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Published on: August 24, 2019
Exercise rehabilitation in pediatric asthma: A systematic review and network meta-analysis
Jing Jiang1,2, Dong Zhang1,3, Yapan Huang2
1School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.
Insights
Exercise-based pulmonary rehabilitation (PR) improves quality of life and exercise capacity in children with asthma. Interval training enhances quality of life, while combined endurance and respiratory training improves lung function.
Area of Science:
- Pediatric Pulmonology
- Exercise Physiology
- Respiratory Medicine
Background:
- Asthma is a common chronic respiratory disease in children, impacting quality of life and physical function.
- Pulmonary rehabilitation (PR) using exercise interventions is explored for pediatric asthma management.
- Optimizing PR designs is crucial for effective treatment outcomes.
Approach:
- A systematic review and network meta-analysis of 24 randomized controlled trials (RCTs) involving 1031 pediatric asthma patients.
- Searches conducted across major databases: PubMed, Embase, Cochrane Library, Web of Science, and Medline.
- Evaluated various exercise modalities including endurance, respiratory, resistance, strength, and interval training.
Key Points:
- Interval training significantly improved the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) total scores and the 6-minute walk test (6MWT).
- Combined endurance and respiratory training significantly improved forced vital capacity (FVC% pred) and forced expiratory flow (FEF25%-75%).
- No adverse events were reported, indicating safety of exercise-based PR.
Conclusions:
- Exercise-based PR is a safe and effective strategy for pediatric asthma.
- Interval training is a key component for enhancing quality of life and exercise capacity.
- Combined respiratory and endurance training positively impacts lung function parameters.
Objective:
This systematic review delineates various exercise-based pulmonary rehabilitation (PR) designs and quantifies how they may be optimized in pediatric asthma treatment.
Design:
Comprehensive systematic review, network meta-analysis, and quality analyses using PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Medline searches.
Interventions:
Discrete and combined endurance, respiratory, resistance, strength, and interval training.
Main Outcome Measures:
Forced expiratory volume at 1 s to predicted value ratio (FEV1 % pred), forced vital capacity to predicted value ratio (FVC% pred), forced expiratory flow between 25% and 75% of vital capacity ratio (FEF25%-75%), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 6-min walk test (6MWT).
Results:
Twenty-four randomized controlled trials (RCTs) involving a combined 1031 patients were included. Endurance training was the most common form of PR (58.3%), typically conducted through outpatient clinics (29.2%). Network meta-analysis showed that compared with other PR, interval training significantly improved PAQLQ total scores, and activity, symptom, and emotional domains. Interval training also had a significant effect on the 6MWT. No adverse events were reported. Exercise training did not have a significant effect on FEV1 % pred; however, combined endurance and respiratory training significantly improved both FVC% pred and FEF25%-75%.
Conclusions:
Exercise-based PR is safe and effective in childhood asthma treatment. Interval training may be a core component for improving quality of life and exercise capacity in this patient population, while combined respiratory and endurance training may significantly affect lung function. The clinical efficacy of these results should be confirmed through high-quality RCTs.
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