Perceptions of sedentary behaviour in people with severe asthma: A qualitative study

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To inform future sedentary behaviour- interventions, this study aimed to explore perceptions of sedentary behaviour among people with severe asthma. Adults (≥ 18 years) with severe asthma (n = 21) participated in face-to-face interviews. Participants were asked open-ended questions about factors influencing their sitting behaviour. A thematic analysis was conducted on phrases and sentences relevant to sedentary behaviour. Participants were predominantly females (62%), with controlled asthma (median [Q1, Q3]: ACQ6 0.5 [0.2,1.8]) and receiving monoclonal antibody therapy (71%). Participants were inactive (19.1 [11.3, 44.5] minutes of MVPA per day) and sedentary (10.8 [9.7, 11.4] hours of sedentary behaviour per day). The analysis generated four main themes: ( 1 ) Sedentary behaviour often stems from habits and routines, ( 2 ) Asthma and associated health issues contribute to sedentary behaviour, ( 3 ) Participants' responsibilities influence their activity levels, and; ( 4 ) Participants’ conscious balance between being physically active and sedentary. The results of this qualitative study offers insights into the perspectives of people with severe asthma regarding sedentary behaviour, highlighting the identification of strategies that can be implemented to optimise sedentary behaviour in this population. Severe asthma sedentary behaviour qualitative Figures Figure 1 Introduction Sedentary behaviour is associated with an increased risk of cardiovascular disease, diabetes, and all-cause mortality 1 . There is evidence that the negative health consequences of prolonged sedentary behaviour are independent of physical activity levels 2 . For people with asthma, more time spent being sedentary is additionally associated with decreased exercise capacity, lung function, and asthma control 3 . Despite the deleterious effects of sedentary behaviour on important health and asthma-specific outcomes, people with severe asthma spend up to nine hours per day being sedentary, with half of this time spent in sitting bouts longer than 30 minutes 4 . Targeting sedentary behaviour as part of asthma management warrants investigation as this approach may positively impact people with severe asthma. In 2020, for the first time, the World Health Organisation physical activity guidelines included recommendations for limiting the amount of time spent sedentary across all age groups and abilities 5 . The inclusion of sedentary behaviour recommendations in guidelines is important, as inactivity and sedentariness are separate constructs. Inactive refers to not meeting the recommended amount of moderate to vigorous physical activity (MVPA). Sedentary refers to spending a high proportion of wake time in sedentary activities; those with a low energy requirement performed in a sitting or lying position. It is therefore possible to be active and sedentary, or inactive yet not sedentary. Consequently, addressing inactivity is different to addressing sedentariness 6 . There is limited research addressing how to address sedentary behaviour in people with severe asthma 7 . Existing randomised controlled trials (RCT) have primarily focused on the impact of physical activity interventions on both activity and sedentary behaviour outcomes 8–10 . To date, there are no RCT that have implemented a sedentary behaviour focused intervention in people with severe asthma. Interventions targeting sedentary behaviour in the general population and in chronic disease conditions have shown promising results when solely focusing on sedentary behaviour and not co-targeting other health behaviours like physical activity and diet 6 . Behaviour change interventions are complex, requiring a systematic approach to understand how and under what circumstances change in behaviour is achieved 11, 12 . The United Kingdom Medical Research Council’s framework for the development of complex interventions identifies the importance of involving key stakeholders to develop programme theory 12 . Taking this into consideration, the perspectives of people with severe asthma are needed to inform a sedentary behaviour targeted intervention; however, this is yet to be investigated. To address this knowledge gap, we sought to explore perceptions of sedentary behaviour among people with severe asthma. Methods Study Design A descriptive qualitative study was conducted as part of a single centre, parallel group RCT in people with severe asthma, reported previously 13 . Briefly, participants were randomised to a yoga and mindfulness intervention or usual care with tailored information about physical activity, mindfulness, and goal setting. After completing the trial, all participants were interviewed face-to-face regarding perceptions of physical activity, sedentary behaviour and perceived benefits and weaknesses of the intervention. Ethics approval was obtained from the Hunter New England Human Research Ethics Committee (2018/ETH00338) and the trial was registered on the Australia New Zealand Clinical Trials Register (ACTRN12618001914257). Written informed consent was obtained from each participant prior to data collection in accordance with Good Clinical Practice. Participant recruitment and selection Adults (≥ 18 years) with severe asthma (defined according to the European Respiratory Society (ERS) / American Thoracic Society (ATS) Task force definition 14 ) were recruited to the RCT. Details of inclusion and exclusion criteria have been previously reported 13 . Participants were recruited via consecutive methods through the research database and clinics of the Department of Respiratory and Sleep Medicine at John Hunter Hospital, NSW and via general/social media advertisement. Expressions of interest were extended via treating respiratory physicians, who referred eligible patients to the study. A total of 24 participants recruited and randomised to the RCT. All participants were invited to a face-to-face semi structured interview within 2 months of completing the intervention on an intention to treat basis 13 . Assessment The assessment included collecting self-reported demographic information, asthma and exacerbation history (previous 12 months), and respiratory medication use. Clinical measures were also completed by participants as part of their participation in the RCT 13 . Pre and post-bronchodilator (400 µg of Salbutamol) spirometry according to ATS/ERS guidelines was completed to attain measures of lung function and 2012 GLI equations were used to calculate predicted values 15 . Participant’s functional exercise capacity was measured using the 6-minute walk test (6MWT), to calculate 6-minute walk distance (6MWD), according to guidelines 16 . Participants wore a tri-axial accelerometer (Actigraph wGT3X-BT) for eight consecutive days to measure moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LPA) and sedentary time. Tri-axial accelerometer data processing details have been described previously 17 . The Asthma Control Questionnaire (ACQ) was administered to assess the level of asthma control. Health-related quality of life was measured using the St. George’s Respiratory Questionnaire (SGRQ). The Dyspnoea-12 (D-12) questionnaire was completed by participants to assess breathlessness. Levels of anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Interview procedure The interviews took place in a private room at the Hunter Medical Research Centre (Newcastle, NSW, Australia) for a mean (SD) duration of 97 minutes ( 21 ). Present during the interviews was the participant and the facilitator. A semi-structured, open-ended interview guide was used. Participants were asked open-ended questions from an interview guide about factors that influence their sitting behaviour. For this study, phrases and sentences that were relevant and referred to sedentary behaviour specifically underwent a secondary analysis. The facilitator was author SAH (PhD), a female post-doctoral researcher who is trained in qualitative research, did not have an established role in providing clinical care to the participants and did not deliver the intervention as part of the RCT. Data generation and analysis Descriptive statistics were calculated using SPSS version 28 (IBM, Armonk, NY, USA). The interviews were audio-recorded and transcribed verbatim. Participants were informed they may review and edit their transcript of the interview. Transcripts were pseudonymised to protect confidentiality. Data familiarisation, both in written form and audio recording was undertaken 18, 19 . The analysis accounted for field notes, vocal tone, and participant emphasis on certain words and phrases to enable underlying emotions to be understood within the context of the conversation. Inductive thematic analysis was undertaken according to Braun and Clarke’s six steps approach 19 by author PUG using NVivo 12 Pro (QSR International, Melbourne, VIC, Australia). Data were reviewed line by line to capture relevant data to sedentary behaviour. As a concept became apparent codes assigned, organising the data into meaningful groups. Themes were then generated from the codes. A second qualitative researcher (EM) independently coded 30% of the transcripts, with comparison made to resolve discrepancies. Coding agreement was achieved with a mean (SD) percentage agreement of 99.9 (0.3). Generated codes and themes and the interpretation of the findings were discussed and reviewed with co-authors PG, HL and VM. Results Participant characteristics A total of 21 participants attended and completed the face-to-face semi structured interview 13 . All 21 interview transcripts were included in the analysis, 62% of which were participants who were randomised to the yoga and mindfulness intervention and the remaining in the active control group 13 . Participant’s demographics, clinical and movement characteristics are summarised in Table 1 . Participants were mostly females and obese. Their asthma was controlled, and most participants were receiving monoclonal antibody therapy for severe asthma (Table 1 ). Participants were inactive and sedentary. Table 1 Participant demographic and asthma-related characteristics Demographic characteristics n = 21 Sex, females (n, %) 13 (62) Age, years (mean ± SD) 67 ± 9 BMI, kg/m 2 (mean ± SD) 31.9 ± 5.9 Age of diagnosis, years (median, Q1; Q3) 33 (5; 49) Race (n, %) Caucasian 20 (95%) Aboriginal or Torres Strait Islander 1 (5%) Living arrangement* (n, %) Living alone 5 ( 24 ) Living with spouse/partner 12 (57) Living with family 3 ( 14 ) Employment or study status (n, %) Working fulltime or part time 7 ( 33 ) Not working or retired 14 (67) Medications Prescribed monoclonal antibody therapy (n, %) 15 (71%) Beclomethasone daily equivalent, mcg (mean ± SD) 1771 ± 811 Clinical measures ACQ6, score (median, Q1; Q3) 0.5 (0.2; 1.8) Post BD FEV 1 , % predicted (mean ± SD) 77.1 ± 20.8 Post BD FEV 1 /FVC, ratio (mean ± SD) 0.67 ± 0.14 6MWD, m (mean ± SD) 486.8 ± 115.4 Self-reported measures SGRQ, total score (mean ± SD) 36.8 ± 20.9 D12, total score (mean ± SD) 10.0 ± 8.8 HADS-Anxiety, sub score (mean ± SD) 5.4 ± 3.7 HADS-Depression, sub score (mean ± SD) 4.4 ± 4.0 HADS, total score (mean ± SD) 9.8 ± 6.9 Exacerbation History (previous 12 months) Hospital admissions (n, %) 3 ( 14 ) Emergency department admissions (n, %) 4 ( 19 ) General practitioner visits (n, %) 6 ( 29 ) OCS use (n, %) 17 (81) Antibiotic use (n, %) 15 (71) Total exacerbation rate 2 ( 1 , 4 ) Movement Behaviours (per day) Moderate to vigorous physical activity, minutes (median, Q1; Q3) 19.1 (11.3; 44.5) Light intensity physical activity, hours (median, Q1; Q3) 2.3 (1.8; 3.0) Sedentary time, hours (median, Q1; Q3) 10.8 (9.7; 11.4) BMI, Body mass index; ACQ, Asthma control questionnaire; BD, Bronchodilator; FEV 1 , Forced expiratory volume in 1 second; FVC, Forced vital capacity; 6MWD, 6-minute walk distance; SGRQ, St. George respiratory questionnaire; D12, Dyspnoea-12; HADS, Hospital anxiety and depression scale; OCS, Oral corticosteroids. *missing data from n = 1 Themes During the thematic analysis process, data saturation was achieved (no new information emerged from the data) and 14 codes were reviewed and collated into themes. The analysis generated four main themes and 10 subthemes (Fig. 1, Table 2 ). Table 2 Exemplar quotes for themes and subthemes. Theme 1: Habits and Routine Subtheme: Time of day “Yeah, I'd prefer to do something morning rather than anything in the afternoon. Mainly because I think by the afternoon, if I do have a busy morning, the afternoons - it's just rest time” - Female, 64 years “Um so, I’ve always been like someone who’s got 10 things to do that day, so I’ll get them all done and have my like little job list and then I’ll sit down of a night” - Female, 49 years “I'm a morning person, so I tend to be a little bit more active in the morning and then in the afternoon, after lunch, is when I normally do my sewing or do my Scrabble or doing things like I just sit down” - Female, 57 years “… Yeah, in the evening where I'll sit down and maybe for four hours, four or five hours in the evening sitting there, working - looking at the computer and TV and such. During the daytime, I try to keep moving around doing little things around the home and in the backyard; or I have a friend who I sometimes go out with” - Male, 68 years Subtheme: The cycle “Sometimes, I can’t even stand the ads and I say, there is a break, get out of it. If you watch that again, you will go totally mad. So you get up and you move” - Female, 77 years “It's not - it makes me lazy; it does. If I sit around for too long then I really don't want to get up and do anything” - Female, 64 years “It sounds like a bit of a cycle. You don't want to get up so you don't get up and then that makes you less likely to want to get up” - Female, 64 years “…you have to be wary of just sitting there watching and that’s where I find this getting up and doing something in between and even if it’s just getting out of the chair, walking out and wiping the dishes, making a cup of tea, looking around in your kitchen and say oh, I’ll put that there for tomorrow or whatever and not just sit totally for a long period” - Female, 77 years Subtheme: Mindset “So it’s not just your lungs, it’s your bones and your blood circulation. So if you don’t keep all those going, the whole thing is just - it’s like a car that sits in the garage; it won't start after a while, you know?” - Female, 77 years “The other bit is getting on with life, people who sit too much don't do enough, I don't think” - Male, 63 years “You’ve got to keep moving, get up and - even if you’re in the house in a dressing gown, move because that’s wrong” - Female, 77 years “Sometimes I don't feel - like, I think, yeah, maybe I'll go out today and then I think, no, I think I'll just stay at home, where I probably should push myself to get dressed and go out, but I don't” - Female, 64 years Theme 2: The burden of asthma Subtheme: Symptom management “I spent two whole weeks in bed, I didn't move. So, 1000 steps in a day was huge for me because I was so sick. Getting up and going to the toilet and then getting back into bed was about as far as I went…” - Female, 49 years “That's all you think about is moving and breathing, moving and breathing, and it's slow moving and it's not puffing you out and it's not making your asthma any worse. Then you can actually sit down and go I can actually breathe better. As soon as you start to breathe a little bit better, your mind is going I'm good, I'm okay now, and the clouds clear” - Female, 49 years “If I’m not feeling well, if my cough is bad, after dinner every night, I’ll park myself in front of the TV and sit there and cough and carry on and watch TV until the early hours of the morning” - Male, 73 years “…if I’m having an asthma attack, yeah and I sit down to relieve that” - Female, 62 years Subtheme Physical limitations “I'd just like to be able to do things around the house without any pain and without - to be without pain would be unbelievable” - Female, 64 years “I don't get up in a hurry. I sit up and then I've usually got to push myself out of bed these days because I'm not as strong in the knees, and I put that down to lack of exercise” - Male, 63 years “So that's when I'll sit down and read because I won't go to sleep because I'll be a bit lethargic and think, oh, I've had enough today” - Female, 70 years “For me, if I open the door and it's overcast and the wind is cold and it's drizzly, I'd be better off to shut the door, go back inside and wait for a nice day…but if it's sunny and warm outside, it - I'm more conducive to being outside doing things” - Male, 64 years Theme 3: Driven by responsibility and purpose Subtheme: For and with someone else “His motivation has really fallen and I think that brings me down a bit, not having somebody that says, come on, let's get up and go” - Female, 64 years “Probably if I'm on the phone to friends I'd be sitting yapping away” - Female, 61 years “I’m a sewer; I make quilts and take everybody’s clothes - the legs of pants takes in, darts here, the usual everyone piles it on and the family which I don’t mind” - Female, 77 years “So I'm sitting on my bum for four to six hours a day, whereas previously I wouldn't be sitting on my backside for that period of time. But it's something I want to do and something I'm doing that's beneficial to somebody else. It's not a paid position, but it's something that I'm doing to help some friends out and I enjoy doing it. It's keeping the mind active and that too, as well” - Male, 75 years Subtheme: A good purpose “…yesterday with the 3000 steps when I sat in front of the computer for three hours, you know doing something that that really fascinates me” - Male, 63 years “…so the sitting is a luxury, which I enjoy but it's still a luxury and I'd like to always keep it that way” - Male, 63 years “I think that that then helps the rest of your day, it gives you the energy to be able to move on and do the important things. But you've got to make your body learn to relax again. Again, I suppose that's where that sedentary part is actually an active sedentary part because it becomes important in the active parts of your day” - Male, 63 years “So I sit here and I relax my body and I'm good” - Male, 75 years Subtheme: Completing tasks “During the daytime, I try to keep moving around doing little things around the home and in the backyard” - Male, 68 years “I mean I do all the washing and cooking and cleaning up of the house. But I don’t do the floors or the bathrooms. I get someone to come in and help me with that. So, that takes a good, I suppose half an hour, hour a day. It depends what - this morning I've done a couple of loads of washing and just hung it out on the horse inside” - Female, 78 years “…and you want to just sit down in front of the couch, actually getting up to cook is another little activity that you do…” - Male, 64 years “If you've got a shopping day, and then you might decide that you're going to do other things while you're out shopping. So I won't sit around much that day at all” - Female, 70 years Theme 4: Physical activity Subtheme: Pacing myself “…and if I get up and do something active - and not all the time, because I think relax-, everybody needs to be able to relax, I think, that's very important. You must smell the roses in your life” - Male, 63 years “I know it's only going to be five or 10 minutes and I'm going to be running again. I've just run out of petrol. Just refuel and away you go” - Male, 75 years “When I do a really active day, the next day I'm not too active. Because I get quite tired” - Female, 64 years “I can rake for a little while but I can't rake very long or push a broom very long because that runs me out of air. I can pick up rocks but I can't pick up four rocks. I'll only pick up one rock at a time for two rocks. Then I'll go and sit down and then I'll come back and I'll pick up another two” - Male, 75 years Subtheme: Two sides of the same coin “Because I’m so active I’m not a particularly sedentary person” - Male, 63 years “…but being sedentary to me is part of your life but for me the more important the more enjoyable part of my life is doing the exercise” - Male, 63 years “Well, when I’m not feeling well, I just become inactive. It might be just a habit that I park myself in front of the TV and watch sport. I love watching sport on TV. I watch back - I watch old football games, old cricket games, go back 30 years and that sort of thing” - Male, 73 years “…because it's like when you say less sedentary, it could be right, okay, look off you go and play tennis or something like that” - Female, 57 years Theme one: Habits and routine This theme describes how participants’ sedentary behaviour pattern is often a result of established habits and routine. The subtheme ‘time of day’ refers to participants’ formed habits and routine based on the time of the day, where the morning was dedicated to activities such as shopping, physical activity and social engagements and the evenings to being at home, sitting, and watching television. Another subtheme was ‘the cycle’ which represented participants’ habit of sitting for long periods uninterrupted and the conscious need to break this habit otherwise the cycle will continue. The third subtheme for habits and routine was ‘mindset’. This was formed to describe how participants’ self-perception or belief towards being a sedentary person influenced their established routines/habits to avoid sedentary behaviour. “I don't want to be one of these old people that sit there waiting to die” - Female, 70 years However, some participants described situations where that mindset breaks and no longer had the mental ability to keep up their routines/habits to avoid being sedentary. Theme two: The burden of asthma Participants highlighted that having asthma and associated multi-morbidity impacts the amount of sedentary behaviour they participate in. This further produced the subtheme ‘symptom management’ which extrapolated that their behaviour is dependent on how well their symptoms were managed. Participants particularly described how breathlessness is the most problematic symptom they experience and that they engage in sedentary behaviour to alleviate it. “I can sit down and concentrate and deep breathe and get out of the tight feeling and relax” - Female, 78 years The subtheme ‘physical limitation’ captured the presence of physical limitations such as pain, fatigue, and how the physical environment such as the weather, reduces their capability and opportunities to participate in non-sedentary behaviour. Theme three: Driven by responsibility and purpose This theme described how participants’ roles or responsibilities dictate the type of activity they engage in, and consequently, if the activity is completed in a sedentary way or not. Within this theme is the subtheme ‘for or with someone else’. This refers to participants discussing how fulfilling a social or caring role contributes to the type of activity they engage in. This subtheme also includes the impact that a fellow companion or partner has on their own behaviour, for example, a companion may encourage or discourage sedentary behaviour. “…my husband will come in and say, come on, we're going to do something. You've been sitting there long enough” - Female, 70 years Another formed subtheme is ‘a good purpose’. Participants described how they benefit from engaging in sedentary behaviour including time to reflect, relax, focus, and do hobbies. Lastly, the subtheme ‘completing tasks’ captured the responsibility or role participants held, particularly household tasks. These tasks lead to less sedentary behaviour as it fulfills their sense of purpose. Theme four: Physical activity Participants discussed the relationship between physical activity and sedentary behaviour. One subtheme for physical activity is ‘pacing myself’ which represents participants’ conscious balance between being physically active and sedentary. For example, if they pushed themselves beyond their physical capability, this led to prolonged sedentary behaviour. Whereas, if they paced themselves with their physical activity, their sedentary behaviour would be accumulated in shorter bouts. “For me to mow the grass, it might take me all day. But I get it done. I go and do one strip and come back. One strip and come back and sit down” - Male, 75 years ‘Two sides of the same coin’ is another subtheme that captures participants understanding about the difference between physical activity and sedentary behaviour. To the participants, being sedentary meant you are not doing enough physical activity and conversely, you are not being sedentary if you are doing enough physical activity. “…because it's like when you say be less sedentary, it could be right, okay, look off you go and play tennis or something like that” - Female, 57 years Discussion This qualitative study reports the perceptions of sedentary behaviour among people with severe asthma. There were three main findings from these data ( 1 ) while people with severe asthma perceived sedentary behaviour negatively when accumulated in long continuous bouts, they considered sedentary behaviour to be necessary to manage symptoms, rest, and relax; ( 2 ) sedentary behaviour patterns were part of established habits or routines, which were driven by the status of their asthma control, the roles and responsibilities they hold, and by external influences; and ( 3 ) we identified misconceptions in relation to physical inactivity and sedentary behaviour; participants often perceived that, to not be sedentary, meant you had to be doing enough purposeful physical activity. These data provide underpinning programme theory on sedentary behaviour in people with severe asthma, which should be considered when designing targeted sedentary behaviour interventions. How people accumulate sedentary behaviour has different impacts on health outcomes. Previous research shows that despite spending a similar amount of time being sedentary as non-asthma counterparts (9 hrs), people with severe asthma accumulate sedentary behaviour in longer bouts, which may be more deleterious for health (5 versus 4 hours) 4 . In this study, people with severe asthma described their consciousness of participating in long periods of uninterrupted sedentary behaviour. Conversely, participants advocated for sedentary behaviour by describing the benefits of allocating time in their day to sit and participate in sedentary activities that are important to them. Therefore, sedentary behaviour is not necessarily always viewed as a negative behaviour for people with severe asthma. This finding has similarly been shown in an older adult population 20 . Specifically in our study, people with severe asthma commonly mentioned television watching as an activity that enables long periods of sedentary behaviour. Higher amounts of television-viewing is related to worse health outcomes irrespective of high levels of moderate intensity physical activity 21 . Additionally, participants in our study described the afternoon as being the most common time for long uninterrupted bouts of sitting. Therefore, the afternoon may be an opportunistic time of the day to break up sedentary time in people with severe asthma 22 . Shared-decision making may be required to find alternative types of behaviour that do not lead to prolonged sitting but continue to provide relaxation. Symptoms such as breathlessness, pain, and fatigue impact the amount of sedentary behaviour that people with severe asthma engage in. When asthma symptoms were increased, participants described an inability to do anything requiring effort. This is similarly reported by people with rheumatoid arthritis, where the fluctuation of the inflammatory disease makes it a constant battle between days with low amounts of sedentary behaviour and days with high amounts of sedentary behaviour 23 . The pain experienced by people with severe asthma may be attributed to the presence of musculoskeletal conditions 24 . Having musculoskeletal conditions is associated with spending a full day being sedentary 25 . Specifically, the prevalence of osteoarthritis has been shown to be as high as 32% in people with asthma, a higher prevalence than in healthy controls and people with COPD 26 . Although we can not determine if osteoarthritis was the driver of pain causing sedentary behaviour in this study, people with asthma and people with osteoarthritis spend up to two thirds of their day being sedentary and attribute this to pain 27, 28 . These findings show the importance of managing asthma symptoms and comorbidities as part of a multi-dimensional approach to addressing sedentary behaviour in people with severe asthma. Further educating people with severe asthma about replacing sedentary behaviour with feasible options such as standing or LPA while experiencing symptoms may also be beneficial for their health and wellbeing. People with severe asthma spoke about the importance of social roles and household responsibilities they hold. As with people with COPD 29 , the behaviour of people with severe asthma is influenced by their family, friends, and household members. They expressed that their loved ones either facilitated sedentary behaviour, or conversely, active behaviours 29 . Individuals’ sedentary behaviour patterns have been shown to be linked to the behaviours of loved ones, such as partners or household members 30 . These findings warrant the establishment a collaborative plan including people with severe asthma and their significant others 31 to optimise sedentary behaviour. Participants in this study, described that doing their planned household chores is one of the main reasons for moving from a sitting to standing position when at home. In line with this finding, doing household chores was reported as one of the most common non-sitting activities in older adults 32 . Additionally, completing household chores is also of importance to people with COPD 33 . Therefore, encouraging people with severe asthma to take on activities within the household may reinforce the benefits that these types of activities can have on breaking up their sedentary behaviour and consequently the associated health benefits. Misperceptions around sedentary behaviour being the same as physical inactivity are common 34 , and observed in this current study. For example, people with severe asthma linked the number of steps performed per day to their level of sedentary behaviour. This indicates a misunderstanding that to reduce sedentary behaviour, requires replacing with walking or purposeful physical activity. This is reflected in intervention studies where a sedentary behaviour change intervention in people with COPD was shown to not reduce time spent being sedentary however increased time spent doing MVPA 35 . The authors attributed this to participants choosing to replace sedentary behaviour with steps, this corroborate that an increase in MVPA does not necessarily translate to a reduction in sedentary time. People with severe asthma spend up to 9 hrs per day sedentary 4 . It is not feasible, nor expected, that people with severe asthma could replace any significant amount of this time with MVPA. Instead, a more feasible approach would be to replace or break up sedentary behaviour with standing or other LPA including household tasks, as previously discussed. These data provide novel insights from the perspective of people with severe asthma on their perception of sedentary behaviour. The study includes a purposeful sample size of people with confirmed severe asthma that ensures the validity of the data. We acknowledge that the generalisability of our findings may be limited. Participants were recruited from one geographical location and were mostly not working or were retired. Therefore, future studies should incorporate people with a mix of demographic characteristics. This study provided key elements in understanding the perception of sedentary behaviour in people with severe asthma. Our findings show that future interventions should ( 1 ) target periods of long sitting in the afternoon, particularly during TV-viewing time ( 2 ) manage asthma and comorbidity symptoms known to enable sedentary behaviour ( 3 ) establish a plan to be less sedentary with social peers and promote completing household tasks and ( 4 ) provide education on the difference between sedentary and physical inactivity. Future sedentary behaviour intervention targeted at people with severe asthma should incorporate these findings to develop programme theory. Declarations Ethics approval and consent to participate Informed consent was obtained from all participants according to GCP. Ethics approval was obtained from the Hunter New England Human Research Ethics Committee (2018/ETH00338). Consent for publication All participants provided consent for the publication of anonymised quotes. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests PUG, EM and SH declare no competing interests. HL reports consulting fees from Boehringer Ingelheim, grants from HMRI and Diabetes Australia, speaking fees from Lung Foundation Australia, TSANZ, Exercise and Sports Science Australia, and European Respiratory Society, shares in 4DMedical, outside the submitted work. PG reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, grants from AstraZeneca, GlaxoSmithKline, outside the submitted work. VM reports speaker and advisory board fees from AstraZeneca, GlaxoSmithKline, and Boehringer Ingelhiem. VM reports other grants from AstraZeneca, GlaxoSmithKline, Cyclomedica, outside the submitted work. Funding This study was supported by a John Hunter Charitable Trust grant. PUG is supported by a Research Training Program (RTP), University of Newcastle PhD Scholarship. The funders were not involved in data collection, analysis, or interpretation; design; participant recruitment; or any aspect pertinent to the study. Authors' contributions All authors contributed to data interpretation and critical review of the manuscript. VMM conceived the study and developed the research question. VMM, SAH, PGG, and PDUG contributed to developing the study design. VMM, PGG, HL, and PDUG developed the analysis plan. PDUG recruited participants and conducted outcome assessments. VMM and PGG reviewed patient eligibility, safety, and progress. SAH conducted qualitative interviews. PDUG and EM conducted data analysis. PDUG drafted the manuscript. All authors read and approved the final manuscript. References Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55:2895–905. 10.1007/s00125-012-2677-z . Owen N, Healy GN, Matthews CE, et al. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38:105–13. 10.1097/JES.0b013e3181e373a2 . Cordova-Rivera L, Gibson PG, Gardiner PA, et al. Physical Activity and Exercise Capacity in Severe Asthma: Key Clinical Associations. J Allergy Clin Immunology: Pract. 2018;6:814–22. https://doi.org/10.1016/j.jaip.2017.09.022 . Cordova-Rivera L, Gardiner PA, Gibson PG, et al. Sedentary time in people with obstructive airway diseases. Respir Med. 2021;181:106367. https://doi.org/10.1016/j.rmed.2021.106367 . World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Switzerland: Geneva; 2020. Prince SA, Saunders TJ, Gresty K, et al. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev. 2014;15:905–19. 2014/08/11. Urroz Guerrero PD, Oliveira JM, Lewthwaite H et al. Key Considerations When Addressing Physical Inactivity and Sedentary Behaviour in People with Asthma. J 12: 5998. 10.3390/jcm12185998 . Freitas PD, Passos NFP, Carvalho-Pinto RM, et al. A Behavior Change Intervention Aimed at Increasing Physical Activity Improves Clinical Control in Adults With Asthma: A Randomized Controlled Trial. Chest. 2021;159:46–57. 10.1016/j.chest.2020.08.2113 . Freitas PD, Silva AG, Ferreira PG, et al. Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma. Med Sci Sports Exerc. 2018;50:1367–76. 2018/02/13. Scott HA, Gibson PG, Garg ML, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Experimental Allergy. 2013;43:36–49. https://doi.org/10.1111/cea.12004 . Blackburn NE, Wilson JJ, McMullan II, et al. The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis. Int J Behav Nutr Phys Activity. 2020;17:53. 10.1186/s12966-020-00957-0 . Skivington K, Matthews L, Simpson SA et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ 2021; 374: n2061. 10.1136/bmj.n 2061. Hiles SA, Urroz PD, Gibson PG, et al. A feasibility randomised controlled trial of Novel Activity Management in severe ASthma-Tailored Exercise (NAMASTE): yoga and mindfulness. BMC Pulm Med. 2021;21:71. 10.1186/s12890-021-01436-3 . Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43:343–73. 10.1183/09031936.00202013 . Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324. 10.1183/09031936.00080312 . Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44:1428. 10.1183/09031936.00150314 . Cordova-Rivera L, Gibson P, Gardiner P, et al. Physical Activity and Exercise Capacity in Severe Asthma: Key Clinical Associations. J Allergy Clin Immunology: Pract. 2018;6:814–22. https://doi.org/10.1016/j.jaip.2017.09.022 . Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes and theory. Health Serv Res. 2007;53:2858–1772. 10.1111/j.1475-6773.2006.00684.x . Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706qp063oa . Palmer VJ, Gray CM, Fitzsimons C, et al. Sitting as a moral practice: Older adults’ accounts from qualitative interviews on sedentary behaviours. Sociol Health Illn. 2021;43:2102–20. https://doi.org/10.1111/1467-9566.13383 . Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388:1302–10. 10.1016/S0140-6736(16)30370-1 . Lai T-F, Liao Y, Lin C-Y, et al. Diurnal pattern of breaks in sedentary time and the physical function of older adults. Archives Public Health. 2023;81:35. 10.1186/s13690-023-01050-1 . Thomsen T, Beyer N, Aadahl M et al. Sedentary behaviour in patients with rheumatoid arthritis: A qualitative study. Int J Qual Stud Health Well-being 2015; 10: 28578. 20151012. 10.3402/qhw.v10.28578 . Centre of Excellence in Severe Asthma. Severe Asthma Toolkit, https://toolkit.severeasthma.org.au (2018, accessed 23/09/2023). Dzakpasu FQS, Carver A, Brakenridge CJ, et al. Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. Int J Behav Nutr Phys Activity. 2021;18:159. 10.1186/s12966-021-01191-y . Koo H-K, Song P, Lee J-H. Novel association between asthma and osteoarthritis: a nationwide health and nutrition examination survey. BMC Pulm Med. 2021;21:59. 10.1186/s12890-021-01425-6 . Webber SC, Ripat JD, Pachu NS, et al. Exploring physical activity and sedentary behaviour: perspectives of individuals with osteoarthritis and knee arthroplasty. Disabil Rehabil. 2020;42:1971–8. 10.1080/09638288.2018.1543463 . Lee J, Chang RW, Ehrlich-Jones L, et al. Sedentary Behavior and Physical Function: Objective Evidence From the Osteoarthritis Initiative. Arthritis Care Res. 2015;67:366–73. https://doi.org/10.1002/acr.22432 . Wshah A, Selzler A-M, Hill K, et al. Determinants of Sedentary Behaviour in Individuals with COPD: A Qualitative Exploration Guided by the Theoretical Domains Framework. COPD: J Chronic Obstr Pulmonary Disease. 2020;17:65–73. 10.1080/15412555.2019.1708883 . Pauly T, Keller J, Knoll N, et al. Moving in Sync: Hourly Physical Activity and Sedentary Behavior are Synchronized in Couples. Ann Behav Med. 2020;54:10–21. 10.1093/abm/kaz019 . Majellano EC, Clark VL, Foster JM, et al. It's like being on a roller coaster: the burden of caring for people with severe asthma. ERJ open res. 2021;7(20210412). 10.1183/23120541.00812-2020 . Palmer VJ, Gray CM, Fitzsimons CF, et al. What Do Older People Do When Sitting and Why? Implications for Decreasing Sedentary Behavior. Gerontologist. 2019;59:686–97. 10.1093/geront/gny020 . Weedon AE, Saukko PM, Downey JW, et al. Meanings of sitting in the context of chronic disease: a critical reflection on sedentary behaviour, health, choice and enjoyment. Qualitative Res Sport Exerc Health. 2020;12:363–76. 10.1080/2159676X.2019.1595105 . van der Ploeg HP, Hillsdon M. Is sedentary behaviour just physical inactivity by another name? Int J Behav Nutr Phys Activity. 2017;14:142. 10.1186/s12966-017-0601-0 . Cheng SWM, Alison J, Stamatakis E et al. Six-week behaviour change intervention to reduce sedentary behaviour in people with chronic obstructive pulmonary disease: a randomised controlled trial. Thorax 2021 2021/07/07. 10.1136/thoraxjnl-2020-214885 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Oct, 2024 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 21 May, 2024 Submission checks completed at journal 14 May, 2024 Editor assigned by journal 14 May, 2024 First submitted to journal 14 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4416456","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":304980932,"identity":"7684e120-a5eb-4b98-809f-6e25bf52f24b","order_by":0,"name":"Paola D Urroz Guerrero","email":"","orcid":"","institution":"University of Newcastle","correspondingAuthor":false,"prefix":"","firstName":"Paola","middleName":"D Urroz","lastName":"Guerrero","suffix":""},{"id":304980933,"identity":"98ca53a3-e4a1-44ed-8fdc-7a2c28b6164a","order_by":1,"name":"Peter G Gibson","email":"","orcid":"","institution":"John Hunter Hospital","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"G","lastName":"Gibson","suffix":""},{"id":304980934,"identity":"4afd207e-c89d-4fb5-9c38-99aea28d3945","order_by":2,"name":"Hayley Lewthwaite","email":"","orcid":"","institution":"University of Newcastle","correspondingAuthor":false,"prefix":"","firstName":"Hayley","middleName":"","lastName":"Lewthwaite","suffix":""},{"id":304980935,"identity":"0d6216e1-57bf-4ed9-b23e-95dae0132dc3","order_by":3,"name":"Eleanor Majellano","email":"","orcid":"","institution":"University of Newcastle","correspondingAuthor":false,"prefix":"","firstName":"Eleanor","middleName":"","lastName":"Majellano","suffix":""},{"id":304980936,"identity":"373d0630-0391-439b-affa-2325d53693c3","order_by":4,"name":"Sarah A Hiles","email":"","orcid":"","institution":"University of Newcastle","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"A","lastName":"Hiles","suffix":""},{"id":304980937,"identity":"ab7a549f-3a62-4a44-af26-48c762496936","order_by":5,"name":"Vanessa M McDonald","email":"data:image/png;base64,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","orcid":"","institution":"University of Newcastle","correspondingAuthor":true,"prefix":"","firstName":"Vanessa","middleName":"M","lastName":"McDonald","suffix":""}],"badges":[],"createdAt":"2024-05-14 04:38:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4416456/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4416456/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-024-20446-4","type":"published","date":"2024-10-30T16:20:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57427837,"identity":"b32a6e15-c1d7-4c58-9707-e2c37cd36d40","added_by":"auto","created_at":"2024-05-30 14:35:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":447608,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual diagram of generated themes and subthemes\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4416456/v1/4039402ed57c14c2c303aacd.jpg"},{"id":68207131,"identity":"e1cac6e6-809e-46b6-841c-fb0501e66013","added_by":"auto","created_at":"2024-11-04 16:35:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1026208,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4416456/v1/dd5ed0e6-17dc-425f-ba9a-46dec7783709.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions of sedentary behaviour in people with severe asthma: A qualitative study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSedentary behaviour is associated with an increased risk of cardiovascular disease, diabetes, and all-cause mortality\u003csup\u003e1\u003c/sup\u003e. There is evidence that the negative health consequences of prolonged sedentary behaviour are independent of physical activity levels\u003csup\u003e2\u003c/sup\u003e. For people with asthma, more time spent being sedentary is additionally associated with decreased exercise capacity, lung function, and asthma control\u003csup\u003e3\u003c/sup\u003e. Despite the deleterious effects of sedentary behaviour on important health and asthma-specific outcomes, people with severe asthma spend up to nine hours per day being sedentary, with half of this time spent in sitting bouts longer than 30 minutes\u003csup\u003e4\u003c/sup\u003e. Targeting sedentary behaviour as part of asthma management warrants investigation as this approach may positively impact people with severe asthma.\u003c/p\u003e \u003cp\u003eIn 2020, for the first time, the World Health Organisation physical activity guidelines included recommendations for limiting the amount of time spent sedentary across all age groups and abilities\u003csup\u003e5\u003c/sup\u003e. The inclusion of sedentary behaviour recommendations in guidelines is important, as inactivity and sedentariness are separate constructs. Inactive refers to not meeting the recommended amount of moderate to vigorous physical activity (MVPA). Sedentary refers to spending a high proportion of wake time in sedentary activities; those with a low energy requirement performed in a sitting or lying position. It is therefore possible to be active and sedentary, or inactive yet not sedentary. Consequently, addressing inactivity is different to addressing sedentariness\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere is limited research addressing how to address sedentary behaviour in people with severe asthma\u003csup\u003e7\u003c/sup\u003e. Existing randomised controlled trials (RCT) have primarily focused on the impact of physical activity interventions on both activity and sedentary behaviour outcomes\u003csup\u003e8\u0026ndash;10\u003c/sup\u003e. To date, there are no RCT that have implemented a sedentary behaviour focused intervention in people with severe asthma. Interventions targeting sedentary behaviour in the general population and in chronic disease conditions have shown promising results when solely focusing on sedentary behaviour and not co-targeting other health behaviours like physical activity and diet\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBehaviour change interventions are complex, requiring a systematic approach to understand how and under what circumstances change in behaviour is achieved\u003csup\u003e11, 12\u003c/sup\u003e. The United Kingdom Medical Research Council\u0026rsquo;s framework for the development of complex interventions identifies the importance of involving key stakeholders to develop programme theory\u003csup\u003e12\u003c/sup\u003e. Taking this into consideration, the perspectives of people with severe asthma are needed to inform a sedentary behaviour targeted intervention; however, this is yet to be investigated. To address this knowledge gap, we sought to explore perceptions of sedentary behaviour among people with severe asthma.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA descriptive qualitative study was conducted as part of a single centre, parallel group RCT in people with severe asthma, reported previously\u003csup\u003e13\u003c/sup\u003e. Briefly, participants were randomised to a yoga and mindfulness intervention or usual care with tailored information about physical activity, mindfulness, and goal setting. After completing the trial, all participants were interviewed face-to-face regarding perceptions of physical activity, sedentary behaviour and perceived benefits and weaknesses of the intervention.\u003c/p\u003e \u003cp\u003eEthics approval was obtained from the Hunter New England Human Research Ethics Committee (2018/ETH00338) and the trial was registered on the Australia New Zealand Clinical Trials Register (ACTRN12618001914257). Written informed consent was obtained from each participant prior to data collection in accordance with Good Clinical Practice.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipant recruitment and selection\u003c/h2\u003e \u003cp\u003eAdults (\u0026ge;\u0026thinsp;18 years) with severe asthma (defined according to the European Respiratory Society (ERS) / American Thoracic Society (ATS) Task force definition\u003csup\u003e14\u003c/sup\u003e) were recruited to the RCT. Details of inclusion and exclusion criteria have been previously reported\u003csup\u003e13\u003c/sup\u003e. Participants were recruited \u003cem\u003evia\u003c/em\u003e consecutive methods through the research database and clinics of the Department of Respiratory and Sleep Medicine at John Hunter Hospital, NSW and via general/social media advertisement. Expressions of interest were extended \u003cem\u003evia\u003c/em\u003e treating respiratory physicians, who referred eligible patients to the study. A total of 24 participants recruited and randomised to the RCT. All participants were invited to a face-to-face semi structured interview within 2 months of completing the intervention on an intention to treat basis\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment\u003c/h2\u003e \u003cp\u003eThe assessment included collecting self-reported demographic information, asthma and exacerbation history (previous 12 months), and respiratory medication use. Clinical measures were also completed by participants as part of their participation in the RCT\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePre and post-bronchodilator (400 \u0026micro;g of Salbutamol) spirometry according to ATS/ERS guidelines was completed to attain measures of lung function and 2012 GLI equations were used to calculate predicted values\u003csup\u003e15\u003c/sup\u003e. Participant\u0026rsquo;s functional exercise capacity was measured using the 6-minute walk test (6MWT), to calculate 6-minute walk distance (6MWD), according to guidelines\u003csup\u003e16\u003c/sup\u003e. Participants wore a tri-axial accelerometer (Actigraph wGT3X-BT) for eight consecutive days to measure moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LPA) and sedentary time. Tri-axial accelerometer data processing details have been described previously\u003csup\u003e17\u003c/sup\u003e. The Asthma Control Questionnaire (ACQ) was administered to assess the level of asthma control. Health-related quality of life was measured using the St. George\u0026rsquo;s Respiratory Questionnaire (SGRQ). The Dyspnoea-12 (D-12) questionnaire was completed by participants to assess breathlessness. Levels of anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale (HADS).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInterview procedure\u003c/h2\u003e \u003cp\u003eThe interviews took place in a private room at the Hunter Medical Research Centre (Newcastle, NSW, Australia) for a mean (SD) duration of 97 minutes (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Present during the interviews was the participant and the facilitator. A semi-structured, open-ended interview guide was used. Participants were asked open-ended questions from an interview guide about factors that influence their sitting behaviour. For this study, phrases and sentences that were relevant and referred to sedentary behaviour specifically underwent a secondary analysis. The facilitator was author SAH (PhD), a female post-doctoral researcher who is trained in qualitative research, did not have an established role in providing clinical care to the participants and did not deliver the intervention as part of the RCT.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData generation and analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were calculated using SPSS version 28 (IBM, Armonk, NY, USA). The interviews were audio-recorded and transcribed verbatim. Participants were informed they may review and edit their transcript of the interview. Transcripts were pseudonymised to protect confidentiality. Data familiarisation, both in written form and audio recording was undertaken\u003csup\u003e18, 19\u003c/sup\u003e. The analysis accounted for field notes, vocal tone, and participant emphasis on certain words and phrases to enable underlying emotions to be understood within the context of the conversation.\u003c/p\u003e \u003cp\u003eInductive thematic analysis was undertaken according to Braun and Clarke\u0026rsquo;s six steps approach\u003csup\u003e19\u003c/sup\u003e by author PUG using NVivo 12 Pro (QSR International, Melbourne, VIC, Australia). Data were reviewed line by line to capture relevant data to sedentary behaviour. As a concept became apparent codes assigned, organising the data into meaningful groups. Themes were then generated from the codes. A second qualitative researcher (EM) independently coded 30% of the transcripts, with comparison made to resolve discrepancies. Coding agreement was achieved with a mean (SD) percentage agreement of 99.9 (0.3). Generated codes and themes and the interpretation of the findings were discussed and reviewed with co-authors PG, HL and VM.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eA total of 21 participants attended and completed the face-to-face semi structured interview\u003csup\u003e13\u003c/sup\u003e. All 21 interview transcripts were included in the analysis, 62% of which were participants who were randomised to the yoga and mindfulness intervention and the remaining in the active control group\u003csup\u003e13\u003c/sup\u003e. Participant\u0026rsquo;s demographics, clinical and movement characteristics are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants were mostly females and obese. Their asthma was controlled, and most participants were receiving monoclonal antibody therapy for severe asthma (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants were inactive and sedentary.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant demographic and asthma-related characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, females (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of diagnosis, years (median, Q1; Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (5; 49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAboriginal or Torres Strait Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving arrangement* (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with spouse/partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment or study status (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking fulltime or part time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working or retired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribed monoclonal antibody therapy (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeclomethasone daily equivalent, mcg (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1771\u0026thinsp;\u0026plusmn;\u0026thinsp;811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical measures\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACQ6, score (median, Q1; Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5 (0.2; 1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost BD FEV\u003csub\u003e1\u003c/sub\u003e, % predicted (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost BD FEV\u003csub\u003e1\u003c/sub\u003e/FVC, ratio (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6MWD, m (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e486.8\u0026thinsp;\u0026plusmn;\u0026thinsp;115.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-reported measures\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGRQ, total score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD12, total score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-Anxiety, sub score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-Depression, sub score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS, total score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExacerbation History (previous 12 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital admissions (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency department admissions (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral practitioner visits (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOCS use (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic use (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal exacerbation rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMovement Behaviours (per day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate to vigorous physical activity, minutes (median, Q1; Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.1 (11.3; 44.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLight intensity physical activity, hours (median, Q1; Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 (1.8; 3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary time, hours (median, Q1; Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.8 (9.7; 11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI, Body mass index; ACQ, Asthma control questionnaire; BD, Bronchodilator; FEV\u003csub\u003e1\u003c/sub\u003e, Forced expiratory volume in 1 second; FVC, Forced vital capacity; 6MWD, 6-minute walk distance; SGRQ, St. George respiratory questionnaire; D12, Dyspnoea-12; HADS, Hospital anxiety and depression scale; OCS, Oral corticosteroids. *missing data from n\u0026thinsp;=\u0026thinsp;1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eThemes\u003c/h2\u003e \u003cp\u003eDuring the thematic analysis process, data saturation was achieved (no new information emerged from the data) and 14 codes were reviewed and collated into themes. The analysis generated four main themes and 10 subthemes (Fig.\u0026nbsp;1, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExemplar quotes for themes and subthemes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme 1: Habits and Routine\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: Time of day\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;Yeah, I'd prefer to do something morning rather than anything in the afternoon. Mainly because I think by the afternoon, if I do have a busy morning, the afternoons - it's just rest time\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;Um so, I\u0026rsquo;ve always been like someone who\u0026rsquo;s got 10 things to do that day, so I\u0026rsquo;ll get them all done and have my like little job list and then I\u0026rsquo;ll sit down of a night\u0026rdquo; - Female, 49 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I'm a morning person, so I tend to be a little bit more active in the morning and then in the afternoon, after lunch, is when I normally do my sewing or do my Scrabble or doing things like I just sit down\u0026rdquo; - Female, 57 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip; Yeah, in the evening where I'll sit down and maybe for four hours, four or five hours in the evening sitting there, working - looking at the computer and TV and such. During the daytime, I try to keep moving around doing little things around the home and in the backyard; or I have a friend who I sometimes go out with\u0026rdquo; - Male, 68 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: The cycle\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;Sometimes, I can\u0026rsquo;t even stand the ads and I say, there is a break, get out of it. If you watch that again, you will go totally mad. So you get up and you move\u0026rdquo; - Female, 77 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;It's not - it makes me lazy; it does. If I sit around for too long then I really don't want to get up and do anything\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;It sounds like a bit of a cycle. You don't want to get up so you don't get up and then that makes you less likely to want to get up\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;you have to be wary of just sitting there watching and that\u0026rsquo;s where I find this getting up and doing something in between and even if it\u0026rsquo;s just getting out of the chair, walking out and wiping the dishes, making a cup of tea, looking around in your kitchen and say oh, I\u0026rsquo;ll put that there for tomorrow or whatever and not just sit totally for a long period\u0026rdquo; - Female, 77 years\u003c/p\u003e \u003cp\u003e\u003cem\u003eSubtheme: Mindset\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;So it\u0026rsquo;s not just your lungs, it\u0026rsquo;s your bones and your blood circulation. So if you don\u0026rsquo;t keep all those going, the whole thing is just - it\u0026rsquo;s like a car that sits in the garage; it won't start after a while, you know?\u0026rdquo; - Female, 77 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;The other bit is getting on with life, people who sit too much don't do enough, I don't think\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;You\u0026rsquo;ve got to keep moving, get up and - even if you\u0026rsquo;re in the house in a dressing gown, move because that\u0026rsquo;s wrong\u0026rdquo; - Female, 77 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;Sometimes I don't feel - like, I think, yeah, maybe I'll go out today and then I think, no, I think I'll just stay at home, where I probably should push myself to get dressed and go out, but I don't\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTheme 2: The burden of asthma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: Symptom management\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I spent two whole weeks in bed, I didn't move. So, 1000 steps in a day was huge for me because I was so sick. Getting up and going to the toilet and then getting back into bed was about as far as I went\u0026hellip;\u0026rdquo; - Female, 49 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;That's all you think about is moving and breathing, moving and breathing, and it's slow moving and it's not puffing you out and it's not making your asthma any worse. Then you can actually sit down and go I can actually breathe better. As soon as you start to breathe a little bit better, your mind is going I'm good, I'm okay now, and the clouds clear\u0026rdquo; - Female, 49 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;If I\u0026rsquo;m not feeling well, if my cough is bad, after dinner every night, I\u0026rsquo;ll park myself in front of the TV and sit there and cough and carry on and watch TV until the early hours of the morning\u0026rdquo; - Male, 73 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;if I\u0026rsquo;m having an asthma attack, yeah and I sit down to relieve that\u0026rdquo; - Female, 62 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme Physical limitations\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;I'd just like to be able to do things around the house without any pain and without - to be without pain would be unbelievable\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I don't get up in a hurry. I sit up and then I've usually got to push myself out of bed these days because I'm not as strong in the knees, and I put that down to lack of exercise\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;So that's when I'll sit down and read because I won't go to sleep because I'll be a bit lethargic and think, oh, I've had enough today\u0026rdquo; - Female, 70 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;For me, if I open the door and it's overcast and the wind is cold and it's drizzly, I'd be better off to shut the door, go back inside and wait for a nice day\u0026hellip;but if it's sunny and warm outside, it - I'm more conducive to being outside doing things\u0026rdquo; - Male, 64 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTheme 3: Driven by responsibility and purpose\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: For and with someone else\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;His motivation has really fallen and I think that brings me down a bit, not having somebody that says, come on, let's get up and go\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;Probably if I'm on the phone to friends I'd be sitting yapping away\u0026rdquo; - Female, 61 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I\u0026rsquo;m a sewer; I make quilts and take everybody\u0026rsquo;s clothes - the legs of pants takes in, darts here, the usual everyone piles it on and the family which I don\u0026rsquo;t mind\u0026rdquo; - Female, 77 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;So I'm sitting on my bum for four to six hours a day, whereas previously I wouldn't be sitting on my backside for that period of time. But it's something I want to do and something I'm doing that's beneficial to somebody else. It's not a paid position, but it's something that I'm doing to help some friends out and I enjoy doing it. It's keeping the mind active and that too, as well\u0026rdquo; - Male, 75 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: A good purpose\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;yesterday with the 3000 steps when I sat in front of the computer for three hours, you know doing something that that really fascinates me\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;so the sitting is a luxury, which I enjoy but it's still a luxury and I'd like to always keep it that way\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I think that that then helps the rest of your day, it gives you the energy to be able to move on and do the important things. But you've got to make your body learn to relax again. Again, I suppose that's where that sedentary part is actually an active sedentary part because it becomes important in the active parts of your day\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;So I sit here and I relax my body and I'm good\u0026rdquo; - Male, 75 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: Completing tasks\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;During the daytime, I try to keep moving around doing little things around the home and in the backyard\u0026rdquo; - Male, 68 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I mean I do all the washing and cooking and cleaning up of the house. But I don\u0026rsquo;t do the floors or the bathrooms. I get someone to come in and help me with that. So, that takes a good, I suppose half an hour, hour a day. It depends what - this morning I've done a couple of loads of washing and just hung it out on the horse inside\u0026rdquo; - Female, 78 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;and you want to just sit down in front of the couch, actually getting up to cook is another little activity that you do\u0026hellip;\u0026rdquo; - Male, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;If you've got a shopping day, and then you might decide that you're going to do other things while you're out shopping. So I won't sit around much that day at all\u0026rdquo; - Female, 70 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTheme 4: Physical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: Pacing myself\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;and if I get up and do something active - and not all the time, because I think relax-, everybody needs to be able to relax, I think, that's very important. You must smell the roses in your life\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I know it's only going to be five or 10 minutes and I'm going to be running again. I've just run out of petrol. Just refuel and away you go\u0026rdquo; - Male, 75 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;When I do a really active day, the next day I'm not too active. Because I get quite tired\u0026rdquo; - Female, 64 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;I can rake for a little while but I can't rake very long or push a broom very long because that runs me out of air. I can pick up rocks but I can't pick up four rocks. I'll only pick up one rock at a time for two rocks. Then I'll go and sit down and then I'll come back and I'll pick up another two\u0026rdquo; - Male, 75 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSubtheme: Two sides of the same coin\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ldquo;Because I\u0026rsquo;m so active I\u0026rsquo;m not a particularly sedentary person\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;but being sedentary to me is part of your life but for me the more important the more enjoyable part of my life is doing the exercise\u0026rdquo; - Male, 63 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;Well, when I\u0026rsquo;m not feeling well, I just become inactive. It might be just a habit that I park myself in front of the TV and watch sport. I love watching sport on TV. I watch back - I watch old football games, old cricket games, go back 30 years and that sort of thing\u0026rdquo; - Male, 73 years\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;because it's like when you say less sedentary, it could be right, okay, look off you go and play tennis or something like that\u0026rdquo; - Female, 57 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme one: Habits and routine\u003c/h2\u003e \u003cp\u003eThis theme describes how participants\u0026rsquo; sedentary behaviour pattern is often a result of established habits and routine. The subtheme \u0026lsquo;time of day\u0026rsquo; refers to participants\u0026rsquo; formed habits and routine based on the time of the day, where the morning was dedicated to activities such as shopping, physical activity and social engagements and the evenings to being at home, sitting, and watching television. Another subtheme was \u0026lsquo;the cycle\u0026rsquo; which represented participants\u0026rsquo; habit of sitting for long periods uninterrupted and the conscious need to break this habit otherwise the cycle will continue. The third subtheme for habits and routine was \u0026lsquo;mindset\u0026rsquo;. This was formed to describe how participants\u0026rsquo; self-perception or belief towards being a sedentary person influenced their established routines/habits to avoid sedentary behaviour.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I don't want to be one of these old people that sit there waiting to die\u0026rdquo; - Female, 70 years\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHowever, some participants described situations where that mindset breaks and no longer had the mental ability to keep up their routines/habits to avoid being sedentary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme two: The burden of asthma\u003c/h2\u003e \u003cp\u003eParticipants highlighted that having asthma and associated multi-morbidity impacts the amount of sedentary behaviour they participate in. This further produced the subtheme \u0026lsquo;symptom management\u0026rsquo; which extrapolated that their behaviour is dependent on how well their symptoms were managed. Participants particularly described how breathlessness is the most problematic symptom they experience and that they engage in sedentary behaviour to alleviate it.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I can sit down and concentrate and deep breathe and get out of the tight feeling and relax\u0026rdquo; - Female, 78 years\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe subtheme \u0026lsquo;physical limitation\u0026rsquo; captured the presence of physical limitations such as pain, fatigue, and how the physical environment such as the weather, reduces their capability and opportunities to participate in non-sedentary behaviour.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme three: Driven by responsibility and purpose\u003c/h2\u003e \u003cp\u003eThis theme described how participants\u0026rsquo; roles or responsibilities dictate the type of activity they engage in, and consequently, if the activity is completed in a sedentary way or not. Within this theme is the subtheme \u0026lsquo;for or with someone else\u0026rsquo;. This refers to participants discussing how fulfilling a social or caring role contributes to the type of activity they engage in. This subtheme also includes the impact that a fellow companion or partner has on their own behaviour, for example, a companion may encourage or discourage sedentary behaviour.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;my husband will come in and say, come on, we're going to do something. You've been sitting there long enough\u0026rdquo; - Female, 70 years\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother formed subtheme is \u0026lsquo;a good purpose\u0026rsquo;. Participants described how they benefit from engaging in sedentary behaviour including time to reflect, relax, focus, and do hobbies. Lastly, the subtheme \u0026lsquo;completing tasks\u0026rsquo; captured the responsibility or role participants held, particularly household tasks. These tasks lead to less sedentary behaviour as it fulfills their sense of purpose.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme four: Physical activity\u003c/h2\u003e \u003cp\u003e Participants discussed the relationship between physical activity and sedentary behaviour. One subtheme for physical activity is \u0026lsquo;pacing myself\u0026rsquo; which represents participants\u0026rsquo; conscious balance between being physically active and sedentary. For example, if they pushed themselves beyond their physical capability, this led to prolonged sedentary behaviour. Whereas, if they paced themselves with their physical activity, their sedentary behaviour would be accumulated in shorter bouts.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For me to mow the grass, it might take me all day. But I get it done. I go and do one strip and come back. One strip and come back and sit down\u0026rdquo; - Male, 75 years\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u0026lsquo;Two sides of the same coin\u0026rsquo; is another subtheme that captures participants understanding about the difference between physical activity and sedentary behaviour. To the participants, being sedentary meant you are not doing enough physical activity and conversely, you are not being sedentary if you are doing enough physical activity.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;because it's like when you say be less sedentary, it could be right, okay, look off you go and play tennis or something like that\u0026rdquo; - Female, 57 years\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study reports the perceptions of sedentary behaviour among people with severe asthma. There were three main findings from these data (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) while people with severe asthma perceived sedentary behaviour negatively when accumulated in long continuous bouts, they considered sedentary behaviour to be necessary to manage symptoms, rest, and relax; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) sedentary behaviour patterns were part of established habits or routines, which were driven by the status of their asthma control, the roles and responsibilities they hold, and by external influences; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) we identified misconceptions in relation to physical inactivity and sedentary behaviour; participants often perceived that, to not be sedentary, meant you had to be doing enough purposeful physical activity. These data provide underpinning programme theory on sedentary behaviour in people with severe asthma, which should be considered when designing targeted sedentary behaviour interventions.\u003c/p\u003e \u003cp\u003eHow people accumulate sedentary behaviour has different impacts on health outcomes. Previous research shows that despite spending a similar amount of time being sedentary as non-asthma counterparts (9 hrs), people with severe asthma accumulate sedentary behaviour in longer bouts, which may be more deleterious for health (5 versus 4 hours)\u003csup\u003e4\u003c/sup\u003e. In this study, people with severe asthma described their consciousness of participating in long periods of uninterrupted sedentary behaviour. Conversely, participants advocated for sedentary behaviour by describing the benefits of allocating time in their day to sit and participate in sedentary activities that are important to them. Therefore, sedentary behaviour is not necessarily always viewed as a negative behaviour for people with severe asthma. This finding has similarly been shown in an older adult population\u003csup\u003e20\u003c/sup\u003e. Specifically in our study, people with severe asthma commonly mentioned television watching as an activity that enables long periods of sedentary behaviour. Higher amounts of television-viewing is related to worse health outcomes irrespective of high levels of moderate intensity physical activity\u003csup\u003e21\u003c/sup\u003e. Additionally, participants in our study described the afternoon as being the most common time for long uninterrupted bouts of sitting. Therefore, the afternoon may be an opportunistic time of the day to break up sedentary time in people with severe asthma\u003csup\u003e22\u003c/sup\u003e. Shared-decision making may be required to find alternative types of behaviour that do not lead to prolonged sitting but continue to provide relaxation.\u003c/p\u003e \u003cp\u003eSymptoms such as breathlessness, pain, and fatigue impact the amount of sedentary behaviour that people with severe asthma engage in. When asthma symptoms were increased, participants described an inability to do anything requiring effort. This is similarly reported by people with rheumatoid arthritis, where the fluctuation of the inflammatory disease makes it a constant battle between days with low amounts of sedentary behaviour and days with high amounts of sedentary behaviour\u003csup\u003e23\u003c/sup\u003e. The pain experienced by people with severe asthma may be attributed to the presence of musculoskeletal conditions\u003csup\u003e24\u003c/sup\u003e. Having musculoskeletal conditions is associated with spending a full day being sedentary\u003csup\u003e25\u003c/sup\u003e. Specifically, the prevalence of osteoarthritis has been shown to be as high as 32% in people with asthma, a higher prevalence than in healthy controls and people with COPD\u003csup\u003e26\u003c/sup\u003e. Although we can not determine if osteoarthritis was the driver of pain causing sedentary behaviour in this study, people with asthma and people with osteoarthritis spend up to two thirds of their day being sedentary and attribute this to pain\u003csup\u003e27, 28\u003c/sup\u003e. These findings show the importance of managing asthma symptoms and comorbidities as part of a multi-dimensional approach to addressing sedentary behaviour in people with severe asthma. Further educating people with severe asthma about replacing sedentary behaviour with feasible options such as standing or LPA while experiencing symptoms may also be beneficial for their health and wellbeing.\u003c/p\u003e \u003cp\u003ePeople with severe asthma spoke about the importance of social roles and household responsibilities they hold. As with people with COPD\u003csup\u003e29\u003c/sup\u003e, the behaviour of people with severe asthma is influenced by their family, friends, and household members. They expressed that their loved ones either facilitated sedentary behaviour, or conversely, active behaviours\u003csup\u003e29\u003c/sup\u003e. Individuals\u0026rsquo; sedentary behaviour patterns have been shown to be linked to the behaviours of loved ones, such as partners or household members\u003csup\u003e30\u003c/sup\u003e. These findings warrant the establishment a collaborative plan including people with severe asthma and their significant others\u003csup\u003e31\u003c/sup\u003e to optimise sedentary behaviour. Participants in this study, described that doing their planned household chores is one of the main reasons for moving from a sitting to standing position when at home. In line with this finding, doing household chores was reported as one of the most common non-sitting activities in older adults\u003csup\u003e32\u003c/sup\u003e. Additionally, completing household chores is also of importance to people with COPD\u003csup\u003e33\u003c/sup\u003e. Therefore, encouraging people with severe asthma to take on activities within the household may reinforce the benefits that these types of activities can have on breaking up their sedentary behaviour and consequently the associated health benefits.\u003c/p\u003e \u003cp\u003eMisperceptions around sedentary behaviour being the same as physical inactivity are common\u003csup\u003e34\u003c/sup\u003e, and observed in this current study. For example, people with severe asthma linked the number of steps performed per day to their level of sedentary behaviour. This indicates a misunderstanding that to reduce sedentary behaviour, requires replacing with walking or purposeful physical activity. This is reflected in intervention studies where a sedentary behaviour change intervention in people with COPD was shown to not reduce time spent being sedentary however increased time spent doing MVPA\u003csup\u003e35\u003c/sup\u003e. The authors attributed this to participants choosing to replace sedentary behaviour with steps, this corroborate that an increase in MVPA does not necessarily translate to a reduction in sedentary time. People with severe asthma spend up to 9 hrs per day sedentary\u003csup\u003e4\u003c/sup\u003e. It is not feasible, nor expected, that people with severe asthma could replace any significant amount of this time with MVPA. Instead, a more feasible approach would be to replace or break up sedentary behaviour with standing or other LPA including household tasks, as previously discussed.\u003c/p\u003e \u003cp\u003eThese data provide novel insights from the perspective of people with severe asthma on their perception of sedentary behaviour. The study includes a purposeful sample size of people with confirmed severe asthma that ensures the validity of the data. We acknowledge that the generalisability of our findings may be limited. Participants were recruited from one geographical location and were mostly not working or were retired. Therefore, future studies should incorporate people with a mix of demographic characteristics.\u003c/p\u003e \u003cp\u003eThis study provided key elements in understanding the perception of sedentary behaviour in people with severe asthma. Our findings show that future interventions should (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) target periods of long sitting in the afternoon, particularly during TV-viewing time (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) manage asthma and comorbidity symptoms known to enable sedentary behaviour (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) establish a plan to be less sedentary with social peers and promote completing household tasks and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) provide education on the difference between sedentary and physical inactivity. Future sedentary behaviour intervention targeted at people with severe asthma should incorporate these findings to develop programme theory.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants according to GCP. Ethics approval was obtained from the Hunter New England Human Research Ethics Committee (2018/ETH00338).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided consent for the publication of anonymised quotes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePUG, EM and SH declare no competing interests. HL reports consulting fees from Boehringer Ingelheim, grants from HMRI and Diabetes Australia, speaking fees from Lung Foundation Australia, TSANZ, Exercise and Sports Science Australia, and European Respiratory Society, shares in 4DMedical, outside the submitted work. PG reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, grants from AstraZeneca, GlaxoSmithKline, outside the submitted work. VM reports speaker and advisory board fees from AstraZeneca, GlaxoSmithKline, and Boehringer Ingelhiem. VM reports other grants from AstraZeneca, GlaxoSmithKline, Cyclomedica, outside the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a John Hunter Charitable Trust grant. PUG is supported by a Research Training Program (RTP), University of Newcastle PhD Scholarship. The funders were not involved in data collection, analysis, or interpretation; design; participant recruitment; or any aspect pertinent to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to data interpretation and critical review of the manuscript. VMM conceived the study and developed the research question. VMM, SAH, PGG, and PDUG contributed to developing the study design. VMM, PGG, HL, and PDUG developed the analysis plan. PDUG recruited participants and conducted outcome assessments. VMM and PGG reviewed patient eligibility, safety, and progress. SAH conducted qualitative interviews. PDUG and EM conducted data analysis. PDUG drafted the manuscript. All authors read and approved the final manuscript. \u0026nbsp; \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. 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Int J Behav Nutr Phys Activity. 2017;14:142. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12966-017-0601-0\u003c/span\u003e\u003cspan address=\"10.1186/s12966-017-0601-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng SWM, Alison J, Stamatakis E et al. Six-week behaviour change intervention to reduce sedentary behaviour in people with chronic obstructive pulmonary disease: a randomised controlled trial. \u003cem\u003eThorax\u003c/em\u003e 2021 2021/07/07. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/thoraxjnl-2020-214885\u003c/span\u003e\u003cspan address=\"10.1136/thoraxjnl-2020-214885\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Severe asthma, sedentary behaviour, qualitative","lastPublishedDoi":"10.21203/rs.3.rs-4416456/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4416456/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePeople with severe asthma often lead sedentary lifestyles, which adversely affects overall health and asthma-specific outcomes. To inform future sedentary behaviour- interventions, this study aimed to explore perceptions of sedentary behaviour among people with severe asthma.\u003c/p\u003e \u003cp\u003e Adults (\u0026ge;\u0026thinsp;18 years) with severe asthma (n\u0026thinsp;=\u0026thinsp;21) participated in face-to-face interviews. Participants were asked open-ended questions about factors influencing their sitting behaviour. A thematic analysis was conducted on phrases and sentences relevant to sedentary behaviour.\u003c/p\u003e \u003cp\u003eParticipants were predominantly females (62%), with controlled asthma (median [Q1, Q3]: ACQ6 0.5 [0.2,1.8]) and receiving monoclonal antibody therapy (71%). Participants were inactive (19.1 [11.3, 44.5] minutes of MVPA per day) and sedentary (10.8 [9.7, 11.4] hours of sedentary behaviour per day).\u003c/p\u003e \u003cp\u003eThe analysis generated four main themes: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Sedentary behaviour often stems from habits and routines, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Asthma and associated health issues contribute to sedentary behaviour, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Participants' responsibilities influence their activity levels, and; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Participants\u0026rsquo; conscious balance between being physically active and sedentary.\u003c/p\u003e \u003cp\u003eThe results of this qualitative study offers insights into the perspectives of people with severe asthma regarding sedentary behaviour, highlighting the identification of strategies that can be implemented to optimise sedentary behaviour in this population.\u003c/p\u003e","manuscriptTitle":"Perceptions of sedentary behaviour in people with severe asthma: A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-30 14:35:52","doi":"10.21203/rs.3.rs-4416456/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-21T10:57:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-14T12:30:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-14T12:30:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-05-14T04:35:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"62d2cf89-22b9-4fba-9ce3-74e6c33c694e","owner":[],"postedDate":"May 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T16:27:39+00:00","versionOfRecord":{"articleIdentity":"rs-4416456","link":"https://doi.org/10.1186/s12889-024-20446-4","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2024-10-30 16:20:22","publishedOnDateReadable":"October 30th, 2024"},"versionCreatedAt":"2024-05-30 14:35:52","video":"","vorDoi":"10.1186/s12889-024-20446-4","vorDoiUrl":"https://doi.org/10.1186/s12889-024-20446-4","workflowStages":[]},"version":"v1","identity":"rs-4416456","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4416456","identity":"rs-4416456","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}