78A - Fit and Well Column for July 11th, 2004

78A - TITLE: "Exercise and Asthma"

Dear Trish and David,

I am in my mid-twenties, and starting to gain a bit too much weight. I would love to start a regular exercise program as you suggest…. But I can't. You see, I have Bronchial Asthma, and I have difficulty breathing any time I exert myself.

I've tried cutting down my calories, but I'm always hungry, and now I have less energy than ever.

What do you suggest?

Sincerely,

Francis in West Annapolis

Dear Francis,

Did YOU ask the right person! When recalling my personal background, I often forget to include a very important "piece" of my fitness journey. I suffered very severe bronchial asthma from the time I was a small child. I still are somewhat effected by some of the symptoms, but have learned to manage it… partially through exercise! More about that later.

Having asthma really made an impact on many areas of my life. Of course, my ability to exercise was limited (I would begin to wheeze after running less than 50 yards). I couldn't participate in any sports. And socially, it made me feel inadequate and very much apart from everyone else. Quite traumatic for any youngster. Combine that with being overweight and no wonder I have so few happy memories of my childhood!

Let's first take a look at some general "types" of asthma (a layman's look, of course), and then discuss how exercise can be used to offset some of the symptoms and limitations of the disease. Of course, before embarking on any new exercise program, it is imperative that you consult your medical practitioner to get recommendations and guidelines. This is ESPECIALLY critical if you have asthma, or other physical problems.

For some people, exercise-induced asthma occurs within three to eight minutes of starting activity or exercise. For others, exercise-induced asthma occurs after stopping exercise. Often the exercise-induced asthma starts during exercise and worsens when exercise stops. The most common symptoms of exercise-induced asthma are:

• Coughing
• Wheezing
• Shortness of breath
• Chest tightness

Some people are not aware of these symptoms but know they tire easily and have a hard time keeping up with others. It is important to recognize the difference between poor conditioning and exercise-induced asthma. In well-conditioned athletes, symptoms of exercise-induced asthma may only occur with the most vigorous activity or exercise.

Think about how you feel when you exercise. Do you tire easily or cough and wheeze? Be sure to talk to your medical practitioner about this.

It is NOT merely the workload that begins to trigger asthmatic symptoms. When we work out, our airways lose both heat and moisture, especially if the air is cold and dry. One of those losses -- or both -- seems to help inflame the bronchial tubes and set the stage for an attack. That explains why a winter jog around the neighborhood is more likely than a run in a warm gym to cause an attack.

Some sports seem tailor-made to set off asthma attacks. Take, for instance, cross-country skiing, ice skating, and ice hockey, all vigorous sports performed in the cold. A recent study found that 55 percent of elite cross-country skiers and 35 percent of figure skaters showed signs of asthma.

Asthma attacks are also common in sports that require intense, continuous effort, such as long-distance running, soccer, and cycling. On the other hand, stop-and-go activities such as baseball, sprinting, and golf rarely cause trouble. Swimming and water polo don't bring on many attacks, either, probably because pools are so humid. Dry air is very troublesome with asthma.

It is important to know the difference between being out of condition and having exercise-induced asthma. A well-conditioned person will usually only experience the symptoms of EIA with vigorous activity or exercise. To make a diagnosis, your doctor will take a thorough history and may perform a series of test. These are well worth having!

My condition was chronic asthma, NOT exercise induced asthma. However, any physical exertion would make my asthma symptoms even worse. Throw in seasonal hay fever, and you can imagine that in the spring I was truly suffering!

A vicious cycle is often seen in people with breathing problems, and I was a prime example. Children with asthma may feel breathless, or show other signs of asthma, at lower levels of activity than children with normal lungs. To avoid this sensation the child reduces his or her level of activity, which leads to a greater degree of de-conditioning, which in turn increases breathlessness at even lower levels of activity. The cycle continues until one is left with a population of inactive, unfit children who become teenagers and then adults. They may become too embarrassed to begin exercising again.

Well, now that we know the problem, IS there a solution? The answer is yes… and I am living proof of it!

A program of regular physical activity, including aerobic and anaerobic exercises, increases fitness and if undertaken appropriately, can actually result in less troublesome asthma symptoms. You can break the negative spiral!

For years it was thought that asthmatics could not and should not take part in team sports and vigorous activities. We now know that this is not correct. Exercise improves self-esteem, confidence, psychological and physical well being. If your asthma is well controlled, and you carefully follow the directions of your doctor and certain guidelines, you CAN participate in regular physical activities and exercise programs with minimal difficulties.

Today, with proper detection and treatment, those affected by asthma can be capable of exercise that's beneficial to both their physical health as well as their emotional well being.

People have different levels of tolerance to exercise, so individual assessment and programs are very important.

Some of the best sports for people with asthma are:

• Swimming. Many consider this to be the most asthma-friendly sport. The moist environment of a pool seems to benefit people with asthma.
• Golf. The easy pace of a golf game can be customized to suit anyone's needs.
• Sailing. Being on the ocean can be exhilarating, and the moist sea air can be beneficial.
• Bicycling. Go at your own pace and enjoy your surroundings.
• Walking. An excellent activity that does not require strenuous exertion.
• Yoga. Good for mind, body, and soul, the relaxing art of yoga is just right for people with asthma.

• Pilates. Gentle, and easily managed.
• Body Building. YES… Bodybuilding! Working out in a gym to increase overall fitness, AND shape and define body shape and contour is an excellent way to engage in physical activity, and pace yourself safely and effectively!

• Before exercising, warm up with some gentle stretching and a few minutes of running in place.
• In cold weather, take the preventive medications recommended by your doctor about 15 minutes before exercising
• Before and after exercising in cold weather, warm up and cool down with 10 to 15 minutes of mild to moderate activity
• When the weather is cold, it's better to exercise inside a gym or workout room. Many people walk laps at their local mall or go up and down the stairs of their office building.
• If you must exercise outside in cold weather, wear a scarf over your mouth and nose to warm and moisten the air. Breathing in through your nose allows the air you take in to be humidified and kept at a constant temperature by your nose's built-in filtering system.
• Inhale through the nose while you warm up and cool down.
• Cool down gradually.
• Test yourself with a peak flow meter before and during exercise for an objective reading on how your body is doing.
• Let your doctor know about any exercise-related problems you have. He may prescribe medication for you to take before and after physical activities. PLAN your program with him or her. And FOLLOW the plan!

Regular exercise is critical for people with asthma (just as it is with ALL people!). This is especially true for children and teenagers. Many habits are well formed by the time people reach their early teens. Children may learn to avoid outdoor play, sports, and other physical activities that produce symptoms, just as I did. Untreated asthma and EIB can limit normal activities; this may result in lasting physical and psychological effects including poor self-image.

Help yourself, and your family! Start moving!