Physical fitness in a group of 49 stable asthmatic children was determined by an incremental exercise test. Thirty-one normal children served as a control group. The asthmatic children were divided into three groups. Group 1 was comprised of 16 children who actively participated in organized sports, Group 2 of 16 children who did not participate in organized sports but who engaged in free-play, and Group 3 of 17 children with a sedentary life-style who avoided even free-play. The results of cardiopulmonary evaluation before and after maximal incremental exercise testing have shown that Groups 1 and 2 behaved like the control group and their physical fitness was similar. Group 3 whose life-style was sedentary had poor physical fitness as compared to the other asthmatics and to the control group. This was the result of poor cardiovascular conditioning and was unrelated to the respiratory limitation. We conclude that poor physical fitness in asthmatic children is the result of a sedentary life-style and can be potentially normalized.

The Lymphapress, a pneumatic sequential intermittent device is recognized as one of the most effective conservative treatments for lymphoedema, due to its effective 'milking mechanism'. This led us to hypothesize that accelerated removal of fatigue-causing metabolites by mechanical massage could improve an athlete's performance capacity. We conducted trials with 11 men who exercised at a constant workload, on a cycle ergometer, until exhaustion. During a 20-min recovery period a new modified pneumatic sequential intermittent device (the MISPD) was applied to the subjects' legs. The men then performed a second constant load exercise bout. Cardiorespiratory parameters were measured during exercise and blood was withdrawn during recovery for the determination of lactate, pyruvate, ammonia, bicarbonate and pH. No difference was found in the blood levels of the 'fatigue causing metabolites' during passive recovery (PR) and recovery with the MISPD (MR). However, the MISPD effected a 45% improvement in the subjects' ability to perform the subsequent exercise bout. The accumulation of fluid in the interstitial space after exercise and its disappearance after the use of the MISPD offers one possible explanation for these results, although psychological effects cannot be discounted.

Background -Theophylline is a well known bronchodilator which has been used for more than 50 years in the treatment of obstructive pulmonary diseases. In patients with severe chronic obstructive pulmonary disease whose cardiopulmonary performance is Theophylline continues to be widely used in the treatment of obstructive lung diseases and may improve the ventilatory capacity by its bronchodilator effect and possibly by an effect on respiratory muscle performance.'`5 Murciano et aP in a randomised controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease (COPD) found an improvement in respiratory function and dyspnoea which they related to improved respiratory muscle performance. Marsh et aP found a delay in skeletal muscle fatigue during progressive exercise at therapeutic concentrations of theophylline, suggesting an enhancement of the oxidative capacity of the muscle. The purpose of the present study was to further assess the possible effect of improved respiratory function on exercise performance in patients with COPD in a randomised, placebo controlled, double blind, crossover trial. The hypothesis was that any improvement in respiratory function would improve exercise performance in subjects limited by their ventilatory capacity. MethodsTwenty two patients (17 men and five women of mean (SD) age 68 (3) years) with severe but stable COPD were studied. All were smokers or former smokers. Baseline measurements before inclusion in the protocol included pulmonary function indices, arterial blood gases, maximal voluntary ventilation (MVV), and an incremental exercise test. Most patients had been previously receiving theophylline on a long term basis. All other medications, including corticosteroids given by inhalation and other bronchodilators, were continued as before. Theophylline was withdrawn two weeks before the baseline studies, and theophylline blood levels were determined on the day of the initial baseline study. Only patients with an FEV, of 50% or less of predicted were included; those with known cardiac disease or in whom cardiac disorders were shown on the baseline incremental exercise test were excluded.Patients received either theophylline (Theotrim, Trima Laboratories, Israel) or an identical placebo in a random fashion. Those weighing less than 60 kg received an initial dose of 200 mg twice daily, and those weighing more than 60 kg received 300 mg twice daily.After the first week theophylline blood levels were determined and the dose was adjusted if the level was below 55-5 pmol/l. This adjustment was repeated until all patients had a Exercise Physiology Laboratory