Isabella Martins de Albuquerque

Efeitos da pressão positiva expiratória nas vias aéreas sobre a atividade eletromiográfica da musculatura acessória da inspiração em portadores de DPOC

OBJECTIVE To evaluate the electromyographic activity (EA) of sternocleidomastoid (SCM) and scalene muscles during and after the use of expiratory positive airway pressure (EPAP) in patients with COPD. METHODS This was a clinical single-blind trial involving 13 healthy subjects as controls and 12 patients with stable COPD. At baseline, we determined EA during spontaneous respiration, lung function parameters, and respiratory muscle strength. Subsequently, EPAP at 15 cmH2O was applied by means of a face mask for 25 min, during which the EA of the SCM and scalene muscles was recorded every 5 min. A final record was obtained 10 min after the mask removal. RESULTS We found that the behavior of the EA of SCM and scalene muscles was comparable between the controls and the COPD patients (p = 0.716 and p = 0.789, respectively). However, during the use of EPAP, both muscles showed a trend toward an increase in the EA. In addition, there was a significant decrease in the EA of the SCM between the baseline and final measurements (p = 0.034). CONCLUSIONS The use of EPAP promoted a significant reduction in the EA of the SCM in the controls and in the patients with stable COPD. However, this did not occur regarding the EA of the scalene muscle.

Capacidade funcional submáxima e força muscular respiratória entre idosas praticantes de hidroginástica e dança: um estudo comparativo

Exercise is an effective strategy to prevent and slow the functional losses of aging, but there are few studies indicating the best method to improve functional status of the elderly. OBJETIVE: To compare respiratory muscle strength (RMS) and submaximal functional capacity of older practitioners of hydrogymnastics and dance. MATERIAL AND METHODS: A cross-sectional study with elderly women (n=46), practitioners of hydrogymnastics (Hydrogymnastics Group - HG; n=23) and dance (Dance Group - DG; n=23). For the measurement of physical activity, it was used tthe International Physical Activity Questionnaire (IPAQ - short version); the RMS was assessed by measurement of the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP); and the measure of submaximal functional capacity was assessed by the six-minute walk test (6MWT). RESULTS: The DG showed that higher MIP (84 ± 12.49 cmH2O) compared to the HG (63.35 ± 10.47 cmH2O) (p< 0.0001) and the MEP did not differ significantly between the groups (p= 0.08). The distance covered in the 6MWT DG (616.53 ± 60.81 m) was better performed than HG (446.65 ± 48.67 m) (p <0.0001). For the physical activity level, the DG showed that 19 elderly women (82.61%) were very active and four (17.39%) active, and the HG showed that eight elderly women (30.67%) were very active and 15 (69.23%) active. CONCLUSION: The elderly women practitioners of dance showed higher respiratory muscle strength and submaximal functional capacity, possibly due to the higher level of physical activity and also because dance is primarily an aerobic modality.

Acute effects of Expiratory Positive Airway Pressure (EPAP) on different levels in ventilation and electrical activity of sternocleidomastoid and parasternal muscles in Chronic Obstructive Pulmonary Disease (COPD) patients: a randomized controlled trial

ABSTRACT Objective To investigate the acute effects of EPAP on the activity of sternocleidomastoid (SCM), parasternal muscles and ventilatory parameters in COPD patients. Method Twenty-four patients with COPD were studied using surface electromyography (sEMG) and a ventilometer. Patients were randomly assigned to EPAP 10 cmH2O-EPAP10 or 15 cmH2O-EPAP15 for 20 minutes. Results The parasternal muscle sEMG activity increased during EPAP10 and EPAP15; however, a greater and significant increase was observed with EPAP10 (mean between-group difference: 12.5% RMS, 95% CI: 9.5 to 15.4, p<0.001). In relation to the baseline, at 10 and 20 minutes and upon recovery, respectively parasternal activity increased by 23.9%, 28.9% and 19.1% during EPAP10 and by 10.7% at 10 and 20 minutes and upon recovery, respectively, 11.4% and 6.9% during EPAP15 at 10 and 20 minutes and upon recovery, respectively. The sEMG activity of SCM muscle showed an opposite pattern, increasing with EPAP15 and decreasing with EPAP10 (mean between-group difference: 15.5% RMS, 95% CI: 12.6 to 18.4, p<0.001). SCM muscle activity during EPAP15, increased by 4.8% and 6.1% at 10 and 20 minutes and decreased by -4.0% upon recovery compared to decreases of –5.6%, –20.6% and –21.3% during EPAP10 at 10, 20 minutes, and recovery. Ventilation at both EPAP intensities promoted significant reductions in respiratory rate (RR) and dyspnea, more pronounced in EPAP15: RR (mean between-group difference: –3,8bpm, 95%CI: –7,5 to –0,2, p=0,015) and dyspnea (mean between-group difference: –1.01, 95%CI: –1.4 to –0.53, p=0.028) . Conclusion In COPD patients, the use of EPAP10 was more effective in reducing accessory inspiratory activity and increasing parasternal activity, which was accompanied by an improvement in ventilation and a reduction in dyspnea.

Short-term inspiratory muscle training potentiates the benefits of aerobic and resistance training in patients undergoing CABG in phase II cardiac rehabilitation program

Objective To investigate the efficiency of short-term inspiratory muscle training program associated with combined aerobic and resistance exercise on respiratory muscle strength, functional capacity and quality of life in patients who underwent coronary artery bypass and are in the phase II cardiac rehabilitation program. Methods A prospective, quasi-experimental study with 24 patients who underwent coronary artery bypass and were randomly assigned to two groups in the Phase II cardiac rehabilitation program: inspiratory muscle training program associated with combined training (aerobic and resistance) group (GCR + IMT, n=12) and combined training with respiratory exercises group (GCR, n=12), over a period of 12 weeks, with two sessions per week. Before and after intervention, the following measurements were obtained: maximal inspiratory and expiratory pressures (PImax and PEmax), peak oxygen consumption (peak VO2) and quality of life scores. Data were compared between pre- and post-intervention at baseline and the variation between the pre- and post-phase II cardiac rehabilitation program using the Students t-test, except the categorical variables, which were compared using the Chi-square test. Values of P<0.05 were considered statistically significant. Results Compared to GCR, the GCR + IMT group showed larger increments in PImax (P<0.001), PEmax (P<0.001), peak VO2 (P<0.001) and quality of life scores (P<0.001). Conclusion The present study demonstrated that the addition of inspiratory muscle training, even when applied for a short period, may potentiate the effects of combined aerobic and resistance training, becoming a simple and inexpensive strategy for patients who underwent coronary artery bypass and are in phase II cardiac rehabilitation.

Effects of short inspiratory muscle training on inspiratory muscle strength and functional capacity in physically active elderly: A quasi-experimental study

Abstract The aim of the current study was to evaluate the effects of a short inspiratory muscle training (IMT) program results in functional capacity, inspiratory muscle strength and quality of life in physically active elderly people. Twenty-six physically active elderly subjects were assigned to either a 6-week IMT program (13 subjects) or a placebo-IMT (P-IMT; 13 subjects). The following parameters were measured before and after intervention: 6-minute walk test (6MWT) distance, inspiratory muscle strength (PImax) and quality of life scores. Between-groups analysis of functional capacity was not statistically significant, but showed a tendency to improvement in the IMT group from 469.4 m (IQR: 418–532 m) at baseline to 516.4 m (IQR: 462.5–560.1 m) during follow-up. The IMT program induced significant improvement in inspiratory strength between the groups from 55 cm H2O (IQR: 45–71.25 cm H2O) at baseline to 90 cm H2O (IQR: 76.25–107.5 cm H2O) during follow-up, whereas the P-IMT group had a slight decrease from 75 cm H2O (IQR: 67.5–95 cm H2O) at baseline to 67.5 cm H2O (IQR: 65–75 cm H2O; p = 0.010). The quality of life questionnaire did not improve after the IMT program. The present study demonstrates that a short-term 6-week IMT program results in improvement in inspiratory muscle strength and a tendency to improvement in functional capacity in physically active elderly people.

Continuous positive airway pressure and body position alter lung clearance of the radiopharmaceutical 99mtechnetium-diethylenetriaminepentaacetic acid (99mTc-DTPA)

The purpose of this investigation was to evaluate the pulmonary clearance rate of 99m technetium-diethylenetriaminepentaacetic acid ( 99m Tc-DTPA) through the use of continuous positive airway pressure (CPAP) in different postures. It was a quasi-experimental study involving 36 healthy individuals with normal spirometry. 99m Tc-DTPA, as aerosol, was nebulized for 3 min with the individual in a sitting position. The pulmonary clearance rate was assessed through pulmonary scintigraphy under spontaneous breathing and under 20 and 10 cmH 2 O CPAP in the sitting and supine positions. The clearance rate was expressed as the half-time (T 1/2 ), that is, the time for the activity to decrease to 50% of the peak value. 20 cmH 2 O CPAP produced significant reduction of the T 1/2 of 99m Tc-DTPA in the supine position (P = 0.009) and in the sitting position (P = 0.005). However, 10 cmH 2 O CPAP did not alter the T 1/2 of DTPA in both positions. The postural variation from supine to the sitting position with 10 cmH 2 O CPAP (P = 0.01) and 20 cmH 2 O (P = 0.02) also reduced the T 1/2 of 99m Tc-DTPA. High levels of positive pressure in normal lungs resulted in faster 99m Tc-DTPA clearance. Moreover, the sitting position further increased the clearance rate of the 99mTc radioaerosol imaging in the two pressure levels studied. Key words: Continuous positive airway pressure, 99m Tc-DTPA, scintigraphy, posture.

TREINAMENTO MUSCULAR INSPIRATÓRIO EM INDIVÍDUOS OBESOS: UM ESTUDO PILOTO

To investigate the effects of TMI on lipid peroxidation in obese individuals. Methods: Seven obese subjects with a mean age of 34 ± 5 years participated in this study. It was evaluated the respiratory muscle strength, the inspiratory muscle endurance, the exercise tolerance by the 6-minute walk test (6MWT) and the quality of life, as well, is was investigate the occurrence of lipid peroxidation by determining the levels of reactive substances thiobarbituric acid (TBARS) before and after four weeks of TMI, performed at 30% of maximal inspiratory pressure. Results: TMI induced increase in inspiratory muscle strength (p=0.008), inspiratory muscle resistance (p=0.0003) and improvement in the physical domain of quality of life score. However, TMI did not alter the distance on the 6MWT and the levels of TBARS (p=0.85). Conclusion: Four weeks of TMI increases inspiratory muscle strength and endurance and improves the physical domain of quality of life, but does not change the TBARS levels in obese.

COMPARAÇÃO DE DOIS PROTOCOLOS DE ESPIROMETRIA DE INCENTIVO NO PÓS-OPERATÓRIO DE CIRURGIA DE REVASCULARIZAÇÃO DO MIOCÁRDIO: ESTUDO PILOTO

Objetivo: Comparar os efeitos da espirometria de incentivo (EI), a fluxo e a volume, sobre a forca muscular respiratoria, volumes e capacidades pulmonares e expansibilidade toracoabdominal apos Cirurgia de Revascularizacao do Miocardio (CRM). Metodologia: Estudo piloto com pacientes submetidos a CRM num hospital privado de Santa Maria-RS, Brasil. Foram avaliados 11 pacientes, de ambos os generos, faixa etaria entre 49 e 78 anos, randomizados em grupo Respiron (GR, n = 6) e grupo Voldyne (GV, n = 5). A Fisioterapia foi iniciada no primeiro dia de pos-operatorio (PO); protocolo de EI desenvolvido em tres series de 10 repeticoes; alem da fisioterapia respiratoria padronizada para ambos os grupos. As variaveis de cirtometria, pressoes respiratorias maximas e espirometria foram coletadas no pre-operatorio, 2o, 4o e 7o PO. Resultados: Na comparacao intragrupo, evidenciou-se reducao, em todas as variaveis, entre o pre-operatorio e o 2o PO com recuperacao parcial ate o 7o PO. Nao houve diferenca na comparacao entre grupos. Conclusao: Ambas as tecnicas de EI, atuaram de forma semelhante no restabelecimento da funcao pulmonar de pacientes submetidos a CRM. Descritores: Exercicios Respiratorios; Fisioterapia; Musculos Respiratorios; Cirurgia Cardiovascular.

Short-term inspiratory muscle training associated with combined aerobic and resistance training is benefic in patients undergoing CABG surgery in phase II cardiac rehabilitation program

Objective To investigate the efficiency of short-term inspiratory muscle training program associated with combined aerobic and resistance exercise on respiratory muscle strength, functional capacity and quality of life in patients who underwent coronary artery bypass and are in the phase II cardiac rehabilitation program. Methods A prospective, quasi-experimental study with 24 patients who underwent coronary artery bypass and were randomly assigned to two groups in the Phase II cardiac rehabilitation program: inspiratory muscle training program associated with combined training (aerobic and resistance) group (GCR + IMT, n=12) and combined training with respiratory exercises group (GCR, n=12), over a period of 12 weeks, with two sessions per week. Before and after intervention, the following measurements were obtained: maximal inspiratory and expiratory pressures (PImax and PEmax), peak oxygen consumption (peak VO2) and quality of life scores. Data were compared between pre- and post-intervention at baseline and the variation between the pre- and post-phase II cardiac rehabilitation program using the Students t-test, except the categorical variables, which were compared using the Chi-square test. Values of P<0.05 were considered statistically significant. Results Compared to GCR, the GCR + IMT group showed larger increments in PImax (P<0.001), PEmax (P<0.001), peak VO2 (P<0.001) and quality of life scores (P<0.001). Conclusion The present study demonstrated that the addition of inspiratory muscle training, even when applied for a short period, may potentiate the effects of combined aerobic and resistance training, becoming a simple and inexpensive strategy for patients who underwent coronary artery bypass and are in phase II cardiac rehabilitation.

Physical therapy performance in the rehabilitation of survivors of the Kiss nightclub tragedy: an experience report

Introduction : As a result of a fire in the Kiss nightclub that occurred in the city of Santa Maria - RS, 242 people were killed, of whom 235 died on the day of the episode, asphyxiated by the inhalation of toxic smoke. Approximately 1,000 more were injured. Objective : To report the experience of a group of physical therapists, professors at the Federal University of Santa Maria (UFSM), in the rehabilitation of survivors of the fire, victims of burns and inhalation injury. Materials and methods : Quantitative and qualitative study, in which an evaluation protocol of physical functional ability was designed to identify rehabilitation needs. Results : Two hundred seventy patients (147 men, mean age 26.72 ± 9.5 years) were examined, of which approximately 70% had some type of clinical modification or functional impairment that indicated the need for rehabilitation. The most prevalent respiratory signs and symptoms were: dry or productive cough (59.2%); abnormal respiratory pace (11.4%); fatigue (35.92%); dyspnea (17.7%); and chest pain (16.6%). Neurological symptoms such as persistent headache (88.51%), memory loss (11.4%), and paresthesia (8.1%) were also reported. Musculoskeletal injuries (14.7%) and extensive burns (8.8%) were also observed. One hundred and eighty-nine patients were referred to outpatient physical therapy and, of these, 22 still remain at the Outpatient Physical Therapy Unit of the University Hospital of (HUSM). Conclusions : Despite the vast professional experience of this group of physical therapists, the situations experienced were unique and unprecedented, both professionally and personally, and reinforced the importance of joining forces within an emergency care unit, as well as the importance of comprehensive and multi-professional outpatient monitoring.