Aims Children with well-controlled asthma can exercise safely and asthma management guidelines recommend physical activity (PA), yet many children with asthma fail to achieve recommended levels of PA. Some barriers to PA might specifically affect children and young people with asthma, so tailored interventions are likely needed to improve this patient group’s access to the benefits associated with PA. To inform future interventions, we systematically reviewed studies exploring barriers and facilitators to PA for children and young people with asthma.
Methods Multiple databases were searched for ‘asthma’, ‘children’, ‘exercise’, ‘physical activity’ and their derivatives. All study designs were considered. Studies focused on athletes, published before 1995 or without an English translation were excluded. Two researchers independently selected studies, extracted data and appraised quality (EPPI-Centre weight of evidence frame-work). A third researcher reviewed disagreements. This review is PROSPERO registered, number CRD42015030067.
Results The search returned 5161 results. 166 abstracts and 33 studies satisfied the inclusion criteria. Subjects of included studies were children and young people aged 6–20 years, parents/caregivers and teachers. Twenty studies used quantitative methods, including three intervention studies; ten studies used qualitative methods and three used mixed methods. Qualitative interviews revealed that children with asthma identify positive benefits of PA and feel they should be physically active. Identified barriers and facilitators to PA included patient, family, healthcare professional (HCPs), environmental, psychosocial, school and medication factors. Five qualitative studies discussed HCPs. These suggested that doctors often do not provide specific advice for PA, contributing to children not participating in PA. One quantitative study provided supporting data; 58.7% of students undertaking high levels of PA had a doctor who approved their activity, compared with only 33.8% of students with low levels of PA. Four quantitative studies examined the effect of parental activity restrictions. Restrictions had no influence on children’s activity levels in two studies and were associated with lower PA levels in the other two.
Conclusion PA barriers and facilitators were identified within medical, home and school domains. HCPs might influence children with asthma’s PA participation by promoting good asthma control and by educating and supporting parents and school staff.