Working Out Works Well in Asthma

ORLANDO – People with asthma who engaged in a structured exercise program had sustained quality-of-life improvements, a small study has shown.

Although exercise is often anathema to people with asthma, previously sedentary people with asthma who were randomized in a small study to engage in three exercise sessions per week reported a twofold greater improvement in their symptom-related quality of life, compared with those who did not increase their routine exercise, reported Dr. Thomas Platts-Mills, professor of medicine, allergy, and clinical immunology at the University of Virginia in Charlottesville.

Neil Osterweil/Elsevier Global Medical News

The preliminary study was designed to convince health insurers to fund structured exercise programs in commercial gyms for patients with asthma, Dr. Platts-Mills said.

"You’ve got three obstacles to overcome: one is that the patients think that it’s a problem having to do exercise, because it will make their asthma worse," he noted. "Secondly, the gym may be resistant, because they think they’ll have asthma attacks to deal with; and third, the insurance companies are resistant, period."

The investigators recruited from a local commercial health plan 13 patients with persistent asthma as defined by National Asthma Education and Prevention Program guidelines. The participants were all treated with inhaled corticosteroids (ICS) and leukotriene agents that were on the health plan’s formulary.

All 13 patients were identified as engaging in no or little exercise (fewer than two sessions of aerobic activity per week over the past 6 months). Patients who participated more than 3 hours per week in any kind of moderate-level physical activity were excluded, as were patients with active pulmonary infections, cardiovascular disease, musculoskeletal disease, or other conditions that might impair their ability to exercise.

The authors convinced the insurer to pay a gym to enroll plan members with asthma, and they helped gym staff establish an asthma protocol that included monitoring asthmatics for symptoms and providing access to nebulizers.

"The gyms, we hope, will want to do this, and it’s very much in the insurance company’s favor to do it," Dr. Platts-Mills said. "But it’s still very difficult to get people to do regular exercise."

The seven participants assigned to the exercise group kept an exercise log recording the duration, type, and perceived exertion of all physical activities, including the three assigned exercise sessions each week. They also kept a log of medication use, asthma symptoms, unplanned medical visits, and unplanned asthma-related absences from work or school. Participants also answered a telephone-based asthma quality of life questionnaire at the end of weeks 4, 8, 12 and 16 (the study’s end).

Six participants assigned to be controls were given educational materials on exercise, participated in the telephone survey, and kept logs recording the same information as that of the exercise group. Researchers crossed over those participants to the exercise arm at 4 months.

At week 8, scores on the symptom domain of the quality-of-life questionnaire were significantly higher among exercisers, with 78.3% of responses indicating improvement, compared with 39.5% of responses by participants in the delayed-exercise group (P = .05).

Similarly, on the activity limitations domain, 78.3% of responding exercisers said they saw improvement, compared with 37.2% of delayed exercisers (P = .036). There were trends favoring exercise, but no significant differences, in the emotional function and environmental stimuli domains of the quality-of-life questionnaire.

"We have established that you can get an insurance company to pay a gym to enroll people and establish a protocol in the gym for asthmatics," Dr. Platts-Mills said. "I think this would be far more important for children with asthma if this could be achieved."

The study was supported by Southern Health Services Inc. Dr. Platts-Mills and colleagues reported that they had no conflicts of interest.

ORLANDO – People with asthma who engaged in a structured exercise program had sustained quality-of-life improvements, a small study has shown.

Although exercise is often anathema to people with asthma, previously sedentary people with asthma who were randomized in a small study to engage in three exercise sessions per week reported a twofold greater improvement in their symptom-related quality of life, compared with those who did not increase their routine exercise, reported Dr. Thomas Platts-Mills, professor of medicine, allergy, and clinical immunology at the University of Virginia in Charlottesville.

Neil Osterweil/Elsevier Global Medical News

The preliminary study was designed to convince health insurers to fund structured exercise programs in commercial gyms for patients with asthma, Dr. Platts-Mills said.

"You’ve got three obstacles to overcome: one is that the patients think that it’s a problem having to do exercise, because it will make their asthma worse," he noted. "Secondly, the gym may be resistant, because they think they’ll have asthma attacks to deal with; and third, the insurance companies are resistant, period."

The investigators recruited from a local commercial health plan 13 patients with persistent asthma as defined by National Asthma Education and Prevention Program guidelines. The participants were all treated with inhaled corticosteroids (ICS) and leukotriene agents that were on the health plan’s formulary.

All 13 patients were identified as engaging in no or little exercise (fewer than two sessions of aerobic activity per week over the past 6 months). Patients who participated more than 3 hours per week in any kind of moderate-level physical activity were excluded, as were patients with active pulmonary infections, cardiovascular disease, musculoskeletal disease, or other conditions that might impair their ability to exercise.

The authors convinced the insurer to pay a gym to enroll plan members with asthma, and they helped gym staff establish an asthma protocol that included monitoring asthmatics for symptoms and providing access to nebulizers.

"The gyms, we hope, will want to do this, and it’s very much in the insurance company’s favor to do it," Dr. Platts-Mills said. "But it’s still very difficult to get people to do regular exercise."

The seven participants assigned to the exercise group kept an exercise log recording the duration, type, and perceived exertion of all physical activities, including the three assigned exercise sessions each week. They also kept a log of medication use, asthma symptoms, unplanned medical visits, and unplanned asthma-related absences from work or school. Participants also answered a telephone-based asthma quality of life questionnaire at the end of weeks 4, 8, 12 and 16 (the study’s end).

Six participants assigned to be controls were given educational materials on exercise, participated in the telephone survey, and kept logs recording the same information as that of the exercise group. Researchers crossed over those participants to the exercise arm at 4 months.

At week 8, scores on the symptom domain of the quality-of-life questionnaire were significantly higher among exercisers, with 78.3% of responses indicating improvement, compared with 39.5% of responses by participants in the delayed-exercise group (P = .05).

Similarly, on the activity limitations domain, 78.3% of responding exercisers said they saw improvement, compared with 37.2% of delayed exercisers (P = .036). There were trends favoring exercise, but no significant differences, in the emotional function and environmental stimuli domains of the quality-of-life questionnaire.

"We have established that you can get an insurance company to pay a gym to enroll people and establish a protocol in the gym for asthmatics," Dr. Platts-Mills said. "I think this would be far more important for children with asthma if this could be achieved."

The study was supported by Southern Health Services Inc. Dr. Platts-Mills and colleagues reported that they had no conflicts of interest.

ORLANDO – People with asthma who engaged in a structured exercise program had sustained quality-of-life improvements, a small study has shown.

Although exercise is often anathema to people with asthma, previously sedentary people with asthma who were randomized in a small study to engage in three exercise sessions per week reported a twofold greater improvement in their symptom-related quality of life, compared with those who did not increase their routine exercise, reported Dr. Thomas Platts-Mills, professor of medicine, allergy, and clinical immunology at the University of Virginia in Charlottesville.

Neil Osterweil/Elsevier Global Medical News

The preliminary study was designed to convince health insurers to fund structured exercise programs in commercial gyms for patients with asthma, Dr. Platts-Mills said.

"You’ve got three obstacles to overcome: one is that the patients think that it’s a problem having to do exercise, because it will make their asthma worse," he noted. "Secondly, the gym may be resistant, because they think they’ll have asthma attacks to deal with; and third, the insurance companies are resistant, period."

The investigators recruited from a local commercial health plan 13 patients with persistent asthma as defined by National Asthma Education and Prevention Program guidelines. The participants were all treated with inhaled corticosteroids (ICS) and leukotriene agents that were on the health plan’s formulary.

All 13 patients were identified as engaging in no or little exercise (fewer than two sessions of aerobic activity per week over the past 6 months). Patients who participated more than 3 hours per week in any kind of moderate-level physical activity were excluded, as were patients with active pulmonary infections, cardiovascular disease, musculoskeletal disease, or other conditions that might impair their ability to exercise.

The authors convinced the insurer to pay a gym to enroll plan members with asthma, and they helped gym staff establish an asthma protocol that included monitoring asthmatics for symptoms and providing access to nebulizers.

"The gyms, we hope, will want to do this, and it’s very much in the insurance company’s favor to do it," Dr. Platts-Mills said. "But it’s still very difficult to get people to do regular exercise."

The seven participants assigned to the exercise group kept an exercise log recording the duration, type, and perceived exertion of all physical activities, including the three assigned exercise sessions each week. They also kept a log of medication use, asthma symptoms, unplanned medical visits, and unplanned asthma-related absences from work or school. Participants also answered a telephone-based asthma quality of life questionnaire at the end of weeks 4, 8, 12 and 16 (the study’s end).

Six participants assigned to be controls were given educational materials on exercise, participated in the telephone survey, and kept logs recording the same information as that of the exercise group. Researchers crossed over those participants to the exercise arm at 4 months.

At week 8, scores on the symptom domain of the quality-of-life questionnaire were significantly higher among exercisers, with 78.3% of responses indicating improvement, compared with 39.5% of responses by participants in the delayed-exercise group (P = .05).

Similarly, on the activity limitations domain, 78.3% of responding exercisers said they saw improvement, compared with 37.2% of delayed exercisers (P = .036). There were trends favoring exercise, but no significant differences, in the emotional function and environmental stimuli domains of the quality-of-life questionnaire.

"We have established that you can get an insurance company to pay a gym to enroll people and establish a protocol in the gym for asthmatics," Dr. Platts-Mills said. "I think this would be far more important for children with asthma if this could be achieved."

The study was supported by Southern Health Services Inc. Dr. Platts-Mills and colleagues reported that they had no conflicts of interest.