Stimulating physical activity in children with asthma

In the Netherlands approximately 7-10% of all children live with asthma
(Brunekreef, et al., 2002). Each year almost 40,000 children aged 0-19 years
old are newly diagnosed with asthma (Bindels et al., 2014). Asthma is a chronic
respiratory disease which often occurs in episodes, which are called asthma
attacks (Bindels et al., 2014). During an asthma attack, children are short of
breath, wheeze and cough a lot (Bindels et al., 2014). In an acute situation,
medication helps to reduce these asthma symptoms. In a more preventive manner,
exercises and guidance by a physical therapist may help to improve physical
functioning (physical fitness), to increase knowledge about the disease and
learn about an optimal posture to increase lung capacity. In addition they
coach children with asthma to reintegrate and participate in normal life by
training physical fitness.
For children with asthma, exercising is important to increase their lung
condition. Exercise strengthens the respiratory muscles, making children more
comfortable when breathing. Despite these known profits, children with asthma
exercise 50% less than their healthy peers (Van Veldhoven et al., 2001; Lucas
et al., 2005; Williams et al., 2008; Kitsantas et al., 2000; Van der Giessen et
al., 2005). Due to fear for asthma attacks exercising like biking, swimming,
school gym and active play games during school breaks are avoided (Van
Veldhoven et al., 2001; Lucas et al., 2005; Williams et al., 2008; Kitsantas et
al., 2000; van der Giessen et al., 2005). As a result of decreased physical
activity levels, children with asthma often have reduced physical fitness,
reduced muscle strength, reduced self-esteem and higher incidence of obesity
compared to healthy peers (Vahlkvist and Pedersen, 2009; Wanrooij et al.,
2014). This all may negatively affect their general health (Wanrooij et al.,
2014).
According to the Royal Dutch Society of Physiotherapy (KNGF) guideline children
with asthma, the aim of asthma therapy is to increase joyful exercising, to
guide children to become active at home and to decrease risk factors for an
inactive lifestyle (Van der Giessen et al., 2005). Physical therapists who work
with children with asthma support these children to increase their physical
fitness, to coop with the disease and they teach them how to breathe during
exercising (Zorgstandaard Astma kinderen & jongeren, 2012; Van der Giessen et
al., 2005). Currently, programs to increase exercise and daily physical
activity often show short-term effects, but long-term effects on physical
fitness are absent (Wanrooij et al., 2014; Kotte et al., 2014). Little
knowledge regarding factors influencing exercise behavior in children with
asthma is present. Research on interventions using games that influence
physical activity in healthy children show positive results. Games are matching
the needs of the 21st century children and therefore are able to influence
exercise behavior.
Physical therapists in the Netherlands make little use of digital tools, games,
apps or smartwatches in their treatments of children with asthma. However they
acknowledge the need for a sustainable game that can stimulate physical
activity. This may help them to facilitate and motivate joyful exercising,
increase and monitor daily physical activity for children with asthma. It can
be an effective method of stimulating daily physical activity and pleasure in
the long term (Pijpers & Scholte, 2013; Granic et al., 2014).

The SIMBA project is a research collaboration in which children with asthma,
their parents and healthcare professionals play an important role. The SIMBA
study is a two year program that aims to develop and finally (pilot) test an
exercise game that stimulates children with asthma being more physically
active. The aim of this study, phase one and two, is to increase physical
activity in children with asthma by developing an exercise game.
The research will identify factors that restrict and promote exercise behavior
in children with asthma and will identify which ingredients for an exercise
game are best suited to the needs of children with asthma.

Primary research question
* Which factors that restrict and promote exercise behavior in children with
asthma, aged 8 to12 years, and how can the promoting factors be included as
ingredients for the development of an exercise game to stimulate daily physical
activity and asthma control?

Secondary research questions
* Which factors that restrict and promote exercise behavior play a role in the
exercise behavior of children with asthma, aged 8 to12 years?
* Which of these factors need to be included in the exercise game to increase
joyful exercising and physical activity stimulation and participation?
* What makes an exercise game effective, useful and valid to increase joyful
exercising and physical activity participation in children with asthma?

This is a cross-sectional observational study; including one assessment day in
phase 1 and two sound board group meetings in phase 2.

Phase 1 includes a one-day meeting; the children and their parents participate
in two working groups in which free thinking about solutions and ideas are
motivated to allow asthma children to increase their daily physical activity.

When children and parents also like to participate in phase 2 they are asked to
contribute in two soundboard group meetings; each with a duration of one and a
half hours.

Both the meeting of phase 1 and those of phase 2 are located outside the
hospital in a central location in the Netherlands.
Participation is without risks for the patients, parents and healthcare
professionals. Due to the nature and content of the study it is expected that
children will enjoy participation in the study.