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Background The net metabolic cost of walking (NCw) and the co-activation of leg muscles are both higher in old adults (OG) than in young adults (YG). Nevertheless, the relation between the two remains unresolved, mainly due to the controversial co-activation measurement method used in previous studies. Research question To compare ankle and knee co-contraction (CCI), calculated using an EMG-driven method, between the groups and to examine their relationship with NCw. Methods Nine young (YG = 25.2 +/- 3.3 years old) and nine older (OG = 68.7 +/5.9 years old) adults walked on a treadmill at five speeds (YG: 1; 1.2; 1.4; 1.6; 1.8 m/s; OG: 0.6; 0.8; 1; 1.2; 1.4 m/s) while electromyography (sEMG) and oxygen consumption were measured. CCI were calculated around the ankle and knee for different parts of the gait cycle (entire gait cycle 0–100 %, stance phase 0–60 %, swing phase 60–100 %). Results NCw was significantly higher (25 %, averaged over the walking speeds) in OG as were Knee_CCI, Knee_CCI_swing and Knee_CCI_stance. Multiple regression models in YG, OG and YG + OG highlighted Ankle_CCI as the main contributor in NCw (β = 0.08−0.188, p Significance The present findings provide a better understanding of the association between muscle co-contraction and metabolic cost in older adults. It may help scientists and clinicians to further develop strategies aimed at neuromuscular rehabilitation as a means of improving mobility and independence among older adults.

BackgroundBehavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention.MethodsThis double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 hour). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are: Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2 and the Hospital Anxiety and Depression Scale.DiscussionThe intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has potential to improve physical activity levels and asthma management, and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient’s attendance and has the potential to be largely offered elsewhere.Trial registrationClinical Trials; NCT05241223; registered on January 22 2022; https://clinicaltrials.gov/show/NCT05241223

Aerobic and respiratory exercises are non-pharmacological treatments recommended to improve asthma clinical control; however, the association of both interventions has never been tested. Aim: To assess the effect of aerobic and breathing exercises on the clinical control in subjects with asthma. Methods: Subjects with moderate to severe asthma were randomly assigned to either aerobic+stretching(sham) exercises(AS;n=11) or aerobic+breathing exercises(AB;n=16) for 24 sessions. All patients were assessed before and after the interventions for clinical control (ACQ), health-related quality of life (AQLQ), sleep quality (Pittsburgh), anxiety and depression symptoms (HADS), and hyperventilation symptoms (Nijmegen). Results: There was no difference between groups before intervention. After intervention, no difference was observed on clinical control (-0.27±0.65 vs -0.55±0.59 score), AQLQ (0.76±0.89 vs 0.48±0.75 score), anxiety and depression symptoms (-2.27±4.12 vs -1.13±3.07 score), physical capacity (54.81±97.12 vs 102.12±133.11 meters), and sleep quality (-2.79±6.91 vs. -4.50±9.99 score) between AS and AB (p>0.05 for all outcomes). However, patients from AB improved the hyperventilation symptoms (-1±8.40 vs. -6.73±7.83 score; p=0.02) after intervention compared to AS. Conclusion: The association of aerobic and respiratory exercises seems not to improve asthma control, HRQoL, anxiety and depression symptoms, and sleep quality compared with aerobic exercise alone in patients with moderated and severe asthma. The association of breathing exercise was more effective in improving hyperventilation in this population.

Adults with asthma are more likely to be physically inactive and to develop sleep disorders, which may worsen asthma symptoms. However, it is unknown whether an increase in physical activity levels (PAL) improves sleep quality. Aim: To investigate the effects of a behaviour change intervention aimed to increase PAL on sleep quality. Methods: adults with moderate-to-severe asthma were randomly assigned to either a control (CG) or an intervention group (IG). Both groups received usual care and educational programme. Patients in the IG also underwent an 8-week behaviour change intervention. The face-to-face intervention was delivered once weekly and focused on goal-setting and feedback. Before and after the intervention, subjects were assessed on sleep quality (Actisleep, Pittsburgh and Berlin questionnaire), PAL (GT9X accelerometer), asthma symptoms (daily diary) and psychosocial symptoms (HADS). Results: 49 subjects were included (CG=25; IG=24). At baseline, there was no difference between groups. On the completion of the intervention, was observed an improvement in sleep efficiency (6.8±5.9 vs -2.4± 6.2%) and latency (-3.9±9.1 vs -1.0±8.3min) in the IG compared with CG. The proportion of patients with improvements in the Pittsburg index (50±51% vs 10±31%) and in the depression symptoms (43 vs 0%) was greater in the IG compared with GC (P Conclusion: Our results suggest that the behavioural intervention increased PAL and improved sleep quality in adults with asthma.

Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated.To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers, and lung function.Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program plus exercise (WL + E group, n = 28) or a weight-loss program plus sham (WL + S group, n = 27), where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL + E group incorporated aerobic and resistance muscle training, whereas the WL + S group incorporated breathing and stretching exercises.The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength, and inflammatory/antiinflammatory biomarkers. After 3 months, 51 patients were analyzed. Compared with the WL + S group, the WL + E group demonstrated improved clinical control scores (median [25th to 75th percentile], -0.7 [-1.3 to -0.3] vs. -0.3 [-0.9 to 0.4]; P = 0.01) and greater weight loss (mean ± SD, -6.8% ± 3.5 vs. -3.1% ± 2.6; P 0.001) and aerobic capacity (median [25th to 75th percentile], 3.0 [2.4 to 4.0] vs. 0.9 [-0.3 to 1.3] ml OAdding exercise to a short-term weight-loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients. Clinical trial registered with www.clinicaltrials.gov (NCT 02188940).

Increases in physical fitness have been associated with improvements in several outcomes in adults with asthma. However, it is unknown whether changes in physical activity level (PAL) affect asthma control. Aim: To investigate the effects of a behaviour change intervention aimed at increasing PAL on asthma clinical control. Methods: Adults with moderate-to-severe asthma were randomly assigned to either a control (CG) or an intervention group (IG). Both groups received usual care (pharmacological treatment) and similar educational programme. Participants in the IG also underwent an 8-week behaviour change intervention aimed at increasing PAL. The face-to-face intervention was delivered once weekly and focused on goal-setting and feedback. Before and after the intervention period, assessments were made of: asthma clinical control (ACQ), PAL (GT9X accelerometer), HRQoL (AQLQ) and asthma exacerbation. Results: 37 participants were included (CG=18; IG=19). On completion of the intervention, compared to the CG, patients in the IG increased PAL (3,291±2,370 vs 249±2,370 steps/day, respectively; p Conclusion: Our results suggest that the behavioural intervention improved PAL which contributed to better clinical control in adults with asthma.

BackgroundAsthma is a heterogeneous and complex disease, and the description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.Objectiveto identify and characterise clusters based on clinical, functional, anthropometrical, and psychological characteristics in participants with moderate-to-severe asthma.MethodsThis is a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (N=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function, psychological, and health-status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal-Wallis, and Chi-square tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.ResultsWe identified four clusters: (1)controlled asthma who were physically active, (2)uncontrolled asthma who were physically inactive and more sedentary, (3)uncontrolled asthma with low physical activity, who were also obese and experienced anxiety and/or depression symptoms (4)very uncontrolled asthma, who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex, and anxiety symptoms were associated with increased odds of exacerbation risk while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity, and health-status.ConclusionTraits such as physical inactivity, obesity, and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably with asthma control. This cluster analysis supports the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.

Obese individuals and patients with asthma can develop dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a factor associated with reduced exercise capacity in obese asthmatic women. The aim of the present study was to examine the occurrence of DH and exercise limitations in obese asthmatics. Obese grade II [obese group (Ob-G); BMI 35–39.9 kg/m2; n=36] and nonobese [nonobese group (NOb-G); BMI 18.5-29.9 kg/m2; n=18] asthmatic patients performed a cardiopulmonary test to quantify peak V̇o2 and a submaximal exercise test to assess DH. Anthropometric measurements, quadriceps endurance, and lung function were also evaluated. A forward stepwise regression was used to evaluate the association between exercise tolerance (wattage) and limiting exercise factors. Fifty-four patients completed the protocol. The Ob-G ( n = 36) presented higher peak V̇o2 values but lower power-to-weight ratio values than the NOb-G ( P 2 = 0.67). This study shows that dynamic hyperinflation is a common condition in obese asthmatics; they have reduced fitness for activities of daily living compared to nonobese asthmatics. However, peripheral limitation was the main factor associated with reduced capacity of exercise in these patients. NEW & NOTEWORTHY This is the first study to investigate the occurrence of dynamic hyperinflation (DH) in obese asthmatics. Our results demonstrate that obese asthmatics present a higher frequency and intensity of DH than nonobese asthmatics. We also show that physical deconditioning in this population is linearly associated with cardiac (O2 pulse), respiratory (DH), and peripheral muscle (resistance) limitation. However, multiple linear regression demonstrated that peripheral muscle limitation may explain the exercise limitation in this population.

Background: Obese and asthmatic patients present dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a cause of reduced capacity exercise in obese asthmatics. Aim: to assess if DH is involved in exercise intolerance and to examine other limiting factors during exercise in obese asthmatics. Methods: This cross sectional study included 54 asthmatics with either non obese (NOb-G; BMI≤24.9kg/m 2 ; n=18) or grade II obesity (Ob-G; BMI≥35kg/m 2 ; n=36). Patients performed a cardiopulmonary test to quantify peakVO 2 and a submaximal exercise test to assess DH. Anthropometric measurement, quadriceps muscle endurance and lung function test were also evaluated. Chi-square test was used to compare categorical and t-test or Mann-Whitney test for numerical outcomes. A forward stepwise regression was used to evaluate the association between exercise tolerance and limiting exercise factors. Results: Ob-G had a lower peakVO 2 15 (14-16) vs. 21 ml/kg/min (16-23; 50% interval confidence) compared with NOb-G, respectively (p vs. -4%; p 2 =0.67). Conclusion: DH is a frequent condition among obese asthmatics; however, the peripheral limitation seems the main cause of exercise intolerance in these patients.

There are evidences suggesting that aerobic training improves clinical control in asthmatic patients; however, remains unclear, which instrument is more reliable to detect such benefits. Aim: To compare three different instruments regarding the ability to identify change on asthma control in asthmatics submitted to aerobic training. Methods: 110 patients with moderate or severe asthma were divided in two groups: Control (CG; educational program+breathing exercise as placebo; n=71) or Training (TG; similar to CG+aerobic training; n=39). Interventions were composed of 24 sessions, Clinical control was evaluated before and after interventions by using the questionnaires: Asthma control test (ACT) and two versions of the Asthma clinical control: ACQ-6 and ACQ-7. The data were analyzed using t-test (p Results: Both groups were similar in the baseline data (p>0.05). Surprisingly, only ACQ-6 and ACQ-7 were able to identify a significantly improvement on asthma control in TG compared to CG (ACQ-6: 0.58±0.88 vs 0.14±0.88; p=0.01 and ACQ-7: 0.44±0.77 vs 0.11±0.75; p=0.03), however only the ACQ-6 detected a clinical improvement between TG and CG. The ACT not identify improvement on asthma control between the groups (2.41±3.62 vs 1.41±3.48; p=0.16). Although these results, it was not found difference on the percentage of improves on clinical control when compared ACQ-6, ACQ-7 and ACT in each group (TG: 23.9%, 15.4%, 18.1%; and CG: 6.4%, 2.3%, 13.3%, respectively) (p>0.05). Conclusions: Our results suggest that ACQ-6 is more reliable to identity clinical and significantly improvement on asthma control in patients that performed the exercise training.

A asma é uma doença inflamatória crônica das vias aéreas cujo diagnóstico é clínico e o tratamento visa principalmente controlar os sintomas e diminuir os riscos de exacerbação. Mesmo sob tratamento clínico-medicamentoso adequado, os pacientes nem sempre atingem o controle clínico adequado. Por isso, recomenda-se o uso de terapias não farmacológicas, destacando-se o exercício físico (EF), que é, atualmente, reconhecido como parte fundamental do programa de reabilitação para asmáticos. A revisão que se segue objetivou explorar os aspectos relacionados à melhora do controle clínico da doença induzidos pelo EF em pacientes asmáticos. Para tanto, foram revisados artigos publicados na base de dados Pubmed e SciELO (de 1970 a 2015). Verificou-se que os primeiros estudos sugeririam que o EF, predominantemente aeróbio, melhora o condicionamento físico e a percepção de falta de ar (dispneia). Essa tendência foi mantida até os anos 90 e a partir de então surgiram estudos com maior rigor metodológico mostrando que o EF pode reduzir o broncoespasmo induzido pelo exercício (BIE), a responsividade brônquica bem como e a capacidade física aeróbia. Evidências mostrando que o EF melhora os fatores de saúde relacionados à qualidade de vida, o controle clínico da asma e a inflamação pulmonar passaram a ser melhor investigados apenas nos últimos 5 anos. Atualmente, considera-se a prática de EF como um componente fundamental no programa de tratamento para pacientes com asma moderada e grave, quando realizado com predominância aeróbia, em intensidade de baixa a moderada e feito pelo menos duas vezes por semana de forma individualizada. Portanto, o exercício físico parece potencializar o controle clínico da asma através da melhora do condicionamento físico, sendo importante sua indicação na prática clínica para os pacientes que estão em tratamento clínico-medicamentoso otimizado.