# Exercise as it relates to Disease/Self-administered Exercise in Asthmatic Adults

This is a critical analysis of 'Exercise is Associated with Improved Asthma Control in Adults', a 2011 journal article by authors S. Dogra, J.L. Kuk, J. Baker and V. Jamnik.

## About The Research
### What is the background to this research?

Asthma is a chronic condition causing sufferers to have sensitive airways which react to swell and increase mucus production and surface area coverage. This narrowing of the airways makes normal breathing difficult for asthmatics and can be fatal in severe cases.
The study in question is the first to explicitly show the positive effects of regular physical activity on overall asthma control. The study had the purpose of determining whether a supervised exercise program with an exercise professional would lead to improvements in the asthma control and aerobic fitness of adults with partially controlled asthma and whether the participants could continue to maintain the benefits with a self-administered exercise program.

### Where is the research from?

The authors of this research are all affiliated with York University in Toronto, Canada. S. Dogra and J. Baker are involved with the Lifespan Health and Performance Laboratory; and V. Jamnik works closely with the Human Performance Laboratory.

### What kind of research was this?

This study involved two groups of individuals with partially controlled asthma. One group acted as the control and maintained their normal lifestyle over the study period, whist the other group were subjected to a 12 week exercise program created and supervised by certified exercise physiologists, followed by another 12 weeks of self-administered exercise that paralleled the program from the exercise physiologist.

### What did the research involve?

Willing individuals over the age of 18 who used prescribed medication for their asthmatic condition and were physically inactive according to the Canadian Physical Activity Guidelines undertook the Asthma Contol Questionnaire (ACQ) to determine how controlled their asthma was. Those with well-controlled or poorly controlled asthma were not included in the study, those with scores indicating a partially controlled condition were able to participate.
As aforementioned, the individuals who met this criteria for inclusion in the study were separated into either a control or exercise group. The control group did not make any changes to their lifestyles for the study period. The exercise group firstly took part in exercise sessions three times a week with an exercise physiologist for 12 weeks. These sessions typically focused on aerobic training, with one set of strength exercises per week targeting the major muscle groups. The training sessions were tailored to individuals to suit their strengths, improve their weaknesses and include exercises and equipment they were comfortable with. The exercise intensity was determined based on the heart rate of the participants; starting at 70% maximum heart rate, the intensity increased by 5% every three weeks. The self-administered exercise programs were shaped for participants to exercise at 85% maximum heart rate and they were encouraged to exercise 5 times a week.

### What were the basic results of this research?

What follows is a table including the most notable results from the study:
| | Control-Before | Control-After | Exercise-Before | Exercise-12 Weeks | Exercise-After |
| ACQ | 0.90 | 0.99 | 1.30 | 0.72 | 0.72 |
| Perceived Asthma Control | 2.33 | 2.25 | 2.56 | 1.94 | 2.00 |
| Maximum Oxygen Uptake | 2.66 | 2.77 | 2.63 | 2.88 | 3.00 |
The study conductors observed that the exercise group experienced significant improvements in asthma control and VO$_2$max over the 24 weeks as opposed to the control group.

## Research Analysis
### What conclusions can be made from this research?

Some limitations outlined in the discussion of this research article included the following:
* lack of clinical measures of asthma control and severity (e.g. peak flow variability, exhaled nitric oxide)
* no objective physical activity monitors were used, meaning the self-administered exercise program may have not been followed correctly by participants
* due to gym accessibility, the two groups were not completely randomised
* the season in which the study took place had an adverse effect on the results in the control group, as these individuals showed improvements in their asthmatic conditions despite no lifestyle changes
Despite these limitations, the findings in this research can conclude that exercise leads to improvements in asthma control. It can be assumed that by undertaking appropriate regular exercise, asthmatics can improve their asthma control leading to a better quality of life, a decrease in the use and reliance on medication and a slight relief on the health care system.

### What advice can be taken from this research?

From the results of this study it is overwhelmingly clear that physical activity has a significant positive effect on the well-being of asthma sufferers. Obviously, it would be wise for many asthmatic people to undertake physical activity in order to reap the benefits regarding control over their condition. However, exercise can also pose a threat to those suffering with asthma. Many sufferers experience Exercise Induced Asthma (EIA) which can lead to asthma attacks depending on the temperature of the air when exercising, type of exercise and the intensity of the exercise. Asthmatics deciding to engage in physical activity should:
* check with a health and/or exercise professional to determine what type and intensity of exercise is safe and appropriate for them,
* always have a trusted person know when and where they are exercising
* keep immediate-action asthma medication on their person
* never continue exercising if they are feeling serious asthma symptoms occurring

## Further Information
### Resources

The following resources can be accessed for further reading and information regarding this topic:
* Asthma Australia Homepage: https://www.asthmaaustralia.org.au/act/home
* The Australian Lung Foundation - ASTHMA AND EXERCISE IN SPORT: http://www.nevdgp.org.au/info/lungf/asthma-exercise-health.html
* Australian Asthma Handbook - Exercise and Asthma: http://www.asthmahandbook.org.au/clinical-issues/exercise

### References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Dogra, S., Kuk, J.L., Baker, J., Jamnik, V., (2011), European Respiratory Journal vol.37, Exercise is associated with Improved Asthma Control in Adults
* ↑ Asthma Australia, About Asthma, https://www.asthmaaustralia.org.au/act/about-asthma
* ↑ Elliot, I., Reddel, H.K., (2017), New England Journal of Medicine, Sever and Difficult-to-Treat Asthma in Adults
* ↑ Public Health Agency of Canada, Canada's Physical Activity Guide to Healthy Living,www.phac-aspc.gc.ca/pau-uap/paguide/
* ↑ O’Byrne PM, Naya IP, Kallen A, et al (2008) Increasing doses of inhaled corticosteroids compared to adding long-acting inhaled b2-agonists in achieving asthma control
* ↑ Williams SA, Wagner S, Kannan H, et al (2009) J Occup Environ Med, The association between asthma control and health care utilization, work productivity loss and health-related quality of life
* 1 2 3 4 5 The Australian Lung Foundation, ASTHMA & EXERCISE IN SPORT, http://www.nevdgp.org.au/info/lungf/asthma-exercise-health.html