Raquel Calvo Gonçalves

Effects of Aerobic Training on Psychosocial Morbidity and Symptoms in Patients With Asthma A Randomized Clinical Trial

BACKGROUNDnAsthma symptoms reduce patients daily activities, impair their health-related quality of life (HRQoL), and increase their reports of anxiety and depression, all of which seem to be related to a decrease in asthma control. Aerobic exercise training is known to improve aerobic fitness and reduce dyspnea in asthmatics; however, its effect in reducing psychologic distress and symptoms remains poorly understood. We evaluated the role of an aerobic training program in improving HRQoL (primary aim) and reducing psychologic distress and asthma symptoms (secondary aims) for patients with moderate or severe persistent asthma.nnnMETHODSnA total of 101 patients were randomly assigned to either a control group or an aerobic training group and studied during the period between medical consultations. Control group patients (educational program plus breathing exercises) (n = 51) and training group patients (educational program plus breathing exercises plus aerobic training) (n = 50) were followed twice a week during a 3-month period. HRQoL and levels of anxiety and depression were quantified before and after treatment. Asthma symptoms were evaluated monthly.nnnRESULTSnAt 3 months, the domains (physical limitations, frequency of symptoms, and psychosocial) and total scores of HRQoL significantly improved only in the training group patients (P < .001); the number of asthma-symptom-free days and anxiety and depression levels also significantly improved in this group (P < .001). In addition, a linear relationship between improvement in aerobic capacity and the days without asthma symptoms was observed (r = 0.47; P < .01).nnnCONCLUSIONSnOur results suggest that aerobic training can play an important role in the clinical management of patients with persistent asthma. Further, they may be especially useful for patients with higher degrees of psychosocial distress.nnnTRIAL REGISTRATIONnclinicaltrials.gov; Identifier: NCT-00989365.

Assessment of muscle shortening and static posture in children with persistent asthma

Asthmatic patients experience an increase in airway resistance that overburdens both respiratory and non-respiratory muscles. The objective of the present study was to determine whether children with persistent asthma present muscle shortening and postural changes. The 60 boys evaluated, aged 7–12 (pubertal ages up to Tanner stage G2) were divided into three age- and BMI-matched groups of equal number: CON (no history of asthma or allergy); MPA (mild persistent asthma); SPA (severe persistent asthma). Pulmonary function, muscle shortening and static posture were evaluated. The SPA group presented higher protraction of the head and shoulder compared with the CON group [9.5 (6.0–12.0) degrees vs 5.5 (0.0–12.0) degrees, Pu2009<u20090.05; 0.89 (0.80–0.94) anterior/posterior ratio vs 0.94 (0.87–1.1) anterior/posterior ratio, Pu2009<u20090.01)]. Severe asthmatic patients also presented shortening of arm flexor and posterior muscle of the thigh compared with the CON group [18.0 (10.0–24.0) degrees vs 12.0 (6.0–16.0) degrees, Pu2009<u20090.05; and 16.5 (10.0–38.5) cm vs 8.0 (0.0–21.0) cm, respectively, Pu2009<u20090.05]. Chest expansion at axillar and xiphoid levels were limited in SPA subjects compared with CON subjects [3.7 (1.5–6.5) cm vs 5.5 (2.0–8.0) cm and 4.7 (1.5–6.5) vs 6.0 (3.5–8.0) cm, respectively, Pu2009<u20090.01]. SPA subjects also presented a higher incidence of lumbar spine straightening compared with CON and MPA subjects. Moderate asthmatic subjects presented intermediate values compared with severe and control subjects in five out nine evaluated outcomes. Our data suggest that severe asthmatic children present postural adaptations and muscle shortening that seem to be related to disease severity.

Efeito de um programa de condicionamento físico aeróbio nos aspectos psicossociais, na qualidade de vida, nos sintomas e no óxido nítrico exalado de portadores de asma persistente moderada ou grave

OBJECTIVE: To evaluate the role of an aerobic physical training program on psychosocial characteristics, quality of life, symptoms and exhaled nitric oxide of adults with moderate or severe persistent asthma. METHODS: Twenty patients were randomly assigned to a Control Group (CG, n= 10, education program and respiratory exercises) and a Trained Group (TG, n= 10, education program and respiratory exercises plus aerobic training at 70% of the maximum power obtained). The intervention took place twice a week for three months. Maximum aerobic capacity, pulmonary function, effort dyspnea, anxiety levels, depression levels and quality of life were assessed before and after the treatment. Exhaled nitric oxide at rest and the number of days without asthma symptoms were evaluated every month. RESULTS: The TG presented increased numbers of symptom-free days (TG 24.8 days [95%CI= 23-27] versus CG 15.7 days [95%CI= 9-21]; p< 0.05), decreased exhaled nitric oxide levels (TG 25.8 ppb [95%CI=xa015.3-44.0] versus CG 44.3 ppb [95%CI= 24-60]; p< 0.05), decreased anxiety scores (TG 39.3 [95%CI= 37-50] versus CG 40.9 [95%CI=xa037-50]; p< 0.001), decreased depression scores (TG 6.6 [95%CI= 1-21] versus CG 9 [95%CI= 1-20]; p< 0.001), improved quality of life (TG 42.8% [95%CI=xa034.3-71.7] versus CG 69.6% [95%CI= 45.1-87.9]; p< 0.001) and improved aerobic aptitude (TG 25.7 mL/kg/min [95%CI=xa06.2-31.3] versus CG 20.5 mL/kg/min [95%CI= 17.3-24.1]; p< 0.001). CONCLUSIONS: Our results suggest that physical training reduces exhaled nitric oxide and symptoms and improves the quality of life and psychosocial characteristics of adults with moderate or severe persistent asthma.

Frequência de sintomas de asma e de redução da função pulmonar entre crianças e adolescentes nadadores amadores

OBJECTIVEnTo investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil.nnnMETHODSnThe study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest.nnnRESULTSnThe overall incidence of asthma symptoms (ISAAC score > 6) among the swimmers was 16.8%. Of the 119 swimmers submitted to spirometry, 39 (32.7%) presented spirometric alterations (FEV1/FVC < 0.75). Among those with an ISAAC score > 6, there were 10 (31.2%) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24% made use of bronchodilators but not of corticosteroids.nnnCONCLUSIONSnThe incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.

A game for robot operation training in search and rescue missions

Search and rescue (SAR) teams often face several complex and dangerous tasks, which could be aided by unmanned robotic vehicles (UV). UV agents can potentially be used to decrease the risk in the loss of lives both of the rescuers and victims and aid in the search and transportation of survivors and in the removal of debris in a catastrophe scenario. Depending on the nature of a catastrophe and its geographical location, there are potentially three types of UVs that can be deployed: aerial, surface and ground. Due to the control and manipulation particularities each type of UV contemplates, their operators need prior training and certification. To train and certify the operators a tool (serious game) is under development. In this paper we will make an overview about our approach in its development. This game uses a typical client-server architecture where all client agents (virtual UVs and operator client interfaces) share the same immersive virtual environment which is generated through the merging of GIS data and a semantic model extracted from 3D laser data. There will be several types of scenarios suitable to several types of catastrophe situations. Each of these scenarios has its own mission plan for the trainees to follow. The game will also provide an interface for mission planning so that each mission plan will be carefully designed to accurately correspond to a matrix of skills. This matrix lists a set of common skills in various different UV operational case studies which will allow the certification of operators.

Efeito do tratamento clínico de um corredor de longa distância com broncoespasmo induzido pelo exercício: relato de caso

Exercise induced bronchoconstriction (EIB) is characterized by a transient airway constriction during or after vigorous physical activity. This clinical condition is more prevalent in asthmatic patients. The prevalence of EIB in competitive athletes is high; however, EIB is under-diagnosed in this specific athlete population. The present study described a case report of a male 23 year-old long distance runner who, despite not presenting previous asthma history, presented chest squeak and decline on spirometric performance after a cardiopulmonary exercise testing. After specific testing, the athlete was diagnosed as positive EIB. A clinical treatment with bronchodilator was then initiated and after 30 days an important increase in his oxygen uptake peak (VO2peak) was observed.