Renata Pedrolongo Basso-Vanelli

Limitation of Activities of Daily Living and Quality of Life Based on COPD Combined Classification

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 update recommends that the management and treatment of COPD be made to combine the impact of disease and future risk of exacerbation. These patients have worsening quality of life and limitation of activities of daily living (ADLs), which can be manifested as a decrease in SpO2 and progressive dyspnea. The aim of this study was to determine whether the COPD combined classification proposed by GOLD 2011 is able to differentiate patients with ADL limitation, such as oxygen desaturation or dyspnea, and impaired quality of life. METHODS: This was an observational, cross-sectional study. Forty-four subjects were categorized in 4 GOLD groups (A–D). The mean age was 69 ± 8.8 y, with FEV1 of 1.33 ± 0.53 L (49 ± 15.7% of predicted). The Modified Medical Research Council dyspnea and London Chest Activity of Daily Living (LCADL) scales and the St George Respiratory Questionnaire (SGRQ) were applied. The 6-min walk test and ADL simulation in an appropriate laboratory were also conducted. RESULTS: There was no association between the COPD combined evaluation groups and the presence of oxygen desaturation and dyspnea (chi-square test), although a higher prevalence of oxygen desaturation was noticed in group D subjects. With regard to dyspnea, there were subjects with dyspnea in all groups when ADLs were performed. No correlation between dyspnea and oxygen desaturation variation was found. Group B and D subjects showed higher ADL dyspnea (total LCADL scores of 28% and 30%) compared with group A subjects. Group D subjects showed poorer quality of life (total SGRQ score of 49.3%) compared with less symptomatic groups. CONCLUSIONS: The COPD combined classification was not efficient in determining oxygen desaturation and dyspnea while subjects were performing ADLs. The subjects in the symptomatic groups with increased risk of exacerbation showed poorer quality of life and higher dyspnea levels. (ClinicalTrials.gov registration NCT01977469)

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness.

BACKGROUND: Patients with COPD may experience respiratory muscle weakness. Two therapeutic approaches to the respiratory muscles are inspiratory muscle training and calisthenics-and-breathing exercises. The aims of the study are to compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion. In addition, these gains were compared between subjects with and without respiratory muscle weakness. METHODS: 25 subjects completed the study: 13 composed the inspiratory muscle training group, and 12 composed the calisthenics-and-breathing exercises group. Subjects were assessed before and after training by spirometry, measurements of respiratory muscle strength and test of inspiratory muscle endurance, thoracoabdominal excursion measurements, and the 6-min walk test. Moreover, scores for the Modified Medical Research Council dyspnea scale were reported. RESULTS: After intervention, there was a significant improvement in both groups of respiratory muscle strength and endurance, thoracoabdominal mobility, and walking distance in the 6-min walk test. Additionally, there was a decrease of dyspnea in the 6-min walk test peak. A difference was found between groups, with higher values of respiratory muscle strength and thoracoabdominal mobility and lower values of dyspnea in the 6-min walk test peak and the Modified Medical Research Council dyspnea scale in the inspiratory muscle training group. In the inspiratory muscle training group, subjects with respiratory muscle weakness had greater gains in inspiratory muscle strength and endurance. CONCLUSIONS: Both interventions increased exercise capacity and decreased dyspnea during physical effort. However, inspiratory muscle training was more effective in increasing inspiratory muscle strength and endurance, which could result in a decreased sensation of dyspnea. In addition, subjects with respiratory muscle weakness that performed inspiratory muscle training had higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity. (ClinicalTrials.gov registration NCT01510041.)

Metabolic syndrome impact on cardiac autonomic modulation and exercise capacity in obese adults

Obesity is often associated with increased risk of cardiometabolic morbidities and mortality. However, evidence shows that some obese individuals are more likely to develop such risk factors early in life, including those with Metabolic Syndrome (MetS). Whether the presence of MetS in obese people impairs cardiac autonomic modulation (CAM) remains to be investigated. METHODS Cross-sectional study. Sixty-six subjects were classified as normal-weight (NW, n = 24) or obese (BMI ≥ 30 kg·m-2): metabolically healthy (MHO, n = 19) vs unhealthy (MUHO, n = 23: NCEP/ATPIII-MetS criteria). Body composition (bioimpedance), metabolic (glucose-insulin/lipid) and inflammatory profiles were determined. Linear and nonlinear heart rate variability (HRV) indices were computed at rest and during the submaximal six-minute step test (6MST). Blood pressure (BP) and metabolic and ventilatory variables were assessed (oxygen uptake, VO2; carbon dioxide production, VCO2; minute ventilation, VE) during the 6MST and the maximal cardiopulmonary exercise testing (CPX). RESULTS All groups reached the same 6MST intensity (VO2 ~ 80% and HR ~ 87% of CPX peak values). Both obese groups, independently of MetS, presented higher BP and lower maximal VO2 than NW. However, HRV differed between groups according to MetS at rest and during exercise: MUHO had lower meanRRi and SD1 than NW and lower RMSSD and pNN50 than MHO at rest; during exercise, the lowest SDNN, TINN, SD1 and Shannon entropy were observed for MUHO. Significant correlations were found between MetS, insulin resistance and HRV indices; and between insulin resistance and aerobic capacity (VO2peak). CONCLUSION Obesity per se impairs aerobic-hemodynamic responses to exercise. However, MetS in obese young adults negatively impacts overall HRV, parasympathetic activity and HRV complexity.

Myostatin and adipokines: The role of the metabolically unhealthy obese phenotype in muscle function and aerobic capacity in young adults

HighlightsMyostatin is related to Metabolic Syndrome, hypertrophy and inflammation in humans.Adipokines are related to body fatness and aerobic capacity.Myostatin and adipokines are not associated with energy expenditure and muscle function.Myostatin and adipokines cutoffs can identify metabolically unhealthy obesity. &NA; Obesity is often associated with metabolic disorders. However, some obese people can present a metabolically healthy phenotype, despite having excessive body fat. Obesity‐related cytokines, such as myostatin (MSTN), leptin (LP) and adiponectin (ADP) appear to be key factors for the regulation of muscle and energy metabolism. Our aim was to compare lipid, glucose‐insulin and inflammatory (tumor necrosis factor alpha; TNF‐&agr;) profiles, muscle function, energy expenditure and aerobic capacity between healthy normal‐weight (NW) adults, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) adults; to study the associations between these outcomes and the cytokines MSTN, ADP, LP; and to establish cutoffs for MSTN and LP/ADP to identify the MUHO phenotype. Sixty‐one young adults (NW, n = 24; MHO, n = 16; MUHO, n = 21) underwent body composition (body fat ‐BF and muscle mass ‐ MM), energy expenditure at rest (RER) and aerobic capacity (VO2peak) evaluation, muscle strength and endurance tests and blood profile characterization (glucose‐insulin homeostasis and serum MSTN, ADP, LP and TNF‐&agr;). MHO and MUHO had a BMI ≥ 30 kg m−2. MUHO was defined as presenting ≥3 criteria for metabolic syndrome (NCEP/ATPIII) in association with insulin resistance (HOMA‐IR ≥3.46). MSTN and LP/ADP were associated with MM, MetS and glucose‐insulin profile; MSTN was associated with TNF‐&agr; and only LP/ADP was associated with parameters of obesity and VO2peak. Neither MSTN nor LP/ADP was associated with muscle functions (p < .05 for adjusted correlations). Both of them were able to discriminate the MUHO phenotype: MSTN [AUC(95%CI) = 0.71(0.55–0.86), MSTN > 517.3 pg/mL] and LP/ADP [AUC(95%CI) = 0.89(0.81–0.97), LP/ADP > 2.14 pg/ng]. In conclusion, high MSTN and LP/ADP are associated with MetS, glucose‐insulin homeostasis impairment and low muscle mass. Myostatin is associated with TNF‐&agr; and leptin‐to‐adiponectin ratio is associated with body fatness and aerobic capacity. Neither MSTN nor LP/ADP is associated with energy expenditure, muscle strength and endurance. Myostatin and adipokines cutoffs can identify the metabolically unhealthy obese phenotype in young adults with acceptable accuracy.

Chronic obstructive pulmonary disease Assessment Test in assessing of patients with chronic obstructive pulmonary disease: there is a relationship with activities of daily living and mortality predictor index? A cross-sectional study

O objetivo do estudo foi investigar se ha relacao entre o impacto da Doenca Pulmonar Obstrutiva Cronica (DPOC) no estado de saude com o nivel de dispneia nas atividades de vida diaria (AVD) e o indice preditor de mortalidade em pacientes em reabilitacao pulmonar (RP). Trata-se de um estudo transversal, em que foram avaliados 32 pacientes com DPOC moderada a muito grave (23 homens; 66,6±12,0 anos; VEF1: 40,6±15,6% previsto) por meio do COPD Assessment Test (CAT), Indice de Massa Corporea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Indice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlacoes positivas moderadas do CAT com o questionario mMRC (r=0,35; p=0,048), a pontuacao total da LCADL (r=0,60; p<0,001) e com a porcentagem da pontuacao total da LCADL (r=0,57; p=0,001). Apenas a pontuacao total da LCADL e capaz de predizer independentemente a pontuacao do questionario CAT (p<0,05; r2=0,61). Nao foram constatadas correlacoes significativas entre o CAT e o Indice BODE, IMC, TC6 e VEF1. Dessa forma, quanto maior o nivel de dispneia nas AVD, maior o impacto da DPOC no estado de saude do paciente, entretanto, o mesmo nao ocorre em relacao ao prognostico de mortalidade nos pacientes com DPOC em RP.Correspondence to: Julia Gianjoppe-Santos – Rua Episcopal, 2474, apto 172 A – CEP: 13560–049 – Sao Carlos (SP), Brazil – E-mail: juliagianjoppe@gmail.com Presentation: Jun. 2013 – Accepted for publication: Nov. 2013 – Financing source: National Counsel of Technological and Scientific Development” (CNPq) – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 174.730. ABSTRACT | The aim of this study was to investigate if there is a relationship between the impact of Chronic Obstructive Pulmonary Disease (COPD) on health status and the level of dyspnea in Activities of Daily Living (ADL) and the mortality predictor index in patients undergoing Pulmonary Rehabilitation (PR). It is a cross-sectional study in which 32 patients with moderate to very severe COPD (23 men; 66.6±12.0 years; FEV 1 : 40.6±15.6% predicted) were assessed by: COPD Assessment Test (CAT), Body Mass Index (BMI), six-Minute Walking Test (6MWT), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) and BODE Index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). The CAT score presented moderate correlation with the mMRC questionnaire (r=0.35; p=0.048), total score of LCADL (r=0.60; p<0.001) and total score LCADL percentage (r=0.57; p=0.001). Only the total score of LCADL is able to predict the CAT questionnaire scores (p<0.05; r2=0.61). There were no significant correlations between CAT and BODE index, BMI, FEV 1 and 6MWT. Thus, the Chronic Obstructive Pulmonary Disease Assessment Test in assessing of patients with chronic obstructive pulmonary disease: there is a relationship with activities of daily living and mortality predictor index? a cross-sectional study Chronic Obstructive Pulmonary Disease Assessment Test na avaliacao de pacientes com doenca pulmonar obstrutiva cronica em reabilitacao pulmonar: ha relacao com nivel de dispneia nas atividades de vida diaria e com indice preditor de mortalidade? estudo transversal Chronic Obstructive Pulmonary Disease Assessment Test en la evaluacion de pacientes con enfermedad pulmonar obstructiva cronica en rehabilitacion pulmonar: ?Hay relacion con el nivel de disnea en las actividades de la vida diaria y con el indice predictor de mortalidad? Estudio transversal Julia Gianjoppe-Santos, Samantha Maria Nyssen, Bruna Varanda Pessoa, Renata Pedrolongo Basso-Vanelli, Mauricio Jamami, Valeria Amorim Pires Di Lorenzo

Improvement in lung function and functional capacity in morbidly obese women subjected to bariatric surgery

OBJECTIVE: To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics. METHODS: Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery. RESULTS: Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes. CONCLUSION: The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.

Comparison of diaphragmatic motion measured by M-mode sonography between different classes of obesity

Background: obesity can affect the respiratory system (RS) resulting in a lower tidal volume, decreased functional residual capacity, higher respiratory rate, low strength and endurance of the respiratory muscles and high levels of fatigue. However, little is known about the mobility of the diaphragm (MD) in this population. Aims : the aim of this study was to compare MD measured by M-mode ultrasonography between different classes of obesity. Methods : 20 obese (7 men/13 women) completed thestudy: 6 were classified as classII (45±11.3 years; BMI: 38.1±1.6 kg/m 2 ) and 14 as class III (41.4±7.1 years; BMI: 46.5±4.8 kg/m 2 ). Right MD was measured by ultrasonographic images by M-mode during quiet (QB) and deep breathing (DB). Results: Right MD during QB and DB were significantly (p Conclusion : morbidly obese negatively impact on MD. Strategies to increase MD and thus reduce RS alterations may be implemented in future studies. Supported by Capes/PNPD .

Inspiratory muscle training improves thoracoabdominal asynchronism during unsupported upper limb exercise in COPD patients – Pilot study

Background: Chronic Obstructive Pulmonary Disease (COPD) resulting in alterations which leads to thoracoabdominal asynchronism (TA) mainly during daily life activities. However, there is no scientific evidence that the inspiratory muscle training(IMT) associated with the physical training (PT) could improve the TA of COPD. Aims: to verify whether theIMT-PTcan improve theTA and dyspnea at rest and during unsupported upper limb (UUL) exercises and compare with PT alone (GPT). Methods: Sixteen patients with COPD were divided into two groups: 9 in IMT-PT and 7 in the PT group. IMT was composed by breathing exercises (BE) in IMT trainer, 3 times a week, during 16 weeks and PT consisted of aerobic+calisthenics-and-BE.Patients were assessed on baseline and after intervention by respiratory inductance plethysmography to evaluate TA at rest and during UUL exercises (1: shoulder flexion until 90°; 2: until 180°) in the stand posture. Results: Only IMT-PT showed significant reduction of TA and dyspnea (IMT-PT: pre 0.75(0-2)/ post 0(0-0); p Conclusion: the IMT+PT can beneficially modulate TA at rest and during UUL exercises. Recommendations of IMT may provide helpful tool to enhance TA. Supported by Capes.

Chronic obstructive pulmonary disease Assessment Test na avaliação de pacientes com doença pulmonar obstrutiva crônica em reabilitação pulmonar: há relação com nível de dispneia nas atividades de vida diária e com índice preditor de mortalidade? Estudo transversal

O objetivo do estudo foi investigar se ha relacao entre o impacto da Doenca Pulmonar Obstrutiva Cronica (DPOC) no estado de saude com o nivel de dispneia nas atividades de vida diaria (AVD) e o indice preditor de mortalidade em pacientes em reabilitacao pulmonar (RP). Trata-se de um estudo transversal, em que foram avaliados 32 pacientes com DPOC moderada a muito grave (23 homens; 66,6±12,0 anos; VEF1: 40,6±15,6% previsto) por meio do COPD Assessment Test (CAT), Indice de Massa Corporea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Indice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlacoes positivas moderadas do CAT com o questionario mMRC (r=0,35; p=0,048), a pontuacao total da LCADL (r=0,60; p<0,001) e com a porcentagem da pontuacao total da LCADL (r=0,57; p=0,001). Apenas a pontuacao total da LCADL e capaz de predizer independentemente a pontuacao do questionario CAT (p<0,05; r2=0,61). Nao foram constatadas correlacoes significativas entre o CAT e o Indice BODE, IMC, TC6 e VEF1. Dessa forma, quanto maior o nivel de dispneia nas AVD, maior o impacto da DPOC no estado de saude do paciente, entretanto, o mesmo nao ocorre em relacao ao prognostico de mortalidade nos pacientes com DPOC em RP.Correspondence to: Julia Gianjoppe-Santos – Rua Episcopal, 2474, apto 172 A – CEP: 13560–049 – Sao Carlos (SP), Brazil – E-mail: juliagianjoppe@gmail.com Presentation: Jun. 2013 – Accepted for publication: Nov. 2013 – Financing source: National Counsel of Technological and Scientific Development” (CNPq) – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 174.730. ABSTRACT | The aim of this study was to investigate if there is a relationship between the impact of Chronic Obstructive Pulmonary Disease (COPD) on health status and the level of dyspnea in Activities of Daily Living (ADL) and the mortality predictor index in patients undergoing Pulmonary Rehabilitation (PR). It is a cross-sectional study in which 32 patients with moderate to very severe COPD (23 men; 66.6±12.0 years; FEV 1 : 40.6±15.6% predicted) were assessed by: COPD Assessment Test (CAT), Body Mass Index (BMI), six-Minute Walking Test (6MWT), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) and BODE Index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). The CAT score presented moderate correlation with the mMRC questionnaire (r=0.35; p=0.048), total score of LCADL (r=0.60; p<0.001) and total score LCADL percentage (r=0.57; p=0.001). Only the total score of LCADL is able to predict the CAT questionnaire scores (p<0.05; r2=0.61). There were no significant correlations between CAT and BODE index, BMI, FEV 1 and 6MWT. Thus, the Chronic Obstructive Pulmonary Disease Assessment Test in assessing of patients with chronic obstructive pulmonary disease: there is a relationship with activities of daily living and mortality predictor index? a cross-sectional study Chronic Obstructive Pulmonary Disease Assessment Test na avaliacao de pacientes com doenca pulmonar obstrutiva cronica em reabilitacao pulmonar: ha relacao com nivel de dispneia nas atividades de vida diaria e com indice preditor de mortalidade? estudo transversal Chronic Obstructive Pulmonary Disease Assessment Test en la evaluacion de pacientes con enfermedad pulmonar obstructiva cronica en rehabilitacion pulmonar: ?Hay relacion con el nivel de disnea en las actividades de la vida diaria y con el indice predictor de mortalidad? Estudio transversal Julia Gianjoppe-Santos, Samantha Maria Nyssen, Bruna Varanda Pessoa, Renata Pedrolongo Basso-Vanelli, Mauricio Jamami, Valeria Amorim Pires Di Lorenzo