Flexibility and Strength Training in Asthma

The treatment of symptomatic asthma currently focuses on the use of medications - inhaled or
systemic - that have the principal goals of relieving airway pathology, namely airway
narrowing, inflammation, mucus metaplasia and hyper-reactivity. There are no therapies
directed at the chest wall or its connective tissue structural units, including connective
tissue matrix, bone health and chest wall musculature. Resistive flexibility and strength
training (RFST) is a new physical therapy technique that has successfully addressed
abnormalities in the upper and lower extremities and back. In this application, we propose to
use internal funding for a pilot project to explore the potential holistic benefits of RFST
directed to the chest wall in symptomatic asthmatics as well as the potential mechanical
basis of its therapeutic benefits if observed.

In RFST, the practitioner extends or flexes a joint, while the patient actively resists the
motion applied by the practitioner. In other words, the patient performs an eccentric
contraction of extensor muscles if the joint is flexed, or of flexor muscles if the joint is
extended. The technique is based on the following theoretical principles:

- Opposing muscle pairs (i.e. ipsilateral flexor/extensor) can become dysfunctional when
connective tissue within one of the muscles (either the flexor or the extensor) becomes
chronically shortened—thought to be due to long-standing exaggerated centrally driven
tonic muscle activity either following an injury or due to posture habit. When this
happens, connective tissue within the opposing muscle will become chronically lengthened
due to shortening of the paired muscle.

- The connective tissue can become inelastic and restrictive resulting in the muscles
being held in a chronically short or lengthened position. These positions can change.

- In the trunk, imbalances can occur between flexor/extensor groups (e.g.
psoas/multifidus) and also between right/left muscle pairs, creating postural
asymmetries. For example, shortening of the psoas muscle on one side will lead to
lengthening of the psoas on the contralateral side.

- Shortening of limb girdle muscles (e.g. pectoralis, gluteus) can create complex
imbalance patterns both across local flexor/extensor pairs, across sides, and diagonally
across the trunk (e.g. shortening of pectoralis major on one side causing lengthening of
extensor muscles in contralateral hip).

- The end result of these imbalances is that the shortened muscles restrict the range of
movement, and the lengthened muscles cannot function optimally in a lengthened position.

It is thought that resistance stretching 1) allows the shortened muscles to lengthen and the
lengthened muscles to shorten by remodeling intramuscular and perimuscular connective tissue,
2) allows lengthened muscles to contract at a more favorable length and 3) allows for an
increase in flexion, extension, and flexibility through joint ranges of motion.

Inclusion Criteria:

- Male and female patients, age ≥ 18 yrs

- Physician-diagnosed asthma

- Currently taking asthma medications

- Asthma Control Questionnaire (ACQ) score >1.25

Exclusion Criteria:

- Smoking history of ≥10 pack years

- Pregnancy or lactation or subjects planning to get pregnant during the course of the
trial

- Major medical problems prohibiting study participation, i.e. presence of chronic or
active lung disease other than asthma or history of unstable significant medical
illness other than asthma or concurrent medical problems that would place the
participant at increased risk as determined by the study physician