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Winter Exercise Reduces Allergic Airway Inflammation: A Randomized Controlled Study.

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Institution
1 Institute of Ecomedicine, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; 2 Department of Physiotherapy, Salzburg University of Applied Sciences, 5412 Puch/Urstein, Austria
Institution Typology
University
Country
Austria
Description
Intervention design
To refresh basic knowledge about asthma self-management and safety aspects, the participants of the intervention groups participated in a one-hour asthma class with a physiotherapist. The exercise program was composed of four 3–5 h guided GPS-monitored hiking/snow-shoe tours with an average altitude difference of 411 m and 11 km in distance per day and four all day skiing sessions with an average of 42 km in ski slopes in three different ski regions (2.000–2.500 m). Ambient air temperature for the exercise program ranged between 5.6 oC to 8.7 oC The control group did not receive any intervention.

People involved
Adults between 18 and 55 years with a house dust mite sensitization and allergic asthma and/or rhinitis.
Inclusion criteria were as follows: aged 18–55 years, house dust mite
sensitization (radioallergosorbent test (RAST) >1; positive PRICK test or total immunoglobulin E (IgE) > 0.7 kU/l), controlled allergic rhinitis and/or allergic asthma and the physical ability—including moderate skiing skills—to meet the demands of the exercise program. Exclusion criteria were as follows: uncontrolled asthma (asthma control test <20) malignant neoplastic disorders, exercise induced bronchoconstriction, cardiovascular diseases, orthopedic diseases, lung function disorder, acute infection or fever, uncontrolled metabolic diseases and pregnancy.

Identified barriers. No harms or unintended effects like further injuries, exercise-induced bronchoconstriction or severe asthma symptoms were observed.
Transferability. Recreational outdoor winter exercise may be therefore recommended for patients with good disease control. All patients showed high compliance and good physical tolerance.
Disease
Asthma
Activity level
Intense
Activity Typology
Home-based activities
Motivation Tools
Not available
Innovation
The aim of this randomized controlled clinical study was to examine whether moderate winter exercise improves allergic airway inflammation and quality of life in patients suffering from allergic rhinitis and/or asthma. Additionally, the effects on spirometry, differential blood count, eosinophilic cell count from nasal lavage, six-minute walk test and allergic symptoms were examined. A significant reduction of FeNO and nasal eosinophilic cell count as well as sustainable improvements in allergic symptoms were found in the exercise group.
Evaluation System
Primary outcomes were fractional exhaled nitric oxide (FeNO) and the German version of the Rhin Asthma Quality of Life Scale. Secondary outcomes were spirometry, differential blood count, eosinophilic cell count from nasal lavage, six-minute walk test (6MWT), mucociliary clearance time and inverse visual analogue scale concerning health status and allergy symptoms (a higher value indicates a better clinical result). Assessments were performed at baseline (day 0; T0), after the intervention (day 10; T1) and after two months (day 60, T2). To assess short-term effects of a single winter hike, three additional FeNO measurements were performed at day 9.



A significant improvement of fractional oral exhaled nitric oxide (FeNO; p = 0.008, day 10) and a significant decrease in FeNO after a single 4 h hiking tour (p < 0.001, time e_ect) were observed for the exercise group. The nasal eosinophilic cell count revealed a short-term reduction (p = 0.021, treatment e_ect) in the exercise

group and for the visual analogue scale sustainable improvements in allergic symptoms (p < 0.001, day 60) were found. No adverse e_ects of outdoor winter exercise were observed.



A ten-day winter sports program reduced the allergic airway inflammation in patients suffering from allergic rhinitis and/or asthma.

Furthermore, the number of eosinophilic cells from nasal lavage decreased and allergic symptoms improved, thus indicating an overall improvement of the inflammatory milieu in the airways. None of the participants reported undesirable effects during measurements or the winter exercise program.

Assessment
This study design allows for comparison of a ten-day holiday with recreational winter exercise with real life conditions and the daily routine of people suffering from allergic rhinitis and/or asthma.
References
Prossegger J, Huber D, Grafetstätter C, et al. Winter Exercise Reduces Allergic Airway Inflammation: A Randomized Controlled Study. Int J Environ Res Public Health. 2019;16(11):2040. Published 2019 Jun 8. doi:10.3390/ijerph16112040
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