Rejane Agnelo Silva de Castro

Effects of a pulmonary rehabilitation program on physical capacity, peripheral muscle function and inflammatory markers in asthmatic children and adolescents: study protocol for a randomized controlled trial

BackgroundIndividuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease.The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program.MethodThis is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 μcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers.Trial registrationClinical Trial Number: NCT02383069. Data of registration: 03/03/2015

Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis

BackgroundnBronchiectasis is characterized by a progressive structural lung damage, recurrent infections and chronic inflammation which compromise the exertion tolerance, and may have an impact on skeletal muscle function and physical function.nnnObjectivenThe purpose of this study was to compare peripheral muscle strength, exercise capacity, and physical activity in daily life between participants with bronchiectasis and controls and to investigate the determinants of the peripheral muscle strength and physical activity in daily life in bronchiectasis.nnnDesignnThis study used a cross-sectional design.nnnMethodsnThe participants quadriceps femoris and biceps brachii muscle strength was measured. They performed the incremental shuttle walk test (ISWT) and cardiopulmonary exercise testing, and the number of steps/day was measured by a pedometer.nnnResultsnParticipants had reduced quadriceps femoris muscle strength (mean difference to control groupxa0=xa07 kg, 95% CIxa0=xa03.8-10.1 kg), biceps brachii muscle strength (2.1 kg, 95% CIxa0=xa00.7-3.4 kg), ISWT (227 m, 95% CIxa0=xa0174-281 m), peak VO2 (6.4 ml/Kg/min, 95% CIxa0=xa04.0-8.7 ml/Kg/min), and number of steps/day (3,332 steps/day, 95% CIxa0=xa01,758-4,890 steps/day). A lower quadriceps femoris strength is independently associated to an older age, female sex, lower body mass index (BMI), higher score on the modified Medical Research Council scale, and shorter distance on the ISWT (R2xa0=xa00.449). Biceps brachii strength is independently associated with sex, BMI, and dyspnea (R2xa0=xa00.447). The determinants of number of daily steps were dyspnea and distance walked in ISWT, explaining only 27.7% of its variance.nnnLimitationsnNumber of steps per day was evaluated by a pedometer.nnnConclusionsnPeople with bronchiectasis have reduced peripheral muscle strength, and reduced aerobic and functional capacities, and they also are less active in daily life. Modifiable variables such as BMI, dyspnea, and distance walked on the ISWT are associated with peripheral muscle strength and physical activity in daily life.

Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care?

Highlights • Home-based pulmonary rehabilitation (HBPR) has been used in several chronic pulmonary obstructive diseases.• HBPR has never been investigated in patients with bronchiectasis.• Short- and long-term effects of HBPR will be investigated in this population.• The study will provide evidence to guide recommendations about HBPR for bronchiectasis.

Reduced Physical Activity With Bronchiectasis

BACKGROUND: Bronchiectasis leads to reduced functional capacity, which might have implications for physical activity. The impact of dyspnea and long-term oxygen therapy on physical activity has never been investigated in subjects with bronchiectasis. Based on these findings, specific strategies could be applied to allow individuals to be more active in their daily life. In this study we aimed to evaluate physical activity, the impact of dyspnea and long-term oxygen therapy on physical activity, and the determinants of physical activity in subjects with bronchiectasis. METHODS: We performed a cross-sectional study in 139 subjects with bronchiectasis (age 45 ± 13 y, FVC 70 ± 22% of predicted, FEV1 54 ± 25% of predicted) and 49 healthy subjects as controls. Physical activity was assessed using steps per day (measured with a pedometer), spirometry, incremental shuttle walking test (ISWT), and dyspnea. RESULTS: Reduced physical activity was observed in subjects with bronchiectasis, who recorded a median (interquartile range) of 8,007 (5,131–10,432) steps/d compared with controls, who recorded 10,994 (8,551–14,078) steps/d (P < .001). Significant correlations were observed between physical activity and FVC (r = 0.43), FEV1 (r = 0.36), ISWT (r = 0.37), and dyspnea (r = −0.48). Determinants for reduced physical activity included pulmonary function (R2 = 0.150), dyspnea (R2 = 0.075), ISWT (R2 = 0.044), and long-term oxygen therapy (R2 = 0.038); these factors explained 32% of the physical activity. CONCLUSION: Subjects with bronchiectasis exhibited reduced physical activity compared with healthy peers. Dyspnea has a negative impact on physical activity. Independent factors associated with physical activity included pulmonary function, dyspnea, functional capacity, and long-term oxygen therapy. These findings will guide strategies to enhance daily physical activity and to encourage subjects with bronchiectasis to be more active.

Incremental Shuttle Walk Test to Assess and Prescribe Exercise for Subjects With Bronchiectasis: Hallway Versus Treadmill

INTRODUCTION: The incremental shuttle walk test was initially developed to be carried out in a hallway (ISWT-H) but has been modified to be performed on a treadmill (ISWT-T). However, it is still unknown whether performance on ISWT-H and ISWT-T are similar in patients with bronchiectasis. In this study, we compared the performance, physiological responses, and perception of effort between the ISWT-T with a handrail and ISWT-H for subjects with bronchiectasis. We also sought to estimate and compare the prescription for training intensity with both tests. METHODS: This was a cross-sectional study in which 24 subjects with bronchiectasis were evaluated on 2 different days (24 h apart). Distance walked (m) was compared between the ISWT-H and ISWT-T. A training session was held on a treadmill at 75% of the speed obtained from both tests. The walking distance, oxygen uptake (V̇O2), carbon dioxide production (V̇CO2), heart rate, and ventilation (V̇E) were measured. RESULTS: There was a difference in the walking distance between the ISWT-T and ISWT-H, but physiological responses for V̇O2, V̇CO2, heart rate, and V̇E were similar. However, the speed estimated for training was different, as were the V̇O2, V̇CO2, and heart rate. CONCLUSIONS: The ISWT-T with handrail and the ISWT-H are not interchangeable in subjects with bronchiectasis. A slower speed of training intensity may occur when the test is performed in a hallway, as originally described, and this may underestimate responses to aerobic training

Are shuttle walk tests on a treadmill and in a corridor with patients with COPD interchangeable

Introduction: A percentage of the speed reached in the incremental shuttle walk test performed in corridor (SWT-C) has been used to set the speed of aerobic training on treadmill for patients with COPD. A question arises: is there a difference in the speed achieved in the SWT-C and the shuttle walk test on a treadmill (SWT-T)? If so, these differences could under or overestimate training intensity. Objective: To compare the speed and the cardiopulmonary responses between the SWT-C and SWT-T. Method: Twenty patients (65±7 years, FEV 1 55 ± 17% % pred) underwent a SWT-C and a SWT-T on different days in a randomized order. Pulmonary gas exchange, heart rate (HR) and SpO 2 were continuously measured during the tests. Dyspnea and fatigue were recorded at the beginning and end of the tests. Results: The speed and distance walked were higher in the SWT-T (2.3 mph [2.0 – 2.6] and 435±167 m, respectively) than in the SWT-C (2.1 mph [1.8 – 2.3] and 354±156 m, respectively); p = 0.03 for speed and p = 0.001 for distance walked. There was no difference between peak VO 2 in the SWT-T and SWT-C (87.0 ± 23.0% pred vs . 81.2 ± 20.3 % pred) and HR (78 ± 12%pred vs . 80 ± 11% pred). Dyspnea and fatigue were similar in both tests. Considering an aerobic training session based on 60% of the speed achieved on a SWT, the speed would be lower when using that obtained from the SWT-C than SWT-T (1.2 [1.1 – 1.4] vs 1.4 [1.2 – 1.5]), p Conclusion: Exercise prescriptions based on the velocity obtained from the SWT-C underestimate the intensity of aerobic training. When aerobic training on the treadmill is based on the speed of the SWT, we suggest that the SWT is carried out on the treadmill.