Abstract
BackgroundAsthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus. Aerobic and breathing exercises have been demonstrated to benefit asthmatic patients; however, there is no evidence comparing the effectiveness of these treatments.Methods/designThis is a prospective, comparative, blinded, and randomized clinical trial with 2 groups that will receive distinct interventions. Forty-eight asthmatic adults with optimized medical treatment will be randomly divided into either aerobic (AG) or breathing exercises (BG). Patients will perform breathing or aerobic exercise twice a week for 3 months, totalizing 24 sessions of 40 minutes each. Before intervention, both groups will complete an educational program consisting of 2 educational classes. Before and after interventions, the following parameters will be quantified: clinical control (main outcome), health related quality of life, levels of anxiety and depression, daily living physical activity and maximal exercise capacity (secondary outcome). Hyperventilation syndrome symptoms, autonomic nervous imbalance, thoracoabdominal kinematics, inflammatory cells in the sputum, fraction of exhaled nitric oxide (FENO) and systemic inflammatory cytokines will also be evaluated as possible mechanisms to explain the benefits of both interventions.DiscussionAlthough the benefits of breathing and aerobic exercises have been extensively studied, the comparison between both has never been investigated. Furthermore, the findings of our results will allow us to understand its application and suitability to patients that will have more benefits for every intervention optimizing its effect.Trial registrationClinicaltrials.gov; Identifier: NCT02065258.
Highlights
Asthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus
Aerobic and breathing exercises have been considered important as complementary therapies in addition to the pharmacological treatment mainly for patients with controlled or partially controlled asthma, because they improve disease control [1]
Asthmatic patients have 2 main clinical conditions that support the importance of these nonpharmacological interventions: they are more prone to be physically deconditioned compared with their peers and they have a high prevalence of hyperventilation symptoms [39]
Summary
Asthma symptoms have a significant impact on patient’s life and the proper clinical treatment is very important to reduce those symptoms; sometimes clinical control is difficult, despite the appropriate amount of prescribed medication. The proposal of our study, comparing the benefits of aerobic and breathing exercises training on clinical control, seems quite relevant because even if both techniques have similar effects in reducing asthma symptoms, we will further investigate some mechanisms in order to understand how patients develop their benefits at each and every intervention. A recent Cochrane review confirmed these benefits and demonstrated that physical training can be well tolerated among people with asthma [42] These studies show us that there was some evidence to suggest that physical training may have positive effects on HRQoL. The practice of breathing exercises have been shown to improve HRQoL, peak expiratory flow, asthma symptoms as well as to reduce the levels of hyperventilation symptoms, anxiety and depression and medication consumption [44]. CRFC: significant manuscript writer; study concept and design; data analysis and interpretation. Dr Arnaldo 455, Rm 1210, São Paulo, SP 01246-903, Brazil. 2Department of Medicine, São Paulo, SP, Brazil. 3Medicine and Pulmonary Diseases, São Paulo, SP, Brazil. 4Sports Center, University of São Paulo, São Paulo, SP, Brazil
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