Ingrid G. Azevedo

Comparação entre o manovacuômetro nacional e o importado para medida da pressão inspiratória nasal

BACKGROUND the measurement of nasal inspiratory pressure, known as the sniff test, was developed as a new test of inspiratory muscle strength, mainly used in neuromuscular conditions. The test is easy to be performed and noninvasive. Despite the clinical importance of assessment of nasal inspiratory pressure a national equipment is not available to assess it. OBJECTIVES to compare a national with a foreign manovacuometer in assessing the nasal inspiratory pressure (sniff test) in healthy subjects. METHODS 18 subjects were evaluated (age 21.44 ± 2.8 years, BMI 23.4 ± 2.5 kg/m² , FVC 102.1 ±1 0.3% pred, FEV1 98.4 ± 1% pred). We performed two measures of nasal inspiratory pressure using two different manovacuometer: a national and a foreign. All subjects performed the tests at the same time of day, in different days being the order of the testes established randomly. It was used the paired t test, Pearson correlation and the Bland-Altman plots for statistical analysis considering a 5% significance level. RESULTS The averages observed for the two measures of nasal pressures were 125 ± 42.4 cmH2O for the foreign equipment, and 131.7 ± 2 8.7 cmH2O for the national equipment. The Pearson correlation showed significant correlation between the means with a coefficient of r=0.63. The t test showed no significant differences between both measurements (p>0,05). The BIAS ± SD found in Bland-Altman plot analysis was 7 cmH2O with limits of agreement between -57.5 cmH2O and 71.5 cmH2O. CONCLUSION the results suggest that the national electronic device is feasible and safe to the sniff test measurement in healthy subjects.

Muscle impairment in neuromuscular disease using an expiratory/inspiratory pressure ratio.

BACKGROUND: Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (PImax) and maximum static expiratory pressure (PEmax), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate PEmax/PImax ratio for these groups. METHODS: Seventy (35 males) subjects with NMDs (amyotrophic lateral sclerosis, myasthenia gravis, and myotonic dystrophy), and 93 (47 males) healthy individuals 20–80 y of age were evaluated for anthropometry, pulmonary function, PImax, and PEmax, respectively. RESULTS: Healthy individuals showed greater values for PImax and PEmax when compared with subjects with NMDs. PEmax/PImax ratio for healthy subjects was 1.31 ± 0.26, and PEmax%/PImax% was 1.04 ± 0.05; for subjects with NMDs, PEmax/PImax ratio was 1.45 ± 0.65, and PEmax%/PImax% ratio was 1.42 ± 0.67. We found that PEmax%/PImax% for myotonic dystrophy was 0.93 ± 0.24, for myasthenia gravis 1.94 ± 0.6, and for amyotrophic lateral sclerosis 1.33 ± 0.62 when we analyzed them separately. All healthy individuals showed higher PEmax compared with PImax. For subjects with NMDs, the impairment of PEmax and PImax is different among the 3 pathologies studied (P < .001). CONCLUSIONS: Healthy individuals and subjects with NMDs showed higher PEmax in comparison to PImax regarding the PEmax/PImax ratio. Based on the ratio, it is possible to state that NMDs show different patterns of respiratory muscle strength loss. PEmax/PImax ratio is a useful parameter to assess the impairment of respiratory muscles in a patient and to customize rehabilitation and treatment.

Adaptation of the Threshold IMT® with double spring load allows higher inspiratory pressure for muscle training

Purpose:  We aimed to evaluate the functionality of an adapted inspiratory muscle training device designed to allow pressures higher than 41 cmH2O that can be precisely controlled. The adaptation was made in a commercially available Threshold IMT® device, and the opening pressures and linearity of load were evaluated in an experimental setting.

Heart rate recovery after physical exertion tests in elderly hypertensive patients undergoing resistance training

Introduction: Heart rate recovery after exercise is a valuable variable, associated with prognosis and it has been used as an indicator of cardiorespiratory fitness, especially in patients with heart disease, as hypertensive patients. Objective: This study aimed to analyze the response of heart rate recovery in elderly hypertensive patients undergoing a resistance training program. Methods: Sample was composed for 10 elderly women with a mean age of 70.7 ± 7.4 years. Exercise test and six-minute walk test were developed and we checked heart rate recovery in the 1st and 2nd minute post tests, before and after resistance training. Results: There was an increase in mean heart rate recovery in the analyzed minutes in both tests, but only in the 1st minute after six minutes walk test we found a significant increase (p = 0.02). Conclusion: The results suggest the efficacy of resistance training to improve cardiorespiratory fitness of elderly hypertensive patients.