Cochrane for Clinicians

Putting Evidence into Practice

Physical Training for Patients with Asthma



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Am Fam Physician. 2013 Mar 1;87(5):313.

This clinical content by Drs. Saguil and Okpokwasili conforms to AAFP criteria for evidence-based continuing medical education (EB CME). See the CME Quiz.

Clinical Question

Should physicians prescribe physical training to improve symptom control and quality of life for patients with asthma?

Evidence-Based Answer

Physical training lasting for at least 20 to 30 minutes, two to three times a week for at least six weeks, improves physical fitness in patients with asthma. Physical training is not associated with worsening of asthma symptoms, and it improves health-related quality of life. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Asthma affects 300 million persons worldwide.1 In the United States, the prevalence of asthma increased from 7.3 percent in 2001 to 8.2 percent in 2009, affecting nearly 25 million persons.2 Despite being treatable, asthma was responsible for 10.5 million missed school days and 14.2 million missed work days in 2008, and was responsible for 1.75 million emergency department visits and 456,000 hospitalizations in 2007.3

This Cochrane review examined the effect of medically supervised physical training on the health of persons with asthma. Training programs consisted of aerobic and strength training lasting 30 to 90 minutes, two to three days per week for six to 16 weeks. Outcomes included physiologic measurements, exercise capacity, and measures of asthma severity and health-related quality of life. Although 19 studies with 695 patients eight years and older were included, different outcome measures limited the ability to pool results. In comparison with those in education-only control groups, patients who participated in physical training programs improved their cardiopulmonary fitness as measured by maximum oxygen uptake (mean difference = 5.57 mL per kg per minute; 95% confidence interval [CI], 4.36 to 6.78; six studies with 149 participants). Physical training also improved maximum expiratory ventilation (mean difference = 6.0 L per minute; 95% CI, 1.57 to 10.43; four studies with 111 participants); there was no effect on resting lung function. Four out of five studies demonstrated a positive effect on health-related quality of life. No adverse effects of training on asthma symptoms were reported.

The improvements in cardiorespiratory parameters are clinically significant. An increase in maximum oxygen uptake of 5.57 mL per kg per minute is equivalent to the difference between being limited to light activities (e.g., desk work) to tolerating moderate activities (e.g., walking or biking).4,5 Also, the improvements in quality of life are considered to be clinically significant.6,7

The physical training regimens in this study were conducted under controlled conditions and may not be generalizable. On the other hand, because none of the programs in this review were associated with adverse effects, it would seem reasonable for physicians to recommend that patients with asthma take advantage of locally available physical training programs.

Although clinical practice guidelines note that exercise is a potential trigger of asthma, the National Asthma Education and Prevention Program advocates promoting physical activity,8 and the Scottish Intercollegiate Guidelines Network suggests that physical training be viewed as part of the general approach to improving the lifestyle of patients with asthma.9

Author disclosure: No relevant financial affiliations.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department or the U.S. Army Service at large.

SOURCE: Chandratilleke MG, Carson KV, Picot J, Brinn MP, Esterman AJ, Smith BJ. Physical training for asthma. Cochrane Database Syst Rev. 2012;5:CD001116.

The practice recommendations in this activity are available at http://summaries.cochrane.org/CD001116.

 

REFERENCES

1. Global strategy for asthma management and prevention. Global Initiative for Asthma (GINA) 2012. http://www.ginasthma.org/. Accessed February 6, 2013.

2. Centers for Disease Control and Prevention (CDC). Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001–2009. MMWR Morb Mortal Wkly Rep. 2011;60(17):547–552.

3. Akinbami LJ, et al. Asthma prevalence, health care use, and mortality: United States, 2005–2009. Natl Health Stat Report. 2011;(32):1–14.

4. Garber CE, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359.

5. Physical Activity Guidelines Writing Group. 2008 Physical Activity Guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2008.

6. Juniper EF, et al. Measuring quality of life in children with asthma. Qual Life Res. 1996;5(1):35–46.

7. Juniper EF, et al. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol. 1994;47(1):81–87.

8. Expert Panel Report 3 (EPR3). Guidelines for the diagnosis and management of asthma. National Asthma Education and Prevention Program. 2007. http://www.nhlbi.nih.gov/guidelines/asthma/. Accessed August 14, 2012.

9. British guideline on the management of asthma. Guideline no. 101. May 2008, revised 2012. Scottish Intercollegiate Guidelines Network. http://www.sign.ac.uk/guidelines/fulltext/101/index.html. Accessed August 14, 2012.

These are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Kenneth W. Lin, MD, Department of Family Medicine, Georgetown University School of Medicine, Washington, DC.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.


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