Improvements in Symptoms and Quality of Life following Exercise Training in Older Adults with Moderate/Severe Persistent Asthma Short term effects of aerobic training in the clinical management of moderate to severe asthma in children Self-directed exercise improves perceived measures of health in adults with partly controlled asthma The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Effects of swimming on spirometric parameters and bronchial hyperresponsiveness in children and adolescents with moderate persistent atopic asthma. Effects of swimming training on children with asthma. Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Effect of aerobic exercise training on pulmonary function and tolerance of activity in asthmatic patients. Physical training does not increase allergic inflammation in asthmatic children Comparison of morning and afternoon exercise training for asthmatic children. Training of aerobic and anaerobic fitness in children with asthma. 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. An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial. Cardiorespiratory fitness evaluation by the shuttle test in asthmatic subjects during aerobic training. The effects of a swimming intervention for children with asthma. Children with asthma and physical exercise: effects of an exercise programme [Effect of ambulatory sports therapy on bronchial asthma in children]. Pulmonary Function and Abdominal and Thoracic Kinematic Changes Following Aerobic and Inspiratory Resistive Diaphragmatic Breathing Training in Asthmatics 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. 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. Aerobic conditioning in mild asthma decreases the hyperpnea of exercise and improves exercise and ventilatory capacity. [Controlled study of the effect of sports training on cardiopulmonary functions in asthmatic children and adolescents]. Moderate and vigorous exercise programs in children with asthma: safety, parental satisfaction, and asthma outcomes. Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma. Effects of exercise training and montelukast in children with mild asthma.
Background : Some individuals with moderate/severe persistent asthma develop irreversible airway obstruction . These individuals present with dyspnoea , exercise intolerance and impaired quality of life ( QOL ) , all of which could potentially be alleviated with exercise training . Objective : To investigate whether exercise training improves functional exercise capacity and QOL in middle-aged and older adults with fixed airway obstruction asthma ( FAOA ) . Methods : 35 subjects aged 67.8 ± 10.6 years , with FEV1 59 ± 16 % of predicted , were r and omised to a 6-week  ‘ intervention ’ period of supervised exercise training ( n = 20 ) or usual care ( n = 15 ) . This period was preceded by a 3-week run-in period during which asthma control was assessed weekly . Functional exercise capacity ( 6-min walk distance , 6MWD ) and QOL ( Asthma QOL Question naire , AQLQ ) were measured before , immediately following and 3 months after the intervention period . Results : 34 subjects ( exercise group , n = 19 , and control group , n = 15 ) completed the intervention period . Relative to the control group , the exercise group had greater improvements immediately following and 3 months after the intervention in the AQLQ symptom domain ( 0.61 , p = 0.001 , and 0.57 points per item , p = 0.005 ) and AQLQ activity limitation domain ( 0.43 , p = 0.04 , and 0.55 points per item , p = 0.04 ) . 6MWD increased ( 36 ± 37 m , p < 0.01 ) in the exercise group immediately following training and remained elevated ( 34 ± 45 m , p < 0.01 ) at the 3-month follow-up . The magnitude of change in 6MWD between groups was not significant , despite no change in the control group . Conclusions : Supervised exercise training improves symptoms and QOL in adults with FAOA 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 Background . Supervised exercise leads to significant improvements in asthma control and quality -of-life in adults with partly controlled asthma ; however , the role of unsupervised exercise is unknown . Methods . The purpose of this study was to determine the impact of self-directed exercise on subjective and objective indices of asthma-related health .  Participants ( n = 24 ) were assigned to an exercise group or a control group for a 12-week period . Those in the exercise group were provided with exercise programs by a qualified exercise professional . These programs were up date d through electronic mail every 3 weeks to ensure progression . Controls maintained their current lifestyle habits for the intervention period . Assessment s of aerobic fitness , lung function , and subjective and objective asthma measures were conducted at baseline and after completion of the 12-week intervention period for both groups . Analysis of covariance was used to detect differences between groups from baseline to week 12 . Qualitative analyses were used to assess responses to open-ended questions . Results . Adherence to the program was poor . Perceived asthma control and self-reported frequency and severity of asthma improved significantly in the exercise group at week 12 compared with that in the control group . Objective measures of asthma such as asthma control , quality -of-life , and lung function , as well as peak and submaximal aerobic fitness did not change relative to controls . Responses to open-ended questions revealed improvements in three areas : asthma management , perceived fitness , and well-being . Conclusion . Adults with partly controlled asthma are able to improve perceived control and subjective measures of asthma-related health with 12 weeks of self-directed exercise ; however , supervision may be required to make significant improvements to measured asthma control , quality of life , and aerobic fitness . Future research should focus on the means to improve adherence of self-directed exercise programs  in this population The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment , and a 3 month control period of drug treatment only , for asthmatic patients and patients with chronic obstructive pulmonary disease ( COPD ) . The programme was run by physiotherapists in eight local practice s , and included exercise training , patient education , breathing retraining , evacuation of mucus , relaxation techniques , and recreational activities . In a r and omized controlled trial with a cross-over design , the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life ( QOL ) . Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests .  QOL was evaluated by means of the Chronic Respiratory Disease Question naire ( CRDQ ) . After 3 months , the patients who started with rehabilitation showed significant improvements in endurance time ( 421 s ) and cardiac frequency ( 6 beats.min-1 ) during cycling , walking distance ( 39 m ) , and total CRDQ score ( 17 points ) compared to the control group . These improvements were still significant after 6 months . Additional analysis indicated that the asthmatic patients and the patients with COPD responded to rehabilitation in a similar way , with the exception that there was a greater improvement in walking distance for asthmatics . Improvements in exercise tolerance were not significantly correlated with improvements in QOL .  Rehabilitation of patients with asthma or chronic obstructive pulmonary disease in local physiotherapy practice s improves exercise tolerance and quality of life OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma ( MPAA ) . METHODS A r and omized , prospect i ve study of children and adolescents ( age 7 - 18 years ) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas ( UNICAMP ) , Campinas , Brazil . After a 1-month run-in period , 61 patients ( 34 female ) were r and omized into two groups , a swimming group ( n = 30 ) and a control group ( n = 31 ) , and followed for 3 months . Both patient groups received inhaled fluticasone ( dry powder , 250 mcg twice a day ) and salbutamol as needed . The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions . Both groups underwent  spirometric assessment  and methacholine challenge test -- provocative concentration of methacholine causing a 20 % fall in FEV1 (PC₂₀)--before and after the study period . Maximal inspiratory pressure ( MIP ) and maximal expiratory pressure ( MEP ) were measured only in the swimming group . RESULTS Significant increases in PC₂₀ ( pre-training , 0.31±0.25 ; post-training , 0.63±0.78 ; p = 0.008 ) , MIP ( pre-training , 67.08±17.13 cm H₂O ; post-training 79.46±18.66 ; p < 0.001 ) , and MEP ( pre-training , 71.69±20.01 cm H₂O ; post-training , 78.92±21.45 cm H₂O ; p < 0.001 ) were found in the swimming group . CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness , as determined by increased PC₂₀ values , when compared with asthmatic controls who did not undergo swim training . Participants in the swimming group also showed improvement in elastic recoil of the chest wall In a programme to examine the effect of 5 months of swimming training on school-children with asthma , 46 children swam a total distance of 3608 km ( 2242 miles ) during 2806 training sessions . On post-training re-examination , nonspecific effects of physical conditioning were detected including improved posture and fitness , reduced fat folds , and enhanced swimming ability . Continuous monitoring of asthma and medication showed significant decreases in both parameters during the final phases of the study between children who continued to swim regularly and those who did not . The frequency and severity of exercise-induced asthma ( after running ) was unchanged by swimming training . Post-training question naires indicated a high degree of enthusiasm and acceptance of the programme by children and parents . No significant adverse effects were observed or reported during the study The aim of this study was to evaluate the long-term outcome of an outpatient pulmonary rehabilitation programme ( PRP ) in patients with chronic airway obstruction ( CAO ) . In 61 CAO patients ( 35 asthmatics and 26 chronic obstructive pulmonary disease ( COPD ) ) lung and respiratory muscle function , exercise tolerance ( by symptom limited cycloergometer and walking tests ) , dyspnoea ( Borg scale , visual analogue scale ( VAS ) , baseline and transitional dyspnoea index ( BDI and TDI , respectively ) ) and quality of life ( St George 's Respiratory Question naire ( SGRQ ) ) were assessed at baseline ( to ) , at discharge ( t1 ) and 12 months postdischarge ( t2 ) . Preprogramme and post-programme hospital admissions and exacerbations of disease were also recorded . In comparison with baseline , no significant change was observed in lung function tests in either diagnostic group , either at t1 or at t2 . In both groups improvements in respiratory muscle strength , exercise tolerance , Borg scale and VAS reported at t1 were partially reduced at t2 . Analysis of variance showed that these changes over time were similar in the two groups . Mean values of SGRQ and BDI/TDI improved at t1 , and , unlike exercise tolerance , did not worsen at t2 . However , a clinical ly relevant difference in SGRQ between t2 and to was reported only in 56 % of asthmatics and 52 % of COPD patients . Compared with the preceding 2 yrs , in the year following PRP , hospital admissions and disease exacerbations decreased significantly in both diagnostic groups . Regardless of diagnosis , patients with chronic airway obstruction who underwent an outpatient pulmonary rehabilitation programme maintained an improved quality of life 12 months postdischarge despite a partial loss of the improvement in exercise tolerance 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 r and omly 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 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 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 dem and 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 OBJECTIVE To assess the effect of a training protocol on aerobic and anaerobic fitness in children with asthma . STUDY DESIGN 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 r and omly 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 . RESULTS 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 ) . CONCLUSION 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 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 OBJECTIVES This study investigates the effectiveness of 24-week aerobic and weight-training exercise plus behavior modification for mental health and quality of life ( QOL ) outcomes . METHODS Mental health and QOL data was collected using the Depression Anxiety and Stress Scales and SF-36 Health Status Survey , respectively . Employees from a single work-site were r and omized into either treatment or wait-list control groups . RESULTS Mental Health ( P = 0.005 ) , Vitality ( P < 0.001 ) , General Health ( P = 0.009 ) , Bodily Pain ( P = 0.005 ) , Physical Functioning ( P = 0.004 ) , Depression ( P = 0.048 ) , and Stress ( P = 0.036 ) scales significantly improved for the treatment group compared to wait-list controls after 24 weeks . CONCLUSIONS Multimodal exercise is as effective as other single-modality exercise treatments for depressive symptoms and , in contrast to other studies , does improve stress symptoms and QOL outcomes PURPOSE 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 . METHODS 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 r and omly 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 ) . CONCLUSION 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 BACKGROUND AND OBJECTIVE 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 . METHODS Young asthmatics were r and omly 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 . RESULTS 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 . CONCLUSIONS 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 Objective : To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis . Design : Intervention study : a r and omized pretest – post-test control group design . Setting and subjects : Forty-seven children with clinical ly diagnosed asthma participated in the intervention study , including 34 boys and 13 girls , from 8 to 13 years of age ( mean age 10.6 ) . Interventions : 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 . Main outcome measures : Maximum incremental exercise test , endurance test , the Self-Perception Profile for Children ( CBSK ) , the Asthma Coping Test ( ACBT ) , lung function and exercise-induced bronchoconstriction . Results : 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 VO 2max ( 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 ) . Conclusion : It was concluded that participation in the physical exercise programme not only enhanced physical fitness , but also improved coping behaviour with asthma Exercise-induced asthma ( EIA ) is very common in children with asthma . For this reason they avoid every strenuous exercise because they fear a new asthma attack . Working capacity and maturation of motor performance can be insufficient as a consequence . We investigated whether a special training programme in an asthma sports group has positive effects not only on asthma , but also on working capacity and motor performance . 11 children with extrinsic asthma ( 4 girls , 7 boys ) , 8 to 14 years old , were studied before and after a 6-month  out-patient rehabilitative sports therapy ( sports group ) with regard to their degree of bronchial hyperreactivity ( BHR ) , frequency of EIA , cardiopulmonary capacity for exercise ; knowledge about their asthma , level of coordination and condition , and their movement-related anxiety . There were 9 children with extrinsic asthma ( 2 girls , 7 boys ) , 8 to 15 years old , in a control group . They did not take part in any special training programme . After the sports therapy we found in 3 children of the sports group a decrease in BHR , EIA was now present in only 2 of formerly 4 children . Physical working capacity ( PWC ) at the aerobic/anaerobic threshold improved in the sports group by about 1 W/kg body weight ( p = 0.008 ) , efficiency of work from 23.7 % to 27.9 % ( p = 0.009 ) . We also found a remarkable improvement of motor abilities . Movement-related anxiety decreased in the sports group both in Indoor sports ( p = 0.0089 ) and aquatics ( p = 0.026 ) . In the control group there was no significant change . Physical training in children with asthma has many positive effects on lung function and motor performance . We believe that the limit for an EIA release is shifted to a higher PWC . The reduction of the anxiety over sports at a higher level of PWC contributes to an improved quality of life for children with asthma This study investigated the effect of 8 weeks , three times weekly , of aerobic exercise ( AE ) , diaphragmatic inspiratory resistive breathing ( DR ) , and aerobic exercise combined with diaphragmatic inspiratory resistive breathing ( CE ) on pulmonary function and abdominal and thoracic dimensions and kinematics in asthmatics . Eighty-eight inactive , moderate-persistent asthmatics were matched and r and omly assigned to AE , DR , CE , or nonexercise control ( NE ) groups ( n = 22 each ) . AE subjects walked and /or jogged at 60 % of age-predicted maximum heart rate . DR subjects performed diaphragmatic breathing combined with inspiratory resistive breathing at varying inspiration , expiration ratios . CE subjects utilized a combination of the AE and DR programs . AE , DR , and CE significantly ( p ≤ 0.05 ) improved chest dimensions and kinematics during inspiration at the height of the second intercostal space , during inspiration and expiration at the height of the xiphoid process , and during inspiration and expiration at the height of the midpoint between the xiphoid process and umbilicus . All exercise interventions significantly improved FVC , FEV1 , PEF , and IVC , while MVV improved following AE and CE . However , CE proved superior to AE at improving FVC ( p = 0.001 ) , FEV1 ( p = 0.001 ) , and IVC ( p = 0.009 ) . There were no significant changes ( p > 0.05 ) in any of the measured parameters in the NE group . CE produces adaptations greater than those for single-mode training in moderate-persistent asthmatics . The results suggest synergy rather than interference between aerobic exercise and diaphragmatic inspiratory resistive breathing and that this mode of training might be useful as an adjunct therapy in asthmatic patients 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 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 . METHODS A total of 101 patients were r and omly 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 . RESULTS 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 ) . CONCLUSIONS 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 clinical trials.gov ; Identifier : NCT-00989365 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 STUDY OBJECTIVE To determine the effect of an aerobic conditioning program on fitness , respiratory physiology , and resting lung function in patients with mild asthma . DESIGN Prospect i ve cohort study . SETTING Outpatient rehabilitation facility . METHODS Five patients with mild intermittent asthma and five normal control subjects completed a 10-week aerobic conditioning program .  Pulmonary function studies and noninvasive cardiopulmonary exercise tests were performed before and after the conditioning program . RESULTS After aerobic conditioning , there were significant gains in maximum oxygen consumption ( VO(2)max ; 22.73 mL/kg/min vs 25.29 mL/kg/min , p = 0.01 , asthma ; 22.94 mL/kg/min vs 27.85 mL/kg/min , p = 0.03 , control ) and anaerobic threshold ( 0.99 L/min vs 1.09 L/min , p = 0.03 , asthma ; 0.89 L/min vs 1.13 L/min , p = 0.01 , control ) in both groups . Although FEV(1 ) was unchanged , the maximum voluntary ventilation ( MVV ) improved in the asthma group ( 96.0 L/min vs 108.2 L/min , p = 0.08 , asthma ; 134.0 L/min vs 131.2 L/min , p = 0.35 , control ) . During exercise , minute ventilation ( VE ) for each level of work was decreased in the asthma group after conditioning , while little change occurred in the control group ( 68 . 48 L/min vs 51.70 L/min at initial VO(2)max , p = 0 . 02 , asthma ; 65.82 L/min vs 63.12 L/min at initial VO(2)max , p = 0.60 , control ) . A significant decrease in the ventilatory equivalent ( VE/oxygen consumption , 40.8 vs 30.4 at VO(2)max , p = 0.02 , asthma ; 37.2 vs 35.8 4 at VO(2)max , p = 0.02 , control ) and the dyspnea index ( VE/MVV ) at submaximal ( 0.44 vs 0.38 , p = 0.05 , asthma ; 0.32 vs 0.38 , p < 0.01 , control ) and maximal exercise ( 0.72 vs 0.63 , p = 0.03 , asthma ; 0.49 vs 0.62 , p = 0.02 , control ) occurred in the asthma group . CONCLUSIONS Exercise rehabilitation improves aerobic fitness in both asthmatic and nonasthmatic participants of a 10-week aerobic fitness program . Additional benefits of improved ventilatory capacity and decreased hyperpnea of exercise occurred in patients with mild asthma The influence of physical training on the cardiopulmonary system and on lung function of asthmatic children was determined in a controlled study . The children were all indoor patients of the Hochgebirgsklinik Davos , Switzerl and . 36 children at the age of 10 to 16 years entered the study . They were placed into either a " free running group " , a " swimming group " or a " control group . " The children of the training groups underwent a training of at least 10 units of 30 minutes each in 3 weeks . The control group did not participate in any regular physical training . Heart rate was measured before and after a bicycle ergometer exercise of 5 minutes at 2.5 watts/kg body weight . This was repeated at the end of the study . In the " free running group " a significant decrease of the heart rate at rest ( p less than 0.05 ) and at the end of bicycle ergometer exercise ( p less than 0.01 ) could be seen . In the " swimming group " the decrease of the latter was significant ( p less than 0.05 ) . In both groups an increase in work tolerance could be demonstrated , but not in the " control group . " In all three groups an improvement of lung function ( IVC , FEV1 ) was found , but it was not significant in any of the groups . The small improvement might be due to a reduction in allergen exposure and better medical treatment . The study confirms the possibility of physical training of children with asthma even if exercise-induced asthmatic signs and symptoms are present BACKGROUND Previous research suggests that physical activity programs may improve fitness and reduce symptoms in children with asthma , but few studies have included severe asthmatics and focused on safety and parental satisfaction with the programs . OBJECTIVE To examine safety , parental satisfaction , and pre- to post-intervention changes in symptoms and quality of life ( QOL ) in a pilot study of the impact of vigorous physical activity ( swimming ) and moderate-intensity activity ( golf ) on inner-city children with asthma . DESIGN / METHODS Children with asthma ( 7 - 14 years old ) residing in Milwaukee 's highest asthma prevalence zip codes were r and omized to a 9-week swimming or golf program . Pre- and post-intervention data were obtained on safety , parental satisfaction , asthma symptoms , quality of life , and urgent asthma physician visits . RESULTS Twenty-eight children in the swimming group and 17 in the golf group completed the program . Combined group analysis ( N = 45 ) revealed that only six symptom exacerbations occurred during 1,125 person-sessions of swimming and golf ( all resolved with bronchodilator therapy ) , 92 % of parents were very or extremely satisfied with the program , and post-exercise decreases were observed in asthma symptom severity scores ( 9.3 - 7.3 , P < 0.001 ) , improved parental QOL ( 4.9 - 5.4 , P < 0.001 ) , and reduced urgent physician visits for asthma ( 1.3 - 0.2 visits per person , P = 0.04 ) . The study lacked sufficient power to perform intergroup comparisons . CONCLUSIONS Findings from this pilot study indicate that vigorous ( swimming ) and moderate-intensity ( golf ) physical activity programs are well-tolerated , safe , and achieve high parental satisfaction . Participants and parents reported reduced childhood asthma symptoms and physician office visits and improved parental QOL . These findings suggest a potentially beneficial role for moderate to vigorous physical activity in childhood asthma OBJECTIVE To investigate the effects of regular submaximal exercise on quality of life , exercise capacity and pulmonary function in asthmatic children . PATIENTS AND METHODS Sixty-two children with mild-moderate asthma ( mean age 10.4 ( SD 2.1 ) years ) were r and omly allocated into exercise and control groups . The exercise group underwent a moderately intensive basketball training program for 8 weeks . A home respiratory exercise program was advised to both groups . Pediatric Asthma Quality of Life Question naire ( PAQLQ ) was used for the evaluation of activity limitation , symptoms and emotional functions . Exercise capacity was evaluated through the physical work capacity ( PWC 170 test ) on a cycle ergometer and 6-minute walk test . Spirometric tests were also performed and medication and symptom scores were recorded . RESULTS Although PAQLQ scores improved in both groups , the improvement in the exercise group was significantly higher . The exercise group performed better in the PWC 170 and 6-minute walk tests , whereas no improvement was detected in the control group at the end of the trial . Medication scores improved in both groups , but symptom scores improved only in the exercise group . No significant changes were detected in pulmonary function in either group , except for peak expiratory flow values in the exercise group . CONCLUSION Eight weeks of regular submaximal exercise has beneficial effects on quality of life and exercise capacity in children with asthma .  Submaximal basketball training is an effective alternative exercise program for asthmatic children 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 Although physical exercise is recommended for asthmatics , evidence on the effects of exercise on clinical key factors is still missing .
Objectives We performed a systematic review and meta- analysis to determine the effect of exercise training ( EXT ) on quality of life ( QoL ) , bronchial hyperresponsiveness ( BHR ) , exercise-induced bronchoconstriction ( EIB ) , lung function and exercise capacity , plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT .