Development of a management model for the treatment of asthma

D.Phil.Asthma exemplifies a major medical concern and is a considerable cause of morbidity and mortality globally and in South Africa. Biokineticists have in the past primarily prescribed aerobic modes of exercise to asthmatics regardless of other modes of exercise that could be used in the management of asthma, each with their own unique benefits. The aim of this investigation was to develop a management model from a biokinetic perspective for the management of asthma in moderate, persistent asthmatics. The present study utilised a quantitative, comparative, research trial making use of a pre-test, eight-week intervention period and a post-test. Eighty-eight sedentary moderate, persistent asthmatics were matched by age and gender and randomly assigned to either a non-exercising control group (NE) (n = 22), an aerobic exercise group (AE) (n = 22), a diaphragmatic inspiratory resistive breathing group (DR) (n = 22) or an aerobic exercise combined with diaphragmatic resistive breathing group (CE) (n = 22). Dependent t-Tests and rank-ordered analyses revealed that five of the 13 pulmonary function parameters assessed were found to be significantly altered following the AE and CE training, with the CE training having a larger impact than AE training. The DR training resulted in improvements in four of the 13 pulmonary function parameters. The CE and AE training were also found to be equally effective at altering physical work capacity, while the DR training proved ineffective at altering physical work capacity. The CE training proved to be the most effective at improving the abdominal and chest wall excursion parameters. The DR training was found to be the least effective mode of exercise training to impact favourably on abdominal and chest wall excursion parameters. The DR and CE training had a similar significant and favourable change in respiratory muscle flexibility followed by the AE training only impacting on nine of the 11 respiratory muscle flexibility parameters. Regarding the respiratory muscle strength, despite AE and CE training altering 18 of the 20 parameters, CE training was found to be more effective. DR training only altered 16 of the 20 respiratory muscle strength parameters. The DR training was the only modality to alter a postural parameter, albeit unfavourably. Even though the DR and AE training significantly altered four of the six anthropometric parameters, the AE training proved to be superior, while CE training proved least effective as it altered v only three of the measured anthropometric parameters. The overall success of the CE training exemplified the fact that an optimal training regime for the management of asthma may require both an aerobic exercise and diaphragmatic inspiratory resistive breathing component. Exercise training, and specifically CE training is a cost-effective, home-based asthma management programme that may reduce the public health burden of this disease and provide the patient with alternative treatment options. CE training should form the cornerstone in the management of asthma to minimise and prevent asthma exacerbations and thus improve health-related quality of life and may even prove to be life-saving