Br. J. Sp.
Med; Vol 23
endurance running
The effect of
asthmatic adults
W. Freeman, BSc, MPhil, M.G.L. Nute, BSc, C. Williams, MSc, PhD
Department of Physical Education and Sports Science, Loughborough University of Technology, Loughborough,
Leicestershire
Nine mild to moderate asthmatic adults (three males, six
females) and six non-asthmatics (one male, five females)
underwent endurance running training three times per
week for five weeks, at self selected running speeds on a
motorized treadmill. After training, the asthmatic group
had a significantly higher maximum oxygen uptake, signifi-
cantly lower blood lactate and heart rate in submaximal
running, and a significantly reduced time to complete a two
mile treadmill run, partly attributable to the ability to exer-
cise at a higher %VO2 max after training. These training
induced changes of the asthmatic group were generally of a
greater magnitude than those shown by the non-asthmatic
group. Although seven of the nine asthmatics did show a
reduction in the post-exercise fall in FEV, after the five
week training period, this was not statistically significant
for the asthmatic group as a whole. The results of this study
therefore suggest that endurance running training can im-
prove the aerobic fitness of asthmatic adults, and may
reduce the severity of exercise-induced asthma.
Keywords: Asthma, exercise, running, aerobic capacity,
fitness, blood lactate
Introduction
Although physical training is now recommended in
the management of asthma to improve cardiorespir-
atory fitness1, the prescription of the type of exercise is
not well defined. Studies on the asthmatic adult have
demonstrated improvements in physical fitness after
training3 comprising sports and calisthenics2, circuit
.4
training and high intensity intermittent exercise . Sixteen asthmatic adults (nine males, seven females)
However, such activities are more likely to lead to
gains in strength and muscular coordination than in
cardiorespiratory fitness, when compared to contin-
uous aerobic exercise.
Continuous exercise, however, may be a less suit-
able form of exercise for the asthmatic because it is
more likely to provoke exercise induced asthma (EIA)
than activity of an intermittent nature5. Furthermore,
when compared under conditions of the same relative
heat loss, land based activities such as running provoke
more EIA than swimming6. Although the safety and
Address for correspondence: Miss W. Freeman, Department of
Respiratory Medicine, East Birmingham Hospital, Bordesley Green
East, Birmingham, B9 5ST
© 1989 Butterworth & Co (Publishers) Ltd
0306-3674/89/020115-08 $03.00
training on
Br J Sports Med: first published as 10.1136/bjsm.23.2.115 on 1 June 1989. Downloaded from http://bjsm.bmj.com/ on 4 October 2018 by guest. Protected by copyright.
beneficial effects of a training programme of endur-
ance running has been reported for asthmatic child-
ren7, endurance running has not been evaluated as an
activity for previously sedentary asthmatic adults.
The increase in both the rate and depth of ventila-
tion with physical activity is a major cause of EIA in
asthmatics8. A number of studies have demonstrated
that the severity of EIA at the same work load is re-
duced after training, which is thought to be due to
either a reduction in the ventilatory demands9'O, or
the result of a reduction in the basic hyperreactivity of
the airways" . In contrast, some studies employing
continuous exercise have reported no change in EIA
after training7'12, although the methods of the test for
EIA may have been doubtful. In the first study, the
work load for the EIA test was not the same before and
after training. In the second study, the principle of
specificity of training was not recognized because the
children were tested for EIA on a cycle ergometer
whereas they underwent swimming training. There-
fore the effect of a programme of training employing
continuous exercise on the severity of EIA merits
further attention.
The present study examined the effect of a training
programme of endurance running on the cardiores-
piratory fitness and the severity of EIA in asthmatic
adults.
Methods
from the general public and student populations vol-.
unteered for the study. Each had a history of asthma
and 14 were on regular medication. Six healthy stu-
dents, without a previous history of asthma, formed
the control group for this study. None of the asthmatic
or non-asthmatic subjects were currently engaged in
endurance running training, although several of the
subjects took part in other forms of activity.
Endurance training was performed three times a
week on a motorized treadmill (Woodway Ltd) for five
weeks. The speed of the treadmill could be altered
using a hand held switch, so that the subjects could
train at self-selected speeds. Subjects were encour-
aged to perform the training sessions at a fairly con-
stant and continuous pace, aiming to improve their
endurance as represented by the duration and dis-
tance covered in the training session. Throughout
each training session, the distance covered, the time
Br. J. Sp. Med., Vol. 23, No. 2 115
Endurance running and asthmatics: W. Freeman et al.
elapsed, and the running speed were visible on the
screen of a microcomputer. The distance covered and
the duration of each training session was recorded in a
training diary. The subjects were encouraged not to
alter their habitual level of activity, and to perform the
running training in addition to other activities in
which they normally participated.
The asthmatic subjects were encouraged to take
their usual pre-exercise asthmatic medication before
each training session (usually an inhaled B2 agonist or
disodium cromoglycate), and were asked not to alter
their prophylactic asthmatic medication for the dura-
tion of the study. The forced expiratory volume in one
second (FEV1) was recorded at the start of each train-
ing session, both before and after medication, and at
between 7 and 10 minutes post-exercise. The percent-
age fall of the FEVy after training sessions (from pre-
exercise pre-treatment values) was used as a measure
of the severity of EIA.
In order to assess the physiological changes associ-
ated with the endurance running training, four tests
were performed before and immediately after training
as described below.
After familiarization with running on the motorized
treadmill, the maximum oxygen uptake (VO2 max)
was determined during uphill treadmill running using
a modification of the protocol of Taylor et a113. The test,
performed by the asthmatics with pre-exercise medi-
cation, involved uphill running at a constant speed,
with increases in the gradient of 2.5 per cent every
three minutes (from an initial slope of 3.5 per cent),
until exhaustion. Heart rate was monitored continu-
ously and expired air was collected during the final
minute at each gradient and during the final minute of
exercise. Expired air samples were analysed for oxy-
gen and carbon dioxide along with the ventilatory vol-
ume from which V02 max was calculated. Subjective
ratings of the level of exertion were recorded14; a res-
piratory exchange ratio (VCO2IVO2) greater than 1.10
was taken as criterion for the achievement of V02 max.
The second treadmill test involved continuous run-
ning on a level treadmill for four minutes at each of
four submaximal speeds, selected to elicit approxi-
mately 60, 70, 80 and 90 per cent of each individuals
V02 max. Expired air was collected during the final
minute at each speed for the determination of oxygen
uptake and ventilation. Heart rate was recorded
throughout the test. Duplicate capillary blood samples
from the thumb were collected at rest and during the
final 30 seconds at each running speed, without slow-
ing the treadmill. The blood samples were later
analysed for lactic acid using a modification15 of the
fluorimetric procedure of Olsen16. The running speed,
oxygen uptake and the %VO2 max at a blood lactate
concentration of 2 mmol.1-1 was calculated for each
subject.
The third test assessed the incidence and severity of
exercise-induced asthma (EIA) for the asthmatic sub-
jects only. Asthmatic medication had been withheld
for the following periods prior to this test: short acting
bronchodilators (i.e. B2 agonists, anti-cholinergics) for
eight hours, long acting bronchodilators (i.e.
theophylline) and disodium cromoglycate for 24
hours. Inhaled steroids were continued throughout. A
continuous protocol was employed with subjects
running for two minutes at a warm-up speed, and
116 Br. J. Sp. Med., Vol. 23, No. 2
then six minutes at a faster speed selected to elicit
approximately 80 per cent V02 max for an optimum
provocation test17. In order to assess the intensity of
the exercise, heart rate was monitored continuously
Br J Sports Med: first published as 10.1136/bjsm.23.2.115 on 1 June 1989. Downloaded from http://bjsm.bmj.com/ on 4 October 2018 by guest. Protected by copyright.
and a sample of expired air was collected during the
final minute of exercise for the determination of oxy-
gen uptake. At rest, the forced expiratory volume in
one second (FEV1) and the forced vital capacity (FVC)
were measured from a dry spirometer (Vitalograph
Ltd). These measurements were expressed as a per-
centage of predicted normal values based on sex and
age18. Measurements of FEVy were made at 1, 5, 10, 15
and 20 minutes after exercise. The maximum percent-
age fall in the FEV1 after exercise from resting values
was calculated for each asthmatic; a reduction greater
than 10 per cent confirmed EIA19.
The running speeds for the above three tests were
selected according to the running ability of each sub-
ject, and remained the same for both the pre- and post-
training tests.
The fourth test was a two mile (3.2 km) treadmill
time trial in which subjects were encouraged to com-
plete the distance in as fast a time as possible. As for
the training sessions, the speed of the treadmill was
controlled by each subject using a hand held switch,
and details of the running speed, distance covered and
time elapsed were visible on the screen of a microcom-
puter. Expired air collections and heart rate recordings
were made every half mile (0.8 km). From the oxygen
uptake results the average %VO2 max utilized during
the run was calculated.
During each of the tests, heart rate and ECG protiles
were monitored continuously using three chest elec-
trodes and an oscilloscope (Rigel Ltd). The collections
of expired air were made through a low resistance
respiratory valve20 via lightweight wide bore tubing
into a 150 litre capacity Douglas bag. The samples of
expired air were later analysed for the percentages of
oxygen and carbon dioxide using a paramagnetic oxy-
gen analyser (Servomex-Taylor Ltd, Model 370A) and
an infra-red carbon dioxide analyser (Mines Safety
Appliance Ltd., Lira Model 303). The volume of the
expired air sample was determined by evacuating the
contents of the Douglas bag through a dry gas meter
(Parkinson-Cowen Ltd). This allowed the calculation
of oxygen uptake (VO2), carbon dioxide production
(VCO2) and ventilation rate (VE).
A paired 't' test was used to examine the significance
of any changes after training for the asthmatic and
non-asthmatic groups, separately. A pooled 't' test
was used to compare the pre-training responses of
those asthmatics who completed the training with
those asthmatics who withdrew from the study, and
the quality and quantity of training performed by the
asthmatic and non-asthmatic groups. A Pearson pro-
duct moment correlation was used to examine the
interrelationships between the physiological changes
induced by training.
Results
Seven of the sixteen asthmatic adults (six males, one
female) who started the running training programme
withdrew from the study. Although one subject had to
discontinue endurance running as a result of an
exacerbation of his asthma caused by infection, factors

other than asthma such as lack of time (2), minor in-
juries (2) and poor motivation to train (2) were the
reasons for the non-compliance of these subjects with
the training programme. The severity of EIA in the
Endurance running and asthmatics: W. Freeman et al.
range 18 to 21 years. Table 1 gives the FEV1 expressed
in absolute values and as a percentage of predicted
normal, the percentage fall in the FEV1 after the non-
medicated running test, and the asthmatic medication

pre-training tests was not significantly different for the
seven who withdrew from the study (38.3±17.9 per
cent fall FEV1), compared to the nine who completed
the study (26.4±11.7 per cent fall FEV1). Similarly the
FEV1, expressed as a percentage of predicted normal
values, was not significantly different for the group
who withdrew from the study (79.5±25.4 per cent)
compared to the group who completed the training
(88.4±15.1 per cent). All six of the control group com-
pleted the study.
The following results are those from the nine asth-
matics (three male, six female) and six non-asthmatics
(one male, five females) who complied with the train-
ing programme, running three times per week for the
five week study period. The average total distance run
by each subject was not significantly different for the
asthmatic (57±26 km) and non-asthmatic (62±11 km)
groups. Furthermore, the average intensity of the
endurance running training, estimated from the
pre-training laboratory tests, was similar for the
two groups (A: 83.8±10.0 vs NA: 80.4±6.5 %VO2
max, ns).
The asthmatic group were aged 26±8 years (range
18 to 37 years). The non-asthmatics from the univer-
sity student population were slightly younger (20± 1,
Br J Sports Med: first published as 10.1136/bjsm.23.2.115 on 1 June 1989. Downloaded from http://bjsm.bmj.com/ on 4 October 2018 by guest. Protected by copyright.
of each of the nine asthmatics on entry to the study. Of
the nine asthmatics, eight had had asthma since child-
hood, and six were taking daily prophylactic medi-
cation. The FEV1 represented 88.4±15.1 per cent of the
predicted normal (range 65.7-109.2 per cent pre-
dicted), indicative of mild to moderate airflow obstruc-
tion. In response to the test without medication, each
of the nine asthmatics demonstrated at least a 10 per
cent fall in FEV1, consistent with exercise induced
asthma.
Table 2 gives the response of the asthmatic and non-
asthmatic groups to the maximum exercise test. After
training, both groups showed significant increases in
both V02 max and test duration. The change in V02
max was approximately seven per cent for both
groups, although there was a large range between
subjects from 0 per cent to 24 per cent. There was no
significant change in either the maximum ventilation
nor in the maximum heart rate for either group.
In the submaximal test, blood lactate was signifi-
cantly reduced over the range of running speeds for
the asthmatic group, whereas a reduction in blood lac-
tate was only detectable at the highest running speed
for the non-asthmatic group (Figure 1). Indeed, the
running velocity at a reference blood lactate concentra-

Table 1. The duration of asthma, medication, and the FEV1 at rest and in response to the non-medicated exercise test at entry to the
study for the nine asthmatics
Duration of FEVI % Fall FEVy Daily
Age asthma (yrs) 1 % pred. post exercise medication
Males 18 9 4.28 86.5 18.2
18 9 3.95 107.0 19.0
22 21 3.45 83.3 20.3 DSCG+isoprenaline sulphate
Females 19 1 3.64 109.2 43.7 salbutamol
24 23 3.57 100.0 30.0 DSCG+isoprenaline sulphate
salbutamol
24 9 2.95 88.5 10.2 BDP/salbutamol
34 30 2.38 69.6 19.3 DSCG+isoprenaline sulphate
35 30 2.00 65.7 37.5 DSCG+isoprenaline sulphate
salbutamol
37 30 2.92 86.2 39.7 DSCG/salbutamol
Mean 26 18 3.24 88.4 26.4
+SD 8 11 0.74 15.1 11.6
DSCG - disodium cromoglycate, BDP - beclomethasone dipropionate

Table 2. The physiological responses to the maximum exercise test before and after training for the asthmatic (n = 9) and non-asth-
matic (n = 6) groups
Run time VO2 max VEm HRmax
(min) (mI.kg.-'min-') (I.min'- BTPS) (beats.min-1)
Pre Post Pre Post Pre Post Pre Post
Asthmatics
mean 7.93 9.57** 41.0 43.8* 81.5 85.0 184 181
+SD 1.40 1.53 8.2 8.8 19.4 21.0 8 7
Non-asthmatics
mean 8.32 9.42* 43.0 46.0* 93.1 95.7 192 191
+SD 1.72 2.46 8.2 9.1 22.3 26.0 6 3
*p < 0.05, **p < 0.01: Significant difference before and after training

Br. J. Sp. Med., Vol. 23, No. 2 117

Endurance running and asthmatics: W. Freeman et al.
12 200 -

I 10 *
1 180-
-J
-i **
-.5 8-

Br J Sports Med: first published as 10.1136/bjsm.23.2.115 on 1 June 1989. Downloaded from http://bjsm.bmj.com/ on 4 October 2018 by guest. Protected by copyright.
E *
D
E .0 160- .n...
w 6-
O
0 140-
-D 4 -
152
*
L1
0 I-

0- I
100- I I I I I 3
u I I
2.0 2.2 2.4 2.6 2.8 3.0 2.0 2.2 2.4 2.6 2.8 3.0
a a Speed (m.s-1)
Speed (m.s-1)

12 -1 *
200 -

-J ri
.E
180-
-i
E
E
8-
X. 160- I-~~~~~~~
0' 6-
*w 140-
'o 4
° 120-
co 2 X

A- 100 - I I I I I I1
I I I

2.2 2.4 2.6 2.8 3.0 3.2 3.4 3.6 2.2 2.4 2.6 2.8 3.0 3.2 3.4 3.6
b Speed (mis-1) b Speed (m.s-1)

Figure 1. The blood lactate concentration at a range of Figure 2. The heart rate at a range of submaximal running
submaximal running speeds before (@-@) and after (0--O) speeds before (@-@) and after (0--O) training for a) the
training, for a) the asthmatic and b) non-asthmatic groups. asthmatic and b) non-asthmatic groups. Values are mean ±SD.
Values are mean ±SD. (*p < 0.05) (*p < 0.05; **p < 0.01)

tion of 2 mmol.1-1 (V(2 mmol.l-F)) was 11 per cent
higher for the asthmatic group after training (Pre:
2.29±0.59 vs Post: 2.54±0.54 m.s-, p < 0.01). In con-
trast, there was no significant difference in the V(2
mmol.l-F) after training for the non-asthmatic group
(Pre: 2.47±0.38 vs Post 2.63±0.51 m.s-1, ns). How-
ever, when the oxygen uptake equivalent to the blood
lactate concentration of 2 mmol.1-1 was expressed as a
percentage of the new V02 max, there was no signifi-
cant change after training for either the asthmatic (Pre:
67.4±9.3 vs Post: 70.5±10.7 %VO2 max, ns) or the
non-asthmatic (Pre: 68.3±7.6 vs Post: 69.2±5.0 %VO2
max, ns) groups.
There was a significant reduction in the heart-rate of
approximately 10 beats.min-1 over the range of sub-
maximal running speeds for the asthmatic group dur-
ing the submaximal test (Figure 2). The non-asthmatic
group however showed a less pronounced reduction
in heart rate, only reaching statistical significance at
the highest running speed. There was no significant
change in the minute ventilation during the submaxi-
mal test for either the asthmatic or non-asthmatic
groups.
118 Br. J. Sp. Med., Vol. 23, No. 2
The results from the 3.2 km (two mile) treadmill
time trial are shown in Table 3. After training, both
groups were able to complete the two miles in a signifi-
cantly (p < 0.01) faster time. Furthermore, both
groups were able to utilize a significantly higher per-
centage of V02 max during the two mile time trial,
after training (p < 0.05).
The test for exercise-induced asthma was performed
at the same absolute running speed before and after
training. Although the absolute oxygen uptake for the
tests was similar (Pre: 38.1±7.7 vs Post: 36.9±7.7
ml.kg-l.min-1, ns), this represented a lower percen-
tage of V02 max after training (Pre: 92.7±3.2 vs Post:
84.5±9.8 %VO2 max, p < 0.05). Furthermore, the
ventilation (Pre: 84.7±22.5 vs Post: 70.5±21.0 l.min-1
BTPS, p < 0.05) and the heart rate (Pre: 181±11 vs
Post: 164±11 beats.min-1, p < 0.01) required at this
work load were significantly reduced after training.
Inspite of the reduced relative exercise intensity of the
non-medicated running test after training, there was
no significant change in the degree of EIA, with
26.4±11.6 per cent fall in the FEVy pre-training com-
pared to 23.0±17.5 per cent post-training.
 Endurance running and asthmatics: W. Freeman et al.
Table 3. The time, oxygen uptake (V02) and the %VO2 max utilised for the two mile treadmill time trial for the asthmatic (n = 9) and
non-asthmatic groups (n = 6), pre- and post-training
Two mile time Run speed V02
(m.s-') (ml.kg-'min-')

Br J Sports Med: first published as 10.1136/bjsm.23.2.115 on 1 June 1989. Downloaded from http://bjsm.bmj.com/ on 4 October 2018 by guest. Protected by copyright.
(min) %VO2max
Pre Post Pre Post Pre Post Pre Post
Asthmatics
mean 20.30 18.16** 2.77 3.10** 34.9 39.1** 84.9 88.9*
+SD 4.62 4.28 0.65 0.73 7.9 9.1 7.7 6.1
Non-asthmatics
mean 18.47 16.62* 2.97 3.32* 36.2 41.5** 84.8 90.5**
+SD 2.81 2.82 0.49 0.63 5.3 7.0 5.0 4.8
*p < 0.05, **p < 0.01: Significant difference before and after training

However, an examination of the individual data
revealed that seven out of nine asthmatics showed a
reduction in the degree of EIA after training (Figure 3).
The changes in the degree of EIA after training within
the group was not correlated with the changes in the
ventilation required to complete the non-medicated
running test (r = -0.300, ns). The large increases in
the severity of EIA of the two asthmatics may have
been due to either the adverse effects of a period of
cold weather, or more probably due to modifications
in the asthmatic treatment. One of the asthmatics (6),
under the supervision of her general practitioner,
stopped taking beclomethasone dipropionate (BDP)
for two weeks in the middle of the training period.
Although she restarted the BDP prior to the post-train-
ing tests, the interruption in treatment seemed to ad-
versely affect her asthma and therefore may account
70-
60 -
50-
> 40-
w cation had average decreases in FEV1 of 9.6 per cent
U-
2 30-
7
20-
for the increase in the post-exercise fall in FEV1, from
10.2 per cent pre-training to 25.2 per cent post-train-
ing. The other asthmatic subject who had an increase
in the severity of EIA from 39.7 to 63.6 per cent fall in
the severity of EIA from 39.7 to 63.6 per cent fall in
FEVy (4) voluntarily reduced the daily and pre-exercise
use of disodium cromoglycate, preferring to use sal-
butamol as this gave more immediate relief. The alter-
ation in the treatment of these two asthmatics may ex-
plain their greater severity of EIA in the post-training
tests. The severity of EIA of the seven asthmatics who
had no change in treatment was significantly lower
after training (Pre: 26.9±10.4 vs Post: 16.9±9.4 per
cent fall FEV1, p < 0.01).
There was no difference after training in the baseline
lung function measured by the FEV1, FVC and PEFR
for the asthmatic group before the test without asth-
matic medication and for the non-asthmatic group
(Table 4). Figure 4 shows a histogram of the percentage
change in the FEVy from baseline (without medication)
after the training sessions. On a few occasions, the
FEV1 fell significantly below baseline, although these
decreases were always reversed using a B2 agonist
from an inhaler or from a 'spacer' device. Pre-exercise
medication abolished EIA for five of the asthmatics
during the majority of the training sessions. For two
asthmatics pre-exercise medication failed to abolish
the EIA, showing average decreases in FEV1 of 18.1
per cent and 18.8 per cent after the training sessions.
The two asthmatics who did not take asthmatic medi-
and 14.1 per cent after the training sessions. One of the
asthmatics who did not take pre-exercise medication
performed half of his training out of doors. The sever-
ity of EIA was greater when training outside
(20.9±10.2 per cent fall FEV1) than on the treadmill
(8.4±4.8 per cent fall FEV1).

I
Discussion
IO
This study has examined the physiological effects of
five weeks of endurance running training in groups of
asthmatic and non-asthmatic adults. The training was
at self selected running speeds on the treadmill, akin
Pre-training Post-training
to that which woul& be undertaken at the start of an
endurance running programme performed out of
Figure 3. The percentage decrease in the FEV1 after the non- doors. Seven of the sixteen asthmatics who started the
medicated running test for the nine asthmatic subjects before training programme withdrew from the study. In only
and after training. Group mean (±SD) also shown one of these was the reason for withdrawal connected
Br. J. Sp. Med., Vol. 23, No. 2 119
Endurance running and asthmatics: W. Freeman et al.
Table 4. The lung function, pre- and post-training, of the asthmatic (n = 9) and non-asthmatic (n = 6) groups
FVC (I-BTPS) FEV1 (I-BTPS) FEVI/FVC % PEFR(l.min-1)
Pre Post Pre Post Pre Post Pre Post

Br J Sports Med: first published as 10.1136/bjsm.23.2.115 on 1 June 1989. Downloaded from http://bjsm.bmj.com/ on 4 October 2018 by guest. Protected by copyright.
Asthmatics
mean 4.04 4.05 3.24 3.16 79.8 77.2 448 438
±SD 0.65 0.72 0.74 0.83 11.3 11.8 69 88
Non-asthmatics
mean 4.00 3.97 3.55 3.59 90.1 90.7 463 443
±SD 0.67 0.62 0.62 0.53 3.8 2.6 79 59

40- lactate concentrations are more sensitive indicators of

training adaptations than V02 max23. The lower blood
35 - lactate at the same absolute work load after training is
a reflection of an increased contribution of energy
30-1 from aerobic metabolism as a result of the increased
c oxidative capacity of the mitochondria24.
o
25- Blood lactate concentrations were however not dif-
ferent when the running speeds were expressed at the
C

.'a 20- same relative exercise intensity (%VO2 max) before

and after training. Previous studies on non-asthmatics
0 have suggested that a period of training longer than
'. 15-- five weeks is required to reduce blood lactate at the
E same relative work load23'26.
z ,\
1U- The significant reduction in heart rate at submaxi-
mal running speeds without any change in the maxi-
5- mum heart rate for the asthmatic group are consistent
with the findings reported in studies on physical train-
0-
0 0 o
I
o
I I
o
ing in non-asthmatics27'28. The reduced heart rate is
~1. ro cQ _ o o 0 thought to be due to an increase in the stroke volume
vI vI Nfv v v v v v and a decrease in peripheral resistance24.
6LO 6I0t o
r4 o
Nx -
o o 6CM In addition, an improvement in the running per-
7
% Change FEV, formance over two miles (3.2 km) was also demon-
strated, with both groups able to run the distance in a
Figure 4. A frequency distribution of the percentage change in significantly faster time. An improvement in running
the pre-exercise FEV1 (before medication) recorded after the performance was traditionally associated with an in-
training sessions crease in V02 max. However, both groups were able to
sustain a higher %VO2 max in the two mile time trial
after training, supporting the observations by Daniels
to asthma, with an infective exacerbation, and not et al.29 that factors not involved in the test of V02 max
necessarily due to the training. A similar reduction in contribute to the improvements in running perfor-
numbers has been observed by Bundgaard et al. mance. The absence of a reduction in blood lactate at
when training asthmatic adults. the same relative work load after training suggests that
The five week period of endurance running training the subjects may have tolerated a higher level of blood
resulted in a similar improvement in V02 max of ap- lactate over the two mile performance trial, enabling
proximately seven per cent in both the asthmatic and them to sustain a higher %V02 max after training.
non-asthmatic groups. This agrees with other inves- The asthmatic group therefore demonstrated simi-
tigators examining the effect of short term training in lar and even enhanced improvements in the
previously untrained non-asthmatic subjects22. How- physiological parameters chosen to measure cardio-
ever, it has been suggested that parameters measured respiratory fitness after the five week training period
during submaximal exercise may be more valid indi- than the non-asthmatic group performing similar
cators of training status than V02 max, if for no other training. These differences in the physiological bene-
reason than submaximal exercise does not require the fits obtained after training between the asthmatic and
same high levels of motivation needed in maximum non-asthmatic groups may be due to the greater initial
tests23 level of fitness of the non-asthmatic group before
During submaximal exercise the asthmatic group training. Asthma does not therefore impair the ability
showed a significant reduction in the blood lactate to obtain the physiological benefits associated with
concentrations after the five weeks of training, endurance running training, supporting observations
whereas the non-asthmatic group showed no change. in asthmatic children7. Endurance running is therefore
The 11 per cent increase in the running speed at the a good activity for the asthmatic when an improve-
reference blood lactate concentration of 2 mmol.l-F ment in the cardio-respiratory fitness is sought.
compared favourably to the seven per cent increase in A reduction in the severity of EIA at the same abso-
V02 max for the asthmatic group, supporting the ob- lute work load after training has been observed by a
servation in non-asthmatics that changes in blood number of studies, and is thought to be due to lower
120 Br. J. Sp. Med., Vol. 23, No. 2

ventilatory demands9'10 or more controversially to a
reduction in the basic hyperreactivity of the airways".
It has been suggested that a reduction in EIA is the
most important effect of an improvement in physical
fitness9. In the present study, although the group
results showed no change in the severity of EIA, seven
of the nine asthmatics did show a significant reduction
in the severity of EIA after training at the same abso-
lute work load. The increase in the severity of EIA for
the remaining two asthmatics could possibly be ex-
plained by changes in their medication.
The safety of the programme of endurance running
training on the asthmatic adult was also evaluated.
Endurance running is not considered the most suit-
able form of exercise for the asthmatic due to its greater
ability to provoke EIA compared to intermittent exer-
cise5 and swimming6. Indeed, effective training in-
tensities required to improve cardio-respiratory
fitness may provoke EIA in the untreated asthmatic. In
this study, seven out of the nine asthmatics took pre-
exercise medication to minimise EIA, ensuring that
full benefit could be gained from the training pro-
gramme9. However, for three of the asthmatic the pre-
exercise medication was only partially successful at
inhibiting EIA during the training sessions, although
the bronchospasm was always immediately reversed
by the inhalation of salbutamol. Indeed, when using
pre-exercise medication, the severity of EIA after run-
ning was not significantly different to that experienced
after swimming , so that running training is probably
no worse at provoking EIA than other activities when
pre-exercise medication is taken.
One asthmatic who did not take any medication for
his asthma performed half of his training out of doors.
The outdoor training sessions provoked more severe
EIA than similar indoor training. This observation is
consistent with the findings of Eggleston31 and Shapiro
et al.32 who demonstrated that free range running pro-
vokes more severe EIA than treadmill running. A
further study to evaluate the safety of outdoor running
training in the asthmatic adult is required. Indeed,
when training in cold conditions it may be necessary
for the asthmatic to use face masks to warm and
humidify the inspired air33.
The major findings of this study suggest that adults
with mild to moderate asthma show similar and even
enhanced improvements in their cardio-respiratory
fitness after short term endurance running training
when compared to non-asthmatics. The severity of
EIA at the same work load was not significantly re-
duced for the group as a whole by this improvement
in physical fitness. Nevertheless, seven of the nine
asthmatics did demonstrate a reduction in EIA after
training.
Acknowledgements
We gratefully acknowledge the financial support for
this study from Fisons Pharmaceuticals Ltd. and
medical supervision by Dr J. Shipman.
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99s

British Association of Sport and Medicine

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A full programme is planned including Ethics,
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Gala dinner Saturday £15.50 extra.
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122 Br. J. Sp. Med., Vol. 23, No. 2