UNIVERSITY OF EAST LONDON

ASTHMA AND EXERCISE HOW PHYSICAL ACTIVITY CAN IMPROVE

SYMPTOMS

LUANNA ANDRADE MENDES

U1344355

SPORTS THERAPY 2014/15

INTRODUCTION
Asthma is a common chronic respiratory condition and it consists of the
inflammation and narrowing of the airways. This condition can be triggered by such
factors as: house dust, animal fur, pollen, smoking, air pollution, exercise, viral
infections. The most common symptoms when a patient is facing an asthma attack
are wheezing, coughing, breathlessness and chest tightness. When a trigger
substance is inhaled, the airways react by tightening the muscles around them,
making the bronchi narrow, swollen and very sensitive. (AsthmaUK, NHS, NIH
USA, NICE)
There are 5.4 million people receiving treatment for asthma at the UK (20.4%
children and 79.6% adults), that still has one of the worlds highest rates, even
though the prevalence has stabilized since the late 1990s. NHS spends around 1
billion per year treating asthma, and 75% of the hospital admissions related could be
prevented by a rehab protocol or daily care, for example. Recent surveys by CDC
USA also showed that the incidence is higher in children, women and black patients.

Some of the risk factors considered more relevant to develop asthma are:
family history (a blood relative with asthma), another allergic condition, overweight,
smoking or secondhand smoking, smoking during pregnancy (the baby can develop
asthma), exposure to pollution and/or occupational triggers.

MAIN CONTENT
The medications used to prevent or relieve asthma have minor side effects
and, when they have, its only when high doses are taken; the effects are really mild
(like increased heartbeat and muscle shakes) and they disappear quickly. But as
most of the medicines are steroids, taking them too much for a long period of time
can lead to some more severe side effects, such as: changes in mood and appetite,
feeling hyperactive (leading to sleep problems), fattened face, heartburn and
indigestion, osteoporosis and an increased tendency to diabetes.
Regular physical activity is been proved to be helpful on the management of
asthma, but when introducing actions that may lead to exhaustion and short of
breath, the patients get scared and apprehensive to take part in these activities.
Most asthmatic patients present a low level of physical activity; this leads to a low
level of physical fitness, so most studies point a deficit in cardiorespiratory fitness
and Orensteins review (2002) presented exercise conditioning as a key tool in
asthma management. This kind of intervention provides psychological (improves
social participation and emotional status) and physiological (decreased risk of
cardiovascular diseases and diabetes; improved aerobic capacity; body composition
and muscle strength and flexibility) benefits. Some studies show increased airways
resistance right after a vigorous exercise, but other studies concluded that exercising

does not influence an inflammatory response of the airways. The training

programmes proposed by some studies aim to, not only improve fitness, but also
work on neuromuscular coordination and strengthening of respiratory muscles, since
it can lead to reduce the perception of breathlessness after exercising. Swallow
(2007) also presented the muscle atrophy due to a low level of physical activity as
another exercise limiting factor, since this atrophied muscles will fatigue quicker and
they will request more ventilation to maintain the activity, leading to a short of breath
and a possible exercise-induced asthma.
On Chandratilleke et al review (2012), they included studies with any type of
physical training as a whole body aerobic exercise of at least 20 minutes, twice a
week for a minimum duration of four weeks. From the 19 papers who fit in the
inclusion criteria, the results found was that physical activity does improve asthma
symptoms and cardiopulmonary fitness (identified by an increase in maximum
oxygen uptake, work load or maximum expiratory ventilation), besides not changing
the severity of exercise-induced bronchoconstriction (EIB), which leads to a lower
perception of breathlessness and a higher maximum exercise effort. This study didnt
present enough data to analyse the effect of exercise in the quality of life of
asthmatic patients.
Fanelli et al study (2007) looked for proof to state exercise as a tool to
improve quality of life in asthmatic children. The protocol used was: 90 minutes of
physical activity, twice a week, for 16 weeks; the training program was subdivided in
warm-up and stretching (15 minutes), aerobic exercise on cycle or treadmill (30
minutes), upper limb, lower limb and abdomen endurance exercises (30 minutes)
and cool down, stretch and relaxation (15 minutes). Some of the results were: a
significant improvement on aerobic fitness parameters (VO2, work rate and oxygen

pulse), an improvement in EIB and its relationship with a decrease in postexercise

dyspnoea. There were no improvement in quality of life test scores along with the
exercise capacity improvement, however the dosage of inhaled steroids was
reduced in half of the trained children.
In the review made by Cambach et al (1999), they evaluated the effects of a
pulmonary rehabilitation program and its outcome measures of health related quality
of life (HRQL). They looked for studies with at least one control group and one
treatment group, with exercises such as walking, cycling, stepping and stair climbing.
The programs duration varied between 6 weeks and 6 months, with a frequency
between twice a week and daily. The results for maximal exercise capacity,
endurance time and walking distance were statistically significant, showing that the
program brought improvements in these outcomes. About the HRQL, improvements
were found for dyspnoea, fatigue, emotion and mastery in the treatment group; but
the authors end the review by talking about the need of developing a reliable, valid
and sensitive tool to evaluate the improvements in exercise capacity and HRQL in
more meaningful and individual ways.
The study ran by Lake et al (1990) compared the effects of an upper-limb
training, alone and associated with a lower-limb activity. The 28 patients were divided
in four groups: one control, one with upper-limb training only, one with lower-limb
training only and one with both upper- and lower- limbs training. The treatment
groups attended the one-hour sessions, three times a week during eight weeks. The
upper-limb group program consisted in: 10 minutes of general warm-up, 20 minutes
of a circuit training and 10 minutes to cool off; the lower-limb program consisted in:
10 minutes of general warm-up, 20 minutes of a walking training and 10 minutes to
cool off; the combined program consisted in: 10 minutes of general warm-up, 15

minutes of a upper-limb circuit training, 15 minutes of walking training and 10

minutes to cool off. The assessment was performed before and right at the end of
the entire program: they used spirometry to measure FEV1 and FVC,
plethysmography to measure lung volume, inspiratory loaded breathing to assess
respiratory muscle endurance. The Bandura scale of self-efficacy only showed a
significant improvement in the combined group, since the other three had scores
really similar and not so improved. This study didnt find significant differences in
expiratory flow rates, muscle strength and endurance, maximum work load, oxygen
uptake or maximum ventilation.
The British Thoracic Society (BTS)/SIGN presented a guideline to asthma
management, but it is basically based on pharmacological therapy with inhaled
steroids and prophylaxis. About the physical training, it only mentions a Cochrane
review that says it has shown no effect on PEF, FEV1, FVC or VEmax, but oxygen
consumption, work capacity and maximum heart rate all increased significantly. Even
if it doesnt have positive influence on the pulmonary rates, the exercise still is listed
as a tool in asthma rehabilitation.
In the National Institute for Health and Care Excellence (NICE) quality
standards for diagnosing and treating asthmatic patients, some statements are
presented, like: diagnosis according to the BTS/SIGN guideline; each patient gets
your written and individual action plan; the new patients have to receive a training in
inhaler technique; any exacerbation of the symptoms are assessed and objectively
measured; patients with more severe cases are assessed by a multidisciplinary
team. These statements are important in order to deliver a more efficient and human
treatment to asthmatic patients.

SUMMARY AND CONCLUSION

The great majority of the studies used in this essay agreed that physical
activity is a valid and effective measure on asthma management, as it can improve
muscle strength and endurance, reduce the perception of short of breath during and
after exercising, improve aerobic capacity, improve neuromuscular coordination and
all of this without changing the severity of exercise-induced bronchoconstriction and
without influencing an inflammatory response of the airways. The introduction of this
activity can reduce significantly the number of hospital admissions due to asthma
attacks and it can also improve the quality of life of these patients, since the exercise
in groups is a great tool to bring psychological benefits, since the patient interacts
with others on the same condition and they see that the situation is not as bad as
seems, giving them more willpower to carry on the treatment and taking care of
themselves.
As of the protocols researched, they prioritized the aerobic programs, with
whole-body exercises (as cycling and walking/running on a treadmill) to improve
cardiorespiratory fitness, for at least twice a week; some protocols isolated upperand lower- limbs to see if they affect differently on the conditioning; and some used
muscle endurance exercises, to improve the functioning of these muscles and so,
improving their oxygenation. The results of these studies are easy to interpret and
understand as some parameters were objectively analysed, as: VO2, work rate,
FEV1, FVC and oxygen pulse. The quality of life of these patients is something
extremely important and the studies found still doesnt have a solid and valid
evidence on this, so giving a bigger attention to this aspect is needed, with more

studies and the development of a valid and more sensitive tool, that can understand
the psychological aspects of the disease and the rehabilitation in a more complete
and deep way. And, most of all, each patient is a unique human being, so they
should be treated and looked as so. Each protocol must suit the patients needs and
respect his limitations and difficulties, so that they can trust and put effort into their
rehabilitation, bringing a lot of benefits to themselves.

WORD COUNT: 1666 words

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