A Meta Analysis of Physical Exercise on Improving Lung Function and Quality of Life Among Asthma Patients

Figures & data

Figure 1 Literature screening process. # PubMed=908, EMbase=1090, The Cochrane Library=1742, Web of Science=519, CBM=151, Wan Fang=315, VIP=141, CNKI=199.

Table 1 Basic Features of the Included Literature

Literature	Year of Publication	Sample Size T/C	Age T/C	Country/Region	Severity of the Disease	Intervention Features of Physical Exercise					Outcome Indicators
						Type of Exercise	Exercise Cycle	Exercise Duration	Exercise Frequency (Times/Week)	Exercise Intensity
Cochrane and Clark.^Citation12	1990	18/18	27/28	UK	(mild, moderate)	Aerobic exercise (bicycle, jogging, callisthenics exercise)	3 months	30min	3	75% of the maximum heart rate	FEV1(%pred)
Van et al^Citation22	2001	23/24	10.5/10.7	Netherlands	(mild, moderate)	Free choice by child-patients	3 months	30min	2	Individualized intensity	FEV1(%pred)
Counil et al^Citation13	2003	7/7	14/13.9	France	(mild, moderate)	Oxygen escalation to ventilation threshold (bicycle)	6 weeks	45min	3	Increase to anaerobic threshold	FEV1(%pred)
Basaran et al^Citation25	2006	31/31	10.3/10.4	Turkey	(moderate)	Combined exercise (basketball, callisthenics exercise)	8weeks	50min	3	70—85% of individual’s maximum capacity	FEV1(%pred), PAQLQ
Moreira et al^Citation14	2008	17/17	12.9/12.5	Portugal	(mild)	Aerobic exercise,	12weeks	50min	2	70—85% of individual’s maximum capacity	FEV1(%pred), PAQLQ
Wang and Hung.^Citation15	2009	15/15	10/10	China (Taiwan)	Diagnosed as asthma by The American thoracic society (ATS)	Aerobic exercise (swimming)	6weeks	50min	3	65% of the maximum heart rate	FEV1(%pred)
Cheng Boli.^Citation23	2010	50/49	9.1/9.1	China	Diagnosed as asthma by Pediatric Branch of Chinese Medical Association	Free choice by child-patients	4 months	20min	3	Individualized intensity	FEV1(%pred), PAQLQ
Turner et al^Citation16	2011	19/15	65.3/71.0	Australia	(moderate, severe)	Aerobic exercise (walking, bicycle, muscular endurance training	6 weeks	90min	3	12–14 range of the scale Borg6–20 RPE	AQLQ
Chen and Yang.^Citation27	2012	27/25	—	China	(moderate)	Breathing exercise(Tai Chi), aerobic exercises (jogging, swimming)	4 years	60min	5	60–80% of the heart rate	FEV1(%pred)
LI and Wang.^Citation17	2016	15/12	12.5/10.8	China	(moderate)	Cycling at intervals	8 weeks	30s*4*4(intensity duration 8min)	3	90% of the maximum heart rate	FEV1(%pred)
		14/12	11.7/10.8			Aerobic cycling	8 weeks	40min	4	50% of the maximum heart rate	FEV1(%pred)
Abdelbassetet al^Citation18	2018	19/19	9.8/10.0	Saudi Arabia	(moderate)	Incremental aerobic (running)	10 weeks	40min	3	70% of the maximum heart rate	FEV1(%pred)
Carew and Cox.^Citation19	2018	9/12	13.3/12.0	Ireland	(mild, moderate)	Aerobic exercise (swimming)	6 weeks	40min	1	—	FEV1(%pred)
		9/12	13.2/12.0			Combined exercise (football)
		11/12	13.5/12.0			Combined exercise (basketball)
Toennesen et al^Citation20	2018	29/34	39.4/38.2	Denmark	Diagnosed as asthma	Aerobic Incremental Exercise (bicycle)	8 weeks	10,15,20(min) increase by weeks	3	30%–60%–90% increase according to individual’s capacity	FEV1(%pred), AQLQ
Tan Jing et al^Citation24	2019	80/76	8.2/8.0	China	Diagnosed as asthma according to the standard of Chinese Medical Association	Free choice by child-patients	3 months	30min	3	Individualized intensity	FEV1(%pred), PAQLQ,
Verónica et al^Citation26	2020	25/28	12.1/11.1	Spain	(mild, moderate)	Resistance exercise	12 weeks	60min	3	40%5RM-60%5RM*15	PAQLQ
Gülcan and Tan.^Citation28	2020	56/56	37.4/40.2	Turkey	Diagnosed as asthma by local thoracic hospital	Yoga (breathing exercise)	6 weeks	70min	3	—	FEV1(%pred), AQLQ
Gao Wei^Citation29	2020	60/60	40.6/40.9	China	Diagnosed as asthma	Aerobic exercises(swimming, running) and breathing exercise(Tai Chi)	—	60min	3	60–80% of heart rate	FEV1(%pred)
Chen and Wang.^Citation21	2020	20/20	11.4/12.1	China	(mild, moderate)	Aerobic exercise(fixed treadmill)	3 months	30min	3	50%–60%–70% increase to maximum heart rate	FEV1(%pred), AQLQ

Note: T for experimental group; C for control group; “—” means no record in the papers.

Figure 2 Risk of bias summary.

Figure 3 Risk of bias graph.

Figure 4 Improvements of physical exercise to lung function FEV1(%pred).

Figure 5 Effect of Physical Exercise on quality of life Scale.

Table 2 Subgroup Analyses of the Effect of Physical Exercise on Lung Function FEV1 (%) Among Asthma Patients

Research Features	Groups	Included Papers/Sample Size	MD	95% CI	P value of MD	I^2/%	Heterogeneity of P
Type of exercise	Aerobic exercise	(9) 296	2.45	0.06, 4.84	0.04	19	0.27
	Combined exercise	(2) 87	0.79	−3.94, 5.51	0.74	0	0.38
	Free choice of exercise	(3) 302	1.63	−0.48, 3.75	0.13	0	0.66
	Breathing exercise	(3) 284	20.08	13.33, 26.83	<0.01	67	0.05
Exercise intensity	<80%	(8) 189	6.07	0.76, 11.83	<0.01	77	<0.01
	80%~90%	(6) 168	1.95	−0.28, 4.18	0.09	62	0.03
	Individualized intensity	(3) 302	1.63	−0.48, 3.75	0.13	0	0.66
	Unrecorded	(2) 166	13.48	9.00, 20.52	<0.01	87	<0.01
Age	<10	(3) 283	3.05	1.12, 4.89	<0.01	70	0.04
	10~20 year-old	(10) 152	0.40	−1.69, 2.49	0.92	0	0.71
	>20 year-old	(4) 331	12.89	9.44, 16.33	<0.01	90	<0.01
Exercise duration	≤40min	(9) 295	2.50	0.83, 4.17	<0.01	4	0.41
	40~60min	(4) 132	−0.09	−2.89, 2.70	0.95	0	0.97
	≥60min	(3) 284	19.46	15.65, 23.27	<0.01	67	0.05

Table 3 A Sensitivity Analysis of Physical Exercise on Quality of Life of Asthma Patients

Excluded Literature	MD	95% CI	P (Combined Effect)	I^2/%
Gülcan2020	0.41	0.32, 0.51	<0.001	18

Figure 6 Improvements on lung function FEV1(%pred) after eliminating heterogeneous papers.

Figure 7 Improvements on quality of life after eliminating heterogeneous papers.

Figure 8 Subgroup analyses of the effect of physical exercise on lung function FEV1 (%) among asthma patients.

Figure 9 Improvement of quality of life by aerobic exercise.

Table 4 Sensitivity Analysis of FEV1 (%pred) in Respiratory Exercise Group

Excluded Papers	MD	95% CI	P (Combined Effect)	I/%
Gülcan and Tan2020	16.64	11.96, 21.33	<0.01	4
Gao Wei 2020	23.34	17.49, 29.18	<0.01	20
Chen and Yang 2012	20.27	9.44, 31.11	<0.01	83

Cochrane LM, Clark CJ. Benefits and problems of a physical training programme for asthmatic patients. J Cardiopulm Rehabil Prev. 1992;12(5):345–351.

 Google Scholar

Van Veldhoven NHMJ, Vermeer A, Bogaard JM, et al. Children with asthma and physical exercise: effects of an exercise programme. Clin Rehabil. 2001;15(4):360–370. doi:10.1191/026921501678310162

 PubMed Web of Science ®Google Scholar

Counil FP, Varray A, Matecki S, et al. Training of aerobic and anaerobic fitness in children with asthma. J Pediatr. 2003;142(2):179–184. doi:10.1067/mpd.2003.83

 PubMed Web of Science ®Google Scholar

Basaran SS, Guleruysal FF, Ergen NN, et al. Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma. J Rehabil Med. 2006;38(2):130–135. doi:10.1080/16501970500476142

 PubMed Web of Science ®Google Scholar

Moreira A, Delgado L, Haahtela T, et al. Physical training does not increase allergic inflammation in asthmatic children. Eur Respir J. 2008;32(6):1570.130–135. doi:10.1183/09031936.00171707

 Web of Science ®Google Scholar

Wang JS, Hung WP. The effects of a swimming intervention for children with asthma. Respirology. 2010;14(6):838–842. doi:10.1111/j.1440-1843.2009.01567.x

 Web of Science ®Google Scholar

Boli C, Study on the role of exercise in the prevention and management of childhood asthma [D] Chongqing Medical University, 2010.

 Google Scholar

Turner S, Eastwood P, Cook A, et al. Improvements in symptoms and quality of life following exercise training in older adults with moderate/severe persistent asthma. Respiration. 2010;81(4):302–310. doi:10.1159/000315142

 PubMed Web of Science ®Google Scholar

Ming C, Yang G. Effect of exercise on rehabilitation treatment of patients with bronchial asthma . J Wannan Med Coll. 2012;1(6):458–461.

 Google Scholar

Jia L, Xingqiao W, Army B, et al. The role of high-intensity intermittent exercise and medium intensity continuous exercise in the management of childhood asthma . J Beijing Sport Univ. 2016;39(10):58–64.

 Google Scholar

Abdelbasset WK, Alsubaie SF, Tantawy SA, et al. Evaluating pulmonary function, aerobic capacity, and pediatric quality of life following a 10-week aerobic exercise training in school-aged asthmatics: a randomized controlled trial. Patient Prefer Adherence. 2018;12:1015–1023. doi:10.2147/PPA.S159622

 PubMed Web of Science ®Google Scholar

Carew C, Cox DW. Laps or lengths? The effects of different exercise programs on asthma control in children. J Asthma. 2017;55:881–887.

 Web of Science ®Google Scholar

Toennesen LL, Meteran H, Hostrup M, et al. Effects of exercise and diet in nonobese asthma patients—A randomized controlled trial. J Allergy Clin Immunol Pract. 2017;2017:S2213219817307912.803–811.

 Google Scholar

Jing T, Chengjun L, Junming H, et al. Application of exercise prescription in condition control of children with asthma. Chin J Child Health. 2019;27(12):1331.

 Google Scholar

Sanz‐Santiago V, Diez‐Vega I, Santana‐Sosa E, et al. Effect of a combined exercise program on physical fitness, lung function, and quality of life in patients with controlled asthma and exercise symptoms: a randomized controlled trial. Pediatr Pulmonol. 2020;55:1608–1616.

 PubMed Web of Science ®Google Scholar

Turan GB, Tan M. The effect of yoga on respiratory functions, symptom control and quality of life of asthma patients: a randomized controlled study. Complement Ther Clin Pract. 2020;38(1):101070. doi:10.1016/j.ctcp.2019.101070

 PubMed Web of Science ®Google Scholar

Wei G. Effectiveness analysis of respiratory training combined with exercise therapy in patients with asthma in remission . China Pract Med. 2020;15(24):154–156.

 Google Scholar

Qiong C, Fengqin W, Sun X. Experimental study on aerobic exercise improving exercise ability and quality of life of asthmatic children . Guangzhou Sports Institute Daily. 2020;40(5):125–128.

 Google Scholar