Incremental shuttle walk test: is it able to detect exercise-induced bronchospasm in young adult asthmatics?

OBJECTIVE: To determine the accuracy of incremental Shuttle Walking Test (ISWT) in detecting exercise-induced bronchospasm (EIB) in adults with asthma and to verify whether there is an association of the drop in FEV1 between ISWT and cardiopulmonary exercise testing with constant-load CPET-CL. METHODS: In this cross-sectional study 32 individuals with asthma performed two ISWTs, an incremental cardiopulmonary exercise test (CPET-I) and a constant-load cardiopulmonary exercise test (CPET-CL) with na interval of 48 h between tests. Spirometric measurements were obtained 5, 10, 15, 20 and 30 min after exercise; an FEV1 decline > 10% was considered EIB. RESULTS: Fifteen individuals had EIB in both tests [χ2 = 9.41; κ = 0.46 p < 0.002 (95% CI: 0.201-0.708)], with moderate agreement. There was a significant correlation between the greatest variation in the drop in FEV1 between the ISWT and the CPET-CL (r = 0.48; p < 0.01). There was a significant difference for ventilation maintenance time above 40% of Maximum Voluntary Ventilation between the groups of positive EIB (p = 0.001) and negative EIB (p = 0.001) and for ventilatory demand (positive EIB group) (p = 0.008) between ISWT vs CPET-CL. Moreover, assuming CPET-CL as the criterion test, ISWT presented a sensitivity of 62.5% and specificity was 100%. CONCLUSION: ISWT showed moderate accuracy in detecting EIB in adults with asthma and was able to show similar metabolic and ventilatory demand presented in CPET-CL.

Increased sympathetic modulation and decreased response of the heart rate variability in controlled asthma.

OBJECTIVE: To compare the autonomic modulation of heart rate (HR) in asthmatic and healthy volunteers to correlate it with the forced expiratory volume in the first second (FEV1). METHODS: Ten healthy and 14 asthmatic volunteers were included in this cross-sectional study. The volunteers underwent a cardiopulmonary exercise test, spirometry and a register of both resting heart rate variability (HRV) in the supine and seated positions along with HRV during the respiratory sinus arrhythmia maneuver (M-RSA). RESULTS: At rest in supine, asthmatic volunteers presented a higher HR (77.1 ± 9.9 vs. 68.7 ± 8.7 bpm), shorter interval between two R waves (R-Ri) (807.5 ± 107.2 vs. 887.5 ± 112.7 ms) when compared with the healthy volunteers, respectively. Moreover, in the frequency domain of HRV, there was increased low frequency (LF) index (50.4 ± 17.1 vs. 29.2 ± 11.1 n.u.) and decreased high frequency (HF) index (49.4 ± 17.1 vs. 70.7 ± 11.1 n.u.). During the M-RSA, the asthmatic presented higher HR (82.6 ± 10.0 vs. 72.4 ± 7.6 bpm) and lower values of R-Ri (746.4 ± 92.1 vs. 846.4 ± 81.4 ms) and approximate entropy (ApEn) (0.7 ± 0.0 vs. 0.8 ± 0.1). FEV1 was strongly correlated with the change of the continuous beat-to-beat variability of HR (SD2) index from the seated to the supine position (r = 0.78). CONCLUSION: Controlled asthma in adults appears to induce an increased sympathetic modulation and attenuated response to the postural changes and the M-RSA. Furthermore, there is a correlation between the airways' obstruction and HRV, especially during postural changes.

Translation and cross-cultural adaptation of the Nordic Occupational Skin Symptoms Questionnaire to Brazilian Portuguese.

Introduction: Occupational skin diseases are a frequently self-reported condition in industrialized countries. However, there are few developed and standardized self-report instruments to screen the population at risk for occupational dermatological diseases. Objectives: Translation and cross-cultural adaptation of the long and short versions of The Nordic Occupational Skin Symptoms Questionnaire into Brazilian Portuguese. Methods: The process of translation and cross-cultural adaptation of the questionnaire was developed following the good practice recommendations of the International Society for Pharmacoeconomics and Outcomes Research. Results: After translation into Brazilian Portuguese, the first reconciled version of the questionnaire was evaluated in a first round of interviews with 28 individuals, including patients with dermatological disease and healthy people. In the first meeting of the study review group, changes were made to 43 questions (75.4%) (e.g., inclusion of definition of terms, reformulation of instructions, and changes to alternative words or synonyms). In the second meeting of the study review group, there were modifications in three questions, creation of the second consensus version in Brazilian Portuguese, and then the back-translation of this version. After the second round of cognitive interviews, which took place with 10 patients, we had the third review group meeting (no modification was made) and definition of the final version of the questionnaire. Conclusions: The short and long versions of the Nordic Occupational Skin Symptoms Questionnaire questionnaire are available in Brazilian Portuguese.

Introdução: As doenças ocupacionais de pele são uma condição frequentemente autorrelatada em países industrializados. No entanto, existem poucos instrumentos de autorrelato desenvolvidos e padronizados para triagem da população de risco para doenças ocupacionais de pele. Objetivos: Tradução e Adaptação Transcultural da versão longa e curta do Nordic Occupational Skin Symptoms Questionnaire para o português brasileiro. Métodos: O processo de tradução e adaptação transcultural do questionário foi desenvolvido seguindo as boas práticas recomendadas pela International Society for Pharmacoeconomics and Outcomes Research. Resultados: Após a tradução para o português brasileiro, a primeira versão conciliada do questionário foi avaliada em uma primeira rodada de entrevistas com 28 indivíduos entre pacientes com doença dermatológica e pessoas saudáveis. Na primeira reunião do grupo de revisão do estudo, foram feitas alterações em 43 questões (75,4%) (por exemplo, inclusão de definição de termos, reformulação de instruções e alteração para palavras alternativas ou sinônimos). Na segunda reunião do grupo de revisão do estudo, houve modificações em três questões, criação da segunda versão de consenso em português brasileiro e, posteriormente, a retrotradução desta versão. Após a segunda rodada de entrevistas cognitivas, que ocorreram com 10 pacientes, tivemos a terceira reunião do grupo de revisão (não houve modificação) e definição da versão final do questionário. Conclusões: As versões curta e longa do questionário Nordic Occupational Skin Symptoms Questionnaire estão disponíveis em português brasileiro.

Reliability of Cardiorespiratory and Metabolic Responses During Incremental Shuttle Walk Test in Adult Subjects With Asthma.

BACKGROUND: The incremental shuttle walk test (ISWT) has been widely used to assess exercise capacity of subjects with COPD. However, to date, no studies have assessed its reliability in the asthmatic population. This study aimed to assess the test-retest reliability of ISWT for the distance walked (ISWD) and cardiorespiratory and metabolic responses in adult subjects with asthma. METHODS: This was a cross-sectional observational study. Thirty-four subjects of both genders, 18-45 y old, with a diagnosis of controlled asthma, were recruited from March 2012 to December 2015. The subjects performed 3 ISWTs on different days, with a minimum interval of 48 h and a maximum of 1 week between the second and third ISWT. For the reliability analysis, the values of the second and third ISWTs were used, eliminating the influence of any learning effect from the first test. RESULTS: The intraclass correlation coefficients were > 0.75 (P < .001) for ISWD (m), speed (km/h),oxygen uptake (V̇O2 ), ventilatory equivalent carbon dioxide (V̇E/V̇CO2 ), and minute ventilation (V̇E) at the ISWT peak. The Bland-Altman plot presented a mean error close to zero, and measurement distribution was within acceptable limits of variation. CONCLUSION: The ISWT presented excellent reliability for the ISWD and metabolic responses. The cardiorespiratory responses in the ISWTs presented good reliability. We concluded that the ISWT was reliable for young adult subjects with controlled asthma.

Relationship between exercise capacity and quality of life in adolescents with asthma.

OBJECTIVE: To determine whether the quality of life of adolescents with asthma correlates with parameters obtained prior to and after the six-minute step test (6MST); spirometric results after the 6MST; and level of physical activity. METHODS: Nineteen adolescents with asthma, ranging from 11-15 years of age, were assessed with spirometry, 6MST, the International Physical Activity Questionnaire (IPAQ), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 10-point Borg category-ratio (CR10) scale. RESULTS: Sensation of dyspnea correlated negatively with the total PAQLQ score (r = -0.54) and with the scores of its activity limitation (AL) and symptoms domains (r = -0.64 and r = -0.63, respectively), leg fatigue also correlating negatively with those same domains (r = -0.49 and r = -0.56, respectively). The total IPAQ score correlated with total PAQLQ score (r = 0.47) and with the PAQLQ AL domain (r = 0.51); IPAQ time spent walking correlated with the PAQLQ symptoms domain (r = 0.45); and IPAQ time spent in vigorous activity correlated with the AL domain (r = 0.50). In the regression analysis, only sensation of dyspnea remained significantly correlated with the total PAQLQ score and its AL domain; leg fatigue remained significantly correlated with the symptoms domain. CONCLUSIONS: Higher levels of physical activity indicate better quality of life, as do lower perception of dyspnea and less leg fatigue. The 6MST proved to be a viable option for evaluating exercise capacity in adolescents with asthma, because it reflects the discomfort that asthma causes during activities of daily living.

Manovacuometria realizada por meio de traqueias de diferentes comprimentos / La realización de la manovacuometría con tráqueas de distintas longitudes / Manovacuometry performed by different length tracheas

RESUMO A manovacuometria é um teste simples, rápido e não invasivo por meio do qual a pressão inspiratória máxima (PImáx) e a pressão expiratória máxima (PEmáx) são obtidas, a fim de auxiliar na avaliação muscular respiratória. Atualmente, há grande variedade de modelos e marcas de manovacuômetros, com diferentes diâmetros e comprimentos de traqueias, no entanto, a interferência desses modelos nas medidas obtidas por esses equipamentos necessita de investigação. Desta forma, o objetivo primário deste estudo foi verificar a influência do comprimento de traqueias nas pressões respiratórias máximas, obtidas por meio de manovacuômetro analógico, em indivíduos saudáveis e, secundariamente, se há correlação entre as medidas. Foram avaliados 50 indivíduos, de 18 a 30 anos, de ambos os sexos, por meio da espirometria e manovacuometria. As PImáx e PEmáx foram realizadas com uso de traqueias de mesmo diâmetro interno (0,5 cm) e comprimentos de 30, 60 e 90 cm. Foram observados valores significativamente menores de PImáx obtidos com a traqueia de comprimento de 90 cm comparados às PImáx obtidas com as traqueias de 30 e 60 cm (teste de Friedman's ANOVA com teste de Wilcoxon com ajuste de Bonferroni). As traqueias de 30, 60 e 90 cm de comprimento e mesmo diâmetro não influenciaram os valores de PEmáx e PImáx, exceto a traqueia de 90 cm para os valores de PImáx, o que pode interferir na prática clínica fisioterapêutica. Novos estudos são necessários para analisar a necessidade de padronização do comprimento da traqueia utilizada em manovacuômetros.

RESUMEN La manovacuometría es una prueba sencilla, rápida y no invasiva por la cual se obtienen la presión inspiratoria máxima (PImax) y la presión espiratoria máxima (PEmax), con el objetivo de ayudar en el examen muscular respiratorio. Hoy día se encuentran una gran variedad de modelos y marcas de manovacuometros, con diferentes diámetros y longitudes de las tráqueas, pero hacen falta estudios sobre la interferencia de estos modelos en las mediciones por este instrumento. En este texto se propone examinar en sujetos sanos, en primer lugar, la influencia en la longitud de las tráqueas en las presiones respiratorias máximas, obtenidas por manovacuometros analógicos, y en segundo lugar comprobar la existencia de correlación entre las mediciones. Se evaluaron a cincuenta sujetos entre 18 y 30 años de edad, tanto varones como mujeres, empleando la espirometría y la manovacuometría. Se midió la PImax y la PEmax empleando tráqueas de mismo diámetro interno (0,5 cm) y con longitudes de 30, 60 e 90 cm. Se observaron valores significativamente menores de PImax con la tráquea de longitud de 90 cm en comparación con las PImax con las tráqueas de 30 y 60 cm (prueba de Friedman's ANOVA, la de Wilcoxon con ajustes de Bonferroni). Las tráqueas de 30, 60 y 90 cm de longitud y mismo diámetro no influyeron en los valores de la PEmax y de la PImax, con excepción de la tráquea de 90 cm en los valores de la PImax, lo que puede interferir la práctica clínica fisioterapéutica. Se necesitan más estudios para evaluar la necesidad de estándares de la longitud de tráqueas empleadas en manovacuometros.

ABSTRACT Manovacuometry is a simple, fast, and non-invasive test, with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) obtained to assist respiratory muscle assessment. Currently, there is a wide variety of models and brands of manovacuometers with different trachea diameters and lengths. However, the interference of these models in the measurements obtained by these equipments needs to be investigated. Thus, this study mainly aimed to verify the influence of tracheal length on maximal respiratory pressures (MRP), obtained by an analog manovacuometer, in healthy individuals. Our secondary objective was to verify the correlation between measurements. Fifty individuals, aged 18 to 30, of both sexes, were evaluated by spirometry and manovacuometry. MIP and MEP were performed using tracheas with same internal diameter (0.5 cm) and 30 cm, 60 cm, and 90 cm length. Significantly lower MIP values were observed when comparing a 90 cm trachea to 30 and 60 cm tracheas (Friedman's ANOVA test and Wilcoxon test with Bonferroni adjustment). Tracheas with 30, 60, and 90 cm length and same diameter did not affect MIP and MEP values, except the 90 cm trachea for MIP values, which may interfere in the physical therapy clinical practice. Further studies are required to analyze the need for standardizing the trachea length used in manovacuometers.

Reprodutibilidade do teste de caminhada e do degrau de 6 minutos em adultos jovens saudáveis / Reproducibility of the six-minute walk and step tests in healthy young adults / Reproductibilidad del test de caminata y del escalón de 6 minutos en adultos jóvenes saludables

INTRODUÇÃO: Os testes caminhada de seis minutos (TC6) e degrau de seis minutos (TD6) são meios de avaliação da capacidade funcional. No entanto, pouco se sabe sobre sua reprodutibilidade em adultos jovens. OBJETIVO: Avaliar a reprodutibilidade relativa e absoluta tanto intra quanto inter-avaliadores do TC6 e TD6 em indivíduos adultos jovens. MÉTODOS: Foram avaliados 33 indivíduos adultos jovens aparentemente saudáveis por meio da espirometria; e realizados os testes TC6 e TD6. Três (T1, T2 e T3) TC6 e TD6 foram feitos em cada indivíduo, sendo o último de cada teste realizado por um avaliador diferente. Para a análise intra-avaliadores foram comparados os desempenhos do T1 e T2 enquanto que a análise inter-avaliadores foi feita pela comparação dos desempenhos do T3 com: T1; T2; e escolha do melhor dos primeiros dois testes. Foi calculado o coeficiente de correlação intra-classe (CCI) como medida da reprodutibilidade relativa; o erro padrão de medida; a diferença mínima detectável; traçados gráficos de Bland-Altman e teste ANOVA para analisar a reprodutibilidade absoluta. RESULTADOS: Observaram-se, nos dois testes funcionais, intra e inter-avaliadores, valores excelentes de reprodutibilidade relativa (CCI>0,75) e a reprodutibilidade absoluta mostrou alto erro. CONCLUSÃO: O TD6 e o TC6 apresentaram reprodutibilidade intra e inter-avaliadores excelente para a população adulto jovem, mas altos valores de erro. .

INTRODUCTION: Six Minute Walk Test (6MWT) and Six Minute Step Test (6MST) are tests to evaluate functional capacity. However, reproducibility of these tests is still not well known in young adults. OBJECTIVE: To evaluate intra and inter-rater relative and absolute reproducibility of 6MWT and 6MST in young adults. METHODS: Thirty-three apparently health young adults were evaluated through spirometry, 6MWT and 6MST. Three (T1, T2 and T3) of each 6MWT and 6MST were carried out on each individual, the latter (T3) by a different evaluator. Intra-rater analysis was performed comparing the performance of T1 and T2, while the inter-rater analysis was executed using the comparisons of T3 with T1, T2 and the best result of the first two. Intra-class correlation coefficient (ICC) was calculated as a measure of relative reproducibility; the standard error of measurement, minimal detectable change, Bland-Altman plots and repeated measures ANOVA were used to verify absolute reproducibility. RESULTS: Excellent values of relative reproducibility (ICC>0.75) were observed in both 6MWT and 6MST, yet high error values were found in absolute reproducibility analysis. CONCLUSION: 6MWT and 6MST present excellent intra and inter-rater relative reproducibility, but high error values. .

INTRODUCCIÓN: Los tests de caminata de seis minutos (TC6) y escalón de seis minutos (TD6) son medios de evaluación de la capacidad funcional. Mientras tanto, poco se sabe sobre su reproductibilidad en adultos jóvenes. OBJETIVO: Evaluar la reproductibilidad relativa y absoluta tanto intra como inter-evaluadores del TC6 y TD6 en individuos adultos jóvenes. MÉTODOS: Fueron evaluados 33 individuos adultos jóvenes aparentemente saludables por medio de espirometría; y realizados los tests TC6 y TD6. Tres (T1, T2 y T3) TC6 y TD6 fueron hechos en cada individuo, siendo el último de cada test realizado por un evaluador diferente. Para el análisis intra-evaluadores fueron comparados los desempeños del T1 y T2 mientras que el análisis inter-evaluadores fue hecho por la comparación de los desempeños del T3 con: T1; T2; y selección del mejor de los primeros dos tests. Fue calculado el coeficiente de correlación intra-clase (CCI) como medida de la reproductibilidad relativa; el Error Estándar de Medida; la diferencia mínima detectable; trazados gráficos de Bland-Altman y test ANOVA para analizar la reproductibilidad absoluta. RESULTADOS: Se observaron, en los dos tests funcionales, intra e inter-evaluadores, valores excelentes de reproductibilidad relativa (CCI>0,75) y la reproductibilidad absoluta mostró alto error. CONCLUSIÓN: El TD6 y el TC6 presentaron reproductibilidad intra e inter-evaluadores excelente para la población adulto joven, pero altos valores de error. .

Relação da capacidade de exercício com a qualidade de vida de adolescentes asmáticos / Relationship between exercise capacity and quality of life in adolescents with asthma

OBJETIVO: Determinar se parâmetros obtidos antes e depois da realização do teste do degrau de seis minutos (TD6), respostas espirométricas após o TD6 e o nível de atividade física se correlacionam com a qualidade de vida de adolescentes asmáticos. MÉTODOS: Foram avaliados 19 adolescentes asmáticos, com idades variando de 11-15 anos, por meio de espirometria, TD6, International Physical Activity Questionnaire (IPAQ, Questionário Internacional de Atividade Física), Questionário sobre a Qualidade de Vida na Asma Pediátrica (QQVAP) e escala CR10 de Borg. RESULTADOS: Houve correlações negativas entre sensação de dispneia e pontuação total do QQVAP (r = -0,54) e de seus domínios limitação nas atividades (LA) e sintomas (r = -0,64 e r = -0,63, respectivamente), assim como entre fadiga nos membros inferiores (MMII) e os mesmos domínios (r = -0,49 e r = -0,56, respectivamente). O escore total do IPAQ correlacionou-se com a pontuação total do QQVAP (r = 0,47) e o domínio LA (r = 0,51), enquanto o tempo de caminhada correlacionou-se com o domínio sintomas (r = 0,45), e o tempo de atividade intensa correlacionou-se com o domínio LA (r = 0,50). Na análise de regressão, somente a sensação de dispneia associou-se significativamente ao escore total e o domínio limitação nas atividades do QQVAP, e o mesmo ocorreu entre a fadiga dos MMII e o domínio sintomas. CONCLUSÕES: Quanto maior for o nível de atividade física e menor for a dispneia e a fadiga nos MMII, melhor é a qualidade de vida. O TD6 mostrou-se uma opção na avaliação da capacidade ao exercício desses indivíduos por refletir o incômodo que a asma provoca na prática das atividades da vida diária.

OBJECTIVE: To determine whether the quality of life of adolescents with asthma correlates with parameters obtained prior to and after the six-minute step test (6MST); spirometric results after the 6MST; and level of physical activity. METHODS: Nineteen adolescents with asthma, ranging from 11-15 years of age, were assessed with spirometry, 6MST, the International Physical Activity Questionnaire (IPAQ), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 10-point Borg category-ratio (CR10) scale. RESULTS: Sensation of dyspnea correlated negatively with the total PAQLQ score (r = -0.54) and with the scores of its activity limitation (AL) and symptoms domains (r = -0.64 and r = -0.63, respectively), leg fatigue also correlating negatively with those same domains (r = -0.49 and r = -0.56, respectively). The total IPAQ score correlated with total PAQLQ score (r = 0.47) and with the PAQLQ AL domain (r = 0.51); IPAQ time spent walking correlated with the PAQLQ symptoms domain (r = 0.45); and IPAQ time spent in vigorous activity correlated with the AL domain (r = 0.50). In the regression analysis, only sensation of dyspnea remained significantly correlated with the total PAQLQ score and its AL domain; leg fatigue remained significantly correlated with the symptoms domain. CONCLUSIONS: Higher levels of physical activity indicate better quality of life, as do lower perception of dyspnea and less leg fatigue. The 6MST proved to be a viable option for evaluating exercise capacity in adolescents with asthma, because it reflects the discomfort that asthma causes during activities of daily living.