Exercise programs improve lung function in adults with asthma
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Key takeaways:
- Relaxation training had the largest impact on FEV1.
- Breathing and aerobic training had the biggest effect on forced vital capacity levels.
- Yoga had the greatest effect on peak expiratory flow.
Adults with asthma who participated in exercise programs including breathing, aerobic, relaxation and yoga training experienced improvements in lung function, according to a review published in Annals of Medicine.
“Breathing training combined with aerobic training, and yoga training, appear to be particularly advantageous, offering potential avenues for effective treatment approaches,” Shuangtao Xing, MEd, associate professor at the School of Physician Education at Henan Normal University, said in a press release.
The review comprised 28 randomized controlled trials involving 2,155 participants, including 18 from Chinese literature and 10 from English literature, published through February 2023.
In 22 studies with 1,670 participants, standardized mean differences (SMDs) in FEV1 indicating improvements with exercise included 0.52 (95% CI, 0.22-0.82) for aerobic training, 0.53 (95% CI, 0.36-0.71) for breathing training, 1.13 (95% CI, 0.84-1.42) for relaxation training, 0.67 (95% CI, 0.48-0.87) for yoga training and 0.98 (95% CI, 0.77-1.18) for combinations of breathing and aerobic training (P < .001 for all modes of exercise).
The researchers found no statistically significant differences between the modes of exercise, although relaxation training was the most effective and breathing training was the least effective in improving FEV1.
Similarly, 17 studies with 1,297 participants examined forced vital capacity (FVC). SMDs indicating improvements included 0.53 (95% CI, 0.3-0.76) for aerobic training, 0.66 (95% CI, 0.5-0.83) for breathing training, 0.42 (95% CI, 0.22-0.61) for yoga training, and 0.71 (95% CI, 0.47-0.95) for combinations of breathing and aerobic training, (P < .001 for all modes).
Again, the researchers found no statistically significant differences between the exercise modalities, although combinations of breathing and aerobic training were most effective and yoga training was least effective in improving FVC.
Seventeen studies with 1,256 participants that examined peak expiratory flow (PEF) found improvements with all modes of exercise as well. SMDs included 0.61 (95% CI, 0.36-0.85; P < .001) for breathing training, 0.53 (95% CI, 0.3-0.76; P < .001) for aerobic training, 0.67 (95% CI, 0.24-1.09; P = .002) for relaxation training, 0.79 (95% CI, 0.53-1.02; P < .001) for yoga training and 0.6 (95% CI, 95% CI, 0.38-0.82; P < .001) for combinations of breathing and aerobic training.
There were no statistically significant differences between these exercises either, the researchers wrote, adding that yoga training was the most effective and aerobic training was the least effective in improving PEF.
Ten studies with 637 participants found improvements in FEV1/FVC with breathing, aerobic and yoga training as well. SMDs included 0.77 (95% CI, 0.52-1.03) for breathing training, 0.49 (95% CI, 0.26-0.72) for aerobic training and 0.54 (95% CI, 0.31-0.77) for yoga training (P < .001 for all modes).
With no statistically significant differences between the different types of exercise, the researchers found that breathing training was most effective and aerobic training was least effective in improving FEV1/FVC.
These improvements in lung function can lead to fewer ER visits, hospitalizations and days in the hospital, the researchers wrote, in addition to reductions in medication and economic burdens among patients with asthma.
Although combinations of breathing and aerobic training and yoga training offered the most advantages, the researchers continued, they cautioned that patient characteristics, family history, environmental influences and disease duration should be considered when designing exercise programs for individual patients.
With physical and mental conditions in mind, the researchers said, exercise intensity, frequency and duration are important in optimizing treatment outcomes.
Future objective and standardized studies should focus on exercise mode, intensity, frequency, age and gender to validate and expand upon the findings of this review, the researchers said.
“Larger, well-designed randomized controlled trials are now needed to more accurately estimate the benefits of exercise training for individuals with asthma,” Xing said.
Perspective
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The meta-analysis study on the effect of exercise intervention on lung function in asthmatic adults was one I read with great interest. It has been my experience, as a provider treating asthma for more than 30 years, that those who maintain their physical fitness have fewer problems with asthma management.
Of course, exercise-induced bronchospasm is a real thing, and those who have it must take appropriate measures such as properly warming up prior to exercise and using a bronchodilator (albuterol) before exercise. Another consideration when exercising, especially outdoors, is pollen exposure. This could be, at least partially, responsible for one’s asthma symptoms.
It is well known that exercise improves overall lung function and capacity. Exercise positively affects overall health, so it is not surprising that aerobic activities would improve lung function. But it was interesting to see how the metrics used in this meta-analysis (breathing training, aerobic training, relaxation training, yoga training, and breathing and aerobic training together) targeted specific aspects of respiratory function.
As mentioned in the study, research has shown that “exercise can promote longitudinal growth of lung volume, improve the FEV1, FVC, FEV1/FVC, and PEF indexes, and improve lung function in asthmatic patients.” Again, this is not surprising as it supports what I believe from experience.
Additionally, exercise has been shown to support immune health, making patients less susceptible to respiratory infections that can trigger asthma exacerbations. Regular exercise has positive effects on mental health and stress reduction. Also, it can help patients maintain a healthy weight, which is important since obesity is a risk factor for asthma and other chronic diseases.
The meta-analysis found that breathing and aerobic training together and yoga training are not only effective in improving lung function but also may represent the most effective methods for enhancing lung function in adult asthmatics. I think most clinicians who treat patients with asthma would believe, at least intuitively, that these interventions make sense and would help.
Studies like this can help providers formulate an individualized training program focusing on regular, consistent exercise based on a patient’s age and gender. As stated in the conclusion, individual factors such as patient characteristics, family history, environmental influences and disease duration should be considered.
Future research, as stated in the study, should be directed toward large-scale, diversified, double-blind trials. These studies should look at the effect of different types of exercise (cardio and strength training), intensity (ratio of zone 2 vs. zone 5 training), and frequency needed to have the optimal effect on asthma control.
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