Effect of warm-up exercise on exercise-induced bronchoconstriction
Stickland MK, Rowe BH, Spooner CH, Vandermeer B, Dryden DM. Med Sci Sports Exerc. 2012 Mar;44(3):383-91.
Following a warm-up that induces exercise-induced bronchoconstriction (EIB), a temporary airway narrowing associated with exercise, some individuals experience a 1 to 4 hour refractory period during which they have less severe or no EIB after additional vigorous exercise. Numerous warm-up programs have been suggested to induce a refractory period but it is unclear how effective they are. Therefore, Stickland et al conducted a systematic review to evaluate the effectiveness of different warm-up routines to cause a refractory period. In August 2009, the authors searched the literature for randomized clinical trials that assessed the influence of warm-ups on adults or children with EIB. Warm-up routines were classified into four groups: 1) interval high-intensity, 2) continuous low-intensity, 3) continuous high-intensity, and variable intensity warm-ups (e.g., a combination of low and very high intensity). Among the seven studies the authors identified the interval high-intensity and variable intensity warm-ups decreased EIB. In contrast, continuous low-intensity and continuous high-intensity warm-ups did not. The interval protocols involved repetitive sprints of 26 to 30 seconds at 100% maximal oxygen consumption (or higher; the article provides a table giving more details). One of the variable intensity warm-ups included 6-minute treadmill run, a 10-minute rest followed by 7 30-second sprints, and finally a 20-minute rest before the final 6-minute treadmill run.
This systematic review is interesting because it highlights that an appropriate warm-up protocol could function as a short-term nonpharmacological alternative for reducing EIB. The authors note that the interval high-intensity warm-up “may be superior as it is a more easily standardized for the athletes/coach, and there is more evidence for this strategy”. A simple interval program may be particularly valuable because some athletes may be able to perform the 15 to 30 minute warm-up without direct supervision; saving staff time. While this review provides support for interval high-intensity and variable intensity warm-ups (e.g., warm-ups with maximal-exertion sprints) more research in this area may help optimize the benefits of these warm-ups. Furthermore, it will be interesting to see how these warm-ups compare to inhalers. Do you feel that these warm-ups could be beneficial for your athletes? Do you have athletes perform these warm-ups?
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas
Stickland MK, Rowe BH, Spooner CH, Vandermeer B, & Dryden DM (2012). Effect of warm-up exercise on exercise-induced bronchoconstriction. Medicine and Science in Sports and Exercise, 44 (3), 383-91 PMID: 21811185
I have EIA and have tried a couple of these to see if they would help. In one case, after an interval warm up, I was able to prevent some of the asthma s/s. However, I still did not feel very well the rest of the time exercising because I induced a little too severe asthma reaction. After this warm up, I felt exhausted the rest of the day in spite of my breathing being relatively normal. In the other instance, I tried to induce with continuous high intensity exercise and either it didn't work or my rest time was not long enough to allow for resolution of symptoms.
Hi Timothy. Thanks for the insight. It is always a plus to hear from someone who has used a program like this on themselves. It was very informative. Thanks!
I am a 73 year old male who began serious cycling exactly two years ago after a 43 year hiatus. In the past two years I have ridded 10,000 miles using first a hybrid and then a road bicycle. In most of my rides I experienced EIB the first half-hour to forty-five minutes not realizing what it was. After a terribly difficult allergy filled spring I saw al allergist. In addition to medication he casually mentioned stopping after the discomfort began and waiting a while, then starting and it should go away. Researching the internet I discovered my dilemma was not unique and rather well documented and realized he was referring to the refractory period.
Spending four months now on a Kurt Kinetic trainer under controlled conditions I have found that vigorous initial exercise brought on severe enough discomfort that I had to quit while the discomfort remained for hours. After long weeks of trial and error I have managed to completely eliminate the discomfort by riding at approximately 55% MHR for five miles (20 minutes) and then increasing from there. I have been EIB free for over a month.
As a reminder two weeks ago I raced up a hill to make an appointment and encountered severe EIB. If I hadn't just gone through a thorough heart test which revealed no detectable blockage I might have thought I was having a heart attack. The effects lasted several days.