Asthma.
Conditions
Keywords
exercise, bronchial hyperresponsiveness, inflammation
Brief summary
Exercise training has been proposed as adjunctive therapy in asthma to improve many clinical outcomes; however its effects on bronchial hyperresponsiveness (BHR) and inflammation, characteristic features in asthma, remains poorly understood. We aim to investigate the effects of aerobic training on BHR (primary aim) and systemic inflammation (secondary aim). In addition, clinical control and health related quality of life (HRQoL) will be also assessed.
Detailed description
This is a randomized, controlled and single-blind trial whose intervention will be an aerobic training. Fifty -eight patients with moderate or severe persistent asthma will be recruited at a university hospital and randomly assigned in two groups: control (CG) or training (TG) .The study will be performed between two medical visits with intervals of six months and during this period the same medication dosage will be maintained. Patients in CG will perform (an educational program + breathing exercise; n=28) and TG patients will perform (an educational program+breathing exercises+aerobic training; n=30).The sessions will be conducted twice a week, for 3 months. Before and after the intervention, all patients will be evaluated by bronchial hyperresponsiveness, serum cytokines levels, total immunoglobulin E, induced sputum, fractional exhaled nitric oxide (FeNO), asthma clinical control (daily symptoms dairy, exacerbations and asthma control questionnaire - ACQ), health related quality of life (HRQoL); asthma quality of life questionnaire-(AQLQ), pulmonary function and cardiopulmonary exercise testing. All the patients will be evaluated by specific immunoglobulin E (atopy) through (skin prick test or Phadiatop).
Interventions
OTHERAerobic training
the intervention will be an aerobic training program. For the TG subjects, breathing exercises will have duration of 30 minutes and will be always followed by aerobic training sessions that will consist in 35 minutes divided in 5 minutes of warm-up, 25 minutes of aerobic training and 5 minutes of cool down. Initially, aerobic training will be performed at the heart rate (HR) corresponding to one third of the difference between the anaerobic threshold (AnT) and the respiratory compensation point (RCP) obtained in the incremental cardiopulmonary testing (CPET) and after two weeks of the adaptation, the intensity will increased to two thirds of the difference between AnT and RCP. The program will be performed twice a week, for 3 months.
OTHERBreathing exercise
Patients from the control group will be taught breathing exercises with 30 min per session , twice a week , during 3 months. Every exercise will be performed in sets of 3 (2 min each) and 60 s of rest .
Sponsors
University of Sao Paulo
Fundação de Amparo à Pesquisa do Estado de São Paulo
Instituto de Investigação em Imunologia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
20 Years to 59 Years
Healthy volunteers
No
Inclusion criteria
* Patients with moderate and severe persistent asthma * Asthma will diagnosed according to Global Initiative for Asthma (GINA) * Body Mass Index \<35 kg/ m2 * Patients will submitted the medical treatment, followed by pulmonary specialists for at least 6 months. Patients will considered clinically stable (i.e., no exacerbation or changes in medication for at least 30 days).
Exclusion criteria
* Patients will diagnosed with cardiovascular, musculoskeletal or other chronic lung diseases; * Patients with current participation in exercise programs * current smokers or ex-smokers will excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Bronchial hyperresponsiveness | Before and after 3 months of intervetion | The bronchial provocation test will be conducted according to American Thoracic Society (ATS) guideline (1999). Patients will inhale increasing concentrations of histamine following the sequences: 0.0625, 0.25, 1.0, 4.0 and 16.0 mg/ ml using the method of the dosimeter (DeVilbiss 646nebulizer, DeVilbiss Health Care, USA) . Forced expiratory volume in one second (FEV1) will be measured after 30 and 90 seconds from the end of inhalations. The test will considered positive when the concentration of histamine promotes a fall ≥ 20% in FEV1 (PC20) with respect to the post-saline value or when the maximum concentration is reached (16 mg/mL). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| serum cytokines levels | Before and after 3 months of intervention | The plasma levels of inflammatory mediators will be evaluated before and after 3 months of intervention.The method Cytometric Beat Array (CBA) (BD Biosciences, USA) will be used to analyze the levels of interleukins (IL) IL-4, IL-5, IL-6, IL-8, IL -10, Tumor Necrosis Factor (TNF-α) and IL-12p70 and chemokines IL-8, Monocyte Chemotactic Protein-1 (MCP-1/CCL2) and RANTES |
Other
| Measure | Time frame | Description |
|---|---|---|
| Clinical control | before and after 3 months of intervention | Clinical control will be evaluated by daily symptoms dairy , exacerbation and asthma control questionnaire (ACQ) and |
| Health related quality of life | before and after 3 months of interventions | Health related quality of life will be assessed by the Asthma Quality Life Questionnaire (AQLQ) . |
Countries
Brazil
Contacts
Primary ContactPedro Giavina-Bianchi, MD, PhD
Outcome results
None listed