Single breath counting technique to assess pulmonary function: a systematic review and meta-analysis.

Pulmonary function is usually assessed by measuring Vital Capacity (VC) using equipment such as a spirometer or ventilometer, but these are not always available to the population, as they are relatively expensive tests, difficult to transport and require trained professionals. However, the single breath counting technique (SBCT) appears as a possible alternative to respiratory function tests, to help in the pathophysiological understanding of lung diseases. The objective is to verify the applicability of the SBCT as a parameter for evaluating VC. This is a systematic review registered in the International Prospective Register of Systematic Reviews (CRD42023383706) and used for PubMed®, Scientific Electronic Library Online, LILACS, EMBASE, and Web of Science databases of articles published until January 2023. Methodological quality regarding the risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and National Institutes of Health tools. Eleven of a total of 574 studies were included, of these, nine showed a correlation between VC and SBCT (weak in healthy, moderate in neuromuscular and strong in hospitalized patients). One study of hospitalized patients accurately identified a count value of 21 for a VC of 20 ml kg-1(Sensitivity = 94% and Specificity = 77%), and another estimated a count lower than 41 for a VC below 80% of predicted in patients with neuromuscular dystrophy (Sensitivity = 89% and Specificity = 62%), and another showed good intra and inter-examiner reproducibility in young, adult, and elderly populations. A meta-analysis of three studies showed a moderate correlation in subjects with neuromuscular diseases (r= 0.62, 95% CI = 0.52-0.71,p< 0.01). A high risk of bias was identified regarding the justification of the sample size and blinding of the evaluators. SBCT has been presented as an alternative to assess VC in the absence of specific equipment. There is a clear relationship between SBCT and VC, especially in neuromuscular and hospitalized individuals. New validation studies conducted with greater control of potential bias risks are necessary.

Analysis of the association between exercise induced bronchospasm, cardiorespiratory fitness, and physical activity levels of adolescents / Análise da relação entre broncoespasmo induzido por exercício, aptidão cardiorrespiratória e nível de atividade física de adolescentes / Análisis de la relación entre el broncoespasmo inducido por el ejercicio, la capacidad cardiorrespiratoria y el nivel de actividad física entre adolescentes

ABSTRACT This study aims to verify the association between exercise-induced bronchospasm (EIB), cardiorespiratory fitness, and physical activity levels in adolescents. To do so, we evaluated 202 healthy adolescents aged from 13 to 18 years, out of which 94 (46.5%) were females and 108 (53.5%) males. Participants performed a bronchial challenge test in a treadmill (Master Super ATL, Inbramed®) to evaluate bronchial hyper-responsiveness; a spirometric test (Microquark, Cosmed®) to evaluate lung function; answered the Baecke's Questionnaire of Habitual Physical Activity; and performed the progressive aerobic cardiovascular endurance run test. Data were analyzed using Spearman's correlation, chi-square test, and odds ratio. The significance level adopted was p<0.05. No statistically significant correlations were found between the decrease of the forced expiratory volume in the first second (FEV1), cardiorespiratory fitness, and physical activity levels. Likewise, the chi-squared test revealed no significant differences between classifications of cardiorespiratory fitness (low or adequate) and EIB (presence or absence) (χ2=0.155; p=0.694). Finally, odds ratio showed no increased chances of the presence of EIB in participants who presented low cardiorespiratory fitness (OR=1.130; CI: 0.616-2.073). We concluded that cardiorespiratory fitness and physical activity levels are not associated with the decrease of FEV1 and that there is no relation between the presence of EIB and the classification of cardiorespiratory fitness of adolescents.

RESUMO Este estudo teve como objetivo verificar a associação entre o broncoespasmo induzido pelo exercício (BIE), a aptidão cardiorrespiratória e o nível de atividade física de adolescentes. Para tanto, participaram do estudo 202 adolescentes saudáveis com idades entre 13 e 18 anos, sendo 94 (46,5%) do sexo feminino e 108 (53,5%) do sexo masculino. Os participantes realizaram um teste de broncoprovocação em esteira ergométrica e um teste espirométrico, além de responderem a um questionário de nível de atividade física (Baecke's Questionnaire of Habitual Physical Activity) e realizarem um teste de aptidão cardiorrespiratória (progressive aerobic cardiovascular endurance run test). Os dados foram analisados por meio da correlação de Spearman, teste qui-quadrado e cálculo de razão de chances (odds ratio). O nível de significância adotado foi p<0,05. Não foram encontradas correlações significativas entre a queda do volume expiratório forçado no primeiro segundo (VEF1), a aptidão cardiorrespiratória e o nível de atividade física dos adolescentes. Da mesma maneira, o teste qui-quadrado não revelou diferenças significativas entre as classificações da aptidão cardiorrespiratória (baixa ou adequada) e o BIE (presença ou ausência) (χ2=0,155; p=0,694). Por fim, a análise de razão de chance não demonstrou maiores chances de se verificar a presença de BIE nos participantes que apresentaram baixa aptidão cardiorrespiratória (OR=1,130; IC: 0,616-2,073). Conclui-se que a aptidão cardiorrespiratória e o nível de atividade física não estão associados com a queda do VEF1, e que não há relação entre a presença de BIE com a classificação da aptidão cardiorrespiratória de adolescentes.

RESUMEN Este estudio tuvo como objetivo verificar la asociación entre el broncoespasmo inducido por el ejercicio (BIE), la capacidad cardiorrespiratoria y el nivel de actividad física entre adolescentes. Para ello, participaron en el estudio 202 adolescentes sanos de entre 13 y 18 años, de los cuales 94 (46,5%) son mujeres y 108 (53,5%) hombres. Los participantes realizaron una prueba de provocación bronquial en cinta rodante (Master Super ATL, Inbramed®) y una prueba espirométrica (Microquark, Cosmed®), respondieron un cuestionario de nivel de actividad física (Baecke's Questionnaire of Habitual Physical Activity) y realizaron una prueba de aptitud cardiorrespiratoria (progressive aerobic cardiovascular endurance run test). Los datos se analizaron mediante la correlación de Spearman, la prueba de chi-cuadrado y la razón de probabilidades (odds ratio). El nivel de significancia adoptado p<0,05. No se encontraron correlaciones significativas entre la caída del volumen espiratorio forzado en un segundo (VEF1), la capacidad cardiorrespiratoria y el nivel de actividad física de los adolescentes. Asimismo, la prueba de Chi-Cuadrado no reveló diferencias significativas entre las clasificaciones de capacidad cardiorrespiratoria (baja o adecuada) y la BIE (presencia o ausencia) (χ2=0,155; p=0,694). Finalmente, el análisis de la razón de posibilidades no mostró mayores posibilidades de presencia de EIB en participantes que tenían baja capacidad cardiorrespiratoria (OR=1,130; IC: 0,616-2,073). Se concluye que la capacidad cardiorrespiratoria y el nivel de actividad física no se asocian con una caída del VEF1 y que no existe relación entre la presencia de BIE y la clasificación de capacidad cardiorrespiratoria de los adolescentes.

Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region.

OBJECTIVE: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. METHODS: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. RESULTS: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. CONCLUSION: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

Comparison of the printed and online administration of the Behavioral Regulation in Exercise Questionnaire (BREQ-2).

OBJECTIVE: To compare the traditional printed form of the Behavioral Regulation in Exercise Questionnaire with a proposed online form in terms of validity, reliability, and applicability. METHODS: A crossover design study was conducted with 157 undergraduate students. Half of the sample answered the printed questionnaire first and then answered the online questionnaire 7 days later, while the other half of the sample did the inverse. Cronbach's alpha was used to analyze the internal consistency of both the online and printed questionnaires. The construct validity was analyzed by confirmatory factor analysis, using a weighted least square mean and adjusted variance estimation and oblique rotation. The quality of the model was tested with fit indices. RESULTS: The confirmatory factor analysis showed the 19-item structure with five factors: χ2 of 230.718; degrees of freedom of 142; χ2/degrees of freedom of 1.625; comparative fit index of 0.978 and root mean square error of approximation of 0.073. All items presented factorial loads above 0.5. There was also excellent consistency between the formats of administration in all dimensions, with Cronbach's alpha values above 0.70. The stability between the formats of administration varied between 0.78 (95%CI: 0.69-0.85) and 0.84 (95%CI: 0.77-0.89), suggesting desirable confidence between both formats of administration. CONCLUSION: The five-factor model of the online Behavioral Regulation in Exercise Questionnaire shows internal consistency both in terms of the scale dimensions as well as in terms of the total items.

Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region / Influência de alterações climáticas sobre a ocorrência do broncoespasmo induzido por exercício em adolescentes de uma região semiárida

ABSTRACT Objective: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. Methods: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. Results: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. Conclusion: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

RESUMO Objetivo: Verificar a influência das alterações climáticas sobre o broncoespasmo induzido por exercício, nos períodos chuvoso e seco de uma região do semiárido brasileiro. Métodos: Foram submetidos à avaliação do broncoespasmo em esteira ergométrica, em ambiente externo, nos períodos chuvoso e seco, 82 adolescentes, com idades de 15 a 18 anos. Foram avaliadas as variáveis antropométricas, a maturação sexual e o volume expiratório forçado no primeiro segundo. Para comparação da temperatura e umidade, queda do volume expiratório forçado no primeiro segundo (%) e frequência do broncoespasmo entre os períodos, foram utilizados o teste t de Student independente, o teste de Wilcoxon e o teste de McNemar, respectivamente. O nível de significância adotado foi p<0,05. Resultados: A média de idade foi 15,65±0,82 anos. A temperatura, a umidade e a queda do volume expiratório forçado no primeiro segundo (%) diferiram entre os períodos, com valores de temperatura e umidade maiores no período chuvoso (29,6ºC±0,1 e 70,8%±0,6 versus 28,5ºC±0,2 e 48,4%±0,6; p<0,05). A queda do volume expiratório forçado no primeiro segundo (%) foi maior no período seco (9,43%±9,97 versus 12,94%±15,65; p<0,05), e não foi encontrada diferença da frequência do broncoespasmo entre os períodos. Conclusão: O período seco influenciou negativamente no volume expiratório forçado no primeiro segundo de adolescentes, observando maior percentual de queda dessa variável nesse período. De acordo com os achados, propõe-se uma maior gravidade do broncoespasmo induzido por exercício em condições de baixa umidade.

Maximum phonation time in the pulmonary function assessment / Tempo máximo de fonação para avaliação da função pulmonar

ABSTRACT Purpose: to evaluate the reliability of the maximum phonation time (MPT) and Vital Capacity intra and inter-examiner, by means of the single-breath counting test (CT) and the sustained /a/ phoneme, and the slow vital capacity (SVC). Methods: a reliability study carried out in three groups of healthy individuals, each group with 30 volunteers, allocated according to age. SVC was measured using a spirometer, while the MPT was assessed by the phoneme /a/ and CT. The data were analyzed using SPSS version 20.0. Initially, descriptive statistics were used and for data reliability, the intraclass correlation coefficient (ICC). Results: the Intraclass Correlation Coefficients (ICC) were considered excellent, with significant results above 0.92 for SVC and greater than 0.79 for CT and phoneme /a/. Regarding the inter-examiner evaluation, the ICCs were also significant for both SVC with values greater than 0.96, and for CT and the phoneme /a/ with values greater than 0.85. The error inherent in the technique was assessed using the standard error of the measurement for intra and inter-examiner analyses with values ranging from 1.79 to 3.29 for phoneme /a/, 3.20 to 6.58 for CT and 65, 05 to 206.73 for SVCml. Conclusion: phonation techniques with the phoneme /a/ and CT, as well as SVC, have an excellent reliability, due to intra and inter-examiner agreement measures.

RESUMO Objetivo: avaliar a concordância do tempo máximo de fonação (TMF) com a Capacidade Vital, intra e interexaminador, por meio da técnica de contagem numérica em uma única respiração (TC) e do fonema /a/ sustentado e da capacidade vital lenta (CVL). Métodos: trata-se de um estudo de concordância realizado em três grupos de indivíduos saudáveis, cada grupo com 30 voluntários, alocados de acordo a idade. A CVL foi mensurada por meio do espirômetro, enquanto o TMF foi avaliado pela emissão do fonema/a/ e da TC. Os dados foram analisados pelo programa SPSS versão 20.0. Inicialmente utilizou-se estatística descritiva e para concordância dos dados foi utilizado o coeficiente de correlação intraclasse (CCI). Resultados: os Coeficientes de Correlação Intraclasse (CCI) intraexaminadores foram considerados excelentes, com resultados significantes acima de 0,92 para a CVL e maiores que 0.79 para a TC e fonema/a/. Em relação à avaliação interexaminadores, os CCIs também foram significantes tanto para a CVL com valores maiores que 0,96 quanto para a TC e o fonema/a/ com valores maiores que 0,85. O erro inerente a técnica foi avaliada por meio do erro padrão da medida para as analises intra e interexaminadores com valores que variaram de 1,79 a 3,29 para fonema/a/, 3,20 a 6,58 para TC e 65,05 a 206,73 para CVLml. Conclusão: as técnicas de fonação com o fonema /a/ e TC, assim como a CVL, demonstraram uma excelente concordância intra e interexaminadores.

Comparison of the printed and online administration of the Behavioral Regulation in Exercise Questionnaire (BREQ-2) / Comparação da administração impressa e on-line do Behavioral Regulation in Exercise Questionnaire (BREQ-2)

ABSTRACT Objective: To compare the traditional printed form of the Behavioral Regulation in Exercise Questionnaire with a proposed online form in terms of validity, reliability, and applicability. Methods: A crossover design study was conducted with 157 undergraduate students. Half of the sample answered the printed questionnaire first and then answered the online questionnaire 7 days later, while the other half of the sample did the inverse. Cronbach's alpha was used to analyze the internal consistency of both the online and printed questionnaires. The construct validity was analyzed by confirmatory factor analysis, using a weighted least square mean and adjusted variance estimation and oblique rotation. The quality of the model was tested with fit indices. Results: The confirmatory factor analysis showed the 19-item structure with five factors: χ2 of 230.718; degrees of freedom of 142; χ2/degrees of freedom of 1.625; comparative fit index of 0.978 and root mean square error of approximation of 0.073. All items presented factorial loads above 0.5. There was also excellent consistency between the formats of administration in all dimensions, with Cronbach's alpha values above 0.70. The stability between the formats of administration varied between 0.78 (95%CI: 0.69-0.85) and 0.84 (95%CI: 0.77-0.89), suggesting desirable confidence between both formats of administration. Conclusion: The five-factor model of the online Behavioral Regulation in Exercise Questionnaire shows internal consistency both in terms of the scale dimensions as well as in terms of the total items.

RESUMO Objetivo: Comparar a forma tradicional impressa do Behavioral Regulation in Exercise Questionnaire com uma proposta de formulário on-line, em termos de validade, confiabilidade e aplicabilidade. Métodos: Estudo de delineamento cruzado (crossover) realizado com 157 estudantes universitários de graduação. Metade da amostra respondeu primeiro ao questionário impresso e, 7 dias depois, ao questionário on-line, enquanto a outra metade da amostra fez o inverso. O coeficiente alfa de Cronbach foi usado para analisar a consistência interna dos questionários on-line e impressos. A validade de construção foi verificada por análise fatorial confirmatória, utilizando-se um estimador de mínimos quadrados ajustados pela média e variância e rotação oblíqua. A qualidade do modelo foi testada com índices de ajuste. Resultados: A análise fatorial confirmatória mostrou a estrutura de 19 itens com cinco fatores: χ2 de 230,718; graus de liberdade de 142; χ2/grau de liberdade de 1,625; índice de ajuste comparativo de 0,978 e raiz do erro quadrático médio de aproximação de 0,073. Todos os itens apresentaram cargas fatoriais acima de 0,5. Também houve excelente consistência entre os formatos de administração em todas as dimensões, com valores de alfa de Cronbach acima de 0,70. A estabilidade entre os formatos de administração variou entre 0,78 (IC95%: 0,69-0,85) e 0,84 (IC95%: 0,77-0,89), sugerindo confiança desejável entre os dois formatos de administração. Conclusão: O modelo de cinco fatores do Behavioral Regulation in Exercise Questionnaire on-line apresenta consistência interna tanto em relação às dimensões da escala quanto em relação ao total de itens.

Reliability of questionnaire The International Fitness Scale: a systematic review and meta-analysis.

Objective To perform a systematic literature review and meta-analysis to investigate the reliability of The International Fitness Scale questionnaire for assessing overall physical fitness and related components. Methods PubMed®, BIREME, SciELO, EMBASE, SPORTDiscus, LILACS and Cochrane databases were searched using the following search terms: "The International Fitness Scale", "International Fitness Scale" and "IFIS". Article selection and data extraction were performed according to the following eligibility criteria: reliability and/or validity study of the measure tools of The International Fitness Scale; adoption of the The International Fitness Scale as a reference criterion (gold standard) and being an original article. Quality of the study was considered based on Assessment of Reliability Studies. Data analysis used Kappa coefficient of agreement, Cochran and the Higgins I2 test. Sensitivity analysis was conducted using the withdrawal model. Results A total of seven articles were included in the analysis. Test-retest reliability coefficients ranged from 0.40 to 0.99, with most studies achieving values ≥0.60, indicative of moderate to substantial reliability. Conclusion In spite of appropriate test-retest scores attributed to most reliability indicators, heterogeneity among the studies remained high. Therefore, further studies with low risk of bias are needed to support the reliability of the self-reported The International Fitness Scale.

Reliability of questionnaire The International Fitness Scale: a systematic review and meta-analysis / Confiabilidade do questionário The International Fitness Scale: uma revisão sistemática e metanálise

ABSTRACT Objective To perform a systematic literature review and meta-analysis to investigate the reliability of The International Fitness Scale questionnaire for assessing overall physical fitness and related components. Methods PubMed®, BIREME, SciELO, EMBASE, SPORTDiscus, LILACS and Cochrane databases were searched using the following search terms: "The International Fitness Scale", "International Fitness Scale" and "IFIS". Article selection and data extraction were performed according to the following eligibility criteria: reliability and/or validity study of the measure tools of The International Fitness Scale; adoption of the The International Fitness Scale as a reference criterion (gold standard) and being an original article. Quality of the study was considered based on Assessment of Reliability Studies. Data analysis used Kappa coefficient of agreement, Cochran and the Higgins I2 test. Sensitivity analysis was conducted using the withdrawal model. Results A total of seven articles were included in the analysis. Test-retest reliability coefficients ranged from 0.40 to 0.99, with most studies achieving values ≥0.60, indicative of moderate to substantial reliability. Conclusion In spite of appropriate test-retest scores attributed to most reliability indicators, heterogeneity among the studies remained high. Therefore, further studies with low risk of bias are needed to support the reliability of the self-reported The International Fitness Scale.

RESUMO Objetivo Realizar uma revisão sistemática da literatura e metanálise para verificar se o questionário The International Fitness Scale apresenta boa confiabilidade na avaliação da aptidão física geral e seus componentes. Métodos A busca bibliográfica realizou-se nas bases de dados: PubMed®, BIREME, SciELO, EMBASE, SPORTDiscus, LILACS e Cochrane, a partir dos termos: "The International Fitness Scale ", " International Fitness Scale " e "IFIS". O processo de seleção e extração dos dados seguiram os critérios de elegibilidade: ser estudo de confiabilidade e/ou validade de instrumentos de medida do The International Fitness Scale ; ter o The International Fitness Scale como critério de referência (padrão-ouro); e ser artigo original. A qualidade dos estudos foi avaliada pelo Assessment of Reliability Studies . Para análise dos dados, utilizaram-se o coeficiente de concordância de Kappa, o teste Cochran e o I2de Higgins; para análise de sensibilidade, foi usado o modelo de retirada. Resultados No total, sete artigos foram incluídos na análise. Os coeficientes de confiabilidade teste-reteste dos estudos variaram de 0,40 a 0,99, sendo a maioria representada por valores ≥0,60, indicando de moderada a substancial confiabilidade. Conclusão Apesar dos indicadores de confiabilidade apresentarem um escore adequado para o teste-reteste, a heterogeneidade entre os estudos permaneceu elevada, necessitando de mais pesquisas com baixo risco de viés, para que o The International Fitness Scale autorrelatado seja considerado alternativa confiável.