By: Darlene A. Herfurt, MSHA, MBA

Excerpts from the Aquatic Therapy Journal

. . . indicates extensive material eliminated.

This excerpt is approximately 1/3 of the original article. Illustrations of the exercise program, bibliography and resources are not included here.

. . .

Very often, symptoms are overlooked or ignored. Many attribute EIA symptoms to being out of shape. Adults with EIA attribute their symptoms to a normal decrease in exercise tolerance due to their age. Others deny the symptoms altogether.

The most common symptoms of EIA include coughing, wheezing, shortness of breath, or chest tightness during or after physical activity. Less common symptoms include fatigue, stomach ache, headache, or dry throat. . .Failure to diagnose and treat EIA may result in avoidance of physical activity, which results in poor physical conditioning and can then lead to poor self-esteem. . . .

There are numerous reasons why aquatics is good for individuals with asthma. These include low asthmogenicity, induces less severe bronchoconstriction, and enhances ventilatory muscle endurance and mucus clearance. Aquatics is well tolerated, it improves lung capacity, circulation, cough reflex and breath control. It also increases aerobic capacity, overall fitness, balance and coordination, and individuals can work at their own pace. . . .

Pharmacological and nonpharmacological interventions have been reported to be efficient in the treatment of EIA. The medication of choice for the prevention of EIA is an inhaled Beta 2-agonist, such as albuterol. . . .

Nonpharmacological treatment may include discussion/education about a proper warm-up, climatic conditions, pacing and self-monitoring skills, use of a peak flow meter, improving cardiopulmonary fitness, and choice of activity.

• Warming up before exercise prepares the body for more vigorous activity and may reduce the risk of injury. . .
• Pacing is the ability to regulate the speed of an individual’s exertion level. . .
• Self-monitoring is the ability to listen to what the body is telling you. . . .
• A peak flow meter is a device that demonstrates how well the airways are working during physical activity. . . .
• Choice of activity can also contribute to fewer EIA episodes. . . .
• Climatic conditions refer to the temperature and humidity of the inspired air during exercise. Breathing warm humid air is thought to be less asthmogenic than breathing cold dry air. . . .

EIA can be easily diagnosed and treated. It is a common disorder and may occur in individuals who do not otherwise have asthma. Aerobic training, especially in the pool, should be a component of the overall individualized asthma management plan. When properly treated, individuals with asthma should be able to participate or compete in the majority of physical activities and sports. Swimming, aquatic aerobics, or aquatic therapy are highly recommended due to their low asthmogenicity as well as providing a successful experience with exercise.

Asthma Article Response

by Ruth Sova

. . .Although encouraging clients with EIA to exercise may sound contradictory, researchers have found that exercise can improve their condition (Gong).

Additional exercise guidelines suggested by the fitness industry include:

• Mode – Rather than high intensity/long duration or low intensity/long duration, short bouts of exercise are usually recommended (Morton and Varray). . . .
• Intensity – Start all activities for these clients at a low intensity level and allow them to rest as often as necessary. . . .
• Duration – The duration of a session can be ten minutes or sixty minutes according to the client’s ability. Begin with a work-to-recovery ratio of one (work) to four (recovery) for approximately five cycles (one cycle is one set of work and recovery) and modify the ratio to tolerance. . . .
• Frequency – Once the client has begun the program he or she should continue at least three times a week. . . .
• Water depth – Water depth at midriff level is a moderate place to start. If the client becomes distressed, move to waist depth water. . . .
• Water temperature – Temperature can vary according to the severity of the breathing disorder. Athletes can work in cooler (80 – 85 degree) water because their energy output will create heat. The less conditioned will need warm (86 to 93 degree) water. . . .
• Other – Guidelines for a client with asthma are often the same for a client with chronic bronchitis or emphysema, however those clients should consult with their physician prior to participating in a program.

Here is a sample program that Dr. Fran Stanat and I have used.

Photos of each exercise only available in the Journal

Precautions:

• For people with reduced vital capacity, hydrostatic pressure may cause breathing difficulties. . . .
• Pool chemicals may also cause breathing difficulties. . . .
• Monitor perceived exertion, . . .
• A longer warm-up is beneficial. . . .
• An adequate cool down is required . . .
• Know the signs and symptoms of potential pulmonary events.