Eloisa Maria Gatti Regueiro

Validity of physical activity monitors during daily life in patients with COPD

Symptoms during physical activity and physical inactivity are hallmarks of chronic obstructive pulmonary disease (COPD). Our aim was to evaluate the validity and usability of six activity monitors in patients with COPD against the doubly labelled water (DLW) indirect calorimetry method. 80 COPD patients (mean±sd age 68±6 years and forced expiratory volume in 1 s 57±19% predicted) recruited in four centres each wore simultaneously three or four out of six commercially available monitors validated in chronic conditions for 14 consecutive days. A priori validity criteria were defined. These included the ability to explain total energy expenditure (TEE) variance through multiple regression analysis, using TEE as the dependent variable with total body water (TBW) plus several physical activity monitor outputs as independent variables; and correlation with activity energy expenditure (AEE) measured by DLW. The Actigraph GT3X (Actigraph LLC, Pensacola, FL, USA), and DynaPort MoveMonitor (McRoberts BV, The Hague, the Netherlands) best explained the majority of the TEE variance not explained by TBW (53% and 70%, respectively) and showed the most significant correlations with AEE (r=0.71, p<0.001 and r=0.70, p<0.0001, respectively). The results of this study should guide users in choosing valid activity monitors for research or for clinical use in patients with chronic diseases such as COPD. This study validates six activity monitors in the field against indirect calorimetry (DLW) in patients with COPD http://ow.ly/o9VIE

Relationship of Bode Index to Functional Tests in Chronic Obstructive Pulmonary Disease

OBJECTIVE To determine if there is a correlation between the BODE Index and variables assessed during the Activities of Daily Living assessment, performance on lower limber tests, and peripheral muscle impairment of the upper limb in patients with chronic obstructive pulmonary disease. MATERIALS AND METHODS Ten men (aged 58 to 80 years old) with moderate to very severe obstruction were evaluated and classified by the BODE Index. They were evaluated by pulmonary ventilation (V̇E), oxygen consumption (V̇O2), and carbonic gas production (V̇CO2) on the ADL assessment; Distance Walking (DW) in the Six Minute Walking Test (6MWT) and the Six Minute Walking Test on Treadmill (6MWTT); number of repetitions in the Sit-to-Stand Test; and the Hand Grip Strength Test. Correlations were evaluated between the classification and the tests performed (Pearson and Spearman test, p<0.05). RESULTS The mean of the total score for the BODE Index was 2.80 (±1.03), with three patients scoring in the first quartile (Q1) and seven scoring in the second quartile (Q2). This Index showed a negative correlation with the 6MWTT (r=−0.86), the Sit-to-Stand Test (r=−0.66), and the Hand Grip Strength Test (r=−0.83). CONCLUSIONS Our results show that there is no correlation between the BODE Index and the ventilatory and metabolic responses in the Activities of Daily Living assessment. On the other hand, a correlation was observed between the BODE Index and the variables assessed in the 6MWTT, Sit-to-Stand Test, and Hand Grip Strength Test in moderate to very severe Chronic Obstructive Pulmonary Disease patients. This suggests that these tests can be employed as predictors of physical exercise capacity, perhaps as complementary tests to the BODE Index.

Avaliação da capacidade de exercício em adolescentes asmáticos e saudáveis

Resumen pt: OBJETIVOS: Comparar o desempenho fisico e as respostas obtidas nos testes de caminhada de seis minutos (TC6) e do degrau de seis minutos (TD6) entre adol...

Teste do degrau e teste da cadeira: comportamento das respostas metábolo-ventilatórias e cardiovasculares na DPOC

OBJECTIVES: Verify the metabolic, ventilatory, cardiovascular and perceived effort responses between the isotime two minute step test (2MST) and six minute step test (6MST) with two minute sit-to-stand test (STST) in individuals with COPD. MATERIALS AND METHODS:11 men with COPD (71 ± 8 years, FEV1 = 46.1 ± 15.2% predicted), clinically stable, were evaluation by STST and 6MST associated gas analysis and blood lactate in days which were not consecutive and not coincidental. In the 6MST and 2MST, the subjects were instructed ascend-to-descend a step 20 cm in height as quickly as possible. It was recommended that in the STST was performed in a chair 46 cm high. RESULTS: In the inter-tests analysis, there was no significant difference in the metabolic, ventilatory, cardiovascular variables and delta of variation (Δ) dyspnea at the peak of both tests, and 2MST. The Δheart frequency and Δfatigue in the lower limbs were significantly higher compared to STST for 2MST. We observed moderate and strong positive correlations between oxygen consumption, Δheart frequency and performances in 2MST and 6MST, between performances in 6MST and STST, and 2MST with STST. CONCLUSION: The tests showed metabolic, ventilatory, cardiovascular and dyspnoea responses similar; and 2MST, can be alternative to assess the functional limitations of individuals with COPD severe obstruction, providing a lower cardiovascular stress and muscle fatigue compared to the STST, the peripheral metabolic requirements and postural adjustments.

Relação da medida da amplitude tóraco-abdominal de adolescentes asmáticos e saudáveis com seu desempenho físico

AIMS: The aims were verify the differences of amplitude thoracoabdominal by cirtometry, at the levels axillary, xiphoid and abdominal in asthmatics and healthy adolescents and to compare the difference between them. In addition correlate them with the physical exercise capacity. MATERIALS AND METHODS: Thirty eight adolescents were assessed, aged from 11 to 15 years, of both sex. Nineteen were asthmatic adolescent, which composed the asthmatic group (AG), and nineteen were health adolescents, which composed the healthy group (HG). A clinical history was provided and all subjects were submitted an anthropometric and spirometric evaluation, the six minute step test (6MST), the cirtometry, and was calculated the amplitude thoracoabdominal index (TAI). RESULTS: Significant difference (p < 0.05) was observed to TAI, between axillary and abdominal levels, and xiphoid and abdominal levels in both group. No significant difference in regard to TAI between groups. Only in the AG there was positive correlation of the total number of ascent in the 6MST with the axillary and xiphoid TAI (r = 0,57 e r = 0,50; p < 0,05). CONCLUSION: There were no difference in the thoracic and abdominal cirtometry in adolescents with intermittent and persistent mild asthma when compared with the healthy adolescents and there were correlation axillary and xiphoid TAI with the physical performance in the 6MST.

Effects of Acupuncture at the Yintang and the Chengjiang Acupoints on Cardiac Arrhythmias and Neurocardiogenic Syncope in Emergency First Aid

This study evaluated the effectiveness of YinTang and ChengJiang acupoints on patients with cardiac arrhythmia and neurocardiogenic syncope in emergency first aid. A 45 year old woman underwent acupuncture. She had a previous history of a valvuloplasty for rheumatic disease and two acute myocardial infarctions, followed by four catheterizations and an angioplasty. Needling of the YinTang acupoint and stimulation of the ChengJiang acupoint through acupressure were performed for 20 minutes soon after syncope and during tachycardia, hypertension, tachypnea, and precordial pain, without any effect on peripheral oxygen saturation (SpO2) or the glycemic index. Data were analyzed comparatively by using the following parameters at rest, during syncope, and at 1 minute and 10 minutes after an emergency acupuncture procedure: blood pressure; heart rate; SpO2; and respiratory rate. We found that acupuncture at YinTang and ChenJiang acupoints induced cardiovascular responses, increased the limits of the bodys homeostasis, and normalized the patients condition in the case of syncope. Acupuncture using a combination of ChengJiang and YinTang acupoints had an immediate effect on the autonomic nervous system and on maintaining homeostasis and energy balance in the body. Although this technique was effective, the patient was still referred to the Emergency Room.

Análise da demanda metabólica e ventilatória durante a execução de atividades de vida diária em indivíduos com doença pulmonar obstrutiva crônica

Individuals with Chronic Obstructive Pulmonary Disease (COPD) report that fatigue and dyspnea are the main symptoms experienced as a result of efforts made during the realization of daily life activities (DLA). Based on this context, this study aimed to analyze and compare individuals with COPD (FEV1<60%), classified as Group 1 (G1) and healthy individuals, classified as Group 2 (G2), during the execution of five DLA. The chosen DLA were: changing a light bulb (L); lifting a weight (LW); sweeping (S); climbing steps (CA) and walking on a treadmill (WT). The following variables were monitored during these activities: metabolic (MR) and ventilatory reserve (VR); heart rate reserve (HRR); oxygenation and sensation of dyspnea (SD). For G1, there was a significant decrease in the MR compared with resting (R) for each of the five DLA (Friedman ANOVA; p<0.05). For G2, differences were found for LW, S, CA and WT. Between the groups, there was a difference for WT (Mann-Whitney; p<0.05). In relation to the VR for G1, there was a significant decrease for L, LW, CA and S when compared with resting (R), against differences in LW, S, CA and WT for G2. Between G1 and G2, differences were found for R, L, LW and CA. In relation to HRR, for G1 and G2, there was a significant decrease for the DLA when compared with R. For oxygenation between groups, there was a difference for the five DLA when compared with resting (R); as to the sensation of dyspnea, differences were found for L, LW, S, CA & WT. Individuals with COPD present a decrease in MR, VR and HRR during the realization of DLA, which can explain the fatigue and dyspnea they report.Individuos com Doenca Pulmonar Obstrutiva Cronica (DPOC) relatam como principais sintomas a fadiga e dispneia aos minimos esforcos envolvidos nas Atividades de Vida Diaria (AVD). Baseados nesse contexto, o objetivo deste estudo foi analisar e comparar individuos com DPOC (VEF1<60%) Grupo 1 (G1) e individuos saudaveis Grupo 2 (G2), durante a realizacao de cinco AVD: trocar lâmpada (L), elevar peso (P), varrer (V), subir degrau (D) e caminhar em esteira rolante (C) nos seguintes aspectos: reserva metabolica (RM) e ventilatoria (RV), de frequencia cardiaca (RFC), oxigenacao e sensacao de dispneia (SD). De acordo com os resultados, constatou-se diminuicao significativa da RM para o G1 em relacao ao repouso (R) para as 5 AVD (Friedman ANOVA; p<0,05), para o G2 nas AVD P, V, D e C. Entre os grupos observou-se diferenca significativa na AVD C (Mann-Whitney; p<0,05). No que se refere a RV para o G1 verificou-se diminuicao significativa nas AVD L, P, D, V em relacao ao R e para o G2, AVD P, V, D e C, entre G1 e G2 nas situacoes de R, L, P e D. Em relacao a RFC para o G1 e G2 houve diminuicao significativa nas 5 AVD em relacao ao R; e entre eles, AVD P, L e V. Para oxigenacao, entre os grupos houve diferenca nas 5 AVD; e SD nas AVD L, P, V, D e C. Conclui-se que os individuos com DPOC apresentaram diminuicao da RM, RV e RFC durante a realizacao das AVD, o que pode explicar a fadiga e dispneia por eles relatada.

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness.

BACKGROUND: Patients with COPD may experience respiratory muscle weakness. Two therapeutic approaches to the respiratory muscles are inspiratory muscle training and calisthenics-and-breathing exercises. The aims of the study are to compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion. In addition, these gains were compared between subjects with and without respiratory muscle weakness. METHODS: 25 subjects completed the study: 13 composed the inspiratory muscle training group, and 12 composed the calisthenics-and-breathing exercises group. Subjects were assessed before and after training by spirometry, measurements of respiratory muscle strength and test of inspiratory muscle endurance, thoracoabdominal excursion measurements, and the 6-min walk test. Moreover, scores for the Modified Medical Research Council dyspnea scale were reported. RESULTS: After intervention, there was a significant improvement in both groups of respiratory muscle strength and endurance, thoracoabdominal mobility, and walking distance in the 6-min walk test. Additionally, there was a decrease of dyspnea in the 6-min walk test peak. A difference was found between groups, with higher values of respiratory muscle strength and thoracoabdominal mobility and lower values of dyspnea in the 6-min walk test peak and the Modified Medical Research Council dyspnea scale in the inspiratory muscle training group. In the inspiratory muscle training group, subjects with respiratory muscle weakness had greater gains in inspiratory muscle strength and endurance. CONCLUSIONS: Both interventions increased exercise capacity and decreased dyspnea during physical effort. However, inspiratory muscle training was more effective in increasing inspiratory muscle strength and endurance, which could result in a decreased sensation of dyspnea. In addition, subjects with respiratory muscle weakness that performed inspiratory muscle training had higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity. (ClinicalTrials.gov registration NCT01510041.)

Analysis of metabolic and ventilatory demand during the execution of daily life activities in individuals with chronic obstructive pulmonary disease

Individuals with Chronic Obstructive Pulmonary Disease (COPD) report that fatigue and dyspnea are the main symptoms experienced as a result of efforts made during the realization of daily life activities (DLA). Based on this context, this study aimed to analyze and compare individuals with COPD (FEV1<60%), classified as Group 1 (G1) and healthy individuals, classified as Group 2 (G2), during the execution of five DLA. The chosen DLA were: changing a light bulb (L); lifting a weight (LW); sweeping (S); climbing steps (CA) and walking on a treadmill (WT). The following variables were monitored during these activities: metabolic (MR) and ventilatory reserve (VR); heart rate reserve (HRR); oxygenation and sensation of dyspnea (SD). For G1, there was a significant decrease in the MR compared with resting (R) for each of the five DLA (Friedman ANOVA; p<0.05). For G2, differences were found for LW, S, CA and WT. Between the groups, there was a difference for WT (Mann-Whitney; p<0.05). In relation to the VR for G1, there was a significant decrease for L, LW, CA and S when compared with resting (R), against differences in LW, S, CA and WT for G2. Between G1 and G2, differences were found for R, L, LW and CA. In relation to HRR, for G1 and G2, there was a significant decrease for the DLA when compared with R. For oxygenation between groups, there was a difference for the five DLA when compared with resting (R); as to the sensation of dyspnea, differences were found for L, LW, S, CA & WT. Individuals with COPD present a decrease in MR, VR and HRR during the realization of DLA, which can explain the fatigue and dyspnea they report.Individuos com Doenca Pulmonar Obstrutiva Cronica (DPOC) relatam como principais sintomas a fadiga e dispneia aos minimos esforcos envolvidos nas Atividades de Vida Diaria (AVD). Baseados nesse contexto, o objetivo deste estudo foi analisar e comparar individuos com DPOC (VEF1<60%) Grupo 1 (G1) e individuos saudaveis Grupo 2 (G2), durante a realizacao de cinco AVD: trocar lâmpada (L), elevar peso (P), varrer (V), subir degrau (D) e caminhar em esteira rolante (C) nos seguintes aspectos: reserva metabolica (RM) e ventilatoria (RV), de frequencia cardiaca (RFC), oxigenacao e sensacao de dispneia (SD). De acordo com os resultados, constatou-se diminuicao significativa da RM para o G1 em relacao ao repouso (R) para as 5 AVD (Friedman ANOVA; p<0,05), para o G2 nas AVD P, V, D e C. Entre os grupos observou-se diferenca significativa na AVD C (Mann-Whitney; p<0,05). No que se refere a RV para o G1 verificou-se diminuicao significativa nas AVD L, P, D, V em relacao ao R e para o G2, AVD P, V, D e C, entre G1 e G2 nas situacoes de R, L, P e D. Em relacao a RFC para o G1 e G2 houve diminuicao significativa nas 5 AVD em relacao ao R; e entre eles, AVD P, L e V. Para oxigenacao, entre os grupos houve diferenca nas 5 AVD; e SD nas AVD L, P, V, D e C. Conclui-se que os individuos com DPOC apresentaram diminuicao da RM, RV e RFC durante a realizacao das AVD, o que pode explicar a fadiga e dispneia por eles relatada.

Validation of the Dyspnoea-12 Scale Into Portuguese Speaking COPD Patients

Dyspnoea‐12 assesses dyspnea based on the physical and affective components of the symptom. The aim of this study was to translate the Dyspnoea‐12 into Portuguese, and to obtain validation data regarding the use of this tool in patients with chronic obstructive lung disease (COPD).