Short term effects of aerobic training in the clinical management of moderate to severe asthma in children The effectiveness of an indoor intermittent training program for improving lung function, physical capacity, body composition and quality of life in children with asthma Laps or lengths? The effects of different exercise programs on asthma control in children The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effects of swimming on spirometric parameters and bronchial hyperresponsiveness in children and adolescents with moderate persistent atopic asthma. 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. The effects of a swimming intervention for children with asthma. Children with asthma and physical exercise: effects of an exercise programme GRADE guidelines: 3. Rating the quality of evidence. Breathing retraining for African-American adolescents with asthma: a pilot study of a school-based randomized controlled trial Effect of Physiotherapy in Asthmatic Children–A One‐year Follow‐up after Physical Training Once a Week Inspiratory muscle training and respiratory exercises in children with asthma. Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma. Evaluating pulmonary function, aerobic capacity, and pediatric quality of life following a 10-week aerobic exercise training in school-aged asthmatics: a randomized controlled trial
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 Abstract Objective : The objective of this study is to analyze the effects of a 12-week indoor intermittent training program on lung function , physical capacity , body composition and quality of life in children with asthma . Methods : Participants were r and omized in an experimental group ( EG , 58 children , age = 11.55 ± 1.01 years ) and in a control group ( CG , 47 children , age = 11.51 ± 1.42 years ) . The training program was conducted indoors and consisted of alternating high- and low-intensity stimuli , for three sessions of 60 min/week , for 12 weeks . Physical exercise and sports activities were organized to follow the criteria of the American College of Sports Medicine ( 1999 ) and previous interventions ’ studies . Results : In EG , there was a significant improvement ( p < 0.05 ) in FEV1 , FEV6 , 6MWT , h and grip strength , CMJ and flexibility . Reductions in BMI and fat mass as well as an increase in quality of life were all shown . The dyspnea index decreased significantly and there were no episodes of EIA . There is a significant positive correlation ( p < 0.01 ) between the ΔFEV1 with Δh and grip strength and Δ6MWT and a negative correlation with Δfat mass . Conclusions : An indoor intermittent training program with these characteristics has improved lung function , physical capacity , body composition and quality of life in children with asthma . These training adaptations are particularly relevant for those patients suffering from asthma as a regular physical exercise routine will greatly improve their quality of life ABSTRACT Introduction : Exercise training has been shown in numerous studies to improve lung function and asthma control in children with asthma . Swimming has been shown to be of benefit in children with asthma , but which form of exercise is better for asthmatics has not been determined to date . The aim of this study was to examine if swimming improved lung function and asthma symptoms in asthmatic children when compared with different forms of exercise and a control group . Methods : Subjects with asthma were r and omly assigned to either one of three different exercise training groups ( swimming , football , and basketball ) or a control group .  Spirometry was performed before and after and the subjects were asked to keep asthma diaries and perform daily peak flow measurements . Results : 41 children and adolescents between the ages of 9 and 16 participated in the study . After completing the training , children across all three exercise programs had significantly higher forced vital capacity ( FVC ) percentage values when compared to the control group . The swimming group demonstrated a significant increase in the percentage peak expiratory flow ( PEF ) following the exercise program when compared with the control group ( 78.3 ± 9.3 versus 89.0 ± 14.9 , p = 0.04 ) . All children on exercise training programs reported an improvement in their asthma symptoms via asthma diaries . Conclusion : This study suggests that a swimming training program is more beneficial in terms of peak flow measurements when compared with other exercise training programs Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 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 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 This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence Abstract Objective : Asthma affects approximately seven million children/adolescents in the USA , with African-American children disproportionately affected . Breathing retraining techniques have been shown to improve asthma outcomes in adults , though research in youth is limited . The purpose of this pilot study was to test the feasibility and preliminary efficacy of a school-based r and omized controlled trial of breathing retraining for asthma outcomes and anxiety symptoms in a sample of urban , African-American adolescents . Methods : Adolescents were r and omized into either the intervention group ( 20-min breathing retraining plus education ) or control group ( 20-min st and ard education ) . Participants completed two study visits , one month apart . Asthma control , asthma quality of life and lung functioning ( FEV1 and peak flow ) were the primary outcomes , and state anxiety ( pre-post the intervention ) and trait anxiety ( over the one-month period ) were the secondary outcomes . Results : Thirty-three African-American adolescents participated in the study , with a 90 % retention rate between visit 1 and visit 2 . Asthma control and asthma quality of life , significantly improved over time ( p ≤ 0.01 ) with no differences between intervention and control groups . State anxiety significantly decreased ( p ≤ 0.01 ) immediately post intervention at both time points with no differences between groups . There were no significant differences found in lung functioning or trait anxiety over the one-month time period . Conclusions : These preliminary results suggest that breathing retraining is a feasible , acceptable and potentially efficacious intervention ( although no significant differences between groups were found ) for improving asthma symptoms in urban adolescents with asthma in a school-based setting Physiotherapy is an established treatment in asthmatic children . One purpose is to increase tolerance towards physical activity , decrease broncho-obstruction and promote elimination of secretions . A positive effect of physical training in asthmatic children has been reported in many studies . An improved working capacity has e.g. been shown after supervised physical training at least twice a week for a period of three months ( 1 ) . This was not a realistic level of training intensity in our clinical practice . Therefore , the goal of this study was to test whether physiotherapy combined with physical training once a week had any effect on working capacity or lung function tests in asthmatic children OBJECTIVE The aim of the present study was to evaluate the effects that inspiratory muscle training ( IMT ) and respiratory exercises have on muscle strength , peak expiratory flow ( PEF ) and severity variables in children with asthma . METHODS This was a r and omized analytical study involving 50 children with asthma allocated to one of two groups : an  IMT group  , comprising 25 children su bmi tted to IMT via an asthma education and treatment program ;  and a control group  , comprising 25 children who were su bmi tted only to monthly medical visits and education on asthma .  The IMT was performed using a pressure threshold load of 40 % of maximal inspiratory pressure ( MIP ) . The results were evaluated using analysis of variance , the chi-square test and Fisher 's exact test , values of p > 0.05 being considered significant . RESULTS In the comparative analysis , pre- and post-intervention values of MIP , maximal expiratory pressure ( MEP ) and PEF increased significantly in the IMT group : MIP from -;48.32 + /- 5.706 to -;109.92 + /- 18.041 ( p < 0.0001 ) ; MEP from 50.64 + /- 6.55 to 82.04 + /- 17.006 ( p < 0.0001 ) ; and PEF from 173.6 + /- 50.817 to 312 + /- 54.848 ( p < 0.0001 ) . In the control group , however , there were no significant differences between the two time points in terms of MIP or MEP , although PEF increased from 188 + /- 43.97 to 208.80 + /- 44.283 ( p < 0.0001 ) . There was a significant improvement in the severity variables in the IMT group ( p < 0.0001 ) . CONCLUSIONS Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles , as well as improving PEF and severity variables 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 Background It has been documented that aerobic exercise may increase pulmonary functions and aerobic capacity , but limited data has evaluated a child ’s satisfaction and pediatric quality of life ( PQoL ) with exercise training . Objectives This study aim ed to investigate the effects of moderate-intensity exercise training on asthmatic school-aged children . Subjects and methods This study included 38 school-aged children with asthma ( 23 males and 15 females ) aged between 8–12 years . They were r and omly assigned to two groups , aerobic exercise ( AE ) and conventional treatment ( Con ttt ) groups . The AE group received a program of moderate-intensity aerobic exercise for 10 weeks with asthma medications and the Con ttt group received only asthma medications without exercise intervention . A home respiratory exercise was recommended for the two groups . Aerobic capacity was investigated using maximal oxygen uptake ( VO2max ) , 6-minute walk test ( 6MWT ) , and fatigue index . PQoL was evaluated using Pediatric Quality of Life Question naire ( PQoLQ ) . Also , pulmonary function tests were performed , and the results recorded . Results The findings of this study showed significant improvements in pulmonary functions and VO2max in the two groups ; however , this improvement was significantly higher in the AE group than in the Con ttt group ( p<0.05 ) . The 6MWT and fatigue index improved in the AE group ( p<0.05 ) but not in the Con ttt group ( p>0.05 ) . All dimensions of PQoL significantly improved in the AE group ( p<0.05 ) , but there was no significant improvement in the Con ttt group after the 10-week intervention period ( p>0.05 ) . Conclusion Ten weeks of physical exercise had beneficial effects on pulmonary functions , aerobic capacity , and PQoL in school-aged children with asthma . Effort and awareness should be dedicated to encouraging the active lifestyle among different population s , especially asthmatic children
Asthma is a common chronic respiratory disease in children .
In addition to medications , physical therapy is considered as a treatment strategy for asthma .
We conducted this study to investigate the effects of physical therapy on lung function in children with asthma .
Our study review ed the physical therapies for children with asthma and clarified whether and how these therapies affect them .