Luciana Maria Malosá Sampaio

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 +/- 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 +/- 16 and 36 +/- 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 +/- 14 vs 14 +/- 5 cmH2O, and 87 +/- 30 vs 34 +/- 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 +/- 0.7 vs 2.3 +/- 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial

BackgroundChronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed.MethodsPatients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks.ResultsThere was a significant difference in the distance covered on the six-minute walk test (p < 0.05) and BODE index (p < 0.001) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline.ConclusionA home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.RiassuntoRazionaleLa broncopneumopatia cronica ostruttiva (BPCO) è una causa frequente di morbilità e mortalità che colpisce un’ampia quota di popolazione sia nel mondo industrializzato che nei Paesi in via di sviluppo e rappresenta un peso economico di rilievo per pazienti, familiari e collettività. La riabilitazione respiratoria (PR) è un programma multidisciplinare che inegra componenti di riallenamento all’esercizio fisico, educazionale, supporto nutrizionale, supporto psicologico ed autoaiuto, che porta ad un miglioramento della dispnea, della affaticabilità e della qualità della vita. Nonostante la provata efficacia e le forti raccomandazioni delle società scientifiche al suo impiego routinario nel trattamento della BPCO, la PR è generalmente sottoutilizzata e si rendono perciò necessarie strategie per aumentarne l’utilizzo. La PR effettuata a domicilio ed auto-monitorata dal paziente stesso è un’alternativa alla classica riabilitazione ambulatoriale. In questo studio sono stati valuati pazienti con BPCO di grado lieve, moderato e grave sottoposti a un programma di PR ambulatoriale o domiciliare.MetodiI pazienti eligibili allo studio sono stati randomizzati in tre gruppi: un gruppo ambulatoriale che effettuava tutte le attività in ospedale, un gruppo domiciliare che effettuava il programma a domicilio ed un gruppo di controllo. Il programma di PR consisteva in una combinazione di esercizi aerobici e di rafforzamento della muscolatura degli arti superiori e inferiori per 3 volte la settimana per 12 settimane.RisultatiSia nel gruppo che ha partecipato al PR ambulatoriale che in quello domiciliare si sono rilevate differenze significative rispetto alle misure di base nella distanza coperta con il test del cammino di 6 minuti (p < 0.05) che nell’indice BODE (p < 0.001).ConclusioniUn programma di riabilitazione respiratoria automonitorato eseguito a domicilio ha efficacia sovrapponibile ad un programma ambulatoriale e può perciò essere considerato una valida alternativa nella gestione del paziente con BPCO.

A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial

Objective: Compare the effects of treadmill training and training with overground walking (both without partial weight support) on motor skills in children with cerebral palsy. Design: Randomized controlled clinical trial. Setting: Physical therapy clinics. Subjects: Thirty-six children with cerebral palsy (levels I–III of the Gross Motor Functional Classification System) randomly divided into two intervention groups. Interventions: Experimental group (17 children) submitted to treadmill training without partial weight support. Overground walking group (18 children) submitted to gait training on a fixed surface (ground). Training was performed for seven consecutive weeks (two sessions per week), with four subsequent weeks of follow-up. Results: Both groups demonstrated improvements on the 6-minute walk test (experimental group from 227.4 SD 49.4 to 377.2 SD 93.0; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0), timed up-and-go test (experimental group from 14.3 SD 2.9 to 7.8 SD 2.2; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5), Pediatric Evaluation Disability Inventory (experimental group from 128.0 SD 19.9 to 139.0 SD 18.4; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2), Gross Motor Function Measure-88 (experimental group from 81.6 SD 8.7 to 93.0 SD 5.7; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2), Berg Balance Scale (experimental group from 34.9 SD 8.5 to 46.7 SD 7.6; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8) after treatment. The experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up (p < 0.05). Conclusion: Treadmill training proved more effective than training with overground walking regarding functional mobility, functional performance, gross motor function and functional balance in children with cerebral palsy.

THE IMPACT OF NONINVASIVE VENTILATION DURING THE PHYSICAL TRAINING IN PATIENTS WITH MODERATE-TO-SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

OBJECTIVE To evaluate the influence of physical training with or without noninvasive ventilation at 2 levels of pressure in the airways (BiPAP) in patients with chronic obstructive pulmonary disease. METHODS Eighteen patients with FEV(1) = 34 +/- 8% of predicted values, mean age of 68 +/- 9 years were randomly distributed into 2 groups, one group performing physical training on a treadmill and the other group performing physical training associated with BiPAP (physical training+B), for 30 minutes, 3 times a week for 12 weeks. The training velocity was based on a test of cardiopulmonary force performed pre- and postintervention, which registered the values for heart rate, systolic blood pressure, diastolic blood pressure, peripheral oxygen saturation, blood lactate, sensation of dyspnea, respiratory muscle strength, and analysis of gases expired such as oxygen consumption and the production of carbon dioxide. RESULTS For both groups, there was a significant improvement in dyspnea and peripheral oxygen saturation at identical levels of physical exercise, in distance walked during the physical training, and in respiratory muscle strength (P < 0.05). Only the physical training+B group had a significant improvement in heart rate, systolic blood pressure, and oxygen consumption after training (P < 0.05). Significant reductions of blood lactate were observed at identical levels of exercise in physical training+B when compared to isolated physical training (from 1.3 +/- 0.7 mMol/L versus 2.5 +/- 0.9 mMol/L, (P < 0.05), respectively). CONCLUSION Physical training associated with BiPAP enhanced the oxidative muscular capacity and could be an adjunctive recourse for physical rehabilitation in patients with chronic obstructive pulmonary disease.

Avaliação da força muscular respiratória e amplitudes torácicas e abdominais após a RFR em indivíduos obesos

Este estudo teve como objetivo avaliar os elementos da mecânica respiratoria, de individuos obesos no que se refere a forca muscular respiratoria, atraves das medidas de Pressao Respiratoria Maxima (PImax e PEmax) e, da mobilidade toraco abdominal, atraves da Amplitude Toraco-Abdominal nos niveis: axilar (AAx), xifoidiano (AXf) e abdominal (AAb). Avaliaram-se 29 individuos obesos com media de idade de 43 ± 13 anos, divididos em dois grupos: Grupo Experimental (E) e Grupo Controle (C), atraves das medidas da PImax e da PEmax e Amplitude Toraco-abdominal. O Grupo E foi submetido a 18 sessoes de Reeducacao Funcional Respiratoria (RFR) que constituiu-se de orientacao respiratoria, exercicios de coordenacao da respiracao associados aos movimentos de tronco e membros, alongamento geral da musculatura e relaxamento muscular, 2 vezes por semana, durante 9 semanas. Constatou-se, atraves do Teste-t de Student (p<0.05), que nao ocorreram diferencas significativas nos valores da PEmax em ambos os grupos estudados mas, a PImax, a AXif e a AAbd aumentaram significativamente no E. Esses resultados permitem concluir que a RFR causou um aumento na forca muscular inspiratoria e das amplitudes toraco-abdominais desses individuos obesos.The purpose of this study was to assess the elements of respiratory mechanics in obese individuals with respect to respiratory muscle strength determined by maximum respiratory pressure (PImax and PEmax) and the amplitude of thoracoabdominal movements at the levels: axillary (AAX), xiphoid (AXf) and abdominal (AAb). Twenty nine patients (43 +/- 13 years) were divided in two groups: Experimental group (E) and Control group (C). All patients were submitted to an initial evaluation and determination of PImax, PEmax, AAx, AXiph and AAb. The E group was submitted to 18 sessions of a Functional Reeducation of Breathing Program that consisted of respiratory orientation, respiratory coordination exercise associated to trunk and limb movements and muscle relaxation two times a week during 9 weeks. Student t-test showed a significant increase in PImax, Axif and Aabd in the experimental group, but when authors compared the two groups, they did not find any statistical difference. The results showed that the Program increased the respiratory muscle strength and the amplitude of abdominal movements in obese patients.

Acute effects of different levels of continuous positive airway pressure on cardiac autonomic modulation in chronic heart failure and chronic obstructive pulmonary disease

Introduction Non-invasive ventilation may improve autonomic modulation and ventilatory parameters in severely disabled patients. The aim of the present study was to evaluate the physiological influence of acute treatment with different levels of continuous positive airway pressure (CPAP) on the autonomic balance of heart and respiratory responses in patients with stable chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Materials and methods A COPD group (n = 10), CHF group (n = 8) and healthy subjects (n = 10) were evaluated. The participants were randomized to receive three different levels of CPAP on the same day: sham ventilation (Sham), 5 cmH20 (CPAP5) and 10 cmH20 (CPAP10) for 10 min. Respiratory rate, end tidal carbon dioxide (ETCO2), peripheral oxygen saturation (SpO2), heart rate (HR), blood pressure and heart rate variability in the time and frequency domains were measured during spontaneous breathing and under the sham, CPAP5 and CPAP10 conditions. Results All groups experienced a reduction in ETCO2 values during treatment with CPAP (p < 0.05). CPAP increased SpO2 and HR in the COPD group (p < 0.05). The COPD group also had lower RMSSD values during treatment with different levels of CPAP when compared to the control group (p < 0.05). In the CHF group, CPAP5 and CPAP10 increased the SDNN value (p < 0.05). CPAP10 reduced the SDNN value in the COPD group (p < 0.05). Conclusion The findings suggest that CPAP may cause improvements in the neural control of heart rate in patients with stable COPD and CHF. For each patient, the “best CPAP level” should be defined as the best respiratory response and autonomic balance.

Effect of treadmill gait training on static and functional balance in children with cerebral palsy: a randomized controlled trial

BACKGROUND Treadmill gait training as a therapeutic resource in the rehabilitation of children with cerebral palsy has recently been the focus of many studies; however, little is still known regarding its effect on static and functional balance in children. OBJECTIVE The aim of the present study was to compare the effects of treadmill training and over ground gait training in children with cerebral palsy. METHOD A randomized controlled trial with blinded evaluator was conducted with children with cerebral palsy between three and 12 years of age categorized in Levels I to III of the Gross Motor Function Classification System. Assessments were performed before and after the intervention and involved the Berg balance scale as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed. The experimental group was submitted to treadmill training and the control group performed gait training over the ground. The intervention consisted of two 30-minute sessions per week for seven weeks. RESULTS Both groups exhibited better functional balance after the protocol. The experimental group had higher Berg balance scale scores and exhibited lesser mediolateral oscillation with eyes open in comparison to the control group. CONCLUSIONS Treadmill training had a greater effect on functional balance and mediolateral oscillation in comparison to over ground gait training in children with cerebral palsy. TRIAL REGISTRATION RBR-5v3kg9.(Brazilian Registry of Clinical Trials).

Influence of noninvasive ventilation by BiPAP® on exercise tolerance and respiratory muscle strength in chronic obstructive pulmonary disease patients (COPD)

This study aimed to assess the effect of BiPAP, by nasal mask, on exercise tolerance and respiratory muscle strength in patients with a clinical and spirometric diagnosis of moderate/severe COPD (FEV1 < 60% of predicted). Ten patients of 59.4+/-8.9 years old, with FEV1/FVC <70% of predicted level, were treated with 30 minutes of BiPAP (IPAP:10 and 15 cmH2O; EPAP:4 cmH2O), three days per week, during two months. Before and after the treatment, spirometry, inspiratory (MIP) and expiratory (MEP) muscle strength and the distance walked in six minutes (6MWT) were measured. We observed a significant increase (Wilcoxon, p<0.05) in the mean values of MIP (from -55+/-17 to -77+/-19, respectively), MEP (from 75+/-20 to 109+/-36, respectively) and walking distance (from 349+/-67 to 448+/-75). Based on these results, we concluded that BiPAP improves respiratory muscle strength and exercise tolerance in these COPD patients.O objetivo deste estudo foi avaliar o efeito do BiPAP®, atraves de mascara nasal, na tolerância ao exercicio fisico e no desempenho muscular respiratorio em pacientes com diagnostico clinico e espirometrico de DPOC, moderado/grave (VEF1 < 60% do previsto). Com VEF1/CVF <70% do previsto e idade media de 59,4±8,9 anos, dez pacientes com doenca pulmonar obstrutiva cronica (DPOC) foram tratados com 30 minutos de BiPAP® (IPAP=10-15 e EPAP=4 cmH2O), em tres sessoes semanais, durante dois meses. Antes e apos o tratamento mediu-se a espirometria, a forca muscular inspiratoria (PImax) e expiratoria (PEmax) e a distância percorrida em seis minutos (TC6). Foram constatados aumentos significativos (Wilcoxon, p<0,05) na media da PImax (de -55±17 para -77±19 cmH2O), da PEmax (de 75±20 para 109±36 cmH2O) e da distância percorrida (de 349±67 para 448±75 metros). Com base nesses resultados conclui-se que o BiPAP® melhorou o desempenho muscular respiratorio e a tolerância ao exercicio fisico nesses pacientes com DPOC.

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial.

OBJECTIVE To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). METHODS Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 - new Chest Physical therapy- nCPT (Prolonged slow expiration - PSE and Clearance rhinopharyngeal retrograde - CRR), G2 - conventional Chest Physical therapy- cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 - aspiration of the upper airways. The outcomes of interest were the Wangs clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). RESULTS The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). CONCLUSION The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.

home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial

Introduction Pulmonary rehabilitation (PR) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving the functional capacity and quality of life, as well as maintaining the clinical stability of COPD sufferers. However, not all patients are available for such a program despite discomfort with their condition. The aim of this study was to evaluate the effects of a home-based PR (HBPR) program on functional ability, quality of life, and respiratory muscle strength and endurance. Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were randomized (double-blind) into two groups. One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group; the other group received only instructions to perform breathing and stretching exercises, characterizing it as the control group (CG). We assessed the following variables at baseline and 2 months: exercise tolerance (incremental shuttle walk test and upper limb test), respiratory muscle (strength and endurance test), and health-related quality of life (Airways Questionnaire 20). Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life. However, the intervention group had improved respiratory endurance compared with the CG, while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR. Conclusion A program of HBPR with biweekly supervision (although not enough to provide significant improvements in physical capacity or quality of life) played an important role in maintaining the stability of the clinical features of patients with COPD; the patients had no worsening of symptoms during the intervention period according to the daily log.