The bodyweight walking distance product and its relationship with clinical markers in patients with symptomatic peripheral artery disease.

PURPOSE: The six-minute walk test (6MWT) is extensively employed to evaluate gait impairment in patients with symptomatic peripheral artery disease (PAD) and has been associated with different health outcomes. However, various approaches exist for calculating and interpreting the six-minute test in order to address the needs of patients more effectively. Therefore, we investigated how these different approaches correlate with functional capacity and cardiovascular health in patients with symptomatic PAD. METHODS: In total, 227 PAD patients [65.2% men and 67 (13) y.o.] were included in this cross-sectional study. The 6MWT was performed along a 30-meter corridor and the distance was expressed in three ways: absolute (described as the meters walked during the test), relativized (based on the results of the 6MWT in healthy individuals), and DW (multiplying the body weight in kilograms by the absolute distance in the 6MWT). A functional capacity z-score was calculated using the results of the handgrip strength test, 4-meter walking test, and sit-and-stand test. A cardiovascular parameter z-score was calculated with data on brachial and central blood pressure, the low-frequency component/high-frequency component ratio, and carotid-femoral pulse wave velocity. RESULTS: The absolute (b = 0.30, 95%CI: 18-0.43, R² = 0.11, p < 0.001) and DW (b = 0.40, 95%CI: 27-0.53, R² = 0.17, p < 0.001) measures were related to functional capacity, independently of sex, age, and the ankle-arm index of the patients. Neither absolute nor DW were related to cardiovascular health. The relativized measure was not associated with either functional capacity or cardiovascular health. CONCLUSION: In patients with symptomatic PAD, absolute and DW measures are related to functional capacity, but not cardiovascular function.

The Bed Bridge Test: a new functional test for hospital inpatients - a feasibility and measurement study.

PURPOSE: To develop and assess the Bed Bridge Test's (BBT) feasibility, safety, and clinimetric properties and evaluate functional capacity in hospitalised patients. MATERIALS AND METHODS: This feasibility and measurement study examined four BBT versions, including the timed-limited at 30 and 60 s and repetition-limited at 5 and 10 times, in hospitalised patients in a university hospital in Brazil. Ninety-two functionally stable patients with respiratory, gastrointestinal, or post-surgical conditions participated. Participants completed the BBT versions in a random order. BBT concurrent criterion validity was evaluated using the Short Physical Performance Battery (SPPB), Sit-to-Stand (STS) test, and Functional Status Score (FSS). RESULTS: The participants were 51 ± 17 years old, 60% female, and 66% with clinical conditions. All participants completed the BBT versions without adverse events. Test-retest reliability was good-excellent (intraclass correlation coefficient >0.87) for all BBT versions, with acceptable agreement parameters and minimal detectable changes. The time-limited versions of the BBT might be affected by a ceiling effect. Floor effects were minimal for all BBT versions. BBT showed moderate associations with SPPB and STS and weak associations with FSS. CONCLUSIONS: The BBT is feasible and has promising measurement properties.

The Bed Bridge Test (BBT) offers a valuable solution for healthcare professionals by addressing the limitations of existing functional tests, providing a straightforward assessment of functional capacity for both the patient and the assessor.The BBT has demonstrated excellent feasibility and safety, as all eligible participants completed its various versions without adverse events, indicating its potential utility across diverse patient populations.The BBT exhibits good to excellent reliability, indicating its reproducibility in clinical settings.The BBT has validated its effectiveness by exhibiting robust correlations with established functional tests such as the Short Physical Performance Battery (SPPB) and Sit-to-Stand (STS) test.

Impact of an active lifestyle on cardiovascular autonomic modulation and oxidative stress in males with overweight and parental history of hypertension.

Family history of hypertension is associated with early autonomic dysfunction and increased oxidative stress. These alterations have been found to be reinforced by the overweight factor. Conversely, an active lifestyle is effective in improving the mechanisms regulating blood pressure control. Hence, we ought to investigate the effects of an active lifestyle on the hemodynamic, autonomic and oxidative stress parameters in individuals carrying both family history of hypertension and overweight risk factors. Fifty-six normotensive males were divided into four groups: eutrophic offspring of normotensive parents (EN, n = 12), eutrophic and inactive with hypertensive parents (EH, n = 14), overweight and inactive with hypertensive parents (OH, n = 13), and overweight and physically active with hypertensive parents (OAH, n = 17). Cardiovascular autonomic modulation was assessed by heart rate (HRV) and blood pressure (BPV) variability indexes. Oxidative stress included pro/antioxidant markers and nitrite concentration. Inactive offspring of hypertensive parents (EH and OH) showed higher LFSBP (vs EN), an indicator of sympathetic outflow to the vasculature and reduced anti-oxidant activity (vs EN), while higher pro-oxidant markers were found exclusively in OH (vs EN and EH). Conversely, the OAH group showed bradycardia, higher vagally-mediated HFabs index (vs OH and EN), lower sympathovagal balance (vs OH) and preserved LFSBP. Yet, the OAH showed preserved pro/antioxidant markers and nitrite levels. Our findings indicates that overweight offspring of hypertensive parents with an active lifestyle have improved hemodynamic, cardiac autonomic modulation and oxidative stress parameters compared to their inactive peers.

Validity, Reproducibility, and Minimal Detectable Difference of the Functional Upper Extremity Function Test - Simplified Version - for Adults With Moderate to Severe Asthma and COPD.

BACKGROUND: Upper-limbs (ULs) functional tests which are valid and reliable for individuals with chronic respiratory disease (CRD) are scarce. The aim of this study was to investigate the intra-rater reproducibility, validity, minimal detectable difference (MDD), and learning effect of the Upper Extremity Function Test - simplified version (UEFT_S) functional test and to characterize its performance for adults with moderate-severe asthma and COPD. METHODS: The UEFT_S was performed twice, and the number of elbow flexions in 20 s was the outcome. In addition, spirometry, 6-min walk test (6MWT), handgrip dynamometry (HGD), and usual and maximum timed-up-and-go tests (TUG_usual and TUG_max) were also performed. RESULTS: Eighty-four individuals with moderate-severe CRD and 84 control individuals matched by anthropometric data were analyzed. Individuals with CRD presented better performance in the UEFT_S than controls (P = .023). UEFT_S correlated significantly with HGD, TUG_usual, TUG_max, and 6MWT (P < .047 for all). The test-retest intraclass correlation coefficient was 0.91 [0.86-0.94], and the MDD was 0.4%. CONCLUSIONS: The UEFT_S is a valid and reproducible tool to assess the functionality of the ULs in people with moderate-severe asthma and COPD. When applied in the modified form, the test can be considered simple, fast, and inexpensive, with an easy outcome to interpret.

Validation and reproducibility of the Glittre activities of the daily living test for evaluation of functional capacity after a stroke.

METHODS: Thirty patients with hemiparesis stemming from a stroke and 20 healthy peers were evaluated. Reproducibility was determined using the intraclass correlation coefficient (ICC), standard measurement error (SME), minimum detectable change (MDC), and Bland-Altman analysis. For construct validity, the Glittre ADL test was correlated with the Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUG), and Functional Independence Measure (FIM), and analyzed based on convergent validity and the comparison of known groups (stroke survivors and healthy peers). RESULTS: Intra- and inter-observer reliability were excellent (ICC3,1 = 0.98; 0.96, respectively). Intra-observer SME ranged from 0.27 to 0.31 minutes and inter-observer SME was 0.45 minutes. Intra-observer MDC ranged from 1.44 to 1.54 minutes and inter-observer MDC was 1.86 minutes. Strong statistically significant correlations were found between time on the Glittre ADL test and time on the 6MWT (rh = -0.91; p < .001) and TUG test (rh = 0.82; p < .001), whereas a moderate correlation was found with the FIM (rh = -0.47; p < .008). CONCLUSIONS: The Glittre ADL test is valid for assessing functional capacity in stroke patients. It demonstrated good convergent and construct validity and excellent intra- and inter-observer reproducibility.

Shuttle walk test categorization according to the qualifiers of the International Classification of Functioning, Disability, and Health: proposal for use in patients with difficult-to-treat asthma, a cross-sectional study.

AIM: To classify functional capacity of people with difficult-to-treat asthma based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Fifty-seven patients underwent the Incremental Shuttle Walk Test (ISWT) to assess functional capacity, in order to categorize them functionally we used the ICF qualifiers. To qualify ISWT results the individual's impairment (i.e. percentage of distance walked in relation to the percentage of predicted) was analyzed. Additionally, body mass index (BMI); physical activity level (IPAQ); and pulmonary function were evaluated. In order to analyze the difference between functional capacity levels, two groups were compared (i.e. mild/moderate vs. severe impairment); therefore, the participants were matched according to age and BMI and the unpaired Student t test was used. RESULTS: Among the fifty-seven included individuals, only one (1.8%) presented mild functional capacity limitation, 12 (21.1%) moderate limitation and 44 (77.2%) severe limitation. There was a significant difference between the ISWT distance between groups (F = 0.217, p < .001). The other variables did not present differences between the mild/moderate and severe groups. CONCLUSION: The ICF qualifiers were able to categorize the ISWT and classified the functional capacity limitation as mild, moderate and severe. Therefore, it has proved to be a useful clinical tool for evaluation, follow-up and clinical decision-making.

Is the modified shuttle test a maximal effort test in children and adolescents with asthma?

PURPOSE: Whether the modified shuttle test (MST) achieves maximal effort in children and adolescents with asthma is unclear. The aim was to compare the physiological responses of MST to the cardiopulmonary exercise test (CPET) in pediatric patients with asthma, to observe its convergent validity. PATIENTS AND METHODS: A cross-sectional study with volunteers with asthma (6-17 years of age) under regular treatment. The MST is an external-paced test, and the participants were allowed to walk/run. CPET was performed on a cycle ergometer to compare with MST. Gas exchange (VO2 , VCO2 , and VE) and heart rate (HR) were the outcomes and were continuously assessed in both tests. RESULTS: Forty-seven volunteers were included, normal lung function expiratory forced volume at 1st second/forced vital capacity (FEV1 /FVC) 88.6 (7.7). VO2peak was higher at MST (2.0 ± 0.6 L/min) compared to CPET (1.6 ± 0.5 L/min), p < 0.001. Similar results was observed to VE at MST (50 ± 16 L/min) versus VE at CPET (40 ± 13 L/min), and to VCO2 at MST (2.1 ± 0.8 L/min) versus VCO2 at CPET (1.7 ± 0.6 L/min), p < 0.001. HR was also higher at MST (94 ± 6%pred) versus CPET (87 ± 8%pred), p = 0.002. VO2peak in MST correlated to the CPET (r = 0.78, p < 0.001). The ICC of VO2peak between tests was 0.73 (0.06-0.89), p < 0.001, and VO2peak Bland-Altman analysis showed a bias of 0.46 L/min. CONCLUSION: The MST showed a maximal physiologic response in children and adolescents with asthma. It is a valid test and can be used as an alternative to evaluating exercise capacity.

Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease.

BACKGROUND: Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease (COPD), but gains are not maintained over time. Maintenance pulmonary rehabilitation has been defined as ongoing supervised exercise at a lower frequency than the initial pulmonary rehabilitation programme. It is not yet known whether a maintenance programme can preserve the benefits of pulmonary rehabilitation over time. Studies of maintenance programmes following pulmonary rehabilitation are heterogeneous, especially regarding supervision frequency. Furthermore, new maintenance models (remote and home-based) are emerging. OBJECTIVES: To determine whether supervised pulmonary rehabilitation maintenance programmes improve health-related quality of life (HRQoL), exercise performance, and health care utilisation in COPD patients compared with usual care. Secondly, to examine in subgroup analyses the impact of supervision frequency and model (remote or in-person) during the supervised maintenance programme. SEARCH METHODS: We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PEDro, and two additional trial registries platforms up to 31 March 2020, without restriction by language or type of publication. We screened the reference lists of all primary studies for additional references. We also hand-searched conference abstracts and grey literature through the Cochrane Airways Trials Register and CENTRAL. SELECTION CRITERIA: We included only randomised trials comparing pulmonary rehabilitation maintenance for COPD with attention control or usual care. The primary outcomes were HRQoL, exercise capacity and hospitalisation; the secondary outcomes were exacerbation rate, mortality, direct costs of care, and adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts, extracted data, and assessed the risk of bias. Results data that were similar enough to be pooled were meta-analysed using a random-effects model, and those that could not be pooled were reported in narrative form. Subgroup analyses were undertaken for frequency of supervision (programmes offered monthly or less frequently, versus more frequently) and those using remote supervision (e.g. telerehabilitation versus face-to-face supervision). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included 21 studies (39 reports) with 1799 COPD patients. Participants ranged in age from 52 years to 88 years. Disease severity ranged from 24% to 88% of the predicted forced expiratory volume in one second. Programme duration ranged from four weeks to 36 months. In-person supervision was provided in 12 studies, and remote supervision was provided in six studies (telephone or web platform). Four studies provided a combination of in-person and remote supervision. Most studies had a high risk of performance bias due to lack of blinding of participants, and high risk of detection, attrition, and reporting bias. Low- to moderate-certainty evidence showed that supervised maintenance programmes may improve health-related quality of life at six to 12 months following pulmonary rehabilitation compared to usual care (Chronic Respiratory Questionnaire total score mean difference (MD) 0.54 points, 95% confidence interval (CI) 0.04 to 1.03, 258 participants, four studies), with a mean difference that exceeded the minimal important difference of 0.5 points for this outcome. It is possible that supervised maintenance could improve six-minute walk distance, but this is uncertain (MD 26 metres (m), 95% CI -1.04 to 52.84, 639 participants, 10 studies). There was little to no difference between the maintenance programme and the usual care group in exacerbations or all-cause hospitalizations, or the chance of death (odds ratio (OR) for mortality 0.73, 95% CI 0.36 to 1.51, 755 participants, six studies). Insufficient data were available to understand the impact of the frequency of supervision, or of remote versus in-person supervision. No adverse events were reported. AUTHORS' CONCLUSIONS: This review suggests that supervised maintenance programmes for COPD patients after pulmonary rehabilitation are not associated with increased adverse events, may improve health-related quality of life, and could possibly improve exercise capacity at six to 12 months. Effects on exacerbations, hospitalisation and mortality are similar to those of usual care. However, the strength of evidence was limited because most included studies had a high risk of bias and small sample size. The optimal supervision frequency and models for supervised maintenance programmes are still unclear.

Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial.

AIM: To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. METHODS: Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. RESULTS: After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4-143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. CONCLUSION: HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.

A more effective alternative to the 6-minute walk test for the assessment of functional capacity in patients with pulmonary hypertension.

BACKGROUND: The prognosis of Pulmonary Hypertension (PH) is directly correlated with the functional capacity (FC). The most common FC test is the 6-Minute Walk Test (6MWT), however, there is evidence to suggest that the 6MWT does not reflect the real FC in PH patients. AIM: To compare physiological responses among three field walk tests and cardiopulmonary exercise testing (CPET) in patients with pulmonary hypertension (PH), and to determine the determinants of distance walked in the field walk tests. DESIGN: Cross sectional study. SETTING: Outpatient clinic. POPULATION: 26 volunteers (49.8±14.6 years), WHO functional class II-III and a mean pulmonary artery pressure of 45 mmHg. METHODS: Patients underwent three field walk test: 6MWT, incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT) and CPET on different, non-consecutive days. The main outcome measures were heart rate and perception of effort at the peak of exercise. RESULTS: The ISWT achieved maximum levels of effort without significant difference in any physiologic response compared to CPET. The physiological responses during ISWT were significantly higher than 6MWT and ESWT responses. CONCLUSIONS: The ISWT produced the greatest physiologic response of the field tests safely for which reason it appears to be the most effective test to assess FC of PH patients. CLINICAL REHABILITATION IMPACT: The self-paced characteristic of the 6MWT and lower physiologic responses compared to the CPET were the main reason for this test to be classified as submaximal in PH patients. The physiological responses during the ESWT were significantly lower than other field tests highlighting the need for more research on this test and other field test in PH patients.

Heart rate recovery in asthmastic children and adolescents after clinical field test.

BACKGROUND: Inflammation caused by chronic lung disease in childhood may lead to delayed heart rate recovery (HRR) however, there is lack of evidence on HRR in this population. The aim was to assess HRR after functional capacity testing in asthmatic children and adolescents and to compare with severity and disease control. METHOD: This was a study secondary to a randomized control trial. The modified shuttle test (MST) was performed to assess functional capacity and HRR. This is an externally cadenced test in which the distance walked is the outcome. HRR was assessed after MST and was defined as HR at exercise peak minus HR in the second minute after the end of exercise. Asthma control was assessed by the Asthma Control Test (ACT). Data normality was tested by Shapiro Wilk and the comparison between groups was made by Student's t test or Mann Whitney test for numerical variables, and by Chi-square test for categorical variables. Statistical significance was considered when p < 0.05. SPSS version 20 was used in the analyzes. RESULTS: The sample included 77 patients diagnosed with asthma (asthma group - AG) who were regularly treated for asthma. Control group (CG) consisted of 44 volunteers considered healthy, matched in age and gender to AG. The median age of CG was 12 (10-14) years and in AG 11 (9-13 years) being classified as mild to moderate asthmatic, and 57% of the sample had controlled asthma by ACT. Distance walked in the CG was 952 ± 286 m and AG 799 ± 313 m, p = 0.001. HRR was more efficient in CG (79 ± 15 bpm) compared to AG (69 ± 12 bpm), p = 0.001. The mild (69 ± 12 beats) and severe (72 ± 15 beats) AG presented worse HRR compared to control group (79 ± 15 bpm), p < 0.05. CONCLUSIONS: Asthmatic children and adolescents have delayed HRR after modified Shuttle test compared to their peers, suggesting that asthma leads to autonomic nervous system imbalance. TRIAL REGISTRATION: Registered in Clinical Trials under number NCT02383069 and approved by the Universidade Nove de Julho - UNINOVE Research Ethics Committee, protocol number 738192/2014.

Quality of Life Questionnaire-Bronchiectasis: a study of the psychometric properties of the Brazilian Portuguese version.

OBJECTIVE: To evaluate the psychometric properties of the Brazilian Portuguese version of the Quality of Life Questionnaire-Bronchiectasis. DESIGN: Cross-sectional study. SETTING: Outpatient clinic. SUBJECTS: Clinically stable individuals with a diagnosis of bronchiectasis. MEASURES: The evaluations performed were spirometry, incremental shuttle walk test, Saint George's Respiratory Questionnaire, and the modified Medical Research Council dyspnea scale. The Quality of Life Questionnaire-Bronchiectasis was administered twice (seven to 14 days apart). Psychometric analyses were performed as follows: reliability, construct validity, criterion validity, and interpretability. RESULTS: In total, 108 individuals (48 ± 14 years, 61 women) participated in the study. Internal consistency was considered adequate (Cronbach's alpha ⩾ 0.70) for the majority of scales (from 0.58 to 0.93). Test-retest coefficients were moderate to excellent (intraclass correlation coefficients from 0.70 to 0.93). In the construct validity, 35 of 37 items correlated more strongly with their assigned scale than a competing scale. The convergent validity showed significant correlations between scales of the Quality of Life Questionnaire-Bronchiectasis with modified Medical Research Council dyspnea scale, and incremental shuttle walk test (r from 0.20 to 0.59). A low to moderate correlations was revealed between all scales of the Quality of Life Questionnaire-Bronchiectasis and the Saint George's Respiratory Questionnaire domains (r from 0.26 to 0.70). The standard error of measurement was acceptable. Ceiling effects were found for the Social Functioning and Treatment Burden scales. CONCLUSIONS: The Quality of Life Questionnaire-Bronchiectasis is a reliable, valid instrument with adequate internal consistency for the evaluation of the impact of bronchiectasis on the health-related quality of life of Brazilian adults.

Patients with asthma have reduced functional capacity and sedentary behavior / Pacientes com asma apresentam redução da capacidade funcional e comportamento sedentário

Abstract Objective The modified shuttle test is a field test that avoids the ceiling effect, and there are no reports of a multidimensional assessment concerning physical activity in asthmatic patients. Thus, the aim was to evaluate functional capacity by MST, additionally to perform a multidimensional assessment as physical activity in daily life, muscle strength, and cytokine levels in children and adolescents with asthma, and to correlate these variables. Method This cross-sectional study included volunteers aged between 6 and 18 years who were divided into two groups: asthma group (n = 43) that received regular treatment and control group (n = 24). Functional capacity was evaluated by distance walked during the MST; physical activity in daily life was evaluated using an accelerometer by the number of steps. Quadriceps femoris strength was evaluated by load cell. Results Distance walked was lower for the asthma group (790 m [222 m]) when compared with the control group (950 m [240 m]; p = 0.007); however, the number of steps was similar between the two groups (asthma group: 7743 [3075]; control group: 7181 [3040]; p = 0.41), and both groups were classified as sedentary behavior. There was no difference in muscle strength. Tumor necrosis factor-α differed, but interleukin levels were similar between groups. Quadriceps strength was correlated to distance walked (r = 0.62; p < 0.001) and tumor necrosis factor-α to the number of steps taken (r = −0.54, p = 0.005). Conclusion Children and adolescents undergoing regular asthma treatment showed reduced functional capacity and sedentary behavior. The lower the quadriceps strength, the shorter the distance walked; the higher the tumor necrosis factor-α levels, the lower their daily physical activity levels.

Resumo Objetivo O Teste Shuttle Modificado é um teste clínico de campo que evita o efeito-teto e não existem relatos de avaliação multidimensional com relação à atividade física em pacientes com asma. Assim, o objetivo era avaliar a capacidade funcional, a atividade física na vida cotidiana, a força muscular e os níveis de citocina em crianças e adolescentes com asma, a fim de correlacionar essas variáveis. Método Este estudo transversal incluiu voluntários entre seis e 18 anos, os quais foram divididos em dois grupos: o grupo com asma (n = 43), que recebeu tratamento regular, e o grupo de controle (n = 24). A capacidade funcional foi avaliada pela distância percorrida durante o Teste Shuttle Modificado, ao passo que a atividade física na vida cotidiana foi avaliada utilizando um acelerômetro pelo número de passos. A força muscular do quadríceps femoral foi avaliada por uma célula de carga. Resultados A distância percorrida foi menor no grupo com asma (790 m [222 m]) em comparação com o grupo de controle (950 m [240 m]; p = 0,007), contudo o número de passos foi semelhante nos dois grupos (grupo com asma: 7.743 [3.075]; grupo de controle: 7.181 [3.040]; p = 0,41) e ambos os grupos foram classificados como sedentários. Não houve diferença na avaliação da força muscular. O fator de necrose tumoral-α apresentou divergências, porém os níveis de interleucina foram semelhantes entre os grupos. A força muscular do quadríceps foi correlacionada com a distância percorrida (r: 0,62; p < 0,001) e o fator de necrose tumoral-α, ao número de passos dados (r = −0,54, p = 0,005). Conclusão Crianças e adolescentes que recebem tratamento regular de asma apresentaram redução da capacidade funcional e comportamento sedentário. Quanto menor a força muscular do quadríceps, menor a distância percorrida; quanto maiores os níveis de fator de necrose tumoral-α, menores seus níveis diários de atividade física.

Reference equation for maximal voluntary ventilation in children and adolescents.

OBJECTIVES: To develop reference equations of maximal voluntary ventilation (MVV) in children and adolescents, and to test the validity and reproducibility of MVV. STUDY DESIGN: Cross-sectional study. PATIENT-SUBJECT SELECTION: A total of 348 healthy volunteers (6-17 years)-248 for the development of reference equations and 100 to test the validity- were selected. METHODOLOGY: Spirometry and MVV were performed. Volunteers were instructed to breathe quickly and strongly to estimate the MVV. Independent variables tested were age, sex, weight, height, and pulmonary function. RESULTS: All volunteers (50% boys) had a normal pulmonary function. Mean MVV was 66.3 (17.8) L/minute for children and 118.8 (20.0) L/minute for adolescents. The equation developed for children was MVV = 4.865 + (forced expiratory volume in the first second [FEV1] × 16.257) + (peak expiratory flow [PEF] × 7.621); for adolescents was MVV = -25.450 + (FEV1 × 11.591) + (PEF × 6.672) + (sex × 12.179) + (age × 3.613). No significant differences were observed between measured and predicted MVV in children (64.6 [10.3] vs 64.6 [8.5] L/minute; P = .34) or adolescents (111.8 [23.4] vs 113.1 [22.8] L/minute, P = .12). The intraclass correlation coefficient between measured and predicted MVV was 0.95 (0.91-0.97) for children and 0.90 (0.82-0.94) for adolescents. The mean bias of Bland-Altman analysis was -0.8 L/minute for children and -2.7 L/minute for adolescents. CONCLUSIONS: Normative values for MVV were established for children and adolescents, additionally, these equations are reproducible and it can be used to determine the respiratory impairments in the pediatric population.

Patients with asthma have reduced functional capacity and sedentary behavior.

OBJECTIVE: The modified shuttle test is a field test that avoids the ceiling effect, and there are no reports of a multidimensional assessment concerning physical activity in asthmatic patients. Thus, the aim was to evaluate functional capacity by MST, additionally to perform a multidimensional assessment as physical activity in daily life, muscle strength, and cytokine levels in children and adolescents with asthma, and to correlate these variables. METHOD: This cross-sectional study included volunteers aged between 6 and 18 years who were divided into two groups: asthma group (n=43) that received regular treatment and control group (n=24). Functional capacity was evaluated by distance walked during the MST; physical activity in daily life was evaluated using an accelerometer by the number of steps. Quadriceps femoris strength was evaluated by load cell. RESULTS: Distance walked was lower for the asthma group (790m [222m]) when compared with the control group (950m [240m]; p=0.007); however, the number of steps was similar between the two groups (asthma group: 7743 [3075]; control group: 7181 [3040]; p=0.41), and both groups were classified as sedentary behavior. There was no difference in muscle strength. Tumor necrosis factor-α differed, but interleukin levels were similar between groups. Quadriceps strength was correlated to distance walked (r=0.62; p<0.001) and tumor necrosis factor-α to the number of steps taken (r=-0.54, p=0.005). CONCLUSION: Children and adolescents undergoing regular asthma treatment showed reduced functional capacity and sedentary behavior. The lower the quadriceps strength, the shorter the distance walked; the higher the tumor necrosis factor-α levels, the lower their daily physical activity levels.

Acute Effects Using Light-Emitting Diode Therapy (LEDT) for Muscle Function during Isometric Exercise in Asthma Patients: A Pilot Study.

The aim of this study was to evaluate the effectiveness of acute application of LEDT in improving peripheral muscle performance during isometric exercise in patients with asthma. Eleven patients, with a mean age 38 ± 10, underwent a single LEDT and sham application in the femoral quadriceps' dominant member (cluster with 50 LED λ = 850 nm, 50 mW, 15 s; 37.5 J), 48 h apart in a randomized crossover design. Before and after LEDT and sham application, the patients were submitted an isometric endurance test (60% of the maximum isometric voluntary contraction), up to the limit of tolerance simultaneous recording of surface electromyography. There were no statistically significant differences between groups at the time of contraction (before 41±14 versus 44±16; after 46±12 versus 45±20 s) during the isometric contraction test and inflammatory markers before and after a single LEDT application. A single application of LEDT in the parameters and dose according to the equipment used in the study were not able to promote differences in the time of contraction and the fatigue response in asthmatic patients. However, the chronic effects of LEDT application for improving muscle performance in these patients are unknown and may present different responses during applications for a long time.

Ventilatory Demand During Stepping and Running: Implications for Exercise-Induced Bronchoconstriction in Children.

BACKGROUND: Single-step tests have been proposed as simple and inexpensive challenges to diagnose exercise-induced bronchoconstriction (EIB) in the pediatric population. Work performed and the resulting ventilation, however, might be substantially lower in stepping than running. This might decrease the diagnostic yield of step-based challenges. METHODS: In a cross-sectional study, 53 children with asthma with exercise-related symptoms (34 boys, age 6-18 y) underwent an incremental stepping test, a 6-min constant stepping test, and a treadmill running test on different days. RESULTS: Constant and incremental stepping tests presented with lower metabolic demands (V̇O2 1.42 ± 0.48 and 1.34 ± 0.55 L/min, respectively), ventilatory demands (V̇O2 45 ± 14 and 43 ± 16 L/min, respectively), and cardiovascular demands (160 ± 20 and 161 ± 19 beats/min, respectively) than the treadmill running test (1.65 ± 0.60 L/min, 54 ± 17 L/min, and 172 ± 7 beats/min, respectively) (P < .05). Between-test agreement in diagnosing EIB was poor (kappa 0.217-0.361). Although EIB prevalence was higher after the treadmill running test (60%) compared to constant (53%) and incremental (47%) stepping tests, 7 subjects developed EIB only in stepping. Clinical and resting functional characteristics did not differ in discordant subjects (ie, EIB negative in a given test but positive in another) versus concordant subjects (ie, EIB negative or positive in both tests). EIB was not related to individual test ability in eliciting high to very-high ventilation (≥ 40% or ≥ 60% maximum voluntary ventilation, respectively). Moreover, a negative stepping test but a positive treadmill test (and vice versa) was not associated with greater ventilatory demands. CONCLUSIONS: Lower prevalence of EIB in stepping compared to treadmill running is not related to less ventilation demand in the former modality. Although stepping might be useful as a screening EIB test due its portability and low cost, a negative test should be confirmed with a running-based test in symptomatic children.

Effects of Transcranial Direct Current Stimulation (tDCS) and Exercises Treadmill on Autonomic Modulation of Hemiparetic Patients Due To Stroke-Clinic Test, Controlled, Randomized, Double-Blind.

Background: After a Stroke, there is an autonomic nervous system (ANS) changes. Transcranial Direct Current Stimulation (tDCS) can promote the reorganization of the affected circuits. Objective: To evaluate the effects of tDCS applied before a session of physical activity on the treadmill, in the modulation of the autonomic nervous system of post-stroke patients. Methodology: Cross-over study, were randomized 12 adult hemiparetic subjects in 2 groups, Group 1 (active tDCS before exercise on the treadmill) and Group 2 (sham tDCS before exercise on the treadmill). Stimulation times were 20 min; treadmill time was 20 min. The heart rate variability (HRV) and Variability of Systolic Blood Pressure (VSBP) were evaluated for 15 min, in 3 periods (pre and post tDCS and during exercise recovery on the treadmill). Results: There was no difference in the VSBP and the HRV between the groups, compared with the baseline data; however, in the intragroup analysis, the parasympathetic modulation after active tDCS increased by 18% over baseline by the RMSSD with IC 95% (-7.85 to -0.34). In group 1, the post-tDCS active and post-exercise periods presented a value of variance above baseline, indicating a better prognosis. In group 2, there was a significant reduction of 38% of Variance values (p = 0.003) after tDCS sham. Conclusion: tDCS does not generate immediate effects on HRV and VSBP, except for intragroup comparison, which has greater participation in parasympathetic modulation in the group receiving active tDCS.

COPD Assessment Test (CAT) is a Valid and Simple Tool to Measure the Impact of Bronchiectasis on Affected Patients.

The COPD assessment test (CAT) is a short questionnaire developed to help patients and clinicians to assess the impact of symptoms in routine clinical practice. We aimed to validate and to test the reproducibility of CAT in patients with bronchiectasis and correlate with the severity of dyspnea, aerobic and functional capacity, and physical activity in daily life. This is a cross-sectional study, patients with bronchiectasis underwent spirometry, cardiopulmonary exercise test (CPET), incremental shuttle walk test (ISWT), Saint George`s Respiratory Questionnaire (SGRQ), and received pedometer. CAT was applied twice (CAT-1 and CAT-2, 7 to 10 days apart). The severity of bronchiectasis was assessed by E-FACED and bronchiectasis severity index (BSI). A total of 100 patients were evaluated (48 ± 14 years, 59 women, FVC: 67 ± 22% pred, FEV1: 52 ± 25% pred). According to CAT, 14% patients presented low, 40% medium, 32% high, and 14% very high impact. The higher the CAT, the worse the severity of bronchiectasis, dyspnea, quality of life, performance on the CPET, and smaller the distance walked (DW) on the ISWT and number of steps (NS) per day. There was significant correlation between CAT and SGRQ, E-FACED, BSI, NS, ISWT, oxygen uptake, and workload at CPET. CAT-1 and CAT-2 presented similar values: 21 (13-26) and 19 (13-26), respectively. The CAT is a valid and reproducible instrument in patients with bronchiectasis presenting good correlation with clinical, functional, and quality of life measurements. This easy-to-use, easy-to-understand, quick, and useful tool may play an important role to assess the impact of bronchiectasis on both daily medical practice and clinical trial settings.

Reduced Physical Activity With Bronchiectasis.

BACKGROUND: Bronchiectasis leads to reduced functional capacity, which might have implications for physical activity. The impact of dyspnea and long-term oxygen therapy on physical activity has never been investigated in subjects with bronchiectasis. Based on these findings, specific strategies could be applied to allow individuals to be more active in their daily life. In this study we aimed to evaluate physical activity, the impact of dyspnea and long-term oxygen therapy on physical activity, and the determinants of physical activity in subjects with bronchiectasis. METHODS: We performed a cross-sectional study in 139 subjects with bronchiectasis (age 45 ± 13 y, FVC 70 ± 22% of predicted, FEV1 54 ± 25% of predicted) and 49 healthy subjects as controls. Physical activity was assessed using steps per day (measured with a pedometer), spirometry, incremental shuttle walking test (ISWT), and dyspnea. RESULTS: Reduced physical activity was observed in subjects with bronchiectasis, who recorded a median (interquartile range) of 8,007 (5,131-10,432) steps/d compared with controls, who recorded 10,994 (8,551-14,078) steps/d (P < .001). Significant correlations were observed between physical activity and FVC (r = 0.43), FEV1 (r = 0.36), ISWT (r = 0.37), and dyspnea (r = -0.48). Determinants for reduced physical activity included pulmonary function (R2 = 0.150), dyspnea (R2 = 0.075), ISWT (R2 = 0.044), and long-term oxygen therapy (R2 = 0.038); these factors explained 32% of the physical activity. CONCLUSION: Subjects with bronchiectasis exhibited reduced physical activity compared with healthy peers. Dyspnea has a negative impact on physical activity. Independent factors associated with physical activity included pulmonary function, dyspnea, functional capacity, and long-term oxygen therapy. These findings will guide strategies to enhance daily physical activity and to encourage subjects with bronchiectasis to be more active.