# Exercise as it relates to Disease/Swimming training helps kids breathe easy

This is an analysis of the research article “The effects of a swimming intervention for children with asthma” by Wang and Hung (2009). This has been created by u3155694.

## What is the background to this research?

Asthma is one of the most common respiratory diseases affecting 20.8% of Australian children. Asthma is a chronic inflammatory disease, which results in the airway becoming obstructed and narrow causing a mucus build up. Symptoms of asthma include coughing, wheezing, breathlessness and chest tightness. Poor management of asthma can lead to a reduction in daily activities and a reduced quality of life.
Asthma is commonly treated with pharmacological interventions however some studies have shown that regular exercise can reduce the symptoms of asthma and lower the required dosage of medicine. Swimming is a sport uniquely suited to treating asthma as it promotes good breathing technique and expands lung capacity whilst improving overall fitness.

## Where is the research from?

This research was conducted by the Department of Medicine, Taipei Medical University and the Department of Physical Education, Kaohsiung Medical University, Taiwan.

## What kind of research was this?

This was a randomised controlled trial (RCT). RCTs are the most effective way of determining whether a cause-effect relation exists between treatment and outcome.

## What did the research involve?

Thirty children, aged from seven to 12 years were pre-screened according to the American Thoracic Society criteria and were randomly assigned to be in either a control or experimental group. The experiment group participated in six weeks of swimming training three times per week for 50 minutes. Training sessions were conducted in a non-chlorinated pool and the work rate was set at 65% of maximum heart rate. The control group continued with regular treatment for asthma in accordance with guidelines. There was no difference in the severity of asthma between the two groups at the start of the experiment.
A summary of the tests used in the research is in the table below:
| Pulmonary Function Test: | Description: |
| Peak Expiratory Flow (PEF) | A measure of the maximum speed a subject can exhale air. |
| Forced Vital Capacity (FVC) | The total amount of air that can be expelled from the lungs after taking in a deep breath. |
| Forced Expiratory Volume 1 (FEV1) | The amount of air a subject can expel in one second. |
| Forced Expiratory Flow 50 (FEF50) | A measure of speed a subject can exhale air with half empty lungs. |
| Forced Expiratory Volume 1/Forced Vital Capacity (FEV1/FVC) | The ratio of exhalation rate to total volume of air a subject can exhale. |

## What were the basic results?

The children that participated in the six week swimming intervention showed a statistically significant improvement in PEF and importantly a reduction in the severity of asthma symptoms when compared to the control group. In addition the experiment group’s FEV1, FEF50 and PEF results showed a significant improvement post intervention compared to pre-intervention tests. This data suggests that swimming is an effective intervention for improving the disease parameters but does not necessarily improve all pulmonary test parameters.
It is important to note that this study has a relatively small number of participants. Furthermore, the researchers state that those children in the swimming intervention group had increased exposure to health professionals, therefore they knew and understood the differences in asthma medications and switched from relieving to prevention medication. Finally, it is important to remember that this intervention was conducted in a non-chlorinated pool thus reducing any potential allergic reactions, which can cause the airways to become obstructed. Despite these limitations to this study, swimming training was proved to be successful intervention in improving asthma in children.

## What conclusions can we take from this research?

Initially it was thought that asthma could only be treated with traditional medicine however this research highlights that physical activity interventions, such as swimming training, can be used as an effective strategy for reducing asthma.

## Practical advice?

Before commencing exercise always check with your doctor to make sure you and your child are aware of all the signs and symptoms of exercise-induced asthma. Make your child aware of all their asthma triggers (hay fever, dry cool air etc) and make sure they know how to use an asthma prevention inhaler. Lastly, tell them to stop exercising immediately if symptoms persist.
When swimming in chlorinated pools, remember to wear a swimming cap and goggles to protect hair and eyes from excessive exposure to the chlorine. The condition of the pool water may fluctuate throughout the year; strong unpleasant smells or discoloration of the water may irritate your child’s lungs. Finally, don’t forget that swimming is a fun activity and can be enjoyed all year round!

## Further information/resources

For further information regarding asthma and the benefits of swimming to improve asthma, simply click on the links below.
General asthma information:
https://www.asthmaaustralia.org.au
https://www.asthmahandbook.org.au/management/children
Benefits of swimming and asthma:
http://www.swimming.org/learntoswim/swimming-and-asthma/
http://www.medicinenet.com/best_exercises_for_asthma_yoga_swimming_biking-page2/views.htm

## References

* 1 2 3 4 5 6 7 8 Wang, J and Hung, W. (2009). The effects of a swimming intervention for children with asthma. Asian Pacific Society of Respirology, 14: 838-842.
* 1 2 3 4 AIHW, (2009). Asthma in Australian children: Findings from Growing Up in Australia, the Longitudinal Study of Australian Children. Australian Government: Canberra.
* ↑ Sibbald, B. (1998). Understanding controlled trials: Why are randomised controlled trials important? British Medical Journal, 316:201.
* 1 2 3 4 5 Miller, M.R., Pedersen, O. F., Pellegrino, R., & Brusasco. R. (2009). Debating the definition of airflow obstruction: time to move on? European Respiratory Journal 34(3): 527-528.