Cintia Laura Pereira de Araujo

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.

Cardiorespiratory fitness and quality of life at different exercise intensities after myocardial infarction

FUNDAMENTO: Estudos que relacionam exercicios fisicos e saude tem contribuido para a compreensao da influencia de habitos sedentarios com a incidencia de doencas cardiovasculares. OBJETIVO: Comparar o efeito de diferentes intensidades de exercicio aerobio sobre a capacidade funcional (VO2 pico) e a qualidade de vida de pacientes pos-infarto agudo do miocardio. METODOS: 87 homens (57,7 anos, ± 6,1) participaram deste estudo prospectivo, com 12 semanas de treinamento fisico de alta intensidade (n=29), a 85% da frequencia cardiaca maxima, de intensidade moderada (n=29), a 75% da frequencia cardiaca maxima, ou no grupo controle (n=29), que recebeu acompanhamento clinico. O exercicio aerobio foi realizado cinco vezes por semana, 45 minutos por sessao, alem de exercicios de resistencia muscular e alongamentos. O VO2 pico foi mensurado com teste cardiopulmonar, e a qualidade de vida foi avaliada pelo questionario MacNew. RESULTADOS: A ANOVA two-way revelou aumento do VO2 pico significativo (p<0,05) no grupo de alta intensidade (29,9 ± 2,2 ml/kg.min para 41,6 ± 3,9 ml/kg.min) em relacao ao grupo de moderada intensidade (32,0 ± 5,3 ml/kg.min para 37,1 ± 3,9 ml/kg.min). Alem disso, ambos os grupos de exercicio aumentaram significativamente em relacao ao grupo controle (31,6 ± 3,9 para 29,2 ± 4,1). A qualidade de vida teve melhora significativa (p<0,05) no grupo de alta intensidade (5,66 para 6,80) e de moderada intensidade (5,38 para 6,72), mas nao no grupo controle (5,30 para 5,15) CONCLUSAO: Os exercicios de maior intensidade resultaram em maior aumento na capacidade funcional e na qualidade de vida em pacientes no pos-infarto do miocardio.

Aptidão cardiorrespiratória e qualidade de vida pós-infarto em diferentes intensidades de exercício

FUNDAMENTO: Estudos que relacionam exercicios fisicos e saude tem contribuido para a compreensao da influencia de habitos sedentarios com a incidencia de doencas cardiovasculares. OBJETIVO: Comparar o efeito de diferentes intensidades de exercicio aerobio sobre a capacidade funcional (VO2 pico) e a qualidade de vida de pacientes pos-infarto agudo do miocardio. METODOS: 87 homens (57,7 anos, ± 6,1) participaram deste estudo prospectivo, com 12 semanas de treinamento fisico de alta intensidade (n=29), a 85% da frequencia cardiaca maxima, de intensidade moderada (n=29), a 75% da frequencia cardiaca maxima, ou no grupo controle (n=29), que recebeu acompanhamento clinico. O exercicio aerobio foi realizado cinco vezes por semana, 45 minutos por sessao, alem de exercicios de resistencia muscular e alongamentos. O VO2 pico foi mensurado com teste cardiopulmonar, e a qualidade de vida foi avaliada pelo questionario MacNew. RESULTADOS: A ANOVA two-way revelou aumento do VO2 pico significativo (p<0,05) no grupo de alta intensidade (29,9 ± 2,2 ml/kg.min para 41,6 ± 3,9 ml/kg.min) em relacao ao grupo de moderada intensidade (32,0 ± 5,3 ml/kg.min para 37,1 ± 3,9 ml/kg.min). Alem disso, ambos os grupos de exercicio aumentaram significativamente em relacao ao grupo controle (31,6 ± 3,9 para 29,2 ± 4,1). A qualidade de vida teve melhora significativa (p<0,05) no grupo de alta intensidade (5,66 para 6,80) e de moderada intensidade (5,38 para 6,72), mas nao no grupo controle (5,30 para 5,15) CONCLUSAO: Os exercicios de maior intensidade resultaram em maior aumento na capacidade funcional e na qualidade de vida em pacientes no pos-infarto do miocardio.

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.

The Glittre-ADL test reflects functional performance measured by physical activities of daily living in patients with chronic obstructive pulmonary disease

ABSTRACT Background The Glittre-ADL test (TGlittre) is a valid and reliable test for the evaluation of functional capacity and involves multiple physical activities of daily living (PADL), which are known to be troublesome to patients with Chronic Obstructive Pulmonary Disease (COPD). However, it is still unknown if this test is also able to reflect the functional performance of patients with COPD. Objective To investigate whether the TGlittre reflects the functional performance of COPD patients and whether the necessary time to complete the TGlittre and the PADL varies according to disease severity. Method Thirty-eight patients with COPD (age 65, SD=7 years; forced expiratory volume in the first second 41.3, SD=15.2% predicted) underwent anthropometric and lung function assessments and were submitted to the TGlittre and PADL measurement. Results TGlittre performance correlated significantly (p<0.05) with PADL variables, such as time sitting (r=0.50), walking (r=-0.46), number of steps taken (r=–0.53), walking movement intensity (r=–0.66), walking energy expenditure (r=-0.50), and total energy expenditure (r=–0.33). TGlittre performance was not significantly different in patients among the Global Initiative for COPD (GOLD) spirometric stages, but walking and sitting time were significantly lower and greater, respectively, in severe and very severe patients compared to those with moderate disease (p<0.05). Conclusion The performance on the TGlittre correlates with walking and sitting time and other real life PADL measurements. The severity of the disease is associated with the differences in the level of physical activity in daily life more than in functional capacity.

Relationship between the functional status constructs and quality of life in COPD

Abstract Introduction : Functional status is an important component of health related quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD). However there is a lack of studies aiming to evaluate the association between QOL and the different methods for assessing patient´s limitation to perform ADL. Objectives : To investigate the association between QOL and functional status, measured by four different instruments: London Chest Activity of Daily Living scale (LCADL), six-minute walking test (6MWT), Glittre ADL-test (TGlittre) and assessment of physical activities in daily living (PADL). Methods : Twenty-three pa-tients with COPD, GOLD 2 to 4, were submitted to the following evaluations: spirometry, the Saint George Respiratory Questionnaire (SGRQ), LCADL, 6MWT, TGlittre and assessment of PADL. Pearson or Spearman correlation coefficients were used to verify the association between the variables. Results : It was observed correlation between all domains of the SGRQ and the 6MWT, between TGlittre and ‘leisure’ domain of LCADL; and between the domain ‘activity’ of the SGRQ with the total score of LCADL (r = 0.53), LCADL% (r =

Nutritional status and its relationship with different dimensions of functional status in patients with chronic obstructive pulmonary disease

Objective: To investigate whether there is a relationship between nutritional status and limitations in activities of daily living in patients with chronic obstructive pulmonary disease. Methods: A cross sectional study was conducted from July to December 2011 in Santa Catarina. Seventeen chronic obstructive pulmonary disease patients [age (years) = 67±8; forced expiratory volume in one second (% of the predicted value) = 38.6±16.1; body mass index (kg/m2) = 24.7±5.4] underwent the assessments: pulmonary function (spirometry); functional status (London Chest Activity of Daily Living scale, physical activities in daily life, and Glittre ADL-Test; nutritional status (anthropometry and dual-energy X-Ray absorptiometry). Results: The total score of the London Chest Activity of Daily Living scale correlated with fat-free mass (r=-0.50; p=0.04) and lean mass (r=-0.50; p=0.04). The lying time in physical activities in daily life correlated with bone mineral content (r=-0.50; p=0.04). Nutricional status was not correlated with time spent on Glittre ADL-test. Conclusion: Variables that reflect muscle mass depletion are related to variables of self-reported limitation in activities of daily living. Bone mineral content is correlated with time patients spend lying, reflecting the impact of inactive postures on the nutritional status of these patients.

Aptitud cardiorrespiratoria y calidad de vida postinfarto en diferentes intensidades de ejercicio

FUNDAMENTO: Estudos que relacionam exercicios fisicos e saude tem contribuido para a compreensao da influencia de habitos sedentarios com a incidencia de doencas cardiovasculares. OBJETIVO: Comparar o efeito de diferentes intensidades de exercicio aerobio sobre a capacidade funcional (VO2 pico) e a qualidade de vida de pacientes pos-infarto agudo do miocardio. METODOS: 87 homens (57,7 anos, ± 6,1) participaram deste estudo prospectivo, com 12 semanas de treinamento fisico de alta intensidade (n=29), a 85% da frequencia cardiaca maxima, de intensidade moderada (n=29), a 75% da frequencia cardiaca maxima, ou no grupo controle (n=29), que recebeu acompanhamento clinico. O exercicio aerobio foi realizado cinco vezes por semana, 45 minutos por sessao, alem de exercicios de resistencia muscular e alongamentos. O VO2 pico foi mensurado com teste cardiopulmonar, e a qualidade de vida foi avaliada pelo questionario MacNew. RESULTADOS: A ANOVA two-way revelou aumento do VO2 pico significativo (p<0,05) no grupo de alta intensidade (29,9 ± 2,2 ml/kg.min para 41,6 ± 3,9 ml/kg.min) em relacao ao grupo de moderada intensidade (32,0 ± 5,3 ml/kg.min para 37,1 ± 3,9 ml/kg.min). Alem disso, ambos os grupos de exercicio aumentaram significativamente em relacao ao grupo controle (31,6 ± 3,9 para 29,2 ± 4,1). A qualidade de vida teve melhora significativa (p<0,05) no grupo de alta intensidade (5,66 para 6,80) e de moderada intensidade (5,38 para 6,72), mas nao no grupo controle (5,30 para 5,15) CONCLUSAO: Os exercicios de maior intensidade resultaram em maior aumento na capacidade funcional e na qualidade de vida em pacientes no pos-infarto do miocardio.