Journal Reading

The efficacy of aerobic training in

improving the inflammatory component
of asthmatic children. Randomized trial

Darvin Febrian
2015-061-076

Summary (1)
Patients were randomized to do aerobic
training (exercise group; n = 14), another
group did not exercise (control; n = 19).
Primary endpoint: evaluation of serum
cytokines (IL-17, IFN, TNF, IL-10, IL-6, IL-4,
and IL-2).
Secondary endpoints: six minute walk
test, pulmonary function, quality of life,
and symptoms (asthma free days).

Introduction (1)
Practicing physical activity should be
a routine part of childrens life.
Children with asthma have lower
level of physical activity compared
with other children of the same age.
Low level of physical activity leads to
chronic deconditioning.

Introduction (2)
Physical exercise improves
cardiopulmonary fitness and asthmarelated symptoms.
It is unclear whether the benefits of
exercise are the result of a direct
effect in improving inflammation in
the airways or whether they are a
consequence of better
cardiorespiratory fitness and
peripheral muscle strength.

Method
Children and adolescents of 6-17
years with persistent moderate
asthma.
Patients with cardiovascular disease,
lung disease, or any musculoskeletal
disorder were excluded.
Participants were selected from
children consulting a pediatric
pneumologist between March 2012
and April 2013.

Training Program
The intervention consisted of
supervised aerobic training
performed three times a week for six
week on an electric treadmill.
5 minutes stretching period, 10
minutes of warm up, 20 minutes of
training (1st to 2nd weeks); 30 minutes
of training (3rd to 6th weeks).
Followed by 5 minutes of cooldown
period.

Determination of Inflammatory
Mediators
To obtain the primary outcome,
peripheral blood was collected (4
mL).
Cytokines measured: IL-2, IL-4, IL-6,
IL-10, IFN, TNF, IL-17A by flow
cytometry using a cytometric bead
array kit for cytokines.

Baseline Evaluation and Follow-up

(1)
Participants were classified as
sedentary (no physical activity),
practicing some physical activity (2
h/week), or active (practicing >2 h of
physical activity per week.
Other evaluations were performed in
both groups at the beginning of the
study and at the end of the 6th week.

Baseline Evaluation and Follow-up

(2)
6 minutes walk test, as standardized
by the American Thoracic Society.
Respiratory muscle strength, using a
mechanical pressure gauge.
Pulmonary function test was
performed using a digital spirometer.
The occurrence of symptoms and
usage of any medications were
recorded in a diary.

Baseline Evaluation and Follow-up

(3)
Quality of life of the patients was
assessed using Pediatric Asthma
Quality of Life Questionnaire
(PAQLQ).

Criteria Defining Discontinuation and

Loss to Follow-up
Experienced exacerbations on three or
more occasions.
Had severe crisis or hospitalized.
Missed 25% of the sessions (4
sessions)

Results (1)
All children managed to keep up with
the intensity of the exercise without
suffering exacerbations.
No changes in medication during the
program.
No changes occurred in spirometric
values following aerobic training,
except for peak expiratory flow (PEF),
which was higher in the exercise
group.

Results (2)
The distance of 6 minutes walk
increased by a mean of 99,7 m in the
exercise group.
Overall PAQLQ score increased
significantly in the exercise group.
Evaluation of symptom scores show
that asthma-free day was greater in
the exercise group.

Discussion (1)
After 6 weeks of aerobic exercise, no
changes could be found in plasma
cytokine patterns in asthmatic
children and adolescents.
There was an improvement in
functional capacity, maximal
respiratory pressure, quality of life,
and number of asthma free day.

Discussion (2)
The small sample size was the
greatest limitation of this study.
Another issue was the method used
for measuring cytokines in plasma.

Summary (2) - Conclusion

Six weeks of aerobic exercise
resulted in no changes in plasma
cytokines.
Increases were found in functional
capacity, maximal respiratory
pressure, quality of life, and diseaserelated symptoms in asthmatic
children.