Antenor Rodrigues

Development, Validity and Reliability of the Londrina Activities of Daily Living Protocol for Subjects With COPD

BACKGROUND: To avoid symptoms, patients with COPD may reduce the amount of activities of daily living (ADL). Therefore, the aim of the present study was to develop a standardized protocol to evaluate ADL performance in subjects with COPD (Londrina ADL protocol) and to assess the validity and reliability of the protocol in this population. METHODS: The Londrina ADL protocol was created based on activities included in previous studies aimed at investigating outcomes from ADL. Activities were included in the protocol because they could represent other activities of similar patterns and because they could be actually performed, not simulated. Twenty subjects with COPD (12 men, 70 ± 7 y old, FEV1 = 54 ± 15% predicted) wore 2 motion sensors while performing the protocol 4 times, 2 of them wearing a portable gas analyzer. Subjects were also submitted to assessments of lung function, functional exercise capacity, functional status, impact on health status, and physical activity in daily life. RESULTS: The Londrina ADL protocol comprised of 5 activities representing ADL, involving upper limbs, lower limbs, and trunk movements. Londrina ADL protocol duration presented high values of intraclass correlation coefficient, even using a mask for gas analysis (intraclass correlation coefficient >0.90, P < .001). Intensity of movement during the protocol performance was highly correlated to intensity of movement in daily life (r = 0.71). The protocol duration was correlated with functional status and impact on health status variables from questionnaires (0.36 ≤ r ≤ 0.59). There was also correlation between functional exercise capacity and the protocol duration (r = −0.64). CONCLUSIONS: The Londrina ADL protocol was a valid and reliable protocol to evaluate ADL performance in subjects with COPD. It is a protocol that can be used in clinical practice and in future studies to investigate ADL outcomes, including those studies that require gas analysis and the wearing of a mask.

Maximal Exercise capacity as discriminatory factor to identify subjects with COPD as physical active\inactive: Preliminary results

Introduction: Physical activity in daily life (PADL) has been widely studied in subjects with chronic obstructive pulmonary disease (COPD). However, relationship of PADL with variables from maximal exercise tests still lacks attention in the literature. Aim: To identify whether maximal exercise capacity presents discriminative capacity to identify physical activity/inactivity in subjects with COPD. Methods: Fourteen subjects with COPD (9 men) were assessed regarding lung function, PADL (SenseWear® ArmBand during seven days) and maximal exercise capacity (incremental shuttle waking test, ISWT). Furthermore, subjects wore the PADL monitor during the ISWT in order to determine maximal METs achieved. Results: The 3-METs threshold represented 57(35–73)% of the maximum (%max). The intensity of 48%max was identified as point of better discriminative capacity to identify inactive subjects (area under the curve [AUC] 0.64[95%CI 0.27–0.99]; sensitivity 1; specificity 0.36). However lower values were found for the discrimination of active subjects (AUC 0,36[95%CI 0.001–0.73]). Additionally, for 3-METs, 79% of subjects were classified as active and 21% as inactive, whereas for the %max, 86% of subjects were classified as active and 14% inactive (P>0.05). Among subjects in which 3 METs represented lower than 48%max, there was no subject classified as inactive. However, among subjects in which 3METs represented higher than 48%max, 30% of subjects were classified as inactive and 70% as active (P>0.05). Conclusion: These preliminary results show that maximal exercise intensity had good discriminative capacity to identify physical inactivity in subjects with COPD.

Validity of a cutoff point for the London Chest Activity Daily Living scale in patients with COPD

Background: The London Chest Activity Daily Living scale (LCADL) is an option to assess functional status in patients with chronic obstructive pulmonary disease (COPD). A cutoff point to discriminate worse prognosis in this scale was not yet described in the literature. Aims: To propose gender-based cutoff points for the LCADL which are capable to discriminate worse/better prognosis in patients with COPD. Methods: One hundred sixty-five patients with moderate-to-severe COPD (89 men) were evaluated regarding their functional status by the LCADL. Cutoff points were obtained from the best LCADL total score to discriminate patients with worse prognosis by the BODE index (body mass index; airflow obstruction [spirometry]; dyspnea [modified Medical Research Council scale]; and exercise capacity [six-minute walk test]). Results: Women had worse values than men for total score, domestic and leisure domains of the LCADL (P≤0.01 for all). The cutoff points found were 13 points for men (area under the curve [AUC] = 0.62; 95% confidence interval [CI] 0.50–0.74; sensitivity 0.97 and specificity 0.28) and 34 points for women (AUC = 0.77; CI 0.65–0.90; sensitivity 0.56 and specificity 0.88). Patients classified above the cutoff points presented worse prognosis than patients classified below it, as well as worse lung function, exercise capacity, dyspnea and disease severity (P≤0.002 for all). Conclusion: Men and women present significant differences in functional status classification made by the LCADL. The cutoff points of 13 for men and 34 for women were able to adequately discriminate patients concerning their prognosis assessed by the BODE index.

Sedentary behavior and physical inactivity in patients with COPD: two sides of the same coin?

Background: It is possible for an individual to accumulate long amounts of both moderate-vigorous physical activity (MVPA) and sedentary behaviour (SB) throughout the same day. Deleterious effects of this combination in patients with chronic obstructive pulmonary disease (COPD) were not yet investigated. Aims: To investigate the relationship between MVPA and SB in patients with COPD and to identify the profile of physically (in)active and (not) sedentary patients. Methods: MVPA and SB (time spent/day in activities requiring >3 METs and Results: MVPA and SB were correlated in the total sample (n=136; r=-0.74) and in active patients (n=76; r=-0.53), but not in sedentary patients (n=42; r=-0.25). Four groups of patients were compared: Active+Non-Sedentary (Act_NS; n=68); Active+Sedentary (Act_S; n=8); Inactive+Non-Sedentary (Inact_NS; n=26), and Inactive+Sedentary (Inact_S; n=34). Inact_S had worse 6MWT and FEV1 and higher age, BMI and MRC than Act_NS (P Conclusion: SB is negatively related with MVPA in physically active patients, but not in sedentary. Despite better clinical conditions in patients who reach MVPA recommendations combined with a non-sedentary lifestyle, there are no differences between patients presenting only one of these positive behaviours.