Mauricio Jamami

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.

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.

EFEITOS DE TRÊS PROGRAMAS DE FISIOTERAPIA RESPIRATÓRIA (PFR) EM PORTADORES DE DPOC

Effects of Three Respiratory Physical Therapy Programs on Patients with COPD Objective: To evaluate the effects of three respiratory physical therapy programs consisting of physical training on a treadmill and/or respiratory muscle training (RMT), on patients with COPD. Methods: Twenty-five patients of both sexes with moderateto-severe COPD were randomized into three groups: the first group (G1) underwent RMT at 30% of the maximal inspiratory pressure obtained each week; the second group (G2) underwent physical training at 70% of the heart rate achieved in the symptom-limited cardiorespiratory exercise test (CRET); and the third group (G3) underwent RMT together with physical training, at the same intensities mentioned above. All of the programs consisted of three sessions per week for six consecutive weeks. Results: Following treatment, significantly increased respiratory muscle strength was observed in G1. In G2, there was significantly increased walking distance and decreased heart rate and expiratory minute ventilation in CRET at the same velocity (isovelocity), and improvement in the functional capacity domain of the quality of life (QOL) questionnaire. In G3, there was significantly increased respiratory muscle strength, increased walking distance, decreased systolic arterial pressure and decreased blood lactate in CRET at the same velocity, and improvement in QOL. Conclusion: These findings suggest that physical training together with RMT was the best therapeutic alternative among the programs investigated in the present study. As well as providing an evident improvement in effort tolerance and QOL in the patients, it provided an additional effect regarding physiological adaptations to exercise with greater efficacy in clearance and/or lower production of blood lactate during effort.

Relationship of Bode Index to Functional Tests in Chronic Obstructive Pulmonary Disease

OBJECTIVE To determine if there is a correlation between the BODE Index and variables assessed during the Activities of Daily Living assessment, performance on lower limber tests, and peripheral muscle impairment of the upper limb in patients with chronic obstructive pulmonary disease. MATERIALS AND METHODS Ten men (aged 58 to 80 years old) with moderate to very severe obstruction were evaluated and classified by the BODE Index. They were evaluated by pulmonary ventilation (V̇E), oxygen consumption (V̇O2), and carbonic gas production (V̇CO2) on the ADL assessment; Distance Walking (DW) in the Six Minute Walking Test (6MWT) and the Six Minute Walking Test on Treadmill (6MWTT); number of repetitions in the Sit-to-Stand Test; and the Hand Grip Strength Test. Correlations were evaluated between the classification and the tests performed (Pearson and Spearman test, p<0.05). RESULTS The mean of the total score for the BODE Index was 2.80 (±1.03), with three patients scoring in the first quartile (Q1) and seven scoring in the second quartile (Q2). This Index showed a negative correlation with the 6MWTT (r=−0.86), the Sit-to-Stand Test (r=−0.66), and the Hand Grip Strength Test (r=−0.83). CONCLUSIONS Our results show that there is no correlation between the BODE Index and the ventilatory and metabolic responses in the Activities of Daily Living assessment. On the other hand, a correlation was observed between the BODE Index and the variables assessed in the 6MWTT, Sit-to-Stand Test, and Hand Grip Strength Test in moderate to very severe Chronic Obstructive Pulmonary Disease patients. This suggests that these tests can be employed as predictors of physical exercise capacity, perhaps as complementary tests to the BODE Index.

Responsividade do teste do degrau de seis minutos a um programa de treinamento físico em pacientes com DPOC

OBJECTIVE: To evaluate the responsiveness of the six-minute step test (6MST) to an aerobic physical training program (PTP) and to determine the efficacy of the PTP regarding spirometric variables during the 6MST, as well as physical performance, sensation of dyspnea, and SpO2 during the 6MST and the six-minute walk test (6MWT), in patients with COPD. METHODS: This was a controlled, prospective randomized study involving patients clinically diagnosed with COPD, with an FEV1/FVC ratio < 70%, and having been clinically stable in the last two months. The patients were randomized to undergo a PTP on a treadmill, three times a week, for six weeks (PTP group) or not (control group). Histories were taken from all of the patients, who received regular respiratory therapy during the study period, undergoing physical examination and spirometry before and after bronchodilator use; incremental symptom-limited cardiopulmonary exercise testing; the 6MST; and the 6MWT. RESULTS: Of the 36 patients that completed the study, 21 and 15 were in the PTP and control groups, respectively. In the PTP group, there was a significant increase in the number of steps climbed during the 6MST and in the six-minute walk distance (in m and % of predicted), as well as a significant decrease in the sensation of dyspnea during the 6MWT. CONCLUSIONS: The 6MST showed responsiveness to the PTP. However, the 6MWT appears to be more responsive to the PTP proposed.

Avaliação da capacidade de exercício em adolescentes asmáticos e saudáveis

Resumen pt: OBJETIVOS: Comparar o desempenho fisico e as respostas obtidas nos testes de caminhada de seis minutos (TC6) e do degrau de seis minutos (TD6) entre adol...

Teste do degrau e teste da cadeira: comportamento das respostas metábolo-ventilatórias e cardiovasculares na DPOC

OBJECTIVES: Verify the metabolic, ventilatory, cardiovascular and perceived effort responses between the isotime two minute step test (2MST) and six minute step test (6MST) with two minute sit-to-stand test (STST) in individuals with COPD. MATERIALS AND METHODS:11 men with COPD (71 ± 8 years, FEV1 = 46.1 ± 15.2% predicted), clinically stable, were evaluation by STST and 6MST associated gas analysis and blood lactate in days which were not consecutive and not coincidental. In the 6MST and 2MST, the subjects were instructed ascend-to-descend a step 20 cm in height as quickly as possible. It was recommended that in the STST was performed in a chair 46 cm high. RESULTS: In the inter-tests analysis, there was no significant difference in the metabolic, ventilatory, cardiovascular variables and delta of variation (Δ) dyspnea at the peak of both tests, and 2MST. The Δheart frequency and Δfatigue in the lower limbs were significantly higher compared to STST for 2MST. We observed moderate and strong positive correlations between oxygen consumption, Δheart frequency and performances in 2MST and 6MST, between performances in 6MST and STST, and 2MST with STST. CONCLUSION: The tests showed metabolic, ventilatory, cardiovascular and dyspnoea responses similar; and 2MST, can be alternative to assess the functional limitations of individuals with COPD severe obstruction, providing a lower cardiovascular stress and muscle fatigue compared to the STST, the peripheral metabolic requirements and postural adjustments.

Study of peripheral muscle strength and severity indexes in individuals with chronic obstructive pulmonary disease

BACKGROUND AND PURPOSE Individuals with chronic obstructive pulmonary disease (COPD) present reduced peripheral muscle strength, which leads to impaired mobility and increased mortality risk. However, it is not clear whether there is any relationship between muscle strength, muscle mass and the body mass index, airflow obstruction, dyspnea, exercise performance (BODE) index scale, which is considered to be the best predictor of survival for individuals with COPD. The BODE Index is a multidimensional system that measures body composition (B), airway obstruction (O), dyspnea perception (D) and the ability to exercise (E), and rates the severity of the major changes found in individuals with COPD. The objective of this study was to verify any relationship between the BODE Index, muscle mass and maximum muscle strengths of the upper limb (UL) and lower limb (LL) in subjects with moderate to very severe COPD. METHODS Twenty-six individuals with moderate to very severe COPD were evaluated by body composition (body mass index and muscle mass), BODE Index, handgrip strength (HS) and one repetition maximum (1RM) test of the UL and LL. RESULTS There was a positive correlation (Pearson, p < 0.05) of peripheral muscle strength, evaluated by HS and 1RM (pectoral and triceps, round muscles and dorsal section, quadriceps), to muscle mass (0.74, 0.57, 0.74 and 0.62, respectively) and the distance walked in the six-minute walking test (0.52, 0.50, 0.46 and 0.58, respectively), but no correlation of muscle strength was found to forced expiratory volume in one second to dyspnea or the BODE Index. CONCLUSION In accordance with the results of this study, peripheral muscle strength as measured by HS and 1RM is not related to the severity indexes for COPD, unlike UL and LL muscle strength. Therefore, UL and LL measurements now have an additional importance in COPD evaluation.

Lung function and six-minute walk test performance in individuals with sickle cell disease

Background Sickle Cell Disease (SCD), which is characterized by a mutation in the gene encoding beta hemoglobin, causes bodily dysfunctions such as impaired pulmonary function and reduced functional capacity. Objective To assess changes in pulmonary function and functional capacity in patients with SCD and to identify the relationships between these variables. Method We evaluated sociodemographic, anthropometric, lung function (spirometry), respiratory (manovacuometer), peripheral muscle strength (Handgrip strength - HS) and functional capacity (i.e., the six-minute walk test) parameters in 21 individuals with SCD (average age of 29±6 years). Shapiro-Wilk, paired Students, Wilcoxon, Pearson and Spearman correlation tests were used for statistical analyses, and the significance threshold was set at p<0.05. Results A total of 47.6% of the study subjects exhibited an altered ventilation pattern, 42.8% had a restrictive ventilatory pattern (RVP) and 4.8% exhibited a mixed ventilatory pattern (MVP). The observed maximal inspiratory pressure (MIP) values were below the predicted values for women (64 cmH2O), and the maximum expiratory pressure (MEP) values, HS values and distance walked during the 6MWT were below the predicted values for both men (103 cmH2O, 39 Kgf and 447 m, respectively) and women (64 cmH2O; 27 Kgf; 405 m, respectively). Positive correlations were observed between maximum voluntary ventilation (MVV) and MEP (r=0.4; p=0.046); MVV and BMI (r=0.6; p=0.003); and between HS and MIP (r=0.7; p=0.001), MEP (r=0.6; p=0.002), MVV (r=0.5; p=0.015), distance walked in the 6MWT (r=0.4; p=0.038) and BMI (r=0.6; p=0.004). Conclusions SCD promoted changes in lung function and functional capacity, including RVPs and a reduction in the distance walked in the 6MWT when compared to the predictions. In addition, significant correlations between the variables were observed.

Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease

AIM To verify the outcome of different physical therapy interventions in activities of daily living of individuals with chronic obstructive pulmonary disease (COPD). METHODS Twenty-two COPD individuals were randomly divided into three groups: the Lower Limb Training Group (LLTG, n=8) performed treadmill exercise, Upper Limb Training Group (ULTG, n=8) performed upper limb (UL) training, and Control Group (CG, n=6) underwent bronchial hygiene therapy for 6 weeks, three times per week. The following were simulated in the activities of the daily living test: blackboard erasing, weight lifting exercise, stair climbing and treadmill walking. The duration of these tasks was 5 min of blackboard erasing and weight lifting, and 6 min of stair climbing and treadmill walking. RESULTS Intragroup analysis presented a significant post-treatment ventilatory demand (V(E)/MVV) decrease for the LLTG during basal conditions and walking, and significant decrease during blackboard erasing and walking for the ULTG, with similar metabolic demand (VO(2)/VO(2)max) for both groups. Dyspnoea decreased significantly in the LLTG during post-treatment walking and increased for CG. The number of stairs climbed decreased significantly for the CG and increased for LLTG and ULTG post treatment, along with the walked distance for LLTG. The intergroup analysis presented significant differences in post-treatment dyspnoea with greater values observed for the CG during walking. CONCLUSION The different protocols utilized promoted benefits towards physical exercise tolerance, particularly in the ULTG that presented better performance in sustained UL tasks, which may suggest better conditioning and coordination of the muscles involved in UL elevation.