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J Med Sci, Volume 44, No. 1, March 2012: 78 - 83J Med SciVolume 44, No. 1, March 2012: 78 - 83

* corresponding author: novaeno45@yahoo.co.id

Effect of swimming and asthmatic exerciseon forced expiratory volume in 1 second(FEV1) and levels of cortisol hormone inasthmatics patients

Rahmaya Nova Handayani,1*, Denny Agustiningsih2, Achmad Djunaedi21Health Polytechnic of Purwokerto, Ministry of Health, 2 Departement of Physiology,Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta.

ABSTRACTBronchial asthma is one of the allergic diseases characterized by reversible bronchial narrowing dueto bronchial hyperactivity and obstruction of respiratory tract. The prevalence and hospitalizationrates of bronchial asthma keep increasing from year to year, causing asthma to be the top ten causesof morbidity and mortality in Indonesia. The decrease of the forced expiratory volume in 1 second(FEV1) is one of the indicators of the respiratory tract obstruction. Moreover, the cortisol hormonelevel is also associated with asthma. Asthma can be treated not only with pharmacological interventionbut also physical exercises. The aim of the study was to assess the increase of FEV1 and cortisolhormone level after swimming and asthmatic exercise on asthmatic patients. This was a quasiexperimental study using pre and post test control group design. Two groups of 10 asthmaticpatients each conducted swimming and asthmatic exercise as intervention. On pre, middle and postswimming or asthmatic exercise, those two groups underwent the measurement of FEV1 using aspirometer and cortisol hormone levels using ELISA methods. The result showed that the value ofFEV1 and cortisol hormone levels increased significantly after swimming and asthmatic exercise(p

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Handayani et al., Effect of swimming and asthmatic exercise on forced expiratory volume in 1 second (FEV1)and levels of cortisol hormone in asthmatics patients

INTRODUCTION

Asthma is an inflammatory disease ofrespiratory tract that is associated withhiperresponsivity bronchial and obstruction ofreversible respiratory tract.1 The prevalence andincidence rates of asthma hospitalizationincrease progressively over time. Asthma inchildren will potentially interfere with theirgrowth and development. Another negativeimpact of asthma is the frequent absence inschool. Shortly, asthma can disrupt the qualityof life in the form of activity obstacles anddegrade ones performance, if it is not handledproperly.2

The predominant symptom in asthma isrespiratory tract obstruction. One parameter forrespiratory tract obstruction is the decrease ofForced Expiratory Volume in 1 second (FEV1).Forced Expiratory Volume in 1 second is theamount of air released as quickly as possibleon the first one second after taking deep breaths.3

Another important issue related to asthmais the amount of cortisol hormone secreted byhypothalamus pituitary adrenal axis. The cortisolhormone may increase -adrenergic receptorresponsiveness in smooth muscle of respiratorytract. Cortisol can also reduce airway hiper-responsivity because it decreases the numberof circulating eosinophils, inhibiting theproduction and secretion of cytokines in therespiratory tract.4 The stimulation (exercise orstress) on the sympathetic nervous system willcause the release of epinephrine and nor-epinephrine which will result in dilatation ofthe respiratory tract.3 Doing physical exerciseregularly can cause the increase in the musclemitochondrial capacity of airways.5

Some physical exercises are highlyrecommended for asthmatic people, for example,asthmatic exerciseandswimming.Swimmingandasthmatic exercise are aerobic physical exercise,which can alter the muscle fibers, that can cause

changes in some muscle fibers from a fastglykolytic / FG fiber to fast oxidative-glycoltic/FOG fiber. The muscle fibers changes canlead to an increase in diameter, the number ofmitochondria, muscle strength and blood supplyto the respiratory system.3 This study examinedwhether swimming and asthmatic exercise canincrease FEV1 and cortisol hormone level inasthmatic patients.

MATERIALS AND METHODS

Research designThis was an experimental quasi study with

pre-post-test group design. FEV 1 and thecortisol hormone level measurement wereperformed at the early, middle, and at the endof swimming and asthmatic exercise treatment.The protocol of the study has been approved bythe Medical and Health Research EthicsCommittee, Faculty of Medicine, UniversitasGadjah Mada.

SubjectsThe research subjects were men aged 20-

45 years, doing exercise regularly with severalinclusion criteria including FEV1% 40% -75%;normal FVC (4000-6000 L); the fitness levelwas good (50-80). Subjects were divided into2 groups with 10 asthmatic patients in eachgroup. The first group (Group 1) was asthmaticpatients doing swimming and the second group(Group 2) was asthmatic patients doingasthmatic exercise.

Intervention/treatmentFEV1 and corti-sol hormone of all subjects

in Group I were measured before swimming wasperformed. Three days after the firstmeasurement, the subjects swam every Monday,Wednesday and Friday at 7.00 a.m. for 12weeks. Prior to the swimming, they did warmingup and stretching for 5-10 minutes. The

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swimming intensity was 70-75% of maximumpulse within 20-30 minutes. FEV1 and cortisolhormone level from peripheral blood weremeasured after 18th and 36th exercise and 24hours post the last exercise using ELISA method.

The subjects in Group 2 did the asthmaticexercise starting from the 3rd days after the firstFEV1 and cortisol hormone level measurement,with the same intensity and duration as Group 1within 30-45 minutes. The asthmatic exercisewas performed every Tuesday, Thursday andSaturday.At the end of each session of asthmaticexercise, pulse rate was counted. FEV1 andcortisol hormone level from peripheral bloodwere measured after 18th and 36th exercise and24 hours post the last exercise using ELISAmethod with the same method to Group 1.

Data analysisData were analyzed with SPSS version 18.0

to assess the increase of FEV1 and cortisolhormone levels before and after swimming andasthmatic exercise. Analysis of variance

followed by the paired t-test as statistical testswas used to analyse before and afterintervention . Meanwhile, to assess thedifferences in swimming and asthmatic exerciseto the value increase of FEV1 and the cortisolhormone level, the statistical test of unpaired t-test was used.

RESULTS

Characteristic of the subjectsAll subjects in two groups intervention have

similar characteristic, such as the mean of age,BMI, FVC FEV1 and the fitness level. Thevariation of differences between both groupswas not significant (p> 0.05) (TABLE 1). Themeans of age were 33.6 and 32.6 years in Group1 and 2, respectively.The mean of BMI of Group1 was 21.75 and Group 2 was 22.12. The meansof FVC in both groups were closely similar,which were 4.59 and 4.57 liters in Group 1 and2, respectively. The mean of FEV1 in bothgroups was about 73% and the fitness level ingroup 1 and 2 were 72.4 and 73.5, respectively.

TABLE 1. Characteristics of subjects (mean SD) beforeintervention

FEV 1 value after interventionFEV1 values of both group were measured

during pre-, middle- and post-physicalintervention. The FEV1 values after swimming

and asthmatic exercise are presented in TABLE2. A paired t test analysis among pre-, middle-and post physical activities showed a significantdifference among them (p

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Handayani et al., Effect of swimming and asthmatic exercise on forced expiratory volume in 1 second (FEV1)and levels of cortisol hormone in asthmatics patients

TABLE 2. Cortisol hormone level at pre-, middle- and post- physical in-tervention in both groups

Note: * = 3 days before intervention, ** = 18 times after intervention, *** = 36 timesafter intervention; a, b, c = significant difference

Comparison of FEV1 and cotisol hormonelevel between Group 1 and Group 2

The increase of FEV1 values and cortisonhormone levels after post intervention compare

to before intervention in Group 1 were signi-ficantly higher compared to Group 2 (p< 0.05)as presented in TABLE 3.

TABLE 3. Comparison of FEV1 values and cortisol hormone level betweenGroup 1 after swimming and Group 2 after asthmatic exercises

DISCUSSION

Variation in clinical assessment of FEV1using spirometer is influenced by severalaspects including the tools, procedures andbiological variation of subjects. Biologicalvariation includes intraindividual and inter-individual factors. Intraindividual variationconsists of body and head position, and themuscle power. Interindividual factors whichaffect lung functions are gender, body size, age,race, health conditions and environmentalfactors such as geographic factors, environ-mental and occupational exposure in airpollution and socioeconomic status.7

The improvement of FEV1 values at pre-,middle- and post-physical activities in eitherswimm-ing or asthmatic exercise indicates thepresence of stimuli (exercise or stress) on thesympathetic nervous system, which will causethe release of epinephrine and norepinephrine.

The release of epinephrine and norepinephrineresults in the dilatation of respiratory tract.3

Swimming and asthmatic exercise are aerobicexercises that can alter the muscle fibers, whichlead to the change of some fibers called fastglycolytic/FG fiber into fast oxidative-glycolytic/FOG fiber. The change will causethe increase of diameter and the number ofmitochondria, blood supply and muscle strengthin the respiratory system.

This research showed that the FEV1 valuesof the group who did swimming exercise werehigher than the one who did the asthmaticexercises. The FEV1 values of the group whodid asthmatic exercise were similar to thereference groups, which were the people whodid not take swimming and asthmatic exercises.This result is consistent with the statement ofYunus6 that physical exercise affects a personscardio respiratory endurance. The cardio

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respiratory endurance of people who carry outlong-distance running is higher compared tothose who do asthmatic exercise, and the cardiorespiratory endurance of people who doasthmatic exercise is higher than the ones whodo not do any exercise.

In this study, the cortisol hormone levelincreased after 18 th intervention and tended tobe higher at 36 th intervention. The increase ofvariation of cortisol hormone level depends onthe intensity and duration of exercise, nutritionalstatus, fitness levels and circadian rhythms. Theincrease of cortisol hormone level after exerciseis also associated with lipolysis, cytogenesis,and proteolysis.5

The increase of cortisol hormone level isalso influenced by hypothalamus. Hypothalamussecretes CRH, which will stimulate the anteriorpituitary to release ACTH and lead to therelease of cortisol hormone.9 Cortisol hormonecan increase the responsiveness of -adrenergicreceptor on airway smooth muscle. When apostganglionic neuron of the sympatheticdivision is activated, it releases norepinephrineas a neurotransmitter. At the same time, theadrenal medulla is stimulated to secreteepinephrine into the blood. Both norepinephrineand epinephrine regulate the target cells bybinding to adrenergic receptors in the plasmamembran. Acetylcholine (ACh) is released byall preganglionic neurons stimulates thepostganglionic neurons by means of nicotinicACh receptors. Postganglionic sympatheticaxons provide adrenergic regulation of theirtarget organs by binding the neuroepinephrine2 adrenergic receptors causing the dilation ofbronchioles of lungs as well reducing airwayhiperresponsivity.11 This is possible because itcan decrease the number of circulatingeosinophils, the production and secretion ofcytokines in the respiratory tract.4 In this study,the increase of cortisol hormone level was

accompanied by the increase of FEV1. Subjectswith asthma carrying out swimming andasthmatic exercise improved their cortisolhormone level compared to subjects with asthmawho did not do swimming and asthmaticexercise 8. This study strengthens Yunussstatement that exercise can improve thecardiorespiratory function.

In this study, the swimming intensity is 70%- 75% between 20-30 minutes. The exerciseintensity and duration used in this study isdifferent with those recommended by McArdle.5

However, the intensity and duration in this studyare able to stimulate the bodys response.According to McArdle et al.5, low-intensityexercise (60%) with a period of 45 minutes canalso provide benefits. Therefore, whenperforming low-intensity exercise, a longduration is recommended.

The result of this study showed that thecortisol hormone level was higher in the groupwhich carried out swimming than in those whodid ashmatic exercise because the pressure inthe water can cause lipolysis, cytogenesis, andproteolysis, which will lead to cortisol hormonesecretion.10 The average calculation ofmetabolic at rest (MET) or oxygen uptake inliters per minute showed that the group who didswimming needed 1656.48 liters per minute,while the group who did gymnastics needed1309 liters per minute. Based on these results,it can be concluded the group who carried outswimming needs more oxygen, so the energyreleased is also greater than the asthmaticexercise group.

McArdle et al.5 stated that swimmingrequires more energy compared to otherexercises (running or walking) because inswimming, the movement of arms and legs willincrease the pulmonary function in therespiratory muscles.

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Handayani et al., Effect of swimming and asthmatic exercise on forced expiratory volume in 1 second (FEV1)and levels of cortisol hormone in asthmatics patients

CONCLUSION

Regular swimming and asthmatic exercisefor asthmatic patients can increase FEV1 valueand cortisol hormone level of the patients.However, the regular swimming can increaseFEV1 and cortisol hormone level higher thanthe asthmatic exercise. The increase of FEV1value and cortisol hormone level depends onthe frequency, intensity, type and length of timeof the physical exercise. Therefore hopefully,doing swimming and ashmatic exercise canreduce the frequency of drugs consumption inasthmatic patients. In addition, based on theresults of this study, asthmatic exercise withlonger duration can replace swimming.However, more study on the different intensityand duration of swimming and asthmaticexercise and the analysis of the frequency ofasthma attack after swimming and asthmaticexercise needs to be done.

ACKNOWLEDGEMENTS

Authors would like to thank dr. DenyAgustiningsih., M. Kes.,AIFM and dr.AhcmadDjunaedi.,AIFM for their supervision in doingthis study.

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