Flexibility and Strength Training in Asthma
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The aim of the study is proof of concept and to establish the feasibility of performing a
      study of resistive flexibility and strength training (RFST) in patients with asthma, with the
      future goal of designing a larger randomized trial to test the hypothesis that RFST leads to
      greater improvement in asthma symptoms, pulmonary function tests, range of motion and
      connective tissue mobility compared with a control conventional physical therapy
      intervention.
    

Detailed description: 
      The treatment of symptomatic asthma currently focuses on the use of medications - inhaled or
      systemic - that have the principal goals of relieving airway pathology, namely airway
      narrowing, inflammation, mucus metaplasia and hyper-reactivity. There are no therapies
      directed at the chest wall or its connective tissue structural units, including connective
      tissue matrix, bone health and chest wall musculature. Resistive flexibility and strength
      training (RFST) is a new physical therapy technique that has successfully addressed
      abnormalities in the upper and lower extremities and back. In this application, we propose to
      use internal funding for a pilot project to explore the potential holistic benefits of RFST
      directed to the chest wall in symptomatic asthmatics as well as the potential mechanical
      basis of its therapeutic benefits if observed.

      In RFST, the practitioner extends or flexes a joint, while the patient actively resists the
      motion applied by the practitioner. In other words, the patient performs an eccentric
      contraction of extensor muscles if the joint is flexed, or of flexor muscles if the joint is
      extended. The technique is based on the following theoretical principles:

        -  Opposing muscle pairs (i.e. ipsilateral flexor/extensor) can become dysfunctional when
           connective tissue within one of the muscles (either the flexor or the extensor) becomes
           chronically shortened-thought to be due to long-standing exaggerated centrally driven
           tonic muscle activity either following an injury or due to posture habit. When this
           happens, connective tissue within the opposing muscle will become chronically lengthened
           due to shortening of the paired muscle.

        -  The connective tissue can become inelastic and restrictive resulting in the muscles
           being held in a chronically short or lengthened position. These positions can change.

        -  In the trunk, imbalances can occur between flexor/extensor groups (e.g.
           psoas/multifidus) and also between right/left muscle pairs, creating postural
           asymmetries. For example, shortening of the psoas muscle on one side will lead to
           lengthening of the psoas on the contralateral side.

        -  Shortening of limb girdle muscles (e.g. pectoralis, gluteus) can create complex
           imbalance patterns both across local flexor/extensor pairs, across sides, and diagonally
           across the trunk (e.g. shortening of pectoralis major on one side causing lengthening of
           extensor muscles in contralateral hip).

        -  The end result of these imbalances is that the shortened muscles restrict the range of
           movement, and the lengthened muscles cannot function optimally in a lengthened position.

      It is thought that resistance stretching 1) allows the shortened muscles to lengthen and the
      lengthened muscles to shorten by remodeling intramuscular and perimuscular connective tissue,
      2) allows lengthened muscles to contract at a more favorable length and 3) allows for an
      increase in flexion, extension, and flexibility through joint ranges of motion.
    

Intervention name(s): Resistive Flexibility and Strength Training
Intervention type(s): Procedure
Intervention description(s): RFST is a physical therapy technique where a certified practitioner extends or flexes a joint with the subject actively resists the motion applied by the practitioner.
During the RFST treatment a subject will lie on a massage table while the practitioner holds the subject's arm or leg and flexes or extends the limb, instructing the patient to resist the flexion or extension produced by the practitioner. The process is repeated a number of times for each muscle while varying joint positions.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Asthma; RFST; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases