Prediction equation of peak oxygen uptake for the modified shuttle test in healthy adolescents / Equação de predição do consumo máximo de oxigênio para o shuttle test modificado em adolescentes saudáveis / Ecuación de predicción del consumo máximo de oxígeno para el shuttle test modificado en adolescentes sanos

ABSTRACT Given the gap in the literature regarding the peak of oxygen consumption (VO2peak) for adolescents of both sexes, this study aimed to propose an equation to predict the VO2peak in healthy adolescents using the Modified Shuttle Test (MST). This is a cross-sectional study with 84 healthy adolescents between 12 and 18 years old, female and male. The MST is an external paced test, in which the speed increases at each minute. Two MST were performed with at least 30 minutes of rest between them. The test with the longest walked distance was considered for analysis. VO2 was directly monitored by an open circuit spirometry. Mean age was 14.67±1.82 and the walked distance was 864.86±263.48m. Variables included in the prediction equation were walked distance and sex, explaining the VO2peak variability of 53% during MST performance. The prediction equation for VO2peak with the MST was: predicted VO2peak=18.274+(0.18×Distance Walked, meters)+(7.733×Sex); R2=0.53 and p<0.0001 (sex: 0 for girls, 1 for boys). This MST equation, proposed to predict VO2peak in healthy adolescents of both sexes, can be used as a reference to assess exercise capacity in healthy adolescents and to investigate cardiopulmonary function in adolescents with reduced functional capacity.

RESUMO Dada a lacuna na literatura quanto à equação de predição do pico de consumo de oxigênio (VO2) para adolescentes de ambos os sexos, o objetivo deste estudo é propor uma equação para predizer o VO2pico em adolescentes saudáveis utilizando o shuttle test modificado (MST). Trata-se de um estudo transversal realizado com 84 adolescentes saudáveis entre 12 e 18 anos, do sexo feminino e masculino. O MST é um teste de campo ditado por um sinal sonoro que indica o aumento da velocidade a cada minuto. Dois MSTs foram realizados com pelo menos 30 minutos de descanso entre eles. O teste com a maior distância percorrida foi o considerado para análise. O VO2 foi monitorado diretamente por uma espirometria de circuito aberto. A média de idade foi de 14,67±1,82 anos, e a de distância percorrida foi de 864,86±263,48m. As variáveis incluídas na equação de predição foram distância percorrida e sexo, que explicaram 53% da variabilidade do VO2pico durante a realização do MST. A equação de referência para o VO2pico previsto com o MST foi VO2pico predito=18,274+(0,18×Distância percorrida, em metros)+(7,733×Sexo); R2=0,53 e p<0,0001 (sexo: 0 para meninas, 1 para meninos). A equação do MST proposta para predizer o VO2pico em adolescentes saudáveis de ambos os sexos pode ser usada como referência para avaliar a capacidade de exercício em adolescentes saudáveis e investigar a função cardiopulmonar em adolescentes com capacidade funcional reduzida.

RESUMEN Dada una laguna en la literatura con respecto a la ecuación para predecir el consumo máximo de oxígeno (VO2) en adolescentes de ambos sexos, el objetivo de este estudio es proponer una ecuación para predecir el VO2máximo en adolescentes sanos usando el shuttle test modificado (MST). Se trata de un estudio transversal, realizado con 84 adolescentes sanos con edades entre 12 y 18 años, de ambos sexos. El MST es una prueba de campo dictada por una señal sonora que indica el aumento de velocidad cada minuto. Se realizaron dos MST con al menos 30 minutos de descanso entre ellos. Para el análisis se consideró la prueba con mayor distancia recorrida. El monitoreo del VO2 fue realizado directamente por espirometría de circuito abierto. La edad media fue de 14,67±1,82 años; y la distancia recorrida, de 864,86±263,48m. Las variables incluidas en la ecuación de predicción fueron la distancia recorrida y el sexo, que explicaron el 53% de la variabilidad del VO2máximo durante la realización del MST. La ecuación de referencia para el VO2máximo predicho con el MST fue VO2máximo previsto=18,274+(0,18×Distancia recorrida, en metros)+(7,733×Sexo); R2=0,53 y p<0,0001 (sexo: 0 para chicas, 1 para chicos). La ecuación MST propuesta para predecir el VO2máximo en adolescentes sanos de ambos sexos puede utilizarse como una referencia para evaluar la capacidad de ejercicio en adolescentes sanos y para investigar la función cardiopulmonar en adolescentes con capacidad funcional reducida.

Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit.

INTRODUCTION: There is no clarity about which clinical variables during hospitalization in the Neonatal Intensive Care Unit (NICU) are associated with abnormal General Movements (GMs). OBJECTIVE: To describe the trajectory of GMs of preterm newborns and explore the association between clinical variables and the presence of abnormal GMs during the NICU stay. METHODS: Fifty-eight preterm newborns (33 males), with a mean gestational age at birth of 31,93 week's postmenstrual age, were evaluated using the GMs assessment by Hadders-Algra method. Clinical variables recorded weekly throughout the hospitalization period. The weekly association between clinical variables and the presence of abnormal GMs was tested using the Generalized Estimating Equations (GEE) model. RESULTS: Preterm infants were recorded for up to sixteen weeks and more than half of the infants (56.9 %) had abnormal movements in at least one week during hospitalization. The absence of peri-intraventricular hemorrhage (PIVH) grades I-II and non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced, respectively, by 77.3 % (OR = 0.23; p > 0.0001) and 64.3 % (OR = 0.36; p > 0.0001) the chance of having an abnormal classification. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR = 0.025; p > 0.0001). CONCLUSION: PIVH grades I-II, longer durations of mechanical ventilation and the presence of non-invasive ventilatory support and/or oxygen therapy are associated with abnormal movements during stay in the neonatal period. The data suggest that development outcome of infants having these conditions should be closely monitored.

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.

Expanding the Use of Six-Minute Walking Test in Patients with Intermittent Claudication.

BACKGROUND: Six-min walking test (6MWT) has been widely in patients with symptomatic peripheral artery disease (PAD) to quantify the walking impairment and the efficacy of different therapeutic interventions. Despite the aforementioned usefulness of 6MWT for PAD, the information provided by this test goes beyond the meters walked. The aim of this study was to describe the relative values of 6MWT and body weight-walking distance product (DW) in patients with symptomatic PAD. METHODS: Two hundred twenty-seven patients with symptomatic PAD participated in the study. The 6MWT was performed and absolute and claudication distances were obtained. The results of 6MWT were then relativized and expressed as a percentage of a healthy subject. DW was obtained by the product of 6MWT distance by weight. In both sexes, the relative 6MWT ranged from 57% to 64%. RESULTS: Absolute 6MWT total distance (P < 0.001) was lower in women than in men, whereas the relative 6MWT total distance was similar between sexes (P = 0.398). The absolute and relative 6MWT total distance were similar among age categories (P > 0.072). The DW was higher in men than in women (P < 0.05). In addition, in women, DW was higher in younger group than in other age groups (P < 0.05). CONCLUSIONS: Patients with symptomatic PAD achieve less than 70% of the distance achieved by an age-matched healthy subject. In patients with symptomatic PAD, the relative values of 6MWT total distance are similar between sexes and among different age groups, whereas DW are influenced by age and sex.

Reference values for spirometry in Brazilian children.

OBJECTIVE: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. METHODS: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. RESULTS: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. CONCLUSIONS: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.

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.

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.

Reference values for spirometry in Brazilian children / Valores de referência de espirometria para crianças brasileiras

ABSTRACT Objective: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. Methods: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. Results: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. Conclusions: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.

RESUMO Objetivo: Gerar valores de referência para espirometria em crianças brasileiras de 3-12 anos de idade e comparar os resultados obtidos com as equações em uso no Brasil. Métodos: Foram incluídas crianças sadias de 3-12 anos recrutadas em 14 centros (dados primários) e resultados de espirometria de crianças com as mesmas características de seis bancos de dados (dados secundários). As equações quantílicas foram geradas após transformações logarítmicas dos dados espirométricos e antropométricos. A classificação por cor da pele foi autodeclarada. Os resultados obtidos foram comparados com os previstos nas equações em uso no Brasil para testar sua adequação. Resultados: Foram incluídos 1.990 indivíduos de 21 fontes de dados primários e secundários, sendo 1.059 (53%) do sexo feminino. Equações para VEF1, CVF, VEF1/CVF, FEF25-75% e FEF25-75%/CVF foram geradas para crianças brancas e para crianças negras e pardas. Os logaritmos da estatura e da idade e a cor da pele foram os melhores preditores para VEF1 e CVF. Os resultados obtidos foram significativamente maiores do que as estimativas geradas pelas equações em uso no Brasil, tanto para valores previstos quanto para o limite inferior da normalidade, particularmente em crianças negras e pardas. Conclusões: Novas equações espirométricas foram geradas para crianças brasileiras de 3-12 anos de cor branca, negra e parda. As equações atualmente em uso no Brasil parecem subestimar a função pulmonar de crianças brasileiras menores de 12 anos de idade e deveriam ser substituídas pelas equações propostas neste estudo.

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease.

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r<0.55, p<0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (ß=0.001, p<0.001), sit-to-stand test score (ß=-0.005, p=0.012), and WIQ stairs score (ß=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (ß=0.002, p<0.001), WIQ stairs score (ß=0.003, p=0.010), and WELCH total score (ß=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r<0.55, p<0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (β=0.001, p<0.001), sit-to-stand test score (β=-0.005, p=0.012), and WIQ stairs score (β=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (β=0.002, p<0.001), WIQ stairs score (β=0.003, p=0.010), and WELCH total score (β=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.

Predicted Equation for VO2 Based on a 20-Meter Multistage Shuttle Run Test for Children.

This study compared maximum oxygen consumption (VO2max) on a 20-meter multistage shuttle run test (20-Srt) with a cardiopulmonary exercise test (CPET) to determine a VO2max prediction equation for a 20-Srt in children aged 6-10 years. Eighty healthy children performed the CPET on a treadmill, while the 20-Srt took place on a sports court. Heart rate (HR) was measured and the expired gases were continuously measured breath-by-breath using a portable gas analyzer. The VO2max was lower (p<0.05) in CPET than 20-Srt for all, female, and male participants, respectively (46.3±7.9 vs. 48.7±4.6; 42.7±7.8 vs. 46.7±4.8; 49.3±6.8 vs. 50.4±3.9, mL·kg-1·min-1). The standard error estimates were between 3.0 and 3.6 and considered as not clinically relevant if less than 5 mL·kg-1·min-1. The intraclass correlation coefficient between the VO2 in CPET and in 20-Srt was 0.74 (CI95% 0.55-0.84) and considered moderately reliable. The linear multiple regression excluded sex, body mass index and fat-free mass and retained the maximum speed and age in the predictive equation. The 20-Srt estimates the VO2max with moderate reliability and the predictive equation was VO2maxpred=4.302+(maximum speed*5.613)-(age*1.523) for children aged 6-10 years.

Cutoffs of Short-Term Heart Rate Variability Parameters in Brazilian Adolescents Male.

A low heart rate variability (HRV) has been associated with cardiovascular risk factors in adolescents. However, no cut-off points are known for HRV parameters in this age group, making it difficult to use in clinical practice. Thus, the aims of the current study were to establish cutoffs of HRV parameters and to examine their association with cardiovascular risk in Brazilian adolescents male. For this reason, this cross-sectional study included 1152 adolescent boys (16.6 ± 1.2 years old). HRV measures of time (SD of all RR intervals, root mean square of the squared differences between adjacent normal RR intervals, and the percentage of adjacent intervals over 50 ms), frequency domains [low (LF) and high (HF) frequency], and Poincaré plot (SD1, SD2 and SD1/SD2 ratio) were assessed. Cardiovascular risk was assessed by sum of abdominal obesity, high blood pressure, overweight, and low physical activity level. The proposed cutoffs showed moderate to high sensitivity, specificity, and area under curve values (p < 0.05). HRV frequency parameters were statistically superior when compared to time-domain and Poincaré plot parameters. The binary logistic regression analysis indicated that all proposed HRV cutoffs were independently associated with a clustering of cardiovascular risk factors, with greater magnitude of HF and SD1/SD2 ratio (two or more risk factors: OR = 3.59 and 95% CI 1.76-7.34). In conclusion, proposed HRV cutoffs have moderate to high sensitivity in detecting of the cardiovascular risk factor and HRV frequency-domain were better discriminants of cardiovascular risk than time-domain and Poincaré plot parameters.

Pulmonary function in former very low birth weight preterm infants in the first year of life.

BACKGROUND: Pulmonary function in former preterm infants may be compromised during childhood. OBJECTIVES: To assess pulmonary function in very-low-birth-weight preterm infants at 6-12 months of corrected age and analyze the factors associated with abnormal pulmonary function. METHODS: Cross-sectional study with preterm infants at 6-12 months of corrected age with birth weight <1500 g. Children with malformations or affected by neuromuscular and respiratory diseases were excluded. Forced expiratory flows were assessed using the chest compression technique, and volumes were measured by total body plethysmography. Pulmonary function parameters in preterm infants were compared to a control group of same-aged children born at term. RESULTS: We studied 51 preterm and 37 infants born at term. Preterm infants had: gestational age at birth (30.0 ±â€¯2.5 weeks), birth weight (1179 ±â€¯247 g), 27.5% had bronchopulmonary dysplasia, and 45% received mechanical ventilation. Preterm infants had lower median z-scores in comparison to term infants for the following parameters (p < 0.05): FVC (-0.3 vs. 0.7), FEV0.5 (-0.5 vs. 0.9), FEV0.5/FVC (-0.6 vs. -0.5), FEF50 (-0.4 vs. 0.9), FEF75 (-0.3 vs. 0.8), FEF85 (-0.1 vs. 0.6) and FEF25-75 (-0.5 vs. 1.1). No term child had abnormal lung function, compared to 39.2% of preterm infants (p = 0.001). Factors associated with abnormal pulmonary function were lower gestational age at birth, small for gestational age, need for mechanical ventilation and presence of recurrent wheezing. CONCLUSIONS: Preterms had a high prevalence of abnormal pulmonary function and lower pulmonary function in comparison to term infants. Prematurity, intrauterine growth restriction, respiratory support and recurrent wheezing were associated with abnormal pulmonary function.

Effects of periodontal treatment on exacerbation frequency and lung function in patients with chronic periodontitis: study protocol of a 1-year randomized controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has been associated with periodontal disease (PD), and periodontal treatment (PT) has been connected to reduction of lung disease exacerbations. Bronchiectasis has many clinical similarities with COPD but, although it is also a chronic lung disease, to date it has not been studied with relation to PD. The aim of this study is to evaluate whether PT associated with photodynamic therapy (PDT) reduces the number of exacerbations, improves pulmonary function, periodontal clinical parameters and quality of life after 1 year of periodontal treatment follow-up. METHODS: Bronchiectasis patients will undergo medical anamnesis and periodontal examination. Participants with periodontitis will be divided into two groups and PT will be performed as G1 control group (n = 32) - OHO (oral hygiene orientation) + supragingival treatment + simulation of using photodynamic therapy (PDT); G2 experimental (n = 32) - scaling and root planing + PDT + OHO. Lung function will be assessed both at baseline and after 1 year by spirometry, exacerbation history will be analyzed through clinical records monitoring. Three instruments for quality of life assessment will also be applied - Saint George's Respiratory Questionnaire and Impact Profile Analysis Oral health (OHIP-14). It is expected that periodontal treatment can improve the analyzed parameters after 1 year. DISCUSSION: Although only one study evaluates exacerbation in COPD after 1 year of PT, bronchiectasis has not been studied in the dentistry field to date. TRIAL REGISTRATION: NCT02514226. Version #1. This study protocol receives grant from FAPESP (São Paulo Research Foundation) #2015/20535-1. First received: July 22, 2015, 1st version. This protocol has been approved by the Research Ethics Committee of Nove de Julho University.

Bronchodilator response in wheezing infants assessed by the raised volume rapid thoracic compression technique.

BACKGROUND: Bronchodilator response (BDR) analyzed by the raised volume rapid thoracic compression (RVRTC) in wheezing infants is not yet well described, although bronchodilators (BD) are routine in the treatment of this population. OBJECTIVE: To evaluate BDR by RVRTC technique in infants with recurrent wheezing and compare to control group. METHOD: Cross sectional study, 45 infants, age 56 weeks (38-67 weeks). Two groups: wheezing group (WG: history of recurrent wheezing) and control group (CG). RVRTC was evaluated, FVC, FEV0.5, FEF50, FEF75, FEF85, FEF25-75 were measured. Salbutamol was delivered to infants and RVRTC evaluated again. BDR was determined by the increase greater than two standard deviation from the mean change in the CG. RESULTS: In WG (n = 32) lung function was worse than in CG (n = 13): FEV0.5: 0.0(-0.9-0.9z score) vs 0.8(0.2-1.4z score); FEF50: 0.2(-0.3-1.1z score) vs 0.9(0.5-1.4z score); and FEF25-75: 0.2(-0.5-1.1z score) vs 1.1(0.6-1.6z score), respectively, p < 0.05. Both groups had similar increase after BD. In WG 11 patients (34%) were responder and these had worse lung function compared to nonresponder (n = 21) (p < 0.05). The increase in lung function after BD in responder was higher than in nonresponder: FEV0.5: 6.5(2.1-7.1%) vs -0.5(-2.5-0.7%), FEF50: 5.1(2.7-11.7%) vs 0.4(-1.1-2.8%), FEF75: 20.7(4.7-23.6%) vs -1.3(-6.4-3.9%), FEF25-75: 9.9(3.8-16.4%) vs 0.0(-1.5-1.0%), respectively, p < 0.05. CONCLUSION: 34% WG showed BDR measured by the RVRTC. The best variables to detect BDR were FEF75, FEF25-75 and FEV0.5. Patients with worse lung function showed better response to BD.

Effects of a pulmonary rehabilitation program on physical capacity, peripheral muscle function and inflammatory markers in asthmatic children and adolescents: study protocol for a randomized controlled trial.

BACKGROUND: Individuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease. The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program. METHOD: This is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 µcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers. CLINICAL TRIAL NUMBER: NCT02383069. Data of registration: 03/03/2015.

Reference Equation for Respiratory Pressures in Pediatric Population: A Multicenter Study.

Previous studies have proposed only one prediction equation for respiratory muscle strength without taking into consideration differences between ages in pediatric population. In addition, those researches were single-center studies. The objective of this study was to establish reference equations for maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) in children and teenagers. In a multicenter study, 450 healthy volunteers were evaluated (aged 6-18yrs). There were included volunteers with normal lung function. We excluded volunteers who could not perform the tests; participated in physical activity more than twice a week; were born prematurely; smokers; chronic respiratory, cardiologic, and/or neurologic diseases; had acute respiratory disease during the prior three weeks. The volunteers were divided into two groups: Group 6-11 (6-11yrs) and Group 12-18 (12-18yrs). PImax and PEmax were measured according to statement. The mean PImax value was 85.6 (95%IC 83.6-87.6 cmH2O), and PEmax 84.6 (95%IC 85.5-86.2 cmH2O). The prediction equations for PImax and PEmax for Group 6-11 were 37.458-0.559 + (age * 3.253) + (BMI * 0.843) + (age * gender * 0.985); and 38.556 + 15.892 + (age * 3.023) + (BMI * 0.579) + (age * gender * 0.881), respectively (R2 = 0.34 and 0.31, P<0.001). The equations for Group 12-18 were 92.472 + (gender * 9.894) + 7.103, (R2 = 0.27, P = 0.006) for PImax; and 68.113 + (gender * 17.022) + 6.46 + (BMI * 0.927), (R2 = 0.34, P<0.0001) for PEmax. This multicenter study determined the respiratory muscle strength prediction equations for children and teenagers.