Physical activity and exercise recommendations for prescreening of patients with COPD and asthma
| RECOMMENDATION | LEVEL* | GRADE† |
|---|---|---|
| Although no direct evidence was found to support any contraindication to exercise in either COPD or asthma, secondary evidence suggests that patients with substantial hypoxemia (SpO2 < 90%) at rest or during exertion, uncontrolled asthma, or the presence of pulmonary hypertension should be optimally medically managed before starting exercise | IV | C |
| COPD | ||
| O2 therapy should be optimized to ensure SaO2 is maintained > 85% (ideally > 90%) during PA | II | A |
| Persons with COPD who wish to become more physically active should be evaluated using a graded exercise test including ECG monitoring and pulse oximetry. Remarkable test results and evidence of serious cardiovascular conditions (ie, angina, ischemia, complex ectopy, high-degree AV block, uncontrolled blood pressure) should be seen by the appropriate specialist before commencing PA | IV | C |
| Supervising exercise professionals should have specific training with and monitor for potential pulmonary-related complications as well as complications related to the common sequelae and comorbidities of COPD | IV | C |
| Asthma | ||
| Patients whose asthma is well controlled‡ likely have similar PA-related risk to that of healthy individuals without asthma. To reduce the risk of exercise-related adverse events, those with asthma should make sure that their disease is properly controlled before becoming more physically active. Those with poor or partial control of their asthma should see their physicians before becoming more active | II | A |
| For individuals who develop EIB or asthmalike symptoms with exercise, a rapid-acting β2-agonist should be taken before exercise. Individuals with asthma should also incorporate a progressive warm-up and should try to avoid exercising in the excessive cold or environments with known asthma triggers | III | C |
AV—atrioventricular, COPD—chronic obstructive pulmonary disease, ECG—electrocardiogram, EIB—exercise-induced bronchospasm, O2—oxygen, PA— physical activity, SaO2—oxygen saturation in arterial blood, SpO2—oxygen saturation measured by pulse oximeter.
↵* Level I evidence includes randomized controlled trials; level II evidence includes randomized controlled trials with important limitations or observational trials with overwhelming evidence; level III evidence includes observational trials; and level IV evidence includes anecdotal evidence or expert opinion.
↵† Grade A recommendations are strong; grade B recommendations are intermediate; and grade C recommendations are weak.
↵‡ Symptoms on < 2 d/wk, nighttime symptoms < 1 per wk, mild infrequent exacerbations, no absenteeism due to asthma, no limitations to exercise, and < 2 doses of a fast-acting β2-agonist needed per wk.