Determinants of Physical Fitness in Children With Asthma

American Academy of Pediatrics (AAP) - Tập 113 Số 3 - Trang e225-e229 - 2004
Paolo T. Pianosi1, Heather S. Davis1
1From the Department of Pediatrics, Dalhousie University, Halifax, Canada

Tóm tắt

Rationale. This study was designed to examine the relationships among weight, asthma severity, physical activity, and aerobic fitness in children with asthma. Subjects and Methods. Sixty-four asthmatic children 8 to 12 years old (53% female) were assessed while attending a summer asthma camp. Measures included height and weight, spirometry, histamine bronchial provocation challenge, maximal aerobic power, and questionnaires to quantify habitual activity, perceived activity limitations due to asthma, perceived competence in physical activity, and attitudes toward physical activity. Asthma severity was determined from spirometric indices (forced expiratory volume during the first second), degree of airway hyperresponsiveness, and amount of medication prescribed. Results. There was no correlation between asthma severity and aerobic fitness. Only perceived competence at physical activity was found to have a significant correlation with aerobic fitness. Appropriate-weight, overweight, or obese (defined by body mass index) children all had similar results for maximum aerobic power and level of habitual activity. However, overweight or obese children reported greater limitation of physical activity. Their asthma-impairment scores were higher than the scores of appropriate-weight peers, although standard measures of pulmonary function were no different among groups. The higher asthma-severity scores were related to greater medication needs in the overweight or obese children with asthma. Conclusions. Lower maximum aerobic power in asthmatic children is related more to how capable they perceive themselves than to asthma severity. Overweight asthmatic children experience greater limitation of physical activity and thus are prescribed more medication, although by standard measures of asthma severity, they are very similar to normal-weight peers with asthma. Efforts should be directed at understanding the reasons responsible for reduced exercise tolerance before escalating pharmacologic treatment.

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Tài liệu tham khảo

Milgrom H, Taussig LM. Keeping children with exercise-induced asthma active. Pediatrics.1999;104(3). Available at: www.pediatrics.org/cgi/content/full/104/3/e38

Boulet LP, Becker AB, Berube D, Beveridge R, Ernst P. Canadian asthma consensus report, 1999. CMAJ.1999;161(11 suppl):S1–S5

Strunk RC, Mrazek DA, Fukuhara JT, Masterson J, Ludwick SK, LaBrecque JF. Cardiovascular fitness in children with asthma correlates with psychological functioning of the child. Pediatrics.1989;84:460–464

Fink G, Kaye C, Blau H, Spitzer SA. Assessment of exercise capacity in asthmatic children with various degrees of activity. Pediatr Pulmonol.1993;15:41–43

Hedlin G, Graff-Lonnevig V, Freyschuss U. Working capacity and pulmonary gas exchange in children with exercise-induced asthma. Acta Paediatr Scand.1986;75:947–954

Strunk RC, Rubin D, Kelly L, Sherman B, Fukuhara J. Determination of fitness in children with asthma. Use of standardized tests for functional endurance, body fat composition, flexibility, and abdominal strength. Am J Dis Child.1988;142:940–944

Weston AR, Macfarlane DJ, Hopkins WG. Physical activity of asthmatic and nonasthmatic children. J Asthma.1989;26:279–286

Santuz P, Baraldi E, Filippone M, Zacchello F. Exercise performance in healthy children with asthma: is it different from that of healthy controls?Eur Respir J.1997;10:1254–1260

Garfinkel SK, Kesten S, Chapman KR, Rebuck AS. Physiologic and non-physiologic determinants in mild to moderate asthma. Am Rev Respir Dis.1992;145:741–745

Babb TG, Viggiano R, Hurley B, Staats B, Rodarte JR. Effect of mild-to-moderate airflow limitation on exercise capacity. J Appl Physiol.1991;70:223–230

Anderson SD. Exercise-induced asthma. In: Middleton E, Reed C, Ellis E, Adkinson NF Jr, Yanginger JW, Busse WW, eds. Allergy. Principles and Practice. Vol 2. St Louis, MO: Mosby; 1993:1343–1368

Jones NL. Clinical Exercise Testing. Third ed. Toronto, ON, Canada: WB Saunders Co; 1988:58–59

Figueroa-Muñoz JI, Chinn S, Rona RJ. Association between obesity and asthma in 4–11 year old children in the UK. Thorax.2001;56:133–137

von Mutius E, Schwartz J, Neas LM, Dockery D, Weiss ST. Relation of body mass index to asthma and atopy in children: the National Health and Nutrition Examination Study III. Thorax.2001;56:835–838

Chinn S, Rona RJ. Can the increase in body mass index explain the rising trend in asthma in children?Thorax.2001;56:845–850

Schacter LM, Salome CM, Peat JK, Woolcock AJ. Obesity is a risk factor for asthma and wheeze but not airway hyperresponsiveness. Thorax.2001;56:4–8

Sin DD, Jones RL, Man SFP. Obesity is a risk factor for dyspnea but not for airway obstruction. Arch Intern Med.2002;162:1477–1491

Gokbel H, Atas S. Exercise-induced bronchospasm in nonasthmatic obese and nonobese boys. J Sports Med Phys Fitness.1999;39:361–364

Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med.1995;152:1107–1136

Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis.1983;127:725–734

Cockcroft DW, Killian DN, Mellon JJA, Hargreave FE. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy.1977;7:235–243

Hay J, Atkinson SA, Halton J. Examination and Reliability of the HAES. Proceedings of Pediatric Work Physio Symposium XVIII. Champaign, IL: Human Kinetics Publishers; 1995:49

Bukstein DA, McGrath MM, Buchner DA, Landgraff J, Goss TG. Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients. J Allergy Clin Immunol.2000;105:245–251

Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis.1993;147:832–838

Harter S. The perceived competence scale for children. Child Dev.1982;53:87–97

Schulz RW, Smoll FL, Carre FA, Mosher RE. Inventories and norms for children’s attitudes toward physical activity. Res Q Exerc Sport.1985;56:256–265

Guidelines for the evaluation of impairment/disability in patients with asthma. Am Rev Respir Dis.1993;147:1056–1061

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ.2000;320:1240–1243

Rosier MJ, Bishop J, Nolan T, Robertson CF, Carlin JB, Phelan PD. Measurement of functional severity of asthma in children. Am J Respir Crit Care Med.1994;149:1434–1441

Ortega AN, Belanger KD, Bracken MB, Leaderer BP. A childhood asthma severity scale: symptoms, medications, and health care visits. Ann Allergy Asthma Immunol.2001;86:405–413

Ward DS, Bar-Or O. Use of the Borg scale in exercise prescription for overweight youth. Can J Sport Sci.1990;15:120–125

Stenius-Aarniala B, Poussa T, Kvarnstrom J, Gronlund EL, Ylikahri M, Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ.2000;320:827–832

Belamarich PF, Luder E, Kattan M, Mitchell H, Islam S, Lynn H, Crain EF. Do obese inner-city children with asthma have more symptoms than non-obese children with asthma?Pediatrics.2000;106:1436–1441

Luder E, Melnik TA, DiMaio M. Association of being overweight with greater asthma symptoms in inner city black and Hispanic children. J Pediatr.1998;132:699–703

Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA.1999;282:2131–2135

Ding DJ, Martin JG, Macklem PT. Effects of lung volume on maximal methacholine-induced bronchoconstriction in normal humans. J Appl Physiol.1987;62:1324–1330

Shardonofsky FR, Martin JG, Eidelman DH. Effect of body posture on concentration-response curves to inhaled methacholine. Am Rev Respir Dis.1992;145:750–755

Fredberg JJ, Inouye DS, Mijailovich SM, Butler JP. Perturbed equilibrium of myosin binding in airway smooth muscle and its implications in bronchospasm. Am J Respir Crit Care Med.1999;159:959–967

Thomson RJ, Bramley AM, Schellenberg RR. Airway muscle stereology: implications for increased shortening in asthma. Am J Respir Crit Care Med.1996;154:749–757

Montgomery GL, Tepper RS. Changes with airway reactivity with age in normal infants and children. Am Rev Respir Dis.1990;142:1372–1376

Tepper RS, Stevens J, Eigen H. Heightened airway hyperresponsiveness in normal female children compared with adults. Am J Respir Crit Care Med.1994;149:678–681

Stecenko AA, Hutchison AA. Phascinating Physiology. Am Rev Respir Dis.1991;144:1008–1011

Stock SM, Arnott J, Turner DJ, Young S, Landau LI, LeSouëf PN. Bronchial responsiveness and lung function in recurrently wheezy infants. Am Rev Respir Dis.1991;144:1012–1015

Welsman JR, Armstrong N. Daily physical activity and blood lactate indices of aerobic fitness in children. Br J Sports Med.1992;26:228–232

Welk GJ, Corbin CB, Dale D. Measurement issues in the assessment of physical activity levels in children. Res Q Exerc Sport.2000;71(suppl 2):59–73

Cooper DanM, Poage J, Barstow TJ, Springer C. Are obese children truly unfit? Minimizing the confounding effect of body size on the exercise response. J Pediatr.1990;166:223–230

Maffeis C, Zaffanello M, Zoccante L, Schutz Y, Pinelli L. Maximal aerobic power during running and cycling in obese and non-obese children. Acta Pediatr Scand.1994;83:113–116

Ward DS, Blimkie CJR, Bar-Or O. Rating of perceived exertion in obese adolescents [abstract]. Med Sci Sports Exerc.1986;18(suppl):A355