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Medical Forum / Diseases and Disorders / Asthma / October 2004

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Cardiovascular Exercise and Asthma

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Martin Kelly - 03 Oct 2004 21:47 GMT
I enjoy running a few miles 2-3 times a week. My wife would like to join me,
but she asthma. She has tried a training schedule designed for people
without respiratory problems and complained of discomfort related to asthma.
Does anyone have suggestions or know of special training programs developed
for asthmatics?

Marty Kelly
Richard Friedel - 04 Oct 2004 08:09 GMT
> I enjoy running a few miles 2-3 times a week. My wife would like to join me,
> but she asthma. She has tried a training schedule designed for people
[quoted text clipped - 3 lines]
>
> Marty Kelly

Do a Net search on SIMT devices (a sort of choke held in the mouth for
inspiratory muscle training) to see what the various manufacturers are
offering for asthmatics.

This is an alternative approach backed by scientific tests. Here's a
possible argument in favor of the method.

From a study of the asthma literature by gleaning the Net the it may
be seen that asthmatics differ from normal persons in that they are
not able to do a deep inspiration, that would open up the chest.
Asthma research is however here centered on there being a defect in
tissues of  the muscles themselves which could be corrected by a
pharmaceutical.

Breathing is positively affected by nose airway resistance (Swift et
al. (Lancet, 73-75, 16.1.1988)) – lack of nose resistance reduces lung
capacity.

Therefore the positive effects of an SIMT device on asthma are likely
to be due to an enabling effect on the inspiratory muscles.  They are
dependent on resistance.  This cannot however be proved by spirometry
where a maximum deep inhale  is not dependent on how you "breathe" in.

In any case one is faced with (a) the statements in modern scientific
asthma studies that muscle weakness plays a critical role and (b) the
statements of the developers and researchers that SIMT does in fact
strengthen them, so just where is the difficulty in accepting SIMT?
It seems to be a question of the right hand knowing what the left hand
is doing.

The only obstacle seems to be the standard belief that an obstruction
to breathing in is really an obstruction and not a promoting factor.
Variations in nose resistance could be the mystery factor in asthma.
Regards,  Richard Friedel
Steve Freides - 04 Oct 2004 16:28 GMT
>I enjoy running a few miles 2-3 times a week. My wife would like to
>join me,
[quoted text clipped - 4 lines]
> developed
> for asthmatics?

Please tell us what medications, if any, your wife takes.  She might
find a simple change in her medication is all she needs.

Training programs take at least a few weeks to show results and your
wife might need to ease in more gradually - consider throwing away the
training "schedule" and just having her do what feels good.  A simple
program: 20 minutes 3x/week but alternate running and walking to remain
comfortable.  If that means she runs for 1 minute then walks for 4, so
be it.  The idea is to put in the time but not to become terribly
uncomfortable - being able to walk when you feel the need accomplishes
this for most people, and most people eventually learn to run for 20
minutes non-stop.

You might also want to discuss the training specifics on
news:rec.running, a very busy but generally very helpful newsgroup.

-S-
http://www.kbnj.com
Martin Kelly - 05 Oct 2004 01:28 GMT
She uses the Advair Diskus - this allows her to inhale in a crushed pill.
Each dosage contains 100 mcg fluticasone propionate and 50 mcg salmeterol.
She takes this once a day. She did attempt to take this just before training
and did say it helped.

Marty Kelly

> >I enjoy running a few miles 2-3 times a week. My wife would like to
> >join me,
[quoted text clipped - 23 lines]
> -S-
> http://www.kbnj.com
Evgenij Barsukov - 05 Oct 2004 14:16 GMT
>>>I enjoy running a few miles 2-3 times a week. My wife would like to
>>>join me,
[quoted text clipped - 4 lines]
>>>developed
>>>for asthmatics?

Yes, check out exercises for chest muscles and respiratory apparatus
that specifically targets asthmatics and not only does not cause
attacks but can actually stop an ongoing attack:
http://sudy_zhenja.tripod.com/strelnikova_exercises.htm

Regards,
Evgenij

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Steve Freides - 06 Oct 2004 14:12 GMT
> She uses the Advair Diskus - this allows her to inhale in a crushed
> pill.
[quoted text clipped - 3 lines]
> training
> and did say it helped.

The usual recommendation for Advair is twice a day or approximately once
every 12 hours - she might want to ask her doctor about that.  The
medications in Advair are not quick-acting.  I'm not a doctor but my
layman's understanding is that the first medicine, the steroid, needs to
be taken consistently for several weeks to become effective, while the
bronchial dilator salmeterol is a long-acting medicine that, for
different reasons, also doesn't work right away.  Your wife might
experiment with taking Advair sooner, perhaps 45-90 minutes before
running, and she might also ask her doctor about Albuterol (or similar),
a quick-acting bronchial dilator that _is_ suitable to for taking a few
minutes before exercise.  If taking a quick-acting dilator like
Albuterol 15-20 minutes before exercise brings noticeable relief, a
review of her overall medicine program may be in order, e.g., Advair
100/50 twice a day is worth experimenting with, and her doctor might
even want her to try the 250/50 or 500/50 version.  Then again, he may
tell her that he prefers her to take a puff of Albuterol before running
and dispense with the Advair altogether - or one of any number of other
possible changes.  Indeed, consulting a second physician is always worth
considering as well.  I have, e.g., gotten better advice from my general
physician over the years for my asthma than I have gotten from any of
the breathing specialists I've seen.

I'll plug the medicine Singulair while I'm here - I have seen it work
wonders for many people, including me.  I take it every day and it makes
a big difference in the quality of my life.  Singulair has very few
sides effects - none whatsoever for me - and, if I was forced to get rid
of all my medicines but one, this would be the one I'd keep.  Your wife
might want to ask her doctor to try it.  Singulair, from what I know of
it, is also something that must be taken for a few weeks before it
really works, at least that's how it seems to me and to others in my
family.  In particular, my mother got into the habit of trying it only
when she felt bad and always said it never did anything for her, but
when we convinced her to take it every day, her symptoms improved
noticeably.

Allow me to remind you both again that exercise takes weeks to adapt to,
and in many ways months and years and not just weeks.  Please be sure
that she eases into things and allows her body time to adapt to the
stresses of exercise.

> Marty Kelly
>
[quoted text clipped - 31 lines]
>> -S-
>> http://www.kbnj.com
Lou Pecora - 06 Oct 2004 17:38 GMT
> I'll plug the medicine Singulair while I'm here - I have seen it work
> wonders for many people, including me.  I take it every day and it makes
[quoted text clipped - 8 lines]
> when we convinced her to take it every day, her symptoms improved
> noticeably.

I'll second this.  I started taking Singulair several years ago.  I
could not run in the mornings at all anymore (many years before I got
asthmatic I typically ran 4 or 5 miles at a good pace).  Then after
asthma set after  half mile I had to stop to gasp for air.  After
singulair (only on it a few days) I started running a few miles and
eventually built up to 3 to 4 miles of running (not jogging).  At 57 I'm
hardly going to match the pace I used to keep in my 30's, but I can run,
bike, work hard without problems.  It's worth a try.  I have no side
effects.

-- Lou Pecora  (my views are my own)
00doc - 09 Oct 2004 14:18 GMT
> She uses the Advair Diskus - this allows her to inhale in
> a crushed
[quoted text clipped - 3 lines]
> take this
> just before training and did say it helped.

The training schedule for an asthmatic shouldn't be a whole
heck of a lot different then for other people who have not
been all that active for a while. The main difference is how
you handle the asthma (as opposed to the training). The
asthma does add a safety dimension to the normal advice to
start slow and slowly build but the advice basically remains
the same.

If she gets symptoms while exersizing then the first step
would probably be to add a fast acting bronchodilator (like
albuterol) before the exercize. If that does not do it then
increasing the preventative meds is probably needed. The
100ug size of Advair is usually considered a pediatric dose
and she is ony taking half of that. It would probably help
to move up to the 25ug or 500ug size. Also, if she does not
seem to need it on a daily basis then she may be able to
drop the Serevent part and just go with an inhaled steroid.

Keep in mind that cold air and weather changes are also
triggers for a lot of asthmatics so she many need to vary
her routine depending on the weather.

Signature

00doc

David S-H - 04 Oct 2004 18:45 GMT
I can't see a problem with running/training for someone with asthma. Paula
Radcliffe (marathon runner) is asthmatic and only really suffered at the
Olympics because of the high humidity and heat.  It's just a case of how
your wife's medication is managed or used before and during training.  It
also depends whether your wife has exercise induced asthma or not, which can
be made worse by the training.  Your wife's discomfort *might* of course be
the result of being less fit than she thought she was. Exercise can cause
breathlessness, and IMHO if you're asthmatic you're much more aware of how
breathless you are (for fear of an attack etc), so are more concerned when
you can't breath easily.  As someone else says, if she takes it easy and
slows the training down, she might find it helps.  I've also always found a
heart rate monitor helps, as you automatically moderate your training by
reference to the heart rate, rather than how wheezy or breathless you feel.
Finally, I've been using a SIMT device (Powerbreathe), and have noticed a
slight improvement in my stamina when exercising.

Rgds

David

> I enjoy running a few miles 2-3 times a week. My wife would like to join me,
> but she asthma. She has tried a training schedule designed for people
[quoted text clipped - 3 lines]
>
> Marty Kelly
Richard Friedel - 06 Oct 2004 10:38 GMT
> I can't see a problem with running/training for someone with asthma. Paula
> Radcliffe (marathon runner) is asthmatic and only really suffered at the
[quoted text clipped - 15 lines]
>
> David
My conclusions from experimenting with Powerbreathe etc. is that the
constant, fixed suction effect created is not sophisticated enough to
meet the respiratory system's real needs.

Once you accept from the Swift reference (previous posting on this
topic) that nasal resistance is of  critical importance for lung
function (and not merely an impediment as widely supposed – think of
the unsuccessful breathe right  strips to open up the nostrils), then
it seems obvious to consider research on sniff maneuvers and diaphragm
activation ("recruitment"). See on Medline e. g  Eur J Appl Physiol.
2001 Oct;85(6):593-8.     "Effects of muscle group recruitment on
sniff transdiaphragmatic pressure and its components".    Verin E et
al. The aim of this study is however not to develop breathing
exercises for self-treatment but to promote medicalization.

With a bit of skill the diaphragm activating effect of a sniff may be
felt.  If you then gently press on your nostrils, you may sense that
diaphragm action is proportional to nostril resistance or nose lumen.
Another way is to breathe in through the mouth with a finger between
your lips.  Varying this gap seems to be a more convenient way of
varying the suction effect.

So it seems that the Powerbreathe as an SIMT device would only serve
to create a sort of "nose lumen awareness" as a positive factor and
not provide the actual nitty gritty.

From my annual experience of "autumn bronchitis" I get every year a
way of coaxing my so sluggish lungs to open up for exercise is to
inhale noisily through my open mouth using the tongue as a brake for
the air. The difficulty is finding a suitable uphill slope  for the
right intensity and the right length of time.  Breathing efforts
during an inhale should not involve such a level of suction that your
skin around the collar bones is being unnaturally drawn in.

Based on Swift's findings the main problem with asthma is to adopt a
different metaphysic, a different basic instinct on breathing.  On the
other hand for practical purposes Dr. Hahn's approach might lead to a
better solution as opposed to a study of the technicalities of
breathing itself. Regards,  Richard Friedel
 
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