CHAPTER 16 • EXERCISE AND CHRONIC DISEASE 99- Caution must be used in planning an exercise program
for patients with cerebral palsy. Scoliosis, contrac-
tures, chronic arthritis, and risk of hip subluxation can
limit patient’s physical ability. Likewise, patients
often suffer from sensory defects, such as poor vision.
Lastly, behavioral and emotional maladjustments can
be present, so special accommodations may need to
be made (Vessey, 1996).
ASTHMA
- The cardiorespiratory fitness of asthmatic patients is
frequently suboptimal, either because of symptom-
limited exercise tolerance or secondary decondition-
ing from inactivity (Clark, 1999).
•When physically fit and free from significant airway
obstruction, the maximal heart rate, ventilation, blood
pressure, and work capacity of asthma patients fall
within the normal range (Bundgaard, 1985). - Sedentary asthmatics produce more lactate and are
more subject to acidosis than unfit individuals without
asthma who undertake similar physical exertion
(McFadden, Jr, 1984).
•Patients who followed aerobic exercise programs have
demonstrated reductions in airway responsiveness
(Cochrane and Clark, 1990). - It is not clear if the improvement in fitness translates
into a reduction in symptoms or an improvement in
the quality of life (Ram, 2000b). - In a systematic review, physical training had no
effect on resting lung function but led to an improve-
ment in cardiopulmonary fitness as measured by an
increase in maximum oxygen uptake of 5.6
mL/kg/min (95% confidence interval 3.9 to 7.2)
(Ram, 2000a). - Asthma sufferers who exercise regularly may have
fewer exacerbations, use less medication, and miss
less time from school and work (Szentagothai et al,
1987). - Recommendations for rehabilitation of asthmatic
patients include individualized exercise prescription
and advice based on objective criteria of exercise
capability (Clark, 1999).
CHRONIC LUNG DISEASE
IN CHILDREN
CYSTIC FIBROSIS (BRADLEY, 2002;
PRASAD, 2002)
•Exercise is believed to be beneficial to patients with
cystic fibrosis.
- Decreased breathlessness allows greater mobility and
participation with peers in social and sporting activi-
ties, improves confidence and self-esteem, and creates
a greater pleasure in life for the individual patient. - Limitations in exercise performance appear related to
the extent of lung disease and compromised nutri-
tional status. - One systematic review found that the small size, short
duration, and incomplete reporting of most of the
trials limit conclusions about the efficacy of physical
training in cystic fibrosis.
BRONCHOPULMONARY DYSPLASIA- There is limited information concerning the exercise
performance of long-term survivors of bronchopul-
monary dysplasia.
BRONCHIECTASIS•A systematic review only found evidence of the bene-
fits of inspiratory muscle training and provided no
evidence of the effect of other types of physical train-
ing (including pulmonary rehabilitation) in bronchiec-
tasis; however, the review included only two studies.
•Left ventricular diastolic functions are affected in
bronchiectasis, and the performance of patients is
dependent on their pulmonary status. This is the first
study demonstrating the cardiac effects of bronchiecta-
sis according to our survey of the published literature.COPD IN ADULTS- Studies consistently demonstrate that peripheral mus-
cles are weak in patients with chronic obstructive
pulmonary disease(COPD), exhibiting effort-dependent
strength scores that are 70–80% of these measures in
age-matched healthy subjects (Storer, 2001). - In COPD patients, up to 40% of total oxygen intake
during low-level exercise is devoted to the respiratory
muscles, compared to 10–15% in healthy persons
(Mink, 1997). - In a review of 32 studies, 31 showed increased exercise
tolerance after a training program (Belman, 1996). The
most dramatic improvements are often seen in the
most severely impaired patients (Mink, 1997).
•Exercise training improves the fitness of patients with
mild or moderate COPD, but has not been shown to
significantly benefit quality of life, dyspnea, or long-
term disease progression (Chavannes, 2002).