Short term effects of aerobic training in the clinical management of moderate to severe asthma in children Low physical fitness in childhood is associated with the development of asthma in young adulthood: the Odense schoolchild study. Physical training does not increase allergic inflammation in asthmatic children High-intensity physical training in adults with asthma. A 10-week rehabilitation program. Exercise training on disease control and quality of life in asthmatic children. Effects of aerobic training on airway inflammation in asthmatic patients. Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma High-intensity physical training in adults with asthma. A comparison between training on land and in water. Effects of exercise training and montelukast in children with mild asthma.
BACKGROUND Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease Intense physical activity in  children may either improve fitness and protect against asthma , or may trigger symptoms . The aim of this study was to determine whether physical fitness in childhood has an impact on the development of asthma . In this prospect i ve , community-based study , 757 ( 84 % ) asymptomatic children with an average age at inclusion of 9.7 yrs were followed for 10.5 yrs . In both surveys a maximal progressive exercise test on a bicycle ergometer was used to measure physical fitness ( maximal workload ) and to induce airway narrowing . A methacholine provocation test was performed in the subjects at follow-up . During the 10-yr study period , 51 ( 6.7 % ) of the previously asymptomatic children developed  asthma . These subjects had a lower mean physical fitness in 1985 than their peers : ( 3.63 versus 3.89 W x kg(-1 ) ; p=0.02 ) in boys and ( 3.17 versus 3.33 W x kg(-1 ) ; p=0.02 ) in girls . A weak correlation was found between physical fitness in childhood and airway responsiveness to methacholine at follow-up when adjusted for body mass index , age and sex ( r=0.11 ; p<0.01 ) . In a multiple regression analysis , physical fitness was inversely related to the development of physician diagnosed asthma , odds ratio=0.93 ( 0.87 - 0.99 ) . Thus , the risk for the development of asthma during adolescence is reduced 7 % by increasing the maximal workload 1 W x kg(-1 ) . In conclusion , this study showed that physical fitness in childhood is weakly correlated with the development of asthma during adolescence and that high physical fitness seems to be associated with a reduced risk for the development of asthma 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 r and omly 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 Question naire and Paediatric Asthma Caregiver 's Quality of Life Question naire 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 Twenty-six adults ( 23 to 58 years ) with mild to moderate asthma underwent a 10-week supervised rehabilitation program , with emphasis on physical training . In the first 2 weeks , they exercised daily in an indoor swimming pool ( 33 degrees C ) and received education about asthma , medication , and principles of physical training . In the following 8 weeks , they exercised in the pool twice a week . Every training session lasted 45 min . The training sessions were made as suitable as possible for the individual subjects , in order to minimize " drop outs " from the program . The aim of the study was to evaluate the efficacy of the rehabilitation program and to determine if inactive asthmatic adults can exercise at high intensity . The rehabilitation program was preceded by a 6-min submaximal cycle ergometry test , a 12-min walking test , spirometry , and a methacholine provocation test . The subjects also responded to a five-item question naire related to anxiety about exercise , breathlessness , and asthma symptoms using a visual analogue scale . All subjects were able to perform physical training at a very high intensity , to 80 to 90 % of their predicted maximal heart rate . No asthmatic attacks occurred in connection with the training sessions . Twenty-two of the 26 subjects completed the rehabilitation program , felt confident with physical training , and planned to continue regular physical training after the 10-week program . Improvements in cardiovascular conditioning , measured as a decreased heart rate at the same load on the cycle ergometer ( average of 12 beats/min ) , and as a longer distance at the 12-min walking test ( average of 111 m ) , were observed during the program . FEV1 increased significantly from 2.2 to 2.5 L. Forced expiratory flow at 25 % of vital capacity also increased slightly but significantly . Methacholine provocation dose causing a fall in FEV1 by 20 % was unchanged . Seventeen subjects had a peak expiratory flow reduction of more than 15 % after the preprogram ergometry test and were classified as having exercise-induced asthma ( EIA ) . Only three of these subjects had EIA after 10 weeks . The asthmatic subjects were less afraid of experiencing breathlessness during exercise and less anxious about exercising at a high intensity after 10 weeks ( p < 0.05 ) . The asthma symptoms abated significantly during the rehabilitation program and the subjects needed less acute asthma care after the rehabilitation program . The results indicate that asthmatic persons benefit from a rehabilitation period , including physical training . Rehabilitation programs are therefore of value as a supplement to conventional pharmacologic treatment of asthma . This rehabilitation program can be adapted for use in clinical practice PURPOSE 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 . METHODS Thirty-eight children with moderate to severe persistent asthma were r and omly 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 Question naire ( PAQLQ ) scores were also recorded . RESULTS 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 ) . CONCLUSION 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 PURPOSE 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 aim ed 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 . METHODS sixty-eight patients r and omly 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 . RESULTS 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 ) . CONCLUSIONS 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 BACKGROUND 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 . METHODS 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 . RESULTS 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 . CONCLUSION A six week swimming training programme has a beneficial effect on aerobic capacity but not on histamine responsiveness in children with asthma The purpose of this study was to determine whether inactive asthmatic patients could perform high-intensity physical training equally well on l and as in water , and to compare the effects of these training forms . Thirty-two adults with asthma , r and omized into two groups , underwent a 10-week supervised rehabilitation program with emphasis on physical training . All patients , irrespective of training form , were able to exercise to maximal intensity ( 80 - 90 % of estimated maximal heart rate ) . No asthmatic attacks occurred in connection with the training sessions . Respiratory variables remained almost unchanged in both groups . The asthma symptoms declined during the rehabilitation period , and the subjects needed less acute asthma care after the rehabilitation . The cardiovascular condition improved significantly and similarly in the two groups . Ten patients , 5 in each group , had exercise-induced asthma  at the start of the rehabilitation . Only 3 patients , 2 from the water group and 1 from the l and group , had exercise-induced asthma after 10 weeks . We conclude that indoor training , either on l and or in water , is beneficial . The effects of these two training forms are almost equivalent PURPOSE Data from the general population suggest that habitual exercise decreases bronchial responsiveness , but the possible role of exercise in asthmatics is undefined . The leukotriene receptor antagonist montelukast decreases bronchial responsiveness and exercise-induced symptoms in asthmatic children . This r and omized study in children with mild asthma evaluated the combined effects of aerobic training for 12 wk and montelukast or placebo on bronchial responsiveness ( BHR ) to methacholine , exercise-induced bronchoconstriction ( EIB ) , inflammatory markers in exhaled breath condensate ( EBC ) , and asthma exacerbations . METHODS Fifty children ( mean age + /- SD : 10.2 + /- 2.4 yr ) with mild stable asthma were r and omly assigned to placebo ( N = 25 ) or montelukast ( N = 25 ) . Before and after training , we assessed BHR and EIB and markers of airway inflammation-that is , exhaled nitric oxide ( eNO ) , pH , and cysteinyl-leukotriene concentration-in EBC . RESULTS Training increased maximal workload and peak minute ventilation . After training , the methacholine dose causing a 20 % fall in FEV1 ( PD20 ) increased in both groups . A decreased slope of FEV1 decline at increasing methacholine dose was found only in montelukast-treated children . EIB prevalence halved after training in both groups ( EIB + children , placebo group : 10 pretraining , 4 posttraining ; EIB + children , montelukast group : 8 pretraining , 5 posttraining ; P < 0.05 by chi on all children ) . Resting eNO was unaffected , whereas the pH of EBC decreased after training in both groups . Cysteinyl-leukotriene concentrations were low in most children at both times . During training , montelukast-treated children showed fewer asthma exacerbations compared with the same period of the previous year . CONCLUSIONS In children with mild stable asthma , exercise training decreased bronchial responsiveness to methacholine . Montelukast also decreased bronchial reactivity ( FEV1 slope ) and protected against exacerbations , suggesting a beneficial synergistic action of these two interventions in mild asthma
Background There is little data on the effect of exercise on markers of airway inflammation in human asthmatics .
The main objective of this review is to determine the effects of physical training on markers of airway inflammation in animal models of asthma .