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The Effect of Threshold Loading Training and an Innovative Respiratory Training Devices with Lower Torso Sports Training in Asthma Patients: A Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3049804. [PMID: 36852293 PMCID: PMC9966570 DOI: 10.1155/2023/3049804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/15/2023] [Accepted: 02/06/2023] [Indexed: 02/20/2023]
Abstract
This study investigated the influence of two different devices with lower torso sports training in patients with asthma. Patients with asthma (n = 300) aged 55-60 years with FEV1/FVC ratio < 65%, who were repeatedly admitted to a pulmonary rehabilitation centre, participated. Patients were evaluated and randomized into two groups (experimental group 1; EXP-1, n = 150, who applied a conventional threshold loading device, and experimental group 2; EXP-2, n = 150, who used an innovative respiratory training device). Patients were included only if they met the global criteria for asthma. The experimental intervention period lasted 10 weeks with 3 weekly training sessions lasting 30-40 min. The maximal inspiratory pressure (PI, max), pulmonary function test, baseline dyspnoea index (BDI), oxygen saturation, and 6 min walking test (6MWT) performance were all measured at baseline and postintervention. Also, an assessment of the 1 min repeated exercise performance (leg extension and leg press) was performed. Moreover, St. George Respiratory Questionnaire was used to quantify the quality of life (SGRQ). Statistical analysis displayed significant favourable effects on 6MWT, leg press, and FRV1, for patients using both devices (EXP-1 and EXP-2, respectively) with lower torso athletic training. The other variables, weight SPO2 and SGRO, also showed no significant change in neither EXP-1 nor EXP-2. Thus, the new respiratory training device (EXP-2) appeared to be as effective as the conventional threshold loading device (EXP-1). In conclusion, our findings demonstrated beneficial effects of combining respiratory training with athletic training in asthma patients. Additionally, the validity of a unique respiratory training device for asthma patients was confirmed.
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Souza Silva BRV, da Silva GAS, de Albuquerque Rodrigues Filho E, Peixoto DM, de Almeida Santos CM, Quirino PGC, Rizzo JÂ, de Valois Correia Junior MA. Can physical exercise assist in controlling and reducing the severity of exercise-induced bronchospasm in children and adolescents? A systematic review. THE CLINICAL RESPIRATORY JOURNAL 2022; 17:3-12. [PMID: 36463836 PMCID: PMC9829622 DOI: 10.1111/crj.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/28/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The aim of this study was to analyze whether physical exercise can contribute to improving the control and severity of exercise-induced bronchospasm (EIB) in children and adolescents. METHOD This is a systematic review that used PubMed/Medline and Scopus databases as a search source, and using descriptors indexed to DeCS/Mesh. The articles were analyzed in three stages in the selection process. Methodological quality was assessed using the TESTEX scale. RESULT AND DISCUSSION A total of 5867 articles were filtered in the initial search; however, only eight of these were included after the eligibility criteria. All presented improvements in cardiorespiratory fitness. Only two followed the international EIB diagnostic guidelines. Of these, only one described a reduction in FEV1 and considered that this improvement may influence the EIB response in children and adolescent athletes with a non-asthmatic sample. CONCLUSION The studies analyzed in this review did not enable drawing a conclusion regarding the influence of physical exercise on EIB in asthmatics. The lack of clinical trials on EIB and physical exercise, as well as the difficulty in methodological standardization for EIB diagnosis evidence the lack of scientific knowledge in this area, serving as a stimulus for researchers to find more consolidated answers.
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Osadnik CR, Gleeson C, McDonald VM, Holland AE. Pulmonary rehabilitation versus usual care for adults with asthma. Cochrane Database Syst Rev 2022; 8:CD013485. [PMID: 35993916 PMCID: PMC9394585 DOI: 10.1002/14651858.cd013485.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Asthma is a respiratory disease characterised by variable airflow limitation and the presence of respiratory symptoms including wheeze, chest tightness, cough and/or dyspnoea. Exercise training is beneficial for people with asthma; however, the response to conventional models of pulmonary rehabilitation is less clear. OBJECTIVES To evaluate, in adults with asthma, the effectiveness of pulmonary rehabilitation compared to usual care on exercise performance, asthma control, and quality of life (co-primary outcomes), incidence of severe asthma exacerbations/hospitalisations, mental health, muscle strength, physical activity levels, inflammatory biomarkers, and adverse events. SEARCH METHODS We identified studies from the Cochrane Airways Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform, from their inception to May 2021, as well as the reference lists of all primary studies and review articles. SELECTION CRITERIA We included randomised controlled trials in which pulmonary rehabilitation was compared to usual care in adults with asthma. Pulmonary rehabilitation must have included a minimum of four weeks (or eight sessions) aerobic training and education or self-management. Co-interventions were permitted; however, exercise training alone was not. DATA COLLECTION AND ANALYSIS: Following the use of Cochrane's Screen4Me workflow, two review authors independently screened and selected trials for inclusion, extracted study characteristics and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. We contacted study authors to retrieve missing data. We calculated between-group effects via mean differences (MD) or standardised mean differences (SMD) using a random-effects model. We evaluated the certainty of evidence using GRADE methodology. MAIN RESULTS We included 10 studies involving 894 participants (range 24 to 412 participants (n = 2 studies involving n > 100, one contributing to meta-analysis), mean age range 27 to 54 years). We identified one ongoing study and three studies awaiting classification. One study was synthesised narratively, and another involved participants specifically with asthma-COPD overlap. Most programmes were outpatient-based, lasting from three to four weeks (inpatient) or eight to 12 weeks (outpatient). Education or self-management components included breathing retraining and relaxation, nutritional advice and psychological counselling. One programme was specifically tailored for people with severe asthma. Pulmonary rehabilitation compared to usual care may increase maximal oxygen uptake (VO2 max) after programme completion, but the evidence is very uncertain for data derived using mL/kg/min (MD between groups of 3.63 mL/kg/min, 95% confidence interval (CI) 1.48 to 5.77; 3 studies; n = 129) and uncertain for data derived from % predicted VO2 max (MD 14.88%, 95% CI 9.66 to 20.1%; 2 studies; n = 60). The evidence is very uncertain about the effects of pulmonary rehabilitation compared to usual care on incremental shuttle walk test distance (MD between groups 74.0 metres, 95% CI 26.4 to 121.4; 1 study; n = 30). Pulmonary rehabilitation may have little to no effect on VO2 max at longer-term follow up (9 to 12 months), but the evidence is very uncertain (MD -0.69 mL/kg/min, 95% CI -4.79 to 3.42; I2 = 49%; 3 studies; n = 66). Pulmonary rehabilitation likely improves functional exercise capacity as measured by 6-minute walk distance, with MD between groups after programme completion of 79.8 metres (95% CI 66.5 to 93.1; 5 studies; n = 529; moderate certainty evidence). This magnitude of mean change exceeds the minimally clinically important difference (MCID) threshold for people with chronic respiratory disease. The evidence is very uncertain about the longer-term effects one year after pulmonary rehabilitation for this outcome (MD 52.29 metres, 95% CI 0.7 to 103.88; 2 studies; n = 42). Pulmonary rehabilitation may result in a small improvement in asthma control compared to usual care as measured by Asthma Control Questionnaire (ACQ), with an MD between groups of -0.46 (95% CI -0.76 to -0.17; 2 studies; n = 93; low certainty evidence); however, data derived from the Asthma Control Test were very uncertain (MD between groups 3.34, 95% CI -2.32 to 9.01; 2 studies; n = 442). The ACQ finding approximates the MCID of 0.5 points. Pulmonary rehabilitation results in little to no difference in asthma control as measured by ACQ at nine to 12 months follow-up (MD 0.09, 95% CI -0.35 to 0.53; 2 studies; n = 48; low certainty evidence). Pulmonary rehabilitation likely results in a large improvement in quality of life as assessed by the St George's Respiratory Questionnaire (SGRQ) total score (MD -18.51, 95% CI -20.77 to -16.25; 2 studies; n = 440; moderate certainty evidence), with this magnitude of change exceeding the MCID. However, pulmonary rehabilitation may have little to no effect on Asthma Quality of Life Questionnaire (AQLQ) total scores, with the evidence being very uncertain (MD 0.87, 95% CI -0.13 to 1.86; 2 studies; n = 442). Longer-term follow-up data suggested improvements in quality of life may occur as measured by SGRQ (MD -13.4, 95% CI -15.93 to -10.88; 2 studies; n = 430) but not AQLQ (MD 0.58, 95% CI -0.23 to 1.38; 2 studies; n = 435); however, the evidence is very uncertain. One study reported no difference between groups in the proportion of participants who experienced an asthma exacerbation during the intervention period. Data from one study suggest adverse events attributable to the intervention are rare. Overall risk of bias was most commonly impacted by performance bias attributed to a lack of participant blinding to knowledge of the intervention. This is inherently challenging to overcome in rehabilitation studies. AUTHORS' CONCLUSIONS: Moderate certainty evidence shows that pulmonary rehabilitation is probably associated with clinically meaningful improvements in functional exercise capacity and quality of life upon programme completion in adults with asthma. The certainty of evidence relating to maximal exercise capacity was very low to low. Pulmonary rehabilitation appears to confer minimal effect on asthma control, although the certainty of evidence is very low to low. Unclear reporting of study methods and small sample sizes limits our certainty in the overall body of evidence, whilst heterogenous study designs and interventions likely contribute to inconsistent findings across clinical outcomes and studies. There remains considerable scope for future research.
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Affiliation(s)
- Christian R Osadnik
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Ciara Gleeson
- Respiratory Assessment Unit, St. James's Hospital, Dublin, Ireland
| | - Vanessa M McDonald
- Centre of Excellence in Severe Asthma and Centre of Excellence in Treatable Traits, The University of Newcastle, Newcastle, Australia
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2022; 42:423-433. [PMID: 35703265 DOI: 10.1097/hcr.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review aimed to identify the characteristics and determine the effects of exercise interventions on improving health-related physical fitness in adults with asthma. REVIEW METHODS A systematic search was completed in MEDLINE, CINAHL, Embase, and SPORTDiscus for peer-reviewed publications of experimental studies that investigated the effects of an exercise training intervention on performance-based health-related physical fitness outcomes in adults with asthma. Two reviewers independently screened studies for inclusion according to predetermined criteria and performed data extraction and quality assessment of included studies. SUMMARY Forty-five articles were included, in which results for 39 unique studies were reported. Subjects (n = 2135) were aged 22 ± 4 to 71 ± 11 yr with mild-severe asthma. Most exercise programs used aerobic exercise, either alone or in combination with resistance or breathing/stretching exercises. The most common exercise program characteristics were supervised moderate-to-vigorous intensity aerobic exercise performed for 30-45 min 3 d/wk. Meta-analyses revealed significant improvements in cardiorespiratory fitness (V˙o2peak: unstandardized mean difference [MD] 3.1 mL/kg/min, 95% CI, 1.9-4.3), functional fitness (walking distance: MD 41 m, 95% CI, 27-54), and overall health-related physical fitness (standardized mean difference [SMD] 0.67, 95% CI, 0.46-0.89) in favor of groups who underwent experimental exercise training interventions. Aerobic exercise elicited superior improvements in health-related physical fitness compared with breathing/stretching exercise (SMD 0.47, 95% CI, 0.14-0.81).Supervised exercise training programs, particularly those aerobic in nature, are effective in eliciting clinically meaningful improvements in cardiorespiratory and functional fitness in adults with asthma.PROSPERO registration ID number = CRD42018092828.
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O'Neill CD, Patlan I, Jeffery M, Lewis D, Jenkins M, Jones-Taggart H, Green-Johnson J, Dogra S. Effects of high intensity interval training on cardiorespiratory fitness and salivary levels of IL-8, IL-1ra, and IP-10 in adults with asthma and non-asthma controls. J Asthma 2021; 59:2520-2529. [PMID: 34962433 DOI: 10.1080/02770903.2021.2018702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether high intensity interval training (HIIT) would lead to improvements in 1) maximal VO2, VE, VE/VCO2, and VE/MVV, and/or 2) resting salivary concentrations of pro-inflammatory markers Interleukin (IL-8), interferon-gamma-inducible-protein (CXCL10/IP-10)) and anti-inflammatory marker IL-1 receptor antagonist (IL-1ra) in adults with well-controlled asthma compared to non-asthma controls. METHODS Participants completed a maximal exercise test at the beginning (T1) and end (T2) of a 6-week HIIT intervention; saliva samples were obtained at the beginning and 30 min following the first (T1) and last (T2) exercise session. RESULTS Adults with asthma (n = 20; age: 21.4 ± 2.4 years) and non-asthma controls (n = 12; age: 22.5 ± 3.4 years) completed the intervention. VO2max increased from T1 to T2 in both groups (asthma T1 32.9 ± 8, T2 38.6 ± 8.2 ml/kg/min; controls T1 34.5 ± 11.8, T2 38.9 ± 12.3 ml/kg/min). VEmax also increased in both groups (asthma T1 97.7, T2 110.8 units, p < 0.001, hp2 = <0.04; control T1 106.3, T2 118.1, p < 0.001, hp2 0.02). An increase in VE/VCO2 (F(1, 10)=22.11, p = 0.001) and VE/MVV (F(1, 10) = 111.30, p < 0.001) was observed in the control group; no differences were observed in the asthma group. No differences in IL-8 or IL-1ra were observed between groups. In the asthma group, resting salivary IP-10 concentrations significantly decreased from T1 (0.025 pg/ug protein) to T2 (0.015 pg/ug protein, p = 0.039, hp2 = 0.3 (moderate effect)). CONCLUSION A 6-week HIIT intervention led to a similar increase in VO2max and VEmax in those with and without asthma, and a decrease in resting salivary IP-10 levels among adults with asthma.
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Affiliation(s)
- Carley D O'Neill
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Ilana Patlan
- Facuty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Michael Jeffery
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Danielle Lewis
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Michael Jenkins
- Facuty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Holly Jones-Taggart
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Julia Green-Johnson
- Faculty of Science, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Shilpa Dogra
- Facuty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, Ontario, Canada
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Effect of 8 Weeks of Incremental Aerobic Training on Inflammatory Mediators, Cardiorespiratory Indices, and Functional Capacity in Obese Children With Bronchial Asthma. Pediatr Exerc Sci 2021; 33:23-31. [PMID: 33761464 DOI: 10.1123/pes.2020-0076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To appraise the effects of incremental aerobic training (IAT) on systemic inflammatory mediators, cardiorespiratory indices, and functional capacity in obese children with bronchial asthma. METHODS This study included 30 children with asthma (age = 8-16 y) allocated randomly into either the control group (n = 15; received the traditional pulmonary rehabilitation program) or IAT group (n = 15; engaged in 8 weeks of IAT in addition to the traditional pulmonary rehabilitation program). The systemic inflammatory mediators (high-sensitivity C-reactive protein and interleukin-6), cardiorespiratory indices (peak oxygen uptake, minute ventilation, maximum heart rate, heart rate recovery at 1 min after exercises, and oxygen pulse), and functional capacity (represented by 6-min walk test) were analyzed pretreatment and posttreatment. RESULTS A significant reduction in the level of high-sensitivity C-reactive protein and interleukin-6 and increase in peak oxygen uptake, minute ventilation, maximum heart rate, and heart rate recovery at 1 minute after exercises was observed among the IAT group as compared with the control group. In addition, the IAT group covered a longer distance in the 6-minute walk test than the control group, suggesting favorable functional capacity. CONCLUSION The study results imply that IAT has the potential to improve the inflammatory profile, cardiorespiratory fitness, and functional capacity of obese children with bronchial asthma.
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Danazumi MS, Yakasai AM, Dermody G, Nuhu JM. Knowledge and current practices of Nigerian physiotherapists on the physical activity and exercise training in the rehabilitation of patients with asthma. J Asthma 2021; 59:597-606. [PMID: 33356685 DOI: 10.1080/02770903.2020.1868500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study aimed to determine the knowledge and current practices of Nigerian physiotherapists on the physical activity and exercise training in the rehabilitation of patients with asthma and to determine if any difference exists between novice and expert professionals. METHODS This was designed as a cross-sectional study. A total of 311 practicing physiotherapists in Nigeria participated in the study. An electronic questionnaire comprising 34 semi-structured questions with three domains; personal information, knowledge, and current practices, was used to collect data throughout 4-months. Data were analyzed using a pragmatist paradigm. RESULTS Out of the physiotherapists, 51.8% (n = 161) had postgraduate degrees, 46.9% (n = 146) had bachelor's degrees, and 1.3% (n = 4) had a doctor of physiotherapy degrees. The result also indicates that 45.3% (n = 141) of the physiotherapists had insufficient knowledge about asthma, and 39.5% (n = 123) were not using current clinical practice in the rehabilitation of patients with asthma. The results also indicate that expert physiotherapist has more knowledge and also uses current practices when compared to novice physiotherapist. CONCLUSIONS Even though expert physiotherapists have better knowledge and current practices when compared to the novice physiotherapists, the overall outcomes indicate that Nigerian physiotherapists had insufficient knowledge about asthma and were not using current clinical practice in the rehabilitation of patients with asthma.
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Affiliation(s)
- Musa Sani Danazumi
- Department of Physiotherapy, Federal Medical Center, Nguru, Yobe State, Nigeria.,Faculty of Allied Health Sciences, Department of Physiotherapy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Abdulsalam Mohammed Yakasai
- Medical Rehabilitation Therapists (Reg.) Board of Nigeria, Kano, Nigeria.,Department of Physiotherapy, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Gordana Dermody
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jibril Mohammed Nuhu
- Faculty of Allied Health Sciences, Department of Physiotherapy, College of Health Sciences, Bayero University, Kano, Nigeria
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Boutou AK, Daniil Z, Pitsiou G, Papakosta D, Kioumis I, Stanopoulos I. Cardiopulmonary exercise testing in patients with asthma: What is its clinical value? Respir Med 2020; 167:105953. [PMID: 32280032 DOI: 10.1016/j.rmed.2020.105953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 01/28/2023]
Abstract
Asthma is one of the most common respiratory disorders, characterized by fully or largely reversible airflow limitation. Asthma symptoms can be triggered or magnified during exertion, while physical activity limitation is often present among asthmatic patients. Cardiopulmonary exercise testing (CPET) is a dynamic, non-invasive technique which provides a thorough assessment of exercise physiology, involving the integrative assessment of cardiopulmonary, neuromuscular and metabolic responses during exercise. This review summarizes current evidence regarding the utility of CPET in the diagnostic work-up, functional evaluation and therapeutic intervention among patients with asthma, highlighting its potential role for thorough patient assessment and physician clinical desicion-making.
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Affiliation(s)
- Afroditi K Boutou
- Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece.
| | - Zoi Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lopes WA, Porto FE, Leite N. EFFECT OF PHYSICAL TRAINING ON EXERCISE-INDUCED BRONCHOSPASM IN YOUNG ASTHMATICS. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202601201675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
ABSTRACT Introduction: Asthma is the most common chronic disease in childhood and its prevalence has increased in recent years. Although regular physical activity (PA) is considered to be beneficial for the health of asthmatics, especially children and adolescents, it can also be one of the elements that triggers asthma. This is known as exercise-induced bronchospasm (EIB), and is considered one of the factors that limits asthmatics’ participation in PA. Objective: This study aims to review the effects of physical conditioning on EIB in asthmatic children and adolescents. Methods: A systematic review was carried out on the Pubmed, Bireme and Web of Science databases, considering publications from 1998 to April 2019. Results: Eight articles were retrieved; five of the articles presented no significant difference in EIB parameters after physical training, and three demonstrated significant benefits in EIB. Conclusion: There is insufficient evidence that physical training helps reduce the frequency and severity of EIB in young asthmatics. There are still few studies that seek to show the effect of a physical training program on the improvement of EIB in children and adolescents. It is suggested that further randomized clinical trials be conducted, to investigate the effects of physical training on EIB parameters in children and adolescents. Level of Evidence II; Systematic review.
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Bellocq A, Gaspard W, Couffignal C, Vigan M, Guerder A, Ambard J, Caruana S, Similowski T, Garcia G, Taillé C. Outpatient pulmonary rehabilitation for severe asthma with fixed airway obstruction: Comparison with COPD. J Asthma 2019; 56:1325-1333. [PMID: 30693816 DOI: 10.1080/02770903.2018.1541351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: The benefit of exercise has been demonstrated in asthma, but the role of pulmonary rehabilitation (PR) in people with severe asthma, especially with airway obstruction, has been less investigated. The activity limitation mechanisms differ in asthma and COPD, so the effect of a PR program not specific to asthma is unclear. Methods: We retrospectively compared the effect of an ambulatory PR program in nonsmoking patients with severe asthma and airway obstruction (FEV1/FVC ratio <70% and FEV1 < 80% measured twice, not under an exacerbation) and sex-, age-, FEV1-, and BMI-matched COPD controls. Results: We included 29 patients, each with asthma and COPD. Airway obstruction was moderate (median FEV1 57% [44-64]). VO2 at peak was higher for asthma than COPD patients (19.0 [15.7-22.2] vs 16.1 [15.3-19.6] ml.min-1.kg-1, p = 0.05). After PR, asthma and COPD groups showed a significant and similar increase in constant work cycling test of 378 [114-831] s and 377 [246-702] s. Changes in Hospital Anxiety and Depression Scale (HAD) total score were similar (-2.5 [-7.0 to 0.0] vs -2.0 [-5.0 to 2.0], p > 0.05). Quality of life on the St. George's Respiratory Questionnaire (SGRQ) was significantly improved in both groups (-14.0 [-17.7 to -2.0], p < 0.005 and -8.3 [-13.0 to -3.6], p < 0.0001). Conclusion: Outpatient PR is feasible and well tolerated in patients with severe asthma with fixed airway obstruction. A nondedicated program strongly improves HAD and SGRQ scores and constant work-rate sub-maximal cycling, with similar amplitude as with COPD.
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Affiliation(s)
- Agnès Bellocq
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département R3S, Paris, France.,Sorbonne Université, INSERM, UMRS1158, Paris, France
| | - Wanda Gaspard
- Service des Maladies Respiratoires, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Camille Couffignal
- Assistance Publique-Hôpitaux de Paris, Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, Paris, France
| | - Marie Vigan
- Assistance Publique-Hôpitaux de Paris, Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, Paris, France
| | - Antoine Guerder
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et de Réanimation Médicale du Département R3S, Paris, France
| | - Julien Ambard
- Réseau Recup'Air, Agence Régionale de Santé Ile de France, Paris, France
| | - Sylvie Caruana
- Réseau Recup'Air, Agence Régionale de Santé Ile de France, Paris, France
| | - Thomas Similowski
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et de Réanimation Médicale du Département R3S, Paris, France
| | - Gilles Garcia
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service de Pneumologie, Le Kremlin-Bicetre, France
| | - Camille Taillé
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Service de Pneumologie, INSERM UMR1152, Université Paris Diderot, Labex Inflamex, Paris, France
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Lu KD, Cooper DM, Haddad F, Radom-Aizik S. Four Months of a School-Based Exercise Program Improved Aerobic Fitness and Clinical Outcomes in a Low-SES Population of Normal Weight and Overweight/Obese Children With Asthma. Front Pediatr 2018; 6:380. [PMID: 30619785 PMCID: PMC6297379 DOI: 10.3389/fped.2018.00380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fitness can improve asthma management. However, children from disadvantaged and minority communities generally engage less in physical activity, and have increased obesity and asthma disease burden. The goal of this pilot study is to evaluate (1) the feasibility of an exercise intervention program in a school-based setting (attendance and fitness improvement) and (2) the effect of the intervention on fitness, asthma, and clinical outcomes in normal weight and overweight/obese children with asthma from low-SES population. Materials and Methods: Nineteen children, ages 6-13 years, from two elementary schools in Santa Ana, CA, a population with high percentage of Hispanic and low socioeconomic status, participated. Training sessions occurred at the schools during afterschool hours (3 sessions weekly × 4 months) and included mainly aerobic age-appropriate activities/games and a small component of muscle strength. Before and after the intervention, evaluations included pulmonary function testing, cardiopulmonary exercise testing (peak V ˙ O2), assessments of habitual physical activity, body composition (DXA), asthma questionnaires, and blood (cardiometabolic risk factors). Results: Seventeen of 19 participants completed the study. Adherence to the program was 85%. Based on BMI %ile, 11 of the participants were overweight/obese and 8 were normal weight. Ten participants had persistent asthma and 9 children had intermittent asthma. Training was effective as peak V ˙ O2 improved significantly (8.1%, SD ± 10.1). There was no significant change in BMI %ile but a significant improvement in lean body mass (1%, SD ± 2.0) and decrease in body fat (1.9%, SD ± 4.6). Asthma quality of life outcomes improved following the intervention in symptoms, emotional function, and overall. There was no change in asthma control or pulmonary function. Five of 10 participants with persistent asthma decreased their maintenance medications. Lipid levels did not change except HDL levels increased (46.1 ± 8.4 mg/dL to 49.5 ± 10.4 mg/dL, p = 0.04). Discussion: A school-based exercise intervention program designed specifically for children with asthma for a predominantly economically disadvantaged and minority population was feasible with good adherence to the program and substantial engagement from the schools, families and participants. The exercise intervention was effective with improvement in aerobic fitness, body composition, asthma quality of life, and lipid outcomes, setting the stage for a larger multicenter trial designed to study exercise as an adjunct medicine in children with asthma.
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Affiliation(s)
- Kim D. Lu
- Department of Pediatrics, Pediatric Exercise and Genomics Research Center, University of California, Irvine, Irvine, CA, United States
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12
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Effects of physical exercise training on nocturnal symptoms in asthma: Systematic review. PLoS One 2018; 13:e0204953. [PMID: 30346958 PMCID: PMC6197640 DOI: 10.1371/journal.pone.0204953] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Nocturnal worsening of asthma symptoms is a common feature of asthma. Physical exercise training improves general asthma control; however, there is no evidence showing the effects of physical exercise on nocturnal asthma symptoms. Indeed, asthma patients with daytime and nighttime symptoms are physiologically different, and thus the effects of physical exercise on asthma may also be different in these two groups. The objective of this systematic review is to explore the effects of physical exercise on nocturnal asthma symptoms. METHODS Searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and SPORTdiscus (last search on November 2017). Authors from studies that did not report nocturnal symptoms but used questionnaires and/or diaries were contacted for detailed information. Studies that provided results on nocturnal symptoms before and after physical activity intervention were included. Prevalence of nocturnal symptoms was calculated for each study from the percentage of study participants with nocturnal symptoms before and after intervention. RESULTS Eleven studies were included (5 with children and 6 with adults). The prevalence of nocturnal symptoms at baseline ranged from 0% to 63% among children and from 50-73% among adults. In children and adults with nocturnal asthma, aerobic physical exercise reduced the prevalence and frequency of nocturnal symptoms. CONCLUSIONS Aerobic physical exercise improves nocturnal asthma in children and adults by reducing the prevalence and frequency of nocturnal symptoms. Physical exercise training could be used with conventional treatments to improve quality of life and asthma control in patients with nocturnal worsening of asthma.
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13
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Kagawa H, Miki K, Kitada S, Miki M, Yoshimura K, Oshitani Y, Nishida K, Sawa N, Tsujino K, Maekura R. Dyspnea and the Varying Pathophysiologic Manifestations of Chronic Obstructive Pulmonary Disease Evaluated by Cardiopulmonary Exercise Testing With Arterial Blood Analysis. Front Physiol 2018; 9:1293. [PMID: 30333757 PMCID: PMC6176099 DOI: 10.3389/fphys.2018.01293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/27/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) show varying mechanisms of exertional dyspnea with different exercise capacities. Methods: To investigate the pathophysiologic conditions related to exertional dyspnea, 294 COPD patients were evaluated using cardiopulmonary exercise testing (CPET) with arterial blood analyses, with the patients classified into two groups according to their exercise limitation: the leg fatigue group (n = 58) and the dyspnea group (n = 215). The dyspnea group was further subdivided into four groups based on peak oxygen uptake ( V ° O 2 in mL/min/kg): group A (< 11), group B (11 to < 15), group C (15 to < 21), and group D (≥21). Results: In the dyspnea group, group A (n = 28) showed the following findings: (i) the forced expiratory volume in 1 s was not correlated with the peak V ° O 2 (p = 0.288), (ii) the arterial oxygen tension (PaO2) slope (peak minus resting PaO2/Δ V ° O 2 ) was the steepest (p < 0.0001) among all subgroups, (iii) reduced tidal volume (VT) was negatively correlated with respiratory frequency at peak exercise (p < 0.0001), and (iv) a break point in exertional VT curve was determined in 17 (61%) patients in group A. In these patients, there was a significant negative correlation between bicarbonate ion ( HCO 3 - ) levels at peak exercise and VT level when the VT-break point occurred (p = 0.032). In group D (n = 46), HCO 3 - levels were negatively correlated with plasma lactate levels (p < 0.0001). In all subgroups, the HCO 3 - level was negatively correlated with minute ventilation. The dyspnea subgroups showed no significant differences in the overall mean pH [7.363 (SD 0.039)] and Borg scale scores [7.4 (SD, 2.3)] at peak exercise. Conclusions: During exercise, ventilation is stimulated to avoid arterial blood acidosis and hypoxemia, but ventilatory stimulation is restricted in the setting of reduced respiratory system ability. These conditions provoke the exertional dyspnea in COPD. Although symptom levels were similar, the exertional pathophysiologic conditions differed according to residual exercise performance; moreover, COPD patients showed great inter-individual variability. An adequate understanding of individual pathophysiologic conditions using CPET is essential for proper management of COPD patients.
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Affiliation(s)
- Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Kohei Nishida
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Nobuhiko Sawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan.,Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
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14
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Plantier L, Delclaux C. Increased physiological dead space at exercise is a marker of mild pulmonary or cardiovascular disease in dyspneic subjects. Eur Clin Respir J 2018; 5:1492842. [PMID: 30627360 PMCID: PMC6314086 DOI: 10.1080/20018525.2018.1492842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
Background: The characteristics of cardiopulmonary exercise testing (CPET)-derived parameters for the differential diagnosis of exertional dyspnea are not well known. Objectives: We hypothesized that increased physiological dead space ventilation (VD/Vt) is a marker for mild pulmonary or cardiovascular disease in patients with exertional dyspnea. Design: We used receiver operating characteristic analysis to determine the performance of individual CPET parameters for identifying subjects with either mild pulmonary or cardiovascular disease, among 77 subjects with mild-to-moderate exertional dyspnea (modified Medical Research Council scale 1–2). Results: In comparison with subjects without disease, subjects with pulmonary disease (n = 31) had higher VE/V′CO2 slope, higher VD/Vt, and lower ventilatory reserve. Subjects with cardiovascular disease (n = 14) had lower heart rate and cardiovascular double product and higher VD/Vt at peak exercise. At a threshold of 28%, the sensitivity and specificity of VD/Vt at peak exercise for identifying pulmonary or cardiovascular disease were 89% (95% CI: 64–98%) and 72% (95% CI: 46–89%), respectively. Conclusions: Increased physiological VD/Vt at exercise is a sensitive and specific marker of mild pulmonary or cardiovascular disease in dyspneic subjects.
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Affiliation(s)
- Laurent Plantier
- INSERM UMR 1152, Labex Inflamex, Paris, France.,Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,Assistance-Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Christophe Delclaux
- Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,Assistance-Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Physiologie Pédiatrique, Paris, France
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15
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Miki K, Tsujino K, Edahiro R, Kitada S, Miki M, Yoshimura K, Kagawa H, Oshitani Y, Ohara Y, Hosono Y, Kurebe H, Maekura R. Exercise tolerance and balance of inspiratory-to-expiratory muscle strength in relation to breathing timing in patients with chronic obstructive pulmonary disease. J Breath Res 2018; 12:036008. [PMID: 29321341 DOI: 10.1088/1752-7163/aaa6db] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
RATIONALE Little is known about the applicability of respiratory muscle training based on exertional pathophysiological conditions in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the relationship between breathing timing and exertional responses, as well as whether exertional changes in the inspiratory duty cycle (Ti/Ttot) affect pathophysiological conditions, including respiratory muscles. METHODS Forty-five stable COPD patients (mean age: 71.2 years, severe and very severe COPD: 80%) were evaluated based on exertional cardiopulmonary function and respiratory muscle strength. To compare exertional responses and the balance of inspiratory-to-expiratory muscle strength, the patients were divided into two groups according to whether the Ti/Ttot increased (Ti/Ttot-increased group: resting Ti/Ttot ≤ peak Ti/Ttot, n = 21) or decreased during exercise (Ti/Ttot-decreased group: resting Ti/Ttot > peak Ti/Ttot, n = 24). RESULTS At peak exercise, the Ti/Ttot was positively correlated with minute ventilation ([Formula: see text] E), and oxygen uptake ([Formula: see text]) in all patients. No significant differences were seen in breathing frequency, tidal volume, or [Formula: see text] E at peak exercise between the two groups. Compared with the Ti/Ttot-increased group, the Ti/Ttot-decreased group had significantly lower mean values of [Formula: see text] and ΔFO2 (the inspired minus expired oxygen concentration) at peak exercise, and significantly higher mean values of the absolute ratio of maximal inspiratory pressure/maximal expiratory pressure. CONCLUSIONS The exertional change of breathing timing affected exercise tolerance and the balance of inspiratory-to-expiratory muscle strength; this finding might be helpful in making the contradictory choice of managing COPD patients with inspiratory or expiratory muscle training.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
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16
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Effect of an Outpatient Pulmonary Rehabilitation Program on Exercise Tolerance and Asthma Control in Obese Asthma Patients. J Cardiopulm Rehabil Prev 2018; 37:214-222. [PMID: 28448379 DOI: 10.1097/hcr.0000000000000249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the effects of an outpatient pulmonary rehabilitation (PR) program on exercise tolerance and asthma control in obese and nonobese patients with asthma. METHODS Nonobese (body mass index [BMI] <30 kg/m) and obese (BMI ≥ 30 kg/m) patients with asthma who participated in a local multidisciplinary 12-week PR program were analyzed retrospectively. Effects of PR were assessed by changes in 6-minute walking distance (6MWD) and Asthma Control Questionnaire (ACQ). RESULTS A total of 138 asthma patients were included: 53 (38.4%) obese and 85 (61.6%) nonobese. At baseline, obese patients with asthma had a lower level of exercise tolerance reflected by a lower 6MWD (525 m vs 621 m; P < .001). After PR, the 6MWD improved significantly in both groups (≥50 m in nonobese vs ≥45 m in obese; P < .001 in both groups). The improvement in 6MWD was clinically relevant in 71% of the nonobese and 60% of the obese patients. These patients had lower 6MWD (P = .024), higher usage of long-acting β-agonist (P = .034) and oral corticosteroids (P = .033). Asthma control also improved in both groups (ΔACQ -0.3 in nonobese vs ΔACQ -0.4 in obese; P = .021 and P = .019, respectively). Clinically relevant improvement was achieved by 46.5% of nonobese and 51.9% of obese patients with asthma. The improvements between the groups were not statistically different. CONCLUSIONS A standardized PR program is feasible in obese patients with asthma and they benefit as much as nonobese patients with asthma. However, there are still a large number of patients who show no clinically significant improvement. Patients with more severe asthma seem to benefit the most from PR.
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17
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Weatherald J, Lougheed MD, Taillé C, Garcia G. Mechanisms, measurement and management of exertional dyspnoea in asthma: Number 5 in the Series "Exertional dyspnoea" Edited by Pierantonio Laveneziana and Piergiuseppe Agostoni. Eur Respir Rev 2017; 26:26/144/170015. [PMID: 28615308 DOI: 10.1183/16000617.0015-2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/17/2017] [Indexed: 11/05/2022] Open
Abstract
Asthma is a heterogeneous condition, with dyspnoea during exercise affecting individuals to a variable degree. This narrative review explores the mechanisms and measurement of exertional dyspnoea in asthma and summarises the available evidence for the efficacy of various interventions on exertional dyspnoea. Studies on the mechanisms of dyspnoea in asthma have largely utilised direct bronchoprovocation challenges, rather than exercise, which may invoke different physiological mechanisms. Thus, the description of dyspnoea during methacholine challenge can differ from what is experienced during daily activities, including exercise. Dyspnoea perception during exercise is influenced by many interacting variables, such as asthma severity and phenotype, bronchoconstriction, dynamic hyperinflation, respiratory drive and psychological factors. In addition to the intensity of dyspnoea, the qualitative description of dyspnoea may give important clues as to the underlying mechanism and may be an important endpoint for future interventional studies. There is currently little evidence demonstrating whether pharmacological or non-pharmacological interventions specifically improve exertional dyspnoea, which is an important area for future research.
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Affiliation(s)
- Jason Weatherald
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.,INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,Division of Respirology, Dept of Medicine, University of Calgary, Calgary, AB, Canada
| | - M Diane Lougheed
- Division of Respirology, Dept of Medicine, Queen's University, Kingston, ON, Canada.,Dept of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Camille Taillé
- Service de Pneumologie et Centre de Compétence des Maladies Pulmonaires Rares, Hôpital Bichat, AP-HP, Paris, France.,Département Hospitalo-Universitaire FIRE, Université Paris Diderot, INSERM UMR 1152, LabEx Inflamex, Paris, France
| | - Gilles Garcia
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France .,INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,Service de Physiologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
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18
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O'Neill C, Burgomaster K, Sanchez O, Dogra S. The acute response to interval and continuous exercise in adults with confirmed airway hyper-responsiveness. J Sci Med Sport 2017; 20:976-980. [PMID: 28526225 DOI: 10.1016/j.jsams.2017.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 02/03/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine changes in lung function following an acute bout of high intensity interval exercise (HIIE), moderate intensity interval exercise (MIIE), and moderate intensity continuous exercise (MICE) in adults with airway hyper-responsiveness (AHR). DESIGN A randomized cross-over design was used. METHODS Participants completed five laboratory sessions: (1) eucapnic voluntary hyperpnea challenge (2) maximal exercise test to determine peak power output (PPO) and, (3-5) HIIE (90% PPO for 1min followed by 10% PPO for 1min, repeated 10 times), MIIE (65% PPO for 1min followed by 10% PPO for 1min, repeated 10 times) and MICE (65% PPO for 20min). Lung function was assessed pre and post-exercise. RESULTS Thirteen participants (age: 21.1±2.7years) with mild/moderate asthma completed all protocols. Lung function was significantly lower following the MICE (-14.8%±12.2) protocol compared to the HIIE (-7.1%±8.3) and MIIE (-4.5%±3.3). CONCLUSIONS It appears that MICE is associated with the greatest decline in post-exercise FEV1 among those with AHR. Interval exercise may be better tolerated than continuous exercise among those with AHR.
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Affiliation(s)
| | | | - Otto Sanchez
- University of Ontario Institute of Technology, Canada
| | - Shilpa Dogra
- University of Ontario Institute of Technology, Canada
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19
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Brumpton BM, Langhammer A, Henriksen AH, Camargo CA, Chen Y, Romundstad PR, Mai XM. Physical activity and lung function decline in adults with asthma: The HUNT Study. Respirology 2016; 22:278-283. [PMID: 27696634 DOI: 10.1111/resp.12884] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE People with asthma may seek advice about physical activity. However, the benefits of leisure time physical activity on lung function are unclear. We investigated the association between leisure time physical activity and lung function decline in adults with asthma. METHODS In a population-based cohort study in Norway, we used multiple linear regressions to estimate the annual mean decline in lung function (and 95% CI) in 1329 people with asthma over a mean follow-up of 11.6 years. The durations of light and hard physical activity per week in the last year were collected by questionnaire. Inactive participants did not report any light or hard activity, while active participants reported light or hard activity. RESULTS The mean decline in forced expiratory volume in 1 s (FEV1 ) was 37 mL/year among inactive participants and 32 mL/year in active participants (difference: -5 mL/year (95% CI: -13 to 3)). The mean decline in forced vital capacity (FVC) was 33 mL/year among inactive participants and 31 mL/year in active participants (difference: -2 mL/year (95% CI: -11 to 7)). The mean decline in FEV1 /FVC ratio was 0.36%/year among inactive participants and 0.22%/year in active participants (difference: -0.14%/year (95% CI: -0.27 to -0.01)). The mean decline in peak expiratory flow (PEF) was 14 mL/year among the inactive participants and 10 mL/year in active participants (difference: -4 mL/year (95% CI: -9 to 1)). CONCLUSION We observed slightly less decline in lung function in physically active than inactive participants with asthma, particularly for FEV1 , FEV1 /FVC ratio and PEF.
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Affiliation(s)
- Ben M Brumpton
- Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne H Henriksen
- Department of Circulation and Medical Imaging NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Yue Chen
- Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pål R Romundstad
- Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xiao-Mei Mai
- Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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20
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Lu KD, Billimek J, Bar-Yoseph R, Radom-Aizik S, Cooper DM, Anton-Culver H. Sex Differences in the Relationship between Fitness and Obesity on Risk for Asthma in Adolescents. J Pediatr 2016; 176:36-42. [PMID: 27318375 PMCID: PMC5003726 DOI: 10.1016/j.jpeds.2016.05.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 05/12/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the relationship of fitness and obesity on asthma risk in adolescent girls and boys. STUDY DESIGN A cross-sectional assessment of participants 12-19 years of age was conducted by the use of data from the 1999-2004 National Health and Nutrition Examination Survey. Participants completed cardiorespiratory fitness testing, body composition measurements, and respiratory questionnaires. RESULTS A total of 4828 participants were included. Overweight/obesity was associated with increased odds of history of asthma (aOR 1.63, 95% CI 1.16-2.30), current asthma (aOR 1.73, 95% CI 1.13, 2.64), and wheezing (aOR 1.40, 95% CI 1.03-1.91) in girls. Overweight/obesity also was associated with increased odds of asthma attacks (aOR 2.67, 95% CI 1.56-4.65) and wheezing related to exercise (aOR 1.60, 95% CI 1.07-2.38) in girls. High fitness was associated with lower odds of asthma-related visits to the emergency department (aOR 0.24, 95% CI 0.07-0.89), wheezing-related medical visits (aOR 0.31, 95% CI 0.13-0.75), wheezing-related missed days (aOR 0.14, 95% CI 0.06-0.33), and wheezing related to exercise (aOR 0.43, 95% CI 0.24-0.76) in boys. CONCLUSION Overweight/obesity is associated with increased asthma prevalence and morbidity in girls but not in boys, independent of fitness. High fitness is associated with decreased rates of asthma morbidity in boys but not in girls, independent of weight status. Obesity and fitness may each influence asthma onset and severity in different ways for girls compared with boys.
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Affiliation(s)
- Kim D Lu
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA.
| | - John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, CA
| | - Ronen Bar-Yoseph
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA
| | - Shlomit Radom-Aizik
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA
| | - Dan M Cooper
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA
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21
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Vermeulen F, Garcia G, Ninane V, Laveneziana P. Activity limitation and exertional dyspnea in adult asthmatic patients: What do we know? Respir Med 2016; 117:122-30. [PMID: 27492522 DOI: 10.1016/j.rmed.2016.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/11/2016] [Accepted: 06/06/2016] [Indexed: 12/21/2022]
Abstract
Limitation of activity is the most cited symptom described by uncontrolled asthma patients. Assessment of activity limitation can be undertaken through several ways, more or less complex, subjective or objective. Yet little is known about the link between patients sensations and objective measurements. The present review reports the current knowledge regarding activity limitation and symptom perception (i.e., exertional dyspnea) in adult patients with asthma. This work is based on references indexed by PubMed, irrespective of the year of publication. Overall, patients with stable asthma do not have a more sedentary lifestyle than healthy subjects. However, during a cycle ergometric test, the maximal load is reduced when FEV1, FVC and muscle strengths are decreased. Additionally, during the six-minute walking test, mild asthma patients walk less than healthy subjects even if the minimal clinically important difference is not reached. The major complaint of asthma patients when exercising is dyspnea that is mainly related to the inspiratory effort and also to dynamic hyperinflation in some circumstances. Finally, the administration of bronchodilator does not improve the ventilatory pattern and the exercise capacity of asthma patients and little is known on its effect on exertional dyspnea. The present review allows to conclude that until now there is no gold standard test allowing the objective assessment of "activity limitation and exertional dyspnea" in asthma patients.
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Affiliation(s)
| | - Gilles Garcia
- AP-HP, University Hospital Bicêtre, Pulmonary Function Laboratory, Reference Centre for Severe Pulmonary Hypertension, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France; University Paris-South 11, Faculty of Medicine, Le Kremlin-Bicêtre, France; INSERM U999, LabEx LERMIT, Surgical Centre Marie Lannelongue, Le Plessis-Robinson, France
| | - Vincent Ninane
- Chest Service, St Pierre University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Faculty of Medicine, Bruxelles, Belgium
| | - Pierantonio Laveneziana
- University Sorbonne, UPMC University Paris 06, INSERM, UMRS1158 Clinical and Experimental Respiratory Neurophysiology, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Unit of Respiration, Exercise and Dyspnea Assessment (Unit EFRED, Department "R3S", Pôle PRAGUES), Paris, France
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22
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Lu KD, Manoukian K, Radom-Aizik S, Cooper DM, Galant SP. Obesity, Asthma, and Exercise in Child and Adolescent Health. Pediatr Exerc Sci 2016; 28:264-274. [PMID: 26618409 PMCID: PMC5904022 DOI: 10.1123/pes.2015-0122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptomatology and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.
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Affiliation(s)
- Kim D. Lu
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, UC Irvine School of Medicine
| | | | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, UC Irvine School of Medicine
| | - Dan M. Cooper
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, UC Irvine School of Medicine
| | - Stanley P. Galant
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, UC Irvine School of Medicine
- Children’s Hospital of Orange County, Orange, California
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Effect of physical training on health-related quality of life in patients with moderate and severe asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Unverdorben M, Parodi G, Pistolesi M, Storey RF. Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics. Int J Cardiol 2015; 202:167-73. [PMID: 26386945 DOI: 10.1016/j.ijcard.2015.08.162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 08/13/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
Dyspnea is a common symptom physiologically associated with strenuous exercise and pathologically reflecting well-known diseases and conditions that are predominantly pulmonary, cardiovascular, and weight-related in origin. Dyspnea improves with appropriate measures that enhance physical performance and treatment of the underlying diseases. Dyspnea is less commonly triggered by other causes such as the environment (e.g., ozone), drugs, and others, some of which do not seem to affect bronchopulmonary function as evidenced by normal results of comprehensive pulmonary function testing. In cardiovascular medicine, dyspnea has recently attracted attention because it has been reported that this symptom occurs more frequently with the administration of the new oral reversibly-binding platelet P2Y12 receptor inhibitors ticagrelor [1-6], cangrelor [7-10], and elinogrel [11]. This paper succinctly addresses the current understanding of the pathophysiology, clinical presentation, and diagnostics of dyspnea, associated either with bronchopulmonary function impairment, as triggered mainly by pulmonary and cardiovascular diseases, or without bronchopulmonary function impairment, as induced by endogenous or external compounds such as drugs in order to provide a context for understanding, recognizing and managing P2Y12 inhibitor-induced dyspnea.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Academic Teaching Institution of the Goethe-University Frankfurt/Main, Rotenburg an der Fulda, Germany.
| | - Guido Parodi
- Department of Cardiology, Careggi Hospital, Florence, Italy
| | - Massimo Pistolesi
- Department of Experimental and Clinical Medicine, Respiratory Medicine, University of Florence, Italy
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
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Effects of exercise training on airway hyperreactivity in asthma: a systematic review and meta-analysis. Sports Med 2014; 43:1157-70. [PMID: 23846823 DOI: 10.1007/s40279-013-0077-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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. DATA SOURCES A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies. STUDY SELECTION Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses. STUDY APPRAISAL AND SYNTHESIS METHODS Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV₁, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV₁ or PEF) and training hours on QoL and exercise performance. RESULTS In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV1 and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV1 (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity. CONCLUSION EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV1 in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake.
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McNarry MA, Boddy LM, Stratton GS. The relationship between body mass index, aerobic performance and asthma in a pre-pubertal, population-level cohort. Eur J Appl Physiol 2013; 114:243-9. [PMID: 24213885 DOI: 10.1007/s00421-013-2772-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/31/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the relationship between asthma, body mass index (BMI) and aerobic performance, as indicated by a shuttle test. METHODS 20,577 participants (10,413 boys) from the SportsLinx serial cross-sectional study participated. Parental reports of asthma status and home postcode data were gathered from consent forms. Stature, sitting stature and body mass were measured and BMI, somatic maturity and indices of multiple deprivation scores (IMD) were derived. Performance on the 20 m multi-stage shuttle runs test (20mSRT) was used to estimate cardiorespiratory fitness (CRF). RESULTS Asthma [F (1, 17,015) = 82.26, P < 0.01] and gender [F (1, 17,015) = 678.491, P < 0.001] significantly influenced 20mSRT. The addition of BMI, maturity and IMD to the model did not alter these significant effects. There was a significant interaction between 20mSRT and BMI [F (1, 16,723) = 132.80, P < 0.01], with a significant decrease in 20mSRT from the 50th BMI percentile upwards [t (16,699) = 36.88, P < 0.01]. Binary logistic regression revealed gender and 20mSRT to be significant predictors of asthma occurrence; BMI SDS just reached significance whilst maturity and IMD were not significant contributors to the model. CONCLUSIONS This study demonstrates the negative influences of low CRF and high BMI on the risk of asthma occurrence in pre-pubertal children. Furthermore, it highlights the significant influence of BMI on CRF, revealing these effects to be manifest considerably below those BMI percentiles conventionally associated with being overweight or obese.
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Affiliation(s)
- M A McNarry
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Singleton Park, Swansea, Wales, SA2 8PP, UK,
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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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El-Akkary IM, Abdel-Fatah ZEK, El-Seweify MES, El-Batouti GA, Aziz EA, Adam AI. Role of leukotrienes in exercise-induced bronchoconstriction before and after a pilot rehabilitation training program. Int J Gen Med 2013; 6:631-6. [PMID: 23930076 PMCID: PMC3733880 DOI: 10.2147/ijgm.s46953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Whatever the initial stimulus for the exercise-induced bronchoconstriction (EIB) observed in asthmatic patients after exercise, the final effect is release of bronchoactive mediators, especially cysteinyl leukotrienes. Exercise rehabilitation training programs have been reported to protect against EIB. The exact mechanism(s) involved are not well understood. However, this protective effect may be related to adaptation and better coordination during exercise, depletion of cysteinyl leukotrienes, and/or a sluggish cysteinyl leukotriene response to exercise. The aim of the present work was to test the hypothesis that improvement in the incidence and severity of post-exercise bronchoconstriction after a rehabilitation training program is related to a change in leukotriene levels in response to exercise. METHODS Twenty asthmatic children aged 6-12 years and known to develop EIB were enrolled in an exercise training program for 12 weeks. The severity and incidence of EIB before and after training was assessed. Baseline and post-exercise sputum cysteinyl leukotriene levels were assessed before and after the training program. RESULTS The training program offered significant protection against EIB with a concomitant decrease in sputum cysteinyl leukotriene levels in response to exercise. CONCLUSION A training program can result in depletion and/or a sluggish cysteinyl leukotriene response to exercise and may be responsible for the protective effect of training programs on EIB. It is recommended to use an exercise rehabilitation training program as a complementary tool in the management of bronchial asthma, especially EIB.
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Berntsen S, Lødrup Carlsen KC, Anderssen SA, Mowinckel P, Carlsen KH. Factors associated with aerobic fitness in adolescents with asthma. Respir Med 2013; 107:1164-71. [PMID: 23632101 DOI: 10.1016/j.rmed.2013.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND In adolescents with asthma, information on factors associated with cardiorespiratory fitness levels is limited. The present study aimed to determine if objectively measured physical activity as well as potential relevant factors such as lung function, asthma exacerbations, use of inhaled corticosteroids or skin fold thickness are associated with direct measurements of peak oxygen uptake (V˙O2peak) in adolescents with asthma. METHODS From a nested case-control study at 13-years in the Environment and Childhood Asthma birth cohort study in Oslo, Norway, 86 13-years old adolescents with and 76 without asthma performed maximal running on a treadmill with V˙O2peak measured. The sum of four skin fold thicknesses was recorded, followed by wearing an activity monitor for four consecutive days. Lung function was measured by maximum forced expiratory flow-volume curves and body plethysmography. Asthma exacerbations and use of medication were registered by parental structured interview. Data were analysed using multiple regression analysis. RESULTS Vigorous physical activity (coefficients with 95% confidence intervals; 1.73 (0.32, 3.14)) and skin fold thickness -0.35 (-0.41, -0.28)) were significantly associated with V˙O2peak in adolescents with asthma. Neither use of inhaled corticosteroids, lung function nor number of asthma exacerbations was associated with V˙O2peak when taking physical activity and skin fold thickness into account. In the adolescents without asthma only skin fold thicknesses was negatively associated with V˙O2peak -3.5 (-4.1, -2.8). CONCLUSIONS V˙O2peak appears to be determined by vigorous physical activity level in Norwegian adolescents with asthma and not by asthma-related factors such as use of inhaled corticosteroids, lung function nor number of asthma exacerbations.
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Shim YM, Burnette A, Lucas S, Herring RC, Weltman J, Patrie JT, Weltman AL, Platts-Mills TA. Physical deconditioning as a cause of breathlessness among obese adolescents with a diagnosis of asthma. PLoS One 2013; 8:e61022. [PMID: 23637784 PMCID: PMC3634038 DOI: 10.1371/journal.pone.0061022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obese children frequently complain of breathlessness. Asthma and obesity can both contribute to the symptoms during exercise, and this symptom can contribute to a diagnosis of asthma in these children. Despite the high prevalence of obesity few studies have investigated the cardiopulmonary physiology of breathlessness in obese children with a diagnosis of asthma. METHODS In this case-control study, thirty adolescents between age 12 and 19 were studied with baseline spirometry and a cardiopulmonary exercise test. Ten adolescents were normal controls, ten had obesity without a diagnosis of asthma, and ten had obesity with a history of physician-diagnosed asthma. RESULTS Baseline characteristics including complete blood count and spirometry were comparable between obese adolescents with and without a diagnosis of asthma. During exercise, obese asthmatic and obese non-asthmatic adolescents had significantly reduced physical fitness compared to healthy controls as evidenced by decreased peak oxygen uptake after adjusting for actual body weight (21.7 ± 4.5 vs. 21.4 ± 5.4 vs. 35.3 ± 5.8 ml/kg/min, respectively). However, pulmonary capacity at the peak of exercise was comparable among all three groups as evidenced by similar pulmonary reserve. CONCLUSION In this study, breathlessness was primarily due to cardiopulmonary deconditioning in the majority of obese adolescents with or without a diagnosis of asthma.
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Affiliation(s)
- Yun M. Shim
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Autumn Burnette
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Sean Lucas
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Richard C. Herring
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Judith Weltman
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - James T. Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Arthur L. Weltman
- Department of Human Services and Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Thomas A. Platts-Mills
- Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
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Peterson JC, Czajkowski S, Charlson ME, Link AR, Wells MT, Isen AM, Mancuso CA, Allegrante JP, Boutin-Foster C, Ogedegbe G, Jobe JB. Translating basic behavioral and social science research to clinical application: the EVOLVE mixed methods approach. J Consult Clin Psychol 2013; 81:217-30. [PMID: 22963594 PMCID: PMC3578179 DOI: 10.1037/a0029909] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in 3 high-risk clinical populations. Our theoretically derived intervention comprised a combination of positive affect and self-affirmation (PA/SA), which we applied to 3 clinical chronic disease populations. METHOD We employed a sequential mixed methods model (EVOLVE) to design and test the PA/SA intervention in order to increase physical activity in people with coronary artery disease (post-percutaneous coronary intervention [PCI]) or asthma (ASM) and to improve medication adherence in African Americans with hypertension (HTN). In an initial qualitative phase, we explored participant values and beliefs. We next pilot tested and refined the intervention and then conducted 3 randomized controlled trials with parallel study design. Participants were randomized to combined PA/SA versus an informational control and were followed bimonthly for 12 months, assessing for health behaviors and interval medical events. RESULTS Over 4.5 years, we enrolled 1,056 participants. Changes were sequentially made to the intervention during the qualitative and pilot phases. The 3 randomized controlled trials enrolled 242 participants who had undergone PCI, 258 with ASM, and 256 with HTN (n = 756). Overall, 45.1% of PA/SA participants versus 33.6% of informational control participants achieved successful behavior change (p = .001). In multivariate analysis, PA/SA intervention remained a significant predictor of achieving behavior change (p < .002, odds ratio = 1.66), 95% CI [1.22, 2.27], controlling for baseline negative affect, comorbidity, gender, race/ethnicity, medical events, smoking, and age. CONCLUSIONS The EVOLVE method is a means by which basic behavioral science research can be translated into efficacious interventions for chronic disease populations.
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Affiliation(s)
- Janey C Peterson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medical College
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Wanrooij VHM, Willeboordse M, Dompeling E, van de Kant KDG. Exercise training in children with asthma: a systematic review. Br J Sports Med 2013; 48:1024-31. [PMID: 23525551 DOI: 10.1136/bjsports-2012-091347] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Exercise can provoke asthma symptoms, such as dyspnoea, in children with asthma. Exercise-induced bronchoconstriction (EIB) is prevalent in 40-90% of children with asthma. Conversely, exercise can improve physical fitness. The purpose of this paper is to provide a systematic review of the literature regarding the effects of exercise training in children with asthma, particularly in relation to: EIB, asthma control, pulmonary function, cardiorespiratory parameters and parameters of underlying pathophysiology. A systematic search in several databases was performed. Controlled trials that undertook a physical training programme in children with asthma (aged 6-18 years) were selected. Twenty-nine studies were included. Training had positive effects on several cardiorespiratory fitness parameters. A few studies demonstrated that training could improve EIB, especially in cases where there was sufficient room for improvement. Peak expiratory flow was the only lung function parameter that could be improved substantially by training. The effects of training on asthma control, airway inflammation and bronchial hyper-responsiveness were barely studied. Owing to the overall beneficial effects of training and the lack of negative effects, it can be concluded that physical exercise is safe and can be recommended in children with asthma. A training programme should have a minimum duration of 3 months, with at least two 60 min training sessions per week, and a training intensity set at the (personalised) ventilatory threshold. Further research is recommended regarding the effects of exercise on underlying pathophysiological mechanisms and asthma control in children with asthma.
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Affiliation(s)
- Vera H M Wanrooij
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Maartje Willeboordse
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kim D G van de Kant
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Ruas G, Ribeiro GG, Naves JM, Jamami M. The influence of body composition assessed by dual-energy x-ray absorptiometry on functional capacity of patients with chronic obstructive pulmonary disease. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: The individual with chronic obstructive pulmonary disease (COPD) can experience a significant reduction of body composition, peripheral muscle dysfunction, resulting in a negative influence on functional capacity. OBJECTIVES: To analyze the influence of body composition assessed by dual-energy x-ray absorptiometry on functional capacity of patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Eleven male patients with COPD (COPDG), seven presenting moderate obstruction and four severe, and 11 sedentary male subjects (CG) were evaluated by dual-energy x-ray absorptiometry to assess their body composition. All subjects also performed the 6-minute walk test (6MWT) and Step Test (6MST) to assess their functional capacity. RESULTS: No significant differences were found between groups for anthropometric data such as age, weight, height and body mass index (BMI). However, the COPDG presented Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio, Maximal Voluntary Ventilation (MVV), Walked Distance (WD) and Number of Steps (NS) significantly lower than the CG (p < 0.05, Student's t-test). The Body Bone Mass (BBM), BBM%, Lean Mass (LM), LM%, and Right Lower Limb (RLL) and Left Lower Limb (LLL) were significantly lower in the COPDG when compared with the CG, presenting statistically significant positive correlations with 6MWT's WD and 6MST's NS (p < 0.05, Pearson's test). CONCLUSION: We conclude that body composition is an important prognostic factor for patients with COPD, which reinforces the importance of assessing body composition by dual-energy absorptiometry since it has demonstrated with satisfactory accuracy in clinical practice. Moreover, it is a useful parameter for evaluation and reassessment in pulmonary rehabilitation programs.
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Mancuso CA, Choi TN, Westermann H, Wenderoth S, Wells MT, Charlson ME. Improvement in asthma quality of life in patients enrolled in a prospective study to increase lifestyle physical activity. J Asthma 2012; 50:103-7. [PMID: 23173979 DOI: 10.3109/02770903.2012.743150] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma patients know the benefits of exercise but often avoid physical activity because they are concerned that it will exacerbate asthma. The objective of this analysis was to assess longitudinal asthma status in 256 primary care patients in New York City enrolled in a trial to increase lifestyle physical activity. METHODS Patients were randomized to two protocols to increase physical activity during a period of 12 months. At enrollment, patients completed the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) and received asthma self-management instruction through an evaluative test and workbook. Exercise and self-management were reinforced every 2 months. The AQLQ was repeated every 4 months and the ACQ was repeated at 12 months. RESULTS The mean age was 43 years and 75% were women. At 12 months there were clinically important increases in physical activity with no differences between groups; thus, data were pooled for asthma analyses. The enrollment AQLQ score was 5.0 ± 1.3 and increased to 5.9 ± 1.1 corresponding to a clinically important difference. Correlations between AQLQ and physical activity were approximately 0.35 (p < .0001) at each time point. In a mixed effects model, the variables associated with improvement in AQLQ scores over time were male sex, less severe asthma, not taking asthma maintenance medications, fewer depressive symptoms, and increased physical activity (all variables, p < .03). According to the ACQ, asthma was well controlled in 38% at enrollment and in 60% at 12 months (p < .0001). CONCLUSION With attention to self-management, increased physical activity did not compromise asthma control and was associated with improved asthma.
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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 also 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 need 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 April 2011. SELECTION CRITERIA We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training. Physical training had to be undertaken for at least twenty 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 the quality of trials. MAIN RESULTS Nineteen studies (695 participants) were included in this review. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training improved cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (MD 5.57 mL/kg/min; 95% confidence interval (CI) 4.36 to 6.78; six studies on 149 participants) and maximum expiratory ventilation (6.0 L/min, 95% CI 1.57 to 10.43; four studies on 111 participants) with no significant effect on resting lung function (performed in four studies). Although there were insufficient data to pool due to diverse reporting tools, there is some evidence available 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 can improve cardiopulmonary fitness and was well tolerated among people with asthma in the included studies. As such, people with stable asthma should be encouraged to partake in regular exercise training, without fear of symptom exacerbation.
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Heikkinen SAM, Quansah R, Jaakkola JJK, Jaakkola MS. Effects of regular exercise on adult asthma. Eur J Epidemiol 2012; 27:397-407. [PMID: 22531972 DOI: 10.1007/s10654-012-9684-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 04/02/2012] [Indexed: 11/29/2022]
Abstract
Although many guidelines recommend regular exercise for adults with asthma, the empirical evidence on the effect of exercise on adult asthma has been inconsistent and there are no previous systematic reviews on this topic. To fill in this gap of knowledge, we synthesized the data on the effects of regular exercise on physical fitness, asthma control and quality of life of adult asthmatics. We performed a Medline search from 1980 through June 2011. In the systematic review we included all clinical trials that provided information on the effects of regular exercise on adult asthma. We conducted meta-analyses of maximal oxygen consumption (VO(2)max) and forced expiratory volume in 1 s (FEV(1)) based on 9 studies. A total of 11 studies were included in the analyses, but only 6 of them had a non-exercising reference group of asthmatics. The meta-analyses of randomized controlled trials showed that regular exercise significantly improved VO(2)max. There was no obvious improvement in lung function measurements. Some individual studies showed evidence of improvement in quality of life and asthma control. Meta-analyses provided evidence that regular physical exercise improves physical fitness of adult asthmatics. The results on effects on lung function were inconclusive. There is insufficient evidence to assess the effects of exercise on asthma control and quality of life.
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Affiliation(s)
- Sirpa A M Heikkinen
- Center for Environmental and Respiratory Health Research, University of Oulu, POB 5000 (Aapistie 1), 90014, Oulu, Finland
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Turner LA, Mickleborough TD, McConnell AK, Stager JM, Tecklenburg-Lund S, Lindley MR. Effect of inspiratory muscle training on exercise tolerance in asthmatic individuals. Med Sci Sports Exerc 2012; 43:2031-8. [PMID: 21502887 DOI: 10.1249/mss.0b013e31821f4090] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to determine the effects of inspiratory muscle training (IMT) on exercise tolerance, inspiratory muscle fatigue, and the perception of dyspnea in asthmatic individuals. METHODS Using a matched double-blind placebo-controlled design, 15 clinically diagnosed asthmatic individuals underwent either 6 wk of IMT (n = 7) consisting of 30 breaths twice daily at 50% maximum inspiratory pressure (PI max) or sham-IMT (placebo; PLA, n = 8) consisting of 60 breaths daily at 15% PI max. Time to the limit of exercise tolerance (Tlim) was assessed using constant-power output (70% peak power) cycle ergometry. Inspiratory muscle fatigue was determined by comparing the pre- to postexercise reduction in PI max. Dyspnea during the Tlim test was evaluated at 2-min intervals using the Borg CR-10 scale. RESULTS There were no significant changes (P > 0.05) in Tlim, inspiratory muscle fatigue, or perception of dyspnea in the PLA group after the intervention. In contrast, in the IMT group, PI max increased by 28%, and Tlim increased by 16% (P < 0.05). Dyspnea during exercise was also reduced significantly by 16% (P < 0.05). The exercise-induced fall in PI max was reduced from 10% before IMT to 6% after IMT (P < 0.05), despite the longer Tlim. Pulmonary function remained unchanged in both the IMT and PLA groups. CONCLUSIONS These data suggest that IMT attenuates inspiratory muscle fatigue, reduces the perception of dyspnea, and increases exercise tolerance. These findings suggest that IMT may be a helpful adjunct to asthma management that has the potential to improve participation and adherence to exercise training in this group. However, the perception of breathlessness is also an important signal of bronchoconstriction, and thus, caution should be exercised if this symptom is abnormally low.
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Affiliation(s)
- Louise A Turner
- Department of Kinesiology, Indiana University, Bloomington, IN 47401, USA
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Gunay O, Onur E, Yilmaz O, Dundar PE, Tikiz C, Var A, Yuksel H. Effects of physical exercise on lung injury and oxidant stress in children with asthma. Allergol Immunopathol (Madr) 2012; 40:20-4. [PMID: 21334801 DOI: 10.1016/j.aller.2010.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 10/26/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aim of this study was to investigate the influence of exercise training on oxidative stress and markers of lung inflammation in children with asthma. METHODS Thirty children aged 8-13 years diagnosed with asthma were enrolled in the study as well as 13 healthy children. One group received only pharmacological treatment and the other group was also enrolled in an exercise programme. Venous blood and 24-hour urine samples were obtained from the children enrolled in the study at the beginning and end of the study. Leukotriene E4 and creatinine levels were measured in the urine and matrix metallopeptidase (MMP-9), endothelin-1(ET-1), malnodialdehyde (MDA), IgE and specific IgE levels were measured in blood samples. RESULTS Leukotriene E4, MDA and MMP9 levels decreased significantly with treatment in both groups (p < 0.001). However, ET-1 levels decreased significant only in the exercise group (26.5 ± 3.6 vs 21.3 ± 2.4 pg/ml respectively, p = 0.001). Moreover, ET-1 levels were found to be significantly lower in the exercise group compared to the only pharmacotherapy group (24.2 ± 3.1 vs 21.3 ± 2.4 pg/ml, p=0.007). CONCLUSIONS Positive influences of exercise training in children with asthma may be mediated by decrease in ET-1 levels.
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Affiliation(s)
- Ozlem Gunay
- Celal Bayar University Medical Faculty, Dept of Biochemistry, Manisa, Turkey.
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Abstract
Allergy describes a constellation of clinical diseases that affect up to 30% of the world's population. It is characterized by production of allergen-specific IgE, which binds to mast cells and initiates a cascade of molecular and cellular events that affect the respiratory tract (rhinitis and asthma), skin (dermatitis, urticaria), and multiple systems (anaphylaxis) in response to a variety of allergens including pollens, mold spores, animal danders, insect stings, foods, and drugs. The underlying pathophysiology involves immunoregulatory dysfunctions similar to those noted in highly stressed populations. The relationships in terms of potential for intervention are discussed.
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Weiler JM, Anderson SD, Randolph C, Bonini S, Craig TJ, Pearlman DS, Rundell KW, Silvers WS, Storms WW, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Spector SL, Tilles SA, Wallace D, Henderson W, Schwartz L, Kaufman D, Nsouli T, Shieken L, Rosario N. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol 2011; 105:S1-47. [PMID: 21167465 DOI: 10.1016/j.anai.2010.09.021] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023]
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Sandsund M, Thomassen M, Reinertsen RE, Steinshamn S. Exercise-induced asthma in adolescents: challenges for physical education teachers. Chron Respir Dis 2011; 8:171-9. [PMID: 21436221 DOI: 10.1177/1479972310397676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Asthma is the most common chronic medical condition that school-teachers are likely to encounter among their pupils. This study aimed to identify the needs of physical education teachers in dealing with adolescents with exercise-induced asthma, study their self-reported knowledge of asthma and identify future topics for education about exercise-induced asthma. A questionnaire was drawn up on the basis of the requirements that had emerged in the course of interviews with 18 physical education teachers. One hundred and six physical education teachers at secondary schools in the city of Trondheim and colleges in Sør-Trøndelag County in Norway answered the questionnaire (65% response rate). Eighty-two physical education teachers (78.1%) had pupils with asthma in their sports classes, and 89.4% answered positively regarding their need for advice on teaching pupils with asthma. Twenty-seven (25.9%) reported that they had sufficient knowledge to teach adolescents with asthma. Topics about asthma, its management and activities suitable for asthmatics were given high priority by the teachers.
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Affiliation(s)
- M Sandsund
- Department of Health Research, SINTEF Technology and Society, Trondheim, Norway.
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42
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Shaw BS, Shaw I. Pulmonary function and abdominal and thoracic kinematic changes following aerobic and inspiratory resistive diaphragmatic breathing training in asthmatics. Lung 2011; 189:131-9. [PMID: 21318637 DOI: 10.1007/s00408-011-9281-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/27/2011] [Indexed: 11/24/2022]
Abstract
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 randomly 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, FEV(1), PEF, and IVC, while MVV improved following AE and CE. However, CE proved superior to AE at improving FVC (p = 0.001), FEV(1) (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.
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Affiliation(s)
- Brandon S Shaw
- Department of Sport, Rehabilitation and Dental Sciences, Tshwane University of Technology, Private Bag X680, Pretoria, Gauteng 0001, Republic of South Africa.
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Tsai YS, Lai FC, Chen SR, Jeng C. The influence of physical activity level on heart rate variability among asthmatic adults. J Clin Nurs 2010; 20:111-8. [PMID: 21050290 DOI: 10.1111/j.1365-2702.2010.03397.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aim of the study was to evaluate the impact of physical activity levels on heart rate variability among asthmatic patients. BACKGROUND In recent years, heart rate variability is frequently used to assess the autonomic nervous system. The pathogenesis of asthma is probably related to autonomic dysfunction. Adequate exercise is considered beneficial to patients who suffer from asthma. However, the relationship between physical activity and the autonomic nervous system of adult asthmatic patients is still unknown. DESIGN A cross-sectional survey. METHODS A total of 54 subjects (27 healthy persons and 27 asthmatic patients matched by age and gender) were recruited for this study. Heart rate variability was determined by frequency analysis and measured in both resting and active states. The Seven-Day Physical Activity Recall was used to determine the subject's amount of weekly activity. RESULTS The results showed that the total power, low frequency (ms(2)), low frequency (nu) and low frequency/high frequency (nu) but not high frequency (nu) were significantly higher in healthy adults compared to asthmatic patients, no matter whether resting or exercising. In both groups, the greater the amount of moderate-to-vigorous physical activity, the higher the TP observed. However, a positive relationship between the amount of moderate-to-vigorous physical activity and low frequency (nu) and a negative relationship with high frequency (nu), respectively, was demonstrated only in asthmatic patients. There was no significant difference in heart rate variability between the asthmatic patients who engaged in more moderate-to-vigorous physical activity and the healthy patients. CONCLUSIONS Although the asthmatic patients had poor heart rate variability compared with healthy people, engaging in higher amounts of moderate-to-vigorous physical activity may result in a heart rate variability similar to that of healthy people. RELEVANCE TO CLINICAL PRACTICE The results of this study suggest that healthcare professionals should encourage asthmatic patients to take as much physical exercise as they can in their daily lives.
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Affiliation(s)
- Yueh-Shia Tsai
- Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
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44
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Shaw I, Shaw B, Brown G. Role of diaphragmatic breathing and aerobic exercise in improving pulmonary function and maximal oxygen consumption in asthmatics. Sci Sports 2010. [DOI: 10.1016/j.scispo.2009.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Weiss P, Rundell KW. Imitators of exercise-induced bronchoconstriction. Allergy Asthma Clin Immunol 2009; 5:7. [PMID: 20016690 PMCID: PMC2794850 DOI: 10.1186/1710-1492-5-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/17/2009] [Indexed: 11/10/2022] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.
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Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, P.O. Box 208064, New Haven, CT 06520-8064, USA.
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46
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Ngai SPC, Jones AYM, Hui-Chan CWY, Ko FWS, Hui DSC. Effect of Acu-TENS on post-exercise expiratory lung volume in subjects with asthma-A randomized controlled trial. Respir Physiol Neurobiol 2009; 167:348-53. [PMID: 19540365 DOI: 10.1016/j.resp.2009.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 06/06/2009] [Accepted: 06/10/2009] [Indexed: 11/28/2022]
Abstract
This study examined the effect of transcutaneous electrical nerve stimulation applied over acupoints (Acu-TENS) on forced expiratory volume, in patients with asthma, after exercise. Thirty subjects were randomly assigned to three groups. Group 1 received Acu-TENS over acupuncture points Lieque and Dingchuan for 45 min prior to a symptom-limited treadmill exercise test. Group 2 had Acu-TENS similarly applied prior to and throughout the exercise test. Group 3 mimicked Group 1 but without any electrical output from the device. Forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) were recorded before, immediately after and at 20-min intervals post-exercise for 1h. Immediately after exercise, FEV(1) and FVC rose in Group 2 (p=0.015), but decreased in Group 1 and more so in Group 3. The differences became even more marked at 20, 40 and 60 min. Adjunctive Acu-TENS therapy appears to reduce decline of FEV(1) following exercise training in patients with asthma.
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Affiliation(s)
- Shirley P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Hewitt M, Estell K, Davis IC, Schwiebert LM. Repeated bouts of moderate-intensity aerobic exercise reduce airway reactivity in a murine asthma model. Am J Respir Cell Mol Biol 2009; 42:243-9. [PMID: 19423772 DOI: 10.1165/rcmb.2009-0038oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We have reported that moderate-intensity aerobic exercise training attenuates airway inflammation in mice sensitized/challenged with ovalbumin (OVA). The current study determined the effects of repeated bouts of aerobic exercise at a moderate intensity on airway hyperresponsiveness (AHR) in these mice. Mice were sensitized/challenged with OVA or saline and exercised at a moderate intensity 3 times/week for 4 weeks. At protocol completion, mice were analyzed for changes in AHR via mechanical ventilation. Results show that exercise decreased total lung resistance 60% in OVA-treated mice as compared with controls; exercise also decreased airway smooth muscle (ASM) thickness. In contrast, exercise increased circulating epinephrine levels 3-fold in saline- and OVA-treated mice. Because epinephrine binds beta(2)-adrenergic receptors (AR), which facilitate bronchodilatation, the role of beta(2)-AR in exercise-mediated improvements in AHR was examined. Application of the beta(2)-AR antagonist butoxamine HCl blocked the effects of exercise on lung resistance in OVA-treated mice. In parallel, ASM cells were examined for changes in the protein expression of beta(2)-AR and G-protein receptor kinase-2 (GRK-2); GRK-2 promotes beta(2)-AR desensitization. Exercise had no effect on beta(2)-AR expression in ASM cells of OVA-treated mice; however, exercise decreased GRK-2 expression by 50% as compared with controls. Exercise also decreased prostaglandin E(2) (PGE(2)) production 5-fold, but had no effect on E prostanoid-1 (EP1) receptor expression within the lungs of OVA-treated mice; both PGE(2) and the EP1 receptor have been implicated in beta(2)-AR desensitization. Together, these data indicate that moderate-intensity aerobic exercise training attenuates AHR via a mechanism that involves beta(2)-AR.
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Affiliation(s)
- Matt Hewitt
- Department of Physiology and Biophysics, University of Alabama at Birmingham, 1918 University Boulevard, Birmingham, AL 35294-0005, USA
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Weisgerber M, Webber K, Meurer J, Danduran M, Berger S, Flores G. Moderate and vigorous exercise programs in children with asthma: safety, parental satisfaction, and asthma outcomes. Pediatr Pulmonol 2008; 43:1175-82. [PMID: 19003892 DOI: 10.1002/ppul.20895] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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 randomized 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.
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Affiliation(s)
- Michael Weisgerber
- Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Westermann H, Choi TN, Briggs WM, Charlson ME, Mancuso CA. Obesity and exercise habits of asthmatic patients. Ann Allergy Asthma Immunol 2008; 101:488-94. [PMID: 19055202 PMCID: PMC2597623 DOI: 10.1016/s1081-1206(10)60287-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND National guidelines recommend 20 to 30 minutes of exercise 3 to 5 days a week. However, achieving these goals may be challenging for asthmatic patients whose symptoms are exacerbated by exercise. OBJECTIVE To describe relationships among exercise habits, weight, and asthma severity and control in adults with asthma. METHODS Self-reported exercise habits were obtained from 258 stable patients by using the Paffenbarger Physical Activity and Exercise Index. Disease status was measured by using the Asthma Control Questionnaire and the Severity of Asthma Scale. Exercise habits were evaluated in multivariate analyses with age, sex, education, body mass index, and asthma control and severity as independent variables. RESULTS The mean patient age was 42 years; 75% were women, 62% were college graduates, and 40% were obese. Only 44% of patients did any exercise. In bivariate analysis, patients with well-controlled asthma were more likely to exercise; however, in multivariate analysis, asthma control and severity were not associated, but male sex (P = .01), having more education (P = .04), and not being obese (P < .001) were associated. Asthma control and severity also were not associated with type, duration, or frequency of exercise, but not being obese was associated in multivariate analyses. Only 22% of all patients (49% of those who exercised) met national guidelines for weekly exercise. Not being obese was the only variable associated with meeting guidelines in multivariate analysis (P = .02). CONCLUSIONS Compared with the general population, a lower proportion of asthmatic patients did any routine exercise and met national exercise guidelines. Physicians need to manage asthma and obesity to help asthmatic patients meet exercise goals.
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Affiliation(s)
| | | | | | | | - Carol A. Mancuso
- Weill Cornell Medical College, New York, New York
- Hospital for Special Surgery, New York, New York
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50
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Drobnic Martínez F. Muerte súbita de origen respiratorio y deporte. Arch Bronconeumol 2008. [DOI: 10.1016/s0300-2896(08)70446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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