For Asthma Patients, a Brisk Daily Walk Rivals the Treadmill

Patients with moderate-to-severe asthma who were coached to take more steps in their daily routine improved their disease control almost as much as patients assigned to a supervised treadmill program, according to a randomized clinical trial published this week in the journal Pulmonology. The finding, from researchers at the University of São Paulo Medical School (FMUSP) in Brazil, adds to evidence that structured gym-style exercise is not the only route to better breathing for people with the chronic airway disease.

The trial enrolled 52 adults, ages 18 to 65, with uncontrolled moderate-to-severe asthma who were sedentary and had been on stable medical treatment for at least six months. Investigators screened 480 candidates to reach that group. Over eight weeks, one arm of 27 participants completed twice-weekly, 45-minute supervised treadmill sessions at the Hospital das Clínicas, with intensity calibrated to each patient's perceived exertion. A second arm of 25 participants met weekly for counseling sessions focused on removing personal barriers to activity, setting individualized walking goals and using a smartwatch that tracked steps and flagged prolonged sitting.

The numbers

Eight weeks in, 88 percent of the walking-and-counseling group and 78 percent of the treadmill group reached a clinically meaningful improvement in asthma control, a difference researchers said was not statistically significant. At a four-month follow-up, the gains had narrowed but persisted in both groups, with 64 percent of the behavioral-intervention group and 63 percent of the aerobic-training group still meeting that threshold.

Daily step counts told a similar story. The supervised treadmill group increased its average daily steps by 1,537 immediately after the program, settling to 983 more steps than baseline by the four-month mark. The counseling group increased its steps by 1,126 post-intervention and retained about 996 additional daily steps at follow-up. Participants in both arms also reported reduced symptoms of anxiety and depression and improved quality of life, though neither intervention changed sleep quality or body composition.

• 52 patients with moderate-to-severe asthma completed the eight-week trial, drawn from 480 screened
• 88% (behavioral coaching) vs. 78% (treadmill) reached clinically meaningful asthma control at 8 weeks
• 64% vs. 63% maintained that improvement at four-month follow-up
• Average daily steps rose by roughly 1,000 to 1,500 in both groups

From contraindicated to prescribed

The study reflects a broader shift in how pulmonologists think about exertion in asthma care. For decades, vigorous activity was viewed with caution because exercise itself can trigger airway constriction in some patients. Celso Carvalho, an FMUSP professor and the study's senior investigator, said that view has been overturned by two decades of research showing supervised, appropriately dosed exercise improves rather than worsens asthma control.

"Twenty years ago, exercise was contraindicated for people with asthma," said Celso Carvalho, the FMUSP pulmonary rehabilitation researcher who supervised the trial.

The new trial builds on earlier work by the study's lead author, physical therapist David Halen Araújo Pinheiro, a postdoctoral researcher at FMUSP's Laboratory for Research in Physical Therapy and Exercise. In a 2024 study of 426 asthma patients in São Paulo and Londrina, published in The Journal of Allergy and Clinical Immunology: In Practice, Pinheiro's group found that patients who logged at least 7,500 daily steps had better disease control regardless of how much time they otherwise spent sedentary. The new randomized trial was designed to test whether coaching patients toward that kind of everyday movement could match a formal exercise program, rather than simply describing an association.

Who stands to benefit

Nearly 28 million people in the United States have current asthma, according to the Centers for Disease Control and Prevention, and a substantial share do not have their symptoms fully controlled despite medication. Structured pulmonary rehabilitation programs like the treadmill arm in the São Paulo trial require staff, equipment and travel to a clinic — resources many health systems and patients cannot easily sustain. A walking-based approach, the researchers argue, could extend the benefits of exercise to patients who would otherwise be excluded by cost, mobility, transportation or scheduling constraints.

Pinheiro, in comments to the São Paulo research funding agency FAPESP, said the behavioral approach carries practical advantages precisely because it asks less of the health system. Both interventions, he noted, produced similar clinical gains, but only one requires supervised equipment.

Caveats and what comes next

The trial's authors and outside readers of the work note real limits. The sample size was modest, the population was drawn from a single Brazilian academic medical center, and the study measured asthma control alongside step counts and mental-health scores rather than lung function directly. The authors also stress that neither exercise strategy is a substitute for prescribed medication: patients in both arms continued treatment aligned with the Global Initiative for Asthma guidelines throughout the trial, and Pinheiro said patients should never stop their prescribed medicines in favor of walking more.

The research, funded by the São Paulo Research Foundation (FAPESP) and Brazil's National Council for Scientific and Technological Development, is part of a longer-running thematic project on pulmonary rehabilitation methods for chronic lung disease at FMUSP. The trial protocol, which pre-registered the study's design and outcome measures, was published separately and is available through the National Library of Medicine's PubMed Central archive. Larger, multi-site trials would be needed to confirm the findings generalize beyond the São Paulo hospital population and to determine whether the behavioral coaching approach holds up over longer follow-up periods than four months.

The result fits a wider pattern showing up across pulmonary and cardiovascular medicine, where trials increasingly find that unsupervised, low-cost activity coaching approaches the benefit of intensive supervised programs for chronic disease management. For asthma specifically, the FMUSP group argues the practical case is strong: walking requires no membership, no commute to a rehabilitation center and no specialized staff, making it easier for patients to sustain once a formal trial period ends. Whether health systems adopt step-coaching as a standard complement to inhaled medication will likely depend on replication in bigger and more diverse patient populations, as well as on payers' willingness to reimburse counseling-based interventions the way they already reimburse supervised pulmonary rehabilitation.