Cássia Cinara da Costa

Effectiveness of Pulmonary Rehabilitation in Exercise Capacity and Quality of Life in Chronic Obstructive Pulmonary Disease Patients With and Without Global Fat-Free Mass Depletion

OBJECTIVE To investigate the effectiveness of pulmonary rehabilitation (PR) in exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) with and without global fat-free mass (FFM) depletion. DESIGN Retrospective case-control. SETTING Outpatient clinic, university center. PARTICIPANTS COPD patients (N=102) that completed PR were initially evaluated. INTERVENTION PR including whole-body and weight training for 12 weeks, 3 times per week. MAIN OUTCOME MEASURES St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), and FFM evaluation applied before and after PR. RESULTS Patients were stratified according to their FFM status measured by bioelectric impedance. They were considered depleted if the FFM index was ≤ 15 kg/m(2) in women and ≤ 16 kg/m(2) in men. From the initial sample, all depleted patients (n=31) composed the FFM depleted group. It was composed predominantly by women (68%) with a mean age ± SD of 64.4 ± 7.3 years and a forced expiratory volume in 1 second of 33.6%=-13.2% predicted. Paired for sex and age, 31 nondepleted patients were selected from the initial sample to compose the nondepleted group. Improvement in the 6MWD was similar in these 2 groups after PR. Both groups improved SGRQ scores, although the observed power was small and did not allow adequate comparison between depleted and nondepleted patients. There was no difference between groups in weight change, whereas FFM tended to be greater in depleted patients. This increase had no correlation with the 6MWD or the SGRQ. CONCLUSIONS Benefits of PR to exercise capacity were similar comparing FFM depleted and nondepleted COPD patients. Although FFM change tended to be greater in depleted patients, this increase had no definite relation with clinical outcomes.

O trabalho de caminhada dos seis minutos não se correlaciona com o grau de obstrução do fluxo aéreo em doentes portadores de Doença Pulmonar Obstrutiva Crónica (DPOC)

Abstract Abstract Abstract Abstract Introduction: The six-minute walking test distance, despite being considered the main parameter, does not consider body weight which is known to in- fluence exercise capacity. A body of evidence

Six-minute walk work is not correlated to the degree of airflow obstruction in patients with Chronic Obstructive Pulmonary Disease (COPD)*

INTRODUCTION The six-minute walking test distance, despite being considered the main parameter, does not consider body weight which is known to influence exercise capacity. A body of evidence shows the degree of airflow obstruction does not correlate to walking distance and the body weight affects the work/energy required to perform the walk. OBJECTIVE To verify if the degree of airflow obstruction correlates to six-minute walk work obtained by weight-walking distance product. PATIENT AND METHODS A total of 60 patients with chronic obstructive pulmonary disease were evaluated. The physiological and functional variables were correlated to distance and body weight walking distance product (WxW). RESULTS There were no correlations between six- minute walk work and the degree of airflow obstruction. A positive and significant correlation were observed between the distance and Carbon Monoxide Diffusing Capacity (DLCO) (r=0.6; p<0.01) and between the distance and final SatO 2 (r= 0.3 ; p <0.05). Correlation between distance and Borg scale was negative and significant (r= -0.3; p<0.05). The six-minute walk work was positive and significantly correlated to DLCO (r= 0.7; p<0.01) and negative but significantly correlated to Borg scale in the initial (r= - 0.3; p<0.01) and final of the test (r= -0.4; p<0.05). CONCLUSION Based on this data, there was no correlation between the degree of airflow obstruction and six-minute walk work test. The DLCO was the only respiratory functional parameter significantly correlated to the distance and to the six- minute walk work.

Comparação das variáveis fisiológicas no teste de caminhada de seis minutos e no teste da escada em portadores de doença pulmonar obstrutiva crônica

INTRODUCTION: Exercise intolerance interposes daily life activities in chronic obstructive pulmonary diseases (COPD); hence, the evaluation of this functional limitation becomes fundamental. Objective: To compare the six-minute walk test (HR6peak) with the stair-climbing test (SCT) in patients with COPD. METHODS: prospective analysis of twenty-one patients with COPD who were part of the - Pulmonary Rehabilitation Program - (PRP). Patients were evaluated from July to October, 2008 when they performed the HR6peak and ET, analyzing the variables physiological (HR, PSO2), and the modified Borg scale before and after each test. The distance was measured at the end of the tests. RESULTS: Comparing the timing (early versus late) of physiological and subjective perception of exertion (RPE) from Borg, we can observe that all changes were statistically significant (p <0.001) tests. However, when the physiological changes were compared, the PSO2 obtained presented similar reduction (p = 0.912) in both tests, the HR increased significantly in ET (p = 0.006) and on Borg RPE (p <0.001). Regarding the walking distance performed, the HR6peak (p <0.001), allowed participants to advance to a distance significantly longer than the ET. CONCLUSION: the tests expressed important physiological and subjective perception of effort (RPE) from Borg (p <0.001).

The relationship between fat‐free mass index and pulmonary hyperinflation in COPD patients

Reduced fat‐free mass (FFM), a common finding in chronic obstructive pulmonary disease (COPD), may indirectly impact peak exercise capacity through a greater level of pulmonary hyperinflation. We aimed to investigate if FFM index (FFM/squared height) impacts exercise induced dynamic hyperinflation in COPD patients.

PERFIL DEMOGRÁFICO Y CLÍNICO DE PACIENTES PORTADORES DE ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA EN EL SUR DE BRASIL

Objective: To characterize a population of Chronic Obstructive Pulmonary Disease (COPD) patients followed through a Pulmonary Rehabilitation Program (PRP). Methods: the study was observational, descriptive, with 83 patients with a diagnosis of COPD. All patients underwent spirometry and biochemical laboratory tests. Results: 47 men (56.6%) and 36 women (43.4%) were included. The most relevant comorbidity was Hyperten* Fisioterapeuta, Doutora em Ciências Pneumológicas. Professora do curso de fisioterapia da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: cassiac@feevale.br ** Química, Doutora em Bioquímica Toxicológica. Professora do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: daianeb@feevale.br *** Educador Físico, Mestrado em Qualidade Ambiental. Professor do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: rafaelms@feevale.br **** Enfermeira, aluna de Aperfeiçoamento Científico da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: samynh@ hotmail.com ***** Médico, Doutor em Medicina. Professor do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: paulojzt@feevale.br

PERFIL DEMOGRÁFICO E CLÍNICO DE PORTADORES DE DOENÇA PULMONAR OBSTRUTIVA CRÓNICA NO SUL DO BRASIL

Objective: To characterize a population of Chronic Obstructive Pulmonary Disease (COPD) patients followed through a Pulmonary Rehabilitation Program (PRP). Methods: the study was observational, descriptive, with 83 patients with a diagnosis of COPD. All patients underwent spirometry and biochemical laboratory tests. Results: 47 men (56.6%) and 36 women (43.4%) were included. The most relevant comorbidity was Hyperten* Fisioterapeuta, Doutora em Ciências Pneumológicas. Professora do curso de fisioterapia da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: cassiac@feevale.br ** Química, Doutora em Bioquímica Toxicológica. Professora do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: daianeb@feevale.br *** Educador Físico, Mestrado em Qualidade Ambiental. Professor do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: rafaelms@feevale.br **** Enfermeira, aluna de Aperfeiçoamento Científico da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: samynh@ hotmail.com ***** Médico, Doutor em Medicina. Professor do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: paulojzt@feevale.br

DEMOGRAPHIC AND CLINICAL PROFILE OF PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN SOUTHERN BRAZIL

Objective: To characterize a population of Chronic Obstructive Pulmonary Disease (COPD) patients followed through a Pulmonary Rehabilitation Program (PRP). Methods: the study was observational, descriptive, with 83 patients with a diagnosis of COPD. All patients underwent spirometry and biochemical laboratory tests. Results: 47 men (56.6%) and 36 women (43.4%) were included. The most relevant comorbidity was Hyperten* Fisioterapeuta, Doutora em Ciências Pneumológicas. Professora do curso de fisioterapia da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: cassiac@feevale.br ** Química, Doutora em Bioquímica Toxicológica. Professora do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: daianeb@feevale.br *** Educador Físico, Mestrado em Qualidade Ambiental. Professor do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: rafaelms@feevale.br **** Enfermeira, aluna de Aperfeiçoamento Científico da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: samynh@ hotmail.com ***** Médico, Doutor em Medicina. Professor do Instituto de Ciências da Saúde da Universidade Feevale. Novo Hamburgo, Brasil. E-mail: paulojzt@feevale.br