Laís Regina Garcia Ribeiro

Fatores associados ao tabagismo em idosos residentes na cidade de Londrina, Brasil

OBJECTIVE: To describe the characteristics and associated factors of smoking among the elderly. METHODS: Cross-sectional study carried out with 344 seniors (> 60 years old) living in the mid-sized, southern city of Londrina, Brazil in 2008. The dependent variable was smoking and the other studied variables were: socio-economic factors, education, referred health status and use the use of health services. Data were collected through household survey. Descriptive statistics of the variables of study and invariant data analysis were used to assess associations between the smoking habits of both current and former smokers and the exploratory variables. RESULTS: The prevalence of current and past smoking was 23.8% and 37.6% among men, and of 12.7% and 21.8% among women, respectively (p <0.0001). Among current smokers, there was no difference between men and women in relation to consumption of cigarettes per day and degree of dependence on tobacco. Age was not a determining factor among the groups (current smoker, former smoker and never having smoked) either. There was an independent and negative association with schooling and socioeconomic condition and positive association with poor health perception. CONCLUSION: Smoking was a public health concern among older adults in the studied community. Lower degrees of education and socioeconomic condition should be considered in the development of stop smoking programs among the elderly.

Are 30 minutes of rest between two incremental shuttle walking tests enough for cardiovascular variables and perceived exertion to return to baseline values

Objective: To verify whether 30 minutes of rest between two incremental shuttle walking tests (ISWT) are enough for cardiovascular variables and perceived exertion to return to baseline values in healthy subjects in a broad age range. Method: The maximal exercise capacity of 334 apparently healthy subjects (age ≥18) was evaluated using the ISWT. The test was performed twice with 30 minutes of rest in between. Heart rate (HR), arterial blood pressure (ABP), dyspnea, and leg fatigue were evaluated before and after each test. Subjects were allocated to 6 groups according to their age: G1: 18-29 years; G2: 30-39 years; G3: 40-49 years; G4: 50-59 years; G5: 60-69 years and G6: ≥70 years. Results: All groups had a good performance in the ISWT (median >90% of the predicted distance). The initial HR (HRi) of the second ISWT was higher than the first ISWT in the total sample (p<0.0001), as well as in all groups (p<0.0001). No difference was observed in the behavior of ABP (systolic and diastolic) and dyspnea between the two tests, but this difference occurred for leg fatigue (greater before the second ISWT) in G1 (p<0.05). Most subjects (58%) performed better in the second test. Conclusion: 30 minutes of rest between two ISWTs are not enough for all cardiovascular variables and perceived exertion to return to baseline values. However, this period appears to be sufficient for blood pressure and performance to recover in most subjects.

Static and Functional Balance in Individuals With COPD: Comparison With Healthy Controls and Differences According to Sex and Disease Severity

BACKGROUND: Studies have shown that individuals with COPD have impaired body balance, probably caused by the diseases multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COPD and healthy controls and to check possible differences according to sex and degrees of disease severity. METHODS: Forty-seven subjects with COPD and 25 healthy controls were included in this study. Their static balance was assessed in one-legged stance using a force platform and functional balance with the Timed Up and Go test. Additionally, participants performed spirometry, the 6-min walk test and isometric quadriceps maximal voluntary contraction assessment. Disease severity was classified according to the Global Initiative for Obstructive Lung Disease stages and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) scores. RESULTS: In comparison with healthy controls, subjects with COPD had worse static (center of pressure displacement area: 9.3 ± 1.9 cm2 vs 11.6 ± 4.0 cm2, respectively, P = .01) and functional balance (Timed Up and Go test: 8.5 ± 1.3 s vs 10.3 ± 1.8 s, respectively, P < .001). In the COPD group, men performed better in the Timed Up and Go test than women (9.8 ± 1.2 s vs 10.9 ± 2.2 s, respectively, P = .03), whereas women presented a better static balance in comparison with men for all parameters related to center of pressure (P < .005 for all). Disease severity did not affect any balance results. CONCLUSIONS: Individuals with COPD had worse static and functional balance in comparison with healthy controls. Sex can mediate these results, depending on the type of balance evaluation (force platform or functional test). Balance performance was similar among the groups classified according to disease severity.

Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial

OBJECTIVES To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD). DESIGN Randomised controlled trial. SETTING University-based outpatient clinic. PARTICIPANTS Thirty-six patients with predominantly moderate-to-severe COPD completed the study. INTERVENTION Patients were evaluated at baseline, at 3 months and at the end of the programme (i.e. 6 months). For both groups, the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and/or workload, totalling 60 sessions. MAIN OUTCOMES Objective monitoring of physical activity in daily life (PADL, primary outcome), lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, and symptoms of anxiety and depression. RESULTS After 6 months of training, a significant improvement in PADL was seen for both groups [mean difference (95% confidence interval): land group 993 (358 to 1628) steps/day; water group 1669 (404 to 2934) steps/day]. Significant improvements were also seen in inspiratory, expiratory and peripheral muscle strength; maximal and submaximal exercise capacity; quality of life and functional status for both groups. There were no significant improvements in lung function, body composition, and symptoms of anxiety and depression for either group. No difference was found in the magnitude of improvement between the two types of training for any outcome. CONCLUSION High-intensity exercise training in water generates similar effects compared with training on land in patients with moderate-to-severe COPD, rendering it an equally beneficial therapeutic option for this population. CLINICAL TRIAL REGISTRATION NUMBER NCT01691131.