RESUMO
Background: Alpha-1 antitrypsin deficiency (AATD) is an often-overlooked genetic condition that makes individuals susceptible to early onset of chronic obstructive pulmonary disease (COPD). The established benefits of exercise-based pulmonary rehabilitation (PR) for usual COPD patients are unclear for those with underlying AATD, especially given potentially differing muscle adaptations to exercise. This review seeks to compare PR outcomes between AATD and usual COPD patients and to consolidate current knowledge on exercise intervention outcomes for the AATD population. Methods: A thorough search of 4 databases (Ovid, Medline, CINAHL, CENTRAL) was conducted based on 3 search concepts: (1) alpha-1 antitrypsin deficiency, (2) pulmonary rehabilitation OR exercise, and (3) muscle morphology. A dual review process and quality assessment were independently implemented throughout all stages of the review. Results: Four studies highlighted modest exercise capacity and quality of life in AATD patients undergoing PR. However, one study reported unique muscle and mitochondrial responses compared to usual COPD patients. Additionally, a moderate exercise session did not alter pro-inflammatory cytokine levels in AATD patients, despite higher levels of tumor necrosis factor-α levels in muscle biopsies compared to usual COPD patients. Conclusions: The current literature base insufficiently addresses the efficacy of PR on AATD, with indications that exercise adaptation may deviate from that of usual COPD patients. Further research is needed to optimize PR, particularly in identifying the most suitable exercise intensity, and delivery setting, and addressing specific educational needs for individuals with AATD.
RESUMO
The purpose of the study was to investigate the effects of ankle angular position and standing surface type on static upright balance. Ten young adults stood on a force platform or on a firm wedge that induced 15° of either dorsiflexion or plantarflexion. In addition, a piece of foam was placed on top of the force platform and on the wedge. The center of pressure distance and velocity in the anteroposterior and mediolateral directions were calculated. Significantly larger magnitudes in most of the investigated variables were seen while standing with ankles in the dorsiflexion when compared with standing with the ankle joints in a natural position (p < .05). Plantarflexion increased the center of pressure anteroposterior velocity by 87% when compared with a natural stance (p < .05). Standing on the foam surfaces resulted in increases in all of the center of pressure measures by an average of 38% in all of the ankle conditions.