Q&A with Emily M. D’Agostino, DPH: Pediatric Asthma and Physical Fitness
—Dr. D’Agostino, of Duke University, discusses her recent study examining the impact of asthma on children’s physical activity levels.
Severe, persistent asthma in children is linked to decreased physical activity, which may in turn lead to poor physical fitness. Longitudinal research assessing asthma severity as a predictor of physical fitness is limited among the pediatric population. To narrow this knowledge gap, Emily M. D’Agostino, DPH, Duke University, Durham, NC, and her fellow researchers assessed the asthma severity-fitness relationship over time in an urban setting.1
The research team analyzed data obtained from New York City public school students who were in grades 4–12 from 2010–2018. The cohort comprised 663,137 youth (51% were boys; 31%, 40%, and 14% were non-Hispanic Black, Hispanic, and White, respectively; 70% experienced high poverty; and 87%, 11%, and 1% had no, mild, and severe asthma, respectively). Their findings were published in a recent issue of Preventive Medicine.1
In an interview with MedPage Today, Dr. D’Agostino discussed the team’s study findings and how they inform fitness interventions for children with asthma. Dr. D’Agostino is the director of Community-Engaged Research Practice and an assistant professor at Duke University School of Medicine, Department of Family Medicine and Community Health. The interview was lightly edited.
MedPage Today: What was the key finding of your study?
Dr. D’Agostino: The aim of this study was to evaluate the longitudinal relationship between asthma severity and 1-year lagged physical fitness in New York City public school youth enrolled in grades 4-12. In other words, we wanted to examine the strength of the relationship between asthma severity and subsequent physical fitness in this population.
We observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. In other words, as asthma severity increased, subsequent physical fitness decreased. The strength of this association was highest in magnitude for non-Hispanic White youth.
What could explain the stronger magnitude of relationship between asthma severity and subsequent physical fitness among White students?
Although the prevalence of both asthma and low fitness among non-Hispanic Black and Hispanic students is higher compared with non-Hispanic Whites, prior studies have similarly found that non-minoritized urban youth demonstrate a stronger longitudinal association between health outcomes and fitness.
For example, obesity and being overweight were more predictive of fitness among non-Hispanic White children when compared to their Hispanic and non-Hispanic Black counterparts among New York City youth, despite a higher prevalence of severe obesity among Hispanic and non-Hispanic Black students compared to non-Hispanic Whites. Moreover, obesity is correlated with asthma, as the presence of elevated BMI in early childhood is associated with early-onset asthma or wheezing.
One study observed higher concerns of caregivers related to physical activity of non-Hispanic White children with asthma and higher caregiver-reported asthma severity during their child’s participation in exercise compared with their Hispanic and non-Hispanic Black peers. Caregivers may discourage their child from participating in strenuous exercise, or exercise in the presence of environmental triggers, due to perceived risk and associated psychological distress. Further, caregivers of children with more severe asthma may limit their children’s physical activity, which may contribute to the magnitude of the asthma severity-fitness relationship among non-Hispanic Whites.
What socioeconomic or neighborhood factors may affect the asthma-fitness relationship in children?
The asthma-fitness relationship in youth who experience asthma exacerbation may also be more pronounced due to socioeconomic factors, such as caregiver unemployment, that present barriers to timely and accessible healthcare and treatment. However, our study findings also showed a negligible difference between the asthma severity-fitness association for children with high poverty and for those with low poverty.
These findings may be related to neighborhood factors and social determinants of health. For example, minority youth and those living in poverty in this study may reside in urban areas with high walkability and may engage in active transportation out of necessity, potentially providing evidence for a stronger asthma severity-fitness relationship among non-Hispanic White compared to minoritized youth.
Prior studies have demonstrated that low-income neighborhoods have higher walkability than high-income neighborhoods, and high neighborhood walkability is positively correlated with fitness. Walking may also be more positively perceived than other forms of physical activity by caregivers, which may encourage minoritized youth with asthma to participate in walking. In this sense, individual-level socioeconomic status may predict children’s fitness levels overall, while area-level factors may be impacting the asthma-fitness relationship for children regardless of poverty status, such as neighborhood walkability, environment pollution, and access to greenspace.
Previous studies have also demonstrated that area-level factors may be correlated with indicators of youth fitness, independent of asthma status. Existing literature shows an association between neighborhood walkability and decreased BMI z-scores and diastolic blood pressure, but findings on the association between pollution or greenspace and fitness are inconsistent or insignificant.
How do your study findings inform fitness interventions geared to children with asthma?
Our analysis adds to the literature by demonstrating an inverse longitudinal association between asthma severity and 1-year lagged fitness overall, and across sociodemographic factors.
Today, asthma treatments seek to manage and reduce asthma symptoms so patients can engage in normal levels of physical activity, which can contribute to improved health. Future research should examine how neighborhood-level factors—such as neighborhood walkability, income by school district, and neighborhood or school program offerings—impact the asthma severity-physical fitness relationship across racial/ethnic subgroups. This work can provide a more nuanced understanding of the relationship between asthma and fitness to inform disparities reducing interventions.
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