Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Exercise Training in a Weight-loss Lifestyle Intervention on Clinical Control and Psychosocial Morbidity in Obese Asthmatics: a Randomized and Controlled Trial
Brief Summary: Obese asthmatics have more severe symptoms, reduced lung function, poorer quality of life and a reduced response to inhaled corticosteroid medication compared to non-obese asthmatics. In addition, the impact of a weight-loss program on clinical control and psychological outcomes has been poorly demonstrated and the effect of exercise training remain unknown. The investigators aim to investigate the effect of exercise training in a weight-loss program on asthma clinical control (primary outcome), health factors related to quality of life and psychosocial symptoms (secondary outcomes) in obese patients with moderate-to-severe persistent asthma. Physical activity, inflammatory profiles and sleep disorders will also be evaluated. The investigators' hypothesis is that exercise as part of a weight-loss program is more effective to lose weight and improve asthma control, quality of life and psychosocial symptoms in obese asthmatics.


Options:
A: Inclusion Criteria:

* Asthma moderate and severe
* Asthma will diagnosed (Global Initiative for Asthma -GINA)
* Body Mass Index between 35 kg/ m2 and 39,9 kg/m2
* Sedentary
* Medical treatment, for at least 6 months
* Clinically stable (i.e., no exacerbation or medication changes for at least 30 days)

Exclusion Criteria:

* Cardiovascular, musculoskeletal or other chronic lung diseases
* Active Cancer
* Pregnant
* Weight loss more than 5 % in the preceding 6 months
* Using weight-loss medications
* History of bariatric surgery, uncontrolled hypertension or diabetes
* Using overnight continuous positive airway pressure
* Lactating
* Current or ex-smoker
B: Inclusion Criteria:

* Physician diagnosed asthma (confirmed by medical record evidence of bronchodilator reversibility of 12% or a minimum of 180 cc or PC20 methacholine \<= 16 mg/ml)
* Sedentary (currently do less than 60 min of structured / planned physical activity per week)
* Taking at least 250 mg fluticasone equivalent per day
* On stable dose and regimen of asthma medications
* Mild to moderate symptomatic asthma as defined by an Asthma Control Questionnaire score of 1.25 or greater.

Exclusion Criteria:

* Diagnosed co-morbid disease for which there are already established exercise guidelines i.e., cardiac disease or COPD
* Any other medical condition that confers greater illness morbidity than asthma (e.g., active cancer) which will confirmed by physician review
* FEV1 lower than 60% of predicted
* Incapable of exercising
* A BMI \> 30 kg/m2
* Unable to speak or understand either French or English
* \<18 years of age
* Patients who are currently pregnant or intend to become pregnant over the course of the study.
C: Inclusion Criteria:

Participants will meet all of the following:

* Age: 18-70 years of age;
* Obesity: BMI \>30.0 kg/m2;
* Physician-diagnosed asthma that is poorly controlled:

  * Documented diagnosis of asthma on the current medical problem list
  * Currently prescribed an anti-asthma medication
  * Overall score \<20 on the Asthma Control Test (ACT)64 or a score\<3 on any of the first four ACT questions regarding symptoms, nighttime awakening, interference with normal activity, and SABA use for symptom relief
  * Demonstrable airway reversibility
* Seen in primary care at Kaiser at least once in the preceding 24 months;
* KPNC member for \>1 year.

Exclusion Criteria:

Any of the following will exclude participants from the study:

* Inability to speak, read or understand English;
* Intermittent asthma, defined as either seasonal asthma or (daytime asthma symptoms \< 2x/week and nocturnal symptoms \< 2x/month and no use of long-term control medications);
* Diagnosis of COPD (emphysema or chronic bronchitis) on the current medical problem list or suggested by spirometry at baseline;
* Unwilling to attempt weight loss, including unwillingness to perform self-monitoring;
* Body weight change (+/-) \> 10 pounds or use of weight-loss medications in the preceding 3 months;
* Inability to perform pulmonary function tests by spirometry in a consistent manner;
* Significant medical co-morbidities, including uncontrolled metabolic disorders (e.g., thyroid, diabetes, renal, liver), unstable heart disease, heart failure, and ongoing substance abuse;
* Diagnosis of psychiatric disorders that would limit adequate informed consent or ability to comply with study protocol;
* Regular use of medications that can cause weight gain (e.g., oral corticosteroids, insulin, certain oral hypoglycemics, certain antidepressants, etc.);
* Under treatment for cancer or another condition that may prevent completion of follow-up;
* Diagnosis of a terminal illness and/or in hospice care;
* Use of a pacemaker or other implanted medical devices;
* Pregnant, planning to become pregnant, or lactating;
* Actively enrolled in a care management program focused on weight loss at Kaiser or elsewhere;
* Already enrolled or planning to enroll in a research study that would limit full participation in the study or confound the observation and interpretation of the study's findings;
* Family household member already enrolled in the study;
* No longer receiving primary care from Kaiser, or planning not to do so within the study period;
* PCP determination that the study is inappropriate or unsafe for the patient;
* Investigator discretion for clinical safety or protocol adherence reasons.
D: Inclusion Criteria:

* 20-50 years old
* moderate and severe asthma

Exclusion Criteria:

* other pulmonary or cardiovascular disease

Answer: A