The effects of a swimming intervention for children with asthma. Individualized aerobic and high intensity training for asthmatic children in an exercise readaptation program. Is training always helpful for better adaptation to exercise? Comparison of morning and afternoon exercise training for asthmatic children. Training of aerobic and anaerobic fitness in children with asthma. Effect of aerobic exercise training on pulmonary function and tolerance of activity in asthmatic patients. Individualized training reduces excessive exercise hyperventilation in asthmatics. Benefits and problems of a physical training programme for asthmatic patients. Children with asthma and physical exercise: effects of an exercise programme. Cardiorespiratory fitness evaluation by the shuttle test in asthmatic subjects during aerobic training. Effects of aerobic training on airway inflammation in asthmatic patients. Effects of aerobic training on psychosocial morbidity and symptoms in patients with asthma: a randomized clinical trial. Physical training does not increase allergic inflammation in asthmatic children. Deep diaphragmatic breathing: rehabilitation exercises for the asthmatic patient. Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma. Benefits of swimming in asthma: effect of a session of swimming lessons on symptoms and PFTs with review of the literature. Exercise training on disease control and quality of life in asthmatic children.
Asthma is a common paediatric airway disease with increasing prevalence. Studies comparing swimming with other sports have found that swimming is unlikely to provoke unstable asthma but possible benefits are not defined. This study investigated the benefits of a 6 week swimming intervention on pulmonary function tests (PFT), PEF and severity of asthma in children.
                Young asthmatics were randomly assigned to the experimental or the control group, with 15 subjects in each group. In addition to regular treatment for asthma, the experimental group received swimming training for 6 weeks. PFT, PEF and severity of asthma were measured.
                There was a significant improvement (P < 0.01) in PEF in the experimental group compared with the control group (330 L/min, 95% CI: 309-351 vs. 252 L/min, 95% CI: 235-269) after the swimming intervention. There was also a significant improvement (P < 0.05) in the severity of asthma in the experimental group compared with the control group.
                These data suggest that a swimming programme for asthmatic children can improve some disease parameters (PEF and the severity of asthma). Swimming may be an effective non-pharmacological intervention for the child or adolescent with asthma. In order to define the role of individualized training intensity in a conditioning program for asthmatic children, we have trained seven asthmatics (age = 11.4 +/- 1.8 years) at their ventilatory threshold (VTh) intensity level for a three-month period (aerobic training) and at maximal intensity also for three months (high intensity training). VTh is the point at which a nonlinear increase of VE occurs. Another group of seven asthmatics (age = 11.4 +/- 1.5) served as control subjects. Cardiopulmonary fitness was determined on a cycle ergometer before and after each training session. This study demonstrated that aerobic training, correctly adapted to the child's physical ability, induces the following: (1) a rapid and marked cardiovascular fitness increase; and (2) a decrease in VE over a given work range so that VTh is increased. This is of great importance because hyperventilation is a major determinant of exercise-induced bronchospasm. In contrast, even if high intensity training is well tolerated in an indoor swimming pool, the long-term effects are unsuitable for asthmatic children because the decrease of VTh will involve an increase of hyperventilation, even when exercise is performed at submaximal intensity. Fitness improvement was used to compare morning with afternoon exercise periods for asthmatic children. Children with persistent moderate asthma (according to GINA criteria), 8 to 11 years old, were divided into 3 groups: morning training group (N = 23), afternoon training group (N = 23), and non-training group (N = 23). The program was based on twice a week 90-min sessions for 4 months. We measured the 9-min running distance, resting heart rate and abdominal muscle strength (sit-up number) before and after the training. All children took budesonide, 400 microg/day, and an on demand inhaled ss-agonist. The distance covered in 9 min increased (mean +/- SEM) from 1344 +/- 30 m by 248 +/- 30 m for the morning group, from 1327 +/- 30 m by 162 +/- 20 m for the afternoon group, and from 1310 +/- 20 m by 2 +/- 20 m for the control group (P < 0.05 for the comparison of morning and afternoon groups with the control group by ANOVA and P > 0.05 for morning with afternoon comparison). The reduction of resting heart rate from 83 +/- 1, 85 +/- 2 and 86 +/- 1 bpm was 5.1 +/- 0.8 bpm in the morning group, 4.4 +/- 0.8 bpm in the afternoon group, and -0.2 +/- 0.7 bpm in the control group (P > 0.05 for morning with afternoon comparison and P < 0.05 versus control). The number of sit-ups in the morning, afternoon and control groups increased from 22.0 +/- 1.7, 24.3 +/- 1.4 and 23 +/- 1.1 sit-ups by 9.8 +/- 0.9, 7.7 +/- 1.4, and 1.9 +/- 0.7 sit-ups, respectively (P > 0.05 for morning with afternoon comparison and P < 0.05 versus control). No statistically significant differences were detected between the morning and afternoon groups in terms of physical training of asthmatic children. To assess the effect of a training protocol on aerobic and anaerobic fitness in children with asthma.
                Sixteen boys (mean age: 13 years; range: 10-16 years) with mild-to-moderate asthma participated in a rehabilitation program that included 6 weeks of individualized training on a cycle ergometer. Two groups were randomly formed: the control group (CG, n = 7) and the training group (TG, n = 9), which exercised at an intensity set at the heart rate corresponding to the ventilatory threshold, with 1-minute sprints against the maximal aerobic power (MAP) every 4 minutes. Session duration was 45 minutes, 3 sessions per week. Changes in maximal oxygen uptake (VO(2)max), MAP, short-term peak power (PP), and pulmonary function were assessed.
                Two patients of the training group did not complete the study. Pulmonary function remained unchanged in both groups. Improvement in both aerobic and anaerobic fitness was significant only in the training group (TG vs CG): VO(2)max +18% +/- 2.1% versus +9% +/- 4.5% (P <.05), MAP +32% +/- 5% versus 12% +/- 7% (P <.05), PP +21% +/- 5.7% versus +8.8% +/- 10% (P <.01).
                Exercise training with high-intensity bouts is well tolerated in children with mild-to-moderate asthma. When included in a global rehabilitation program, this type of training improves both aerobic and anaerobic fitness. Anaerobic activities should be considered in sports rehabilitation programs for children with asthma. The aim of the present study was to examine the effects of a course of aerobic exercise on pulmonary function and tolerance of activity in asthmatic patients. Among the asthmatic patients, 36 patients (M= 16, F= 20) were chosen after clinical examinations, pulmonary function test, skin prick test (SPT) for aeroallergen and a six minute walk test (6MWT) on their own free will. A patient was said to have Exercise Induced Asthma (EIA) when he/she fulfilled the following criteria; (1) FEV1 less than 80%, (2) 12% increase or more in FEV1 or PEF after short-acting ss2 agonist prescription and (3) 15% decrease in FEV1 or PEF after 6MWT with 70% or 80% of maximum heart rate. The patients were randomly put into two groups of case (M=8, F=10, Mean age=27) and control (M=8, F=10, Mean age=29). Case group participated in eight-week aerobic exercise plan, while control group had no plan of exercise. Pulmonary function tests were done before and after the course of exercise. There were significant changes in FEV1, FVC, PEF, FEF25-75%, MVV, RF and 6MWT between asthmatic patients of the two groups (P less than or equal to 0.05), but FEV1/FVC showed no significant change. Mean of changes in FEV1, FVC, PEF, FEF25-75%, MVV, RF and 6MWT were -25.56, -17.19, 32.09, -27.93, -22.18, 5.63 and -307.5 in case group respectively while they were 6.2, 4.67, 1.96, 6.65, 15.56,-2.87 and 18.78 in the control group. This study shows that aerobic exercises in asthmatic patients lead to an improvement in pulmonary functions. Aerobic exercise rehabilitation can be a complement to medical treatment of asthma. nan The clinical and physiological effects of a medically supervised, indoor physical training programme were investigated in 36 asthmatic subjects aged 16-40 years. After clinical evaluation, lung function assessment, and progressive incremental exercise testing subjects were randomly allocated to control and training groups. The measurements were repeated after a six week run in period and after a further three months in which those in the training group underwent an indoor training programme. The measurements made at three months were compared with those at the end of the run in period. There was no significant change in anthropometric characteristics, blood lipid profiles, or the provocative concentration of histamine causing a 20% fall in FEV1 (histamine PC20) in the group who underwent training. After training there were significant increases in mean maximal oxygen uptake (ml kg-1 min-1) from 23 (5) to 28 (6), oxygen pulse (ml/beat) from 8.8 (2.3) to 10.8 (2.4), and anaerobic threshold (1/min) from 1.11 (0.27) to 1.38 (0.33). These changes were significantly greater in the group undergoing training than in the control group. There was also a significant fall in breathlessness scores (Borg ratings), blood lactate, carbon dioxide output, and minute ventilation during submaximal exercise in the training group, with no change in the control group. The subject's motivation, the initial level of fitness, and the symptom score at the time of training were the most important factors influencing improvements in cardiorespiratory fitness. Thus submaximal physical exercise of controlled intensity, sustained for three months, produced significant improvements in fitness and cardiorespiratory performance that should be advantageous to the exercising asthmatic patient. The availability of medical supervision throughout the exercise programme appears to have contributed to the successful outcome. To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis.
                Intervention study: a randomized pretest-post-test control group design.
                Forty-seven children with clinically diagnosed asthma participated in the intervention study, including 34 boys and 13 girls, from 8 to 13 years of age (mean age 10.6).
                The physical exercise programme consisted of regular group exercises and home exercises for a period of three months. It was based on a theoretical model describing the relationships between physical competence (condition), perceived physical competence, self-esteem and coping behaviour.
                Maximum incremental exercise test, endurance test, the Self-Perception Profile for Children (CBSK), the Asthma Coping Test (ACBT), lung function and exercise-induced bronchoconstriction.
                The results showed significant effects of the intervention programme on physical condition. There was a significant improvement of 15 W on the maximal workload (Wmax) (p < 0.001), of 7% on VO2max (oxygen uptake) (p = 0.002) and a significant decrease on heart rate submaximal of 6% (p = 0.001). There was also a significant improvement of 50% in running time measured with the endurance test (p = 0.021). Furthermore, a significant effect of the intervention was seen on coping with asthma (p = 0.003).
                It was concluded that participation in the physical exercise programme not only enhanced physical fitness, but also improved coping behaviour with asthma. The purpose of this study was to assess the validity of the 20-m shuttle test with 1-min stages (20-MST) to estimate maximal oxygen uptake (VO2 max) and its ability to register cardiorespiratory modifications over the course of an individualized aerobic training program for mild to moderately asthmatic children acclimatized to moderate altitude.
                Forty-eight asthmatic subjects aged 12 to 17 years performed both a maximal incremental exercise test on a cycle ergometer and the 20-MST. Ten of the subjects were then randomly chosen and trained three times per week at their ventilatory threshold (Vth) intensity level for three months. Another group of ten asthmatic subjects served as control subjects. Training intensity was adjusted monthly; heart rate values at Vth were increased by the same proportion as the increase in Vo2 max as measured by the 20-MST. At the end of training, both groups were again evaluated with the two tests. The Vo2 max values by direct measurement and by the 20-MST were not significantly different for the entire population (46.5 +/- 1.6 vs 47.2 +/- 2.1 ml.min-1.kg-1). In addition, the two test results were in close agreement (r = 0.84; p < 0.01). After training, a sharp improvement in the direct Vo2 max (44.1 +/- 2.4 to 51.2 +/- 1.9 ml.min-1.kg-1) was noted in the training group as well as an increase in the Vth (25.6 +/- 1.9 to 32.1 +/- 3.4 ml.min-1.kg-1), the maximal power (152 +/- 7.1 to 185 +/- 3.8 W), and the maximal oxygen pulse (0.24 +/- 0.007 to 0.27 +/- 0.008 ml.beat-1.kg-1).
                The indirect measure confirmed these results: a simultaneous increase in VO2 max (43.7 +/- 2.5 to 53.8 +/- 2.1 ml.min-1.kg-1), maximal oxygen pulse (0.22 +/- 0.004 to 0.27 +/- 0.006 ml.beat-1.kg-1), and the number of stages completed (7 +/- 1.4 to 10.1 +/- 1.3) was observed. It was concluded that the 20-MST has sufficient validity to assess VO2 max and to register cardiorespiratory modifications over the course of individualized aerobic training programs in mild and moderately asthmatic children. It thus may be used to adjust training intensities during these programs. there is evidence suggesting that physical activity has anti-inflammatory effects in many chronic diseases; however, the role of exercise in airway inflammation in asthma is poorly understood. We aimed to evaluate the effects of an aerobic training program on eosinophil inflammation (primary aim) and nitric oxide (secondary aim) in patients with moderate or severe persistent asthma.
                sixty-eight patients randomly assigned to either control (CG) or aerobic training (TG) groups were studied during the period between medical consultations. Patients in the CG (educational program + breathing exercises; N = 34) and TG (educational program + breathing exercises + aerobic training; N = 34) were examined twice a week during a 3-month period. Before and after the intervention, patients underwent induced sputum, fractional exhaled nitric oxide (FeNO), pulmonary function, and cardiopulmonary exercise testing. Asthma symptom-free days were quantified monthly, and asthma exacerbation was monitored during 3 months of intervention.
                at 3 months, decreases in the total and eosinophil cell counts in induced sputum (P = 0.004) and in the levels of FeNO (P = 0.009) were observed after intervention only in the TG. The number of asthma symptom-free days and VO(2max) also significantly improved (P < 0.001), and lower asthma exacerbation occurred in the TG (P < 0.01). In addition, the TG presented a strong positive relationship between baseline FeNO and eosinophil counts as well as their improvement after training (r = 0.77 and r = 0.9, respectively).
                aerobic training reduces sputum eosinophil and FeNO in patients with moderate or severe asthma, and these benefits were more significant in subjects with higher levels of inflammation. These results suggest that aerobic training might be useful as an adjuvant therapy in asthmatic patients under optimized medical treatment. Asthma symptoms reduce patients' daily activities, impair their health-related quality of life (HRQoL), and increase their reports of anxiety and depression, all of which seem to be related to a decrease in asthma control. Aerobic exercise training is known to improve aerobic fitness and reduce dyspnea in asthmatics; however, its effect in reducing psychologic distress and symptoms remains poorly understood. We evaluated the role of an aerobic training program in improving HRQoL (primary aim) and reducing psychologic distress and asthma symptoms (secondary aims) for patients with moderate or severe persistent asthma.
                A total of 101 patients were randomly assigned to either a control group or an aerobic training group and studied during the period between medical consultations. Control group patients (educational program plus breathing exercises) (n = 51) and training group patients (educational program plus breathing exercises plus aerobic training) (n = 50) were followed twice a week during a 3-month period. HRQoL and levels of anxiety and depression were quantified before and after treatment. Asthma symptoms were evaluated monthly.
                At 3 months, the domains (physical limitations, frequency of symptoms, and psychosocial) and total scores of HRQoL significantly improved only in the training group patients (P < .001); the number of asthma-symptom-free days and anxiety and depression levels also significantly improved in this group (P < .001). In addition, a linear relationship between improvement in aerobic capacity and the days without asthma symptoms was observed (r = 0.47; P < .01).
                Our results suggest that aerobic training can play an important role in the clinical management of patients with persistent asthma. Further, they may be especially useful for patients with higher degrees of psychosocial distress. Trial registration: clinicaltrials.gov; Identifier: NCT-00989365. The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma. Subjects with persistent allergic asthma (aged 12.7+/-3.4 yrs; n = 34) were randomly allocated into training and control groups. Exercise consisted of twice-weekly 50-min sessions for 12 weeks. Inflammation was assessed by levels of exhaled nitric oxide, blood eosinophils, eosinophil cationic protein, C-reactive protein, and total and mite-specific immunoglobulin (Ig)E. Lung volumes and bronchial responsiveness to methacholine were determined. The Paediatric Asthma Quality of Life Questionnaire and Paediatric Asthma Caregiver's Quality of Life Questionnaire were used to evaluate activity restrictions, symptoms and emotional stress. The efficacy of the training was assessed by accelerometry. Following the programme, the exercise group spent twice as much time as the controls undertaking moderate-to-vigorous activities. No differences in changes were seen between groups for asthma outcomes. However, total IgE decreased more in the exercise group, as did mite-specific IgE. Training did not increase inflammation in children with persistent asthma, and may have decreased both total and allergen-specific immunoglobulin E levels. It is concluded that there is no reason to discourage asthmatic children with controlled disease to exercise. A new diaphragmatic breathing technique practiced without the aid of a physical corset is outlined, and the findings from a study of its application in the respiratory rehabilitation of asthmatic patients are presented. Sixty-seven asthmatic adults randomly assigned to either deep diaphragmatic breathing training, physical exercise training, or a waiting list control group participated in a 16-week program. Deep diaphragmatic training resulted in significant reductions in medication use and in the intensity of asthmatic symptoms. Importantly, a nearly 300% increase in time spent in physical activities also resulted from deep diaphragmatic training. A follow-up at two months found many patients had returned to earlier medication levels and sedentary habits. A strengthened musculature can replace the need for a physical aid in this respiratory habilitation; adherence to its use may require individually-tailored encouragement. A study was undertaken to determine whether swimming training improved aerobic capacity, exercise induced bronchoconstriction (EIB), and bronchial responsiveness to inhaled histamine in children with asthma.
                Eight children with mild or moderate asthma participated in swimming training every day for six weeks. The intensity of training was individually determined and set at 125% of the child's lactate threshold (LT), measured using a swimming ergometer. Another group of eight asthmatic children served as control subjects. Aerobic capacity and the degree of EIB were assessed by both cycle ergometer and swimming ergometer before and after swimming training.
                The mean (SD) aerobic capacity at LT increased by 0.26 (0.11) kp after training when assessed with the swimming ergometer and by 10.6 (4.5) W when assessed with the cycle ergometer, and these changes were significantly different from the control group. The mean (SD) maximum % fall in forced expiratory volume in one second (FEV1) to an exercise challenge (cycle ergometer) set at 175% of LT decreased from 38.7 (15.4)% before training to 17.9 (17.6)% after training, but with no significant difference from the control group. There was, however, no difference in histamine responsiveness when compared before and after the training period.
                A six week swimming training programme has a beneficial effect on aerobic capacity but not on histamine responsiveness in children with asthma. A study involving eight children with moderate persistent asthma was undertaken to determine whether standard swimming lessons improved symptoms and pulmonary function tests (PFTs) in asthmatic children. Five children ages 7-12 years old with moderate persistent asthma were randomized to a swimming lesson group (5- to 6-week session) and three to a control group. Both groups completed pre- and poststudy period PFTs and symptom questionnaires. Swimming lessons did not produce a significant change in asthma symptoms or PFTs. Review of previous literature found that swimming has been shown to have definite benefits in improving cardiorespiratory fitness in asthmatic children. Swimming has been shown to be less asthmogenic than other forms of exercise. Some studies have also shown improvement in asthma symptoms in children participating in exercise programs. Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children. However, the actual impact of physical training on clinical indicators of disease control remains controversial.
                Thirty-eight children with moderate to severe persistent asthma were randomly assigned to control (N=17) and training (N=21) groups. Spirometry, exercise challenge, and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart. Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores were also recorded.
                Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise (P<0.05); in contrast, no significant changes were found in controls. Severity of exercise-induced bronchoconstriction (EIB) and postexercise breathlessness were significantly lessened in trained patients; improvement in fitness and EIB, however, were not linearly related (P>0.05). In addition, PAQLQ scores improved only in trained children (P<0.01). Daily doses of inhaled steroids were reduced in trained patients (52%), but they remained unchanged or increased in controls (70.6%) (P=0.07).
                Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children. These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease.
This review demonstrated that physical training can improve cardiopulmonary fitness and was well tolerated among people with asthma in the included studies. As such, people with stable asthma should be encouraged to partake in regular exercise training, without fear of symptom exacerbation.