The role of physical training in asthma.

The wide interpatient and intrapatient variability in asthma severity necessitates an individualized approach to rehabilitation. Objectives of management are first, to determine the exercise capacity of the patient; second, to prescribe specific exercise rehabilitation according to the results of evaluation and illness severity; and third, to provide supervised hospital-based programs for specific subgroups. Disability in asthma is influenced by psychosocial variables, including attitude to exercise, education, social circumstances, and personality. A difference in perceived limitation and actual ability is often present. A 4-quadrant analysis is used to illustrate the interrelation between exercise intensity and the resulting ventilatory response in determining training effect in an individual with asthma. Medically supervised training using these principles can significantly improve "cardiovascular fitness" variables and submaximal ventilatory and metabolic responses. Breathlessness is also decreased over a wide range of work corresponding to activities of daily living. PIE evaluation can be used to determine the choice of rehabilitation program to improve either exercise capacity or alternatively muscle strength and mobility depending on individual capabilities.