# Exercise as it relates to Disease/Does Moderate Intensity Exercise Improve Fitness and Quality of Life in Adults with Asthma?

This Wiki Fact sheet is an analysis based on the journal article “A 12-month, moderate-intensity exercise training program improves fitness and quality of life in adults with asthma: a controlled trial”.

## What is the Background to this Research?

Asthma is a chronic disease, characterised by reversible bronchial obstruction, leading to difficulty breathing and limited exercise capabilities. Many asthmatics often develop anxiety when considering participating in physical activity, due to confusion between breathlessness associated with broncho-constriction or exercise-induced hyperventilation, leading to more sedentary lifestyles. Consequently, adult asthmatics often have a lower fitness level and quality of life than their non-asthmatic peers. The benefits of regular aerobic exercise in improving all aspects of health are relevant to both healthy individuals and asthmatics. Most research has been expensive, thus non-transferrable to real-life settings and has focused on children and young adults, not lasting any longer than 6 months. For this reason, a study was developed by Meyer et al. (2015) to prove the physical and mental health benefits of long-term aerobic training in adults with asthma and encourage inactive individuals to start and continue physical training.

## Where is the Research From?

This research was conducted in and comprised of recruited volunteers from the Hamburg metropolitan area, Germany. No specific grant from any funding agency in the public, commercial, or not-for-profit sectors was received for the research in Meyer’s study. The completed study was published in the journal ‘BMC Pulmonary Medicine’.

## What Kind of Research Was This?

Meyer’s research consisted of a pseudo-randomised, controlled study based on a behavioural intervention. This involved one supervised 60-minute aerobic training session per week.

## What Did The Research Involve?

Meyer’s study monitored 24 voluntary participants from the general population, with a diagnosis of asthma according to standard criteria. Volunteers were selected, based on a number of criteria concerning existing health status and willingness to train regularly. These participants were split into an intervention and control group, based on the proximity of their residence to training locations.
The intervention group participated in a standardised, 60 minute aerobic exercise session once a week for 12 months in an indoor gym, equipped with simple training devices. This occurred under the supervision of trainers educated in exercise therapy and respiratory physiotherapy, and one of two physicians. Participants were encouraged to exercise at a frequency of > 60% of the maximum heart rate reached during the initial cardiopulmonary testing. Attendance rates and peak flow measurements before and after each session were recorded.
The control group continued their usual daily routines without any intervention.
All participants were tested at a baseline and after 12 months to determine lung function and quality of life. Inspiratory vital capacity and VO2 Max testing measurements were obtained in the referring pulmonary specialist’s practices, and participants completed two self-administered quality of life questionnaires. From these results, the main findings of the study were determined.
This methodology was a very valid approach to the study, as it provided both pre and post test results that could be analysed within the intervention group to monitor changes in health status throughout the study, as well as the comparison between those that participated in the intervention and the control group. The intervention was conducted in a relatively inexpensive, everyday environment that can be replicated in real life. Some limitations do exist within the methodology, including participant selection. Basing the control and intervention groups on residence to training locations (7 km distance), rather than splitting the group in half, meant that the participants were split into two uneven groups (14 intervention and 10 control). Additionally, the severity of asthma amongst the participants (mild, moderate or severe) also varied, which could have negatively affected/ biased the results.

## What Were The Basic Results?

The results of Meyer et al.’s study showed significant differences in exercise tolerance for the intervention group after 12 months. These differences included;
* Improved mean Work Rate Max of 18 +/- 18 Watts
* Improved mean VO2 Max of 4.6 +/- 4.36 ml/min/kg
* Improved Oxygen Pulse by 1.6 +/- 1.98ml
* Improved minute ventilation by 13.2 +/- 18.72l/min
No changes from the baseline tests were evident in the control group after 12 months.
Results regarding the health-related quality of life questionnaires included significant improvements in physical and social functioning, activities, emotions and overall quality of life scores for the intervention group. All variables remained unchanged for the control group after one year.

## What Conclusions Can We Take From This Research?

Conclusions that can be taken from Meyer et al.’s research are that a long-term, moderate intensity physical training program was associated with relevant improvements of fitness and health-related quality of life in well-motivated older adults with asthma.
The findings from this study strongly correlate with those of similar studies, involving younger patients and shorter-duration exercise programs, thus reinforcing the benefits of exercise on overall health and well being previously discovered in other research.
It is important to consider that the total exercise time per week was unknown, thus it is difficult to determine whether weekly training sessions or general lifestyle changes led to the observed improvements. Additionally, participants may have felt more confident training under the permanent supervision of a health professional, thus exercised closer to their physical limits, which may not occur in real-life situations.

## Practical Advice

The non-randomised intervention allocation process, based on place of residence, was practical for the purposes of the study, however may not be able to be replicated in real life; many people in the general population have to travel further than 7 km to the nearest gym, and cannot afford or do not have access to personal trainers, thus affecting individual motivation levels to engage in regular physical activity.
It is crucial that asthma sufferers continue to use their medication, as advised by a doctor, and continue to monitor their condition throughout their training regime after gaining a medical clearance. Optimal asthma care, including adequate medication, education on disease self-management and psychological support should lead to a normal life without restrictions.

## Further Information/ Resources

National Asthma Council Australia: https://www.nationalasthma.org.au/

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Meyer, A., Günther, S., Volmer, T., Taube, K., & Baumann, H. (2015). A 12-month, moderate-intensity exercise training program improves fitness and quality of life in adults with asthma: a controlled trial. BMC Pulmonary Medicine, 15(1). http://dx.doi.org/10.1186/s12890-015-0053-8
* ↑ Global Initiative for Asthma,. (2016). Retrieved from http://ginasthma.org/asthma-copd-and-asthma-copd-overlap-syndrome-acos/
* 1 2 3 The National Asthma Council Australia. (2016). Nationalasthma.org.au. Retrieved 26 September 2016, from https://www.nationalasthma.org.au/
* ↑ Westermann, H., Choi, T., Briggs, W., Charlson, M., & Mancuso, C. (2008). Obesity and exercise habits of asthmatic patients. Annals Of Allergy, Asthma & Immunology, 101(5), 488-494. http://dx.doi.org/10.1016/s1081-1206(10)60287-6