title: Comparison between breathing and aerobic exercise on clinical control in patients with moderate-to-severe asthma: protocol of a randomized trial.
abstract: BACKGROUND
  Asthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus. Aerobic and breathing exercises have been demonstrated to benefit asthmatic patients; however, there is no evidence comparing the effectiveness of these treatments.
  
  
  METHODS
  This is a prospective, comparative, blinded, and randomized clinical trial with 2 groups that will receive distinct interventions. Forty-eight asthmatic adults with optimized medical treatment will be randomly divided into either aerobic (AG) or breathing exercises (BG). Patients will perform breathing or aerobic exercise twice a week for 3 months, totalizing 24 sessions of 40 minutes each. Before intervention, both groups will complete an educational program consisting of 2 educational classes. Before and after interventions, the following parameters will be quantified: clinical control (main outcome), health related quality of life, levels of anxiety and depression, daily living physical activity and maximal exercise capacity (secondary outcome). Hyperventilation syndrome symptoms, autonomic nervous imbalance, thoracoabdominal kinematics, inflammatory cells in the sputum, fraction of exhaled nitric oxide (FENO) and systemic inflammatory cytokines will also be evaluated as possible mechanisms to explain the benefits of both interventions.
  
  
  CONCLUSIONS
  Although the benefits of breathing and aerobic exercises have been extensively studied, the comparison between both has never been investigated. Furthermore, the findings of our results will allow us to understand its application and suitability to patients that will have more benefits for every intervention optimizing its effect.
  
  
  BACKGROUND
  Clinicaltrials.gov; Identifier: NCT02065258.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Evaristo
authors.forename: Milene G
authors.initials: MG
authors.lastname: Saccomani
authors.forename: Milton A
authors.initials: MA
authors.lastname: Martins
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
authors.forename: Marcos R
authors.initials: MR
authors.lastname: Rodrigues
authors.forename: Danilo F
authors.initials: DF
authors.lastname: Santaella
authors.affiliation: Department of Physical Therapy, School of Medicine, University of São Paulo, Av, Dr Arnaldo 455, Rm 1210, São Paulo, SP 01246-903, Brazil. cscarval@usp.br.
authors.forename: Celso R F
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D001007:Anxiety / Q000209:etiology; D001249:Asthma / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D001945:Breathing Exercises; D003863:Depression / Q000209:etiology; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy; D017079:Exercise Tolerance; D006801:Humans; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D016037:Single-Blind Method