Severity of COPD and its relationship with IL-10.

BACKGROUND: The present study was designed to compare inflammatory and metabolic responses according to severity of airflow among patients with COPD and to verify the relationship between pulmonary function, body composition, metabolic and inflammatory profile. METHODS: Fifty-one patients with mild to very severe COPD were recruited and divided according lung function in Mild-moderate (GOLD 1-2) n= 21; Severe (GOLD 3) n=25 and Very severe (GOLD 4) n=5. Patients were submitted to assessments of lung function (spirometry), functional exercise capacity (6-min walk test), body composition (Octopolar bioelectrical impedance), metabolic profile (glucose, triglycerides, total cholesterol, HDL-cholesterol and albumin (colorimetric assay)) and inflammatory profile (cytokines: IL-6, IL-10, TNF-α and IL-15 (ELISA)). RESULTS: We found that patients in GOLD 3 group had lower levels of IL-10, triglycerides, visceral fat area, and higher IL-6 and IL-6/IL-10 ratio when compared to GOLD 1-2 patients. Additionally, GOLD 1-2 group presented negative correlation between TNF-α and HDL cholesterol (p= .01) and positive correlation between IL-15 and FEV1/FVC (p=.01), while GOLD 3 group showed positive correlation between IL-6 and IL-10 (p< .01), IL-6 and total cholesterol (p<.01) and negative correlation between IL-10 and HDL-cholesterol (p=.01). CONCLUSION: Our findings suggest that patients with severe COPD can exhibit compromised "inflammatory status", characterized by higher IL6, IL-6/IL-10 ratio and lower IL-10 concentration. Furthermore, IL-10 seems to be an interesting cytokine to be investigated in this kind of patients.

Burnt sugarcane harvesting work: effects on pulmonary and systemic inflammatory markers.

Objective: To evaluate the effects of burnt sugarcane harvesting on the plasmatic and urinary concentrations of the club cell secretory protein (CC16) and inflammatory systemic biomarkers in a group of sugarcane cutters. Methods: Seventy-eight sugar cane workers were evaluated. The plasmatic and urinary concentrations of CC16, a pulmonary damage marker and inflammatory systemic biomarkers were collected at three time points: before, three months after and six months after the onset of the burnt sugarcane harvesting period. All evaluations were performed at ∼7 am, before the daily work shift. In the three-month evaluation, a post-work shift assessment (acute effect) was also performed. Results: The age of the workers was 37.9 ± 11.0 years. The PM2.5 concentrations were 27.0 (23.0-33.0) and 101.0 (31.0-139.5) µg/m3 in the pre harvest and harvest periods, respectively (p < .001). Burnt sugarcane harvesting was associated with a reduction, throughout the work during burnt sugarcane harvesting (subchronic effect), in plasmatic and urinary CC16 concentrations. Acutely, there was a decrease in plasmatic concentrations. There were acute and subchronic increases in inflammatory markers (neutrophils, monocytes) and muscle damage markers (CK and LDH) and a decrease in red blood cells. Conclusions: Harvesting of burnt sugarcane was associated with acute and subchronic reductions in the plasmatic and urinary concentrations of CC16 protein and changes in systemic inflammatory markers.

Analysis of Autonomic Modulation in Response to a Session of Aerobic Exercise at Different Intensities in Patients With Moderate and Severe COPD.

Despite the many benefits of performing physical exercise in patients with chronic obstructive pulmonary disease (COPD), information on the response of acute cardiac autonomic modulation in subjects with moderate and severe COPD during and after an aerobic exercise session at different intensities is unknown. The aim of this study was to evaluate the response of cardiac autonomic modulation in patients with moderate and severe COPD during and after an aerobic exercise session at different intensities. Twenty-seven patients with COPD, divided into: Moderate Group and Severe Group, underwent an aerobic exercise sessions with intensities equivalent to 60% and 90% of velocity corresponding to peak oxygen consumption. The heart rate variability (HRV) indices were analyzed in the time and frequency domains at the following times: at rest, during exercise, immediately after, and 5, 10, and 15 minutes after exercise. In the comparison analysis between the two groups, no differences were observed in any of the HRV indices at different intensities applied. However, it was observed that the exercise caused autonomic changes when the groups were analyzed separately. Sessions of aerobic exercise influence the autonomic modulation in patients with COPD. However, COPD severity did not influence the autonomic nervous system response to exercise and recovery moments; and there was no difference between the exercise intensities.

Resistance Training using Low Cost Elastic Tubing is Equally Effective to Conventional Weight Machines in Middle-Aged to Older Healthy Adults: A Quasi-Randomized Controlled Clinical Trial.

The objectives of the study were to compare the effects of resistance training using either a low cost and portable elastic tubing or conventional weight machines on muscle force, functional exercise capacity, and health-related quality of life (HRQOL) in middle-aged to older healthy adults. In this clinical trial twenty-nine middle-aged to older healthy adults were randomly assigned to one of the three groups a priori defined: resistance training with elastic tubing (ETG; n = 10), conventional resistance training (weight machines) (CTG; n = 9) and control group (CG, n = 10). Both ETG and CTG followed a 12-week resistance training (3x/week - upper and lower limbs). Muscle force, functional exercise capacity and HRQOL were evaluated at baseline, 6 and 12 weeks. CG underwent the three evaluations with no formal intervention or activity counseling provided. ETG and CTG increased similarly and significantly muscle force (Δ16-44% in ETG and Δ25-46% in CTG, p < 0.05 for both), functional exercise capacity (ETG Δ4 ± 4% and CTG Δ6±8%; p < 0.05 for both). Improvement on "pain" domain of HRQOL could only be observed in the CTG (Δ21 ± 26% p = 0.037). CG showed no statistical improvement in any of the variables investigated. Resistance training using elastic tubing (a low cost and portable tool) and conventional resistance training using weight machines promoted similar positive effects on peripheral muscle force and functional exercise capacity in middle-aged to older healthy adults.

Correlation between heart rate variability indexes and aerobic physiological variables in patients with COPD.

BACKGROUND AND OBJECTIVE: Previous studies have shown a relationship between the level of physical fitness and autonomic variables. However, these relationships have not been investigated in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to correlate the resting heart rate variability (HRV) indexes with aerobic physiological variables obtained at a maximal exercise test in patients with COPD. METHODS: Thirty-seven patients with COPD (63 (59-70) years; 46 (35.4-63.7) forced expiratory volume in 1 s (FEV1)%) underwent assessment of autonomic modulation at rest for 20 min to determine the HRV indexes in time and frequency domains. Soon after that, the patients performed an incremental exercise test to determine the anaerobic threshold (GET), the peak oxygen uptake (VO 2PEAK) and the velocity corresponding to VO 2PEAK (vVO 2PEAK). RESULTS: The indexes that express parasympathetic component as RMSSD (11.4 [7.5-23.8], HF (ms(2)) (35 [17-195] and SD1 (8.1 [5.3-16.8]), correlated with GET (r = 0.39; r = 0.43; r = 0.39 respectively). The indexes that represent the overall variability, SDNN (19.5 [13.9-28.8]), LF (ms(2)) (111 [38-229]), and SD2 (26.8 [18.6-35.4]) correlated with vVO 2PEAK (r = 0.37; r = 0.38; r = 0.37; r = 0.44; r = 0.43; r = 0.46 respectively). Likewise, the indexes LF (ms(2)), LF (nu) (63.2 [46-77,9]), HF (nu) (36.8 [22.1-54]), and LF/HF (1.7 [0.9-3.5]) correlated with VO 2PEAK (r = 0.35; r = 0.35; r = -0.35; r = 0.40 respectively). CONCLUSIONS: This study demonstrated that HRV indexes at rest may become a predictive tool for aerobic capacity in COPD patients after the development of more consistent methods.

The effects of elastic tubing-based resistance training compared with conventional resistance training in patients with moderate chronic obstructive pulmonary disease: a randomized clinical trial.

OBJECTIVE: To investigate the effects of elastic tubing training compared with conventional resistance training on the improvement of functional exercise capacity, muscle strength, fat-free mass, and systemic inflammation in patients with chronic obstructive pulmonary disease. DESIGN: A prospective, randomized, eight-week clinical trial. SETTING: The study was conducted in a university-based, outpatient, physical therapy clinic. SUBJECTS: A total of 49 patients with moderate chronic obstructive pulmonary disease. INTERVENTIONS: Participants were randomly assigned to perform elastic tubing training or conventional resistance training three times per week for eight weeks. MAIN MEASURES: The primary outcome measure was functional exercise capacity. The secondary outcome measures were peripheral muscle strength, health-related quality of life assessed by the Chronic Respiratory Disease Questionnaire (CRDQ), fat-free mass, and cytokine profile. RESULTS: After eight weeks, the mean distance covered during six minutes increased by 73 meters (±69) in the elastic tubing group and by 42 meters (±59) in the conventional group (p < 0.05). The muscle strength and quality of life improved in both groups (P < 0.05), with no significant differences between the groups. There was a trend toward an improved fat-free mass in both groups (P = 0.05). After the first and last sessions, there was an increase in interleukin 1ß (IL-1ß) and interleukin 10 (IL-10) in both groups, while tumour necrosis factor alpha (TNF-α) was stimulated only in the conventional training group. CONCLUSION: Elastic tubing training had a greater effect on functional exercise capacity than conventional resistance training. Both interventions were equally effective in improving muscle strength and quality of life.

Effects of cigarette smoking intensity on the mucociliary clearance of active smokers.

BACKGROUND: Smoking impairs mucociliary clearance and increases respiratory infection frequency and severity in subjects with and without smoking-related chronic lung diseases. OBJECTIVE: This study evaluated the effects of smoking intensity on mucociliary clearance in active smokers. METHODS: Seventy-five active smokers were grouped into light (1-10 cigarettes/day; n = 14), moderate (11-20 cigarettes/day; n = 34) and heavy smokers (≥21 cigarettes/day; n = 27) before starting a smoking cessation programme. Smoking behaviour, nicotine dependence, pulmonary function, carbon monoxide in exhaled air (exCO), carboxyhaemoglobin (COHb) and mucociliary clearance measured by the saccharin transit time (STT) test were all evaluated. An age-matched non-smoker group (n = 24) was assessed using the same tests. RESULTS: Moderate (49 ± 7 years) and heavy smokers (46 ± 8 years) had higher STT (p = 0.0001), exCO (p < 0.0001) and COHb (p < 0.0001) levels compared with light smokers (51 ± 15 years) and non-smokers (50 ± 11 years). A positive correlation was observed between STT and exCO (r = 0.4; p < 0.0001), STT and cigarettes/day (r = 0.3, p = 0.02) and exCO and cigarettes/day (r = 0.3, p < 0.01). CONCLUSION: Smoking impairs mucociliary clearance and is associated with cigarette smoking intensity.

Combining functional exercises with exercise training in COPD: a randomized controlled trial.

INTRODUCTION: Increasing physical activity in daily life (PADL) in chronic obstructive pulmonary disease (COPD), mainly in short-term training programs, is still a challenge. The combination of functional exercises with aerobic and resistance training may be a strategy to improve PADL and limitations in activities of daily living (ADL) in COPD. OBJECTIVE: To evaluated the short- and medium-term effects of the combination of functional exercises with aerobic and resistance training. METHODS: Seventy-six patients were randomized into (1) functional training group who performed resistance and aerobic and functional exercises; (2) conventional training group (CTG) who performed resistance and aerobic exercise; or (3) usual care group who performed respiratory physiotherapy. Patients were evaluated for PADL (activity monitor), ADL limitations (London Chest Activity of Daily Living scale [LCADL]), functional exercise capacity (6-minute walk test [6MWT]), and peripheral muscle strength before and after eight weeks. Medium-term effects were evaluated 12 weeks after the training. RESULTS: There were no changes or differences between groups in PADL and in 6MWT post-intervention and 12 weeks post-training. Only CTG showed a reduction in the total score on LCADL scale after the intervention and increase at follow-up (score: 20 ± 8; 17 ± 6; 19 ± 8, pre-intervention, post-intervention, and 12 weeks post-training, respectively, p = 0.001), without differences between groups (p = 0.375). There were increases in the muscle strength of knee flexors (p = 0.016) and extensors (p < 0.001) after the intervention only in CTG. CONCLUSIONS: Combined aerobic and resistance training with functional exercises failed to improve PADL and ADL limitations in COPD. Eight weeks of conventional training improved ADL. This, however, was not superior to the results from the other groups and was not sustained at medium-term 12 weeks post-training.

Effect of physical training on cytokine expression in CD4+ T lymphocytes in subjects with stable COPD.

INTRODUCTION: Although evidence suggests that physical exercise reduces systemic inflammation, at the plasma level, there are still contradictions in chronic obstructive pulmonary disease (COPD). In this sense, analysis of intracellular cytokines could clear off the effect of physical exercise on the inflammatory profile of these subjects. AIM: The aim was to evaluate the effect of physical training on cytokine expression in CD4+ T lymphocytes from subjects with COPD. METHODS: This is a randomized controlled trial. Subjects with stable COPD were grouped into two groups, exercise and control. In total, 23 subjects with stable COPD were evaluated, of which 15 underwent aerobic strength training [physical exercise group (PEG)] and 8 underwent breathing exercises [respiratory physiotherapy group (RPG)]. Intracellular cytokines [interleukin (IL)-8, IL-13, IL-17, IL-6, IL-2, IL-10, and tumor necrosis factor alpha (TNF-α)] from CD4+ T lymphocytes were analyzed from peripheral blood through flow cytometry, before and after 8 weeks of intervention. RESULTS: The PEG and RPG groups had a mean age of 68 ± 5.96 and 72.25 ± 6.86 years and predicted forced expiratory volume in the first second (FEV1) of 58.6 ± 15.99% and 39.75 ± 10.39%, respectively. It was possible to detect a significant reduction in IL-8 (p = 0.0125) and an increase in IL-13 (p = 0.0014) and an increase in TNF-α (p < 0.001) in both groups. CONCLUSION: Eight weeks of physical training, both peripheral and respiratory, were able to reduce concentrations of IL-8 and to increase IL-13, and TNF-α in CD4+ T lymphocytes in subjects with stable COPD. The findings reinforce the benefits of interventions in subjects with COPD, revealing data not previously investigated.

Resistance training using different elastic components offers similar gains on muscle strength to weight machine equipment in Individuals with COPD: A randomized controlled trial.

Purpose: To compare the effects of three modalities of resistance training, two using elastic components and one using conventional weight machine on peripheral muscle strength in Individuals with chronic obstructive pulmonary disease (COPD). Effects on exercise capacity, impact of disease on health status, body composition and daily level of physical activity were investigated as secondary endpoints.Methods: Forty-eight participants were randomly allocated (Trials Registry #RBR-6V9SJJ) into Elastic band group (Theraband®) (EBG), Elastic tubes training using Lemgruber® (ETG), and Conventional training with weight machine equipment (CG). Participants were evaluated before and after 12 weeks of training regarding peripheral muscle strength by dynamometry; impact of disease on health status via COPD Assessment Test, CAT; exercise capacity by 6-min walk test, 6MWT; body composition by bioelectrical impedance; and daily level of physical activities via accelerometry.Results: Inter-group comparison of training effects did not elucidate significant differences between the modalities in muscle strength (p ≥ .2). Likewise, all training modalities showed similar effects on CAT, body composition and daily physical activity variables with no statistical significance observed (p ≥ .15).Conclusions: Modalities of resistance training using elastic components presented similar effects on muscle strength, health status, exercise capacity, body composition and daily level of physical activity in individuals with COPD. The effects of elastic resistance were similar to conventional resistance training.

Reversibility of impaired nasal mucociliary clearance in smokers following a smoking cessation programme.

BACKGROUND AND OBJECTIVE: Smoking cessation (SC) is recognized as reducing tobacco-associated mortality and morbidity. The effect of SC on nasal mucociliary clearance (MC) in smokers was evaluated during a 180-day period. METHODS: Thirty-three current smokers enrolled in a SC intervention programme were evaluated after they had stopped smoking. Smoking history, Fagerström's test, lung function, exhaled carbon monoxide (eCO), carboxyhaemoglobin (COHb) and nasal MC as assessed by the saccharin transit time (STT) test were evaluated. All parameters were also measured at baseline in 33 matched non-smokers. RESULTS: Smokers (mean age 49 ± 12 years, mean pack-year index 44 ± 25) were enrolled in a SC intervention and 27% (n = 9) abstained for 180 days, 30% (n = 11) for 120 days, 49.5% (n = 15) for 90 days or 60 days, 62.7% (n = 19) for 30 days and 75.9% (n = 23) for 15 days. A moderate degree of nicotine dependence, higher education levels and less use of bupropion were associated with the capacity to stop smoking (P < 0.05). The STT was prolonged in smokers compared with non-smokers (P = 0.002) and dysfunction of MC was present at baseline both in smokers who had abstained and those who had not abstained for 180 days. eCO and COHb were also significantly increased in smokers compared with non-smokers. STT values decreased to within the normal range on day 15 after SC (P < 0.01), and remained in the normal range until the end of the study period. Similarly, eCO values were reduced from the seventh day after SC. CONCLUSIONS: A SC programme contributed to improvement in MC among smokers from the 15th day after cessation of smoking, and these beneficial effects persisted for 180 days.

Sleep Quality Associated with Habitual Physical Activity Level and Autonomic Nervous System of Smokers. / Qualidade do Sono Associada ao Nível Habitual de Atividade Física e Sistema Nervoso Autônomo de Fumantes.

BACKGROUND: Few studies have examined the relationship of one's habitual physical activity level and autonomic nervous system (ANS) modulation on sleep quality in smokers. OBJECTIVE: The aim of this study was to identify changes in the sleep quality of smokers and its relation with their habitual physical activity level and ANS modulation. METHODS: Forty-two smokers were divided into two groups according to the 50th percentile of the moderate-to-vigorous physical activity (MVPA). Sleep quality was assessed using the Mini-sleep Questionnaire, and ANS modulation was assessed by indices of heart rate variability (HRV). To examine the possible mean differences, the analysis of covariance (ANCOVA) was used, adjusted for age, sex, body composition, pack-years, beta-blockers, anxiety, and depression in log base 10, not including qualitative data, such as sex and beta-blockers. Correlations were made by using the Spearman rank correlation. The statistical significance was set at 5. RESULTS: The smokers who were less active showed poor sleep quality (p=0.048) and insomnia (p=0.045). Furthermore, the less active group presented decreased parasympathetic modulation [HF (un; p=0.049); RMSSD (ms; p=0.047) and SD1 (ms; p=0.047)] and an increased LF (un) index (p=0.033) and LF/HF ratio (p=0.040). A positive correlation between the total Mini-sleep score with LF (un) index (r=0.317, p=0.041) and LF/HF ratio (r=0.318, p=0.040) and negative correlation with HF (un) index (r= -0.322, p=0.038). CONCLUSIONS: Smokers with lower levels of habitual physical activity showed poor sleep quality and alterations in autonomic nervous system modulation; (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: Poucos estudos já examinaram a relação do nível habitual de atividade física e a modulação do sistema nervoso autônomo (SNA) na qualidade do sono de fumantes. OBJETIVOS: O objetivo deste estudo foi identificar alterações na qualidade do sono de fumantes e sua relação com nível habitual de atividade física e modulação do SNA. MÉTODOS: Um total de 42 fumantes foram divididos em dois grupos de acordo com o 50º percentil de atividade física de moderada a vigorosa (AFMV). A qualidade do sono foi avaliada utilizando-se o Mini-Sleep Questionnaire (mini questionário do sono), e a modulação do SNA foi avaliada por índices de variabilidade de frequência cardíaca (VFC). Para a análise de possíveis diferenças de média, foi utilizada a análise de covariância (ANCOVA) para ajuste de idade, gênero, composição corporal, maços-ano, betabloqueadores, ansiedade, e depressão, em log base 10, exceto por dados qualitativos, tais como gênero e betabloqueadores. Foram estabelecidas correlações utilizando-se a correlação de postos de Spearman. A significância estatística foi definida em 5%. RESULTADOS: Os fumantes que eram menos ativos demonstraram pior qualidade do sono (p=0,048) e insônia (p=0,045). Além disso, o grupo menos ativo apresentou redução na modulação parassimpática [HF (un; p=0,049); RMSSD (ms; p=0,047) e SD1 (ms; p=0,047)] e aumento do índice de LF (un) index (p=0,033) e razão LF/HF (p=0,040). Houve correlação positiva entre a pontuação total no Mini-sleep com o índice de LF (un) (r=0,317, p=0,041) e razão LF/HF (r=0,318, p=0,040) e correlação negativa com o índice de HF (un) (r= -0,322, p=0,038). CONCLUSÕES: Fumantes com baixo nível de atividade física habitual apresentaram baixa qualidade do sono e alterações na modulação do sistema nervoso autônomo. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation. METHODS: This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software. RESULTS: The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66-0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups. CONCLUSIONS: According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.

Mucociliary Clearance of Different Respiratory Conditions: A Clinical Study.

Introduction Mucociliary clearance (MCC) is the first line of defense of the pulmonary system. Mucociliary clearance impairment may lead to increased risk of respiratory infections, lung injury, pulmonary repair problems, chronic dysfunctions and progression of respiratory diseases. Objective To characterize the MCC of active and passive smokers and individuals with chronic obstructive pulmonary disease (COPD) and compare the MCC behaviors between men and women of different age groups. Methods Patients with COPD (current smokers and ex-smokers) and apparently healthy individuals (current smokers, passive smokers and nonsmokers) were evaluated. All of the subjects underwent lung function and MCC evaluation (saccharin transport test [STT]). Smokers (with or without COPD) were questioned about the smoking history. Results A total of 418 individuals aged 16 to 82 years old, of both genders, were evaluated. The STT values of active and passive smokers were statistically higher than those of the control group ( p < 0.01). Men of the control group had lower values of STT than active smokers (9.7 ± 7.1 and 15.4 ± 10.1 minute, respectively, p < 0.01). In addition, higher MCC velocity was observed in women that are current smokers (11.7 ± 6.8 minute) compared with men (15.4 ± 10.1 minute) in this group ( p = 0.01). Among the younger age groups (< 50 years old), only passive smokers presented higher STT in relation to the control group. Conclusion Passive and active smoking are factors that influence negatively the MCC, and passive smokers may present losses of this mechanism at a younger age. Additionally, male smokers present worse MCC than male nonsmokers.

Estimation of maximal work rate based on the 6-minute walk test and fat-free mass in chronic obstructive pulmonary disease.

OBJECTIVE: To propose a predictive equation of the maximal work rate (Wmax) in patients with chronic obstructive pulmonary disease (COPD) based on the product of 6-minute walking test (6MWT) and fat-free mass (FFM) and to compare it with a previously proposed equation based on the product of 6MWT and body weight (BW). DESIGN: Descriptive (cross-sectional) study. SETTING: University-based rehabilitation center. PARTICIPANTS: Patients with COPD (N=53; 30 men; forced expiratory volume in 1 second, 45%±15% predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three Wmax were produced: Wmax_real (obtained from the maximal cycle ergometry test), Wmax_BW (estimated from the product of 6MWT and BW), previously proposed by Hill et al. (Arch Phys Med Rehabil 2008; 89(9):1782-7); and Wmax_FFM (estimated from the product of 6MWT and FFM). RESULTS: The equation derived from a regression model to estimate Wmax_FFM was as follows: -27.9717+3.7792*(6MWT*FFM). Wmax_real correlated better with Wmax_FFM (r=.64) than with Wmax_BW (r=.54). There was no difference between Wmax_FFM (median [interquartile range], 41 [29-50] W) and Wmax_real (40 [20-50] W, P=.88), whereas Wmax_BW (60 [52-69] W) significantly overestimated Wmax_real (P<.0001). CONCLUSIONS: In patients with COPD, Wmax is better estimated by an equation including the product of 6MWT and FFM than by a previously proposed equation including the product of 6MWT and body weight.

Body image in COPD and its relation with physical activity levels, lung function and body composition: An observational study.

INTRODUCTION: Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD. OBJECTIVES: To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects. MATERIALS AND METHODS: 109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance). RESULTS: BothCOPD and control subjects presented alterations in body image. Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14). CONCLUSION: In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.

Elastic Resistance Training Produces Benefits Similar to Conventional Resistance Training in People With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to investigate the effectiveness of elastic resistance training on improving muscle strength, functional exercise capacity, health-related quality of life (HRQoL), and dyspnea in people with stable chronic obstructive pulmonary disease (COPD). METHODS: For this systematic review, PubMed, The Cochrane Library, Embase (OVID), PEDro, SciELO, and CINAHL were searched from inception to November 2019. Included studies were randomized clinical trials in which people with stable COPD were allocated to (1) an experimental group that received lower-limb resistance training, upper-limb resistance training, or both using elastic resistance; or (2) a control group that received no or sham resistance training or conventional resistance training using weight machines. Data extraction was performed by 3 review authors. The methodological quality of the studies was assessed using the PEDro scale. Eight studies on 332 participants were included. RESULTS: Knee extensor strength was higher in the experimental group (standardized mean difference = 0.52, 95% CI = 0.09-0.95) compared with the non-exercise control group. Compared with the conventional exercise control, the experimental group presented similar effects for muscle strength, functional exercise capacity, HRQoL, and dyspnea (95% CI overlapped the line of no effect for all). CONCLUSIONS: Elastic resistance training improves muscle strength in people with COPD. The current review suggests elastic resistance as a potential alternative to conventional resistance training using weight machines, as they show similar effects on muscle strength, functional exercise capacity, HRQoL, and dyspnea. IMPACT: Due to its beneficial effects, including reduced risk of exacerbation-related hospitalizations, exercise training is viewed as the cornerstone of pulmonary rehabilitation in people with COPD. This study shows that elastic resistance training can be an effective, portable, practical, and low-cost alternative to conventional weight resistance training. LAY SUMMARY: Training with elastic resistance tubes or bands-which are easy to carry, easy to use, and relatively low cost-can be an effective way to improve strength for people with COPD and promote similar benefits to those achieved with weight machines.

Smoking history: relationships with inflammatory markers, metabolic markers, body composition, muscle strength, and cardiopulmonary capacity in current smokers.

OBJECTIVE: To determine the relationships that smoking history has with inflammatory markers, metabolic markers, body composition, muscle strength, and cardiopulmonary capacity in current smokers. METHODS: This was a cross-sectional study involving 65 smokers (age range: 18-60 years). On three non-consecutive days, each participant was evaluated in terms of smoking history, pre-existing comorbidities, lung function (by spirometry), peripheral muscle strength (by dynamometry), body composition (by bioelectrical impedance analysis), levels of metabolic/inflammatory markers, and maximum cardiopulmonary capacity (by treadmill exercise test). We evaluated the relationships that smoking history has with inflammatory markers, metabolic markers, body composition, muscle strength, and cardiopulmonary capacity, using logarithmic transformation of the data and calculating Pearson's correlation coefficient and for partial correlations adjusted for age, gender, body mass index (BMI), and comorbidities. To identify the influence of smoking history on pre-existing comorbidities, we used a logistic regression model adjusted for age, BMI, and duration of smoking. RESULTS: Smoking history correlated significantly, albeit weakly, with triglyceride level (r = 0.317; p = 0.005), monocyte count (r = 0.308; p = 0.013), and waist circumference (r = 0.299; p = 0.017). However, those correlations did not retain their significance in the adjusted analysis. In the logistic regression model, smoking more than 20 cigarettes/day correlated significantly with the presence of metabolic diseases (OR = 0.31; 95% CI: 1.009-1.701; p = 0.043). CONCLUSIONS: In this sample of smokers, smoking history correlated positively with the triglyceride level, the monocyte count, and waist circumference. The prevalence of metabolic disease was highest in those who smoked more than 20 cigarettes/day.

Analysis of the heart rate deflection point as a tool for exercise prescription in subjects with COPD - a cross-sectional study.

Background: Prescription of exercise training in subjects with chronic obstructive pulmonary disease (COPD) remains a challenge in clinical practice. The heart rate deflection point (HRDP) is an option to reduce costs, reflects the anaerobic threshold and it is noninvasive; however its applicability in COPD is still unknown. Aim: To compare HRDP with gas exchange threshold values (GET) in subjects with COPD. Methods: Thirty-one subjects were evaluated in this cross-sectional study, diagnosed with COPD. The subjects performed an incremental exercise test on a treadmill to determine the GET, peak oxygen consumption (VO2PEAK), speed corresponding to VO2PEAK (sVO2PEAK), and peak values of heart rate (HRPEAK). To determine HRDP the heart rate values observed were plotted as a function of intensity. Results: The HRDP was visible in 96.77% of subjects. There was no difference between HRDP and GET (p = 0.07) and a moderate intraclass correlation coefficient (ICC): 0.74 [0.52-0.87] and high limits of agreements were presented (±1.1 km·h-1). Conclusion: The HRDP cannot be used to determine the limits between the physiological domains of these subjects. Thus, although significant correlation was found between HRDP and GET, their application for training prescription and monitoring in subjects with COPD proved to be limited.