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Physical training for asthma

Physical training for asthma
Physical training for asthma
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.

OBJECTIVES: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials.

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 health-related 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 the included studies and, as such, people with stable asthma should be encouraged to participate in regular exercise training, without fear of symptom exacerbation. More research is needed to understand the mechanisms by which physical activity impacts asthma management.
1469-493X
CD001116-[72pp]
Carson, Kristin V.
e64167a8-6bbe-4b65-ae10-6200d88a2633
Chandratilleke, Madhu G.
c7c787b5-1363-4aee-a3aa-b70fdb4290e5
Picot, Joanna
324d6f20-a105-49fd-9fb0-88791be84ada
Brinn, Malcolm P.
f4155e4a-493a-4ec2-9f3c-47b6aff997ca
Esterman, Adrian J.
61874417-3f0b-49cd-b95b-ed1438b15cc3
Smith, Brian J.
954d05af-a64d-404b-b03e-770e9cff1ac7
Carson, Kristin V.
e64167a8-6bbe-4b65-ae10-6200d88a2633
Chandratilleke, Madhu G.
c7c787b5-1363-4aee-a3aa-b70fdb4290e5
Picot, Joanna
324d6f20-a105-49fd-9fb0-88791be84ada
Brinn, Malcolm P.
f4155e4a-493a-4ec2-9f3c-47b6aff997ca
Esterman, Adrian J.
61874417-3f0b-49cd-b95b-ed1438b15cc3
Smith, Brian J.
954d05af-a64d-404b-b03e-770e9cff1ac7

Carson, Kristin V., Chandratilleke, Madhu G., Picot, Joanna, Brinn, Malcolm P., Esterman, Adrian J. and Smith, Brian J. (2013) Physical training for asthma. Cochrane Database of Systematic Reviews, 9, CD001116-[72pp]. (doi:10.1002/14651858.CD001116.pub4). (PMID:24085631)

Record type: Article

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.

OBJECTIVES: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials.

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 health-related 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 the included studies and, as such, people with stable asthma should be encouraged to participate in regular exercise training, without fear of symptom exacerbation. More research is needed to understand the mechanisms by which physical activity impacts asthma management.

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More information

e-pub ahead of print date: 30 September 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 356172
URI: https://eprints.soton.ac.uk/id/eprint/356172
ISSN: 1469-493X
PURE UUID: a29fa8a4-2e75-405e-abc1-2446a633e97b
ORCID for Joanna Picot: ORCID iD orcid.org/0000-0001-5987-996X

Catalogue record

Date deposited: 10 Oct 2013 11:31
Last modified: 07 Aug 2019 00:43

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Contributors

Author: Kristin V. Carson
Author: Madhu G. Chandratilleke
Author: Joanna Picot ORCID iD
Author: Malcolm P. Brinn
Author: Adrian J. Esterman
Author: Brian J. Smith

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