Evid Based Nurs 9:44 doi:10.1136/ebn.9.2.44
  • Treatment

Review: physical training increases cardiopulmonary fitness in asthma and does not decrease lung function

 Q In patients with asthma, does physical training improve respiratory and general health?


GraphicData sources:

Cochrane Airways Group Specialised Register, Cochrane Central Register of Controlled Trials, Medline (1966 to May 2005), EMBASE/Excerpta Medica (1980 to May 2005), SportDiscus (1949 to May 2005), Current Contents (1995 to May 2005), Science Citation Index (1995 to May 2005), and reference lists of relevant studies.

GraphicStudy selection and assessment:

randomised controlled trials (RCTs) in any language that compared physical training (whole body aerobic exercise lasting 20–30 min 2–3 times/wk) for ⩾4 weeks with usual activity (no encouragement or training) in patients ⩾8 years of age with asthma. Methodological quality assessment of individual trials included allocation concealment, blinding, baseline comparability, outcome measures, and handling of withdrawals and dropouts.


bronchodilator use, episodes of wheeze, symptoms, exercise endurance, work capacity, walking distance, quality of life, lung function, and cardiopulmonary measurements.


13 RCTs met the selection criteria. 10 RCTs were ⩽3 months in duration, 1 assessed outcomes up to 12 months after the intervention, and 2 did not report follow up. 11 RCTs included children and adolescents only (6–17 y of age), and 2 RCTs included adolescents and adults (16–40 y of age).

Physical training resulted in increases in some physiological measurements: maximum expiratory ventilation, maximum oxygen uptake, and maximum heart rate (table). Work capacity was also increased (table). Physical training and control groups did not differ for peak expiratory flow rate, forced expiratory volume in 1 second, forced vital capacity, or episodes of wheeze. Data were insufficient to determine the effect of physical training on maximum voluntary ventilation, bronchodilator use, symptoms, exercise endurance, walking distance, or quality of life.


In patients with asthma, physical training improves cardiopulmonary fitness and has no harmful effect on lung function.


  1. Lisa Cicutto, RN, PhD, ACNP, CAE
  1. Faculty of Nursing, University of Toronto and Toronto Western Hospital Toronto, Ontario, Canada

      The review by Ram et al addresses pivotal issues in asthma: whether patients with asthma can safely be physically active and whether exercise has long term beneficial effects on pulmonary function. Exercise is a common trigger, especially if asthma is poorly controlled, and can increase airway resistance leading to increased dyspnoea, wheeze, and cough.

      The review by Ram et al suggests that adults and children ⩾8 years of age with asthma experience cardiopulmonary health benefits after physical training. The greatest improvements were observed in indicators of aerobic fitness levels, maximum oxygen uptake, and work capacity. This observation confirms that people with asthma respond to physical training in similar ways to those without asthma.

      Unfortunately, the included studies focused on physiological indicators rather than outcomes associated with living with asthma. The asthma literature is severely limited by a lack of studies assessing meaningful outcomes from a patient perspective, such as symptom experience, need for rescue medications, confidence in ability to exercise, and ability to keep up with peers in terms of physical activity. Nurses can extend work in this area by exploring the effects of exercise on quality of life and other meaningful patient outcomes.

      Inactivity is common in patients with asthma. They have often adapted too well to asthma, learning to prevent symptoms by avoiding physical activity. Indeed, they may not realise how many activities they have given up over the years. It is important that nurses inquire about the details of patients’ physical activity levels rather than simply asking whether asthma interferes with their activities.

      People with asthma need to participate in physical activity in order to enjoy its many benefits. To help patients succeed in their physical activities, steps to prevent exercise-induced asthma should be reviewed to ensure that their asthma is under good control.

      Physical training v usual activity for asthma*

 Q In patients with asthma, does physical training improve respiratory and general health?


      • For correspondence: Dr F S F Ram, School of Health Sciences, Massey University – Albany, Auckland, New Zealand. fsfram{at}

      • Source of funding: no external funding.

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