Clinical use of the modified shuttle test in children with cystic fibrosis: Is one test sufficient?

OBJECTIVE: To evaluate the reproducibility of the modified shuttle test (MST) and to determine whether the test needs to be performed more than once to assess the exercise capacity of children and adolescents with cystic fibrosis (CF). METHODS: This was a longitudinal study including patients diagnosed with CF aged more than 6 years. The participants were followed for a period of 9 months and were evaluated at three different time points (visits 1, 2, and 3). Spirometric, anthropometric, clinical, and genetic data were collected, and two MSTs were performed at each visit. RESULTS: Forty-eight clinically stable volunteers with a mean age of 10.1 ± 2.7 years were initially included. The reproducibility of the test was evaluated using the distance achieved (DA) as the main variable. There were no significant differences in the DA (visit 1, p = .23; visit 2, p = .24; visit 3, p = .85), baseline heart rate (HR) (visit 1, p = .35; visit 2, p = .20; visit 3, p = .98), and peak HR (visit 1, p = .16; visit 2, p = .94; visit 3, p = .23) between the tests performed at each visit. The test-retest reliability demonstrated a high intraclass correlation coefficient at all visits (visit 1, 2, and 3: 0.83, 0.90, and 0.80, respectively) and the variation in HR was the main factor associated with the DA in the MST over time. CONCLUSION: The MST was found to be a reproducible and reliable test. The data presented here support the use of a single MST to evaluate and monitor exercise capacity of patients with CF during clinic visits.

FUNCTIONAL PERFORMANCE IN THE MODIFIED SHUTTLE TEST IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS.

OBJECTIVE: To evaluate factors associated with the performance of children and adolescents with cystic fibrosis (CF) in the Modified Shuttle Test (MST) and compare it with healthy children and adolescents. METHODS: This is a cross-sectional study, with children and adolescents divided into two groups: cystic fibrosis (CFG) and control (CG). Variables evaluated in the MST: walking distance, test level, heart rate variation (∆Hr), post-test mean arterial pressure (MAP Pt) and peripheral oxygen saturation variation (∆SPO2). Statistical analysis included Mann Whitney and Spearman coefficient tests, being significant p<0.05. RESULTS: Sixty individuals aged 6-16 years old were evaluated. Anthropometric data was similar between groups. Differences between groups were shown for: baseline heart rate (BHr), peak heart rate (PHr), ∆Hr, recovery heart rate (RHr), post-test respiratory rate (PtBr), saturation variables, peripheral oxygen level (SpO2B) and level test. The ∆Hr and MAP Pt had a moderate positive correlation with distance and level test for both groups (respectively: r=0.6 / p<0.001; r=0.6 / p<0.001). In CFG, the level test had a significant association (r=0.4 - p=0.02) with %FEV1. CONCLUSIONS: Children with cystic fibrosis presented functional limitation in the Modified Shuttle Test, which was influenced by lung function.

Functional performance in the modified shuttle test in children and adolescents with cystic fibrosis / Desempenho funcional no teste modificado de shuttle em crianças e adolescentes com fibrose cística

ABSTRACT Objective: To evaluate factors associated with the performance of children and adolescents with cystic fibrosis (CF) in the Modified Shuttle Test (MST) and compare it with healthy children and adolescents. Methods: This is a cross-sectional study, with children and adolescents divided into two groups: cystic fibrosis (CFG) and control (CG). Variables evaluated in the MST: walking distance, test level, heart rate variation (∆Hr), post-test mean arterial pressure (MAP Pt) and peripheral oxygen saturation variation (∆SPO2). Statistical analysis included Mann Whitney and Spearman coefficient tests, being significant p<0.05. Results: Sixty individuals aged 6-16 years old were evaluated. Anthropometric data was similar between groups. Differences between groups were shown for: baseline heart rate (BHr), peak heart rate (PHr), ∆Hr, recovery heart rate (RHr), post-test respiratory rate (PtBr), saturation variables, peripheral oxygen level (SpO2B) and level test. The ∆Hr and MAP Pt had a moderate positive correlation with distance and level test for both groups (respectively: r=0.6 / p<0.001; r=0.6 / p<0.001). In CFG, the level test had a significant association (r=0.4 - p=0.02) with %FEV1. Conclusions: Children with cystic fibrosis presented functional limitation in the Modified Shuttle Test, which was influenced by lung function.

RESUMO Objetivo: Avaliar os fatores que estão associados ao desempenho de crianças e adolescentes com fibrose cística (FC) no teste modificado de Shuttle (MST) e compará-los com os de crianças e adolescentes saudáveis. Métodos: Estudo de corte transversal com crianças e adolescentes divididos em dois grupos: grupo controle (GC) e grupo FC (GFC). As variáveis avaliadas no MST foram: distância caminhada, nível do teste, variação da frequência cardíaca (∆Fc), pressão arterial média pós-teste (PAMPt) e variação da saturação periférica de oxigênio (∆SpO2). Na análise dos dados, foram utilizados o Teste Mann-Whitney e o coeficiente de Spearman, sendo significante p<0,05. Resultados: Avaliaram-se 60 indivíduos (6-16 anos). Os grupos foram homogêneos em relação aos dados antropométricos. Foi observada diferença significante na frequência cardíaca basal (FcB), na frequência cardíaca de pico (FcP), na ∆Fc, na frequência cardíaca de recuperação (FcR), na frequência respiratória pós-teste (FRPt), na saturação periférica de oxigênio basal (SpO2B) e no nível do teste. A ∆Fc e a PAMPt tiveram correlação moderada positiva (respectivamente, r=0,6 / p<0,001; r=0,6 / p<0,001) com a distância caminhada e o nível do teste em ambos os grupos. No GFC o nível do teste teve associação (r=0,4 / p=0,02) com a porcentagem do predito do volume expiratório forçado do primeiro segundo (%VEF1). Conclusões: Crianças e adolescentes com FC apresentaram limitação funcional no teste modificado de Shuttle, influenciada pela função pulmonar.

Tissue oxygenation in peripheral muscles and functional capacity in cystic fibrosis: a cross-sectional study.

NEW FINDINGS: What is the central question of this study? How do peripheral muscle tissue oxygenation and physical conditioning levels of children and adolescents with cystic fibrosis compare to demographically matched controls? What is the main finding and its importance? Children and adolescents with cystic fibrosis consumed more oxygen, more quickly and exhibited slower recovery, demonstrating that there may have been deficiencies in oxygen supply related to both oxygen uptake and oxygen transport. ABSTRACT: Cystic fibrosis affects skeletal muscle performance and functional capacity. However, it is currently unclear how peripheral muscle behaviour is affected, especially in children and adolescents. To examine this, we compared tissue oxygenation of children and adolescents with cystic fibrosis against healthy volunteers. We also evaluated the functional capacity of participants via the modified shuttle test (MST) and assessed for associations between performance and near-infrared spectroscopy. A total of 124 participants enrolled. Participants were divided into either the cystic fibrosis group (CFG) or the healthy group (HG). Statistical comparisons between groups were evaluated with the Mann-Whitney U test and associations with functional capacity were evaluated using Spearman's correlation coefficient. CFG volunteers scored lower on the MST compared to the HG. They walked shorter distances (P = 0.001) with less efficiency because they performed the tests with a less efficient walking economy (P = 0.001) and a greater deoxyhaemoglobin concentration (P = 0.001). Further, they experienced reduced tissue oxygen saturation (P = 0.037) faster than the HG. As a result, they presented lower respiratory (P = 0.001) and lower heart (P = 0.001) rate values at the end of the MST, with a longer post-test heart rate recovery time (P = 0.005). There was a significant association between deoxygenation time and functional capacity. The CFG consumed more oxygen, more quickly, with a slower recovery, reflecting impairments in the dynamics of muscle oxygen extraction. The results suggest differences in functional capacity and haemodynamic recovery in children and adolescents with cystic fibrosis.

Respiratory physical therapy techniques recommended for patients with cystic fibrosis treated in specialized centers.

BACKGROUND: Respiratory therapy is a part of the treatment of patients with cystic fibrosis (CF). However, there is no information about the main factors influencing the recommendation of the use of different techniques or devices by physical therapists from different specialized centers. OBJECTIVE: To determine the respiratory therapy techniques recommended for the treatment of patients with CF seen in specialized treatment centers in Brazil. METHODS: This is a descriptive study including a sample of Brazilian CF specialized treatment centers. Data on demographics, spirometric variables, and recommended respiratory therapy treatment techniques were collected. RESULTS: Twelve specialized treatment centers with a total of 974 patients were included (13.5±11.3 years old and FEV1 (%) 75.7±27.9). The most recommended techniques were huffing (61.1% of patients), high frequency oral oscillation (HFOO) (52.0%), and positive expiratory pressure (PEP) (45.3%). Most often, recommendation was to perform treatment once (54.8% of patients) or twice (34%) a day. There was great variability in the recommendation among the different states. When data were separated by age, there was a predominance of performing conventional and manual techniques in infants and preschool children. There were no significant variations according to pulmonary function. Based on the literature, techniques based on volume, huffing, and PEP were most prevalently performed in international centers. CONCLUSION: The most recommended treatment techniques for patients with CF in Brazil are huffing, HFOO, and PEP, followed by volume-based techniques. There were geographical variations in the preferred treatment techniques, as well as based on patient age, but not based on the level of pulmonary function.

Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem.

OBJECTIVE: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. METHODS: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. RESULTS: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. CONCLUSION: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem / Contaminação microbiológica de nebulizadores usados por pacientes com fibrose cística: um problema subestimado

ABSTRACT Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

RESUMO Objetivo: Nebulizadores caseiros são usados rotineiramente no tratamento de pacientes com fibrose cística (FC). Este estudo objetiva avaliar a contaminação de nebulizadores utilizados por pacientes de FC que estão cronicamente colonizados por Pseudomonas aeruginosa e a associação da contaminação do nebulizador com a higienização, esterilização e método de secagem. Métodos: Um estudo transversal, observacional, multicêntrico foi conduzido em sete centros de referência de FC no Brasil para obter dados de registros médicos; foram feitas entrevistas estruturadas com os pacientes/cuidadores e partes de nebulizadores (máscara e copo) foram coletados para cultura microbiológica. Resultados: No geral, 77 pacientes com FC foram incluídos. A frequência da contaminação do nebulizador foi de 71,6%. Candida spp. (52,9%), Stenotrophomonas maltophilia (11,9%), P. aeruginosa não mucoide (4,8%), Staphylococcus aureus (4,8%) e complexo Burkholderia cepacia (2.4%) foram os patógenos isolados mais comuns. A frequência de higienização dos nebulizadores foi de 97,4%, e 70,3% dos pacientes relata higienização, esterilização e secagem dos aparelhos. A lavagem com água da torneira e secagem das partes no tempo, em espaço aberto, aumentou significativamente (9 a 10 vezes) a chance de contaminação dos nebulizadores. Conclusões: Apesar dos relatos de frequente higienização dos nebulizadores, os métodos de limpeza e esterilização usados eram inadequados. Uma proporção significativa de nebulizadores foi contaminada com microrganismos potencialmente patogênicos para pacientes com FC. Estes resultados apoiam a necessidade de inclusão dos pacientes/cuidadores em programas educacionais e/ou novas estratégias para fornecimento de antibióticos inalatórios.

Correlação entre a composição corporal e força, resistência da musculaura respiratória e capacidade de exercícios em pacientes com doença pulmonar obstrutiva crônica / Correlation between body composition and respiratory muscle strength, endurance, and exercise capacity in patients with chronic obstrutive pulmonary disease

Este estudo buscou correlações entre a composição corporal (aferida por métodos indiretos) e força, resistência da musculatura respiratória e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica (DPOC). Os 30 voluntários, idosos, foram divididos em três grupos, dois de pacientes com DPOC, estáveis e controlados clinicamente, e um grupo controle, com indivíduos sem doenças pulmonares, selecionados na mesma faixa etária e biótipo daqueles com DPOC. Todos foram submetidos a espirometria e medidas das pressões respiratórias máximas para avaliação da força dos músculos respiratórios, teste de resistência dos músculos respiratórios, teste de caminhada de seis minutos (TC6'), medidas de dobras cutâneas e índice de massa corporal (IMC). Os sujeitos (6 mulheres e 24 homens) foram divididos em: grupo A, n=11, com DPOC moderado a grave (idade 69,5±10,5 anos, IMC 24,00±3,66 kg/m2); grupo B, n=10, com DPOC leve (71,1±8,1 anos, IMC 24,41±0,58 kg/m2); e grupo C controle, n=9 (70,1±5,9 anos, IMC 27,44±1,33 kg/m2). Apenas os valores de porcentagem de gordura corporal e distância caminhada (no TC6') apresentaram diferenças significativas entre os grupos. Os resultados não indicaram correlação significativa entre as variáveis analisadas. Embora a literatura aponte o estado nutricional como um dos fatores do comprometimento respiratório na DPOC, não foi encontrada correlação entre a composição corporal e os parâmetros respiratórios nos pacientes estudados...

This study searched for correlations between body composition (assessed by indirect methods) and respiratory muscle strength, endurance and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Thirty elderly subjects were divided into two groups of COPD patients, in clinically stable condition, and a control group, of subjects with no respiratory disease, selected so as to match COPD patients’ age and biotype. All subjects were submitted to spirometry, maximal respiratory pressures for assessing respiratory muscle strength, respiratory muscle endurance test, the six minute walking test (TC6'), and to skin folds and body mass index (BIM) measurements. Subjects (6 women, 24 men) were divided into: group A, with moderate to severe COPD, n=11 (aged 69.5±10.5, BIM 24.00±3.66 kg/m2); group B with mild COPD, n=10 (aged 71.1±8.1, BIM 24.41±0.58 kg/m2); and control group C, n=9 (aged 70.1±5.9, BMC 27.44±1.33 kg/m2). Significant differences between the groups were found only in body fat percent and distance walked in the TC6'. Results showed no significant correlations between the analysed variables. Though literature consensually points to the nutritional status as a factor for respiratory impairment in COPD patients, no significant correlations could be found between body composition and the analysed respiratory parameters among this study subjects...

Avaliação da pressão positiva expiratória final utilizando o aparelho fisioterápico Quale / Evaluation of positive end expiratory pressure using a physiotherapy device called Quake

O objetivo deste estudo foi avaliar, em voluntários saudáveis, o valor médio da pressão positiva expiratória final (PEEP) na utilização do recurso fisioterápico Quake, relativamente novo no mercado. Participaram 62 indivíduos de ambos os sexos, entre 18 e 30 anos, que foram submetidos a: prova de função pulmonar; avaliação do pico de fluxo expiratório, da sensação subjetiva de esforço (escala de Borg) e da saturação de oxigênio; e à utilização do aparelho, acoplado a um anovacuômetro, para efetuar duas seqüências respiratórias, de 10 e 20 incursões por minuto, monitoradas por retroalimentação visual. Os dados foram tratados estatisticamente. Foi observada diferença significativa entre os valores das pressões geradas apenas na seqüência de 10 incursões por minuto (p=0,03). Na comparação das pressões entre as seqüências, os valores foram significativamente menores na de 10 incursões (29,42±8,04 cmH2O; p=0,03). Não foram encontradas correlações entre as pressões e as variáveis da espirometria, idade e pico de fluxo expiratório. Foi observada uma fraca correlação significativa antes (r=0,36; p=0,003) e depois (r=0,31; p=0,014) da seqüência de 20 incursões entre as pressões nessa seqüência e os escores de fadiga na escala de Borg, tendo o mesmo ocorrido com a saturação de oxigênio. A PEEP gerada pelo Quake em indivíduos saudáveis varia de acordo com a frequência em incursões por minuto, sendo maior durante a seqüência mais rápida, que também gera maior cansaço...

The aim of this study was to assess the mean positive end expiratory pressure(PEEP) during use of the Quake, a relatively new device, in healthy volunteers. Participants were 62 subjects of both sexes aged 18 to 30 years old, who were submitted to: pulmonary function tests; expiratory peak flow evaluation; the Borg scale; assessment of oxygen saturation; and use of the device, coupled to amanometer, in two sequences, of 10 and 20 breaths per minute, with monitoring by visual feedback. Data were statistically analysed. Significant differences between pressures were found only at the 10-breath per minute sequences (p=0.03). When comparing pressures between the sequences, values were significantly lower in the 10-breath per minute sequence (29.42±8.04 cmH2O; p=0.03). No correlations were found between pressures and pulmonary function test measures, age, or expiratory peak flow. A weak, significant correlation was found between Borg scale scores and pressures before (r=0.36; p=0.003) and after (r=0.31; p=0.014) the 20-breath per minute sequence, the same occurring with oxygen saturation. In healthy volunteers, then, Quake PEEP values are higher during the quickest (20-breath per minute) sequence, which also requires more exertion...

Avaliação do volume inspiratório de crianças com paralisia cerebral através de diferentes técnicas / Assessment of inspiratory volume in children with cerebral palsy through different techniques

As crianças com paralisia cerebral (PC) evoluem com um conjunto de alterações neurológicas que são responsáveis pelo comprometimento motor e respiratório freqüentemente observado nesta população. Objetivo: Avaliar o volume inspiratório de crianças portadoras de PC através de diferentes técnicas incentivadoras. Materiais e métodos: Foram selecionadas crianças com PC classificadas no nível V (Gross Motor Function Classification System) que estivessem estáveis hemodinamicamente. Foram excluídas crianças que apresentassem hipersecreção pulmonar que pudesse interferir na realização das medidas. Para a avaliação do volume inspiratório foram utilizados dois recursos fisioterapêuticos distintos: Inspirômetro de incentivo a volume (IIV) e Breath Stacking (BS). Resultados: Foram avaliadas 13 crianças, com idade média de 5,61 ± 2,46 anos, sendo que 69 por cento delas tinham o diagnóstico topográfico de quadriplegia espástica e 31 por cento apresentam componente atetóide na sua classificação. Em relação ao volume inspiratório ocorreu diferença significativa (p = 0,000) entre o IIV (204,60 ± 37,10) e o BS (1134,00 ± 702). Entretanto, no IIV as crianças mobilizaram um volume correspondente a duas vezes o volume corrente mínimo pré-estabelecido para elas de acordo com o peso corporal. Conclusão: Na população estudada, o IIV se mostrou mais eficaz para avaliação do volume inspirado.

Children with cerebral palsy (CP) have a set of neurological alterations responsible for the motor disability and respiratory dysfunctions frequently observed in this population. Aim: Assessment of inspiratory volume in children with CP through different techniques. Materials and methods: Were selected children with CP classified in level V (Gross Motor Function Classification) and that were stable. Children with pulmonary excessive production of sputum that could interfere in the measures were excluded. For the assessment of the inspiratory volume two different resources were used: incentive volumetric spirometer (IVS) and breath stacking (BS). Results: 13 children with mean age of 5.61 ± 2.46 years old were studied. 69 percent had topographical diagnosis of spastic quadriplegia and 31 percent had athetoid component in their classification. About the inspiratory volume was observed differences among IVS (204.60 ± 37.10) and BS (1134.00 ± 702.00) p = 0,000. However, in the IVS the children were able to achieve a volume of two times the minimum tidal volume established according to their body weight. Conclusion: In the population studied the IVS showed efficient for assessment of the inhale volumes.

Avaliação da musculatura inspiratória de pacientes traqueostomizados em regime de internação hospitalar / Evaluation of inspiratory muscles in hospitalized patients with tracheostomy

Introdução: Vários mecanismos podem contribuir para a disfunção dos músculos ventilatórios e quando a demanda ventilatória excede sua capacidade podem ocorrer episódios de hipoventilação e hipoxemia. Objetivo: Avaliar a força e resistência da musculatura inspiratória de pacientes traqueostomizados e hospitalizados. Material e métodos: Foram selecionados pacientes pós-disgnóstico de insuficiência respiratória, traqueostomizados, que deveriam ter recebido alta do centro de terapia intensiva e estar estáveis hemodinamicamente. As medidas da pressão inspiratória e força da musculatura inspiratória respectivamente. Para avaliação da carga inspiratória e força da musculatura inspiratória respectivamente. Para avaliação da resistência, foi utilizado um teste incremental com carga média de 51,00+-19,13 anos e tempo médio de traqueostomia de 32,84+-23,26 dias. Em relação às pressões inspiratórias, foi verificado: PImáx (34,46+-11,90); PI/PImáx(28,15+-15,01). Quanto ao teste de resist~encia, foi observado: carga inicial e final em cmH20 (7,68+-2,78 e 14,54+-9,89) respectivamente); tempo de teste de 7,61+-6,17 segundos. A PImáx apresentou uma correlação significativa com a idade (r=0,691; p=0,009) e carga final do teste (r=0,7764; p=0,002). A carga inicial apresentou uma correlação significativa com a idade (r=0,691; p=0,009) e PI/PImáx (r=0,749; p=0,003). Conclusão: Os pacientes apresentaram fraqueza importante dos músculos inspiratórios que variou com a idade e estavam com esta musculatura no limiar de sobrecarga. Em relação ao teste de resistência, verificou-se uma variação das variáveis analisadas.

Comparative analysis and reproducibility of the modified shuttle walk test in normal children and in children with cystic fibrosis.

OBJECTIVE: To analyze the shuttle walk test, and its respective retest, comparing children with cystic fibrosis (CF) to normal children. METHODS: The children were divided into two groups: the CF group, composed of children in whom the diagnosis had been confirmed through sweat testing; and the control group, composed of normal children with no history of pulmonary diseases and no alterations in respiratory function. The children were submitted to at least two consecutive tests, 30 min apart. We evaluated distance walked, cardiac overload, peripheral oxygen saturation (SpO2) and subjective perception of exertion (dyspnea at rest scale and Borg dyspnea scale). RESULTS: A total of 28 children were evaluated. Ages ranged from 7 to 15 years (11.57 +/= 2.50 and 11.28 +/= 1.85 years for the CF and control groups, respectively). The Borg scale scores were significantly higher in the controls (p = 0.007). No differences were found regarding cardiac overload and SpO2. In relation to the intergroup retest, the controls presented significant improvements on the second test, both in the distance walked and in dyspnea at rest (p = 0.014 and p = 0.036, respectively). The CF group presented a significant improvement only in the dyspnea at rest score (p = 0.168 and p = 0.042, respectively). CONCLUSION: The cardiac overload imposed by the test did not differ between the groups. The greater fatigue at the beginning of the second test suggests that the 30 min rest between the tests was insufficient.

Análise comparativa e reprodutibilidade do teste de caminhada com carga progressiva (modificado) em crianças normais e em portadoras de fibrose cística / Comparative analysis and reproducibility of the modified shuttle walk test in normal children and in children with cystic fibrosis

OBJETIVO: Realizar uma análise comparativa do teste de caminhada com carga progressiva e respectivo re-teste em crianças com fibrose cística (FC), em relação a crianças normais. MÉTODOS: As crianças foram divididas em dois grupos: grupo FC, com diagnóstico confirmado pelo teste de suor, e grupo controle, de crianças normais, sem relatos de doenças pulmonares e com prova de função pulmonar sem alterações. As crianças foram submetidas a pelo menos dois testes consecutivos, com intervalo de 30 min entre eles. Os parâmetros avaliados foram: distância caminhada, sobrecarga cardíaca, saturação periférica de oxigênio (SpO2) e percepção subjetiva do esforço (escala de dispnéia em repouso, e de Borg). RESULTADOS: Foram avaliadas 28 crianças entre 7 e 15 anos de idade (11,57 ± 2,50 e 11,28 ± 1,85 anos para os grupos FC e controle, respectivamente). Os escores da escala de Borg foram significativamente maiores nos controles (p = 0,007). Não foram encontradas diferenças quanto à sobrecarga cardíaca e SpO2. Em relação ao re-teste intergrupos, no segundo teste o grupo controle apresentou aumento significativo tanto da distância caminhada quanto da dispnéia em repouso (p = 0,014 e p = 0,036, respectivamente). O grupo FC apresentou aumento significativo apenas da escala de dispnéia em repouso (p = 0,168 e p = 0,042, respectivamente). CONCLUSÃO: A sobrecarga cardíaca imposta pelo teste não diferiu entre os grupos. O maior cansaço inicial no segundo teste sugere que o intervalo de 30 min entre os testes não foi suficiente para o descanso das crianças.

OBJECTIVE: To analyze the shuttle walk test, and its respective retest, comparing children with cystic fibrosis (CF) to normal children. METHODS: The children were divided into two groups: the CF group, composed of children in whom the diagnosis had been confirmed through sweat testing; and the control group, composed of normal children with no history of pulmonary diseases and no alterations in respiratory function. The children were submitted to at least two consecutive tests, 30 min apart. We evaluated distance walked, cardiac overload, peripheral oxygen saturation (SpO2) and subjective perception of exertion (dyspnea at rest scale and Borg dyspnea scale). RESULTS: A total of 28 children were evaluated. Ages ranged from 7 to 15 years (11.57 ± 2.50 and 11.28 ± 1.85 years for the CF and control groups, respectively). The Borg scale scores were significantly higher in the controls (p = 0.007). No differences were found regarding cardiac overload and SpO2. In relation to the intergroup retest, the controls presented significant improvements on the second test, both in the distance walked and in dyspnea at rest (p = 0.014 and p = 0.036, respectively). The CF group presented a significant improvement only in the dyspnea at rest score (p = 0.168 and p = 0.042, respectively). CONCLUSION: The cardiac overload imposed by the test did not differ between the groups. The greater fatigue at the beginning of the second test suggests that the 30 min rest between the tests was insufficient.