The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol

Simon L Bacon, Kim L Lavoie, Jean Bourbeau, Pierre Ernst, Karim Maghni, Denyse Gautrin, Manon Labrecque, Veronique Pepin, Bente Klarlund Pedersen, Simon L Bacon, Kim L Lavoie, Jean Bourbeau, Pierre Ernst, Karim Maghni, Denyse Gautrin, Manon Labrecque, Veronique Pepin, Bente Klarlund Pedersen

Abstract

Objective: Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles.

Design: A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50-75% of heart rate reserve for weeks 1-4, then 70-85% for weeks 5-12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques.

Ethics and dissemination: The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time.

Results: The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research participants and (3) the general public.

Registration details clinicaltrialsgov identifier: NCT00953342.

Keywords: Exercise; Inflammation; Quality of life.

Figures

Figure 1
Figure 1
Schematic of participant timeline.

References

    1. The National Asthma Control Task Force. 2000. The Prevention and Management of Asthma in Canada: A major challenge now in the future.
    1. Rundall TG, Shortell SM, Wang MC, et al. As good as it gets? Chronic care management in nine leading US physician organisations. BMJ 2002;325:958–61
    1. Statistics Canada. Persons with asthma by age and sex. Secondary Persons with asthma by age and sex. .
    1. Chen Y, Johansen H, Thillaiampalam S, et al. Asthma. Health Rep 2005;16:43
    1. Chapman KR, Rea RM, Boulet LP. Primary care assessment of asthma control; discordance with guideline recommendations. Am J Respir Crit Care Med 2005;171:A549
    1. Statistics Canada. National Population Health Survey, 1996/7. (Health share file)
    1. Lemière C, Bai T, Balter M, et al. Adult Asthma Consensus Guidelines Update 2003. Can Respir J 2004;11(Suppl A):9A–33A
    1. Global Initiative for Asthma Global Strategy for Asthma Management and Prevention: NIH Publication No 02–3659, 2005
    1. Boulet LP, Bai TR, Becker A, et al. What is new since the last (1999) Canadian Asthma Consensus Guidelines? Can Respir J 2001;8(Suppl A):5A–27A
    1. Boulet LP, Becker A, Berube D, et al. Canadian Asthma Consensus Report, 1999. Canadian Asthma Consensus Group. Can Med Assoc J 1999;161(11 Suppl):S1–61
    1. Rabe KF, Adachi M, Lai CKW, et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol 2004;114:40–7
    1. Lucas SR, Platts-Mills TA. Physical activity and exercise in asthma: relevance to etiology and treatment. J Allergy Clin Immunol 2005;115:928–34
    1. Chinen J, Shearer WT. Basic and clinical immunology. J Allergy Clin Immunol 2005;116:411–18
    1. Wills-Karp M. Interleukin-13 in asthma pathogenesis. Immunol Rev 2004;202:175–90
    1. Ichinose M, Barnes PJ. Cytokine-directed therapy in asthma. Curr Drug Targets Inflamm Allergy 2004;3:263–9
    1. Thorburn AN, Hansbro PM. Harnessing regulatory T cells to suppress asthma: from potential to therapy. Am J Respir Cell Mol Biol 2010;43:511–19.
    1. Chandratilleke MG, Carson KV, Picot J, et al. Physical training for asthma. Cochrane Database Syst Rev 2012;5:CD001116.
    1. Juniper EF, O'Byrne PM, Guyatt GH, et al. Development and validation of a questionnaire to measure asthma control. Eur Respir J 1999;14:902–7
    1. Turner S, Eastwood P, Cook A, et al. Improvements in symptoms and quality of life following exercise training in older adults with moderate/severe persistent asthma. Respiration 2011;81:302–10
    1. Mendes FAR, Almeida FM, Cukier A, et al. Effects of aerobic training on airway inflammation in asthmatic patients. Med Sci Sports Ex 2011;43:197–203
    1. Juniper EF. Asthma Control Questinnnaire (ACQ). Secondary Asthma Control Questinnnaire (ACQ). .
    1. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate; a longitudinal study. Ann Med Exp Bio Fenniae 1957;35:307–15
    1. McFadden ER, Gilbert IA. Exercise-induced asthma. N Engl J Med 1994;330:1362–67
    1. Milgrom H. Exercise-induced asthma: ways to wise exercise. Curr Opin Allergy Clin Imm 2004;4:147–53
    1. Storms WW. Asthma associated with exercise. Imm Allergy Clin North Amer 2005;25:31–43
    1. Storms WW. Review of exercise-induced asthma. Med Sci Sports Ex 2003;35:1464–70
    1. American College of Sports Medicine Guidelines for exercise testing and prescription. 6th edn Baltimore, MD: Lippincott, Williams & Wilkins, 2000
    1. American Thoracic Society Pulmonary rehabilitation—1999. Am J Respir Crit Care Med 1999;159:1666–82
    1. Blumenthal JA, Sherwood A, Babyak MA, et al. Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial. JAMA 2005;293:1626–34
    1. Juniper EF, O'Byrne PM, Ferrie PJ, et al. Measuring asthma control. Clinic questionnaire or daily diary? Am J Respir Crit Care Med 2000;162(4 Pt 1):1330–4
    1. Juniper EF, Stahl E, Mork AC, et al. Minimal important difference for the asthma control questionnaire. Eur Respir J 2004;24:460s
    1. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004;113:59–63
    1. Schatz M, Sorkness CA, Li JT, et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 2006;117:549–56
    1. GINA Dissemination Committee Dissemination and Implementation of Asthma Guidelines: Global Initiative for Asthma, 2003
    1. Juniper EF, Guyatt GH, Ferrie PJ, et al. Measuring quality of life in asthma. Am Rev Respir Dis 1993;147:832–8
    1. Juniper EF, Wisniewski ME, Cox FM, et al. Relationship between quality of life and clinical status in asthma: a factor analysis. Eur Respir J 2004;23:287–91
    1. Leidy NK, Coughlin C. Psychometric performance of the Asthma Quality of Life Questionnaire in a US sample. Qual Life Res 1998;7:127–34
    1. Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 1994;47:81–7
    1. Pin I, Gibson PG, Kolendowicz R, et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax 1992;47:25–9
    1. Pizzichini E, Pizzichini MM, Efthimiadis A, et al. Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med 1996;154(2 Pt 1):308–17
    1. Maghni K, Lemiere C, Ghezzo H, et al. Airway inflammation after cessation of exposure to agents causing occupational asthma. Am J Respir Crit Care Med 2004;169:367–72
    1. Luminex Corp. Product Guide. Secondary Product Guide. .
    1. Ram FSF, Robinson SM, Black PN. Effects of physical training in asthma: a systematic review. Br J Sports Med 2000;34:162–7
    1. Ram FSF, Robinson SM, Black PN. Physical training for asthma. Cochrane Database Syst Rev 2005;2:2
    1. American Thoracic Society, American College of Chest Physicians ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211–77
    1. Jones NL. Clinical exercise testing. 4th edn Philadelphia: WB Saunders, 1997
    1. American Thoracic Society Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med 1995;152:1107–36
    1. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines). J Am Coll Cardiol 2002;40:1531–40
    1. Juniper EF, Cockcroft DW, Hargreave FE. Histamine and methacholine inhalation tests: tidal breathing method; laboratory procedure and standardization. 2nd edn Lund, Sweden: AB Draco, 1991
    1. American Thoracic Society Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144:1202–18
    1. Knudson RJ, Lebowitz MD, Holberg CJ, et al. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Resp Dis 1983;127:725–34
    1. Goldman HI, Becklake MR. Respiratory function tests; normal values at median altitudes and the prediction of normal results. Am Rev Tuberc 1959;79:457–67
    1. Cotes JE, Hall AM. The transfer factors for the lung; normal values in adults. In: Arcangeli P.ed Normal values for respiratory function in man. Torino Panminerva Medica, 1970:327–43
    1. Enright PL, Kronmal RA, Higgins M, et al. Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. Am Rev Respir Dis 1993;147:125–33
    1. Lavoie KL, Cartier A, Labrecque M, et al. Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients? Respir Med 2005;99:1249–57
    1. Lavoie KL, Bacon SL, Labrecque M, et al. Body mass index is associated with worse asthma control and quality of life among adult asthma patients. Respir Med 2006;100:648–57
    1. Lavoie KL, Bacon SL, Barone S, et al. What's worse for asthma control and quality of life: mood disorders, anxiety disorders, or both? Chest 2006;130:1039–47
    1. Berkman L, Breslow L, Wingard D. Health practices and mortality risk. In: Berkman L, Breslow L.eds Health and ways of living: the Alameda County Study. New York: Academic Press, 1983:115–60
    1. Statistics Canada. Canadian Health Measures Survey (CHMS). Secondary Canadian Health Measures Survey (CHMS). .
    1. Buysse DJ, Reynolds CFI, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213
    1. Stevens G, Cho J. Socioeconomic indices and the new 1980 occupational classification scheme. Soc Sci Res 1985;14:142–68
    1. Taylor A, Cheng KK. Social deprivation and breast cancer. J Public Health Med 2003;25:228–33
    1. Bem SL. Sex role inventory—short form (BSRI-Short). Palo Alto, CA: CPP/Consulting Psychologists Press, 1981
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24:67–74
    1. Bailey WC, Kohler CL, Richards JM, Jr, et al. Asthma self-management: do patient education programs always have an impact? Arch Int Med 1999;159:2422–8
    1. Hoffman-Goetz L. Exercise and immune function. Boca Raton, FL: CRC Press, 1996
    1. Moher D, Jones A, Lepage L. Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. JAMA 2001;285:1992–5
    1. Montori VM, Guyatt GH. Intention-to-treat principle. Can Med Assoc J 2001;165:1339–41
    1. Goldhammer E, Tanchilevitch A, Maor I, et al. Exercise training modulates cytokines activity in coronary heart disease patients. Int J Cardiol 2005;100:93–9
    1. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51:1173–82
    1. Judd CM, Kenny DA, McClelland GH. Estimating and testing mediation and moderation in within-subject designs. Psychol Methods 2001;6:115–34
    1. Kraemer HC, Wilson GT, Fairburn CG, et al. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 2002;59:877–83
    1. Kraemer HC, Stice E, Kazdin A, et al. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 2001;158:848–56
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Royal Stat Soc 1995;57:289–300
    1. Benjamini Y, Drai D, Elmer G, et al. Controlling the false discovery rate in behavior genetics research. Behav Brain Res 2001;125:279–84
    1. Benjamini Y, Yekutieli D. The control of the false discovery rate in multiple testing under dependency. Ann Stat 2001;29:1165–88
    1. Rubin DB. Multiple imputation for nonresponse in surveys. New York: John Wiley & Sons, 1987
    1. Harrell FE. Regression modeling strategies. New York: Springer, 2001
    1. International Committee of Medical Journal Editors. 2009. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Ethical Considerations in the Conduct and Reporting of Research: Authorship and Contributorship. Secondary Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Ethical Considerations in the Conduct and Reporting of Research: Authorship and Contributorship. .
    1. Chan A-W, Tetzlaff JM, Gøtzsche PC, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013;346:e7586.

Source: PubMed

3
Subscribe