title: Association between maximal aerobic capacity and psychosocial factors in adults with moderate-to-severe asthma.
abstract: BACKGROUND
  The symptoms of asthma impair health-related quality of life (HRQoL), increase anxiety and depression and may keep subjects from engaging in physical exercise. Physical inactivity has been related to poor asthma outcomes; however, the association between physical fitness and psychosocial disorders remains poorly understood.
  
  
  OBJECTIVE
  To verify the association between aerobic capacity, HRQoL, and psychological distress in adults with moderate or severe persistent asthma who were clinically stable.
  
  
  METHODS
  Eighty-eight participants (68 females) with either moderate or severe persistent asthma (age range, 20-60 years) who were under medical treatment for at least 6 months and considered clinically stable were studied. Participants were evaluated on two non-consecutive days. On the first day, the HRQoL, depression and anxiety levels and pulmonary function were assessed. On the second day, subjects underwent cardiopulmonary exercise testing.
  
  
  RESULTS
  Using the agglomerative cluster approach, two clusters were identified: 21 participants (24%) were grouped in Cluster 1, and 67 (76%) were grouped in Cluster 2. Asthmatic subjects from Cluster 1 exhibited increased aerobic capacity, better HRQoL and lower depression levels than did subjects in Cluster 2 (p < .05). No difference was observed between the clusters with respect to gender, age, body mass index (BMI) or pulmonary function (p > .05). The discriminant function model exhibits good accuracy (R(2) = 0.79) and predicted 93% of the case allocations.
  
  
  CONCLUSIONS
  Our results suggest an association between reduced exercise capacity, low HRQoL and increases in depressive symptoms in clinically stable asthmatic subjects. These results suggest the need to assess physical fitness and psychosocial distress during asthma treatment and the importance of a multidisciplinary approach.
authors.affiliation: Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Felipe A R
authors.initials: FA
authors.lastname: Mendes
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Lunardi
authors.forename: Ronaldo A
authors.initials: RA
authors.lastname: Silva
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
authors.forename: Milton A
authors.initials: MA
authors.lastname: Martins
authors.forename: Celso R F
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D015992:Body Mass Index; D003863:Depression / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013147:Spirometry; D055815:Young Adult