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

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Why we need the review

Asthma is the most common chronic medical condition in children and it is important to identify safe and beneficial forms of physical activity for young people with asthma. Swimming in particular is an exercise that has been traditionally lauded as ‘healthy’ for asthmatics, and was recommended as such despite the lack of an explicit evidence base. There are differing viewpoints on the benefits of swimming in asthma, with several observational studies suggesting that it improves physical fitness,

Number of trials and the risks of bias

We found eight randomised controlled trials assessing the impact of swimming training on asthma, involving 262 participants with mild to severe stable asthma. The literature search was conducted to July 2012. The programmes involved two to six sessions per week, sessions lasting 30 to 90 minutes, for six to twelve weeks. All except one took place in indoor pools, with two chlorinated and two non-chlorinated pools and four of unknown status. Seven trials compared swimming with usual care, whilst

Findings on safety and benefits

For the primary outcomes, quality of life, asthma control and exacerbations of asthma, we found no significant benefits for swimming training compared to control. We found that swim training had a significant benefit on exercise capacity, with a mean increase of 9.67 ml/kg/min (95% CI 5.84 to 13.51) in VO2 max (maximal oxygen consumption during a maximum effort exercise test) (see Figure 1). When pooled with other measures of exercise capacity the benefit was of equivalent magnitude, SMD 1.34

Practicality of programmes and advantages over other forms of exercise

The practicality of programmes used in the studies varied, with most having a realistic frequency per week, often training twice weekly. More frequent sessions, namely six per week in one study, would be much harder to match and sustain outside a study environment. We were unable to examine the benefits of swimming for children and adolescents with asthma compared to other forms of physical activity due to lack of trials.

Conclusions

This review shows that swim training is well tolerated in children and adolescents with stable asthma, with a positive impact on cardio-pulmonary fitness and lung function. There was no evidence of adverse effects on asthma control. However whether swimming is better than other forms of physical activity could not be determined. Swimming training is a generally accessible intervention, and children are often encouraged to take part although the availability and acceptability of swimming

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