Does physical activity strengthen lungs and protect against asthma in childhood? A systematic review

Physical activity, sedentary behaviour, and childhood asthma: a European collaborative analysis

OBJECTIVES

To investigate the associations of physical activity (PA) and sedentary behaviour in early childhood with asthma and reduced lung function in later childhood within a large collaborative study.

DESIGN

Pooling of longitudinal data from collaborating birth cohorts using meta-analysis of separate cohort-specific estimates and analysis of individual participant data of all cohorts combined.

SETTING

Children aged 0-18 years from 26 European birth cohorts.

PARTICIPANTS

136 071 individual children from 26 cohorts, with information on PA and/or sedentary behaviour in early childhood and asthma assessment in later childhood.

MAIN OUTCOME MEASURE

Questionnaire-based current asthma and lung function measured by spirometry (forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity) at age 6-18 years.

RESULTS

Questionnaire-based and accelerometry-based PA and sedentary behaviour at age 3-5 years was not associated with asthma at age 6-18 years (PA in hours/day adjusted OR 1.01, 95% CI 0.98 to 1.04; sedentary behaviour in hours/day adjusted OR 1.03, 95% CI 0.99 to 1.07). PA was not associated with lung function at any age. Analyses of sedentary behaviour and lung function showed inconsistent results.

CONCLUSIONS

Reduced PA and increased sedentary behaviour before 6 years of age were not associated with the presence of asthma later in childhood.

Effects of physical activity on lung function and quality of life in asthmatic children: An updated systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

The benefits of physical activity (PA) for asthmatic children were increasingly recognized, and as the design of studies on PA and asthma has become more refined in recent years, the latest evidence needed to be updated. We performed this meta-analysis to synthesize the evidence available from the last 10 years to update the effects of PA in asthmatic children.

METHODS

A systematic search was conducted in three databases, PubMed, Web of Science, and Cochrane Library. Randomized controlled trials were included, and two reviewers independently conducted the inclusion screening, data extraction, and bias assessment.

RESULTS

A total of 9 studies were included in this review after 3,919 articles screened. PA significantly improved the forced vital capacity (FVC) (MD 7.62; 95% CI: 3.46 to 11.78; p < 0.001), and forced expiratory flow between 25% and 75% of forced vital capacity (FEF_25-75) (MD 10.39; 95% CI: 2.96 to 17.82; p = 0.006) in lung function. There was no significant difference in forced expiratory volume in the first second (FEV₁) (MD 3.17; 95% CI: -2.82 to 9.15; p = 0.30) and fractional exhaled nitric oxide (FeNO) (MD -1.74; 95% CI: -11.36 to 7.88; p = 0.72). Also, PA significantly improved the quality of life as assessed by the Pediatric Asthma Quality of Life Questionnaire (all items p < 0.05).

CONCLUSIONS

This review suggested that PA could improve FVC, FEF_25-75, and quality of life in asthmatic children, but there was insufficient evidence of improvement in FEV₁ and airway inflammation.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022338984.

Associations of physical condition with lung function and asthma in adolescents from the general population

BACKGROUND

The relation of physical condition with respiratory outcomes in adolescents is unclear. We examined the hypothesis that adolescents with a lower physical condition represented by a lower cardiorespiratory fitness and physical activity, and a higher screen time have a lower lung function and higher risk of asthma.

METHODS

In a population-based prospective cohort study on 4854 children aged 13 years, we assessed cardiorespiratory fitness by using the peak work rate measured by the steep ramp test. Information on physical activity and screen time was obtained by self-reported questionnaires. Lung function was measured by spirometry and current asthma was assessed by a parental-reported questionnaire.

RESULTS

Taking sociodemographic, lifestyle, and growth-related confounders and multiple hypothesis testing into account, a 1 SD lower cardiorespiratory fitness was associated with a lower FEV₁ , FVC, and FEF₇₅ (Z-score difference (95% CI): -0.31 (-0.35, -0.28), -0.30 (-0.33, -0.26), -0.13 (-0.17, -0.10), respectively), and a higher risk of asthma (Odds Ratio (95% CI) 1.25 (1.06, 1.46)). A 1 SD higher screen time was associated with a lower FVC (Z-score difference (95% CI): -0.06 (-0.10, -0.03)). Physical activity and screen time were not related to asthma. Results did not materially change after additional adjustment for respiratory outcomes at an earlier age.

CONCLUSION

Adolescents with a lower cardiorespiratory fitness had a lower lung function and a higher risk of asthma. Those with a higher screen time had a lower FVC. Further studies are needed to explore the effect of improvements in physical condition on long-term respiratory outcomes.

Self-Reported Physical Activity and Asthma Risk in Children

BACKGROUND

Increased physical activity (PA) may protect against asthma but PA can trigger asthma symptoms.

OBJECTIVE

To investigate relationships between moderate-to-vigorous PA (MVPA) assessed during routine care visits and incident asthma.

METHODS

For this retrospective cohort, 542,486 children between 2 and 17 years from 2010 to 2017 were included who had an MVPA assessment (exercise vital sign) during routine care visits. The association of MVPA and asthma was analyzed using Cox proportional hazards regression models as a function of age, with MVPA and body mass index (BMI) being time-varying factors, adjusted for race and ethnicity, socioeconomic status, and air pollution.

RESULTS

The mean MVPA was 5.4 (standard deviation: 4.4) hours/week. Crude asthma incidence density rate (IDR) was highest in children with <1 hour/week of MVPA (IDR: 9.07, 95% confidence interval [CI]: 8.79, 9.36) and lowest in children engaging in 4 to 7 hours/week of MVPA (IDR: 6.55, 95% CI: 6.33, 6.77). In adjusted models, an increase in MVPA was associated with lower asthma risk in children reporting 0 hour/week of MVPA (hazard ratio: 0.981, 95% CI: 0.973, 0.990). In children with ≥8 hours/week of MVPA, an increase in MVPA was associated with higher asthma risk (1.005, 95% CI: 1.002, 1.009). There was no significant BMI by MVPA interaction.

CONCLUSION

Increasing MVPA in children with low activity levels is associated with lower asthma risk; children reporting high levels of activity may experience greater asthma risk as their activity levels increase further. Understanding the role of PA in the development of asthma and assessing MVPA during routine care visits in children may help to develop targeted interventions and guide asthma management.