研究认为运动可改善气喘控制


  【24drs.com】根据「有氧运动对气喘发病率之影响(Ex-Asthma)」随机研究的初步结果,在体适能相对较差的成年人中,12周有氧运动显著改善气喘控制。
  
  加拿大魁北克蒙特娄Concordia大学du Sacre-Coeur医院的Simon Bacon博士等人表示,这篇研究结果认为,运动可作为这类患者药物治疗的辅助方法。
  
  他解释,从历史上看,人们有不鼓励气喘患者运动的迷思,但有趣的是,当患者做运动时,他们往往能够有比较好的感觉。
  
  这篇研究发表为「CHEST 2015: 美国胸腔科医师学院会议 」的最新发布摘要。
  
  Bacon博士最近参与的一篇研究显示,较常运动的气喘患者疾病控制比较好(BMJ Open Respir Res. 2015;2:e000083)。
  
  目前这篇研究中,由医师诊断有气喘的33名患者被随机分组,接受12周受监督的有氧运动,另外33人则是接受常规治疗,所有研究对象的平均年龄为49岁;主要结果是运动后的气喘控制,采用气喘控制问卷(ACQ)评分加以测量。
  
  所有病患都是病况稳定,在开始时,7分ACQ量表的分数是2.0分,都有使用吸入型皮质类固醇治疗,每日剂量相当于至少250 μg的fluticasone。
  
  如果是有共病症、无法运动、肥胖的患者则不被纳入研究,Bacon博士解释,因为体重和气喘之间的关联相当有趣,我们不希望研究结果受到干扰。
  
  一般来说,研究对象被分类为久坐不动-每周进行运动的时间少于60分钟;这不是一个特别有体适能的族群。
  
  运动介入方法包括每周3次受监督的1小时课程,包括10分钟暖身、40分钟有氧运动(在前4周,心律储量为50%-75%,在第5-12周则是70%-85%),以及10分钟缓和;每次课程前15分钟使用支气管扩张剂,每次课程时检查3次心律。
  
  至于常规治疗组,病患在这12周研究期间维持久坐不动的生活形态,每4周联系一次以检视症状、药物与运动程度,在研究结束时,让他们有机会参与运动介入课程。
  
  运动组的气喘控制显著优于常规治疗组(ACQ分数为1.34 vs 1.82;P = .008)。
  
  另外,每周使用短效支气管扩张剂的次数方面,运动组比常规治疗组少将近3次(P = .003),不过,两组在最大耗氧量、乙酰甲胆碱激发试验、肺功能量计、痰液发炎生物标记等方面没有差异。
  
  运动组和常规治疗组在身体质量指数没有差异,但是腰围的变化有显著差异(P = .04)。Bacon博士表示,与我们在对照组看到的增加幅度相比,(运动组)是真正有减少。
  
  运动也有一个心理上的效益,运动组的贝克忧郁量表分数减少4分。Bacon博士表示,这一组是没有忧郁的,所以,即便是非忧郁组,我们确实看到在心情方面有真正有趣的改善。
  
  ETH Zurich的Christina Spengler博士表示,这篇研究相当不错地证明了我们的系统回顾和统合分析所总结的结果。她的研究团队指出,分析的有关气喘药物使用的七篇研究中,大部份报告指出运动可以减少药物的使用,只有两篇研究认为没有影响(Sports Med. 2013;43:1157-1170)。
  
  Spengler博士解释,Bacon博士等人报告的运动的影响不被认为是有临床意义的,因为ACQ量表0.5分是最小的临床相关性差异。
  
  不幸的是,发表的ACQ量表改善与短效β-致效剂使用方面,在评估的任何气喘特异性损伤上的改善都无法适当解释。举例来说,支气管高反应性、肺功能、或发炎等方面并无改变,而其它研究有显示出这些改善;因此,从机转化的论点来看,观察到的有改善的生理基础仍不清楚。
  
  她指出,其它两方面的研究结果也难以解释。
  
  Spengler博士问道,为什么运动训练组(参与研究前久坐不动者)在3个月的耐力训练之后,最大耗氧量并无显著改善?这是相当意外的,是否是运动负荷量不足以改善他们的体适能程度? 还有,为什么对照组的腰围增加?这也是颇为意外。
  
  巴西Sao Paulo大学医学院Celso Carvalho博士表示,很开心看到其它研究团体开始发现运动真正可以改善气喘治疗。
  
  Carvalho博士在气喘与运动方面曾经发表相当多论述,他的研究团队之前提出许多和Bacon博士的团队一样的发现。
  
  他表示,肺功能量计的结果没有改变是令人惊讶的,因为有两篇统合分析显示会有差异。(Br J Sports Med. 2000;34:162-167以及Cochrane Database Syst Rev. 2013;30:CD001116)。
  
  不过,Carvalho博士指出,以他们的样本规模,我本来预期他们会发现,在乙酰甲胆碱激发试验降低、痰液发炎生物标记增加。
  
  资料来源:http://www.24drs.com/
  
  Native link:Exercise Improves Asthma Control, Study Suggests

Exercise Improves Asthma Control, Study Suggests

By Kate Johnson
Medscape Medical News

MONTREAL — In relatively unfit adults, 12 weeks of aerobic exercise significantly improved asthma control, according to preliminary results from the randomized Impact of Aerobic Exercise on Asthma Morbidity (Ex-Asthma) study.

This finding suggests that exercise could be used as an adjunct to pharmacotherapy in this population, said lead investigator Simon Bacon, PhD, from Concordia University and Hopital du Sacre-Coeur in Montreal, Quebec, Canada.

"Historically, people have built this sort of myth that exercise for people with asthma should be discouraged, but anecdotally, when patients do exercise, they tend to report feeling better," he explained.

The study was presented as a late-breaking abstract here at CHEST 2015: the American College of Chest Physicians Meeting.

Dr Bacon was involved in a recent study showing that patients with asthma reporting higher levels of physical activity had better control of their disease (BMJ Open Respir Res. 2015;2:e000083).

In the current study, 33 patients with physician-diagnosed asthma were randomly assigned to receive 12 weeks of supervised aerobic activity and 33 were assigned to receive usual care. Mean age was 49 years. The primary outcome was postexercise asthma control, measured with the Asthma Control Questionnaire (ACQ) score.

All patients had stable but symptomatic disease, indicated by a baseline score of 2.0 on the 7-point ACQ scale, and were treated with inhaled corticosteroids, at a per day equivalent of at least 250μg of fluticasone.

Patients were excluded from the study if they had comorbidities, were unable to exercise, or were obese "because of the interesting relationship between weight and asthma, and we did not want to confound the findings," Dr Bacon explained.

In general, the cohort was classified as "sedentary," performing less then 60 minutes of planned physical activity per week. "This is not a particularly fit population," he pointed out.

The exercise intervention involved three supervised 1-hour sessions each week that consisted of a 10-minute warm-up, 40 minutes of aerobic exercise titrated at 50% to 75% of heart rate reserve for the first 4 weeks and 70% to 85% from weeks5 to 12, and a 10-minute cool-down. Bronchodilators were used 15 minutes before each session, and heart rate checks were performed three times during the session.

For usual care, patients were encouraged to maintain their sedentary lifestyle for the 12-week study period and were contacted every 4 weeks to check on symptoms, medication, and exercise levels. They were given the opportunity to participate in the exercise intervention at the conclusion of the study.

Asthma Control

Asthma control was significantly better in the exercise group than in the usual-care group (ACQ score, 1.34 vs 1.82; P= .008).

In addition, the weekly use of short-acting bronchodilators was nearly three times less in the exercise group than in the usual-care group (P = .003). However, maximal oxygen consumption, the methacholine challenge test, spirometry, and sputum inflammation biomarkers did not differ between groups.

There was also no difference in body mass index between the exercise and usual-care groups, but a significant difference was seen in change in waist circumference (P = .04). "This was really an attenuation of the increase we saw in the control group," said Dr Bacon.

Even in a nondepressed group, we're seeing some really interesting improvements in mood. Dr Simon Bacon

Exercise also had a psychological benefit. Beck Depression Inventory scores decreased 4 points in the exercise group. "And this is a group that was not depressed," said Dr Bacon. "So even in a nondepressed group, we're seeing some really interesting improvements in mood."

This study "nicely confirms previous results summarized in our systematic review and meta-analysis," said Christina Spengler, PhD, MD, from ETH Zurich. Her team showed that most of the seven studies analyzing the use of asthma medication reported a reduction in medication intake with exercise, whereas two studies reported none (Sports Med. 2013;43:1157-1170).

The effect of exercise reported by Dr Bacon and his colleagues would not be considered clinically meaningful because it is suggested that 0.5 is "the minimal clinically relevant difference in ACQ," Dr Spengler explained.

"Unfortunately, the presented improvements in ACQ and short-acting β-agonist use cannot be explained by improvements in any of the asthma-specific impairments assessed," she said. For instance, "there were no changes in bronchial hyper-reactivity, lung function, or inflammation," but such improvements have been shown in other studies.

"Therefore, from a mechanistic point of view, the physiological basis for the observed improvements remains unclear," she pointed out.

Two other aspects of the results are also difficult to explain, she added.

"Why did the exercise training subjects — a sedentary group before the study — have no significant improvement in maximal oxygen consumption after 3 months of endurance training?" Dr Spengler asked. "This is very unexpected. Was the load not high enough for their fitness level?"

"And why did waist circumference increase in the control group? This is also quite unexpected," she added.

"It is exciting to see that other groups are beginning to show that exercise really improves asthma treatment," said Celso Carvalho, PhD, from the University of Sao Paulo School of Medicine in Brazil.

Dr Carvalho, who has published extensively in the field of asthma and exercise, told Medscape Medical News that his group has previously shown many of the findings reported by Dr Bacon's team.

"Their finding of no change in spirometry is surprising, since there are two meta-analyses demonstrating this," he said (Br J Sports Med. 2000;34:162-167 and Cochrane Database Syst Rev. 2013;30:CD001116).

However, "I expect that they would find a reduction in the methacholine challenge test and sputum inflammation biomarkers with an increase in their sample size," Dr Carvalho added.

Dr Bacon reports financial relationships with GlaxoSmithKline, AbbVie, Schering-Plough, Merck, Kataka Medical Communication, and Novartis. Dr Spengler and Dr Carvalho have disclosed no relevant financial relationships.

CHEST 2015: American College of Chest Physicians Meeting. Presented October26, 2015.

    
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