Anamaria Fleig Mayer

Nível de atividade física e tabagismo em universitários

OBJETIVO: Avaliar o nivel de atividade fisica em estudantes universitarios e sua associacao com habito de fumar. METODOS: Estudo transversal com amostragem estratificada proporcional por conglomerados realizado em Gurupi, TO, em 2005. A amostra estudada incluiu 871 universitarios. Para avaliar o nivel de atividade fisica foi aplicado o questionario International Physical Activity Questionnaire-8. O consumo tabagistico foi avaliado por questionario modificado da Organizacao Mundial de Saude e o grau de dependencia nicotinica dos fumantes pela escala de Fagerstrom. As frequencias, prevalencias e razoes de prevalencia de tabagismo e sedentarismo foram determinadas aplicando-se o teste qui-quadrado pelo metodo de Yates ou o teste exato de Fisher, segundo grupo geral e estratificadas por area, curso, turno e sexo, ao nivel de significância de 5%. RESULTADOS: A media de idade foi 25 (dp±8) anos e a media da idade da primeira experiencia tabagistica foi 17 (dp±4) anos. A prevalencia de sedentarismo foi de 29,9% e de tabagismo 7,2%. A prevalencia geral de sedentarios fumantes foi de 8,5% e a de nao-fumantes 91,5%; mas sem diferenca na proporcao de sedentarios entre fumantes e nao-fumantes. Tabagismo e sedentarismo foram mais prevalentes em individuos acima de 25 anos (48,6%, p 0,05). CONCLUSOES: Sedentarismo ocorreu em fumantes e nao-fumantes na mesma proporcao, nao indicando associacao entre esses dois fatores. As baixas prevalencias de sedentarismo e tabagismo encontradas podem estar associadas a atuacao de programas nacionais, pela aplicacao de medidas preventivas e educativas continuas, sendo necessario que sejam mantidos em longo prazo.

The Brazilian Portuguese version of the London Chest Activity of Daily Living scale for use in patients with chronic obstructive pulmonary disease

OBJECTIVE To translate the London Chest Activity of Daily Living (LCADL) scale into Portuguese and to determine whether this version is reproducible in Brazilian patients with severe chronic obstructive pulmonary disease (COPD). METHODS The LCADL scale was translated into Portuguese and then back-translated into English. This pilot Brazilian Portuguese version was administered to 8 patients with COPD, and possible text-related problems were investigated. The principal problems were discussed with the authors of the original scale, and a final translated version was arrived at. At the study outset, two observers administered this final version (twice in one day) to 31 patients with COPD. One of those observers again administered the scale to the same patients 15-20 days later. At baseline, the patients were submitted to pulmonary function testing and to the six-minute walk test (6MWT). RESULTS The Brazilian Portuguese version of the LCADL scale demonstrated excellent reproducibility in the total score and in most of the questions, with an inter-rater Cronbachs alpha coefficient of 0.97 (95% CI: 0.89-0.97; p < 0.01) and an intra-rater Cronbachs alpha coefficient of 0.96 (95% CI: 0.83-0.96; p < 0.01). The total score presented a negative correlation with forced expiratory volume in one second in liters (r = -0.49; p < 0.05) and with distance covered on the 6MWT (r = -0.56; p < 0.05). CONCLUSION The Brazilian Portuguese version of the LCADL scale is a reliable, reproducible, and valid instrument for evaluating dyspnea during activities of daily living in patients with severe COPD.

The COPD Assessment Test: What Do We Know So Far?: A Systematic Review and Meta-Analysis About Clinical Outcomes Prediction and Classification of Patients Into GOLD Stages

BACKGROUND The COPD Assessment Test (CAT) was developed as a simple instrument to assess health status in patients with COPD. This study aimed to systematically review the determinants of the CAT score, its ability to predict clinical outcomes, and the agreement between CAT (≥ 10) and the modified Medical Research Council scale (mMRC ≥ 2) to categorize patients into the new Global Initiative for Chronic Obstructive Lung Disease classification system. METHODS From January 1, 2009, to June 30, 2015, databases were searched for studies using CAT in adults with COPD and in general populations aiming to detect COPD. Two investigators independently screened, selected, and extracted data by using a standardized form. Where appropriate, the results were combined in a random effects meta-analysis. RESULTS Of 453 studies, 17 were included, and eight were used in the meta-analysis. The models to predict the CAT score were able to explain < 50% of its variance. CAT scores can indicate risk of exacerbation, depression, acute deterioration in health status, and mortality. All studies found a different proportion of patients in each Global Initiative for Chronic Obstructive Lung Disease category using CAT ≥ 10 or mMRC ≥ 2. On average, the distribution was 13% different according to the instrument used. The κ agreement between CAT and mMRC ranged from 0.13 to 0.77. CONCLUSIONS CAT may be used as a complementary tool in a patients clinical assessment to predict COPD exacerbation, health status deterioration, depression, and mortality. The interpretation of this meta-analysis does not support the use of the recommended cutoff points of ≥10 for CAT and ≥2 for mMRC as equivalents for the purpose of assessing patient symptoms.

Can the Glittre ADL test differentiate the functional capacity of COPD patients from that of healthy subjects

BACKGROUND The Glittre ADL (TGlittre) test is a specifically designed to assess functional limitation in chronic obstructive pulmonary disease (COPD) patients. However, it is not known if it can differentiate the performance of these patients from healthy subjects. OBJECTIVES To investigate whether the Glittre ADL test is able to differentiate the functional capacity of COPD patients from that of healthy subjects and to compare the cardiorespiratory response between Glittre ADL and the six-minute walk test (6MWT). METHODS The study included 10 patients with COPD (GOLD 2 to 4) and 10 healthy subjects matched by age who performed the following: spirometry pre- and post-bronchodilator, a Glittre ADL test and two 6MWT on two consecutive days. RESULTS The performance of COPD (FEV1%pred= 38.1±11.8, age=64±10 years, BMI=23.7±5.2 kg/ m²) was worse than the control group on TGlittre (5.26±2.9 min, 3.3±0.3 min, p<0.05) and 6MWT (434.97±105.18 m vs. 593.25±87.36 m, p<0.05). TGlittre correlated with the physical activity domain of the London Chest Activity of Daily Living (LCADL) scale (r=0.67, p<0.05) and with 6MWT when the total sample was analyzed (r=-0.64, p<0.05). The COPD group had a statistically higher (p<0.05) increase in dyspnea (Borg scale) than the control group for both TGlittre and 6MWT, with a similar heart rate and peripheral oxygen saturation variation in both groups (p>0.05). CONCLUSIONS The performance of COPD patients is worse than that of healthy subjects on the Glittre ADL test, with a greater increase in dyspnea and similar heart rates.

Relação entre a limitação nas atividades de vida diária (AVD) e o índice BODE em pacientes com doença pulmonar obstrutiva crônica

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that reduces functional capacity, deteriorating the ability to perform activities of daily living (ADL). A close relationship between morbidity and mortality with functional limitation is observed in patients with COPD. OBJECTIVES: To determine if there is a relationship between ADL limitation and the BODE index, which is a predictor of mortality, in patients with moderate to severe COPD. METHODS: Thirty-nine patients with COPD GOLD 2 to 4 recruited by convenience, were submitted to the following tests: spirometry, body mass index (BMI), the London Chest Activity of Daily Living (LCADL) scale, six-minute walking test (6MWT), the Medical Research Council (MRC) scale and the BODE index was calculated. The total score and the percentage of the total score LCADL (LCADL%total) were compared between patients of the four quartiles of the BODE using the Analysis of Variance test. The Spearman correlation coefficient was used to investigate the association between scores of LCADL and BODE index. RESULTS: Patients had an average of FEV1%pred=37±12% and were on average 66±8 years-old. The LCADL%total correlated with the BODE index (r=0.65, p<0.05) as well as with the variables FEV1, dyspnea and walked distance in the 6MWT (r=-0.42, r=0.76 and r=-0.67, p<0.05, respectively). The comparison of the average scores of the LCADL%total between BODE quartiles 1, 2, 3 and 4, demonstrated that only the 4th quartile differed significantly from the others (p<0.05). CONCLUSIONS: ADL limitation has a strong association with the BODE index in patients with moderate to severe COPD and with three of the four variables that composes it.

PHYSIOLOGIcAL RESPOnSES tO tHE GLIttRE-AdL tESt In PAtIEntS WItH cHROnIc OBStRuctIVE PuLMOnARY dISEASE

OBJECTIVE The aim of this study was to investigate the physiological responses induced by the Glittre-ADL test (TGlittre) test in patients with chronic obstructive pulmonary disease (COPD) and compare them with those induced by the 6-minute walk test (6MWT). DESIGN Cross-sectional observational study. SUBJECTS Eighteen patients with COPD 66 years (standard deviation (SD) 8) and forced expiratory volume in 1 s of 40.4% (SD 16.8) predicted) who performed in randomized order the 6MWT and TGlittre on 2 separate days. RESULTS Baseline cardiopulmonary variables were similar between the 6MWT and TGlittre (p > 0.05). TGlittre induced slightly higher final VO2 than 6MWT 83.6 ml/min (SD 163.9); p < 0.05) and oxygen consumption (VO2) reached a plateau after the third lap during TGlittre. The other physiological variables, except respiratory exchange rate, were similar at the end of both tests (p > 0.05). All measured variables were significantly correlated between the 2 tests (p < 0.05). CONCLUSION TGlittre can induce slightly higher oxygen uptake than the 6MWT with similar cardiovascular and ventilatory demand and ventilatory efficiency.

Level of physical activity and smoking in undergraduate students

OBJETIVO: Avaliar o nivel de atividade fisica em estudantes universitarios e sua associacao com habito de fumar. METODOS: Estudo transversal com amostragem estratificada proporcional por conglomerados realizado em Gurupi, TO, em 2005. A amostra estudada incluiu 871 universitarios. Para avaliar o nivel de atividade fisica foi aplicado o questionario International Physical Activity Questionnaire-8. O consumo tabagistico foi avaliado por questionario modificado da Organizacao Mundial de Saude e o grau de dependencia nicotinica dos fumantes pela escala de Fagerstrom. As frequencias, prevalencias e razoes de prevalencia de tabagismo e sedentarismo foram determinadas aplicando-se o teste qui-quadrado pelo metodo de Yates ou o teste exato de Fisher, segundo grupo geral e estratificadas por area, curso, turno e sexo, ao nivel de significância de 5%. RESULTADOS: A media de idade foi 25 (dp±8) anos e a media da idade da primeira experiencia tabagistica foi 17 (dp±4) anos. A prevalencia de sedentarismo foi de 29,9% e de tabagismo 7,2%. A prevalencia geral de sedentarios fumantes foi de 8,5% e a de nao-fumantes 91,5%; mas sem diferenca na proporcao de sedentarios entre fumantes e nao-fumantes. Tabagismo e sedentarismo foram mais prevalentes em individuos acima de 25 anos (48,6%, p 0,05). CONCLUSOES: Sedentarismo ocorreu em fumantes e nao-fumantes na mesma proporcao, nao indicando associacao entre esses dois fatores. As baixas prevalencias de sedentarismo e tabagismo encontradas podem estar associadas a atuacao de programas nacionais, pela aplicacao de medidas preventivas e educativas continuas, sendo necessario que sejam mantidos em longo prazo.

Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility

The aim of this study was to assess the reproducibility of the ultrasound (US) measurement of craniocaudal displacement of the left branch of the portal vein as an indirect method of measuring right hemidiaphragm mobility in healthy young adults. Forty‐one healthy participants were selected, ranging from 20 to 30 years of age. The US tests were conducted and interpreted by two observers (A and B) on two separate occasions (Test 1 and Test 2). Intra‐observer and interobserver reproducibility and repeatability of US measurements were determined by the intraclass correlation coefficient (ICC[2,1]) using a 95% confidence interval (CI). Interobserver reproducibility assessment showed ‘high correlation’ for Test 1 and Test 2 (ICC[2,1] = 0·83, 95% CI = 0·70–0·91, and ICC[2,1] = 0·79, 95% CI = 0·61–0·89, respectively). Intra‐observer reproducibility assessment showed ‘moderate correlation’ for observer A (ICC[2,1] = 0·69, 95% CI = 0·45–0·84) and for observer B (ICC[2,1] = 0·65, 95% CI = 0·39–0·81). Repeatability assessment showed ‘high correlation’ for all tests performed (ICC[2,1] = 0·86, 0·80, 0·74, 0·79, P<0·001). In conclusion, US measurement of craniocaudal displacement of the left branch of the portal vein is a reproducible method of measuring right hemidiaphragm mobility in healthy young adults.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects

BACKGROUND the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients.

Aplicabilidade de testes de atividades de vida diária em indivíduos com insuficiência cardíaca

Limitation in activities of daily living (ADL) caused by dyspnea is a common finding in patients with heart failure (HF), functional class III and IV. Specific assessment of ADL limitation could be used as a parameter of the disease progression and the therapy response. However, there is a shortage of instruments to assess ADL in this population. This study aimed to determine the applicability of the London Chest Activity of Daily Living (LCADL) and the Glittre ADL-test (TGlittre), to evaluate functional limitations of individuals with HF functional class III and IV. Ten patients (57±9 years, 27.5±4.5kg/m2) of both genders with a clinical diagnosis of HF functional class III and IV and left ventricle ejection fraction (LVEF) 34±7% participated in the study. Spirometry, body mass index (BMI), LCADL, six-minute walking test (6MWT), TGlittre, Medical Research Council Scale (MRC) and SF-36 were performed. The patients had an average score of the LCADLtotal from 27.7±12.1 (LCADL%total: 41.5±16.9) and time of TGlittre 6.3±4.8 minutes. A positive correlation was found between them (r = 0.88, p<0.05). LCADL%total correlated with 6MWT (r =-0.83), LVEF (r =-0.64), MRC (r =0.68) and Functional Capacity (FC) of the SF-36 (r =-0.63) (p<0.05). TGlittre correlated with 6MWT (r =-0.90), LVEF (r =-0.66) and CF of the SF-36 (r =-0.69) (p<0.05). In conclusion, the LCADL scale and TGlittre have applicability in patients with HF class III and IV, demonstrating association with LVEF, distance on the 6MWT, degree of dyspnea and quality of life.