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Behavioral weight loss and physical activity intervention in obese adults with asthma. A randomized trial.
Ann Am Thorac Soc 2015; 12(1):1-11AA

Abstract

RATIONALE

The effect of weight loss on asthma in obese adults warrants rigorous investigation.

OBJECTIVES

To examine an evidence-based, practical, and comprehensive lifestyle intervention targeting modest weight loss and increased physical activity for asthma control.

METHODS

The trial randomized 330 obese adults with uncontrolled asthma to receive usual care enhanced with a pedometer, a weight scale, information about existing weight management services at the participating clinics, and an asthma education DVD, or with these tools plus the 12-month intervention.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was change in Asthma Control Questionnaire (ACQ) scores from baseline to 12 months. Participants (mean [SD] age, 47.6 [12.4] yr) were 70.6% women, 20.0% non-Hispanic black, 20.3% Hispanic/Latino, and 8.2% Asian/Pacific Islander. At baseline, they were obese (mean [SD] body mass index, 37.5 [5.9] kg/m(2)) and had uncontrolled asthma (Asthma Control Test score, 15.1 [3.8]). Compared with control subjects, intervention participants achieved significantly greater mean weight loss (±SE) (intervention, -4.0 ± 0.8 kg vs. control, -2.1 ± 0.8 kg; P = 0.01) and increased leisure-time activity (intervention, 418.2 ± 110.6 metabolic equivalent task-min/wk vs. control, 178.8 ± 109.1 metabolic equivalent task-min/wk; P = 0.05) at 12 months. But between-treatment mean (±SE) differences were not significant for ACQ changes (intervention, -0.3 ± 0.1 vs. control, -0.2 ± 0.1; P = 0.92) from baseline (mean [SD], 1.4 [0.8]), nor for any other clinical asthma outcomes (e.g., spirometric results and asthma exacerbations). Among all participants regardless of treatment assignment, weight loss of 10% or greater was associated with a Cohen d effect of 0.76 and with 3.78 (95% confidence interval, 1.72-8.31) times the odds of achieving clinically significant reductions (i.e., ≥0.5) on ACQ as stable weight (<3% loss or gain from baseline). The effects of other weight change categories were small.

CONCLUSIONS

Moderately and severely obese adults with uncontrolled asthma can safely participate in evidence-based lifestyle intervention for weight loss and active living. The modest average weight and activity improvements are comparable to those shown to reduce cardiometabolic risk factors in studies of similar interventions in other populations but are not associated with significant net benefits for asthma control or other clinical asthma outcomes in the current population. Instead, weight loss of 10% or greater may be required to produce clinically meaningful improvement in asthma. Clinical trial registered with www.clinicaltrials.gov (NCT00901095).

Authors+Show Affiliations

1 Palo Alto Medical Foundation Research Institute, Palo Alto, California.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25496399

Citation

Ma, Jun, et al. "Behavioral Weight Loss and Physical Activity Intervention in Obese Adults With Asthma. a Randomized Trial." Annals of the American Thoracic Society, vol. 12, no. 1, 2015, pp. 1-11.
Ma J, Strub P, Xiao L, et al. Behavioral weight loss and physical activity intervention in obese adults with asthma. A randomized trial. Ann Am Thorac Soc. 2015;12(1):1-11.
Ma, J., Strub, P., Xiao, L., Lavori, P. W., Camargo, C. A., Wilson, S. R., ... Lv, N. (2015). Behavioral weight loss and physical activity intervention in obese adults with asthma. A randomized trial. Annals of the American Thoracic Society, 12(1), pp. 1-11. doi:10.1513/AnnalsATS.201406-271OC.
Ma J, et al. Behavioral Weight Loss and Physical Activity Intervention in Obese Adults With Asthma. a Randomized Trial. Ann Am Thorac Soc. 2015;12(1):1-11. PubMed PMID: 25496399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Behavioral weight loss and physical activity intervention in obese adults with asthma. A randomized trial. AU - Ma,Jun, AU - Strub,Peg, AU - Xiao,Lan, AU - Lavori,Philip W, AU - Camargo,Carlos A,Jr AU - Wilson,Sandra R, AU - Gardner,Christopher D, AU - Buist,A Sonia, AU - Haskell,William L, AU - Lv,Nan, PY - 2014/12/16/entrez PY - 2014/12/17/pubmed PY - 2015/12/15/medline KW - adults KW - asthma KW - clinical trial KW - exercise KW - weight loss SP - 1 EP - 11 JF - Annals of the American Thoracic Society JO - Ann Am Thorac Soc VL - 12 IS - 1 N2 - RATIONALE: The effect of weight loss on asthma in obese adults warrants rigorous investigation. OBJECTIVES: To examine an evidence-based, practical, and comprehensive lifestyle intervention targeting modest weight loss and increased physical activity for asthma control. METHODS: The trial randomized 330 obese adults with uncontrolled asthma to receive usual care enhanced with a pedometer, a weight scale, information about existing weight management services at the participating clinics, and an asthma education DVD, or with these tools plus the 12-month intervention. MEASUREMENTS AND MAIN RESULTS: The primary outcome was change in Asthma Control Questionnaire (ACQ) scores from baseline to 12 months. Participants (mean [SD] age, 47.6 [12.4] yr) were 70.6% women, 20.0% non-Hispanic black, 20.3% Hispanic/Latino, and 8.2% Asian/Pacific Islander. At baseline, they were obese (mean [SD] body mass index, 37.5 [5.9] kg/m(2)) and had uncontrolled asthma (Asthma Control Test score, 15.1 [3.8]). Compared with control subjects, intervention participants achieved significantly greater mean weight loss (±SE) (intervention, -4.0 ± 0.8 kg vs. control, -2.1 ± 0.8 kg; P = 0.01) and increased leisure-time activity (intervention, 418.2 ± 110.6 metabolic equivalent task-min/wk vs. control, 178.8 ± 109.1 metabolic equivalent task-min/wk; P = 0.05) at 12 months. But between-treatment mean (±SE) differences were not significant for ACQ changes (intervention, -0.3 ± 0.1 vs. control, -0.2 ± 0.1; P = 0.92) from baseline (mean [SD], 1.4 [0.8]), nor for any other clinical asthma outcomes (e.g., spirometric results and asthma exacerbations). Among all participants regardless of treatment assignment, weight loss of 10% or greater was associated with a Cohen d effect of 0.76 and with 3.78 (95% confidence interval, 1.72-8.31) times the odds of achieving clinically significant reductions (i.e., ≥0.5) on ACQ as stable weight (<3% loss or gain from baseline). The effects of other weight change categories were small. CONCLUSIONS: Moderately and severely obese adults with uncontrolled asthma can safely participate in evidence-based lifestyle intervention for weight loss and active living. The modest average weight and activity improvements are comparable to those shown to reduce cardiometabolic risk factors in studies of similar interventions in other populations but are not associated with significant net benefits for asthma control or other clinical asthma outcomes in the current population. Instead, weight loss of 10% or greater may be required to produce clinically meaningful improvement in asthma. Clinical trial registered with www.clinicaltrials.gov (NCT00901095). SN - 2325-6621 UR - https://www.unboundmedicine.com/medline/citation/25496399/Behavioral_weight_loss_and_physical_activity_intervention_in_obese_adults_with_asthma__A_randomized_trial_ L2 - http://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201406-271OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -