Effect of three exercise programs on patients with chronic obstructive pulmonary disease.

We compared the effect of three different exercise programs on patients with chronic obstructive pulmonary disease including strength training at 50_80% of one-repetition maximum (1-RM) (ST; N = 11), low-intensity general training (LGT; N = 13), or combined training groups (CT; N = 11). Body composition, muscle strength, treadmill endurance test (TEnd), 6-min walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and baseline dyspnea (BDI) were assessed prior to and after the training programs (12 weeks). The training modalities showed similar improvements (P > 0.05) in SGRQ-total (ST = 13 +/- 14%; CT = 12 +/- 14%; LGT = 11 +/- 10%), BDI (ST = 1.8 +/- 4; CT = 1.8 +/- 3; LGT = 1 +/- 2), 6MWT (ST = 43 +/- 51 m; CT = 48 +/- 50 m; LGT = 31 +/- 75 m), and TEnd (ST = 11 +/- 20 min; CT = 11 +/- 11 min; LGT = 7 +/- 5 min). In the ST and CT groups, an additional improvement in 1-RM values was shown (P < 0.05) compared to the LGT group (ST = 10 +/- 6 to 57 +/- 36 kg; CT = 6 +/- 2 to 38 +/- 16 kg; LGT = 1 +/- 2 to 16 +/- 12 kg). The addition of strength training to our current training program increased muscle strength; however, it produced no additional improvement in walking endurance, dyspnea or quality of life. A simple combined training program provides benefits without increasing the duration of the training sessions.

Effect of three exercise programs on patients with chronic obstructive pulmonary disease

We compared the effect of three different exercise programs on patients with chronic obstructive pulmonary disease including strength training at 50_80 percent of one-repetition maximum (1-RM) (ST; N = 11), low-intensity general training (LGT; N = 13), or combined training groups (CT; N = 11). Body composition, muscle strength, treadmill endurance test (TEnd), 6-min walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and baseline dyspnea (BDI) were assessed prior to and after the training programs (12 weeks). The training modalities showed similar improvements (P > 0.05) in SGRQ-total (ST = 13 ± 14 percent; CT = 12 ± 14 percent; LGT = 11 ± 10 percent), BDI (ST = 1.8 ± 4; CT = 1.8 ± 3; LGT = 1 ± 2), 6MWT (ST = 43 ± 51 m; CT = 48 ± 50 m; LGT = 31 ± 75 m), and TEnd (ST = 11 ± 20 min; CT = 11 ± 11 min; LGT = 7 ± 5 min). In the ST and CT groups, an additional improvement in 1-RM values was shown (P < 0.05) compared to the LGT group (ST = 10 ± 6 to 57 ± 36 kg; CT = 6 ± 2 to 38 ± 16 kg; LGT = 1 ± 2 to 16 ± 12 kg). The addition of strength training to our current training program increased muscle strength; however, it produced no additional improvement in walking endurance, dyspnea or quality of life. A simple combined training program provides benefits without increasing the duration of the training sessions.

Cytokines and dietary energy restriction in stable chronic obstructive pulmonary disease patients.

Tumour necrosis factor (TNF)-alpha has been found to be increased in malnourished chronic obstructive pulmonary disease (COPD) patients; however, the main cause of this phenomenon remains undetermined. In normal subjects, TNF-alpha production may be induced by dietary energy deprivation. The aim of this study was to investigate if stable COPD patients present alterations of inflammatory mediators after 48 h of dietary energy restriction. Fourteen COPD patients were admitted to the hospital while receiving an experimental diet with an energy content of approximately one-third of their energy needs. Clinical evaluation, nutritional assessment and serum levels of interleukin (IL)-6, TNF-alpha and C-reactive protein, and secretion of TNF-alpha by peripheral blood monocytes were assessed on admission and after the experimental diet. For reference values of the laboratory parameters, blood was collected from 10 healthy, elderly subjects. COPD patients showed significantly higher serum concentrations of IL-6 than control subjects, however, the experimental diet was not associated with statistically significant changes in the inflammatory mediators. The findings of this study, although preliminary because of the limited degree and duration of the energy restriction, suggest that the elevated levels of tumour necrosis factor-alpha, previously described in undernourished or weight-losing chronic obstructive pulmonary disease patients, may not be linked to a decrease of dietary energy intake.

Is chronic hypoxemia in patients with chronic obstructive pulmonary disease associated with more marked nutritional deficiency? A study of the fat-free mass evaluated by anthropometry and bioelectrical impedance methods.

In order to determine wheter blood gases abnormalities, specially hypoxemia, are associated with more marked changes in fat-free mass in patients with chronic obstructive pulmonary disease (CPOD), nutritional assessment was performed on 16 normoxemic (PaO2 > 55 mm Hg) and 16 hypoxemic (PaO2 < 55 mm Hg) COPD patients in stable clinical condition. Body weight was expressed as percentage of the ideal body weight. Fat-free mass was estimated by anthropometry (FFM-Anthr) and by bioelectrical impedance (FFM-BI). Handgrip-strength was assessed as a measure of peripheral skeletal muscle strength. Patients were age-matched and presented similar degree of airway obstruction. Malnutrition, defined as body weight less than 90% of the ideal, was observed in 19% of the normoxemic patients and in 25% of the hypoxemic patients (p>0,05). FFM values in hypoxemic patients, estimated by both methods, were not different from those observed in normoxemic patients. No significant difference was observed on handgrip values between the two groups. No correlation was found between nutritional indices and pulmonary function and gases exchange parameters. FFM correlated positively with values of peripheral muscle function in normoxemic and hypoxemic patients. These data add further evidence to the hypothesis that hypoxemia is not a primary cause of the nutritional deficiency observed in COPD patients.

Assessment of vitamin A status in chronic obstructive pulmonary disease patients and healthy smokers.

The relation between vitamin A status and the degree of lung airway obstruction was examined in a cross-sectional study of 36 male subjects aged 43-74 y who were assigned to five groups as follows: healthy nonsmokers (n = 7), healthy smokers (n = 7), mild chronic obstructive pulmonary disease (COPD-mild) patients (n = 9), COPD-moderate-severe patients (n = 7), and COPD-moderate-severe patients with exacerbation (+ex; n = 6). Smoking habits, pulmonary function tests, energy-protein status were assessed; serum concentrations of retinyl esters, retinol, retinol binding protein, and transthyretin and relative dose responses were measured. In addition, 12 male smokers aged 45-61 y with mild COPD were randomly assigned to two groups for a longitudinal study: six subjects consumed vitamin A (1000 RE/d; COPD-vitamin A) and six subjects received placebo for 30 d. Lowered serum retinol concentrations were found in the COPD-moderate-severe and COPD-moderate-severe+ex groups. Measurements of vitamin A status in healthy smokers and in COPD-mild patients were not different from those in healthy nonsmokers. The improvement of pulmonary function test results after vitamin A supplementation [mean increase for 1-s forced expiratory volume (FEV1) = 22.9% in the COPD-vitamin A group] may support the assumption of a local (respiratory) vitamin A deficiency in patients with this disease.

[The use of skinfolds and of the muscle circumference of the upper arm in the diagnosis of protein-energy malnutrition in adults patients: a critical study]. / O uso das pregas cutâneas e da circunferência muscular do braço no diagnóstico de desnutrição energético-protéica em pacientes adultos: estudo crítico.

The use of anthropometric measurements of triceps (TSF) and subscapular skinfolds (SSF) and mid-upper arm muscle circumference (MAMC) was examined as far as the diagnosis of energy-protein malnutrition (EPM) is concerned. The study was undertaken in five groups of patients (n = 231): arterial hypertension (AH, n = 63), chronic obstructive pulmonary disease (COPD, n = 17), hemodialyzed chronic renal failure (CRF, n = 19), critically ill patients with an acute event (CA, n = 42) and critically ill patients with chronic diseases (CCD, n = 90). The results were compared to those obtained in a group of healthy individuals (control group, n = 102). The control group and the group of patients were allocated in subgroups according to sex and age (less than 50 and more than 50 years). It was expected that significant differences would be found for the anthropometric values between the control subgroups and the COPD, the CRF and the CCD subgroups of patients. For the skinfold thicknesses (TSF and SSF), significant differences were found between CRF, CCD subgroups and the control subgroups under fifty years of age; however, the differences were not significant when the subgroups over fifty were analyzed. Concerning the MAMC, significant differences were found: 1 degree) between the CRF subgroups (males and females) and the control subgroups under fifty years of age; 2 degrees) between the CCD male subgroups (younger and older subgroups) and the respective control subgroups and 3 degrees) between the COPD and the control subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of nutritional status of adult middle class healthy subjects. Energy and protein intake, anthropometry, blood biochemical tests, and immunocompetence tests]. / Avaliação do estado nutricional de indivíduos adultos sadios de classe média. Ingestão energética e protéica, antropometria, exames bioquímicos do sangue e testes de imunocompetência.

Nutritional status was assessed in 151 middle-class healthy adult individuals (69 medical students, 18-29 y, 34 males, 35 females); 48 university personnel, 30-49 y, 24 males, 24 females; and their older relatives, 34 subjects, 50-79 y, 19 males, 15 females) living in Botucatu, S. Paulo. Methods included anthropometric measurements, energy and protein intakes, blood biochemical analyses and cutaneous delayed hypersensitivity tests. Anthropometric measurements showed higher values in men, with the exception of the triceps skinfold thickness (higher in women) and of the arm fat area (higher in the older age female groups); aging seemed to be associated with increases of weight, arm muscle variables and with arm fat accumulation in women and with increases of arm muscle variables in men. The values for anthropometric measurements were in general higher than those found in other Brazilian studies; on the other hand, they approximate to but do not entirely agree with the data representative of the international referential adult population: differences were mainly concerned with body weight and upper arm muscle parameters, which were lower in our sample. As regards energy intake, values found in subjects under 50 years of age were lower than the recommended dietary allowances; averages found for protein intake were above the level recommended by WHO/FAO/UNU (1985). The mean values for serum proteins and lipids were similar to those of referential data. As regards the hypersensitivity tests, it was found that none of the individuals challenged with four antigens (PPD, Candidin, Vaccinia and phytohemagglutinin) presented less than two positive skin reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

[The fat absorption test in children]. / Prova de absorção de gordura em crianças.

To overcome the difficulties observed with fecal fat estimations, we studied fat absorption in 4 m to 12 years old children, assessing increments of serum triglycerides after administration of corn oil. Eighteen well-nourished children without gastrointestinal symptoms or parasites, 31 children with protein-calorie malnutrition (PCM), with or without protracted diarrhea and/or intestinal parasites and nine children with specific malabsorptive entities were studied. Serum triglycerides (TG) were measured before, 2 and 4 hours after the administration of 2 g/kg of corn oil per os. For control infants below 2 years no significant differences between the fasting level and those after 2 and 4 hours were observed. For children above this age significant absorption occurred by 2 hours but more intensively after 4 hours, an increment of TG above 35 mg% being considered normal. A good discrimination between TG increments of controls and malabsorptive children over 2 years was observed. In conclusion, the oral fat loading test, is applicable for children over 2 year of age. For infants below this age other schedules should be tested.

Intraepithelial lymphocytes in the jejunal mucosa of malnourished rats.

Intraepithelial lymphocytes (IEL) have been counted in the jejunal mucosa of adult Wistar rats submitted to a protein-free diet for 84 days and of a control group receiving a 20% casein diet, in order to evaluate the effect of protein deprivation. Relative counts (IEL/100 epithelial cells), absolute counts (number of IEL per millimetre of muscularis mucosae), and the proportion of lymphocytes crossing the basement membrane have been evaluated. Both relative and absolute IEL counts were diminished but the proportion of crossing lymphocytes was greatly increased in the malnourished group. The low number of IEL seemed to be related to lymphatic vessel dilatation in the lamina propria. The possibly primary effect of malnutrition on IEL counts in our experimental model and the eventual role of the observed lymphatic dilatation have been discussed.

[Beta-glucuronidase activity in the gastric juice and gastric mucosa of rats subjected to protein deficiency]. / Atividade da beta-glucuronidase no suco gástrico e mucosa gástrica de ratos submetidos à carência protéica.

The experiment was performed in order to evaluate the beta-glucuronidase activity in gastric juice and gastric mucosa of rats submitted to protein-free diet. A group of 36 young adult male wistar rats was fed a protein-free diet ad libitum for five weeks; a second group of 36 wistar rats ingested a purified isocaloric 12,5% casein diet for the same period. The concentration of proteins in plasma, gastric juice and gastric glandular mucosa and the beta-glucuronidase activity in the gastric juice and gastric glandular mucosa were determined. Protein deficient rats had lower plasma protein concentration and also a lower protein concentration in gastric juice and gastric mucosa. In these animals there was no significant change of beta-glucuronidase activity in the gastric juice, but there was a significant increase of the specific enzimatic activity in the gastric mucosa. The results suggest that protein restriction in young adult rats affects the gastric mucosa. The increase of the specific beta-glucuronidase activity might be due to heightened local catabolism or to a comparatively more severe protein depletion.

Body collagen nitrogen in protein-deficient adult rats.

Four groups of 10 young adult male rats of the Wistar strain were fed on a protein-free diet ad libitium for periods of 7, 28, 56, and 84 days. Control groups were fed a purified 20% casein diet. Food intake and body weights of rats were measured. Hemoglobin and plasma protein levels, weight, total nitrogen, and collagen nitrogen of skin, carcass, muscle, and liver were determined. Protein-deficient rats lost body weight and had low plasma protein concentrations, but hemoglobin levels remained normal until day 56 of deficiency. The liver lost weight and nitrogen more rapidly than the other organs; the severity of nitrogen depletion in the organs increased with time fed the protein-deficient diet. When protein deficiency was severe, collagen nitrogen concentration increased in organs and carcass. This was not due to an actual increase of collagen nitrogen content; comparisons among malnourished groups showed that the total amount of collagen nitrogen in carcass, liver, and muscle was maintained and that the amount in skin diminished as periods of protein deprivation increased. In control rats, results indicated that the amount of collagen nitrogen in skin, muscle, and carcass increased during growth. These results indicate that protein restriction in adult rats affects collagen metabolism, with skin collagen being more markedly affected than that of other tissues.

Evaluation of V max TP as an index of myocardial contractility during afterload and preload elevations.

In order to test if the maximal velocity of shortening (V max TP) reflects the level of inotropism and is affected by preload and afterload, the behavior of this index was compared in two groups of anesthetized, atropinized dogs when preload and afterload were raised with an angiotensin II infusion. In seven dogs (group I), the arterial pressure elevation was allowed to inhibit reflectively the sympathetic tone and depress contractility. In eleven dogs (group II), the adrenergic activity was abolished by previous administration of reserpine. In group I, there was a significant decrease in V max TP during the angiotensin infusion. In group II, there was no significant change in the value of this index when the drug was infused. In six animals of this group, a further increase of arterial pressure was induced, but the values of V max TP remained similar to control. These results suggest that this index reflects the inotropic state of the myocardium and does not suffer significantly from the influence of preload and afterload elevations within our experimental limits.

Experimental protein deficiency in adult rats.

Male adult rats of the Wistar strain were fed "ad libitum" either a protein-free or a 20% casein diet for a period of 28 to 32 days. At the end of the experimental procedure, the animals given the protein-free diet presented a marked loss of body weight plus low levels of plasma protein and albumin concentration. Their livers showed diffuse fatty changes; most of the animals had moderate to severe fatty liver infiltration. They had a negative cumulative nitrogen balance; on the contrary, rats fed the 20% casein diet showed nitrogen retention. The animals of one of the two protein-deficient groups had a significant lower food intake than its control group. However, when food intake was related to animal body weight (g/100 g), the rates of rats on the 20% casein diet and those on protein-free diet were not significantly different.

Role of the autonomic nervous system in the inotropic variations induced by the infusion of angiotensin II.

Inotropic effects of angiotensin II were studied in 26 anesthetized dogs with different conditions of autonomic activity. The values of maximal velocity of contraction (Vmax TP) were compared before and 10 minutes after the arterial pressure was elevated by the infusion of the drug. In eight dogs, previously treated with atropine and reserpine, the administration of angiotensin had no effect on mean values of Vmax TP. Nine animals submitted to ganglionic blockade by hexamethonium presented an improvement of myocardial contractility when angiotensin was infused. In nine dogs studied with intact nervous system, infusion of the drug was accompanied by decrease of mean values of the index. It was concluded that the polypeptide exerts no important physiological effects upon myocardial contractility without the mediation of the autonomic nervous system. It was considered that the positive inotropic effect verified in dogs under ganglionic blockade was due to adrenergic hyperactivity induced by angiotensin. The depression of the contractile state observed in intact animals was supposed to be mediated by variations of autonomic nervous system activiity consequent to baroreceptor reflex.

Role of the autonomic nervous system in the inotropic variations induced by the infusion of angiotensin II.

Inotropic effects of angiotensin II were studied in 26 anesthetized dogs with different conditions of autonomic activity. The values of maximal velocity of contraction (Vmax TP) were compared before and 10 minutes after the arterial pressure was elevated by the infusion of the drug. In eight dogs, previously treated with atropine and reserpine, the administration of angiotensin had no effect on mean values of Vmax TP. Nine animals submitted to ganglionic blockade by hexamethonium presented an improvement of myocardial contractility when angiotensin was infused. In nine dogs studied with intact nervous system, infusion of the drug was accompanied by decrease of mean values of the index. It was concluded that the polypeptide exerts no important physiological effects upon myocardial contractility without the mediation of the autonomic nervous system. It was considered that the positive inotropic effect verified in dogs under ganglionic blockade was due to adrenergic hyperactivity induced by angiotensin. The depression of the contractile state observed in intact animals was supposed to be mediated by variations of autonomic nervous system activiity consequent to baroreceptor reflex.

Role of the autonomic nervous system in the inotropic variations induced by the infusion of angiotensin II

Inotropic effects of angiotensin II were studied in 26 anesthetized dogs with different conditions of autonomic activity. The values of maximal velocity of contraction (Vmax TP) were compared before and 10 minutes after the arterial pressure was elevated by the infusion of the drug. In eight dogs, previously treated with atropine and reserpine, the administration of angiotensin had no effect on mean values of Vmax TP. Nine animals submitted to ganglionic blockade by hexamethonium presented an improvement of myocardial contractility when angiotensin was infused. In nine dogs studied with intact nervous system, infusion of the drug was accompanied by decrease of mean values of the index. It was concluded that the polypeptide exerts no important physiological effects upon myocardial contractility without the mediation of the autonomic nervous system. It was considered that the positive inotropic effect verified in dogs under ganglionic blockade was due to adrenergic hyperactivity induced by angiotensin. The depression of the contractile state observed in intact animals was supposed to be mediated by variations of autonomic nervous system activiity consequent to baroreceptor reflex.