title: Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial.
abstract: BACKGROUND
  The benefits of aerobic training for the main features of asthma, such as bronchial hyperresponsiveness (BHR) and inflammation, are poorly understood. We investigated the effects of aerobic training on BHR (primary outcome), serum inflammatory cytokines (secondary outcome), clinical control and asthma quality of life (Asthma Quality of Life Questionnaire (AQLQ)) (tertiary outcomes).
  
  
  METHODS
  Fifty-eight patients were randomly assigned to either the control group (CG) or the aerobic training group (TG). Patients in the CG (educational programme+breathing exercises (sham)) and the TG (same as the CG+aerobic training) were followed for 3 months. BHR, serum cytokine, clinical control, AQLQ, induced sputum and fractional exhaled nitric oxide (FeNO) were evaluated before and after the intervention.
  
  
  RESULTS
  After 12 weeks, 43 patients (21 CG/22 TG) completed the study and were analysed. The TG improved in BHR by 1 doubling dose (dd) (95% CI 0.3 to 1.7 dd), and they experienced reduced interleukin 6 (IL-6) and monocyte chemoattractant protein 1 (MCP-1) and improved AQLQ and asthma exacerbation (p<0.05). No effects were seen for IL-5, IL-8, IL-10, sputum cellularity, FeNO or Asthma Control Questionnaire 7 (ACQ-7; p>0.05). A within-group difference was found in the ACQ-6 for patients with non-well-controlled asthma and in sputum eosinophil and FeNO in patients in the TG who had worse airway inflammation.
  
  
  CONCLUSIONS
  Aerobic training reduced BHR and serum proinflammatory cytokines and improved quality of life and asthma exacerbation in patients with moderate or severe asthma. These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma.
  
  
  BACKGROUND
  NCT02033122.
authors.affiliation: Departments of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, Sao Paulo, Brazil.
authors.forename: Andrezza
authors.initials: A
authors.lastname: França-Pinto
authors.affiliation: Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Felipe A R
authors.initials: FA
authors.lastname: Mendes
authors.affiliation: Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Regina Maria
authors.initials: RM
authors.lastname: de Carvalho-Pinto
authors.affiliation: Departments of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, Sao Paulo, Brazil.
authors.forename: Rosana Câmara
authors.initials: RC
authors.lastname: Agondi
authors.affiliation: Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.affiliation: Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
authors.affiliation: Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Beatriz M
authors.initials: BM
authors.lastname: Saraiva-Romanholo
authors.affiliation: Departments of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, Sao Paulo, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.affiliation: Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Milton A
authors.initials: MA
authors.lastname: Martins
authors.affiliation: Departments of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, Sao Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Giavina-Bianchi
authors.affiliation: Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Celso R F
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016535:Bronchial Hyperreactivity / Q000209:etiology / Q000517:prevention & control*; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Asthma; Exercise; Pulmonary Rehabilitation