Daniela Ike

Novos valores de referência para pressões respiratórias máximas na população brasileira

OBJETIVO: Comparar PImax e PEmax medidas em individuos saudaveis com os valores previstos utilizando-se as equacoes propostas em outro estudo e, se necessario, sugerir novas equacoes para PImax e PEmax para a populacao brasileira. METODOS: Participaram do estudo 60 homens e 60 mulheres saudaveis com idades entre 20 e 80 anos (20 individuos por faixa etaria de 10 anos). As pressoes respiratorias maximas foram determinadas segundo um protocolo padronizado. RESULTADOS: Os valores medidos de PImax foram significativamente menores que aqueles previstos tanto para homens (31%) e mulheres (24%). Nao houve diferencas significativas entre a PEmax medida e prevista nos dois generos. A idade provou ser a variavel com melhor poder preditivo para PImax e PEmax nos dois generos. Novas equacoes foram propostas. CONCLUSOES: As equacoes propostas no estudo previo nao foram capazes de predizer PImax e PEmax de todos os individuos de nossa amostra. Portanto, os resultados deste estudo podem facilitar a predicao da forca muscular respiratoria de adultos saudaveis no Brasil. Novos estudos, com individuos de diferentes regioes do pais, poderao contribuir para o desenvolvimento de melhores tabelas ou equacoes para as pressoes respiratorias maximas na populacao brasileira.

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 ± 7.3 years and an average body mass index (BMI) of 47.4 ± 6.5 K/m² were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP+TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.

Study of peripheral muscle strength and severity indexes in individuals with chronic obstructive pulmonary disease

BACKGROUND AND PURPOSE Individuals with chronic obstructive pulmonary disease (COPD) present reduced peripheral muscle strength, which leads to impaired mobility and increased mortality risk. However, it is not clear whether there is any relationship between muscle strength, muscle mass and the body mass index, airflow obstruction, dyspnea, exercise performance (BODE) index scale, which is considered to be the best predictor of survival for individuals with COPD. The BODE Index is a multidimensional system that measures body composition (B), airway obstruction (O), dyspnea perception (D) and the ability to exercise (E), and rates the severity of the major changes found in individuals with COPD. The objective of this study was to verify any relationship between the BODE Index, muscle mass and maximum muscle strengths of the upper limb (UL) and lower limb (LL) in subjects with moderate to very severe COPD. METHODS Twenty-six individuals with moderate to very severe COPD were evaluated by body composition (body mass index and muscle mass), BODE Index, handgrip strength (HS) and one repetition maximum (1RM) test of the UL and LL. RESULTS There was a positive correlation (Pearson, p < 0.05) of peripheral muscle strength, evaluated by HS and 1RM (pectoral and triceps, round muscles and dorsal section, quadriceps), to muscle mass (0.74, 0.57, 0.74 and 0.62, respectively) and the distance walked in the six-minute walking test (0.52, 0.50, 0.46 and 0.58, respectively), but no correlation of muscle strength was found to forced expiratory volume in one second to dyspnea or the BODE Index. CONCLUSION In accordance with the results of this study, peripheral muscle strength as measured by HS and 1RM is not related to the severity indexes for COPD, unlike UL and LL muscle strength. Therefore, UL and LL measurements now have an additional importance in COPD evaluation.

Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects

BACKGROUND: Diaphragmatic breathing (DB) is widely used in pulmonary rehabilitation (PR) of patients with chronic obstructive pulmonary disease (COPD), however it has been little studied in the scientific literature. The Pilates breathing (PB) method has also been used in the rehabilitation area and has been little studied in the scientific literature and in COPD. OBJECTIVES: To compare ventilatory parameters during DB and PB in COPD patients and healthy adults. METHOD: Fifteen COPD patients (COPD group) and fifteen healthy patients (healthy group) performed three types of respiration: natural breathing (NB), DB, and PB, with the respiratory pattern being analyzed by respiratory inductive plethysmography. The parameters of time, volume, and thoracoabdominal coordination were evaluated. After the Shapiro-Wilk normality test, ANOVA was applied followed by Tukeys test (intragroup analysis) and Students t-test (intergroup analysis; p<0.05). RESULTS: DB promoted increase in respiratory volumes, times, and SpO2 as well as decrease in respiratory rate in both groups. PB increased respiratory volumes in healthy group, with no additional benefits of respiratory pattern in the COPD group. With respect to thoracoabdominal coordination, both groups presented higher asynchrony during DB, with a greater increase in the healthy group. CONCLUSIONS: DB showed positive effects such as increase in lung volumes, respiratory motion, and SpO2 and reduction in respiratory rate. Although there were no changes in volume and time measurements during PB in COPD, this breathing pattern increased volumes in the healthy subjects and increased oxygenation in both groups. In this context, the acute benefits of DB are emphasized as a supporting treatment in respiratory rehabilitation programs.

Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients

INTRODUCTION: Upper limb exercises are frequently used in respiratory physiotherapy, with UL elevation and controlled inspiratory timing. However, the use of expiration during upper limb elevation appears to be a strategy that could minimize the action of accessory muscles in patients with chronic obstructive pulmonary disease. In this context, little is known about the synchrony of upper limb (UL) movements associated with breathing. The aim of this study was to investigate the respiratory pattern of chronic obstructive pulmonary disease patients during different UL exercises associated with respiratory exercises. METHODS: Fifteen chronic obstructive pulmonary disease patients participated in this study. Respiratory pattern analysis by inductance plethysmography was performed during four types of upper limb exercises, two shoulder flexion-extension (one associated with inspiratory time during the concentric phase and the other associated with expiratory time) and two shoulder abduction-adduction (same timing as above). Statistical analysis was performed by the Kolmogorov-Smirnov test and ANOVA with Tukey tests (p≤ 0.05). RESULTS: The thoracoabdominal coordination measurements increased in the two exercises using both inspiration during shoulder flexion (PhRIB: 172%; PhREB: 131%; PhRTB: 142% and PhAng: 238%) as well as in shoulder horizontal abduction (PhRIB: 145%; PhREB: 109%; PhRTB: 130% and PhAng: 229%), differing from the exercises with expiration at the time of shoulder flexion and horizontal abduction. CONCLUSION: The exercises performed with inverted respiratory time produced less asynchrony and can be used as important strategies during physical exercise programs in these patients.

Efeitos do exercício resistido de membros superiores na força muscular periférica e na capacidade funcional do paciente com DPOC

INTRODUCAO: A disfuncao muscular periferica na doenca pulmonar obstrutiva cronica (DPOC) contribui diretamente para a intolerância ao exercicio fisico, porem ainda nao ha consenso sobre estrategias adequadas de treinamento fisico para esses pacientes. OBJETIVO: Avaliar o efeito do exercicio resistido de membros superiores (MMSS) em pacientes com DPOC moderada a muito grave no ganho de forca e na capacidade funcional. METODOS: Doze pacientes com DPOC foram divididos em dois grupos: controle (GC) e treinado (GT). O GT realizou treinamento de forca, tres vezes por semana, durante seis semanas, com carga de 80% de uma repeticao maxima (RM). Antes e apos o tratamento, foram realizados os testes de 1 RM e o Pegboard and Ring Test (PBRT) em ambos os grupos. RESULTADOS: Apos o tratamento, verificou-se aumento significativo da forca muscular no GT (aumento de 52% no supino sentado e 22% no pulley, com p < 0,05); e quanto ao PBRT, nao houve diferenca significativa em ambos os grupos. CONCLUSAO: O treinamento de forca de MMSS com duracao de seis semanas foi capaz de aumentar a forca muscular, mas nao a funcionalidade de pacientes com DPOC moderada a muito grave.

Correlation between functional capacity and health-related quality of life in COPD: a case series

Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St Georges Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearsons (parametric data) or Spearmans (non-parametric data) rank tests, with p < 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

Acute effects of transcutaneous electrical diaphragmatic stimulation on respiratory pattern in COPD patients: cross-sectional and comparative clinical trial

Background Transcutaneous electrical diaphragmatic stimulation (TEDS) has been used to improve respiratory muscle strength in patients with respiratory muscle weakness. However, this physical therapy resource has not been studied in chronic obstructive pulmonary disease (COPD). Objective To evaluate the respiratory pattern during one session of TEDS in COPD patients. Method Fifteen COPD patients participated in one TEDS session for plethysmographic analysis and assessment of peripheral oxygen saturation (SpO2) and heart rate (HR). After the session, patients were divided into two groups: Responder (R; n=9) and Non-Responder (NR; n=6) to TEDS. Statistic analysis was performed using the Shapiro-Wilk normality test and two-way ANOVA. For the parameters that showed interaction, the Student t test was used (P<0.05). Results R group consisted mainly of men, with lower SpO2 and higher HR than NR group. When time (before and during) and groups (R and NR) were compared (interaction), there were differences in the parameters minute ventilation (Vent), inspiratory tidal volume (ViVol), expiratory tidal volume (VeVol), and respiratory rate (Br/M). In the intergroup comparison, differences were observed in the parameters Vent, ViVol, and VeVol. A significant effect was also observed for time in change in end-expiratory lung volume level (qDEEL), phase relation during inspiration (PhRIB); phase relation during expiration (PhREB); phase relation of entire breath (PhRTB), and phase angle (PhAng). During TEDS, there was an increase in SpO2 and a reduction in HR in both groups. Conclusions The most hypoxemic group with greater HR responded to TEDS and there was interaction between group and time of analysis for the pulmonary volumes. The time factor had an influence on the two groups with an increase in thoracoabdominal asynchrony.

The effect of transcutaneous electrical diaphragmatic stimulation on respiratory parameters of Chronic Obstructive Pulmonary Disease patients

Correspondence to: Dirceu Costa – Programa de Pós-graduação em Ciência da Reabilitação, UNINOVE – Rua Vergueiro, 235 – Liberdade – CEP: 01504-001 – São Paulo (SP), Brazil – E-mail: dcosta@uninove.br; dirceu@ufscar.br Presentation: fev. 2013 – Accepted for publication: oct. 2013 – Financing source: PNPD/CNPq – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 114/2009. AbstrAct | The objective of this study was to evaluate the effect of transcutaneous electrical diaphragmatic stimulation (TEDS) on respiratory muscle strength and endurance, thoracic-abdominal expansibility and spirometric variables of subjects with chronic as obstructive pulmonary disease (COPD). Eight COPD patients submitted to respiratory physiotherapy received treatment with TEDS twice a week for 06 weeks, totaling 12 sessions. Before and after TEDS they were evaluated by the following parameters: maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); axillary, xiphoid and abdominal cyrtometry; and spirometry. After the Shapiro-Wilk test, the paired Student’s-t test and the Mann-Whitney test were applied for comparison of the two stages (before and after TEDS). For comparison of the before, after (post-1st session), 1st, 2nd, 3rd, 4th week stages, the ANOVA followed by Tukey test were applied (p<0.05). In accordance with the results obtained it was observed that TEDS promoted significant increase in: MIP (47.3%); MEP (21.7%); axillary (55.5%); xiphoid (59.2%) and abdominal (74.2%) cyrtometry, but not in the spirometric variables. In longitudinal analysis (in the 4 following weeks) the increase found in MIP and in thoracic-abdominal expansibility was maintained. Thus, we conclude that TEDS promoted improvement in respiratory muscle strength and thoracic-abdominal expansibility in COPD patients without alterations in spirometric variables, and some parameters were maintained in the following 4 weeks..O objetivo do estudo foi avaliar o efeito da estimulacao diafragmatica eletrica transcutânea (EDET) sobre a forca e endurance muscular respiratoria, expansibilidade toracoabdominal e variaveis espirometricas de individuos com doenca pulmonar obstrutiva cronica (DPOC). Oito pacientes com DPOC submetidos a fisioterapia respiratoria receberam tratamento com EDET duas vezes por semana durante 06 semanas, totalizando 12 sessoes. Antes e depois do tratamento eles foram avaliados pelos seguintes parâmetros: pressao inspiratoria maxima (PImax); pressao expiratoria maxima (PEmax); cirtometria axilar, xifoideana e abdominal; e espirometria. Apos o teste Shapiro-Wilk, o teste t de Student pareado e o teste Mann-Whitney foram aplicados para a comparacao dos dois estagios (antes e apos a EDET). Para a comparacao dos estagios antes, apos (pos-1a sessao), 1a, 2a, 3a e 4a semana, a ANOVA seguida do teste de Tukey foram aplicados (p<0,05). De acordo com os resultados obtidos, foi observado que a EDET promoveu aumento significativo em: PImax (47,3%); PEmax (21,7%); cirtometria axilar (55,5%); xifoideana (59,2%) e abdominal (74,2%), mas nao nas variaveis espirometricas. Na analise longitudinal (nas 4 semanas seguintes) o aumento encontrado na PImax e na expansibilidade toracoabdominal foi mantido. Assim conclui-se que a EDET promoveu melhora na forca muscular respiratoria e na expansibilidade toracoabdominal em pacientes com DPOC sem alteracao nas variaveis espirometricas; e alguns parâmetros foram mantidos nas quatro semanas seguintes.

Efeito da estimulação diafragmática elétrica transcutânea em parâmetros respiratórios de pacientes com Doença Pulmonar Obstrutiva Crônica

Correspondence to: Dirceu Costa – Programa de Pós-graduação em Ciência da Reabilitação, UNINOVE – Rua Vergueiro, 235 – Liberdade – CEP: 01504-001 – São Paulo (SP), Brazil – E-mail: dcosta@uninove.br; dirceu@ufscar.br Presentation: fev. 2013 – Accepted for publication: oct. 2013 – Financing source: PNPD/CNPq – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 114/2009. AbstrAct | The objective of this study was to evaluate the effect of transcutaneous electrical diaphragmatic stimulation (TEDS) on respiratory muscle strength and endurance, thoracic-abdominal expansibility and spirometric variables of subjects with chronic as obstructive pulmonary disease (COPD). Eight COPD patients submitted to respiratory physiotherapy received treatment with TEDS twice a week for 06 weeks, totaling 12 sessions. Before and after TEDS they were evaluated by the following parameters: maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); axillary, xiphoid and abdominal cyrtometry; and spirometry. After the Shapiro-Wilk test, the paired Student’s-t test and the Mann-Whitney test were applied for comparison of the two stages (before and after TEDS). For comparison of the before, after (post-1st session), 1st, 2nd, 3rd, 4th week stages, the ANOVA followed by Tukey test were applied (p<0.05). In accordance with the results obtained it was observed that TEDS promoted significant increase in: MIP (47.3%); MEP (21.7%); axillary (55.5%); xiphoid (59.2%) and abdominal (74.2%) cyrtometry, but not in the spirometric variables. In longitudinal analysis (in the 4 following weeks) the increase found in MIP and in thoracic-abdominal expansibility was maintained. Thus, we conclude that TEDS promoted improvement in respiratory muscle strength and thoracic-abdominal expansibility in COPD patients without alterations in spirometric variables, and some parameters were maintained in the following 4 weeks..O objetivo do estudo foi avaliar o efeito da estimulacao diafragmatica eletrica transcutânea (EDET) sobre a forca e endurance muscular respiratoria, expansibilidade toracoabdominal e variaveis espirometricas de individuos com doenca pulmonar obstrutiva cronica (DPOC). Oito pacientes com DPOC submetidos a fisioterapia respiratoria receberam tratamento com EDET duas vezes por semana durante 06 semanas, totalizando 12 sessoes. Antes e depois do tratamento eles foram avaliados pelos seguintes parâmetros: pressao inspiratoria maxima (PImax); pressao expiratoria maxima (PEmax); cirtometria axilar, xifoideana e abdominal; e espirometria. Apos o teste Shapiro-Wilk, o teste t de Student pareado e o teste Mann-Whitney foram aplicados para a comparacao dos dois estagios (antes e apos a EDET). Para a comparacao dos estagios antes, apos (pos-1a sessao), 1a, 2a, 3a e 4a semana, a ANOVA seguida do teste de Tukey foram aplicados (p<0,05). De acordo com os resultados obtidos, foi observado que a EDET promoveu aumento significativo em: PImax (47,3%); PEmax (21,7%); cirtometria axilar (55,5%); xifoideana (59,2%) e abdominal (74,2%), mas nao nas variaveis espirometricas. Na analise longitudinal (nas 4 semanas seguintes) o aumento encontrado na PImax e na expansibilidade toracoabdominal foi mantido. Assim conclui-se que a EDET promoveu melhora na forca muscular respiratoria e na expansibilidade toracoabdominal em pacientes com DPOC sem alteracao nas variaveis espirometricas; e alguns parâmetros foram mantidos nas quatro semanas seguintes.