Introduction

Yet some of Australia's Olympic swimmers of the time (such as Dawn Fraser and Jon Henricks) were asthmatic, which suggested that asthma need not be a barrier to physical fitness. The value of swimming for asthmatics was supported by articles in medical journals^1,2 and anecdotal evidence. It was a low weight bearing exercise, potentially life saving, easily supervised, and suited to individual tuition and practice. A swimming program also presented an educational opportunity to teach about health and asthma and efficient breathing.

Logically and physiologically, swimming appeared the most suitable exercise relevant to respiratory and overall well being. The program developed by the Asthma Foundation of NSW modified the teaching methods of the day to meet the special needs of asthmatic children (Box 1). By 1994 the program had expanded from one to 36 pools throughout metropolitan and rural NSW. In those 30 years about 25 000 children were taught by 2000 volunteer instructors.

This kind of growth, based on the voluntary involvement of unpaid instructors and parents of asthmatic children, is itself a measure of success. The anecdotal evidence of those involved in the program is that it improves health, reduces the frequency of asthma attacks and improves the children's quality of life. The NSW Department of Sport and Recreation had acknowledged the value of the program, and included it as an extension course for AUSTSWIM instructors.

In 1994, the Asthma Foundation of NSW allocated $10 000 for an evaluation of the swimming program. That study was a retrospective survey involving a limited statistical analysis and a qualitative evaluation of the effect on the whole child.³ In this article we present the main findings of that evaluation, a full report of which is available from the Foundation.⁴

Two rural and three metropolitan swimming groups were selected for the study. Children were randomly selected from those who had attended for over one year (to avoid a seasonal influence on results).

Three questionnaires were prepared: two for parents and one for instructors. The first parental questionnaire related to the child's condition on entering the program, and the second to the child's condition at the time of the study. They both asked for information about hospitalisation and doctor's visits; physical signs such as mouth breathing, snoring, and chest deformity; general health; other illnesses and allergies; peak flow readings; severity of asthma; school attendance and performance; height and weight; and participation in other swimming classes and sport.

The instructor's questionnaire asked about their participation, how and why they did voluntary work, and their observations on the children and the program.

The main quantifiable results are shown in Box 2.

Asthma medication and medication dosage were highly variable in this group of children. Parents of half the children reported a change in medication since starting the swimming program, with two-thirds showing a decrease. Almost all parents who answered the questionnaire were satisfied with the program and reported that the changes in the children had improved the quality of life of the whole family. Appreciation was expressed for the program, the value of the year-round availability, the individual tuition, and the caring attitude of the volunteers. Also valued was the opportunity to discuss common problems with other parents of asthmatic children, and the asthma education provided.

Instructors had joined the program for many reasons and some had stayed over 25 years. They enjoyed their participation, and felt that they were rewarded by the children's achievements and the improvement seen in their general health and attitudes. They commented that many children were timid and anxious at first, and needed much coaxing. This made the children's eventual success and increase in confidence and self-esteem even more rewarding for the instructors. It was often noted that children who could swim before joining the program were breathing inefficiently. When this was corrected they swam longer distances with greater ease.

Peak flow meter readings taken at every session have been a useful guide for the instructor regarding the child's possible need for pre-swim medication. Huang et al claim improvement in peak flow readings in a swimming program for asthmatic children conducted in the USA,⁵ but our study did not find significant change in this variable. Instead, the program produced more general improvements in psychological and physical wellbeing. The acquisition of a lifelong sporting skill provides a psychological boost and assists in developing self-esteem and confidence to take part in other activities.

The long term commitment and enthusiasm of the volunteer instructors was most impressive and made one appreciate the special value of these people who gave their time and care. For 1999 it was calculated that, had normal hourly rates for swimming instructors been paid, the cost would have been nearly $500 000.

A recent report shows that the cost of asthma to the community is $585-$728 million per year.⁶ Yet here is a program using volunteers, with no government support, which can improve children's health and reduce medication, hospitalisation and visits to doctors, with consequent reduction in parent absenteeism from employment, all of which should result in economic benefits. We hope that others will be encouraged to establish and evaluate programs designed to assist the overall health of people with a specific illness.

1. Jones RS, Buston MG, Wharton MI. The effect of exercise on ventilatory function in the child with asthma. Br J Dis Chest 1962; 56: 78-86.
2. McEthenney RR, Petersen KH. Physical fitness for asthmatic boys. A co-operative pilot study. JAMA 1963; 185: 142-143.
3. Meyer J. Using qualitative methods in health action research. BMJ 2000; 320: 178-181.
4. Wardell CP, Isbister C. Report on thirty years of the Asthma Children's Swimming Program. Sydney: Asthma Foundation NSW, 1994.
5. Huang S-W, Veiga R, Sila U, Reed E, Hines S. The effect of swimming in asthmatic children -- participants in a swimming program in the City of Baltimore. J Asthma 1989; 26: 117-121.
6. National Asthma Campaign. Report on the cost of asthma in Australia. Canberra: National Asthma Campaign, 1992: 8.

Reprints will not be available from the authors.
Correspondence: Dr C Isbister, 142 Wentworth Street, Blackheath, NSW 2785.
wardelljandcATbigpond.com

©MJA 2000
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