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Challenging misconceptions about exercise

With just a little thought children and adults with respiratory problems can be encouraged to remain active, says Dr Karine Nohr.

This morning a patient, who I have known for many years, brought her 11 year old asthmatic son in to surgery. I was shocked to see how fat this child had become.

On asking about exercise, I was told that he was unable to exercise, because if he played football, it brought his asthma on. This view had clearly become entrenched and needed challenging.

Many asthmatic patients can understandably develop this attitude and a little bit of time might be usefully spent in addressing this with them, enabling them to see the implications of their choices, and broaden and reconsider their options. Just how useful is exercise for asthmatic patients?

A Cochrane report (2005) looked at this question and concluded that regular exercise does not improve or worsen pulmonary function (though prevention of deterioration would seem important). It does not reduce the total number of days of wheezing. However, cardiopulmonary function is improved, the patients felt subjectively better, had less breathlessness and were able to endure exercise better.

Secondly, there are certain types of exercise that seem to be worse for asthmatics. These include being exposed to cold dry air, polluted air and grass or forests. So sporting activities that may suit these people less include long distance running, football and skiing. If the patient wishes to undertake these activities regardless, they might be advised to cover their nose and mouth.

Activities that may be more suitable include indoor activities or those with short bursts of activity punctuated by more quiescent periods. Indoor swimming, where the air is warm and humid, can bring on relatively less bronchoconstriction. For those that like running, sprinting may be more suitable, with two to five minute runs alternating with 10-15 minute rest periods. Other sports that include bursts of energy alternating with more quiescent periods might include tennis, basketball and cricket.

There are also some patients who do not have underlying asthma, but get exercise induced bronchoconstriction as a paradoxical response to exercise. This peaks after 15 minutes and then takes 60 minutes to return to normal. There is a small amount of evidence that a large dose of 1500mg of vitamin C taken before exercise can reduce the reduction of FEV1, particularly in these patients. It might be worth trying it out, though traditional advice would of course be to use an inhaled beta agonist.

The advice that all kids should have one hour of exercise daily needs upholding, particularly with the need to avoid the obesity that would only compound their respiratory difficulties. So selecting suitable activities may just need a little bit of thought.

In terms of childhood obesity, there are a great couple of programmes running in Sheffield. If a family member is prepared to be involved, there is the NHS ‘Watch It' for seven to 14 year olds which is an extendable three month programme that works with the family. Secondly, there is the council-lead SHINE (Self Help Independence Nutrition and Exercise) for 10 to 17 year olds.

Steroid dependent asthmatics also need exercise, particularly weight bearing exercise, to reduce their risk of osteoporosis.

We have been running a hugely successful ‘yoga for COPD' group for about five years. Even those requiring ambulatory oxygen are included.

The patients absolutely love it and in addition to the physical benefits of improved exercise tolerance, it has provided a great social support system for many who had lost the confidence to even leave their home. Carers are welcome to join too, the social aspect being so important such that after the death of their partner, a couple of the carers have subsequently continued to attend the group.

Dr Karine Nohr is a GP in Sheffield

Dr Karine Nohr