The effect of aerobic exercise training on asthma control in postmenopausal women (ATOM): a randomized controlled pilot study
Question
Does 12 weeks of regular supervised aerobic high-intensity interval training improve asthma control, and related inflammatory, body composition, lung function, exercise capacity, and cardiac outcomes, in overweight or obese postmenopausal women with uncontrolled late-onset asthma?
Summary
This randomized pilot trial tested whether 12 weeks of supervised high-intensity interval spinning could improve asthma control in overweight or obese postmenopausal women with uncontrolled late-onset asthma. Eight women were assigned to exercise and four to usual care. Asthma control improved by a clinically meaningful but not statistically significant amount, while body fat measures improved significantly. No significant effects were found for lung function, airway inflammation, VO2max, or cardiac function, and no major adverse training effects or respiratory worsening were observed.
Methodology
- Twelve overweight or obese postmenopausal women with late-onset uncontrolled asthma on regular inhaled corticosteroids and inactive lifestyles.
- 12 participants.
- Stationary cycling/spinning.
- Intensity: High-intensity interval training regulated by heart-rate monitors as percentage of HRmax from baseline maximal oxygen consumption test.
- 45 minutes.
- 3 sessions per week.
- 12 weeks.
- Single-blinded randomized controlled pilot intervention study with outcome assessor blinding and intention-to-treat analysis using last observation carried forward for dropouts.
- Asthma control, Body fat percentage, Fat mass, and Android fat mass were tracked.
Outcomes
ACQ-5 asthma control
Exercise reduced ACQ-5 by 0.55 points compared with control; the effect met the clinically relevant 0.5-point threshold but was statistically non-significant.
Mixed model estimate -0.55 points; 95% CI -1.10 to -0.00; P = 0.08.
Body fat percentage
Exercise significantly reduced body fat percentage versus control.
Unadjusted estimate -2.7%; 95% CI -4.5 to -0.8; P = 0.02. Adjusted estimate -2.7%; 95% CI -4.2 to -1.1; P = 0.006.
Fat mass
Exercise significantly reduced total fat mass versus control.
Unadjusted estimate -2.8 kg; 95% CI -5.1 to -0.4; P = 0.044. Adjusted estimate -2.8 kg; 95% CI -4.8 to -0.8; P = 0.022.
Android fat mass
Exercise significantly reduced android fat mass versus control.
Unadjusted estimate -0.33 kg; 95% CI -0.60 to -0.06; P = 0.038. Adjusted estimate -0.33 kg; 95% CI -0.56 to -0.10; P = 0.018.
VO2max
VO2max numerically increased but was not statistically significant.
Unadjusted estimate 174 ml/min; 95% CI -4 to 350; P = 0.09. Adjusted P = 0.09.
Lung function and airway inflammation
No significant effects were found for FEV1, FeNO, methacholine response dose ratio, or blood eosinophilia.
FEV1 P = 0.48; FeNO P = 0.23 unadjusted and 0.14 adjusted; RDR P = 0.43 unadjusted and 0.32 adjusted; blood eosinophilia P = 0.65.
Cardiac function
No significant effects were found on right ventricular fractional area change, diastolic function, or left ventricular function at rest or during increasing workloads.
Insights
- For a screened asthma subgroup, supervised heart-rate-guided cycling HIIT three times weekly was feasible and highly attended.
- This study supports cautious, clinical-context content that exercise may help asthma control in overweight postmenopausal women, but the asthma-control result was not statistically significant.
- The clearest practical outcome was reduced fat measures after 12 weeks.
- Continuous supervision may not be feasible in routine care; the authors suggested learn-to-exercise interventions and digital monitoring as implementation directions.
Limitations
- Small pilot sample of 12 participants.
- Premature termination due to COVID-19 recruitment and facility restrictions.
- Planned sample was 40 participants, but only 12 were included.
- Participants were not blinded.
- Outcome assessor blinding does not remove expectation effects for subjective ACQ-5 symptoms.
- Baseline variability existed across several measures.
- Exact interval work-rest structure and progression were not reported in this article.
- No long-term follow-up was reported.
- Medication adherence was self-reported and may confound symptom outcomes.
Safety
- No major adverse effects of training were observed.
- Participants who trained did not report respiratory worsening.
- Eligibility excluded unstable cardiac disease and pulmonary disease other than asthma.