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University Hospital Bispebjerg, Dep. of Respiratory Medicine

EFFORT Asthma: Effects of diet and exercise in non-obese


patients with asthma

Louise Lindhardt Toennesen MD. PhD

Bispebjerg University Hospital

Respiratory Research Unit


Dept. of Respiratory Medicine
Copenhagen, Denmark

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Conflicts of interest

• None to declare

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Combining exercise and diet interventions
in OBESE asthma patients

• Scot HA et al (2013)
• Freitas P et al (2016)

Exercise combined with diet significantly improves asthma outcomes

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Effects of exercise and diet interventions in (non-obese)
asthma patients

Does the combination of diet and exercise improve


outcomes in non-obese patients

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Aim

To explore of exercise and/or diet can improve asthma


symptoms, airway hyperresponsivenss (AHR) and airway
inflammation in sedentary asthma patients with BMI < 30.

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EFFORT ASTHMA

A randomised, controlled parallel-group study

8- week intervention

4 groups

• Exercise

• Diet

• Exercise+diet

• Control group

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Outcomes and assessment

Efficacy of the interventions:


Fitness levels (VO2max) and DEXA scans (body fat% and muscle mass)

Adherence to ICS: Foster scores

Primary outcome: Asthma Control Questionnaire (5-item version ACQ)

Secondary outcome: Asthma-related Quality of Life Questionnaire


(AQLQ)

Exploratory outcomes: Airway inflammation, blood eosinophil counts and airway


hyperresponsiveness.

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The exercise intervention

125 5 min + 5 min + 5 min + 5 min

• Supervised spinning 100


training
% of HR max
• Three timer per 75

week
10 min warm-up
50
• 10 min warm-up
followed by 12-30
min. high-intensity 25
interval training
0
5 10 15 20 25 30
time /min.

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The diet intervention

• A low glycemic index (GI)

• High protein content (25-28%)

• 6 pieces of fruits/greens per day

• Ad-libitum

• 4 group meetings and 1 individual

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Inclusion criteria

• 18-65 years
• BMI <30
• ACQ >/= 1
• On a stable treatment regime
• A positive test suggesting asthma*

Exclusion criteria

• Other significant conditions


• COPD
• > 10 pack-years
• Clinical infection within the last 3 month

*Either a positive mannitol- metacholine- or reversibility test

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Screened for eligibility
(n=312)

Did not meet inclusion


Randomised criteria
n=149 n=163

Exercise (n=36) Diet (n=38) Exercise+Diet (n=37) Control (n=38)

Failed to complete Failed to complete Failed to complete Failed to complete


study (n=7) study (n=5) study (n=8) study (n=4)
Completed study Completed study Completed study Completed study
n=29 n=33 n=29 n=34

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Baseline measurements

Exercise Diet Exercise+diet Control p-value†

N (completed study) 29 33 29 34

Men (n (%)) 16 (55) 8 (24) 7 (24) 8 (24) 0.02

Age (years) 39.4 (12.5) 40.7 (14.7) 43.7 (13.9) 38.2 (12.7) 0.8

BMI (kg/m2) 24.9 (2.5) 25.0 (2.8) 26.1 (2.5) 25.5 (2.4) 0.8

Smoking (n (%)) 0.6

No 21 (72) 25 (76) 18 (62) 19 (56)

Yes 0 (0) 1 (3) 1 (3) 2 (6)

Former 8 (29) 7 (21) 10 (34) 13 (38)

ACQ 1.7 (0.6) 2.0 (0.6) 1.9 (0.7) 1.8 (0.7) 0.7

FEV1 %pred. 84.9 (12.6) 87.6 (14.5 82.6 (15.2) 81.9 (12.3) 0.6

Atopy (n (%)) 21 (72) 23 (85) 26 (84) 26 (84) 0.5

(no. of patients (%)) or means (SDs)


† This p-values denote the overall significance of differences among the four groups.
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Results: Mean (95% CI.) difference in change in VO2max
between each intervention group and the control group
(reference).

* P < 0.05 (change compared to change in control group)


** P < 0.01(change compared to change in control group)
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Results: Changes in fat mass Mean (95% CI.) difference in fat
mass lost between each intervention group and the control
group (reference).

** P < 0.01 (change compared to change in control group)


*** P < 0.001 (change compared to change in control group)
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Adherence to ICS

• No significant changes in adherence to ICS across


groups

Exercise
Exercise Diet Control p-value
+diet

Use of ICS (n (%)) 22 (76) 24 (73) 17 (59) 23 (68) 0.5

ICS dose (Budesonide


equivalents at entry, ug) 645 (440) 692 (521) 663 (370) 739 (469) 0.6

(no. of patients (%)) and means (SDs)

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Results
Primary outcome: Asthma control questionnaire (ACQ)

n=29 n=33 n=29 n=34


*P < 0.05 (change compared to pre-intervention)
*** P < 0.001 (change compared to pre-intervention)

†P < 0.05 (change compared to change in control group)


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Results
Secondary outcome: Asthma-related quality of life
questionnaire (AQLQ)

n=29 n=33 n=29 n=34


*P < 0.05 (change compared to pre-intervention)
*** P < 0.001 (change compared to pre-intervention)

†P < 0.01 (change compared to change in the control group)


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Results
Eosinophilic (and neutrophilic) inflammation
(exploratory outcomes)

Exercise group Diet group Exercise+diet group Control group

P-
Pre Post Pre Post Pre Post Pre Post
value

Sputum
4.5 0.5 7.8 1.5
eosinophils 2.5 (13.5) 0.5 (2.5) 4.8 (13.1) 0.8 (5.2) 0.19
(15.1) (5.8) (14.9) (6.7)
(%) §, §§

Sputum 43.0
61.3 54.3 60.3
neutrophils 57.3 (18.1) 61.0 (45.5) 46.3 (33.6) 55.4 (33.5) 0.21
(12.0) (26.0) (52.4) (41.0)
(%) §, §§

Blood
0.19 0.16 0.21 0.18
eosinophils 0.19 (0.16) 0.13 (0.18) 0.21 (0.14) 0.18 (0.26) 0.06
(0.22) (0.23) (0.14) (0.19)
(x10-9/l) §

28.5 20.5 32.5 20.8


FeNO (ppb) § 23.5 (36.3) 18 (19.5) 27 (32.3) 20.3 (22.3) 0.12
(23.8) (13.0) (29.0) (35.6)

§: Median (IQR)
§§: No. of patients= 21, 25, 20 and 24 in the exercise-, diet-, exercise+diet- and control group, respectively
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Results: AHR (changes in doubling-dose)

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Conclusion

8 weeks of high-intensity interval training combined with a


diet with a high protein content and a low GI:

• Improves asthma control and quality of life in non-obese asthma


patients.

• Did not significantly affect exploratory outcomes including airway


hyperresponsiveness, airway inflammation and blood eosinophil
counts.

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University Hospital Bispebjerg, Dep. of Respiratory Medicine

Acknowledgements

Vibeke Backer

Celeste Porsbjerg
Morten Hostrup

Patients and staff members at


the Respiratory Research Unit
at Bispebjerg hospital

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University Hospital Bispebjerg, Dep. of Respiratory Medicine

Thank you

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Regression coefficients (B) indicating the change in ACQ and AQLQ
in the three intervention groups when compared to the change in
the control group (reference group).

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Results (Paper II)

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Results (Paper II)

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