1 Department of Physical Therapy.
2 Pulmonary Division, Heart Institute (InCor), Clinics Hospital.
Am J Respir Crit Care Med. 2017 Jan 1;195(1):32-42. doi: 10.1164/rccm.201603-0446OC.
Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated.
To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers, and lung function.
Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program plus exercise (WL + E group, n = 28) or a weight-loss program plus sham (WL + S group, n = 27), where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL + E group incorporated aerobic and resistance muscle training, whereas the WL + S group incorporated breathing and stretching exercises.
The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength, and inflammatory/antiinflammatory biomarkers. After 3 months, 51 patients were analyzed. Compared with the WL + S group, the WL + E group demonstrated improved clinical control scores (median [25th to 75th percentile], -0.7 [-1.3 to -0.3] vs. -0.3 [-0.9 to 0.4]; P = 0.01) and greater weight loss (mean ± SD, -6.8% ± 3.5 vs. -3.1% ± 2.6; P < 0.001) and aerobic capacity (median [25th to 75th percentile], 3.0 [2.4 to 4.0] vs. 0.9 [-0.3 to 1.3] ml O × kg × min; P < 0.001). These improvements in the WL + E group were also accompanied by improvements in lung function, antiinflammatory biomarkers, and vitamin D levels, as well as reductions in airway and systemic inflammation.
Adding exercise to a short-term weight-loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients. Clinical trial registered with www.clinicaltrials.gov (NCT 02188940).
肥胖哮喘患者的临床控制较为困难。减重手术已被推荐用于减肥和改善哮喘控制，但对非手术干预的益处研究甚少。
研究减肥计划中的运动训练对哮喘控制、生活质量、炎症生物标志物和肺功能的影响。
55 例肥胖哮喘患者被随机分为减肥计划加运动（WL+E 组，n=28）或减肥计划加假手术（WL+S 组，n=27），减肥计划包括营养（热量限制）和心理治疗。WL+E 组采用有氧运动和抗阻肌肉训练，WL+S 组采用呼吸和伸展运动。
主要结局为 3 个月时哮喘控制的临床改善。次要结局包括生活质量、肺功能、身体成分、有氧能力、肌肉力量和炎症/抗炎生物标志物。3 个月后，51 例患者纳入分析。与 WL+S 组相比，WL+E 组的临床控制评分改善（中位数[25 至 75 百分位数]，-0.7[-1.3 至-0.3]比-0.3[-0.9 至 0.4]；P=0.01）和体重减轻（均值±标准差，-6.8%±3.5%比-3.1%±2.6%；P<0.001）和有氧能力（中位数[25 至 75 百分位数]，3.0[2.4 至 4.0]比 0.9[-0.3 至 1.3]ml O×kg×min；P<0.001）增加更多。WL+E 组的这些改善还伴有肺功能、抗炎生物标志物和维生素 D 水平的改善，以及气道和全身炎症的减少。
在短期减肥计划中加入运动应被视为肥胖哮喘患者实现临床控制的有用策略。临床试验在 www.clinicaltrials.gov 注册（NCT 02188940）。
