AN INVESTIGATION INTO THE RELATIONSHIP BETWEEN 
ANAEROBIC WORK CAPACITY, PERCENTAGE BODY FAT 
AND THE GRADE OF ASTHMA IN ASTHMATICS AND A 
HEALTHY CONTROL GROUP

M Burger, M Geyer, W Regel, G M Smit, E Terblanche and J A Hendry*

SUMMARY

The goal of this study was to compare the anaerobic working 
capacity of asthmatic children to that of a healthy control 
group and to ascertain the relationship between the degree 
of asthma, anaerobic exercise and percentage body fat.
A total of 41 children, 21 asthmatics and 20 healthy children 
(13-18 years) were tested. Three variables -  percentage 
body fat, pulmonary function and fitness -  were measured. 
It was found that there is very little difference between the 
asthmatic and the healthy child, with regard to anthropome­
tric measurements, fitness and anaerobic working capacity. 
A poor correlation was found between percentage body fat, 
pulmonary function and anaerobic working capacity. The 
results further showed that there is a slight correlation be­
tween the percentage body fat and anaerobic working ca­
pacity. This tendency can only be confirmed with a larger 
random sample of children.
The researchers conclude that asthmatics, irrespective of 
the degree of asthma, are not restricted as far as anaerobic 
activities are concerned. They can therefore lead a normal 
healthy life and, as far as anaerobic exercise is concerned, 
can compete on equal terms with healthy children.

INTRODUCTION
T he physiotherapy profession is growing increasingly in te r­

ested in exercise-induced bronchospasm  (E IB ) because eighty p e r­
cent of all asthm atics develop EIB .

Most research deals with the cardio respiratory fitness o f as 
thm atics while most experimental groups consist o f patients with 
chronic obstructive pulmonary disease o r heterogeneous patients 
with obstructive airway disease2,3’4,5. T he researchers noted that 
th ere  was a definite deficiency in the lite ratu re  providing a well 
controlled study o f a hom ogeneous group of patients and an age- 
equivalent control group. The fact th at such a large percentage of 
children suffer from asthm a served as motivation fo r the use of 
schoolgoing children in this study.

Since the anaerobic working capacity o f asthm atics had not 
been previously docum ented, the question arose w hether asthm atics 
suffered the sam e limitations with anaerobic exercise as with aerobic 
exercise. It was also not known w hether the degree of asthm a and 
the physical build were limiting factors for anaerobic working c apac­
ity.

LITERATURE REVIEW
A pproximately 18% o f all children, 18 years and younger.

O PSOMM ING

Die doel van die studie was om die anaerobiese werkkapasiteit van 
asmalyers en 'n gesonde kontrole groep te vergelyk en om die 
verband tussen die graad van asma, anaerobiese werkkapasiteit 
en persentasie liggaamsvet te ondersoek.
’n Totaal van 41 kinders (21 asmalyers en 20 gesonde kinders), 
tussen die ouderdom 13-18 jaar is getoets. Drie veranderlikes -  
persentasie liggaamsvet, pulmonere funksie en fiksheid -  is ge- 
meet.
Daar is min verskille t.o.v. antropometrie en fiksheid tussen die 
asmalyers en die gesonde kontrole groep gevind. Die anaerobiese 
werkkapasiteit van die asmalyers en die kontrole groep het nie 
verskil nie en daar was 'n swak korrelasie tussen die persentasie 
lig g a a m s v e t, p u lm o n e re  fun ksie en a n a e ro b ie s e  w e rkkap asiteit. 
Die resultate toon voorts dat daar ’n klein waarskynlikheid is dat 
daar ’n verband bestaan tussen persentasie liggaamsvet en an ­
aerobiese werkkapasiteit, asook dat asmalyers geneig is tot 'n hoer 
persentasie liggaamsvet. Hierdie tendens kan egter net met ’n 
groter steekproef bewys word.
Die navorsers het tot die gevolgtrekking gekom dat asmalyers, 
ongeag die graad van asma, nie beperkinge ervaar t.o.v. anaero­
biese tipe aktiwiteite nie en dus met gesonde kinders op gelyke 
vlak kan kompeteer.

experience some form of chronic respiratory dysfunction at som e 
stage. F o u r percent of these children a re  asthm atics .

A ccording to the literature 2 -6 %  of the world population 
suffers from bronchial asthm a , while 6 0 -8 0 %  of all asthm atics also 
suffer from EIB. From  this it can be seen that at least 5%  of the world

7
population of asthm atics also develops bronchospasm  with exercise . 
In 1988 it was found that 6.5%  o f whites and 3,5% o f coloureds -  
between 6 and 18 ^ycars -  in the n o rth ern  suburbs o f C ape Town 
suffered from EIB .

M ost asthm atics develop a noticeable degree of bronchospasm  
as a result o f exercise, which greatly restricts their extram ural a c ti­
vities and sport and can lead to  social and psychological problem s. 
Exercise induced bronchospasm  (E IB ) is not related to  age, sex o r 
the degree of asthma*. It is found in patients with o r  w ithout a 
positive skin test. In som e asthm atics EIB is the only form  o f asthm a 
which they experience.

In 1976 it was found that, while a raised fitness level did not 
necessarily free the asthm atic from  EIB, it could well lead to an 
improved physical work capacity7. In 1989 asthm atics (at age 25) 
were found to have a higher V O 2 maximum (maximal oxygen vol­
um e) and a norm al work capacity on maximum work loading if they 
had followed a regular exercise program m e from  a early age (a p ­
proximately 10 years). This could be due to an e arlie r exposure to an 
exercise program m e o r to a higher m otivation .

* M Burger, M Geyer, W  Regel, G M Smit B S C  in Physiotherapy I V 1990
E  T erblanche Lecturer, D e partm ent o f Physiology, University o f Stellenbosch 
J  A  H endry Lecturer, D e partm ent o f Physiotherapy, University o f Stellenbosch

Bladsy 28 Fisioterapie, Mei 1991, dee147 no 2

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T o d a te  nearly all research has been aim ed at the effect of
aerobic exercise program m es on  the cardiorespiratory function of
p a tie n ts  w ith c h ro n ic  o b s tru c tiv e  a irw a y  d ise a s e . M o s t s tu d ie s  h ave

1 0 1 1 1Z13shown the advantage o f exercise program m es ’ , while o th e r 
researchers have established a erobic exercise program m es to  test 
cardiorespiratory fitness12,14.

As far as can be ascertained, the anaerobic w ork capacity of 
asthm atics has not yet been studied. Since ordinary activities are 
mainly anaerobic in nature, it is im portant , to know how fa r a sth m a ­
tics a re  lim ited with these. A cute asthm atics, fo r whom aerobic 
activities lead to severe bronchospasm , m ight possibly also benefit 
from  anaerobic types o f activity.

METHOD 
Hypothesis

T he anaerobic w ork capacity o f asthm atics and non-asthm atics 
should not differ. T he correlation between the degree of asthm a and 
the anaerobic w ork capacity should indicate w hether asthm a as such 
is a limiting factor for physical activity. A naerobic exercise lasts less 
than 2 m inutes while exercise-induced asthm a only m anifests a fte r 6 
minutes.

Study structure
A  case controlled study was carried o ut on 41 white children 

(21 asthm atics and 20 healthy children) between the ages of 13 and 
18 years, selected from 3 high schools in the n orthern suburbs of 
C ape Town by m eans o f a random  test.

T he test subjects had to comply with the following criteria:

Cases:
•  M ale o r female
•  13-18 years
•  Must a tte n d  High Schools A,B o r C, which are representative 

o f high schools in the north ern  suburbs o f C ape Town
•  G ra d e  I, II, o r III asthm atics
•  O ne o r m ore asthm a attacks in the past 12 m onths
•  N o u p p e r airways diseases for at least 6 weeks before testing.

Controls:
•  M ust a ttend High Schools A, B o r C, which a re  representative 

of high schools in the north ern  suburbs o f C ape Town
•  The sam e age, sex and height, ±  2 c m , a s th e  te s t g ro u p .

Figure 1: Grading of asthma according to dlnical history

H e a lth y
20

G ra d e  II 
15

Procedure
E ach prospective subject com pleted a clinical questionnaire 

from  which the degree of asthm a was established (Figure 1). It was 
then decided w hether the subject satisfied the criteria fo r inclusion.

Next, th ree variables w ere m easured, viz. percentage body fat, 
pulmonary functions and fitness.

T he percentage body fat was d e term ined by anthropom etric 
m easurem ents, viz. height, m ass, bi-epicondylar m easurem ent and 
skinfolds. Spirom etric m easurem ents fo r determ ination o f forced 
expiratory volum e (F E V i), forced vital capacity (FV C ) and peak 
expiratory flow ra te  (P E F R ) w ere carried  o ut by m eans of a M innato 
A u tospiro before and a fte r a fitness test.

T he fitness test consisted o f six isotonic exercises in the form  of 
a circular program m e, i.e. sit-ups, upright bounces, push-ups, walk­
ing test, short runs and “b u rp e e s”. B ecause the a n aerobic work 
capacity was being m easured by high im pact isotonic exercise o f less 
than 2 m inutes duration, each exercise lasted only 30 seconds with a 
rest period of two m inutes betw een each station.

F ifteen seconds a fte r th e  subject com pleted a station, his/her 
pulse was taken fo r 30 seconds.

RESULTS
T he a n th ro p o m etric  m easurem ents, spirom etry and fitness 

test yielded the following results.

Anthropometry:
T h e  difference betw een the asthm atics and the control g ro u p ’s 

param eters was not statistically significant -  specifically also n ot on 
the percentage body fat.

Spirometry:
All the pre-exercise values o f the asthm atics w ere low er than 

those o f the control children. T h e re  w ere, however, two w hose values 
w e r e  s ta tis tic a lly  sig n ific a n tly  lo w e r i.e. t h e  v o lu m e  re la tio n s h ip  
(F E V  i/F V C % ) and the flow tim es 50 (F50) (T able 1). A fte r c o m ­
pletion o f the fitness test th ere  was again a significant d ro p  in the 
F E V  i/F V C %  and F50 of the asthm atics and also in th e ir F E V i 
(T able 2).

TABLE 1: PRE-EXERCISE SPIROMETRY

Asthma Control
FEV1 2 .8 7 ± 0 .5 5 3 .1 8 + 0 .7 3
FVC 3 .5 9 ±  0.65 3 .6 8 -0 .8 5
FEVi/FVC%* 8 0 .1 0 ± 8 .0 8 86.61 ± 5 .1 0
PEFR 6 .6 5 ± 1 .3 0 6 .9 6  ± 1 .7 6
F50* 3.10 ±  0.98 4.07 ±  1.07
(M e a n ±  sd)
* p <  0.05

TABLE 2: SPIROMETRY AFTER EXERCISE (pre-post)

Asthma Control
FEVi -7 .5 5 ± 1 4 .00 0.68 ± 3 .3 6
FVC -5.31 ±  10.76 -1.33 ± 4 .2 7
FEV|/FVC%* -2.77 ±  6.19 2 .1 0 ± 2 .5 7
PEFR -8.80 ±17.54 -1.44 ± 8 .1 0
F50* -2 3 .3 0 ± 4 1 .04 1.00 ± 6 .4 4
(M e a n ±  sd)

p <  0.05

Six of the 21 asthm atics showed a d ro p  o f m ore th an  10%  in 
th eir F E V i a fte r the fitness test. They therefore had a positive 
response to exercise and could be considered to b e  exercise-induced 
asthm atics.

Fitness test:
T he anaerobic work capacity was calculated by adding to g eth e r 

the total n um ber of a tte m p ts at all 6 stations and, while th ere  w as no 
statistically significant difference, the asthm atics recorded few er a t ­
tem pts p e r exercise than the c o ntrol children.

T he h e a r ra te  of the asthm atics during the fitness test was 
uniformly higher than th at o f the c o ntrol children, indicating g re ater 
effort. T hese differences, however, w ere again not statistically signi­
ficant (F igure 2).

Physiotherapy, May 1991, vol 41 no 2 Page 29

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PI<M* 2: Hearl rale response of asthma sufferers and oontroto

2 0 0

160 

100 

60 

0

—*— asthm a sufterers — controls

heart rate

_i_______ i ______ i_______ i_______ i_______ i______ j_
rest s 'tu p s pushups step ups jumps burpee runs

DISCUSSION
T he results of this study dem onstrate very clearly that the 

a n a e r o b ic  w o rk in g  c ap a city  o f  a s th m a tic s  is n o t re s tric te d . F a c to rs  
such as th eir percentage body fat and the degree of asthma did not 
play a lim iting ro le  in th e ir  ex erc ise  ability. T h is im p lies tlial th e  
majority of asthm atics can lead a norm al and active life and, as far as 
fitness is concerned, need not defer to  normal, healthy children.

From  the above it follows that the role of the physiotherapist 
should be not so much on the physical side as on the psychosocial 
implications of regular exercise and hence the total rehabilitation of 
the asthm atic. Asthm atics and their parents should be given infor­
m ation a bout the daily treatm ent of the disease (asthm a) on the 
physical and psychological levels.

F ro m  th e  li t e r a t u r e * '* 6 it is also a p p a r e n t th a t m o r e  r e ­
searchers support the view that the psychosocial benefits of regular 
sp o rt and relaxation arc m ore advantageous for the asthm atic than 
the physical advantages.

A primary shortcom ing of this study is the fact that most of the 
asthm atics suffered from grade II asthm a. T o obtain a true c o rre la ­
tion which would be both clinically and statistically meaningful, a 
larger test group is needed.

The lack of appropriate references in the literature regarding 
the anaerobic work capacity of asthm atics m eant that the results of 
this study could not be com pared with previous studies. T he present 
study should therefore make a valuable contribution.

Because asthm atics already have limited pulmonary function 
during rest, the significant differences in lung function between the 
asthm atics and the control group a fte r exercise w ere not unexpected. 
In contract to the literature'3 which indicates that uninterrupted 
exercise of at least 6 minutes is needed to  produce the typical 
asthm atic response, it was found in this study that interrupted exer­
cise of less than 6 m inutes can also cause exercise-induced b ronchos­
pasm (EIB). However, it appears that his bronchospasm  response to 
anaerobic activities is confined to serious (G ra d e  III) asthmatics, 
since only 6 of the 21 asthm atics showed a d rop of m ore than 10% 
in F E V i a fte r the fitness test.

Asthm atics with EIB developed a significantly g reater change 
in pulmonary function a fte r the fitness test than asthm atics w ithout 
EIB.

T he reasons why only som e of the asthm atics developed b ro n ­
chospasm during anaerobic activity is not obvious. A  possible expla­
nation might be that only serious asthm atics (G ra d e  III) will develop 
EIB during anaerobic activity. A ccording to  the clinical battery only
1 child who developed EIB was a grade III asthm atic, while two were 
grade I and three were grade II asthm atics. On the one hand these 
findings draw attention to  the fact that a clinical history is not an 
objective m easure of the true n ature and range of asthm a and that 
asthm a is often under-diagnosed. On the o th e r hand this study might

indicate a subgroup o f asthm atics who develop bronchospasm  with 
anaerobic types o f activity as well.

Anaerobic Work Capacity
T he findings o f this study c annot be com pared with others 

because no related literature could be found. T he little literature 
which does deal with anaerobic w ork capacity and fitness has one 
main shortcom ing, viz. the quantification of anaerobic work capacity. 
M oreover, fitness tests differ in the content of the exercise battery, 
making com parison of the existing literature impossible.

A lthough the “fitness te s t” used in this study is not an official 
test for anaerobic work capacity, it consisted of six isotonic exercises 
which test the w ork capacity of all the large muscle groups. T he 
researchers therefore believe that this test is a good indicator of 
anaerobic w ork capacity.

T he results show th at th ere  is no significant difference in the 
anaerobic work capacity of asthm atics and a control group. Since the 
asthm atics recorded a sm aller n um ber of attem pts per exercise, 
however, it could be that the opposite might be dem onstrated with 
a larger test group.

The results also show a non-significant difference in the a n ­
a e r o b ic  w o rk  c ap a c ity  o f  a s th m a tic s  w ith E IB  a n d  th o se  w ith o u t. 
Because the pulmonary functions of the asthm atics with EIB showed 
that these children developed bronchospasm  with exercise, it is 
assum ed that these children must have a particularly high motivation 
to reach the sam e work capacity as non-asthmatics.

Accordingly, the researchers concluded that only serious as­
thm atics develop bronchospasm  with anaerobic activity, but that this 
has no detrim ental effect on th eir anaerobic work capacity.

CONCLUSIONS
Tiie researchers cam e to the conclusion that there was no 

difference between the anaerobic work capacity of the asthm atics 
and the control children, which means that this form o f activity is 
m ore advantageous for the asthm atic. However, acute asthm atics 
will still show a positive response to this type of exercise.

T he percentage body fat and the grade of asthm a a re  also not 
limiting factors during anaerobic exercise.

In addition, there was a p oor correlation between the p e rc e n t­
age body fat, pulm onary function and fitness.

A  clinical history is not an objective m easure of the degree of 
asthma and an exercise test is necessary to establish the genuine 
nature and extent of the disease.

It is general practice for the asthm atic o r his p aren ts to c o m ­
plete a clinical battery according to  which the patient is then classified 
as a g ra d e  I, g ra d e  II o r  g ra d e  III a s th m a tic . T h e  a s th m a tic  is th e n  
subjected to an aerobic fitness test of 10 -  12 m inutes on a treadm ill, 
which is stressful for the patient and may also be time-consuming.

In contrast a general p ractitio n er can subject the asthm atic to 
an anaerobic fitness test which is less stressful, can be d one anywhere 
a t any time, requires no a p p ara tu s and takes little time.

REFERENCES
1. H urt M. Physical conditioning in asthm a. AnnAller$> 1964; 22:229-237.
2. M orton A R, Fitch KD, H ahn AG. Physical activity and the asthm atic. The

Physician and Sports M edicine 1981; 6:51-64.
3. Marley WP. Asthm a and Exercise, a review. A m  C o n  T h erJ 1977 (July -

August).
4. T erblanche E. Die voorkoms van oefeninp-geinduseerde brongospasma

onder kinders en dieeffek daarvan o p hulle funksionelestatus. MSc Thesis, 
University o f Stellenbosch, 1988.

5. W alter R, F rontera MD, R ichard P, A dam s PD. E ndurance Exercise:
Norm al Physiology and L im itations Imposed by Pathological Processes 
(P a rt 1). The Physician a n d  Sports m edicine 1986; 14(8):94-104.

6. Tecklin JS. Physical T herapy fo r Children with C hronic Lung D isease.
Phys Ther 1981; 61:1774-1781.

7. Fitch KD, Godfrey S. A sthm a and A thletic Perform ance. JA M A  1976;
236:152-157.

8. Khan AU, Olson D L. Physical Therapy and Exercise-Induced B ronchos­
pasm. Phys Ther 1975; 55:878-880.

9. Fridberg S, Bevegard S, G raff-Lonnevig V, H allback I. A sthm a from

Bladsy 32 Fisioterapie, Mei 1991, deel 47 no 2

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childhood until adulthood. A  follow-up study of 20 subjects with special 
reference to work capacity and pulm onary gas exchange. J  Allergy Clin 
Im m u n o l 1989; 84(2):183-190.

10. C hristie D. Physical training in chronic obstructive lung disease. B rM e d  
J 1968; 2:150-151.

11. C ockcroft A E, Saunders MJ, B erry G . R andom ised controlled trial of 
rehabilitation in chronic respiratory disability. Thorax 1981; 36:200- 
203.

12. McGavin C R , G u pta SP, M cH ardy G JR . Twelve m inute walking test for 
assessing disability in chronic bronchitis. B r M e d J  1976; 1:822-823.

13. McGavin C R , G upta SP, Lloyd EL, M cH ardy G JR . Physical re habilita­
tion for the chronic bronchitic: results of a controlled trial of exercises 
in the hom e. Thorax 1977; 32:307-311.

14. Mungall 1PF, H ainsw orth R . A ssessm ent of respiratory function in 
patients with chronic obstructive airways disease. Thorax 1979; 34:254- 
258.

15. Sly M R , H a rp e r R T , R osselot 1. T he effect of physical conditioning upon 
asthm atic children. A n n  Allergy 1972; 30:86-94.

16. B ooker HA. Exercise Training a nd B reathing C ontrol in Patients with 
C hronic Airflow L im itations. Physiotherapy 1984; 70(7):258-260.

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ACUPUNCTURE COURSE MODULE 1 
Presented by the Private Practitioners Association Northern 

Transvaal Branch
VENUE: Jakaranda Hospital, Muckleneuk, Pretoria
DATES: 15 an d  16 June 1991
FEES: SASP Members: R250: Non-Members R350.
Please send your ap plication, together with the appropriate 
fe e  to the Treasurer, P O Box 14513, Verwoerdburg 0140. 
ENQUIRIES: (012) 628-9654 or (012) 63-1638.

THE HOLISTIC APPROACH TO THE KNEE JOINT 
Presented by Southern Transvaal 
DATES: 29 an d  30 June 1991
VENUE: Johannesburg Hospital Physiotherapy Department 
FEE: SASP Members: R250; Non-Members R350;
Cancellation fee: R100.
Limited to 40 participants 
Teas a n d  lunches included.
Please send your application, together with the appropriate 
fee to Caren Fleishman, 20 John Mackenzie Drive, Em- 
marentia 2195.
ENQUIRIES: Caren Fleishman (011) 884-1981 (w) or Ian Seels 
(011) 442-7641 (h).A

WORK IN THE UNITED STATES

PHYSIOTHERAPISTS
EXCELLENT JOBS

We handle all licensure and visa paperwork. 
Minimum commitment of one year required. 

TRN fees paid by employer 
Write or phone collect:

THERAPY RESOURCE NETWORK 
P O Box 5430 

Plymouth, Michigan 48170, USA

Phone (313) 455-6660

Physiotherapy, May 1991, vol 41 no 2 Page 33

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