***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Some individuals with moderate/severe persistent asthma develop irreversible airway obstruction . These individuals present with dyspnoea , exercise intolerance and impaired quality of life ( QOL ) , all of which could potentially be alleviated with exercise training . Objective : To investigate whether exercise training improves functional exercise capacity and QOL in middle-aged and older adults with fixed airway obstruction asthma ( FAOA ) . Methods : 35 subjects aged 67.8 ± 10.6 years , with FEV1 59 ± 16 % of predicted , were r and omised to a 6-week  ‘ intervention ’ period of supervised exercise training ( n = 20 ) or usual care ( n = 15 ) . This period was preceded by a 3-week run-in period during which asthma control was assessed weekly . Functional exercise capacity ( 6-min walk distance , 6MWD ) and QOL ( Asthma QOL Question naire , AQLQ ) were measured before , immediately following and 3 months after the intervention period . Results : 34 subjects ( exercise group , n = 19 , and control group , n = 15 ) completed the intervention period . Relative to the control group , the exercise group had greater improvements immediately following and 3 months after the intervention in the AQLQ symptom domain ( 0.61 , p = 0.001 , and 0.57 points per item , p = 0.005 ) and AQLQ activity limitation domain ( 0.43 , p = 0.04 , and 0.55 points per item , p = 0.04 ) . 6MWD increased ( 36 ± 37 m , p < 0.01 ) in the exercise group immediately following training and remained elevated ( 34 ± 45 m , p < 0.01 ) at the 3-month follow-up . The magnitude of change in 6MWD between groups was not significant , despite no change in the control group . Conclusions : Supervised exercise training improves symptoms and QOL in adults with FAOA Global asthma control levels are suboptimal . The influence of regular exercise on asthma control is unclear . We assessed the effects of a 12-week supervised exercise intervention followed by 12 weeks of self-administered exercise on adults with partially controlled asthma ( n = 21 ) and matched controls ( n = 15 ) . Assessment s were conducted at baseline and week 12 for both the exercise and control group , and again at week 24 for the exercise group . There was a significant treatment effect on asthma control in the exercise group , as measured by the Asthma Control Question naire ( ACQ ) , from baseline to week 12 , compared with the control group . A clinical ly significant improvement ( 0.5 increase in ACQ score ) was observed for asthma quality of life and ACQ in the exercise group from baseline to week 12 . There was a significant improvement in aerobic fitness from baseline to week 24 in the exercise group . In conclusion , a 12-week supervised exercise intervention led to improvements in asthma control and quality of life in partially controlled asthmatics motivated to exercise . These improvements were maintained , while aerobic fitness and perceived asthma control significantly improved over an additional 12 weeks of self-administered exercise . These findings indicate that a structured exercise intervention can improve asthma control BACKGROUND Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease Background . Supervised exercise leads to significant improvements in asthma control and quality -of-life in adults with partly controlled asthma ; however , the role of unsupervised exercise is unknown . Methods . The purpose of this study was to determine the impact of self-directed exercise on subjective and objective indices of asthma-related health .  Participants ( n = 24 ) were assigned to an exercise group or a control group for a 12-week period . Those in the exercise group were provided with exercise programs by a qualified exercise professional . These programs were up date d through electronic mail every 3 weeks to ensure progression . Controls maintained their current lifestyle habits for the intervention period . Assessment s of aerobic fitness , lung function , and subjective and objective asthma measures were conducted at baseline and after completion of the 12-week intervention period for both groups . Analysis of covariance was used to detect differences between groups from baseline to week 12 . Qualitative analyses were used to assess responses to open-ended questions . Results . Adherence to the program was poor . Perceived asthma control and self-reported frequency and severity of asthma improved significantly in the exercise group at week 12 compared with that in the control group . Objective measures of asthma such as asthma control , quality -of-life , and lung function , as well as peak and submaximal aerobic fitness did not change relative to controls . Responses to open-ended questions revealed improvements in three areas : asthma management , perceived fitness , and well-being . Conclusion . Adults with partly controlled asthma are able to improve perceived control and subjective measures of asthma-related health with 12 weeks of self-directed exercise ; however , supervision may be required to make significant improvements to measured asthma control , quality of life , and aerobic fitness . Future research should focus on the means to improve adherence of self-directed exercise programs  in this population The effect of two types of physical training on patients with perennial asthma were compared in a blind , controlled , r and omized study . Eleven of 27 adults with asthma performed a physical training programme which did not change their oxygen consumption ( control group ) . The remaining 16 asthmatics performed a physical training programme which improved their maximal oxygen consumption ( training group ) . Both of the training programmes were performed for 1 hour , twice a week during a period of 2 months . No complications were reported during the performance of the training programmes . The doses of all medicines apart from beta 2-agonist aerosol were unchanged during the training period . The patients inhaled beta 2-agonist aerosol if their peak expiratory flow ( PEF ) was less than 60 % of their maximal PEF . The training group decreased their use of aerosol from an average of 4.94 puffs per day to 3.41 puffs per day ( P less than 0.05 ) . The control group did not change their use of beta 2-agonist aerosol significantly . It is concluded that physical exercise which improves the maximal oxygen consumption decreases the use of beta 2-agonist spray and that heavy exercise is well tolerated by asthmatics The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment , and a 3 month control period of drug treatment only , for asthmatic patients and patients with chronic obstructive pulmonary disease ( COPD ) . The programme was run by physiotherapists in eight local practice s , and included exercise training , patient education , breathing retraining , evacuation of mucus , relaxation techniques , and recreational activities . In a r and omized controlled trial with a cross-over design , the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life ( QOL ) . Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests .  QOL was evaluated by means of the Chronic Respiratory Disease Question naire ( CRDQ ) . After 3 months , the patients who started with rehabilitation showed significant improvements in endurance time ( 421 s ) and cardiac frequency ( 6 beats.min-1 ) during cycling , walking distance ( 39 m ) , and total CRDQ score ( 17 points ) compared to the control group . These improvements were still significant after 6 months . Additional analysis indicated that the asthmatic patients and the patients with COPD responded to rehabilitation in a similar way , with the exception that there was a greater improvement in walking distance for asthmatics . Improvements in exercise tolerance were not significantly correlated with improvements in QOL .  Rehabilitation of patients with asthma or chronic obstructive pulmonary disease in local physiotherapy practice s improves exercise tolerance and quality of life The aim of the present study was to examine the effects of a course of aerobic exercise on pulmonary function and tolerance of activity in asthmatic patients . Among the asthmatic patients , 36 patients ( M= 16 , F= 20 ) were chosen after clinical examinations , pulmonary function test , skin prick test ( SPT ) for aeroallergen and a six minute walk test ( 6MWT ) on their own free will . A patient was said to have Exercise Induced Asthma ( EIA ) when he/she fulfilled the following criteria ; ( 1 ) FEV1 less than 80 % , ( 2 ) 12 % increase or more in FEV1 or PEF after short-acting ss2 agonist prescription and ( 3 ) 15 % decrease in FEV1 or PEF after 6MWT with 70 % or 80 % of maximum heart rate . The patients were r and omly put into two groups of case ( M=8 , F=10 , Mean age=27 ) and control ( M=8 , F=10 , Mean age=29 ) . Case group participated in eight-week aerobic exercise plan , while control group had no plan of exercise .  Pulmonary function tests were done before and after the course of exercise . There were significant changes in FEV1 , FVC , PEF , FEF25 - 75 % , MVV , RF and 6MWT between asthmatic patients of the two groups ( P less than or equal to 0.05 ) , but FEV1/FVC showed no significant change . Mean of changes in FEV1 , FVC , PEF , FEF25 - 75 % , MVV , RF and 6MWT were -25.56 , -17.19 , 32.09 , -27.93 , -22.18 , 5.63 and -307.5 in case group respectively while they were 6.2 , 4.67 , 1.96 , 6.65 , 15.56,-2.87 and 18.78 in the control group . This study shows that aerobic exercises in asthmatic patients lead to an improvement in pulmonary functions .  Aerobic exercise rehabilitation can be a complement to medical treatment of asthma Background Aerobic exercise appears to have clinical benefits for many asthmatics , yet a complete underst and ing of the mechanisms underlying these benefits has not been eluci date d at this time . Purpose The objective of this study was to determine feasibility for a larger , future study that will define the effect of aerobic exercise on cellular , molecular , and functional measures in adults with mild-moderate asthma . Design Recruited subjects were r and omized into usual care ( sedentary ) or usual care with moderate intensity aerobic exercise treatment groups . Setting / Participants Nineteen adults with mild-moderate asthma but without a recent history of exercise were recruited at the UAB Lung Health Center , Birmingham , AL.InterventionThe exercise group underwent a 12 week walking program exercising at 60 – 75 % of maximum heart rate ( HRmax ) . Subjects self-monitored HRmax levels using heart rate monitors ; exercise diaries and recreation center sign-in logs were also used . Main outcome measures Functional measures , including lung function and asthma control scores , were evaluated for all subjects at pre- and post- study time-points ; fitness measures were also assessed for subjects in the exercise group . Peripheral blood and nasal lavage fluid were collected from all subjects at pre- and post- study visits in order to evaluate cellular and molecular measures , including cell differentials and eosinophilic cationic protein ( ECP ) . Results Sixteen subjects completed the prescribed protocol . Results show that subjects r and omized to the exercise group adhered well ( 80 % ) to the exercise prescription and exhibited a trend toward improved fitness levels upon study completion . Both groups exhibited improvements in ACQ scores . No changes were observed in lung function ( FEV1 , FEV1/FVC ) , cell differentials , or ECP between groups . Conclusions Results indicate that a moderate intensity aerobic exercise training program may improve asthma control and fitness levels without causing asthma deterioration in adult asthmatics . As such , these findings demonstrate the feasibility of the study protocol in preparation for a larger , clinical trial that will eluci date the functional consequences of aerobic exercise on asthmatic cellular and molecular responses The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma . Subjects with persistent allergic asthma ( aged 12.7±3.4 yrs ; n = 34 ) were r and omly allocated into training 
    Output:
    
Physical training was well tolerated with no adverse effects reported .
None of the studies mentioned worsening of asthma symptoms  following physical training .
This review demonstrated that physical training showed significant improvement in maximum oxygen uptake , though no effects were observed in other measures of pulmonary function .
Physical training was well tolerated among people with asthma in the included studies and , as such , people with stable asthma should be encouraged to participate in regular exercise training , without fear of symptom exacerbation .