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Meta-Analysis
. 2013 Apr 30;2013(4):CD009607.
doi: 10.1002/14651858.CD009607.pub2.

Swimming training for asthma in children and adolescents aged 18 years and under

Sean Beggs  1 , Yi Chao Foong, Hong Cecilia T Le, Danial Noor, Richard Wood-Baker, Julia A E Walters
Affiliations
Meta-Analysis

Swimming training for asthma in children and adolescents aged 18 years and under

Sean Beggs et al. Cochrane Database Syst Rev. .

Abstract

Background: Asthma is the most common chronic medical condition in children and a common reason for hospitalisation. Observational studies have suggested that swimming, in particular, is an ideal form of physical activity to improve fitness and decrease the burden of disease in asthma.

Objectives: To determine the effectiveness and safety of swimming training as an intervention for asthma in children and adolescents aged 18 years and under.

Search methods: We searched the Cochrane Airways Group's Specialised Register of trials (CENTRAL), MEDLINE , EMBASE, CINAHL, in November 2011, and repeated the search of CENTRAL in July 2012. We also handsearched ongoing Clinical Trials Registers.

Selection criteria: We included all randomised controlled trials (RCTs) and quasi-RCTs of children and adolescents comparing swimming training with usual care, a non-physical activity, or physical activity other than swimming.

Data collection and analysis: We used standard methods specified in the Cochrane Handbook for Systematic reviews of Interventions. Two review authors used a standard template to independently assess trials for inclusion and extract data on study characteristics, risk of bias elements and outcomes. We contacted trial authors to request data if not published fully. When required, we calculated correlation coefficients from studies with full outcome data to impute standard deviation of changes from baseline.

Main results: Eight studies involving 262 participants were included in the review. Participants had stable asthma, with severity ranging from mild to severe. All studies were randomised trials, three studies had high withdrawal rates. Participants were between five to 18 years of age, and in seven studies swimming training varied from 30 to 90 minutes, two to three times a week, over six to 12 weeks. The programme in one study gave 30 minutes training six times per week. The comparison was usual care in seven studies and golf in one study. Chlorination status of swimming pool was unknown for four studies. Two studies used non-chlorinated pools, one study used an indoor chlorinated pool and one study used a chlorinated but well-ventilated pool.No statistically significant effects were seen in studies comparing swimming training with usual care or another physical activity for the primary outcomes; quality of life, asthma control, asthma exacerbations or use of corticosteroids for asthma. Swimming training had a clinically meaningful effect on exercise capacity compared with usual care, measured as maximal oxygen consumption during a maximum effort exercise test (VO2 max) (two studies, n = 32), with a mean increase of 9.67 mL/kg/min; 95% confidence interval (CI) 5.84 to 13.51. A difference of equivalent magnitude was found when other measures of exercise capacity were also pooled (four studies, n = 74), giving a standardised mean difference (SMD) 1.34; 95% CI 0.82 to 1.86. Swimming training was associated with small increases in resting lung function parameters of varying statistical significance; mean difference (MD) for FEV1 % predicted 8.07; 95% CI 3.59 to 12.54. In sensitivity analyses, by risk of attrition bias or use of imputed standard deviations, there were no important changes on effect sizes. Unknown chlorination status of pools limited subgroup analyses.Based on limited data, there were no adverse effects on asthma control or occurrence of exacerbations.

Authors' conclusions: This review indicates that swimming training is well-tolerated in children and adolescents with stable asthma, and increases lung function (moderate strength evidence) and cardio-pulmonary fitness (high strength evidence). There was no evidence that swimming training caused adverse effects on asthma control in young people 18 years and under with stable asthma of any severity. However whether swimming is better than other forms of physical activity cannot be determined from this review. Further adequately powered trials with longer follow-up periods are needed to better assess the long-term benefits of swimming.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
PRISMA flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Swimming training versus control, outcome: 1.3 Change in asthma symptoms (all).
4
4
Forest plot of comparison: 1 Swimming training versus control, outcome: 1.7 FEV1 % predicted (change).
5
5
Forest plot of comparison: 1 Swimming training versus control, outcome: 1.14 Exercise capacity: VO2 max (mL/kg/min).
6
6
Forest plot of comparison: 1 Swimming training versus control, outcome: 1.16 Exercise Capacity: Any measure (control: usual care).
1.1
1.1. Analysis
Comparison 1 Swimming training versus control, Outcome 1 Quality of life.
1.2
1.2. Analysis
Comparison 1 Swimming training versus control, Outcome 2 Symptoms (change).
1.3
1.3. Analysis
Comparison 1 Swimming training versus control, Outcome 3 Change in asthma symptoms (all).
1.4
1.4. Analysis
Comparison 1 Swimming training versus control, Outcome 4 Urgent asthma physician visits.
1.5
1.5. Analysis
Comparison 1 Swimming training versus control, Outcome 5 Asthma consultation (1 or more) during intervention.
1.6
1.6. Analysis
Comparison 1 Swimming training versus control, Outcome 6 FEV1 L.
1.7
1.7. Analysis
Comparison 1 Swimming training versus control, Outcome 7 FEV1 % predicted (change).
1.8
1.8. Analysis
Comparison 1 Swimming training versus control, Outcome 8 FVC L.
1.9
1.9. Analysis
Comparison 1 Swimming training versus control, Outcome 9 FVC % predicted (change).
1.10
1.10. Analysis
Comparison 1 Swimming training versus control, Outcome 10 FEF 25% to 75 % predicted (change).
1.11
1.11. Analysis
Comparison 1 Swimming training versus control, Outcome 11 FEF 25% to 75% L.
1.12
1.12. Analysis
Comparison 1 Swimming training versus control, Outcome 12 FEF 50 % predicted.
1.13
1.13. Analysis
Comparison 1 Swimming training versus control, Outcome 13 PEF L/min.
1.14
1.14. Analysis
Comparison 1 Swimming training versus control, Outcome 14 Exercise capacity: VO2 max (mL/kg/min).
1.15
1.15. Analysis
Comparison 1 Swimming training versus control, Outcome 15 Exercise Capacity: other measures (control: usual care).
1.16
1.16. Analysis
Comparison 1 Swimming training versus control, Outcome 16 Exercise Capacity: Any measure (control: usual care).
1.17
1.17. Analysis
Comparison 1 Swimming training versus control, Outcome 17 Distance fitness tests‐all (m).
1.18
1.18. Analysis
Comparison 1 Swimming training versus control, Outcome 18 Distance fitness tests‐all (m).
1.19
1.19. Analysis
Comparison 1 Swimming training versus control, Outcome 19 Bronchial hyper‐responsiveness: ln PC20 methacholine.
1.20
1.20. Analysis
Comparison 1 Swimming training versus control, Outcome 20 Exercise induced bronchoconstriction (maximum fall in FEV1 (%).
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Update of

  • doi: 10.1002/14651858.CD009607

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