Effects of a pulmonary rehabilitation program on physical capacity, peripheral muscle function and inflammatory markers in asthmatic children and adolescents: study protocol for a randomized controlled trial

Abstract

BackgroundIndividuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease.The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program.MethodThis is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 μcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers.Trial registrationClinical Trial Number: NCT02383069. Data of registration: 03/03/2015

Reliability of Cardiorespiratory and Metabolic Responses During Incremental Shuttle Walk Test in Adult Subjects With Asthma

“…Asthma is a common respiratory disease characterized by chronic or recurrent airway inflammation associated with variable expiratory flow limitation and bronchial hyper-responsiveness. 1 Patients with chronic lung diseases are more likely to present with lower exercise tolerance, explained not only by the air-flow limitation, but also by peripheral muscle dysfunction. 2 As a consequence, many patients adopt a sedentary lifestyle, predisposing them to early fatigue and exercise intolerance.…”

“…2 As a consequence, many patients adopt a sedentary lifestyle, predisposing them to early fatigue and exercise intolerance. 1 Regular physical training seems to counteract the consequences of the disease and is a cornerstone in the rehabilitation process. It has been suggested that increased exercise capacity may play an important modulatory role in reducing the degree of systemic inflammation in asthma, 3 along with the use of corticosteroids.…”

Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma

“…12 For example, there are studies that have shown that health promotion programmes can reduce asthma exacerbations through encouraging physical activity,13 pilot study level evidence of the potential utility of active play as a physical activity intervention for children14 and current work evaluating intense physiotherapy interventions 15. There are, however, no physical activity behaviour change programmes to increase physical activity in children with asthma.…”

Evaluation of a nurse‐supervised rehabilitation programme on clinical features and systemic inflammation in Chinese children with asthma: A propensity score‐matched analysis

“…Furthermore, because intensities of training were described differently and the strength and endurance of muscle tended to be evaluated poorly, the severity of disease might not be described as determined by consensus; the control group, therefore, might not be well addressed (Reimberg et al, 2015), suggesting that more studies are needed to investigate the pulmonary rehabilitation in the paediatric population.…”