Policy base for activity therapy:
For people with Asthma
The Academy of Medical Royal Colleges' Report:
Exercise regularly – exercise should not trigger your symptoms once you're on appropriate treatment; Asthma UK has advice about exercising with asthma.
The medical team at Asthma UK:
Activity is good for your asthma.
A condition marked by narrowing of the tubes that lead to lungs which results in acute attacks of breathlessness. It may occur with COPD.
Cause and scope for prevention:
The condition is probably due to a genetic susceptibility which leads to an abnormal response to allergens and chemicals in the air.
The person is asked to blow out as hard and as fast as they can into a peak flow meter to determine their Peak Respiratory Flow Rate, and the test can be repeated after they have inhaled a dose of bronchodilator treatment.
Standard medical therapy:
Prescription of one or two inhalers.
Benefit of exercise therapy:
Asthma UK, the lead asthma charity, points out that although exercise may trigger an asthma response the benefits outweigh the risks and they give clear advice and encouragement even for people with severe asthma.
The Faculty of Sport and Exercise Medicine Guidelines on the balance of risks and benefits of activity for people with Shortness of Breath state that:
It is normal for all people to feel more breathless than usual when increasing their activity level. The balance of evidence suggests that the increased risk of adverse events in breathless people when doing physical activity is very low. People should be counselled individually to gradually increase physical activity, taking into account their severity of symptoms and fear of breathlessness.
We search the National Library of Medicine for systematic reviews (see appendix 1 for a definition) We also specifically identify the Cochrane Reviews because Cochrane is committed to their regular updating.
We then search for only the last five years because we have Exercise the Miracle Cure, published in 2015 as a comprehensive account of the evidence at that time.
We then review the titles of the last five years because some of them have been given the wrong keyword and do not relate to exercise therapy.
This produces a list of relevant reviews.
Number of systematic reviews (15-01-2021) - 71
Number of these that are Cochrane reviews - 46
Number of systematic reviews in the last five years - 27
Number of systematic reviews in last five years deemed irrelevant -12
Number of systematic reviews in the last five years deemed relevant APPENDIX 2 -15
In preparing a systematic review the reviewer:
1. Prepares a protocol conforming to one of the standard protocols eg that of Cochrane.
2. Defines a search strategy with the support of a librarian.
3. Uses explicit quality criteria to include or exclude primary studies.
4. Combines the data from the primary studies (a process called meta-analysis).
5. Prepares a report including the references to the excluded studies as well as to the included studies.
The term ‘overview of systematic reviews’ describes an article in which all the available systematic reviews are combined.
Exercise therapy for people with asthma
The National Library of Medicine www.nlm.gov was searched for ‘Systematic Review’, in the last 5 years. 27 reviews were identified.
These were reviewed by Muir Gray for relevance eg some systematic reviews were focused on drug therapy, this removed 12 reviews from the database and the remaining 15 are listed below.
USING THE DATABASE
To read the abstract or the full text simple copy the doi, for example
doi: 10.1016/j.bjpt.2017.06.004. and paste it into your web browser
Asthma exercise therapy Search
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Filters applied: Systematic Review, in the last 5 years.
Effects of physical exercise training on nocturnal symptoms in asthma:
Francisco CO, Bhatawadekar SA, Babineau J, Reid WD, Yadollahi A.
PLoS One. 2018 Oct 22;13(10):e0204953. doi: 10.1371/journal.pone.0204953. eCollection 2018.
PMID: 30346958 Free PMC article.
INTRODUCTION: Nocturnal worsening of asthma symptoms is a common feature of asthma.
Physical exercise training improves general asthma control; however, there is no evidence showing the effects of physical exercise on nocturnal asthma sym …
Effects of physical therapy on lung function in children with asthma: a
systematic review and meta-analysis.
Zhang W, Wang Q, Liu L, Yang W, Liu H.
Pediatr Res. 2020 Apr 3. doi: 10.1038/s41390-020-0874-x. Online ahead of print.
PMID: 32244247 Review.
BACKGROUND: Asthma is a common chronic respiratory disease in children. In addition to medications, physical therapy is considered as a treatment strategy for asthma. ...CONCLUSIONS:
Physical training improved FVC(%pred) significantly in children with asth …
Effect of aerobic exercise training on asthma in adults: a systematic review and meta-analysis.
Hansen ESH, Pitzner-Fabricius A, Toennesen LL, Rasmusen HK, Hostrup M, Hellsten Y, Backer V,
Eur Respir J. 2020 Jul 30;56(1):2000146. doi: 10.1183/13993003.00146-2020. Print 2020 Jul.
OBJECTIVE: To evaluate the effect of aerobic exercise training on asthma control, lung function
and airway inflammation in adults with asthma. ...CONCLUSIONS: In adults with asthma, aerobic
exercise training has potential to improve asthma …
Breathing exercises for children with asthma.
Mac.do TM, Freitas DA, Chaves GS, Holloway EA, Mendon.a KM.
Cochrane Database Syst Rev. 2016 Apr 12;4(4):CD011017. doi: 10.1002/14651858.CD011017.pub2.
PMID: 27070225 Free PMC article. Review.
BACKGROUND: Asthma is the most common chronic disease in childhood. Breathing exercise
techniques have been widely used by researchers and professionals in the search for complementary therapies for the treatment of asthma. ...The studies measured: quality of …
Role of Breathing Exercises and Yoga/Pranayama in Childhood Asthma: A
Das RR, Sankar J, Kabra SK.
Curr Pediatr Rev. 2019;15(3):175-183. doi: 10.2174/1573396315666190121122452.
BACKGROUND: Various complementary or alternative medicines (including breathing exercises and yoga/pranayama) have been tried as an attractive option to pharmacotherapy in childhood asthma.
OBJECTIVE: To evaluate the role of breathing exercise and yoga/pranayama as …
Exercise rehabilitation following intensive care unit discharge for recovery from
critical illness: executive summary of a Cochrane Collaboration systematic
Connolly B, Salisbury L, O'Neill B, Geneen L, Douiri A, Grocott MP, Hart N, Walsh TS, Blackwood B.
J Cachexia Sarcopenia Muscle. 2016 Dec;7(5):520-526. doi: 10.1002/jcsm.12146. Epub 2016 Sep 16.
PMID: 27891297 Free PMC article. Review.
This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU
discharge on primary outcomes of functional exercise capacity and health-related quality of life.
...Overall quality of evidence for both outcomes was very low. All studi …
Breathing exercises for adults with asthma.
Santino TA, Chaves GS, Freitas DA, Fregonezi GA, Mendon.a KM.
Cochrane Database Syst Rev. 2020 Mar 25;3(3):CD001277. doi: 10.1002/14651858.CD001277.pub4.
BACKGROUND: Breathing exercises have been widely used worldwide as a non-pharmacological
therapy to treat people with asthma. Breathing exercises aim to control the symptoms of asthma
and can be performed as the Papworth Method, the Buteyko breathing techniqu …
Weight Loss for Children and Adults with Obesity and Asthma. A Systematic
Review of Randomized Controlled Trials.
Okoniewski W, Lu KD, Forno E.
Ann Am Thorac Soc. 2019 May;16(5):613-625. doi: 10.1513/AnnalsATS.201810-651SR.
PMID: 30605347 Free PMC article.
Obesity is associated with increased asthma risk and severity, and lower asthma-related quality of life. ...All interventions were designed for weight loss and varied from dietary restrictions to
multifactorial interventions with exercise training and cogniti …
Asthma education for school staff.
Kew KM, Carr R, Donovan T, Gordon M.
Cochrane Database Syst Rev. 2017 Apr 12;4(4):CD012255. doi: 10.1002/14651858.CD012255.pub2.
PMID: 28402017 Free PMC article. Review.
Education about asthma could help to improve this knowledge and lead to better asthma outcomes for children. ...Data for symptom days, night-time awakenings, restricted activities of daily living and school absences were skewed or could not be analysed; some mean sc …
Effects of exercise-based pulmonary rehabilitation on adults with asthma: a
systematic review and meta-analysis.
Feng Z, Wang J, Xie Y, Li J.
Respir Res. 2021 Jan 30;22(1):33. doi: 10.1186/s12931-021-01627-w.
PMID: 33516207 Free PMC article. Review.
BACKGROUND: Pulmonary rehabilitation (PR) has been proposed as an effective method for many respiratory diseases. However, the effects of exercise-based PR on asthma are currently
inconclusive. This review aimed to investigate the effects of exercise-based PR …
Effects of physiotherapy treatment in patients with bronchial asthma: A
Garagorri-Guti.rrez D, Leir.s-Rodr.guez R.
Physiother Theory Pract. 2020 Jun 9r1-11. doi: 10.1080/09593985.2020.1772420. Online ahead of print.
BACKGROUND: Bronchial asthma is a chronic inflammatory disease of the respiratory tract. ...Of
these, 5 evaluated a respiratory reeducation intervention, 4 manual therapy techniques, 2
interventions based on therapeutic exercise and 1 relaxation techniques. . …
Cough in the Athlete: CHEST Guideline and Expert Panel Report.
Boulet LP, Turmel J, Irwin RS; CHEST Expert Cough Panel.
Chest. 2017 Feb;151(2):441-454. doi: 10.1016/j.chest.2016.10.054. Epub 2016 Nov 16.
PMID: 27865877 Free PMC article. Review.
Although there was no formal evaluation of causes of cough in the athletic population, the most
common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract
infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), an …
Effects of physical exercise on lung inflammation in animal models of chronic
allergic lung inflammation: a systematic review.
Martins GHC, Palandi J, DE Campos VHK, Bonorino KC, Hizume Kunzler DC.
Exp Anim. 2020 Mar 23. doi: 10.1538/expanim.19-0140. Online ahead of print.
We performed a systematic review to identify and summarize the effects of distinctive aerobic
exercise (AE) protocols on chronic allergic lung inflammation reported in asthma animal models.
We identified 255 preclinical studies of asthma and AE protocols by c …
Community pharmacy interventions for health promotion: effects on
professional practice and health outcomes.
Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJ,
Cochrane Database Syst Rev. 2019 Dec 6;12(12):CD011207. doi: 10.1002/14651858.CD011207.pub2.
PMID: 31808563 Free PMC article.
The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. ...
Videogames in the Treatment of Obstructive Respiratory Diseases: A Systematic
Torres S.nchez I, Meg.as Salmer.n Y, L.pez L.pez L, Ortiz Rubio A, Rodr.guez Torres J, Valenza
Games Health J. 2019 Aug;8(4):237-249. doi: 10.1089/g4h.2018.0062.
Results: Nine articles were included, of which three used videogames as physical training methods and managed to improve exercise capacity, strength, quality of life, and symptoms. The remaining six articles used videogames to educate patients about the disease and showed …
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