Beggs Sean, Foong Yi Chao, Le Hong Cecilia T, Noor Danial, Wood-Baker Richard, Walters Julia A E
Department of Paediatrics, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, Australia, 7000.
Cochrane Database Syst Rev. 2013 Apr 30(4):CD009607. doi: 10.1002/14651858.CD009607.pub2.
Asthma is the most common chronic medical condition in children and a common reason for hospitalisation. Observational studies have suggested that swimming, in particular, is an ideal form of physical activity to improve fitness and decrease the burden of disease in asthma.
To determine the effectiveness and safety of swimming training as an intervention for asthma in children and adolescents aged 18 years and under.
We searched the Cochrane Airways Group's Specialised Register of trials (CENTRAL), MEDLINE , EMBASE, CINAHL, in November 2011, and repeated the search of CENTRAL in July 2012. We also handsearched ongoing Clinical Trials Registers.
We included all randomised controlled trials (RCTs) and quasi-RCTs of children and adolescents comparing swimming training with usual care, a non-physical activity, or physical activity other than swimming.
We used standard methods specified in the Cochrane Handbook for Systematic reviews of Interventions. Two review authors used a standard template to independently assess trials for inclusion and extract data on study characteristics, risk of bias elements and outcomes. We contacted trial authors to request data if not published fully. When required, we calculated correlation coefficients from studies with full outcome data to impute standard deviation of changes from baseline.
Eight studies involving 262 participants were included in the review. Participants had stable asthma, with severity ranging from mild to severe. All studies were randomised trials, three studies had high withdrawal rates. Participants were between five to 18 years of age, and in seven studies swimming training varied from 30 to 90 minutes, two to three times a week, over six to 12 weeks. The programme in one study gave 30 minutes training six times per week. The comparison was usual care in seven studies and golf in one study. Chlorination status of swimming pool was unknown for four studies. Two studies used non-chlorinated pools, one study used an indoor chlorinated pool and one study used a chlorinated but well-ventilated pool.No statistically significant effects were seen in studies comparing swimming training with usual care or another physical activity for the primary outcomes; quality of life, asthma control, asthma exacerbations or use of corticosteroids for asthma. Swimming training had a clinically meaningful effect on exercise capacity compared with usual care, measured as maximal oxygen consumption during a maximum effort exercise test (VO2 max) (two studies, n = 32), with a mean increase of 9.67 mL/kg/min; 95% confidence interval (CI) 5.84 to 13.51. A difference of equivalent magnitude was found when other measures of exercise capacity were also pooled (four studies, n = 74), giving a standardised mean difference (SMD) 1.34; 95% CI 0.82 to 1.86. Swimming training was associated with small increases in resting lung function parameters of varying statistical significance; mean difference (MD) for FEV1 % predicted 8.07; 95% CI 3.59 to 12.54. In sensitivity analyses, by risk of attrition bias or use of imputed standard deviations, there were no important changes on effect sizes. Unknown chlorination status of pools limited subgroup analyses.Based on limited data, there were no adverse effects on asthma control or occurrence of exacerbations.
AUTHORS' CONCLUSIONS: This review indicates that swimming training is well-tolerated in children and adolescents with stable asthma, and increases lung function (moderate strength evidence) and cardio-pulmonary fitness (high strength evidence). There was no evidence that swimming training caused adverse effects on asthma control in young people 18 years and under with stable asthma of any severity. However whether swimming is better than other forms of physical activity cannot be determined from this review. Further adequately powered trials with longer follow-up periods are needed to better assess the long-term benefits of swimming.
哮喘是儿童中最常见的慢性疾病，也是住院的常见原因。观察性研究表明，游泳尤其是一种理想的体育活动形式，有助于提高身体素质并减轻哮喘疾病负担。
确定游泳训练作为18岁及以下儿童和青少年哮喘干预措施的有效性和安全性。
我们于2011年11月检索了Cochrane气道组专业试验注册库（CENTRAL）、MEDLINE、EMBASE、CINAHL，并于2012年7月再次检索CENTRAL。我们还手工检索了正在进行的临床试验注册库。
我们纳入了所有比较游泳训练与常规护理、非体育活动或除游泳外的其他体育活动的儿童和青少年随机对照试验（RCT）和半随机对照试验。
我们采用《Cochrane干预措施系统评价手册》中规定的标准方法。两位综述作者使用标准模板独立评估试验是否纳入，并提取有关研究特征、偏倚风险因素和结局的数据。如果数据未完全发表，我们会联系试验作者索要数据。如有需要，我们会根据具有完整结局数据的研究计算相关系数，以估算基线变化的标准差。
该综述纳入了八项研究，共262名参与者。参与者患有稳定型哮喘，严重程度从轻度到重度不等。所有研究均为随机试验，三项研究的退出率较高。参与者年龄在5至18岁之间，七项研究中的游泳训练为每周两到三次，每次30至90分钟，持续六至十二周。一项研究中的方案为每周六次30分钟训练。七项研究的对照为常规护理，一项研究的对照为高尔夫运动。四项研究中游泳池的氯化状态未知。两项研究使用非氯化泳池，一项研究使用室内氯化泳池，一项研究使用通风良好的氯化泳池。在比较游泳训练与常规护理或其他体育活动的主要结局（生活质量、哮喘控制、哮喘发作或哮喘使用皮质类固醇情况）的研究中，未发现统计学上的显著效果。与常规护理相比，游泳训练对运动能力有临床意义上的影响，以最大努力运动试验中的最大耗氧量（VO2 max）衡量（两项研究，n = 32），平均增加9.67 mL/kg/min；95%置信区间（CI）为5.84至13.51。当汇总其他运动能力测量指标时（四项研究，n = 74），也发现了同等程度的差异，标准化平均差（SMD）为1.34；95% CI为0.82至1.86。游泳训练与静息肺功能参数的小幅增加相关，不同程度具有统计学意义；预测的第一秒用力呼气容积（FEV1）百分比的平均差（MD）为8.07；95% CI为3.59至12.54。在敏感性分析中，按失访偏倚风险或使用估算标准差进行分析，效应大小没有重要变化。游泳池氯化状态未知限制了亚组分析。基于有限的数据，对哮喘控制或发作的发生没有不良影响。
本综述表明，游泳训练在患有稳定型哮喘的儿童和青少年中耐受性良好，并能提高肺功能（中等强度证据）和心肺适能（高强度证据）。没有证据表明游泳训练会对18岁及以下患有任何严重程度稳定型哮喘的年轻人的哮喘控制产生不良影响。然而，本综述无法确定游泳是否优于其他形式的体育活动。需要进一步进行有足够样本量且随访期更长的试验，以更好地评估游泳的长期益处。
