Reliability and validity of the online application of London Chest Activity of Daily Living scale in assessing dyspnea-related functional impairment in individuals after hospitalization for COVID-19.

PURPOSE: To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19. METHODS: Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual's medical record. RESULTS: 104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73-0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach's α = 0.70-0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%). CONCLUSION: The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19.

The London Chest Activity of Daily Living Scale applied online is a method of evaluation of dyspnea-related ADL limitations that is valid and reliable after hospitalization for COVID-19 and can be used both in the telerehabilitation environment and in-person rehabilitation;The online form provides a more sustainable means of data storage, since no paper is needed, and saves time during in-person rehabilitation.

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change.

BACKGROUND: Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners. OBJECTIVE: This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models. METHODS: This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy. RESULTS: The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression. CONCLUSION: These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Translation, cross-cultural adaptation, reliability, and construct validity of the Brazilian Portuguese version of the Basic Psychological Needs in Exercise Scale.

RESULTS: 59 patients were included (61% with COPD and 39% with ILD). BPNES factor scores were not significantly different between raters' assessments (p > 0.05). The internal consistency was 0.70 for autonomy, 0.76 for competence, and 0.80 for relatedness. Inter-rater and test-retest reliability were good to very good for autonomy (ICC = 0.78, 95%CI 0.62-0.87; ICC = 0.75, 95%CI 0.57-0.86, respectively), competence (ICC = 0.81, 95%CI 0.68-0.89; ICC = 0.65, 95%CI 0.43-0.80, respectively), and relatedness (ICC = 0.79, 95%CI 0.65-0.88; ICC = 0.70, 95%CI 0.50-0.83, respectively). Significant correlations were observed between BPNES factors and quality of life, anxiety, depression, and functional status. In conclusion, this study confirmed the reliability and construct validity of the Brazilian Portuguese version of the BPNES in patients with COPD and ILD.

Impact of COVID-19 critical illness on functional status, fatigue symptoms, and health-related quality of life one-year after hospital discharge: a systematic review and meta-analysis.

Purpose: To estimate the prevalence and severity of impairments in functional status, fatigue, and health-related quality of life (HRQoL) among critical COVID-19 survivors one-year after hospital discharge. Methods: A systematic review was conducted following PRISMA statement and registered in PROSPERO (CRD42021258356), with searches in eight databases. Observational studies were selected. The prevalence meta-analysis of abnormalities was performed using random-effects models. Risk of bias was evaluated using the National Heart, Lung, and Blood Institute tool. Results: Twenty studies were included, with data collected between 12 and 13.5 months after hospital discharge and a total of 1828 participants. Of these, 71% were men, and 77.7% were intubated in the intensive care unit (ICU). Impairments and sequelae were identified in varying prevalence and degrees, with greater impact on functional capacity and physical components of fatigue and HRQoL. The prevalence of abnormalities of 32.3% [95% CI 23.9; 41.9] found in the meta-analysis is substantially high. Most studies were classified as having fair and poor quality. Conclusion: Critical COVID-19 survivors experience impairments in functional status, fatigue, and HRQoL to varying degrees one-year after hospital discharge, particularly among patients who stayed in the ICU and on MV for a prolonged period.

Critical COVID-19 survivors exhibit persistent impairments one-year post-discharge.Functional status, fatigue, and health-related quality of life are impaired to varying degrees in approximately one-third of patients.Long-term follow-up care for critical COVID-19 survivors should be prioritized.

Minimally Important Difference of the 20-m 6-Minute Walk Test in Individuals With COPD.

BACKGROUND: The 20-m 6-min-walk test (6MWT20) is a valid, reliable alternative for functional capacity assessment; however, its responsiveness and minimally important difference (MID) have yet to be investigated. The aim of this study was to assess the responsiveness and MID of the 6MWT20 in individuals with COPD. METHODS: Fifty-three subjects completed the study from August 2011-March 2020. The following were assessed: lung function, activities of daily living (ADLs), functional capacity 6MWT20, dyspnea, health status, quality of life, and limitations in ADLs. The primary outcome was the 6MWT20 distance. RESULTS: The study demonstrated that the 6MWT20 is responsive to pulmonary rehabilitation (PR), with an average improvement of 39 ± 36.3 m (P < .001) and an effect size of 1.07. The learning effect declined to 1.45% after PR, with an intraclass correlation coefficient of 0.99 (95% CI 0.98-0.99). The receiver operating characteristic curve indicated a cutoff point of 20 m for the MID of the 6MWT20 based on the MIDs for the modified St George Respiratory Questionnaire (sensitivity 87%, specificity 69%, area under the curve 0.80 [95% CI 0.66-0.90], P < .001, Youden index 0.56) and the number of steps (sensitivity 92%, specificity 73%, area under the curve 0.83 [95% CI 0.70-0.92], P < .01, Youden index 0.56). CONCLUSIONS: The 6MWT20 is responsive to PR, and the MID for the test is 20 m (17-47 m).

An online behavior change intervention to promote physical activity in adults with asthma: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Behavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention. METHODS: This double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 h). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote an increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2, and the Hospital Anxiety and Depression Scale. DISCUSSION: The intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has the potential to improve physical activity levels and asthma management and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient's attendance, and has the potential to be largely offered elsewhere. TRIAL REGISTRATION: ClinicalTrials.gov NCT05241223 . Registered on January 22, 2022.

Characterization of biopsychosocial factors of patients with chronic nonspecific low back pain / Caracterização de fatores biopsicossociais de pacientes com dor lombar crônica inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Low back pain is considered a public health problem worldwide and has a personal, social, occupational and economic impact. Psychosocial signs such as inappropriate beliefs about pain, fear of movement, anxiety, stress, depression and low job satisfaction are characteristics of individuals with low back pain. These clinical signs are mediators of chronic pain and disability. The present study aimed to assess psychological comorbidities in patients with chronic non-specific low back pain who are undergoing physical therapy and patients awaiting physical therapy; in addition to characterizing the psychosocial profile of these individuals. METHODS: This research was carried out with 31 individuals recruited from physical therapy clinics in the region of greater Florianópolis. They were divided into two groups: Treatment (TG) and non-treatment (CG). The following self-report instruments were applied: Hospital Anxiety and Depression Scale (HADS), Health Status Questionnaire (SF-36V2), Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Index (OLBPDI), Fear-Avoidance Belief Questionnaire (FABQ) and Pain Castatrophizing Scale (PCS). RESULTS: Significant differences (p<0.05) were observed in the scores of the instruments applied between the groups. The CG had higher averages than the GT. CONCLUSION: The results obtained in this study support previous findings about the benefits of physical therapy for individuals with chronic nonspecific low back pain, suggesting that, in addition to reducing pain and disability, there are benefits related to psychosocial factors.

RESUMO JUSTIFICATIVA E OBJETIVOS A dor lombar é considerada um problema de saúde pública em todo o mundo e gera impacto pessoal, social, ocupacional e econômico. Os sinais psicossociais como crenças inapropriadas sobre a dor, medo do movimento, ansiedade, estresse, depressão e baixa satisfação no trabalho são características de indivíduos com lombalgia. Esses sinais clínicos são mediadores da dor crônica e incapacidade. O presente estudo teve como objetivo avaliar as comorbidades psicológicas em pacientes com dor lombar crônica inespecífica que estão em atendimento fisioterapêutico e pacientes que aguardam o atendimento de fisioterapia; além de caracterizar o perfil psicossocial desses indivíduos. MÉTODOS Estudo realizado com 31 indivíduos, recrutados em clínicas de fisioterapia na região da grande Florianópolis. Foram divididos em dois grupos: tratamento (GT/n=16) e não tratamento (GC/n=15). Foram aplicados os seguintes instrumentos de autorrelato: Hospital Anxiety and Depression Scale (HADS), Health Status Questionnaire (SF-36V2), Escala Analógica Visual (EAV), Oswestry Low Back Pain Disability Index (OLBPDI), Fear-Avoidance Belief Questionnaire (FABQ) and Pain Castatrophizing Scale (PCS). RESULTADOS: Foram observadas diferenças significativas (p<0,05) nos escores dos instrumentos aplicados entre os grupos. Sendo que o GC apresentou médias maiores que o GT. CONCLUSÃO Os resultados obtidos neste estudo apoiam descobertas anteriores sobre os benefícios da fisioterapia para indivíduos com dor lombar crônica inespecífica, sugerindo que, além da redução da dor e incapacidade, há benefícios relacionados aos fatores psicossociais.

Modified Medical Research Council and COPD Assessment Test Cutoff Points.

BACKGROUND: The modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) are assessment instruments associated with level of physical activity of daily living (PADL) in patients with COPD. This study aimed to identify mMRC and CAT cutoff points to discriminate sedentary behavior and PADL level of subjects with COPD and verify whether these cutoff points differentiate pulmonary function, health-related quality of life (HRQOL), functional status, and mortality index in subjects with COPD. METHODS: Subjects (N = 131, FEV1: 36.7 ± 16.1% predicted) were assessed for lung function, mMRC, CAT, HRQOL, functional status, and mortality index. PADL was monitored using a triaxial accelerometer, and subjects were classified as sedentary/nonsedentary (cutoff point of 8.5 h/d in PADL < 1.5 metabolic equivalent of task [MET]), physically active/inactive (cutoff point of 80 min/d in PADL ≥ 3 METs), and with/without severe physical inactivity (cutoff point of 4,580 steps/d), according to variables provided by accelerometer. RESULTS: ROC curve indicated mMRC cutoff point of ≥ 2 (P < .05) for physical inactivity (sensitivity = 66%, specificity = 56%, AUC = 0.62), severe physical inactivity (sensitivity = 81%, specificity = 66%, AUC = 0.76), and sedentary behavior (sensitivity = 61%, specificity = 70%, AUC = 0.65). The identified CAT cutoff points were ≥ 16 and ≥ 20, considering severe physical inactivity (sensitivity = 76%, specificity = 54%, AUC = 0.69, P < .001) and sedentary behavior (sensitivity = 51%, specificity = 90%, AUC = 0.71, P = .001), respectively. Subjects who had mMRC ≥ 2 and CAT ≥ 16 or ≥ 20 presented worse pulmonary function, HRQOL, functional status, and mortality index compared with those who scored mMRC < 2 and CAT <16 or < 20. CONCLUSIONS: mMRC cutoff point of ≥ 2 is recommended to discriminate PADL level and sedentary behavior, whereas CAT cutoff points of ≥ 16 and ≥ 20 discriminated severe physical inactivity and sedentary behavior, respectively. These cutoff points differentiated subjects with COPD regarding all the outcomes assessed in this study.

The COVID-19 Pandemic Confronts the Motivation Fallacy within Pulmonary Rehabilitation Programs.

Social distancing and quarantines have been implemented worldwide to reduce the spread of Coronavirus Disease (COVID-19). However, social distancing has had far-reaching health consequences, considering that the COVID-19 pandemic has exposed people to the hazard of physical inactivity and sedentary behavior. For patients with Chronic Obstructive Pulmonary Disease (COPD), which is one of the main diseases at risk for COVID-19, the impact is even greater since outpatient pulmonary rehabilitation (PR) programs are temporarily closed. More than ever, patients' behavior change to exercise calls for urgent debate. We propose a theoretical discussion in light of Self-Determination Theory, aiming to make PR a setting that supports autonomous forms of motivation. The scenario will not be changed in the short-term; but if other conditions hinder the development of PR in its most traditional form, the PR community will be better prepared to overcome the barriers to maintain physical exercise.

Breast cancer surgery does not impact long-term pulmonary function and respiratory muscle strength / A cirurgia para o câncer de mama não compromete a função pulmonar e a força muscular respiratória a longo-prazo

INTRODUCTION: Long-term disabilities are frequently related to postoperative complications on breast cancer patients. OBJECTIVE: To assess the effect of breast cancer surgery on pulmonary function and respiratory muscle strength over the course of 60 days after the surgery. METHODS: Prospective study with 32 women. Pulmonary function was evaluated using spirometry and respiratory muscle strength was evaluated using manovacuometry. The evaluations were performed in preoperative period, between 12 to 48h after surgery, 30 and 60 days after the surgery. RESULTS: Vital capacity (VC) and inspiratory capacity (IC) were diminished 48h after surgery (VC: 2.18±0.63; IC: 1.71±0.49; p<0.01 vs baseline), returned to the baseline parameters after 30 days (VC: 2.76±0.60; CI: 2.16±0.57; p<0.01 vs PO48h) and were maintained after 60 days of the surgery (VC: 2.64±0.60; CI: 2.11±0.62; p<0.01 vs PO48h). No difference was observed in tidal volume over the evaluations, except when comparing 60 days to the 48h after surgery values (0.84±0.37 vs 0.64±0.19, respectively; p=0.028). Respiratory muscle strength was reduced 48h after surgery (MIP: -33.89±12.9 cmH2O; MEP: 39.72±21.0 cmH2O; p<0.01 vs basal) and returned to baseline values after 30 (MIP: -50.1±21.2 cmH2O; MEP: 59.86±24.7 cmH2O; p<0.01 vs PO48h) and 60 days of the surgery (MIP: -50.78±19.2 cmH2O; MEP: 61.67±23.4 cmH2O; p<0.01vs PO48h). CONCLUSION: Breast cancer surgery does not impact pulmonary function and respiratory muscle strength 30 days after the surgery.

INTRODUÇÃO: Mulheres com câncer de mama podem apresentar complicações a longo-prazo relacionadas ao procedimento cirúrgico. OBJETIVO: Avaliar a função pulmonar e a força muscular respiratória em mulheres submetidas a tratamento cirúrgico para câncer de mama ao longo de 60 dias. MÉTODOS: Estudo longitudinal com 32 mulheres. A função pulmonar e a força muscular respiratória foram avaliadas utilizando espirometria e manovacuometria, respectivamente, no pré-operatório, de 12 a 48h no período pós-operatório, 30 dias e 60 dias após a cirurgia. RESULTADOS: A capacidade vital (CV) e a capacidade inspiratória (CI) apresentaram redução significante no pós-operatório de até 48h (CV: 2,18±0,63; CI: 1,71±0,49; p<0,01 vs basal), com retorno aos parâmetros basais em 30 dias após a cirurgia (CV: 2,76±0,60; CI: 2,16±0,57; p<0,01 vs PO48h) e manutenção destes no pós-operatório de 60 dias (CV: 2,64±0,60; CI: 2,11±0,62; p< 0,01 vs PO48h). Não foi observada diferença estatisticamente significante entre os valores de volume corrente nos quatro períodos avaliados, exceto quando comparado o período pós-operatório de 60 dias com o pós-operatório de até 48h (0,84±0,37 vs 0,64±0,19, respectivamente; p=0,028). Todos os valores de força muscular respiratória apresentaram-se significantemente reduzidos no pós-operatório de até 48h (PImax: -33,89±12,9 cmH2O; PEmax: 39,72±21,0 cmH2O; p<0,01 vs basal), com retorno aos valores basais em 30 (PImax: -50,1±21,2 cmH2O; PEmax: 59,86±24,7 cmH2O; p<0,01 vs PO48h) e 60 dias (PImax -50,78±19,2 cmH2O; PEmax 61,67±23.4 cmH2O; p<0,01 vs PO48h). CONCLUSÃO: A cirurgia para tratamento do câncer de mama não impacta na função pulmonar e força muscular respiratória 30 dias após a cirurgia.

The minimal important difference for Glittre-ADL test in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine Glittre-ADL test minimal important difference in patients with chronic obstructive pulmonary disease. METHODS: This is quasi-experimental study. Sixty patients with moderate to very severe chronic obstructive pulmonary disease (age 64.1, SD=9.09 years; forced expiratory volume in the first second 37.9, SD=13.0% predicted participated in a pulmonary rehabilitation program based on physical training, conducted over 24 sessions supervised, three times a week, including aerobic training in treadmill and resistance training for upper limbs and lower limbs. The main outcomes were the Glittre-ADL test and six-minute walk test, before and after 24 sessions of pulmonary rehabilitation. The minimal important difference was established using the distribution and anchor-based methods. RESULTS: Patients improved their functional capacity after the pulmonary rehabilitation. The effect sizes of Glittre-ADL test and six-minute walk test improvement were similar (0.45 vs 0.44, respectively). The established minimal important differences ranged from -0.38 to -1.05. The reduction of 0.38min (23s) corresponded to a sensitivity of 64% and a specificity of 69% with an area under the curve of 0.66 (95%CI 0.51-0.81; p=0.04). Subjects who achieved the minimal important difference of -0.38min for the Glittre-ADL test had a superior improvement of approximately 42m in the six-minute walk test when compared to patients who did not. CONCLUSIONS: The present findings suggest -0.38min as the minimal important difference in the time spent in the Glittre-ADL test after 24 sessions of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. TRIAL REGISTRATION: NCT03251781 (https://clinicaltrials.gov/ct2/show/NCT03251781).

Body mass index, asthma, and respiratory symptoms: a population-based study.

OBJECTIVE: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. METHODS: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). RESULTS: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). CONCLUSIONS: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.

Reliability of the five-repetition sit-to-stand test in patients with chronic obstructive pulmonary disease on domiciliary oxygen therapy.

Objectives: To evaluate the reliability and learning effect of the five-repetition sit-to-stand test (5STSt) in severe and very severe chronic obstructive pulmonary disease (COPD) patients on domiciliary oxygen therapy compare the results with those of COPD patients not on such therapy. Methods: Twenty-eight COPD patients were included in the domiciliary oxygen therapy group (DOTG) and 17 in the control group (CG). The participants of the groups were paired by age, sex, body mass index, and lung function. The groups performed two 5STSt (5STSt1 and 5STSt2). Results: In total, 96% of the patients in the DOTG performed better on the second 5STSt (5STSt2) (17.1 ± 4.63s), with an average reduction of 3.87 ± 3.50 s (p < 0.001) and a learning effect of 18.4%. In the CG, 82.3% of patients had better performance on the 5STSt2 (15.06 ± 3.45 s), with an average reduction of 1.38 ± 2.51 s (p = 0.035) and a learning effect of 8.39%. The 5STSt had an ICC of 0.79 (95%CI: 0.02-0.93; p < 0.001) in the DOTG and of 0.89 (95%CI: 0.65-0.96; p < 0.001) in the CG. Conclusion: The 5STSt is reliable in patients with severe and very severe COPD on domiciliary oxygen therapy, with learning effect of nearly 18% in the DOTG. Thus, performing two tests is recommended to achieve the patient´s best performance in this population.

Body mass index, asthma, and respiratory symptoms: a population-based study / Índice de massa corpórea, asma e sintomas respiratórios: um estudo de base populacional

ABSTRACT Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.

RESUMO Objetivo: Estimar a prevalência de sintomas respiratórios e asma de acordo com o índice de massa corpórea (IMC) em indivíduos com idade ≥ 40 anos e avaliar os fatores associados ao relato de diagnóstico médico de asma. Métodos: Estudo transversal de base populacional realizado no município de Florianópolis (SC), com coleta domiciliar de dados e processo de amostragem probabilístico. Foram coletadas informações demográficas, assim como sobre relato de diagnóstico médico de asma, sintomas respiratórios, medicações em uso e comorbidades. Também foram realizadas medidas antropométricas e espirometria pré- e pós-broncodilatador. O IMC foi categorizado em normal (IMC < 25 kg/m2), sobrepeso (25 kg/m2 ≥ IMC < 30 kg/m2) e obesidade (IMC ≥ 30 kg/m2). Resultados: Foram avaliados 1.026 indivíduos, 274 (26,7%) com IMC normal, 436 (42,5%) com sobrepeso e 316 (30,8%) obesos. A prevalência de diagnóstico médico de asma foi de 11,0%. A prevalência de obesidade foi maior em mulheres (p = 0,03) e em entrevistados com escolaridade < 4 anos (p < 0,001) ou com renda familiar entre 3-10 salários mínimos. Obesos, quando comparados com aqueles com sobrepeso e peso normal, relataram mais frequentemente diagnóstico médico de asma (16,1%, 9,9% e 8,0%, respectivamente; p = 0,04), dispneia (35,5%, 22,5% e 17,9%, respectivamente; p < 0,001) e sibilos no último ano (25,6%, 11,9% e 14,6%, respectivamente; p < 0,001). Esses resultados foram independentes do status tabágico. Além disso, obesos tinham uma chance três vezes maior de relato de diagnóstico médico de asma do que não obesos (p = 0,005). Conclusões: Houve associação significativa entre o relato de diagnóstico médico de asma em indivíduos com idade ≥ 40 anos e IMC ≥ 30 kg/m2. Ser obeso triplicou a chance de diagnóstico médico de asma.

Impact of Home Oxygen Therapy on the Level of Physical Activities in Daily Life in Subjects With COPD.

BACKGROUND: Chronic hypoxemia in patients with COPD is a limiting factor that is associated with disease progression and significantly contributes to decreased physical activity. Although correction of hypoxemia results in physiological improvements, oxygen therapy may be related to social isolation and inactivity. However, few studies have objectively investigated the level of physical activity in daily life (PADL) in these patients. The objective of this study was to compare the level of PADL in subjects with COPD on home oxygen therapy and in subjects with no oxygen therapy, and to investigate whether home oxygen therapy is associated with the level of PADL. METHODS: In this study, 29 subjects with COPD composed the home oxygen therapy group, and 30 subjects with COPD composed the control group. All of them underwent assessment of anthropometric measurements, spirometry, peripheral muscle strength, limitations in activities of dalily living, perception of dyspnea, health status, as well as PADL monitoring. RESULTS: Home oxygen therapy subjects showed less time walking (P = .001), in active physical activities (P = .003), in physical activities ≥ 3 METs (P = .001), and in physical activities < 1.5 METs (P = .042), as well as fewer steps (P = .001). Physical inactivity was present in 24 home oxygen subjects (82.8%) and 18 control subjects (60%). Oxygen therapy was associated with severe physical inactivity (Cramer's V = 0.29, P = .040). The time using oxygen therapy (h/d) was the strongest predictor of the level of PADL (r2 = 0.38-0.43, P < .001). CONCLUSION: Subjects with COPD using oxygen at home showed reduced level of PADL. The results indicate that oxygen therapy is associated with severe physical inactivity and may be a predictor of the level of PADL.

Baseline characteristics associated to improvement of patients with COPD in physical activity in daily life level after pulmonary rehabilitation.

BACKGROUND: Knowing the patients with chronic obstructive pulmonary disease (COPD) that increase the physical activity of daily living (PADL) after pulmonary rehabilitation (PR) is a challenge. AIMS: to compare baseline characteristics between patients who achieved and failed to achieve the minimal important difference (MID) of PADL post-PR; to verify which baseline variables better predict the change and identify a cut-off point to discriminate MID achievers. METHODS: Fifty-three patients with COPD (FEV1: 38.3; 95%CI 34.4-42.2%pred) were evaluated for spirometry, dyspnea, quality of life, functional capacity, mortality risk and PADL level. After 24 sessions of PR had their PADL level revaluated. RESULTS: The MID achievers presented lower FEV1, functional capacity, time walking, number of steps, active time, energy expenditure (EE) walking, time on PADL≥3 metabolic equivalent of task (METs) and higher time on PADL<1.5MET. Inactive patients and with severe physical inactivity presented a hazard ratio of 4.27 and 6.90 (95%CI: 1.31-13.9, p = 0.02; 95%CI: 1.99-23.9, p = 0.002; respectively) for achieving the MID. The variables of predictive model for the change in the PADL were EE walking and time on PADL<1.5MET (R2: 0.37; p = 0.002). The cut-off point of 6525 steps [sensitivity = 95%; specificity = 61%; AUC = 0.82 (95%CI: 0.71-0.93), p < 0.001] was able to discriminate patients who achieved and failed to achieve the MID. CONCLUSION: Patients with worse lung function, functional capacity and lower PADL level before PR are those that improve the PADL level. EE walking and time on PADL<1.5MET better predict this change. The cut-off point of 6525 steps can help to identify patients with higher chances of improving the PADL level.

Translation, cross-cultural adaptation, and reliability of the Understanding COPD questionnaire for use in Brazil.

OBJECTIVE: To translate the Understanding COPD (UCOPD) questionnaire into Portuguese, adapt it for use in Brazil, and assess its reliability. METHODS: The UCOPD questionnaire consists of two sections, designated section A and section B. Section A comprises 18 items divided into three domains: "About COPD", "Managing Symptoms of COPD", and "Accessing Help and Support". Section B includes five questions regarding patient satisfaction with the educational component of pulmonary rehabilitation programs. The UCOPD questionnaire was applied twice on the same day by two different raters (with a 10-min interval between applications) and once again 15-20 days later. The Wilcoxon test was used in order to compare the scores among applications. Reliability was assessed by the intraclass correlation coefficient and Bland-Altman plots. RESULTS: The study sample consisted of 50 COPD patients (35 men; mean age, 65.3 ± 7.91 years; mean FEV1, 36.4 ± 16.2% of the predicted value). Inter-rater intraclass correlation coefficients for section A total scores and domain scores ranged from moderate to high. Section A scores and domain scores had no significant differences regarding test-retest reliability (p < 0.05). The test-retest and inter-rater Cronbach's alpha coefficients for section A total scores were 0.93 and 0.86, respectively (p < 0.001). There were no floor or ceiling effects. CONCLUSIONS: The Brazilian Portuguese version of the UCOPD questionnaire is reliable.

Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD.

OBJECTIVE: To investigate the validity of an eight-contact electrode bioelectrical impedance analysis (BIA) system within a household scale for assessing whole body composition in COPD patients. METHODS: Seventeen patients with COPD (mean age = 67 ± 8 years; mean FEV1 = 38.6 ± 16.1% of predicted; and mean body mass index = 24.7 ± 5.4 kg/m2) underwent dual-energy X-ray absorptiometry (DEXA) and an eight-contact electrode BIA system for body composition assessment. RESULTS: There was a strong inter-method correlation for fat mass (r = 0.95), fat-free mass (r = 0.93), and lean mass (r = 0.93), but the correlation was moderate for bone mineral content (r = 0.73; p < 0.01 for all). In the agreement analysis, the values between DEXA and the BIA system differed by only 0.15 kg (-6.39 to 6.70 kg), 0.26 kg (-5.96 to 6.49 kg), -0.13 kg (-0.76 to 0.50 kg), and -0.55 kg (-6.71 to 5.61 kg) for fat-free mass, lean mass, bone mineral content, and fat mass, respectively. CONCLUSIONS: The eight-contact electrode BIA system showed to be a valid tool in the assessment of whole body composition in our sample of patients with COPD.