Having asthma, or other lung conditions, should not excuse children from exercise. The benefits of exercise are well known and the consequences of not exercising, perhaps, are even more well known. Without exercise, we are at risk of gaining too much weight (when coupled with an unhealthy diet). Being overweight or obese increases your child’s risk for developing obstructive sleep apnea. Both obesity and obstructive sleep apnea can both make other inflammatory conditions, like asthma, more troublesome and difficult to get under control. But there is a vicious cycle where an overweight child may be more prone to exercise induced asthma, limiting their willingness or ability to exercise, leading to a worsening of their obesity and all of the medical complications associated with obesity (diabetes, high blood pressure, obstructive sleep apnea etc.). It is this cycle that needs to be interrupted.

There are many benefits to exercise. Most of what we know comes from studying adults, however we can translate these findings to children as well. Regular exercise has been associated with reduced cardiovascular disease including systemic hypertension and heart attacks, reduction in type 2 diabetes, and a reduced rate of dying (mortality) from various cancers or heart disease.[1] There are notable improvements in memory, cognition (thinking and problem solving) and school performance in children.[2] We also know that regular exercise, in the form of pulmonary rehabilitation (exercise monitored and prescribed by an exercise physiologist or physician) can improve endurance and overall well-being in patients with chronic lung disease, most notably chronic obstructive pulmonary disease, a condition with similar challenges to that of asthma.[3]

This form of “prescribed” regular exercise (pulmonary rehabilitation) allows for a strict and regimented escalation in exercise intensity while monitoring for worrisome changes in heart or lung health. The process also allows the physician or exercise physiologist to monitor improvements in fitness and exercise tolerance. But we know this works in healthy individuals, we just call it something else: “training”. Start running 3 miles today, doing so every day for 6 months, and you’re bound to have a faster or at least easier run at the end of the six months than when you started.

The term “rehabilitation” implies a loss of function or an attempt to return to a baseline and may be required in progressive conditions of the lungs. Cystic fibrosis may be one such condition where, if not well controlled, there can be significant, ongoing lung disease. Exercise (amongst many other therapies) has long been a recommended therapy for people with cystic fibrosis and may improve aerobic exercise capacity, pulmonary function and health related quality of life with no or limited risk.[4] With the overwhelming evidence pointing towards the benefits of regular exercise, why then has this not been regularly prescribed for other respiratory conditions? After all, exercise is medicine!

The truth is, pediatricians, pediatric pulmonologists and pediatric cardiologists have long been recommending exercise for children with lung disease. But why not “pulmonary rehabilitation”? Unfortunately, it’s not very easy to study, and insurance companies have a hard time paying for anything that is not scientifically proven to be beneficial. Dr. Stephen Kirkby and his colleagues at Nationwide Children’s Hospital in Columbus, Ohio may have finally solved that problem with a recent publication in the journal, Pediatric Pulmonology.[5] Dr. Kirkby and his colleagues looked through their prior records for children who underwent pulmonary rehabilitation for various reasons and identified several with asthma. Following a 6-8 week regimented rehabilitation program, those with asthma had a significant improvement in the distance they could walk in 6 minutes (a routine test of everyday activity tolerance) and forced expiratory volume in 1 second (FEV1; a common lung function test monitored in asthmatics). They also reported an improvement in quality of life following the completion of the study.

While this study had some limitations, including a relatively small group of children, many of them with obesity (74%) and reported exercise limitations (69%) already, it is none-the-less exciting to see that regimented pulmonary rehabilitation may be helpful in our asthmatic population. This, along with the neurologic, metabolic and cardiovascular benefits of exercise, should make regular exercise an important part of our daily routines. We as physicians, and more importantly, as parents, should always be encouraging our children to exercise.

Warburton, D.E.R. and S.S.D. Bredin, Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol, 2017. 32(5): p. 541-556.
Diamond, A.B., The Cognitive Benefits of Exercise in Youth. Curr Sports Med Rep, 2015. 14(4): p. 320-6.
Ries, A.L., et al., Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest, 2007. 131(5 Suppl): p. 4S-42S.
Radtke, T., et al., Physical exercise training for cystic fibrosis. Cochrane Database Syst Rev, 2017. 11: p. CD002768.
Kirkby, S., et al., Benefits of pulmonary rehabilitation in pediatric asthma. Pediatr Pulmonol, 2018. 53(8): p. 1014-1017.