularly suffering with allergies, they should avoid training that day. As the symptoms of asthma tend to be worse first thing, it’s best for clients to exercise later in the morning.

If it’s particularly cold, this can cause issues, too; the warmer the air in the room, the more moist the bronchial tract so it’s less likely to contract and restrict breathing.

Finally, gyms tend to use a lot of cleaning products which can trigger an asthma attack in some clients.

Because those with asthma can quickly go from breathing easily and comfortably to experiencing severely restricted airways, a personal trainer should always be ready to respond to the fluctuation in the client’s ability to train.

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