Just accepted by Journal of Asthma

Asthma and aerobic exercise: A review of the

empirical literature
Kimberly M. Avallone & Alison C. McLeish
doi:10.3109/02770903.2012.759963
Objective: The purpose of the present paper was to provide a comprehensive review of
the empirical literature on the association between asthma and aerobic exercise among
adults. Methods: A literature search was conducted utilizing electronic search engines
(i.e., PsycINFO and PubMed) using the following keyword algorithms: asthma AND
(exercise OR physical activity). Results: These searches resulted in approximately
5,665 citations. Only results that were directly relevant were included in the present
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

review. Conclusions: Overall, empirical evidence suggests that (1) individuals with
asthma are less likely to engage in physical activity than those without asthma; (2)
individuals with asthma are not biased in their subjective reporting of symptoms during
aerobic exercise; (3) physical inactivity among individuals with asthma is associated
with negative health consequences and increased asthma-related difficulties; and (4)
regular aerobic exercise improves asthma symptom management, lung function, and
mental health.
For personal use only.

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Running head: ASTHMA AND AEROBIC EXERCISE

Asthma and aerobic exercise: A review of the empirical literature

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Kimberly M. Avallone & Alison C. McLeish
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University of Cincinnati

Author Note
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For personal use only.

Kimberly M. Avallone, M.A., Department of Psychology, University of Cincinnati;

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Alison C. McLeish, Ph.D., Department of Psychology, University of Cincinnati.
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Correspondence concerning this article should be addressed to Alison C. McLeish,

Department of Psychology, University of Cincinnati, PO Box 210376, Cincinnati, OH 45221-

0376. E-mail: alison.mcleish@uc.edu

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Keywords: asthma, aerobic exercise, physical activity, aerobic activity

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LJAS_A_759963_Page 1 of 22
 ASTHMA AND AEROBIC EXERCISE 2

Abstract

Objective: The purpose of the present paper was to provide a comprehensive review of the

empirical literature on the association between asthma and aerobic exercise among adults.

Methods: A literature search was conducted utilizing electronic search engines (i.e., PsycINFO

and PubMed) using the following keyword algorithms: asthma AND (exercise OR physical

D
activity). Results: These searches resulted in approximately 5,665 citations. Only results that
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

were directly relevant were included in the present review. Conclusions: Overall, empirical

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evidence suggests that (1) individuals with asthma are less likely to engage in physical activity

than those without asthma; (2) individuals with asthma are not biased in their subjective

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reporting of symptoms during aerobic exercise; (3) physical inactivity among individuals with

asthma is associated with negative health consequences and increased asthma-related difficulties;
For personal use only.

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and (4) regular aerobic exercise improves asthma symptom management, lung function, and

mental health.
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 ASTHMA AND AEROBIC EXERCISE 3

Introduction

Despite the well-established benefits of exercise, approximately one-fourth of adults in

the U.S. do not engage in any type of regular exercise, and almost half of those who do exercise

fail to meet the federal physical activity guidelines for aerobic and muscle-strengthening exercise

(i.e., 2.5 hours of moderate intensity aerobic activity and muscle-strengthening activities on two

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or more days per week) [1]. Individuals with asthma may be particularly at risk for failing to
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meet federal guidelines for physical activity, because exercise is often a trigger of asthma

symptoms and exacerbations [2-4]. Indeed, while regular exercise has been found to result in

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improvements in lung functioning and asthma symptom management [3, 4], approximately 40-

90% of individuals with asthma experience asthma symptoms as a result of exercise [5-7].
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Although effective pharmacologic and nonpharmacologic approaches for managing symptoms

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related to asthma during exercise exist, individuals with asthma may avoid or limit their physical
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activity in order to prevent asthma exacerbations, resulting in significant negative health

consequences [8].

While there is a large body of research examining associations between asthma and
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aerobic exercise among adults, no comprehensive, critical review of this literature exists. The

purpose of the present paper, therefore, is to review the empirical literature on the association

between asthma and aerobic exercise. In the first section of the paper, we define our search
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selection strategy. In the second section, we examine exercise habits among individuals with

asthma. Third, we document symptom perception and physiological responses to exercise among

individuals with asthma. Fourth, we review all available empirical information pertaining to

aerobic exercise as an intervention or treatment for asthma. The final section of the paper
 ASTHMA AND AEROBIC EXERCISE 4

highlights major gaps in empirical knowledge and delineates future directions for this area of

research.

Method

Search Strategy and Study Selection Criteria

We conducted literature searches utilizing electronic search engines (i.e., PsycINFO and

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PubMed) to examine databases using the following key word combinations: Asthma AND
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(exercise OR physical activity). These searches yielded 5,665 citations. The majority of these

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were not relevant to the present review and were excluded because they (a) focused on only

asthma or exercise; (b) examined exercise-induced asthma or exercise-induced

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bronchoconstriction; (c) did not involve aerobic exercise (e.g., studies examining deep breathing,

yoga); (d) did not use a primarily adult sample; or (e) were not empirical articles. Please see
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Figure 1 for a detailed flow chart of study retrieval and selection. Thus, we focused on the

remaining 23 articles that were directly applicable to the present review.

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Results

Asthma and Exercise Habits

In an attempt to better understand the impact of aerobic exercise, one of the major lines
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of asthma research has focused on exercise habits among individuals with asthma (see Table 1

for a summary of these studies). Overall, the literature examining associations between asthma
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and physical activity suggests that individuals with a current or lifetime asthma diagnosis,

compared to those without, engage in less physical activity [9, 10]. Moreover, when they do

engage in exercise, individuals with asthma choose lower intensity activities (e.g., walking,

gardening) over high intensity activities (e.g., running, competitive sports), potentially due to

inaccurate beliefs about frequency, intensity, and types of exercise appropriate for individuals
 ASTHMA AND AEROBIC EXERCISE 5

with asthma [9, 11]. Studies suggest that this physical inactivity among individuals with asthma

results in negative health consequences, such as poorer respiratory functioning (i.e., lower FEV1

and PEF), greater health care utilization (e.g., increased physician office visits, ED visits,

overnight hospital stays), decreased physical and mental health, and decreased quality of life [11-

14]. There is also evidence that physical inactivity increases the risk of having a diagnosis of

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asthma and greater asthma severity [13]. In contrast, one study found that active (i.e., ˃ 3.0
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

kcal/kg of body weight per day) individuals reported greater perceived overall health and mental

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health, greater satisfaction with life, fewer chronic medical conditions, and fewer activity

limitations than individuals who were moderately active (i.e., 1.5 – 3.0 kcal/kg of body weight

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per day) or inactive (i.e., ˂ 1.5 kcal/kg of body weight per day) [15]. The only study, to date,

examining attitudes and barriers to physical activity among adult asthma patients indicates that
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despite believing in the benefits of physical activity, the majority of asthma patients avoided

activities that were considered more intense (e.g., climbing stairs, competitive sports) and
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believed having a chronic medical condition was a barrier to engaging in physical activity [16].

Further, those with more severe asthma were more likely to believe that individuals with asthma

should avoid physical activity altogether.

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Asthma and Exercise-Related Symptom Perception and Physiological Responding

In addition to examining exercise habits, a number of studies have examined symptom

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perception and physiological responding during aerobic exercise among individuals with asthma

(see Table 2 for a summary of these studies). While limited, the literature examining symptom

perception during aerobic exercise suggests that individuals with asthma may not be biased in

their symptom perception. Two of the three studies in this area found similar patterns of

associations between subjective and objective ratings of physical symptoms while at rest and
 ASTHMA AND AEROBIC EXERCISE 6

exercising in those with and without asthma [17-18]; however, one study found that individuals

with asthma or another chronic medical condition reported greater subjective symptoms of

breathlessness during stress compared to those without asthma or another chronic medical

condition [19]. The authors suggest that the presence of any physical illness, rather than asthma

specifically, may make an individual more sensitive to bodily changes.

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Research has also focused on examining the impact of physical activity on physiological
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outcomes (e.g., asthma exacerbations, lung function, heart rate variability) among individuals

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with asthma. Though also limited in number, studies in this area have consistently found that

physical activity results in improved functioning across a number of physiological domains.

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Specifically, individuals with asthma who engage in regular physical activity have been found to

report decreased asthma exacerbations and improved PEF and FEV1 [3, 4]. There is also some
For personal use only.

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evidence that physical activity may improve improved heart rate variability (HRV). Indeed,

results of a study comparing adults with a physician diagnosis of mild to moderate asthma to
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age- and gender-matched controls suggest that although individuals with asthma have poorer

HRV compared to their non-asthmatic peers, moderate to vigorous physical activity resulted in

HRV levels similar to those without asthma who also engaged in moderate to vigorous physical
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activity [20].

Aerobic Exercise as an Intervention for Asthma

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Given the benefits of physical activity for individuals with asthma, a number of studies

have evaluated the utility of aerobic exercise as a treatment for asthma (see Table 3 for a

summary of these studies). The majority of research in this area indicates that aerobic exercise

results in a number of physiological and psychological improvements, including improved lung

function (e.g., PEF, FEV1, FEF25), decreased airway inflammation (i.e., decreased total and
 ASTHMA AND AEROBIC EXERCISE 7

eosinophil counts in induced sputum), fewer asthma exacerbations, increased asthma control,

fewer ED visits, and decreased anxiety and depression [21-27]. These effects do not appear to be

limited to specific types of aerobic exercise as these benefits were found for various forms (e.g.,

combined strength training and aerobic exercise, indoor circuit training, swimming, treadmill;

supervised versus unsupervised), intensities (e.g., exercise completed at 60-70% VO2max;

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inactive, moderately active, active), and frequency (ranging from 6 weeks to 3 months) of
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aerobic exercise. It should be noted, however, that two studies did not find significant

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improvements in lung function [28, 29]. Indeed, one study only found aerobic exercise-related

improvements in subjective (i.e., improved perceived asthma control and decreased self-reported

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frequency and severity of symptoms), but not objective (i.e., spirometry), measures of asthma

symptoms and lung function [28]. This discrepancy may be due to the fact that the aerobic
For personal use only.

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exercise intervention used in this study was the only self-guided intervention. Thus, aerobic

exercise interventions may need to be more structured and led by a health professional in order to
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be maximally effective. The other study found that while a 6-week supervised aerobic exercise

program resulted in significant improvements in asthma-related quality of life, no significant

improvements in spirometry levels were found post-intervention [29].

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Discussion

The present review evaluated existing empirical work focused on aerobic exercise and
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asthma. Overall, empirical evidence suggests that (1) individuals with asthma are less likely to

engage in physical activity than those without asthma and are more likely to engage in lower

intensity aerobic exercises when they do exercise; (2) individuals with asthma are not biased in

their subjective reporting of symptoms during aerobic exercise; (3) physical inactivity among

individuals with asthma is associated with general negative health consequences as well as
 ASTHMA AND AEROBIC EXERCISE 8

increased asthma-related difficulties; and (4) physical activity is associated with improvements

in lung function (e.g., PEF, FEV1, FEF25), asthma symptom management (e.g., fewer asthma

exacerbations, increased asthma control), and mental health (e.g., anxiety, depression).

A major strength of the existing literature on asthma and aerobic exercise lies in the

diversity of samples and methodologies used. Studies in this area have used clinical, non-clinical,

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and epidemiologically defined samples as well as objective and subjective assessments of both
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asthma and aerobic exercise and laboratory-based as well as intervention research. Furthermore,

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researchers have examined various types and severity of asthma presentation as well as types of

physical activity. The current review does, however, suggest a number of limitations and

directions for future research.

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First, there is a need to expand on the primarily cross-sectional nature of the current body
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of literature by conducting longitudinal studies that examine associations between asthma and

aerobic exercise over time. Such studies would not only provide important information about
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how physical activity impacts asthma over time, but also information regarding the temporal

pattern of these associations. A second limitation is that the majority of studies included in this

review did not objectively verify asthma diagnosis. Objective verification of asthma diagnosis
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rather than relying on self-report or a previous diagnosis by a physician would increase

confidence that the individual did indeed meet criteria for asthma. It would also be helpful for
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studies to specify how asthma was diagnosed by physicians when patients are recruited from

clinics and hospitals so that diagnostic methods can be compared across studies. Third, few

studies have examined the mechanisms (i.e., barriers and motivators) that influence physical

activity level among individuals with asthma. Understanding these mechanisms would enable

researchers to develop targeted intervention programs to address these barriers and increase
 ASTHMA AND AEROBIC EXERCISE 9

overall motivation to exercise among this population. Fourth, additional research is needed in

order to better understand the physiological responses during aerobic exercise among individuals

with asthma. Although the majority of studies that have been conducted in this area suggest that

aerobic exercise results in physiological improvements, including improved lung function, these

findings have not been consistent across all studies.

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Fifth, little is known about the type, amount, and intensity of aerobic exercise that
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provides the greatest benefit to individuals with asthma. There is little consistency in these

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aspects of aerobic exercise across studies, making it difficult to determine the “optimal” level or

type of aerobic exercise for individuals with asthma. Indeed, the existing literature has examined

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the impact of numerous types of aerobic exercise programs (e.g., circuit training, swimming,

combined aerobic and strength training) on asthma and related symptoms and overall found
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physiological and psychological improvements; however, it is unclear which program provides

the most benefit to individuals with asthma. Lastly, there is a need to examine the impact of
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psychosocial variables on asthma. For example, there have been no studies examining the impact

of anxiety on aerobic exercise among individuals with asthma. Extant research indicates that

anxiety negatively impacts both asthma and aerobic exercise [30-33]. Therefore, anxiety may be
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particularly detrimental for individuals with asthma attempting to exercise and may impact

motivation to exercise, perceptions during aerobic exercise, and perceived benefits from aerobic
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exercise. Despite these limitations, however, the present review clearly documents the beneficial

effects of aerobic exercise for individuals with asthma and highlights the importance of

encouraging them to exercise regularly. Future work in this domain of study will lead to

clinically relevant healthcare advances as well as the development of theoretically-driven,

methodologically diverse lines of research exploring the asthma-aerobic exercise association.

 ASTHMA AND AEROBIC EXERCISE 10

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and

writing of the paper.

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For personal use only.

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 ASTHMA AND AEROBIC EXERCISE 11

References

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 ASTHMA AND AEROBIC EXERCISE 12

10. Teramoto M, Moonie S. Physical activity participation among adult Nevadans with self-

reported asthma. J Asthma. 2011;48:517-522.

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Life Among People with Asthma: Findings from the Behavioral Risk Factor Surveillance
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 ASTHMA AND AEROBIC EXERCISE 13

20. Tsai YÄ, Lai FÄ, Chen SÄ, Jeng C. The influence of physical activity level on heart rate

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21. Itkin IH, Nacman M. The effect of exercise on the hospitalized asthmatic patient. J Allergy.

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23. Emtner M, Herala M, Stalenheim G. High-intensity physical training in adults with asthma.

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29. Turner S, Eastwood P, Cook A, Jenkins S. Improvements in symptoms and quality of life

following exercise training in older adults with moderate/severe persistent asthma.

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30. Burton D. Do anxious swimmers swim slower? Reexamining the elusive anxiety-

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31. Feldman JM, Lehrer PM, Borson S, Hallstrand TS, Siddique MI. Health care use and quality
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Table 1. Summary of studies examining exercise habits among individuals with asthma
Study Sample Asthma Physical Activity Assessment Findings
Assessment

ED
Ford et al., 165,123 adults Self-report Self-report; classified as (a) regular vigorous Individuals with current asthma were more
2003 [9] with current activity (i.e., requiring rhythmic contraction of likely to be physically inactive. Individuals
(12,489), former large muscle groups at 50% functional with current or former asthma were less
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(4, 892) or no capacity for at least 20 min 3 times/week; likely to engage in more intense exercise.
asthma (147,742) (b) regular activity (i.e., requiring less than
from the BRFSS 50% of functional capacity for at least 20 min

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3 times/week; (c) irregular activity (i.e., less
than 20 min or less than 3 times/week; and (d)

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physically inactive (i.e., engaging in no
physical activity

Teramoto et 3,840 adults Self-report Self-report; same classifications as Ford et al., Current and lifetime asthma diagnosis was
al., 2011 [10] living in Nevada 2003 associated with physical inactivity (OR =
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participating in 3.01 and 2.17, respectively).

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2009 BRFSS

Malkia et al., 7,193 adults with Self-report Self-reported activities across settings (e.g., Individuals with asthma engaged in lower
1998 [11] (178) and
without asthma
(7,015)
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metabolic unit (MET) value from 1.5 to 10
intensity physical activity compared to
those without asthma. Less intense physical
activity was associated with lower levels of
FEV1, FEV1%, and PEF.

Ford et al., 12,111 adults Self-report Self-report; same classifications as Ford et al., Physical inactivity or irregular physical
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2004 [12] with asthma 2003 activity was associated with greater
from the BRFSS physical and mental impairment and
activity limitations.
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LJAS_A_759963_Page 15 of 22
 ASTHMA AND AEROBIC EXERCISE 16

Strine et al., 354,025 U.S. Self-report Self-report; same classifications as Ford et al., Asthma more likely among individuals who
2007 [13] adults 2003 were physically inactive (AOR = 1.2).
participating in Physical inactivity was associated with
the BRFSS increased doctor (AOR = 1.5) and ED visits

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(AOR = 2.4), activity limitations (AOR =
1.7), asthma symptoms (AOR = 1.7), and
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inhaler use (AOR = 1.9).

Dogra et al., 84,886 adults Self-report Self-report, based on total daily energy Individuals with asthma who were inactive

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2009 [14] with (6,835) and expenditure classified as “inactive”(i.e., ˂ 1.5 reported greater health care use within the
without (78,051) kcal/kg of body weight per day), “moderately last year.
asthma from active” (i.e., 1.5 – 3.0 kcal/kg of body weight

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CCHS per day) and “active” (i.e., ˃ 3.0 kcal/kg of
body weight per day)

Dogra & 11,243 Self-report Self-report; same classification as Dogra & Physical activity associated with greater
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Baker, 2006 Canadians with Baker, 2009 perceived health, life satisfaction, fewer

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[15] asthma medical conditions, and fewer activity
participating in limitations.
CCHS

Mancuso et
al., 2006 [16]
60 adults with
physician-
verified asthma
Physician-
verified
diagnosis;
AC Self-reported attitudes and beliefs about
exercise
Believed exercise was beneficial. Those
with more severe asthma more likely to
believe others with asthma should avoid
prescription of physical activity. The majority of patients
daily asthma viewed having a chronic medical condition
medication as a barrier to engaging in physical activity.
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required
Note. For Asthma Assessment, the term “physician-verified diagnosis” represents patients recruited from primary care clinics or hospitals with a prior diagnosis of asthma made by
a physician. The term “self-report” was used for studies that asked participants in some way whether they had ever been diagnosed with asthma. For all studies, if objective
measures were utilized to diagnose or confirm a diagnosis of asthma, it is specified.
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 ASTHMA AND AEROBIC EXERCISE 17

Table 2. Summary of studies examining asthma and exercise-related symptom perception and physiological responding
Study Sample Asthma Physical Activity Assessment Findings

ED
Assessment
Ergood et al., 10 adolescent Physician- Aerobic exercise performed for six minutes No differences between subjective and
1985 [17] males with verified on ergometer cycle at workload sufficient to objective (as measured by a peak flow
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asthma and 10 diagnosis; at maintain heart rate of 60% of calculated meter) ratings of expiratory flow during
age- and sex- least three maximum aerobic exercise or at rest between those
matched documented with and without asthma.

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controls asthma attacks
with medical

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attention

Mahler et al., Adolescents Based on Incremental exercise test on cycle ergometer No group differences in associations
2006 [18] with (n = 14) asthma history, (15 watts/minute ramp protocol) between objective (as measured by
and without (n = current spirometry and peak oxygen consumption)
For personal use only.

33) asthma treatment, and and subjective ratings of breathlessness

C
pulmonary during aerobic exercise.
function testing
(i.e.,
FEV1/FVC <
AC
70% or ≥ 10%
decrease in
post-exercise
FEV1)
ST

Rietvelt et al., 55 women: 19 Self-report; 15 minutes of cycling on a bicycle home No group differences in FEV1. Individuals
2004 [19] with severe current asthma trainer set at minimal resistance with asthma and individuals with multiple
asthma, 18 with medication physical symptoms reported more
multiple subjective breathlessness than controls.
physical
symptoms, and
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18 controls
 ASTHMA AND AEROBIC EXERCISE 18

Garcia- Longitudinal Self-report; use Self-reported physical activity, activities Greater physical activity associated with
Aymerich et data from 2,818 of asthma summed to obtain MET hour/week score 25% decreased risk for asthma
al., 2009 [3] women with medication exacerbations (i.e., one or more asthma-
asthma ages 30- within past 12 related health care events including hospital

ED
55 months admission, emergency room visit, urgent
office visit)
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Ritz et al., 20 adults with Physician- Self-reported in electronic diary about activity Among those with asthma, greater physical
2010 [4] asthma and 20 verified in last 30 minutes: none (e.g., lying, sitting activity associated with improved PEF and

T
healthy controls diagnosis still), mild (e.g., normal walking, light manual FEV1 values.
desk work), moderate (e.g., fast walking),
heavy (e.g., running, carrying several heavy

EP
items)

Tsai et al., 27 Taiwanese Physician- Self-report of physical activity (i.e., Seven- Asthma was associated with poorer HRV.
2011 [20] adults with verified Day Physical Activity Recall) This effect was reduced among individuals
For personal use only.

asthma and 27 diagnosis mild who engaged in moderate to vigorous

C
age-and gender- to moderate physical activity.
matched asthma
controls

AC
Note. For Asthma Assessment, the term “physician-verified diagnosis” represents patients recruited from primary care clinics or hospitals with a prior diagnosis of asthma made by
a physician. The term “self-report” was used for studies that asked participants in some way whether they had ever been diagnosed with asthma. For all studies, if objective
measures were utilized to diagnose or confirm a diagnosis of asthma, it is specified.
ST
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 ASTHMA AND AEROBIC EXERCISE 19

Table 3. Summary of studies examining aerobic exercise as an intervention for asthma

Study Sample Asthma Physical Activity Assessment/Condition Findings
Assessment

ED
Itkin et al., 39 hospitalized Physician-verified Control condition: three-month Aerobic exercise was not associated with
1966 [21] patients with allergic asthma participation in normal hospital activities, increased medication utilization and
asthma based on history, but no additional physical exertion; resulted in improved athletic ability and
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

skin tests, removal Aerobic exercise condition: three month lung function.
and reexposure to aerobic exercise program consisting of 1
allergen hour of calisthenics (e.g., stationary

T
bicycle, sit ups) and 1 hour of planned
sports activity daily for five days per week.

EP
Robinson et 8 individuals Physician-verified 12 weeks of indoor circuit training Circuit training was associated with
al., 1992 [22] with moderate to diagnosis consisting of a warm-up and between one increased peak oxygen uptake, improved
severe asthma and four circuits involving seven exercises
lung functioning, increased regular
and 7 healthy completed for 50 seconds each with a 30- physical activity, and greater perceived
For personal use only.

controls second rest in between ability to perform physical tasks for both

C
groups.
Emtner et al., 26 adults with Physician-verified 10-week supervised rehabilitation program 10-week aerobic exercise rehabilitation
1996 [23] mild to moderate diagnosis of consisting of 2 weeks of psychoeducation program resulted in improved lung and
asthma chronic well-
AC
controlled mild to
moderate asthma;
minimum of 20%
and daily indoor swimming exercises and 8 cardiovascular functioning and fewer
weeks of indoor swimming exercise twice a asthma symptoms.
week. All sessions lasted 45 minutes

reversibility in
PEFR after
treatment with β2-
ST

agonist

Mendes et 101 individuals Physician-verified Control condition: 4-hour education Aerobic exercise program resulted in
al., 2010 [24] with moderate to diagnosis of program, breathing exercises for 30 improved HRQoL, reductions in state
severe persistent moderate to severe minutes twice a week for 3 months; anxiety and depression, improvements in
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asthma ages 20- persistent asthma; Exercise condition: completed all maximum oxygen consumption and
50 diagnosis based on components of control condition and 3- number of symptom-free days.
Global Initiative month aerobic training program consisting
for Asthma of 30-minute session twice per week of
 ASTHMA AND AEROBIC EXERCISE 20

aerobic exercise completed at 60-70%

VO2max

Mendes et 68 patients with Physician-verified Control condition: 4-hour education Aerobic training program resulted in

ED
al., 2011 [25] moderate to diagnosis of program, breathing exercises for 30 decreased airway inflammation, fewer ED
severe asthma moderate to severe minutes twice a week for 3 months; visits, and more symptom-free days.
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

persistent asthma; Exercise condition: completed all

diagnosis based on components of control condition and 3-
Global Initiative month aerobic training program consisting

T
for Asthma of 30-minute session twice per week of
aerobic exercise on indoor treadmill
completed at 60-70% VO2max

EP
Dogra et al., 36 adults with Self-report; current Control condition: maintained current Aerobic exercise intervention resulted in
2011 [26] partially prescription for lifestyle throughout study; Exercise improved in asthma-related quality of life,
controlled asthma medication condition: completed 12-week supervised asthma control, and aerobic fitness.
For personal use only.

asthma exercise programs provided by qualified

C
exercise professional consisting of 30
minutes of aerobic exercise and strength
training three times per week followed by

Goncalves et 20 patients with

AC
Physician-verified
12-week self-administered exercise
program

Control condition: 4-hour education Aerobic conditioning program resulted in

al., 2008 [27] moderate to diagnosis of program and respiratory exercise program more symptom-free days, improved
severe asthma moderate to severe lasting 30 minutes twice per week for 3 quality of life, improved aerobic aptitude,
asthma based on months; Exercise condition: completed all decreased exhaled nitric oxide, and
ST

guidelines from components of control condition plus decreased anxiety and depression.
Global Initiative aerobic training on treadmill (at 70%
for Asthma maximum power obtained in
cardiopulmonary effort test) lasting 30
minutes twice per week for 3 months
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 ASTHMA AND AEROBIC EXERCISE 21

Dogra et al., 24 individuals Self-report; Control condition: maintained current Aerobic exercise program resulted in
2010 [28] with partly experience regular lifestyle throughout study; Exercise improved perceived asthma control and
controlled non-severe asthma condition: completed 12-week decreased frequency and severity of
asthma symptoms and unsupervised exercise programs provided asthma symptoms. The program did not

ED
have current by qualified exercise professional impact quality of life, objective measures
prescription for consisting of 30 minutes of aerobic of asthma control, and lung functioning.
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

asthma medication exercise, strength training, and stretching

Turner et al., 34 adults over Self-reported Control condition: usual care; Exercise Supervised aerobic exercise intervention

T
2011 [29] 40 years with diagnosis of condition: three 80-90 minute supervised resulted in improvements in asthma-
moderate to moderate to severe exercise classes per week for 6 weeks, related quality of life but not lung

EP
severe persistent asthma; evidence classes consisted of 10-15 minute warm-up, functioning.
asthma of fixed airflow 20-minute walking training, 5-10 minute
obstruction by cool-down, 45-minute exercise circuit
spirometry; stable (cycle ergometer, step-ups, wall squats,
asthma medication upper limb endurance training)
For personal use only.

regimen; normal or

C
raised gas transfer;
activity limitations
related to asthma
AC
Note. For Asthma Assessment, the term “physician-verified diagnosis” represents patients recruited from primary care clinics or hospitals with a prior diagnosis of asthma made by
a physician.. The term “self-report” was used for studies that asked participants in some way whether they had ever been diagnosed with asthma. For all studies, if objective
measures were utilized to diagnose or confirm a diagnosis of asthma, it is specified.
ST
JU
 22

Results identified from all databases

n = 5,665

D
Results excluded based on:
Language n = 841
Other species n = 294
J Asthma Downloaded from informahealthcare.com by Duke University Serials Dept on 01/21/13

TE
Age (children & adolescents) n = 2,542
EIA/EIB n = 678
Review article/Meta-analysis n = 993

Potentially relevant studies

EP
For personal use only.

n = 317
C
AC

Results excluded due to relevance

based on screening of titles and
abstracts
n = 294
ST

Studies included in the present review

n = 23
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Figure 1. Flow diagram illustrating study retrieval and selection.

LJAS_A_759963_Page 22 of 22