Physical training for asthma

Abstract

BACKGROUND: People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered. OBJECTIVE: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. METHODS:Search methods: We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. Selection criteria: We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Data collection and analysis: Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies. MAIN RESULTS: Twenty-one studies (772 participants) were included in this review with two additional 2012 studies identified as 'awaiting classification' . Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD) 4.92 mL/kg/min; 95% confidence interval (CI) 3.98 to 5.87; P < 0.00001; 8 studies on 267 participants); however, no statistically significant effects were observed for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), minute ventilation at maximal exercise (VEmax) or peak expiratory flow rate (PEFR). Meta-analysis of four studies detected a statistically significant increase in maximum heart rate, and following a sensitivity analysis and removal of two studies significance was maintained (MD 3.67 bpm; 95% CI 0.90 to 3.44; P = 0.01). Although there were insufficient data to pool results due to diverse reporting tools, there was some evidence to suggest that physical training may have positive effects on healthrelated quality of life, with four of five studies producing a statistically and clinically significant benefit. AUTHORS' CONCLUSIONS:This review demonstrated that physical training showed significant improvement in maximum oxygen uptake, though no effects were observed in other measures of pulmonary function. Physical training was well tolerated among people with asthma in...

Daily physical activity and lung function decline in adult-onset asthma: a 12-year follow-up study

“…Physical exercise reduces systemic and bronchial inflammation, and increases maximal oxygen uptake [12,13]. Most research on daily physical activity in asthma focuses either on the risk of developing asthma or exercise-induced bronchoconstriction.…”

Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis (Preprint)

“…Recent systematic reviews have shown physical activity and exercise to be beneficial for pulmonary function and healthrelated quality of life in both asthma [5] and CF [6]. Physical activity is also negatively associated with mortality and exacerbations in COPD [7].…”

Comparação entre exercício aeróbio e respiratório no controle clínico e inflamação pulmonar de pacientes com asma persistente moderada ou grave: ensaio clínico aleatorizado

“…Ao contrário do que se acreditava há algumas décadas, os pacientes asmáticos podem e devem realizar exercícios físicos e praticar esportes regularmente 22,31 , sendo o treinamento físico hoje considerado um componente importante do programa de reabilitação pulmonar, recomendado pelos principais consensos internacionais 32,33 . Diferentes programas de treinamento físico têm sido recomendados, porém existe uma grande variabilidade entre os estudos e atividades como caminhada, corrida, ciclismo, ginástica, subida de degraus, natação e dança têm sido propostas 22 .…”

“…Diferentes programas de treinamento físico têm sido recomendados, porém existe uma grande variabilidade entre os estudos e atividades como caminhada, corrida, ciclismo, ginástica, subida de degraus, natação e dança têm sido propostas 22 . As evidências na literatura têm demonstrado que os exercícios aeróbios podem proporcionar aos pacientes: melhora dos fatores relacionados à qualidade de vida 34,24,35 e do controle clínico 36 , bem como redução do número de crises e uso da medicação de alívio 37,24,35 , do broncoespasmo induzido pelo exercício 34 , da hiperresponsividade das vias aéreas 38 , do uso de corticosteróide 34 , do risco de exacerbação da asma 27,24,39 .…”

“…Atualmente, tem-se sugerido que o exercício físico tenha um efeito antiinflamatório na asma evidenciado pela redução da fração de óxido nítrico exalado (FeNO) 39,40 e redução na porcentagem de eosinófilos no escarro 39 . Apesar desses estudos, os únicos benefícios amplamente reconhecidos do treinamento físico aeróbio em pacientes asmáticos, avaliados por análise sistemática, são o aumento da capacidade aeróbica, melhora dos fatores de saúde relacionados a qualidade de vida e redução da dispneia durante o exercício 22 .…”