Novel Activity Management in severe ASthma - Tailored Exercise (NAMASTE): Yoga and Mindfulness.

INTERVENTION: Participants randomised to the intervention group will participate in two supervised 75‐minute classes of yoga and mindfulness per week for 16 weeks in a private meeting room at the Hunter Medical Research Institute, in addition to usual care. Classes will be mixed‐gender. The sessions will be taught by an accredited yoga practitioner with a first aid certificate and will be designed to consider the needs of people with severe asthma. The yoga intervention has been designed so that is suitable for all participants regardless of experience, ability and physical limitations. The classes provide the opportunity for participants to practice within the classes, to learn the practices, then to take and apply what they have learnt within their home environment. The classes will focus on three key concepts, increasing movement, controlling breath and meditation activities to improvement mindfulness 1.Asana (Movement ‐ physical practices): The postures will include forward bends, back bends, side bends and spinal twists in standing, sitting or lying positions. Balancing practices are included to develop strength, confidence, stability, focus and a sense of calm. A ‘Flow’ of practices will be taught individually and then put together in a gentle, moving sequence. 2.Pranayama (Breath): A series of simple breathing practices will be taught with the intention of deepening the ‘yogic’ experience rather than any real focus on alleviating asthma related issues. Practices such as abdominal breathing, thoracic breathing, full yogic breath (a combination of abdominal and thoracic), ujjayi breath and alternate nostril breathing to bring awareness, balance, focus and calm to an individuals practice. 3.Meditation (focus, concentration, relaxation, stillness, awareness): The meditation practices are an extension of the posture and breathing practices. These practices will include observing of the natural breath, counting the breath, the layering of mental ancho CONDITION: Physical Medicine / Rehabilitation ‐ Other physical medicine / rehabilitation Respiratory ‐ Asthma Severe Asthma; ; Severe Asthma PRIMARY OUTCOME: Health‐related quality of life assessed using St George’s Respiratory Questionnaire (SGRQ).[16 weeks post‐commencement of intervention] SECONDARY OUTCOME: Anxiety and depression: Patient‐reported Hospital and Anxiety Depression Scale (HADS)[16 weeks post‐commencement of intervention] Asthma symptom control: Patient‐reported Asthma Control Questionnaire, a validated questionnaire in severe asthma (ACQ)[16 weeks post‐commencement of intervention] Dyspnoea: Patient reported with the Dyspnoea‐12 questionnaire[16 weeks post‐commencement of intervention] Physical activity: Patient‐reported via the International Physical Activity Questionnaire (IPAQ)[16 weeks post‐commencement of intervention] INCLUSION CRITERIA: 1. 18 years of age or older. 2. Evidence of variable airflow limitation in the last 10 years. 3. Severe asthma meeting the European Respiratory Society/American Thoracic Society taskforce definition: asthma requiring high‐dose inhaled corticosteroids (>1000µg beclomethasone equivalent) with a second controller to prevent “uncontrolledâ€� disease or disease that remains “uncontrolledâ€� despite therapy.