PULMONARY REHABILITATION IN ASTHMATICS CHILDREN. EFFECTS ON EXERCISE TOLERANCE, FUNCTIONAL CAPACITY, PERIPHERAL MUSCLE STRENGTH AND PHYSICAL ACTIVITY: A RANDOMIZED CONTROLLED TRIAL

Mazzuca Reimberg M.1, Pacchi Rodrigues Selmam J.1, Silva Meneses A.1, Bocudo Silva A.1, Wandalsen G.2, Solé D.1, José A.1, Dal Corso S.1, de Cordoba Lanza F.1
1Nove de Julho University, Sao Paulo, Brazil, 2Federal University of São Paulo - UNIFESP, Sao Paulo, Brazil

Background: The chronic effects of asthma cause reduced exercise tolerance in the pediatric population. However, the effects of pulmonary rehabilitation on functional capacity, peripheral muscle strength, and physical activity in daily life (PADL) in children with asthma have not been studied.

Purpose: To evaluate the effects of pulmonary rehabilitation on exercise tolerance, functional capacity, peripheral muscle strength, and PADL in children with asthma.

Methods: This was a preliminary data of a randomized controlled trial with 19 children with asthma divided in two groups: the intervention group (IG, n=10, 11 ± 2 years of age) performed aerobic training (intensity, 60%-80% of maximal heart rate), strength training (intensity, 40%-70%), and chest physiotherapy by Shaker®. The control group (CG, n=9, 12 ± 3 years of age) performed stretching exercises and Shaker®. All patients underwent a supervised program, twice a week for 2 months, with each session lasting 50-60 minutes. The primary outcomes measures were workload performed in the cardiopulmonary exercise test (CPET) on a cycle ergometer (workload increase between 5 and 10 W), and percent of predicted distance walked in the Incremental Shuttle Walk Test (ISWT). Secondary outcomes measures were peripheral muscle strength on biceps and quadriceps assessed by maximal voluntary contraction (MVC) by load cell, and percent of time spent in moderate and vigorous physical activity (%MVPA) and sedentary activity (%SEDA), assessed with accelerometry (at least 4 days and more than 8 h per day). Data presented are mean (CI 95%) intragroup difference (post- minus pre-rehabilitation).

Results: The participants were classified as mild to moderate treated asthma: Global Initiative for Asthma (GINA) 2 (1-4) vs GINA 3 (1-3), P=0.53. FEV1/FVC was 83.0% ± 8.8% vs 90.5 ± 7.7 (P=0.06) for IG and CG, respectively. Preliminary data show that after pulmonary rehabilitation there was no significant difference in IG and CG, respectively, in percent predicted distance walked in the ISWT (-0.6% [-11.7–10.4%] vs 5.2% [-3.0–13.4%], P=0.44), in MVC for biceps (1.2 KgF [-0.4–2.9 KgF] vs 1.6 KgF [-1.6–4.8 KgF], P=0.54), MVC for quadriceps (2.7 KgF [-1.0–6.4 KgF] vs 2.4 KgF [-2.6–7.4 KgF], P=0.19), %MVPA (0.3% [-5.2–36.5%] vs 6.6% [-1.3–1.0%], P=0.39), %SEDA (-2.5% [-7.0–2.0%] vs -5.0% [-11.2–1.1%], P=0.14), and workload in CPET (9.5 W [-4.6–23.8 W] vs 5.1 W [-6.6–19.2 W], P=0.46) wherever there was a clinically important increase in this outcome (>5 W).

Conclusion(s): This preliminary data demonstrate that pulmonary rehabilitation in children with asthma causes clinically significant improvement in CPET workload. No statically difference was observed in all outcomes.

Implications: Pulmonary rehabilitation can be used to improve the exercise tolerance in children with asthma.

Funding acknowledgements: Sao Paulo Research Foundation (FAPESP), grant: 2014/12040-0.

Topic: Paediatrics

Ethics approval: 738192/14, Clinical Trial Number: NCT02383069. Data of registration: 03/03/2015.


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