The mean increase in V02 max for the group
was 2400 of pretraining Vo2 max values but
there was a wide range of improvement, from
1 .50o to 54%. In the multiple regression
analysis the change in FEV, secondary to
treatment did not contribute independently to
the increased Vo2 max, from which we conclude
that treatment changes were not responsible
for the improvement in exercise performance
in the study group. Those who were
least fit at the outset of the training gained most
in terms of a training effect, as has been
reported in healthy subjects.' The motivation
score taken early in the introductory period was
also highly predictive, despite subsequent
education, discussion, and access to medical
advice. An initial motivational assessment may
therefore save limited resources by identifying
potential non-compliers early. The symptom
score at the time of training was the third
important factor determining training outcome,
reflecting not only the severity and
variability of asthma but also the inevitable
asynchrony between the optimal training condition
of the patient and availability of supervised
exercise sessions. When subjects had
symptoms either they missed the session
altogether or the training intensity had to be
modified throughout the session. The latter
appears to be the more important factor because
the correlation between frequency of
hospital and home sessions and training outcome
did not reach significance in the multiple
regression analysis. A practical-solution would
be to supplement scheduled sessions with
home exercise once the -patients have been
familarised with all aspects of exercise with
particular reference to their asthma. These
measures would enable patients to undertake
exercise during more favourable periods independently
of supervised training. Exacerbations
may still result in enforced periods of reduced activity with consequent detraining,
and the exercise supervisor should therefore be
aware that these periods are likely to present
asthmatic patients with a particularly difficult
challenge in terms of their motivation.