Effects of low and high resistance training intensities on clinical outcomes in patients with COPD - a randomized trial.

AIM: To compare the effects of two different intensities of combined resistance and aerobic training on physical-functional aspects and perceptual aspects of health status in patients with Chronic Obstructive Pulmonary Disease (COPD). DESIGN: This was a randomized parallel group trial. METHODS: Thirty-one patients were assessed regarding: symptoms (COPD Assessment Test - CAT), quality of life (Saint George's Respiratory Questionnaire - SGRQ); exercise capacity (six-minute walk test and constant-workload resistance test - CWRT); and muscle strength (one-repetition maximum test and isometric muscle strength for knee extensors - Kext and elbow flexors - EFlex). Patients were randomized in two groups to perform a combined training: 1) LL/HR = Low-load/high-repetition resistance training (n = 16; 68 ± 9.3 years; FEV1 = 50.0 ± 15.7%pred); and 2) HL/LR = High-load/low-repetition resistance training (n = 15; 70 ± 6.5 years; FEV1 = 46.8 ± 14.5%pred), and underwent 36 sessions. RESULTS: Symptoms, quality of life and exercise capacity presented significant improvement (p < .05) in both groups. Both intensities of resistance training improved symptoms (∆CAT: LL/HR = -3.9; HL/LR = -2.8) and exercise capacity (∆ tolerance time in CWRT: LL/HR = +450.9s; HL/LR = +583.4s) above minimal clinically important difference value. Nevertheless, improvement in quality of life (∆SGRQ: LL/HR = -3.8; HL/LR = -10) and in isometric muscle strength (∆KExt: LL/HR = +15.8 N; HL/LR = +37.7 N and (∆EFlex: LL/HR = +9.5 N; HL/LR = +29.9 N) was observed only in the HL/LR group, which also presented a larger number of responders considering isometric muscle strength. CONCLUSION: High-intensity resistance training in a combined training was more effective in ameliorating several aspects of patients with COPD, responding more and better to physical-functional aspects and perceptual aspects of health status.

Do London Chest Activity of Daily Living Scale and St George's Respiratory Questionnaire Reflect Limitations During Activities of Daily Living in Patients With COPD?

PURPOSE: It is unclear whether activities of daily living (ADL) and quality-of-life scales reflect real ADL limitations. The aim of the study was to assess the limitation during ADL simulation and to identify whether the London Chest Activity of Daily Living (LCADL) Scale and St George's Respiratory Questionnaire (SGRQ) are able to reflect the patient's real limitations during ADL simulation. METHODS: Forty-eight patients with chronic obstructive pulmonary disease (age = 69 ± 8 y; forced expiratory volume in the first second of expiration [FEV1] = 1.37 ± 0.49 L) were assessed by SGRQ and LCADL Scale. Activities of daily living simulations were performed: showering (ADL1); lifting and lowering containers above the shoulder girdle (ADL2); and raising and lowering pots below the pelvic girdle (ADL3). RESULTS: SpO2 and ΔSpO2 in ADL2 were statistically lower than in ADL3. Ventilatory demand was statistically higher in ADL2 and ADL3 than in ADL1. Metabolic equivalent values were similar between the ADLs with values above 3.6. Oxygen desaturation was present in 41.7% (ADL1) and 33.3% (ADL2) of the patients. The LCADL% showed a moderate positive correlation with dyspnea in ADL3 and metabolic demand in ADL1. The SGRQ score presented a moderate positive correlation with dyspnea in all ADL simulations and metabolic demand in ADL1 and ADL3. Dyspnea in ADL3 and metabolic demand in ADL1 explained 33% of the variability in LCADL%. The dyspnea and metabolic demand in ADL3 explained 67% of the variability in SGRQ. CONCLUSION: Activities of daily living lead to oxygen desaturation and high ventilatory demand. London Chest Activity of Daily Living Scale reflected 33% and SGRQ reflected 67% of the functional limitation during ADL simulation, such as dyspnea and the metabolic demand during ADL.

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 S(pO2) 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).

Influência da força muscular isométrica de membros inferiores sobre equilíbrio e índice BODE em pacientes com DPOC: estudo transversal / Influence of lower limb’s isometric strength on balance and BODE index in COPD patients: a cross-sectional study

Introdução Força muscular de membros inferiores (MMII) diminuída associa-se à limitação da capacidade funcional; entretanto, existem poucas evidências sobre a repercussão direta da fraqueza muscular periférica sobre tarefas de equilíbrio, bem como com o prognóstico de mortalidade nos pacientes com doença pulmonar obstrutiva crônica (DPOC). Objetivos Verificar se há relação da força isométrica de MMII com Índice BODE e equilíbrio funcional de pacientes com DPOC em reabilitação pulmonar (RP), além de investigar se esses pacientes apresentam fraqueza muscular, e se tal característica é capaz de influenciar nessas variáveis. Materiais e métodos Trata-se de um estudo transversal, onde avaliou-se 24 pacientes (idade > 50 anos) de ambos os gêneros, com DPOC moderada a muito grave (VEF1 = 44 (31 - 62,8)% previsto), por meio de:modified Medical Research Council (mMRC), Teste de Caminhada de 6 minutos (TC6), Índice BODE, TesteTimed “Up and Go” (TUG), Escala de Equilíbrio de Berg (EEB),Dynamic Gait Index (DGI) e Teste de Força Isométrica de Extensores de Joelho (ExtJ) e Abdutores de Quadril (AbdQ). Resultados Na amostra estudada, 54% dos pacientes apresentaram fraqueza muscular em ExtJ, com correlações moderadas da força de MMII com Índice BODE (AbdQ = -0,58) e mMRC (ExtJ = -0,48; AbdQ = -0,49). Foram encontradas diferenças para DPTC6 e mMRC quando a força dos ExtJ foi classificada em normal ou diminuída. Conclusão A força de AbdQ está associada ao prognóstico de mortalidade e a força de MMII está associada à sintomatologia em pacientes com DPOC em RP. Embora a força de MMII apresente impacto negativo na capacidade funcional e na dispneia, os pacientes desse estudo mantiveram preservado o equilíbrio e mobilidade funcional.

Introduction Decreased lower limb’s isometric strength (LLIS) is associated with impaired functional capacity, however there is not sufficient evidence showing direct impact of peripheral muscle weakness on balance tasks, as well as on prognosis of mortality in patients with chronic obstructive pulmonary disease (COPD). Objectives To assess the correlation of the LLIS with BODE index and functional balance in patients with COPD in pulmonary rehabilitation (PR) and to investigate if these patients present muscle weakness, being able to influence the balance and the prognosis of mortality. Materials and methods This was a cross-sectional study which evaluated 24 patients (age > 50 years) of either genders, with moderate to very severe obstruction (FEV1 = 44 (31 - 62,8)% predicted). The following assessments were conducted: modified Medical Research Council (mMRC), Six-minute Walk Test (6MWT), BODE index, Timed Test "Up and Go" (TUG), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Muscle Strength Test in Knee Extensors (KExt) and Hip Abductors (HAbd). Results In this sample, 54% of patients had muscle weakness in ExtJ, with significant correlations of LLIS with BODE index (HAbd = -0.58) and mMRC (KExt = -0.48; HAbd = -0.49). There were differences for 6MWT and mMRC among patients with normal or decreased knee extensor strength. Conclusions The HAbd strength is associated with the prognosis of mortality and LLIS with dyspnea in patients with COPD, even under PR program. Although LLIS presented negative impact on functional capacity and dyspnea, these patients tend to keep preserved balance and functional mobility.

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 / 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 en la evaluación de pacientes con enfermedad pulmonar obstructiva crónica en rehabilitación pulmonar: ¿Hay relación con el nivel de disnea en las actividades de la vida diaria y con el índice predictor de mortalidad? Estudio transversal

O objetivo do estudo foi investigar se há relação entre o impacto da Doença Pulmonar Obstrutiva Crônica (DPOC) no estado de saúde com o nível de dispneia nas atividades de vida diária (AVD) e o índice preditor de mortalidade em pacientes em reabilitação 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), Índice de Massa Corpórea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlações positivas moderadas do CAT com o questionário mMRC (r=0,35; p=0,048), a pontuação total da LCADL (r=0,60; p<0,001) e com a porcentagem da pontuação total da LCADL (r=0,57; p=0,001). Apenas a pontuação total da LCADL é capaz de predizer independentemente a pontuação do questionário CAT (p<0,05; r²=0,61). Não foram constatadas correlações significativas entre o CAT e o Índice BODE, IMC, TC6 e VEF1. Dessa forma, quanto maior o nível de dispneia nas AVD, maior o impacto da DPOC no estado de saúde do paciente, entretanto, o mesmo não ocorre em relação ao prognóstico de mortalidade nos pacientes com DPOC em RP...

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; FEV1: 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, FEV1 and 6MWT. Thus, the higher the level of dyspnea in ADL, the greater the impact of COPD on the patient's health status. However, this is not true in relation to mortality prognosis in patients with COPD in PR...

El objetivo del estudio fue investigar si hay relación entre el impacto de la Enfermedad Pulmonar Obstructiva Crónica (EPOC) en el estado de salud con el nivel de disnea en las actividades de la vida diaria (AVD) y el índice predictor de mortalidad en pacientes en rehabilitación pulmonar (RP). Se trata de un estudio transversal, en el que fueron evaluados 32 pacientes con EPOC moderada a muy grave (23 hombres; 66,6±12,0 años; VEF1: 40,6±15,6% previsto) por medio del COPD Assessment Test (CAT), Índice de Masa Corpórea (IMC), Test de Caminata de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), mo dified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Se observaron correlaciones positivas moderadas del CAT con el cuestionario mMRC (r=0,35; p=0,048), la puntuación total de la LCADL (r=0,60; p<0,001) y con el porcentaje de la puntuación total de la LCADL (r=0,57; p=0,001). Apenas la puntuación total de la LCADL es capaz de predecir independientemente la puntuación del cuestionario CAT (p<0,05; r²=0,61). No fueron constatadas correlaciones significativas entre el CAT y el Índice BODE, IMC, TC6 e VEF1. De esa forma, cuanto mayor es el nivel de disnea en las AVD, mayor es el impacto de la EPOC en el estado de salud del paciente, entre tanto, lo mismo no ocurre en relación al pronóstico de mortalidad en los pacientes con EPOC en RP...