Analysis of autonomic modulation during maximal and submaximal work rate and functional capacity in asthmatic children.

BACKGROUND: Children with asthma experience changes in functional capacity and autonomic control. The literature suggests that this imbalance is responsible for bronchial hyperresponsiveness, primarily during physical effort. OBJECTIVE: The aim of the present study was to evaluate variables of autonomic modulation and functional capacity in asthmatic children after maximum and submaximum work rate. METHODS: A cross-sectional study was carried out with 24 children [18 in the asthma group (AG) and 6 in the control group (CG)]. Evaluations involved heart rate variability (HRV) and functional capacity [shuttle walk test (SWT) and three-minute step test]. Pulmonary function was also evaluated through spirometry and the fractional concentration of expired nitric oxide (FeNO). RESULTS: The asthma diagnostic variables FEV(1) and FeNO differed significantly between groups (p = .01). Distance traveled on the SWT was lower in the AG (333.13 ± 97.25 m vs. 442.66 ± 127.21 m; p = .04). Perceived exertion was greater in the AG. The HRV variables rMSSD and HF did not decrease significantly during the SWT (maximum work rate) in the AG (p = .01 and .04). FeNO was negatively correlated with FEV(1)/FVC (r = -0.70; p = .004) and positively correlated with pNN50 (r = 0.50; p = .03) in the AG. CONCLUSION: From the autonomic standpoint, asthmatic and non-asthmatic children respond differently to stress. No withdrawal of parasympathetic cardiac modulation occurs in asthmatic children after maximum work rate. Children with asthma experience changes in functional capacity and lung function may vary depending on the degree of inflammation of the airways.

Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is characterized by pulmonary and systemic inflammation. However, increases in the levels of inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study was to evaluate whether a home-based pulmonary rehabilitation (HBPR) program improves exercise tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of health-related quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers (interleukin [IL]-6 and IL-8). At the end of the evaluations, patients received a booklet containing the physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25 patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant increase in the walked distance and the maximal inspiratory pressure, improvements on two components from the health-related quality-of-life questionnaire, and a decrease in plasma IL-8 levels after the intervention. The HBPR is an important and viable alternative to pulmonary rehabilitation for the treatment of patients with COPD; it improves exercise tolerance, inspiratory muscle strength, quality of life, and systemic inflammation in COPD patients.

Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial.

INTRODUCTION: Pulmonary rehabilitation (PR) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving the functional capacity and quality of life, as well as maintaining the clinical stability of COPD sufferers. However, not all patients are available for such a program despite discomfort with their condition. The aim of this study was to evaluate the effects of a home-based PR (HBPR) program on functional ability, quality of life, and respiratory muscle strength and endurance. PATIENTS AND METHODS: Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were randomized (double-blind) into two groups. One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group; the other group received only instructions to perform breathing and stretching exercises, characterizing it as the control group (CG). We assessed the following variables at baseline and 2 months: exercise tolerance (incremental shuttle walk test and upper limb test), respiratory muscle (strength and endurance test), and health-related quality of life (Airways Questionnaire 20). RESULTS: There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life. However, the intervention group had improved respiratory endurance compared with the CG, while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR. CONCLUSION: A program of HBPR with biweekly supervision (although not enough to provide significant improvements in physical capacity or quality of life) played an important role in maintaining the stability of the clinical features of patients with COPD; the patients had no worsening of symptoms during the intervention period according to the daily log.

Assessment of body composition, functional capacity and pulmonary function in patients with Chronic Obstructive Pulmonary Disease / Evaluación de la composición corporal, la capacidad funcional y la función pulmonar en pacientes con Enfermedad Pulmonar Obstructiva Crónica / Avaliação da composição corporal, capacidade funcional e função pulmonar em pacientes com Doença Pulmonar Obstrutiva Crônica

Chronic obstructive pulmonary disease (COPD) is related to a low body mass index (BMI), reduced functional capacity and reduced bone density, thus justifying the importance of evaluating all of these parameters in the patients with the disease. This is a cross-sectional study, with sample consisting of 20 patients who performed measurement of body composition by bioelectrical impedance, evaluation of functional capacity by the distance traveled in the Incremental Shuttle Walk Test (ISWT) and assessment of severity of obstruction by spirometry. Significant differences were found between the travelled and scheduled distance in the ISWT (p<0.01), positive correlations between muscle mass and distance walked in ISWT (r=0.54 with p=0.01), with FEV1 (r=0.488 with p=0.02), FEV1 and bone mass (r=0.497 with p=0.02) and distance traveled with FEV1 (r=0,541 with p=0.01). The correlations found in this study, besides confirming the hypothesis that the severity of the obstruction presented by the change in the lung parenchyma in patients with COPD is related to changes in body composition and functional capacity reduction, also highlight the correlation with bone mass...

La enfermedad pulmonar obstructiva crónica (EPOC) está relacionada con un bajo índice de masa corporal (IMC), reducción de la capacidad funcional y reducción de la densidad ósea, justificando así la importancia de evaluar todos estos parámetros en pacientes con la enfermedad. Este es un estudio transversal, con una muestra de 20 pacientes, que se sometieron a la medición de la composición corporal por bioimpedancia, la evaluación de la capacidad funcional por la distancia recorrida en el Incremental Shuttle Walk Test (ISWT) y la evaluación de la gravedad de la obstrucción por la espirometría. Se encontraron diferencias significativas entre la distancia recorrida y prevista del ISWT (p<0,01), correlaciones positivas entre la masa muscular y la distancia en el ISWT (r=0,54 con p=0,01), con FEV1 (r=0,488 con p=0,02 ), FEV1 y la masa ósea (r=0,497 con p=0,02) y la distancia recorrida con el FEV1 (r=0,541 con p=0,01) . Las correlaciones encontradas en este estudio, además de confirmar la hipótesis de que la gravedad de la obstrucción presentada por los cambios en el parénquima pulmonar en pacientes con EPOC se asocia con cambios en la composición corporal y la reducción de la capacidad funcional, evidencian también la correlación con la masa ósea...

A doença pulmonar obstrutiva crônica (DPOC) está relacionada a um baixo índice de massa corporal (IMC), à redução da capacidade funcional e à redução da densidade óssea, justificando assim a importância de se avaliar todos esses parâmetros nos pacientes portadores da doença. Trata-se de um estudo transversal, com amostra composta por 20 pacientes, que realizaram medida de composição corporal por bioimpedância, avaliação da capacidade funcional pela distância percorrida no Incremental Shuttle Walk Test (ISWT) e avaliação da gravidade da obstrução pela espirometria. Foram encontradas diferenças significantes entre a distância percorrida e prevista do ISWT (p<0,01), correlações positivas entre massa muscular e distância percorrida no ISWT (r=0,54 com p=0,01), com VEF1 (r=0,488 com p=0,02), VEF1 e massa óssea (r=0,497 com p=0,02) e distância percorrida com VEF1 (r=0,541 com p=0,01). As correlações encontradas neste estudo, além de confirmarem a hipótese de que a gravidade da obstrução apresentada pela alteração no parênquima pulmonar nos pacientes com DPOC está relacionada com as alterações na composição corporal e com a redução da capacidade funcional, evidenciam também a correlação com a massa óssea...

Correlation between functional capacity and health-related quality of life in COPD: a case series / Correlação entre capacidade funcional e qualidade de vida na DPOC: série de casos

Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson's (parametric data) or Spearman's (non-parametric data) rank tests, with p < 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

Objetivo Correlacionar as respostas de testes de capacidade funcional em indivíduos portadores de doença pulmonar obstrutiva crônica (DPOC) com o estado funcional avaliado de maneira subjetiva pelos questionários de qualidade de vida, sendo um específico para doença respiratória (SGRQ) e outro genérico (SF-36). Materiais e métodos Foi realizado um estudo de uma série de casos com oito pacientes portadores de DPOC que realizaram os seguintes testes: 1) Teste de caminhada de seis minutos (TC6’); 2) Shuttle walking test (SWT); 3) Teste do degrau de seis minutos (TD6’); 4) Teste de sentar e levantar-se da cadeira em dois minutos (TCad-2min); e 5) Pegboard and ring test (PBRT). Além dos testes, foram aplicados dois questionários de qualidade de vida: Hospital Saint George na doença respiratória (SGRQ) e o Short Form 36 (SF-36). A análise estatística foi realizada pelo teste de normalidade Shapiro-Wilk seguido dos testes de correlação de Pearson (dados paramétricos) ou de Spearman (dados não-paramétricos) com p < 0,05. Resultados Somente o TC6’ mostrou forte correlação com o SF-36 nos aspectos físicos, estado geral de saúde, vitalidade, aspectos sociais e saúde mental, diferentemente dos outros testes de capacidade funcional que não mostraram correlação com este questionário. Com relação ao SGRQ, não houve correlação com nenhum dos testes. Conclusões O TC6’ pode ser um bom teste para refletir a qualidade de vida dos indivíduos portadores de DPOC.

Reabilitação pulmonar em crianças / Pulmonary rehabilitation in children

As doenças crônicas evoluem com imobilidade, perda da capacidade funcional e diminuição na qualidade de vida dos pacientes. A reabilitação pulmonar tem como objetivo restaurar estas alterações de forma multifatorial e multidisciplinar. Objetivo desta revisão foi mostrar o que os estudos atuais discutem sobre o assunto em diversas situações patológicas e quais as tendências futuras para a reabilitação cardiopulmonar em crianças. Foi realizada uma revisão bibliográfica entre 2000 e 2012 nas bases MedLine, Lilacs, SciELO, PubMed, PEDro com as palavras-chave reabilitação pulmonar em crianças, cardiopatias congênitas, obesidade, fibrose cística, diabetes e realidade virtual. Foram incluídos na revisão os ensaios clínicos. Assim, na base PEDro, dos 17 artigos encontrados, 6 foram incluídos; na PubMed, dos 124 encontrados, 11 foram incluídos, totalizando 17 artigos. A atividade aeróbia, assim como a melhora da capacidade cardiopulmonar esteve presente no cerne de todos os estudos avaliados. A atividade física regular, em especial aeróbia, é benéfica para várias condições patológicas em crianças que evoluem com perda da capacidade funcional e, consequentemente, da qualidade de vida. Métodos alternativos de treinamento como a utilização da realidade virtual com videogames ativos parecem promissores, porém ainda necessitam de maior investigação...