An Evidence Based Protocol: Exercise Training for Children with Asthma

This dissertation, "An Evidence Based Protocol: Exercise Training for Children With Asthma" by Wing-ki, Lee, 李詠琦, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Asthma is a chronic inflammatory disease causing bronchospasm, which leads to the sensation of shortness of breath. Children with asthma are often afraid of exercise because the exercise induced exacerbation which gives children a sense of breathlessness. As a result, they usually have a sedentary lifestyle that decreases their physical fitness. However, there is evidence supporting the claim that exercises do not induce exacerbation, and exercise should be encouraged to asthmatic children to improve their physical fitness. In Hong Kong, protocol for exercise training with asthmatic children is limited. This is unfortunate because recent studies have shown that exercise training has improved the physical fitness of asthmatic children. This present studies used databases included PubMed (from 1950 to 2012), Ovid MEDLINE(R) (from 1950 to 2012), CINAHL (from 1982 to 2012), and ProQuest (from 1999 to 2012), to identify significant research on the topic. Eight studies, including seven RCTs and one cohort study, were chosen for in depth review. They were all good quality studies with satisfactory results that identified improvement in physical fitness for mild to moderate asthmatic children after exercise training. This present studies proposed an exercise training program for a pediatric ward in a public hospital in Hong Kong. The target population is children, aged 7 to 17, who suffer from mild to moderate asthma. They will enroll in an exercise training program to perform cycling in a clinical setting three times per week. The program will be sustained for nine weeks. The participants will undergo the innovation under the supervision of trained nurses. Evidence-based protocol is developed for the innovation to guide nurses on how to carry out the exercise training effectively and smoothly. The Scottish Intercollegiate Guidelines Network (SIGN) grading system is adopted to measure the levels of evidence and grading of the recommendations in the protocol. A communication plan will be developed to gain support from the identified stakeholders. A pilot study plan will be established in order to determine the feasibility of the proposed innovation. The exercise stress test, which is the primary outcome of the innovation, will be measured in the pilot study. Knowledge, job satisfaction, and confidence level of staff will be evaluated. The effectiveness of the innovation will be evaluated based improvements as measured by lung function, exercise stress and quality of life of the asthmatic children after exercise training. It will also consider nurse competency in carrying out the exercise training program. In the pediatric ward of a public hospital, mild to moderate asthmatic children are going to perform cycling under close monitoring and supervision. The proposed clinical setting for exercise program is intentional. Its relax atmosphere may encourage asthmatic children to do more exercises even after the training program. The researcher identifies transferable elements in the innovation, including characteristics of the patients, staff, setting and philosophy of care. The feasibility of the program is evaluated according to the culture and resource environment. The cost effectiveness is considered and it factors in the benefits of the innovation physically and psychologically. In order to implement this program successfully, a well-designed and planned protocol is pro