Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2016

Open Access 01-12-2016 | Research article

Childhood asthma and physical activity: a systematic review with meta-analysis and Graphic Appraisal Tool for Epidemiology assessment

Authors: Lene Lochte, Kim G. Nielsen, Poul Erik Petersen, Thomas A. E. Platts-Mills

Published in: BMC Pediatrics | Issue 1/2016

Login to get access

Abstract

Background

Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents. The objectives of our study were to (1) summarize the evidence available on associations between PA and asthma prevalence in children and adolescents and (2) assess the role of PA in new-onset or incident asthma among children and adolescents.

Methods

We searched Medline, the Cochrane Library, and Embase and extracted data from original articles that met the inclusion criteria. Summary odds ratios (ORs) and confidence intervals (CIs) were used to express the results of the meta-analysis (forest plot). We explored heterogeneity using funnel plots and the Graphic Appraisal Tool for Epidemiology (GATE).

Results

We retrieved 1,571 titles and selected 11 articles describing three cohort and eight cross-sectional studies for inclusion. A meta-analysis of the cohort studies revealed a risk of new-onset asthma in children with low PA (OR [95 % CI] 1.32 [0.95; 1.84] [random effects] and 1.35 [1.13; 1.62] [fixed effects]). Three cross-sectional studies identified significant positive associations between childhood asthma or asthma symptoms and low PA.

Conclusions

Children and adolescents with low PA levels had an increased risk of new-onset asthma, and some had a higher risk of current asthma/or wheezing; however, there was some heterogeneity among the studies. This review reveals a critical need for future longitudinal assessments of low PA, its mechanisms, and its implications for incident asthma in children. The systematic review was prospectively registered at PROSPERO (registration number: CRD42014013761; available at: http://​www.​crd.​york.​ac.​uk/​PROSPERO [accessed: 24 March 2016]).
Appendix
Available only for authorised users
Literature
1.
Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern J, Lemanske R, et al. International consensus on (ICON) pediatric asthma. Allergy. 2012;67:976–97.CrossRefPubMedPubMedCentral
2.
Asher M, Keil U, Anderson H, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8:483–91.CrossRefPubMed
3.
Burney PGJ, Chinn S, Rona RJ. Has the prevalence of asthma increased in children? Evidence from the National Study of Health and Growth 1973-86. BMJ. 1990;300:1306–10.CrossRefPubMedPubMedCentral
4.
Ross Anderson H, Gupta R, Strachan DP, Limb ES. 50 years of asthma: UK trends from 1955 to 2004. Thorax. 2007;62:85–90.CrossRefPubMed
5.
Hill VL, Wood PR. Asthma epidemiology, pathophysiology, and initial evaluation. Pediatr Rev. 2009;30:331–6.CrossRefPubMed
6.
Asher M, Montefort S, Bjorksten B, Lai C, Strachan D, Weiland S, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733–43.CrossRefPubMed
7.
8.
9.
Nystad W, Nafstad P, Harris J. Physical activity affects the prevalence of reported wheeze. Eur J Epidemiol. 2001;17:209–12.CrossRefPubMed
10.
Shaaban R, Leynaert B, Soussan D, Antó JM, Chinn S, de Marco R, et al. Physical activity and bronchial hyperresponsiveness: European Community Respiratory Health Survey II. Thorax. 2007;62:403–10.CrossRefPubMedPubMedCentral
11.
12.
Cypcar D, Lemanske Jr RF. Asthma and exercise. Clin Chest Med. 1994;15:351–68.PubMed
13.
Matsumoto I, Araki H, Tsuda K, Odajima H, Nishima S, Higaki Y, et al. Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma. Thorax. 1999;54:196–201.CrossRefPubMedPubMedCentral
14.
Welsh L, Kemp JG, Roberts RGD. Effects of physical conditioning on children and adolescents with asthma. Sports Med. 2005;35:127–41.CrossRefPubMed
15.
Schwindt CD, Zaldivar F, Wilson L, Leu S-Y, Wang-Rodriguez J, Mills PJ, et al. Do circulating leucocytes and lymphocyte subtypes increase in response to brief exercise in children with and without asthma? Br J Sports Med. 2007;41:34–40.CrossRefPubMedPubMedCentral
16.
Rosa J. Exercise leukocyte profiles in healthy, type 1 diabetic, overweight, and asthmatic children. Pediatr Exerc Sci. 2009;21:19–33.PubMed
17.
Lucas SR, Platts-Mills TAE. Physical activity and exercise in asthma: relevance to etiology and treatment. J Allergy Clin Immunol. 2005;115:928–34.CrossRefPubMed
18.
Cooper DM, Radom-Aizik S, Schwindt C, Zaldivar Jr F. Dangerous exercise: lessons learned from dysregulated inflammatory responses to physical activity. J Appl Physiol. 2007;103:700–9.CrossRefPubMed
19.
Platts-Mills TAE, Woodfolk JA, Chapman MD, Heymann PW. Changing concepts of allergic disease: The attempt to keep up with real changes in lifestyles. J Allergy Clin Immunol. 1996;98:S297–306.CrossRefPubMed
20.
Eijkemans M, Mommers M, de Vries SI, van Buuren S, Stafleu A, Bakker I, et al. Asthmatic symptoms, physical activity, and overweight in young children: a cohort study. Pediatrics. 2008;121:e666–72.CrossRefPubMed
21.
Siersted HC, Boldsen J, Hansen HS, Mostgaard G, Hyldebrandt N, Rees PJ, et al. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ. 1998;316:651–7.CrossRefPubMedPubMedCentral
22.
Lang DM, Butz AM, Duggan AK, Serwint JR. Physical activity in urban school-aged children with asthma. Pediatrics. 2004;113:e341–6.CrossRefPubMed
23.
Mitchell E, Beasley R, Björkstén B, Crane J, García-Marcos L, Keil U. The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three. Clin Exp Allergy. 2013;43:73–84.CrossRefPubMed
24.
Priftis K, Panagiotakos D, Antonogeorgos G, Papadopoulos M, Charisi M, Lagona E, et al. Factors associated with asthma symptoms in schoolchildren from Greece: The Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study. J Asthma. 2007;44:521–7.CrossRefPubMed
25.
Corbo G, Forastiere F, De Sario M, Brunetti L, Bonci E, Bugiani M, et al. Wheeze and asthma in children: associations with body mass index, sports, television viewing, and diet. Epidemiology. 2008;19:747–55.CrossRefPubMed
26.
Ownby D, Peterson E, Nelson D, Joseph C, Williams L, Johnson C. The relationship of physical activity and percentage of body fat to the risk of asthma in 8- to 10-year-old children. J Asthma. 2007;44:885–9.CrossRefPubMed
27.
28.
Jackson R, Ameratunga S, Broad J, Connor J, Lethaby A, Robb G, et al. The GATE frame: critical appraisal with pictures. Evid Based Med. 2006;11:35–8.CrossRefPubMed
29.
Centre for Reviews and Dissemination. Systematic reviews: CRD's guidance for undertaking reviews in health care. York: University of York; 2009.
30.
Moher D, Liberati A, Tetzlaff J, Altman DG, The Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6:e1000097.CrossRefPubMedPubMedCentral
31.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283:2008–12.CrossRefPubMed
32.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–e34.CrossRefPubMed
33.
34.
35.
36.
Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exercise Sport. 2000;71:S1–S14.CrossRef
37.
Howley E. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc. 2001;33:S364–S9.CrossRefPubMed
38.
Haskell WL. What to look for in assessing responsiveness to exercise in a health context. Med Sci Sports Exerc. 2001;33:S454–S8.CrossRefPubMed
39.
Hickmann M, Roberts C, de Matos M. Exercise and leisure-time activities. In: Currie C, Hurrelmann K, Settertobulte W, Smith R, Todd J, editors. Health and health behaviour among young people. Health behaviour in school-aged children: a WHO Cross-National Study (HBSC) International Report. Copenhagen: World Health Organization; 2000. p. 73–82.
40.
Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: the population health science of sedentary behavior. Exerc Sports Sci Rev. 2010;38:105–13.CrossRef
41.
Pettee Gabriel KK, Morrow Jr JR, Woolsey AL. Framework for physical activity as a complex and multidimensional behavior. J Phys Act Health. 2012;9 Suppl 1:S11–S8.PubMed
42.
Romieu I, Mannino DM, Redd SC, McGeehin MA. Dietary intake, physical activity, body mass index, and childhood asthma in the third national health and nutrition survey (NHANES III). Pediatr Pulmonol. 2004;38:31–42.CrossRefPubMed
43.
Moher D, Pham B, Klassen TP, Schulz KF, Berlin JA, Jadad AR, et al. What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol. 2000;53:964–72.CrossRefPubMed
44.
Higgins JPT, Deeks JJ. Table 7.3.a. Checklist for items to consider in data collection or data extraction. In: Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions, Version 5.1.0 [updated March 2011]. Baltimore: The Cochrane Collaboration; 2011. http://​handbook.​cochrane.​org/​. Accessed 30 Mar 2016.
45.
Sherriff A, Maitra A, Ness AR, Mattocks C, Riddoch C, Reilly JJ, et al. Association of duration of television viewing in early childhood with the subsequent development of asthma. Thorax. 2009;64:321–5.CrossRefPubMed
46.
47.
Riley RD, Higgins JPT, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011;342:d549.CrossRefPubMed
48.
Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ; 2008. p. 285–312.
49.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Med. 2009;6:e1000100.CrossRefPubMedPubMedCentral
50.
51.
Islam T, Berhane K, McConnell R, Gauderman WJ, Avol E, Peters JM, et al. Glutathione-S-transferase (GST) P1, GSTM1, exercise, ozone and asthma incidence in school children. Thorax. 2009;64:197–202.CrossRefPubMedPubMedCentral
52.
Vogelberg C, Hirsch T, Radon K, Dressel H, Windstetter D, Weinmayr G, et al. Leisure time activity and new onset of wheezing during adolescence. Eur Respir J. 2007;30:672–6.CrossRefPubMed
53.
Jones S, Merkle S, Fulton J, Wheeler L, Mannino D. Relationship between asthma, overweight, and physical activity among U.S. high school students. J Commun Health. 2006;31:469–78.CrossRef
54.
Kosti R, Priftis K, Anthracopoulos M, Papadimitriou A, Grigoropoulou D, Lentzas Y, et al. The association between leisure-time physical activities and asthma symptoms among 10- to 12-year-old children: the effect of living environment in the PANACEA study. J Asthma. 2012;49:342–8.CrossRefPubMed
55.
Nystad W. The physical activity level in children with asthma based on a survey among 7–16-year-old school children. Scand J Med Sci Sports. 1997;7:331–5.CrossRefPubMed
56.
Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ. 2008;336:601–5.CrossRefPubMedPubMedCentral
57.
Egger M, Davey Smith G, Altman DG. Systematic reviews in health care: meta-analysis in context. London: BMJ Books; 2001.CrossRef
58.
Firrincieli V, Keller A, Ehrensberger R, Platts-Mills J, Shufflebarger C, Geldmaker B, et al. Decreased physical activity among headstart children with a history of wheezing: use of an accelerometer to measure activity. Pediatr Pulm. 2005;40:57–63.CrossRef
59.
Rundle A, Goldstein IF, Mellins RB, Ashby-Thompson M, Hoepner L, Jacobson JS. Physical activity and asthma symptoms among New York City head start children. J Asthma. 2009;46:803–9.CrossRefPubMedPubMedCentral
60.
Radon K, Dressel H, Hümmer S, Riu E, Nowak D, Weinmayr G, et al. Berufliche allergierisiken-die SOLAR-kohortenstudie. University of Munich. BAuA - Forschungsberichte 2005/Forschungsberichte/Schriftenreihe der BAuA/Publikationen/Bundesanstalt für Arbeitsschutz und Arbeitsmedizin - Berufliche Allergierisiken. Accessed 21 Aug 2015.
61.
McConnell R, Berhane K, Gilliland F, London SJ, Islam T, Gauderman WJ, et al. Asthma in exercising children exposed to ozone: a cohort study. Lancet. 2002;359:386–91.CrossRefPubMed
62.
Voss PH, Rehfuess EA. Quality appraisal in systematic reviews of public health interventions: an empirical study on the impact of choice of tool on meta-analysis. J Epidemiol Commun H. 2013;67:98–104.CrossRef
63.
Pearce N. Epidemiology in a changing world: variation, causation and ubiquitous risk factors. Int J Epidemiol. 2011;40:503–12.CrossRefPubMed
64.
65.
Patel S, Jarvelin M-R, Little M. Systematic review of worldwide variations of the prevalence of wheezing symptoms in children. Environ Health. 2008;7:57.CrossRefPubMedPubMedCentral
66.
Dumith SC, Gigante DP, Domingues MR, Kohl 3rd HW. Physical activity change during adolescence: a systematic review and a pooled analysis. Int J Epidemiol. 2011;40:685–98.CrossRefPubMed
67.
68.
69.
Alderman BL, Benham-Deal TB, Jenkins JM. Change in parental influence on children's physical activity over time. J Phys Act Health. 2010;7:60–7.PubMed
70.
Jago R, Page AS, Cooper AR. Friends and physical activity during the transition from primary to secondary school. Med Sci Sports Exerc. 2012;44:111–7.CrossRefPubMed
71.
Warren JM, Ekelund U, Besson H, Mezzani A, Geladas N, Vanhees L. Assessment of physical activity – a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiov Prev R. 2010;17:127–39.CrossRef
72.
Dantas F, Correia M, Silva A, Peixoto D, Sarinho E, Rizzo J. Mothers impose physical activity restrictions on their asthmatic children and adolescents: an analytical cross-sectional study. BMC Public Health. 2014;14:287.CrossRefPubMedPubMedCentral
73.
Cliff DP, Reilly JJ, Okely AD. Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0–5 years. J Sci Med Sport. 2009;12:557–67.CrossRefPubMed
74.
Bornstein DB, Beets MW, Byun W, McIver K. Accelerometer-derived physical activity levels of preschoolers: A meta-analysis. J Sci Med Sport. 2011;14:504–11.CrossRefPubMed
75.
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–S516.CrossRefPubMed
76.
Booth ML, Okely AD, Chey T, Bauman A. The reliability and validity of the physical activity questions in the WHO health behaviour in schoolchildren (HBSC) survey: a population study. Br J Sports Med. 2001;35:263–7.CrossRefPubMedPubMedCentral
77.
Higgins JPT, Deeks JJ. 9.5.4 Incorporating heterogeneity into random-effects models. In: Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions, Version 5.1.0 [updated March 2011]. Baltimore: The Cochrane Collaboration; 2011. http://​handbook.​cochrane.​org/​. Accessed 30 Mar 2016.
78.
79.
Quinto KB, Zuraw BL, Poon KY, Chen W, Schatz M, Christiansen SC. The association of obesity and asthma severity and control in children. J Allergy Clin Immunol. 2011;128:964–9.CrossRefPubMed
80.
Saint-Pierre P, Bourdin A, Chanez P, Daures JP, Godard P. Are overweight asthmatics more difficult to control? Allergy. 2006;61:79–84.PubMed
81.
Nicolacakis K, Skowronski ME, Coreno AJ, West E, Nader NZ, Smith RL, et al. Observations on the physiological interactions between obesity and asthma. J Appl Physiol. 2008;105:1533–41.CrossRefPubMedPubMedCentral
Metadata
Title
Childhood asthma and physical activity: a systematic review with meta-analysis and Graphic Appraisal Tool for Epidemiology assessment
Authors
Lene Lochte
Kim G. Nielsen
Poul Erik Petersen
Thomas A. E. Platts-Mills
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2016
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-016-0571-4

Other articles of this Issue 1/2016

BMC Pediatrics 1/2016 Go to the issue

Research article

Imperforate anus with rectopenile fistula: a case report and systematic review of the literature

Case report

Acute myeloid leukemia following etoposide therapy for EBV-associated hemophagocytic lymphohistiocytosis: a case report and a brief review of the literature

Research article

Effect of 4 % chlorhexidine on cord colonization among hospital and community births in India: a randomized controlled study

Research article

LBW and IUGR temporal trend in 4 population-based birth cohorts: the role of economic inequality

Case report

Central retinal artery occlusion and cerebral infarction associated with Mycoplasma pneumonia infection in children

Case report

Unusual presentation of Rosai-Dorfman disease in a 14-month-old Italian child: a case report and review of the literature