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PHYSICAL CONDITIONING PROGRAM FOR ASTHMATIC CHILDREN’

Sponsored by the Tuberculosis and Health Association of Hennepin County 1829 Portland Avenue, Mirtneapolis, Minnesota 66404

The child with asthma presents a difficult therapeutic problem. Many factors influence the diseae. Among these are specific factors, such as an allergy to a particular substance, and non-specific factors, such aa infection, physical condition, posture, breathing methods, fatigue, irritating substances, and emotions. All of these factors, both specific and non- specific must be considered in the complete management of the child with asthma. Non-specific factors may initiate, aggravate and complicate the course of asthma. Their management is often just as important as that of specific allergens.

Realizing that the asthmatic child presents a problem not only to himself and his family, but everyone who associates with him, the Respira- tory Disease Committee of the Tuberculosis and Health Association of Hennepin County began investigating the problem in the fall of 1965.

One of the first considerations of the Committee was the treatment of the asthmatic youngster’s disease. It was noted that management by the individual’s private physician was of paramount importance. The committee agreed, however, that more could be done for the asthmatic, particularly in relation to non-specific factors i.e., strengthening him physically and emotionally. This was borne out through an investigation of previous studies of asthmatic youngsters?’ 3 - 4 *

Feeling that a “Physical Conditioning Program for Asthmatic Children” would serve the community and be a logical step for a voluntary agency to take, the Respiratory Disease Committee held two meetings in the fall of 1965 to consider a plan and its implementation. As a result of these two meetings and through the efforts of the professional program staff of the Tuberculosis and Health Association a prototype program, designed to deal with the non-specific factors, particularly those resulting from long- term isolation from recreational and social activity, waa approved by the Committee. Of major significance, the prototype plan stipulated that the program was to serve as an adjunct to treatment and that admission to the program would only be upon private physician referral. A $15.00 registration fee was charged to help defray the costs of the program and to obligate participants to attend regularly. In cases where the participant was unable to pay, the Tuberculosis and Health Association absorbed the cost.

‘This paper was ‘ointly written by the professional staff of the Tuberculosis and

2Asthma Research Council; Physical Exercises of Asthma; London, Kings Col-

3Physical Conditioning Program for .4sthmatic Children; Scherr & Frankel,

‘Effect,~ of a Physical Fitness Program Upon Asthmatic Boys; Kay H. Petersen,

&Controlled Exercise in Asthmatic Chldren; Millman, Grundson, Kasch, Wilker-

Health Association olHenuepin County

lege. Strand, 1947.

J.A.H.A., Dec. 1958.

Ph.D. and Thomas R. McElhenney, M.D., Pediatrics, February 1965.

son, Headley, Annals of ALLergy, May 1965.

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The program had three main goals. The fist objective was the improvement of the physical condition of the participants. The youngsters were taught to use their abdominal muscles when breathing, to improve their coordination and to improve their posture.

The second goal waa of a psychological nature. The program was structured to allow the child with asthma to help himself, thus decreasing his dependency on others. As he increased his ability to do breathing exercises, he learned how to diminish the shortness of breath associated with his asthma and in this way his fears and anxiety were decreased. In t u n , dependence on his medications, on his parents and on his physician were markedly reduced. These factors, in addition to his increased competence in physical activities, led to more self-confidence, self sufficiency and to an increased acceptance by his peers.

All too often the child with asthma is looked upon as being different by himself, his friends, his family, and the community. As a result the asthmatic child’s participation in society is less than optimal. Therefore the third objective of the program was the education of the children, parents, and community to give a better understanding of the disease and its care.

The first program consisted of 13 youngsters ages 6 to 14 years; five were girls and eight were boys. It was conducted during a consecutive twelve-week period which started on March 9, 1966. Sessions were held once a week after school hours in the Rehabilitation Unit at Downtown Fairview Hospital, Minneapolis. Earl Pederson, a corrective therapist at Fairview Hospital, served as course supervisor. Malcolm N. Blumenthal, M.D., a local allergy specialist acted as volunteer Medical Director. The Program Staff of the Tuberculosis and Health Association coordinated the program and conducted the parent sessions. The program was named “SDIKREPUS.” (SUPER KIDS spelled backwards). This secret name and a corresponding cheer served to identify the group and bring about cohesion.

The program consisted of planned activities for both the children and parents.

The exercise program for the youngsters included three phases: 1) Specific breathing exercises 2) General body conditioning, postural exercises and chest wall

3) One-half hour sessions in the swimming pool For the specific breathing exercises, a two pound sandbag was placed

on the child’s stomach to demonstrate which muscles should he used in correct abdominal breathing. The child was told to inhale lifting trhe sandbag up for a count of two, and then exhale making a loud hissing sound through the teeth for a count of six. The children walked around the room, using two steps to inhale and six steps to exhale (again hissing through the teeth).

On initial observation of the youngsters it was noted that poor posture, mainly kyphosis (round shoulders), was quite evident. A special effort to rectify this problem was a very important part of the program.

The postural, chest wall strengthening and general body conditioning exercises were incorporated in a series of exercises which included toe- touch; sit-ups (the youngsters were taught to inhale while on their backs

strengthening

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and exhale while sitting up); arms outstretched, feet in place, swinging the arms from side to side: push-ups; and jumping jacks.

The children were instructed in a run, walk and trot exercise hoping that there would be carry-over from the breathing exercises. There were relays where the children were divided into two groups-the first child passing the ball between his legs to the next child who would pass it over his head to the next, etc. In the coordination type relays the youngster would dribble the ball around a mark and then back to his team, giving the ball to the next child. The game room, which contained pool, pingpong, shuffleboard, exercycle and punching bag was also used for coordination activity. Because the course was held only once a week, it waa made clear to each child and parent that he was to do each of the above mentioned exercises daily at home-especially the breathing exercises.

The third phase of the program was swimming. The water in the pool was 90 degrees and the room temperature was 85 degrees. Consequently the humidity was very high and initially was a point of concern. How- ever, only two parents mentioned that their children had any asthmatic problems after having been in the water-and this was only after the first two sessions of the program. In an effort to help the children lose some of their fear of water, they played a few simple beach ball bouncing games which enabled them to relax before starting group swimming lessons.

If there waa a problem, such as a child not wanting to put his head under water, a qualified instructor would work with the youngster until he was able to put his under water and to glide short distances. Some of the children had a great deal more success than others; two of the original non-swimmers, at the end of t,he 12 weeks, were able to swim across the pool, a distance of about 21 feet, without taking a breath.

The instruction given to the youngsters and the enthusiasm shown by the instructor while they were in the pool contributed significantly to their relaxation and their overcoming many original fears as well as instilling confidence in themselves.

The general impression was that the children enjoyed the swimming phase of the program the most and it actually served aa a reward for exercising.

The parents were purposely excluded from the majority of the children’s sessions. While the children’s sessions were being conducted, the parents were taken to another room for group discussions. These discussions promoted a greater understanding of rtsthma and its ramifications. At some sessions Earl Pederson, Course Supervisor, discussed and demon- strated to the parents the various activities which their children were performing and the importance of practice and regularity. Malcolm N. Blumenthal, M.D., Medical Director, covered various aapects of allergic disease and answered questions which arose concerning the program and the children’s asthma. The majority of the sessions consisted of group discussions where the parents shared related experiences concerning their children and the disease. A film describing a similar program called the “Hidden Tear”6 was shown at one of the sessions.

‘“Hidden Tear” is a film describing “A Physical Conditioning Program for Asthmatic Children: done by Scherr and Frankel. See footnote 2. Msy be ob- t,ained by writing: Warner Chilcott Pharmaceutical Co., Film Dept., 200 Tabor Road, Morris Plains, New Jersey.

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The results of the first program were promising. Eleven of the initial 13 children completed the course and were awarded a Certificate of Accomplishment. Two children dropped out because of persistance of severe asthma which made regular attendance difficult. However, the parents of both children expressed a desire to enroll them in a future session.

Evaluation of the program was performed by the course staff, the referring doctor, the children’s teachers, the parents and the children themselves. Parameters used to judge the progress of the children were: improved level in physical activity, severity of symptoms, school attend- ance, participation in outside activity and lung function studies. Stricter methods of testing were purposely avoided for the pilot sessions in an effort not to interfere with the recreational aspects of the sessions. As a final step in this evaluation, a reunion was scheduled. Its purpose was to note changes during an unsupervised period of time equal to the length of the coum.

It should be stressed that the program was not offered as a treatment in itself. It was an adjuvant and was thought of as being complementary to or enhancing the usual asthma regimen prescribed by the private physician. Throughout the sessions, it was emphasized that the program was to teach the children methods of improving their physical condition. It was up to each child to make use of them and continue his daily exercises at home. To encourage this a Home Exercise Record booklet was given to each child.

There are some definite conclusions and several impressions that can be drawn when the program is reviewed. All of the children improved in some way, and none experienced exacerbation of symptoms during the course. The majority of the children demonstrated an increase in tolerance for exercise and in their ability to participate in activities. Several swam for the first time; one started to play Little League Baseball. Others commented that they were able to participate in gym regularly for the first time. A sign8cant number of the children needed less medication than in previous years. Also, there was improved school attendance compared to a similar period during the previous year. Other areas of improvement noted were better sleep at night, less coughing, less excita- bility. The children were able to get along better with their friends. Improved posture and increased tolerance to physical activity were frequently noted. Several of the children were successful in preventing impending asthma attacks through the utilization of the breathing exercises. Greater self-confidence was noted in the majority of the children.

In summary the physical conditioning program for the child with asthma was successful. As noted above, all of the children showed improve- ment. Furthermore, all of the parents expressed a desire to bring their children back to a similar program.

All personnel involved in planning and implementing the course agreed that the program filled a real community need; that this program was a logical step for a voluntary agency to undertake; and that courses of this type should be continued and actually expanded to accommodate those wishing to enroll. * * * * *