Upper Limb Anaerobic Metabolism Capacity is Reduced in Mild and Moderate COPD Patients.

Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3' and 5' of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r2 = 0.604, adjusted r2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3' and 5' of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.

Balance impairment and lower limbs strength in patients with COPD who fell in the previous year.

Fall-related causes in patients with COPD might be associated to functional balance impairments and greater disease severity. We aimed to evaluate the reasons for falls in patients with COPD who had presented any fall during the previous year. This is a cross-sectional study. All COPD's GOLD classifications (mild, moderate, severe, and very severe) patients were recruited. In order to participate, patients ought to be clinically stable and without any exacerbation within 30 days prior to study entry. History of falls was self-reported by patients through an interview. Pre and post bronchodilator (salbutamol 400 µg) spirometry was performed. All patients accomplished postural balance tests such as the Berg Balance Scale, Falls Efficacy Scale-International, Time up and Go, Functional Reach test, Tinetti test and Chalder Scale; furthermore, lower limbs muscle strength (muscle dynamometry) and the COPD Assessment Test (CAT) were assessed. Ninety-six patients with COPD were evaluated and divided into two groups stratified according to any positive history of falls in the previous year. Patients with COPD who had any fall in the previous year presented older age (p=0.01), higher BMI (p=0.04) and worse pulmonary function than those who did not fall. The risk of falls was increased in patients with lower muscle strength in the lower limbs (OR 2.9, CI 95%;1.6 to 3.9), age greater than 65 years (OR 2.7, CI 95%;1.3 to 3.4), BMI greater than 28.8 kg/m2 (OR 3.2, CI 95%;1.1 to 5.6), very severe airway obstruction (OR 3.9, CI 95%;2.2 to 3.9) and fatigue (OR 3.2, CI 95%;1.5 to 5.3). Impaired body balance, reduced lower limb strength, disease severity, presence of fatigue and elevated BMI are important factors for falls in patients with COPD.

Dynamic hyperinflation during activities of daily living in COPD patients.

The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of these ADLs.

Frequency of Osteoporosis and Vertebral Fractures in Chronic Obstructive Pulmonary Disease (COPD) Patients.

BACKGROUND: Osteoporosis is a systemic skeletal disease characterized by low bone mass and/or microarchitectural deterioration of bone. Osteoporosis is a risk factor for fractures specially in patients with advanced COPD. The aim of this cross-sectional study was to determine the frequency of osteoporosis and vertebral fracture in COPD patients. METHODS: We evaluated 91 COPD patients and compared to 82 healthy subjects (control group) matched for gender and age. We measured the bone mineral density by means of dual energy X-ray absorptiometry (DXA), evaluating the lumbar vertebra (L1-L4), proximal femur and total femur and evaluated vertebral fractures in thoracic and lumbar spine using X-ray. We questioned patients whether they had had any fall that resulted in any fracture in the past five years. RESULTS: Males comprised 60.4% of COPD group and 57.3% of the control group. Mean age was 66.2±9.2 years for COPD group and 64.2±8.8 for the control group. The frequency of osteoporosis in the COPD group was 29.7% and 18.3% in control group (p=0.007). The frequency of vertebral fractures was 18.6% in the COPD group and 9.0% in control group (p=0.06). The frequency of reported falls at resulting in any fracture was 36.3% in the COPD group and 7.3% in control group (p=0.001). CONCLUSIONS: Our data indicate that COPD patients present a high frequency of osteoporosis and falls seem to be an important factor for vertebral fracture.

Variability in Quality of Life Outcomes Following a Pulmonary Rehabilitation Program in Patients With COPD.

PURPOSE: Pulmonary rehabilitation (PR) improves exercise tolerance in patients with chronic obstructive pulmonary disease. However, it is unclear why some patients do not improve quality of life during a training program. Our objective was to evaluate the differences between patients with chronic obstructive pulmonary disease who improve and those who do not improve quality of life during a pulmonary rehabilitation program. METHODS: Seventy-three patients underwent a PR program. All patients trained at 80% (legs) and 50% (arms) of their maximum load. Incremental and endurance tests, 6-min walk test, and health-related quality of life with the St George Respiratory Questionnaire (SGRQ) were measured. We subdivided the groups based on a decrease ≥4 points in the pre- and post-PR SGRQ total score (G1); <4-point change in the SGRQ total score (G2); and an increase in scores ≥4 points (G3). RESULTS: Exacerbation frequency (P = .004) and SGRQ total scores (P < .001) were lower in G1 and G2 than in G3. G1 (P = .0007) and G2 (P = .0005) significantly improved 6-min walk test distance. Before PR, G1 and G2 walked greater distances than G3 (P = .003); however, the difference was no longer significant after PR (P = .34). A significant load increase was seen after PR for the 3 groups (P < .05). We found a significant correlation between the SGRQ and the Charlson index (r = 0.78, P < .0001), exacerbation frequency (r = 0.72, P < .0001), and basal dyspnea index (r = -0.48, P < .0001). CONCLUSION: Patients whose quality of life did not improve after comprehensive PR presented a higher number of disease-related exacerbations with comorbidities.

Comparative Postural Control in COPD Patients and Healthy Individuals During Dynamic and Static Activities.

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) have body balance deficits, with consequent fall risk. It is possible that body sway in patients with COPD affects their ability to perform daily activities. The purpose of this study was to determine whether body balance is similar in patients with COPD and healthy persons when performing static and dynamic activities. In addition, we wanted to assess whether impairment of balance is related to the presence of falls in patients with COPD. METHODS: This is a cross-sectional study, in which every spirometric classification in patients with COPD (mild, moderate, severe, and very severe degrees) and age-matched healthy subjects was assessed. Subjects who were current smokers and patients who underwent physical training in the last 6 months prior to the start of the study were excluded. Static balance was assessed by computerized posturography and dynamic body balance using the Berg Balance Scale. RESULTS: Ninety-three patients with COPD and 39 healthy persons were evaluated. Mean age was 67.3 (10.8) and 65.1 (9.7) years and mean forced expiratory volume in 1 second (FEV1) was 50.4 (19.0) and 89.2 (23.6) for patients with COPD and healthy individuals, respectively. The impairment of body balance was higher for the group of patients with COPD (P = .0005). Patients with greater impairment in body balance had greater incidence of falls, and body balance was more affected with age in patients with COPD than in healthy persons. CONCLUSION: Impairment of body balance is more frequent in patients with COPD than in healthy persons while performing dynamic activities, and a greater incidence of falls activities was also found for this group.

Asynchrony and hyperinflation in patients with chronic obstructive pulmonary disease during two types of upper limbs exercise.

INTRODUCTION: Occurrence of dynamic hyperinflation during upper-limbs exercises in chronic obstructive pulmonary disease (COPD) patients it is not well established. We hypothesized that dynamic hyperinflation and thoracoabdominal asynchrony occurs in COPD patients accomplishing arms exercises. We assessed the occurrence and association of dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients during the accomplishment of two arm exercises. PATIENTS AND METHODS: This was a prospective study with 25 COPD patients. A maximal and a sub-maximal upper limbs exercise test with 50% load were performed with the diagonal technique and the arm cycle ergometer technique. Respiratory pattern, thoracoabdominal configuration and dynamic hyperinflation were assessed in the exercise tests. RESULTS: Thirty per cent and 60% of patients hyperinflated at the end of the sub-maximum exercise tests with the diagonal and cycle ergometer techniques, respectively. Thoracoabdominal asynchrony occurred in 80% and 100% of patients who hyperinflated with the diagonal and cycle ergometer techniques, respectively. For both exercises we found enhancement of pulmonary ventilation, dyspnea, central respiratory drive and shortening of expiratory time (P<.05). Upper-limbs exercises with the diagonal technique presented less number of patients with these alterations. CONCLUSIONS: Dynamic pulmonary hyperinflation and thoracoabdominal asynchrony association occurred in both upper-limbs exercises; however, the diagonal technique developed less dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients than the arm cycle ergometer.

Oxygen and ventilatory output during several activities of daily living performed by COPD patients stratified according to disease severity.

OBJECTIVES: To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity. MATERIALS AND METHODS: Metabolic (VO2 and VCO2), ventilatory (f and VE), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts. RESULTS: The activities with the highest proportional metabolic and ventilatory output (VO2/VO2max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05). CONCLUSIONS: COPD patients present an increased proportion of energy expenditure while performing activities of daily living. The activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD's reduced ventilatory reserve.

Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients.

OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.

Benefício do Método Pilates em mulheres com fibromialgia / Benefit Pilates Method in women with fibromyalgia

Introdução: A Síndrome da fibromialgia (SFM) é uma doença crônica com dor difusa. Objetivo - avaliar a eficácia do Método Pilates para a melhora da dor em pacientes com Fibromialgia. Método - Este estudo é prospectivo de autocontrole, os pacientes foram avaliados antes e após o tratamento por meio da algometria e da Escala Visual Analógica. A qualidade de vida por meio do Questionário Impacto da Fibromialgia (QIF) e o sono pelo Índice da Qualidade do Sono de Pittsburgh. O programa de exercícios de Pilates no solo teve 15 sessões, duas vezes por semana, com duração de 60 minutos. Resultados ­ compuseram o estudo 20 mulheres com SDF, tempo de diagnóstico de 6±4 anos, quanto a QIF os pacientes melhoraram em todos os domínios. Foi encontrada correlação entre o impacto da fibromialgia com a qualidade do sono. Conclusão - Os efeitos do Método Pilates são positivos para redução da dor.

Introduction - Fibromyalgia Syndrome (FMS) is a chronic disease with diffuse pain. Objective - To assess the effectiveness of Pilates for pain relief in patients with fibromyalgia. Method - This study is a prospective self-control, patients were evaluated before and after treatment by algometry and Visual Analogue Scale. The quality of life through the Fibromyalgia Impact Questionnaire (FIQ), and sleep by Pittsburgh Sleep Quality Index. The Pilates exercise program on the ground had 15 sessions, twice a week, during 60 minutes. Results - Composed these study 20 women with SDF, diagnosis time of 6 ± 4 years, as QIF patients improved in all areas. Correlation was found among the impact of fibromyalgia on the quality of sleep. Conclusion - The effects of Pilates are positive for reducing pain.

Modulation of operational lung volumes with the use of salbutamol in COPD patients accomplishing upper limbs exercise tests.

INTRODUCTION: Pulmonary dynamic hyperinflation (DH) is an important factor limiting the physical capacity of patients with COPD. Inhaled bronchodilator should be able to reduce DH. OBJECTIVE: To measure DH in COPD patients during upper limbs exercise tests with previous use of bronchodilator or placebo, and to evaluate the respiratory pattern to justify the dynamics of hyperinflation. METHODS: Inspiratory capacity (IC) of 16 patients with COPD (age: 63+/- 13 years; FEV(1) of 1.5+/-0.7 L-41+/-11% predicted) was measured before and after an incremental arm exercise test (diagonal technique) with randomly and double-blinded inhaled placebo or salbutamol. RESULTS: Rest IC increased from 2.32+/-0.44 L to 2.54+/-0.39 L after inhalation of 400 mcg of salbutamol (p=0.0012). There was a decrease in the IC after a maximal incremental arm exercise test, 222+/-158 ml (p=0.001) with placebo use, but no change was seen after the salbutamol use: 104+/-205 ml (p=0.41); 62% of the patients presented a 10% or more reduction in the IC after the exercise with placebo. There was a correlation between DH and lower FEV(1)/FVC (p=0.0067), FEV(1) predicted (p=0.0091) and IC% predicted (p=0.043) and higher VO(2)ml/Kg/min % predicted (p=0.05). Minute ventilation and respiratory rate were higher during the exercise with placebo (p=0.002) whereas VE/MVV ratio was lower in the exercise after salbutamol (p>0.05). CONCLUSION: We conclude that the use of bronchodilator increases the IC of patient with COPD and may help not to increase the DH during a maximal exercise with the arms.

Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients

OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.