Mahara Proença

Reduction of physical activity in daily life and its determinants in smokers without airflow obstruction

In smokers without airflow obstruction, detailed, objective and controlled quantification of the level of physical inactivity in daily life has never been performed. This study aimed to objectively assess the level of physical activity in daily life in adult smokers without airflow obstruction in comparison with matched non‐smokers, and to investigate the determinants for daily physical activity in smokers.

Minimal detectable change of the London chest activity of daily living scale in patients with COPD.

BACKGROUND: Dyspnea and fatigue frequently impair the ability to perform activities of daily living (ADL) in patients with chronic obstructive pulmonary disease. Questionnaires and scales have been used to assess limitations in ADL. The London Chest Activity of Daily Living (LCADL) scale is responsive to intervention to a higher extent when compared with other tools. However, the minimal detectable change (MDC) for this scale remains unknown. The aim of this study was to determine the MDC for functional status improvement measured by the LCADL scale in patients with chronic obstructive pulmonary disease. METHODS: Forty patients (20 men, 66 ± 7 years, forced expired volume in 1 second 44 ± 16% predicted) participated in a 3-month high-intensity exercise training program. Before and after the protocol, participants complete the LCADL scale and the Saint George Respiratory Questionnaire. To calculate the MDC, we used the standard error of measurement and the effect size (distribution-based estimates). RESULTS: There was improvement in the LCADL self-care, domestic and leisure domains, and total score after the training program, with a strong trend for improvement in the physical activity domain. The MDC estimated for the LCADL were 0.89, 2.60, 0.44, 0.58, and 3.88 points for self-care, domestic, physical, and leisure domains, and total score, respectively. Correlations between changes in LCADL and in the Saint George Respiratory Questionnaire were weak (r < 0.4 for all). CONCLUSION: This study provided the MDC for the domains and total score of the LCADL. A change of 4 points in the total score of the LCADL can be interpreted as a meaningful change.

Comparison of two strategies using pedometers to counteract physical inactivity in smokers.

INTRODUCTION This randomized crossover trial aimed to compare the effects of 2 different protocols using pedometers and informative booklets to increase physical activity in daily life (PADL) in smokers. METHODS PADL level was assessed at baseline (A1), and subjects were randomly assigned to 2 groups for a month: booklet + pedometer (GB + P; n = 13), which started the protocol receiving a booklet with encouragement to walk as much as possible in everyday life; pedometer + booklet (GP + B; n = 18), which started the protocol wearing a pedometer aiming to achieve 10,000 steps/day. PADL was reassessed (A2), and the interventions were crossed over for 1 month, followed by PADL reassessment (A3). After A3, both groups used pedometers for 3 months aiming to reach 10,000 steps/day, and final PADL assessment was performed (A4). For the analysis, each group was subdivided according to baseline PADL as physically active or inactive, according to having reached or not reached 10,000 steps/day at baseline. RESULTS The physically active subgroups of GB + P and GP + B showed no change in steps/day. The physically inactive subgroup of GP + B significantly increased steps/day at A2 and maintained this increase until A4. The physically inactive subgroup of GB + P initially increased to a lesser extent, reaching borderline statistical significance at A2 and A3 (p = .06) and statistically significant increase only at A4 (p = .02). CONCLUSIONS Both strategies were effective in increasing the number of steps/day in physically inactive smokers after 5 months, although the increase was more quickly obtained in smokers who used pedometers as the first intervention.

Long-term Effects of a Program to Increase Physical Activity in Smokers

BACKGROUND Programs aimed at increasing physical activity in daily life (PADL) have generated growing interest to prevent the deleterious effects of physical inactivity. Recent literature has shown that a short-term protocol using pedometers increased PADL in smokers with normal lung function. However, the long-term effects of such a protocol were not yet studied. The objective of this study was to evaluate the results of 1-year follow-up after a program aimed at increasing PADL in smokers with normal lung function. METHODS Twenty-four smokers were followed (15 men; mean [interquartile range (IQR)], 51 [41-57] years of age; BMI, 26 [22-29] kg/m2; 20 [20-30] cigarettes/d). Subjects were assessed at baseline, immediately after completion of the program, and 1 year later for PADL, lung function, 6-min walking distance (6MWD), smoking habits, quality of life, anxiety, and depression. The 5-month program used pedometers and informative booklets as interventions. RESULTS The gains achieved after the program were maintained in the long term: steps/d (postprogram vs 1-year follow-up, mean [IQR]: 10,572 [9,804-12,237] vs 10,438 [9,151-12,862]); 6MWD (625 [530-694] m, 88 [81-97] % predicted vs 609 [539-694] m, 89 [81-96] % predicted), anxiety (34 [26-41] points vs 35 [36-47] points) and depression (6 [2-9] points vs 5 [2-11] points) (P > .05 for all). One year after the program, 20% of the subjects had quit smoking. CONCLUSIONS In smokers with normal lung function, improvements in daily physical activity, exercise capacity, anxiety, and depression obtained through a 5-month program aimed at increasing physical activity are sustained 1 year after completion of the program. Furthermore, such a program can contribute to smoking cessation in this population.