ORIGINAL ARTICLE

Reality of physical activity in schoolchildren with asthmaand diabetes in education

Nicolas Lillo Soto • Mario Urrutia Martınez •

Francisca Vidal Mac-Kay • Gustavo Soto De la Barra

Received: 6 March 2014 / Accepted: 2 May 2014

� Springer-Verlag Italia 2014

Abstract Physical education is an important part of a

child’s normal psychosocial development and self-image.

A worldwide rise in the number of children that suffer a

type of diabetes mellitus has occurred in recent years. Also,

there is an increase in some types of lung disease such as

asthma that produce deterioration in the quality of life in

children and adolescents. Because of this, there is concern

to know the level of management that teachers have on

physical education when working with children who have

these diseases. Through a descriptive study it was possible

to establish that despite having some knowledge, not all

physical education teachers know how to act when faced

with asthma attacks or diabetes decomposition in their

pupils. This study should contribute to the development of

effective educational strategies to promote health for pupils

with diabetes and asthma.

Keywords Physical activity � Asthma � Diabetes �Healthy lifestyle � Schoolchildren

Introduction

Physical activity is an important part of healthy lifestyles

and a child’s daily routine. Participation in physical

activity is an important part of a child’s normal psycho-

social development and self-image. Developing good

health and fitness habits in childhood are associated with

physical fitness in adulthood. Children should not be

excluded from physical education (PE) without a compel-

ling medical contraindication [1, 2].

In recent years, there has been a global rise in diabetes

mellitus in young people [3], as well as some types of

obstructive lung diseases, such as asthma [4]. Thus, these

diseases result in the deterioration in the quality of life for

both children and adolescents [5, 6]. This is mainly due to a

decrease in physical activity affecting school absenteeism

and academic performance.

Recent studies indicate a co-morbidity of asthma and

obesity in children in urban areas [7, 8]; however, the

direction of this association is uncertain. Regardless of the

cause and effect, physical activity is an important con-

tributor to fitness in children with asthma and diabetes [9].

Physical activity is especially important in children with

these pathologies. Activities such as running and swim-

ming are associated with improved fitness and decreased

severity of symptoms [10–12]. Regular exercise and level

of physical conditioning are major determinants of exer-

cise tolerance in children with controlled asthma and

diabetes [13–15]. In addition to maintaining cardiovascu-

lar fitness and controlling weight, physical activity can

help to lower blood glucose levels and increase insulin

sensitivity [16].

Despite the severity of these diseases, there are no

constraints on the practice of PE in schools. Teachers find

difficult to distinguish between children who are physically

incapable of exercise due to asthma and those who are

unmotivated [17]. So schools must have trained or prepared

teachers to develop lessons with pupils that have asthma

and diabetes. In this regard, it is important to establish the

level of management that PE teachers have when facing

pupils with asthma and diabetes. The main aim of this

study was to investigate the degree of preparation of PE

teachers working with pupils with asthma and diabetes.

N. L. Soto (&) � M. U. Martınez � F. V. Mac-Kay �G. S. De la Barra

Physical Education, Universidad Andres Bello, Santiago, Chile

e-mail: nicolaslillosoto@gmail.com

123

Sport Sci Health

DOI 10.1007/s11332-014-0189-6

Materials and methods

Participants and study design

A non-experimental descriptive study was conducted to

establish the degree of preparation that PE teachers have when

working with children with asthma and diabetes. Sixty PE

teachers were selected (aged 28–56, who enrolled in April

2012) in the city of Santiago, Chile. Ten percent of the

teachers invited to participate in the study failed to respond to

the invitation. All participants (fifty-four) signed an informed

consent validated by the ethics committee of Universidad

Andres Bello in accordance with the Declaration of Helsinki.

Thus, we conducted a field study based on the collection of

data directly from schools where PE teachers work with stu-

dents diagnosed with asthma and diabetes.

Data collection

In this study, we used the ‘‘International Survey of Situa-

tion of PE in Schools’’ (validated by UNESCO: http://

www.unesco.org/new/fileadmin/MULTIMEDIA/HQ/SHS/

pdf/nwcpea_unesco_survey.pdf) with minor modifications

[18]. Thus, this questionnaire was employed to obtain data

on the domain of PE teachers in the management, infor-

mation and methodologies for physical activity for children

with asthma and diabetes. Furthermore, the internal con-

sistency of the ‘‘International Survey of Situation of PE in

Schools’’ was validated by calculating a-Cronbach (reli-

ability of the results: [0.70).

Statistical analysis

Data were analyzed using SPSS version 17.0 (SPSS, Inc.,

Chicago, Illinois) and expressed as percentages and abso-

lute values with respect to the total. Data analysis was

performed by descriptive statistics.

Results

In this study, 54 PE teachers were selected. The total

number of children taught by the PE teachers corresponded

to 1.800 (age range 8–17 years) from 30 schools.

The study found that 100 % (n = 54) of the PE teachers

had a theoretical knowledge of the physiological manifes-

tations of asthma and diabetes. This is of great importance

when a pupil presents either a respiratory or diabetes crisis.

However, despite having knowledge, not all the PE

teachers knew how to act when faced with an asthma attack

or diabetes decomposition. Thus, 63 (n = 34) and 79 %

(n = 43) of the teachers knew the symptoms of an asthma

attack or diabetes decomposition. Moreover, 55 %

(n = 30) of teachers surveyed knew the theoretical dif-

ference between diabetes Mellitus type 1 and type 2. Fur-

thermore, in this sample, nearly 90 % (n = 49) of

respondents did not know the difference between extrinsic

and intrinsic asthma. A low percentage (11 %) of teachers

knew how to deal with a diabetic crisis, either hypogly-

cemia, fatigue, dizziness or a diabetic coma.

Moreover, *79 % (n = 43) of teachers did not know if

the educational establishment had prevention policies for

pupils with diabetes and asthma when having a crisis during

sports. This situation is of great concern, because not all

teachers know how to react to a asthmatic or diabetes crisis

when the teacher is often the only adult present at a crisis. To

avoid this, it is important that schools implement policies

and training courses for teachers to take the appropriate

action when faced with pupils with these diseases.

It was observed that 37 % (n = 20) of teachers had no

educational experience related to asthma. In addition, 79 %

(n = 43) of the study population had no related emergency

episodes with students with diabetes in PE classes. With

regard to the registration of diseases, only 20 % (n = 11)

of teachers who had or knew the clinical profile of their

pupils with these diseases were observed.

Discussion

This study reveals the lack of knowledge of PE teachers

regarding pupil management when presented with very

common diseases that affect a large part of the population

such as diabetes and asthma [19, 20]. Also, this study

shows that the development of effective educational strat-

egies of PE is very important, among this population.

Cardiovascular diseases (CVD) are a major complication

of diabetes and leading causes of death in the world, and

Chile is no exception. Diabetes is an established risk factor

for myocardial infarction, stroke, lower extremity amputa-

tion, blindness, kidney failure, and premature mortality [21].

Primary prevention consists of interventions promoting

a healthy lifestyle in the general population and it is ben-

eficial and cost effective [22]. In this context, physical

activity appears to slow the initiation and progression of

CVD through salutary effects not only on adiposity but also

on insulin sensitivity, glycemic control, incident type 2

diabetes, blood pressure, lipids, endothelial function,

hemostasis, and inflammatory defense systems [23, 24]. In

this context, both physical activity and glycemic control

appear to be associated with lower all-cause and CVD

mortality risk in adults with diabetes [25–27]. Moreover,

results show that a non-pharmacological treatment based

on exercise exerts important beneficial effects in patients

with diabetes, mainly on the waist circumference, blood

pressure and triglyceride profiles [28].

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The problem of overweight children is an increasing

public health concern in the world. Many children today

consume high-fat diets that are high in fat, lack regular

physical activity, and receive minimal amounts of nutrition

education at school [29]. Physical activity is important to

prevent a clustering of risk factors in young children

especially aged 6–9 years [30, 31]. Physical activity and

exercise are critical components of diabetes management.

Everyone can benefit from regular exercise, but it is even

more important for a young person with diabetes and

asthma [16, 32].

Children with asthma are more likely to be obese and

significantly less active than a comparison group with other

medical conditions. Asthma is identified as a barrier to

exercise by parents and children. Therefore, strategies to

promote exercise within pediatric asthma care are needed

to protect both mental and physical health [33]. Even

available evidence indicates that physical activity is a

possible protective factor against asthma development [34].

As these are common diseases in children, there is a

possibility that the pupils are marginalized in PE class,

because the school and the teachers do not have policies to

work with them. Therefore, it is necessary that PE teachers

clearly know the indications of physical activity that may

make the pupils affected by these pathologies. This will

decrease social isolation and inactivity in these pupils.

Conclusions

The recommendations for PE teachers that work with

schoolchildren with asthma and diabetes are shown in

Table 1. PE is an integral part of education in every pupil.

Trained PE teachers are needed to increase physical com-

petence, health-related fitness, self-responsibility and

enjoyment of physical activity for pupils with asthma and

diabetes, so that they can be physically active all their

lifetime. Furthermore, PE programs can only provide these

benefits if they are well planned and well implemented.

Conflict of interest The authors declare they have no conflict of

interest.

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Table 1 Recommendations for PE teachers working with school-

children with asthma and diabetes

Recommended responsibilities of PE teachers

For schoolchildren with diabetes

Be informed about the role of exercise in the diabetes

Know the symptoms and appropriate treatment for low and

high blood sugar

Encourage the schoolchildren with type 1 diabetes to test blood

glucose levels before starting exercise or physical activity

Promote a supportive environment for students with diabetes

For schoolchildren with asthma

Identify schoolchildren who have asthma

Have quick and easy access to their asthma medications

Recognize their asthma triggers (the factors that make asthma

worse or cause an asthma attack)

Teach schoolchildren asthma awareness and peer sensitivity

Enable schoolchildren to carry and self-administer their asthma

medications

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