3.5.3 PAQLQ
6 studies [15-17,26,27,34] provided PAQLQ data for meta-analysis,
four comparisons with the control group (fig. 8a). The four parts of the
PAQLQ: activity scores, symptoms scores, emotional scores, and total
scores were analyzed. Compared with conventional treatment, both
endurance training and interval training improved PAQLQ. Endurance
training was in the activity scores [MD=1.32, 95% CI (0.60,2.03)],
symptoms scores [MD=1.15, 95% CI (0.78,1.52)], emotional scores
[MD=1.25, 95% CI (0.39,2.12)], total scores [MD=1.16,95% CI
(0.66,1.66)]. Interval training was in the activity scores [MD=3.02,
95% CI (1.74, 4.30)], symptoms scores [MD=2.68, 95% CI (2.04,
3.32)], emotional scores [MD=2.47, 95% CI (0.91 ,4.03)], total
scores [MD=2.68, 95% CI (1.79,3.57)] (fig. 8b-e). The ranking
probability of the SUCRA ranking chart from high to low, activities
scores: endurance training + resistance training + respiratory training,
interval training, endurance training, respiratory training + strength
training, conventional treatment (89.1%, 79.2%, 50.1%, 22.8%,
8.7%). Emotional scores: interval training, endurance training,
respiratory training + strength training, conventional treatment,
endurance training + resistance training + respiratory training (96.9%,
72.8%, 31.7%, 24.9%, 23.8%). Symptoms scores: interval training,
endurance training, respiratory training + strength training, endurance
training + resistance training + respiratory training, conventional
treatment (100%, 74.5%, 30.9%, 29.7%, 14.9%). Total scores:
interval training, endurance training, endurance training + resistance
training + respiratory training, respiratory training + strength
training, conventional treatment (99.9%, 71.7%, 36.9%, 26.5%,
14.9%). Comprehensive analysis of PAQLQ interval training superior to
endurance training(8i-m).
Discussion
As a comprehensive intervention measure, PR has good advantages in
relieving patients’ clinical symptoms, increasing exercise endurance and
improving quality of life. It is considered as the first-line non drug
therapy for chronic respiratory diseases, and widely used in the
clinical practice of childhood asthma [38,39]. Exercise training,
the cornerstone of PR, comes in a variety of forms, and it is unclear
which form will have the best effect on childhood asthma. This
systematic review provides a comprehensive overview of the design of
PR-based programs implemented during asthmatic children and explores
which types of exercise are most effective.
Our systematic review was based on 24 RCTs involving 1031 patients with
asthmatic children. The Standard meta-analysis was based on 16 RCTs with
691 patients, and network meta-analysis was based on 13 RCTs with 433
patients. Most studies were conducted in an inpatient setting (29%) and
the total duration of the intervention ranging from 4-52 weeks.
Endurance training was the most used components, and most of the
interventions included in the studies were combined with endurance
training. Interval training may be a core component of improving quality
of life and exercise capacity in childhood asthma, the combination of
respiratory training and endurance training has significant effects on
lung function. Exercise-based PR is a safe and effective for asthmatic
children. Moreover, exercise-based PR is safe for asthmatic children,
and no serious adverse events have been found.
Lung function, as an important adjustment index for the evaluation,
treatment, and severity monitoring of bronchial asthma, has always been
used for patient-level diagnosis and detection [40], and attracted
more attention in the treatment of pediatric. The results showed that
endurance training combine with respiratory training was significantly
better than other forms of exercise in increasing FVC% pred and
FEF25-75% pred, but no significant difference were found in FEV1%
pred. This result may be due to the lack of exercise-based PR studies on
childhood asthma and different degree of asthma, as well as the total
duration of the intervention, the intensity and frequency of exercise
training, etc.
It is reported that exercise can improve cardiorespiratory fitness,
muscle strength, to relieve or control asthma [41]. Therefore,
improving exercise capacity has a positive effect on children’s quality
of life and asthma symptom control. 6MWT is an effective and reliable
method for measuring children’s motor ability, which is safe, simple,
and easy to operate [42]. Study results show that both endurance
training and interval training improve 6MWT in childhood asthma, but
interval training is better. These results support that exercise-based
PR can improve exercise tolerance, which should be treated with caution
because there are few studies included.
Symptoms and quality of life evaluation are important aspects of asthma
control in children. The Children’s Asthma Quality of Life Questionnaire
(PAQLQ) has high reliability and can more accurately reflect the quality
of life in children with asthma [43]. The higher the score, the
higher the quality of life. Six studies were included in the
meta-analysis, exercise-based PR had a positive effect on the PAQLQ
activity domain, emotional domain, symptom domain and total score. It is
worth noting that interval training and endurance training are better
than other forms of exercise, and interval training is the best. The
results show that exercise-based PR can improve the PAQLQ score and
improve the quality of life on childhood asthma.
Methodological considerations
What needs to be affirmed is that this systematic review and
meta-analysis has certain advantages and limitations. So far, this is
the only Network meta-analysis evaluate the effect of exercise-based PR
on childhood asthma, and exercise-based PR includes a larger and richer
literature. Network meta-analysis makes a direct and indirect comparison
of various types of exercise interventions to determine the best type of
exercise. At the same time, our study has some limitations. First, some
studies have small sample size and poor representativeness, which may
lead to inaccurate results. Second, some studies have not clearly stated
the exercise intensity and frequency, which may lead to some differences
in the results. In addition, it is very difficult to use exercise as an
intervention and blind method, which may affect the authenticity of the
results.
Conclusions
Exercise-based PR may be a safe and effective measure for childhood
asthma to improve children’s lung function, exercise capacity, and
quality of life. The combination of endurance and respiratory training
seems to be the most effective for improvements on lung function.
Interval training was more effective in improving quality of life and
exercise capacity. Therefore, the effectiveness of exercise-based PR on
childhood asthma control can provide a reference for children’s clinical
treatment. However, the site, intensity, duration, and frequency of
exercise interventions varied among included studies, so results may be
controversial. In conclusion, it is necessary to validate large-scale,
higher-quality RCTs in the future.
Authors’ Contributions
W Zhang and D Zhang were responsible for conception and design; J Jiang
and ZG Wu were responsible for research screening; J Jiang and D Zhang
were responsible for collection and assembly of data; J Jiang and YP
Huang were responsible for study quality assessment; W Zhang and D Zhang
were responsible for data analysis and interpretation; all authors were
responsible for manuscript writing and final approval of manuscript. J
Jiang and D Zhang contributed equally to this work and should be cofirst
authors.