| الوصف: |
This thesis studies physical activity levels, pulmonary rehabilitation and their effects in participants with difficult-to-treat asthma associated with elevated body mass index (BMI). The three results chapters present the original research which I conducted during my period of study. All three chapters are presented as contracted papers, two of which have been peer-reviewed and published in scientific journals. This thesis has been approved for submission as an 'alternative format' thesis by the Higher Degrees Committee of the University of Glasgow. The focus of the thesis is exercise in participants with difficult-to-treat asthma associated with elevated body mass index. There are two research questions addressed by the thesis, do asthma severity or body mass index affect physical activity levels in asthma? The first results chapter concludes that they both do. Secondly, does pulmonary rehabilitation improve asthma control in this group of participants? The results of the work suggest that it may lead to some improvements in asthma control, but not to a clinically significant degree. "Physical activity levels in asthma: relationship with disease severity, body mass index and novel accelerometer-derived metrics" was published in the Journal of Asthma, online version published 2nd August 2022. This paper reports physical activity (PA) levels in participants with varying degrees of asthma severity and body mass index (BMI). It incorporates the use of two novel accelerometerbased metrics and how they correlate with asthma control. This paper provides an introduction into how difficult-to-treat asthma and elevated BMI affect physical activity and leads onto the main work in pulmonary rehabilitation. "A pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult-to-control asthma and elevated body mass index" was published in BMC Pulmonary Medicine, online version published 24th September 2022. This paper presents the initial outcomes at completion of an eight-week asthma-tailored pulmonary rehabilitation programme, comparing participants who completed PR with a control group who had usual care. The final results chapter, "Immediate and longer-term effects of an asthma tailored pulmonary rehabilitation programme in overweight and obese participants with difficult-to-treat asthma" has been submitted to Respiratory Medicine, to be considered for publication. This paper presents wider results of the above trial in a prospective observational format, as everyone who was randomised to usual care was invited to participate in PR after completion of the initial 8-week observation period. Here we consider the immediate and longerterm outcomes of a larger group of participants undergoing PR, and look at possible predictors of response. |