Diego Marmorato Marino

Responsividade do teste do degrau de seis minutos a um programa de treinamento físico em pacientes com DPOC

OBJECTIVE: To evaluate the responsiveness of the six-minute step test (6MST) to an aerobic physical training program (PTP) and to determine the efficacy of the PTP regarding spirometric variables during the 6MST, as well as physical performance, sensation of dyspnea, and SpO2 during the 6MST and the six-minute walk test (6MWT), in patients with COPD. METHODS: This was a controlled, prospective randomized study involving patients clinically diagnosed with COPD, with an FEV1/FVC ratio < 70%, and having been clinically stable in the last two months. The patients were randomized to undergo a PTP on a treadmill, three times a week, for six weeks (PTP group) or not (control group). Histories were taken from all of the patients, who received regular respiratory therapy during the study period, undergoing physical examination and spirometry before and after bronchodilator use; incremental symptom-limited cardiopulmonary exercise testing; the 6MST; and the 6MWT. RESULTS: Of the 36 patients that completed the study, 21 and 15 were in the PTP and control groups, respectively. In the PTP group, there was a significant increase in the number of steps climbed during the 6MST and in the six-minute walk distance (in m and % of predicted), as well as a significant decrease in the sensation of dyspnea during the 6MWT. CONCLUSIONS: The 6MST showed responsiveness to the PTP. However, the 6MWT appears to be more responsive to the PTP proposed.

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.

Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease

AIM To verify the outcome of different physical therapy interventions in activities of daily living of individuals with chronic obstructive pulmonary disease (COPD). METHODS Twenty-two COPD individuals were randomly divided into three groups: the Lower Limb Training Group (LLTG, n=8) performed treadmill exercise, Upper Limb Training Group (ULTG, n=8) performed upper limb (UL) training, and Control Group (CG, n=6) underwent bronchial hygiene therapy for 6 weeks, three times per week. The following were simulated in the activities of the daily living test: blackboard erasing, weight lifting exercise, stair climbing and treadmill walking. The duration of these tasks was 5 min of blackboard erasing and weight lifting, and 6 min of stair climbing and treadmill walking. RESULTS Intragroup analysis presented a significant post-treatment ventilatory demand (V(E)/MVV) decrease for the LLTG during basal conditions and walking, and significant decrease during blackboard erasing and walking for the ULTG, with similar metabolic demand (VO(2)/VO(2)max) for both groups. Dyspnoea decreased significantly in the LLTG during post-treatment walking and increased for CG. The number of stairs climbed decreased significantly for the CG and increased for LLTG and ULTG post treatment, along with the walked distance for LLTG. The intergroup analysis presented significant differences in post-treatment dyspnoea with greater values observed for the CG during walking. CONCLUSION The different protocols utilized promoted benefits towards physical exercise tolerance, particularly in the ULTG that presented better performance in sustained UL tasks, which may suggest better conditioning and coordination of the muscles involved in UL elevation.

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.

Fatores que influenciam a capacidade física de pacientes com doença pulmonar obstrutiva crônica

The purpose of this study was to verify to what extent certain factors may influence physical capacity (as assessed by the six-minute walk test, 6MWT) of patients with chronic obstructive pulmonary disease (COPD); factors considered were age, forced expiratory volume in one second (FEV1), maximum voluntary ventilation (MVV), and distance covered in the symptom-limited cardiopulmonary exercise test (CET). Subjects were 18 male elderly (mean age 69.6±8.4 years) with II- and III-degree COPD diagnosis, submitted to spirometry and the 6MW and CE tests. Moderate significant correlations were found between distance walked at the 6MWT and FEV1 (r=0.62), MVV (r=0.50), and distance walked in CET (r=0.67); no correlation was found with age. Therefore, it may be said that the degree of airway obstruction, endurance of respiratory muscles, and maximum exertion capacity may influence physical capacity of subjects with II- and III-degree COPD when performing a daily activity such as walking.

Teste de caminhada de seis minutos na doença pulmonar obstrutiva crônica com diferentes graus de obstrução

RESUMO Introducao: Alguns testes funcionais sao utilizados complementando a avaliacao dinâmica na doenca pulmonar obstrutiva cronica (DPOC), como o teste de caminhada de seis minutos (TC6). Objetivos: Verificar quanto o grau de obstrucao compromete a tolerância ao esforco avaliado pelo TC6 e comparar a distância percorrida e prevista atraves da equacao de Enright e Sherrill (1998) para individuos saudaveis e com DPOC apresentando grau de obstrucao leve, moderado e grave, alem de comparar a distância percorrida entre os grupos. Metodos: Foram avaliados 90 individuos do sexo masculino, sendo 19 saudaveis (grupo 1-G1, idade media de 67 ± 6,6 anos), 24 individuos com DPOC apresentando obstrucao leve (grupo 2-G2, idade media de 69 ± 11,3 anos), 26 com DPOC moderada (grupo 3-G3, idade media de 71 ± 9,1 anos) e 21 com DPOC grave (grupo 4-G4, idade media de 70 ± 9,4 anos) quanto a distância percorrida, alem da distância prevista atraves da equacao. Resultados: Constatou-se diferenca significativa (teste t de Student, p ≤ 0,05) ao comparar distância percorrida e prevista para G3 (387 ± 71m vs 456 ± 56m) e G4 (318 ± 97m vs 477 ± 52m), sendo a percorrida menor que a prevista para ambos. Na analise intergrupos, quanto a distância percorrida verificou-se diferenca significativa (ANOVA, p ≤ 0,05), sendo que G1 (506 ± 56m) e G2 (452 ± 60m) apresentaram valores maiores (Newman-Keuls, p ≤ 0,05) que G3 (387 ± 71m) e G4 (318 ± 97m), assim como G3 maior que G4. Conclusao: Conclui-se que quanto maior a limitacao ao fluxo aereo, menor a tolerância ao esforco fisico; individuos saudaveis e com DPOC leve obtiveram desempenho semelhante, alem de mostrar distância percorrida similar a prevista. Assim, o TC6 permite avaliar a capacidade funcional dos individuos saudaveis e com DPOC, estimando quanto o grau de obstrucao do fluxo aereo compromete o desempenho fisico.

Exacerbation and functional capacity of patients with COPD undergoing an exercise training program: longitudinal study

Objective To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods Sixty three patients were distributed in two groups, (Exacerbation Group — EG, n = 29; Non-Exacerbated Group — NEG, n = 34). The Mann Whitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p < 0.05. Results There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the BMI with the WD, this and the isolated dyspnoea, and lean body mass with body weight. Conclusion Involving several variables along the follow up of patients with COPD in physical therapy programs is important, since it may prevent or reduce the chance of the occurrence of exacerbations. In addition, older patients with less tolerance to physical activity had a higher number of episodes of exacerbation, even when participating in a physiotherapy program associated to exercise training.