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Short-term and long-term effect of a high intensity pulmonary rehabilitation program in obese patients with asthma: a randomised controlled trial
Turk Y, Theel W, van Huisstede A, van de Geijn GM, Birnie E, Hiemstra PS, Sont JK, Taube C, Braunstahl GJ
The European Respiratory Journal 2020 Apr 16:Epub ahead of print
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine the short-term and long-term effects of a high intensity pulmonary rehabilitation (PR) program on asthma control, body composition, lung function and exercise capacity in obese asthma patients. METHODS: Patients with obesity (BMI >= 30 kg/m2) and suboptimal controlled asthma (Asthma Control Questionnaire (ACQ) >= 0.75) were randomly assigned to a 3-month pulmonary rehabilitation program (PR only), pulmonary rehabilitation program with the use of an internet based self-management support program (PR+SMS) or usual care. The PR program included high intensity interval training, nutritional intervention and psychological group sessions. Patients in the usual care group were advised to lose weight and to exercise. The primary outcome was the difference of change of ACQ between PR only and PR+SMS after 3 months. Total follow-up was 12 months. RESULTS: Thirty-four patients were included in the study (14 PR only, 9 PR+SMS, 11 control). Compared to patients in usual care, patients in the PR only group had a significant reduction in BMI and significant improvements in asthma control, exercise capacity and aerobic capacity after 3 months. These improvements persisted during 12 months of follow-up. No difference in ACQ between PR+SMS and PR only groups were observed. However, users of the SMS program had a significant lower BMI after 12 months compared to subjects in the PR only group. CONCLUSION: A high intensity pulmonary rehabilitation program provides sustained improvements in asthma control, body composition and exercise capacity in obese asthmatics that are not optimally controlled and, therefore, should be considered in the treatment of these patients.
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