Normative values and prediction equations for the modified incremental step test in healthy adults aged 18-83 years.

OBJECTIVE: To establish normative values and reference equations for predicting the number of steps and oxygen consumption (VO2) from the modified incremental step test (MIST) in healthy adults aged 18-83 years. DESIGN: Prospective observational study. PARTICIPANTS: One hundred and ninety-four healthy adults aged 18-83 years with normal spirometry. SETTINGS: Exercise physiology laboratory of a university. METHODS: Participants underwent two MISTs (30 minutes apart). The MIST was performed on a 20-cm-high step using an externally paced rhythm imposed by audible signals, starting with 10 steps per minute and with constant increments of 1 step every 30 seconds. MAIN OUTCOMES: Number of steps and VO2 obtained from MIST. RESULTS: Normative values were provided for males and females for each age group. The following equations were determined: number of steps = 675.113 + (66.165*sex, 0 female and 1 male) - (5.353*age) - (6.593*body mass index) (R² =0.44, P < 0.001); VO2 = 0.106 + (0.216*sex, 0 female and 1 male) - (0.008*age [years]) + (0.021*weight [kilograms]) + (0.001*number of steps) (R² =0.80, P < 0.001). CONCLUSION: Normative values and prediction equations are proposed for the number of steps and VO2 which can be used to interpret performance on the MIST in individuals with different health conditions. These equations now need validation in other samples.

Reliability and validity of the London Chest Activity of Daily Living scale for adults with asthma.

INTRODUCTION: Dyspnea during activities of daily living (ADL) is frequently reported by adults with asthma. However, instruments that specifically assess that in people with asthma have not yet been validated. OBJECTIVES: To investigate the validity and reliability, including standard error of measurement (SEM) and Minimum Detectable Change (MDC), of the London Chest Activity of Daily Living (LCADL) scale for adults with asthma. METHODS: Adults with asthma answered the LCADL scale which was performed twice by the same rater. Spirometry, 6-min walk test (6MWT), St George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea scale, Asthma Quality of Life questionnaire (AQLQ), Asthma Control Test (ACT), and Glittre-ADL test were assessed. For statistical analyses, Spearman correlation, Wilcoxon test, Intraclass Correlation Coefficient (ICC), Cronbach's alpha coefficient, SEM, MDC were performed. RESULTS: Seventy participants were included (30% men, 44 ± 15 years old, BMI 27[23-31]kg/m2, FEV1 80 ± 17%predicted). For convergent validity, the LCADL scale was moderately correlated with SGRQ, AQLQ, and Glittre-ADL (r = 0.57, -0.46, and 0.41 respectively; p < 0.0001). The LCADL scale correlated weakly with the mMRC scale, ACT, and spirometry measures (-0.23

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change.

BACKGROUND: Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners. OBJECTIVE: This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models. METHODS: This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy. RESULTS: The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression. CONCLUSION: These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Comparison of Physical Activity Patterns among Three Major Chronic Respiratory Diseases.

Although the level of physical activity in daily life (PADL) plays a vital role concerning the health of subjects with chronic lung diseases, it remains uncertain how PADL patterns compare among different conditions. This study's objective was to compare the PADL levels of subjects with COPD, asthma and idiopathic pulmonary fibrosis (IPF); and to investigate PADL behaviour in different diseases' severity. Stable subjects who had not undergone pulmonary rehabilitation in the previous year were included. Subjects were divided into two subgroups according to disease severity: mild/moderate and severe/very severe. The primary outcome was time spent in moderate-to-vigorous physical activities (MVPA) (Actigraph GT3x) measured during one week over 12 h/day; other assessments included pulmonary function, peripheral muscle strength and exercise capacity. Comparisons among subgroups were corrected for age, BMI and sex. The analysis involved 119 subjects (47 asthma, 48 COPD and 24 IPF). Subjects with asthma had higher PADL levels than those with COPD and IPF (MVPA 18(14-22) vs. 8(4-12) vs. 7(1-12) min/day, respectively; p ancova = 0.002). Subjects with severe/very severe IPF had the lowest PADL level among all subgroups. Adult subjects with asthma have higher PADL levels than those with COPD and IPF, whereas patients with severe and very severe IPF are the most physically inactive subjects.

Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD.

OBJECTIVE: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. METHODS: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity. RESULTS: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: "amount" domain = 0.87 (95% CI, 0.73-0.94) and "difficulty" domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = -0.63). CONCLUSIONS: The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

Assessment of sedentary behaviour in individuals with COPD: how many days are necessary?

Objective: The objective of the present study was to define the minimum number of monitoring days required for the adequate cross-sectional assessment of sedentary behaviour in individuals with chronic obstructive pulmonary disease (COPD). Methods: In this cross-sectional study, the sedentary behaviour of individuals with COPD was assessed using two physical activity monitors during awake time for seven consecutive days. Time spent per day in activities requiring ≤1.5 metabolic equivalents (METs) and in sitting, lying and sitting+lying positions was calculated taking into account the average of 7 days (as a reference in all analyses) and of all 119 possible combinations of 2---6 days. Intraclass correlation coefficients (ICCs) and linear regression analyses were performed for all combinations. Results: 91 individuals were analysed (47 female, 66±9 years, forced expiratory volume in 1 s 50±15% predicted). For the variables time spent per day in activities ≤1.5METs and sitting, the average of any combination of at least four assessment days was sufficient to adequately reflect the average of 7 days (adjusted R2≥0.929, ICC≥0.962, p<0.0001 for all). For time spent per day lying and sitting+lying, only two assessment days were enough (adjusted R2≥0.937, ICC≥0.968, p<0.0001 for all). Results were maintained independently of patient sex, disease severity, day of the week, daylight time or daytime naps. Conclusions: The average of 4 days of objective monitoring was sufficient to adequately reflect the results of a 1-week assessment of the main outcomes related to sedentary behaviour in individuals with moderate to very severe COPD, regardless of sex, disease severity, day of the week, daylight time and occurrence of daytime naps.

Do Functional Tests Estimate Physical Activity in COPD?

The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern.

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.

Validity of the International Physical Activity Questionnaire (short form) in adults with asthma.

BACKGROUND: The short form of the International Physical Activity Questionnaire (IPAQ) is widely used to assess PA and has already been used in adults with asthma; however, its validity has not been yet studied in this population. Therefore, the aim of this study was to verify the convergent and discriminative validity of the IPAQ short form in adults with asthma. METHODS: Fifty-three adults with asthma (36 females; 48±15 years; 29±6 kg/m²) wore the triaxial activity monitor Actigraph for eight days to objectively measure steps/day, time in light physical activity (PA), moderate-to-vigorous PA (MVPA), and sedentary behaviour. Participants filled out the IPAQ matching with the same week they wore the Actigraph, with measures of: time of MVPA and total PA/week; categorization of low, moderate or high PA level; time in seated position. RESULTS: IPAQ self-reported total time of PA/week was weakly correlated with steps/day. The IPAQ categorization correlated moderately with time in light, MVPA and steps/day. Self-reported time in seated position on weekdays was moderately correlated with objective percentage/day of time in sedentary behaviour in the same period. IPAQ categorization in PA levels was able to differentiate between low to moderate and low to high PA levels. CONCLUSIONS: These results cannot confidently infer the convergent validity of the IPAQ to quantify number of steps/day and time spent in PA of adults with asthma. However, this instrument may be useful to categorize patients into three levels of PA.

Translation, transcultural adaptation, and validation of the Brazilian Portuguese version of the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire.

PURPOSE: To analyse the psychometric properties of the translated and cross-culturally adapted version of the OSAKA (Obstructive Sleep Apnea Knowledge and Attitudes) questionnaire in the Brazilian Portuguese language. METHODS: The OSAKA instrument was translated by two independent translators, and the back-translated conciliated version was presented and approved by Washington University, which holds the intellectual property for the OSAKA questionnaire. Physicians from different specialties electronically completed the OSAKA instrument and the ASKME (Assessment of Sleep Knowledge in Medical Education) questionnaire, which was used as an auxiliary instrument to analyse the construct validity. RESULTS: The questionnaire was tested with 176 physicians. The items from the knowledge and attitudes domains presented acceptable internal consistency values, with McDonald's omega coefficients (Ω) of 0.70 and 0.73, respectively. The OSAKA questionnaire showed a moderate correlation with the ASKME instrument (r = 0.60, p < 0.001) and excellent retest reliability, with an intraclass correlation coefficient of 0.81. There were differences in knowledge between the medical specialties (p < 0.001). Regarding attitudes, most respondents considered obstructive sleep apnoea and its diagnosis to be important and felt confident in identifying it, but the same majority did not feel confident in treating the disease. CONCLUSION: The OSAKA instrument, as a translated and cross-culturally adapted Brazilian Portuguese version, presented psychometric properties with adequate reliability and validity.

Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD / Adaptação cultural e validação da versão brasileira do instrumento PROactive Physical Activity in COPD-clinical visit para indivíduos com DPOC

ABSTRACT Objective: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. Methods: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity. Results: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: "amount" domain = 0.87 (95% CI, 0.73-0.94) and "difficulty" domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = −0.63). Conclusions: The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

RESUMO Objetivo: Adaptar o instrumento PROactive Physical Activity in COPD - clinical visit (C-PPAC) ao contexto cultural brasileiro e determinar a validade de critério, concordância da confiabilidade teste-reteste e consistência interna dessa versão. Métodos: Um protocolo de adaptação cultural e validação foi fornecido pelos autores do instrumento original e, juntamente com outra diretriz, foi aplicado em uma versão em português desenvolvida por um grupo de pesquisa parceiro de Portugal. A versão brasileira adaptada foi então aplicada transversalmente duas vezes, com intervalo de sete dias, em 30 indivíduos com DPOC (57% de homens; média de idade de 69 ± 6 anos; e média do VEF1 de 53 ± 18% do previsto) para avaliação da consistência interna e da confiabilidade teste-reteste. Os participantes também responderam ao International Physical Activity Questionnaire (IPAQ), à escala modificada do Medical Research Council, ao COPD Assessment Test e ao Saint George's Respiratory Questionnaire para avaliação da validade de critério. Resultados: O instrumento C-PPAC apresentou boa consistência interna e excelente confiabilidade teste-reteste: domínio "quantidade" = 0,87 (IC95%: 0,73-0,94) e domínio "dificuldade" = 0,90 (IC95%: 0,76-0,96). As disposições gráficas de Bland-Altman, juntamente com os altos coeficientes de correlação de concordância de Lin, reforçaram essa concordância. A validade de critério mostrou correlações moderadas a fortes do instrumento C-PPAC com todos os outros instrumentos avaliados, principalmente com o IPAQ (rho = −0,63). Conclusões: A versão brasileira do instrumento C-PPAC é uma ferramenta confiável e válida para avaliar a experiência de indivíduos brasileiros com DPOC em relação à sua atividade física na vida diária.

An online behavior change intervention to promote physical activity in adults with asthma: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Behavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention. METHODS: This double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 h). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote an increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2, and the Hospital Anxiety and Depression Scale. DISCUSSION: The intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has the potential to improve physical activity levels and asthma management and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient's attendance, and has the potential to be largely offered elsewhere. TRIAL REGISTRATION: ClinicalTrials.gov NCT05241223 . Registered on January 22, 2022.

Sleep-onset time variability and sleep characteristics on weekday and weekend nights in patients with COPD.

OBJECTIVE: To evaluate sleep-onset time variability, as well as sleep characteristics on weekday and weekend nights, in individuals with moderate-to-severe COPD. METHODS: Sleep was objectively assessed by an activity/sleep monitor for seven consecutive nights in individuals with COPD. For analysis, individuals were divided into two groups according to sleep-onset time variability results, characterized by intrasubject standard deviation of sleep-onset time (SOTV) ≥ 60 min or < 60 min. RESULTS: The sample comprised 55 individuals (28 males; mean age = 66 ± 8 years; and median FEV1 % of predicted = 55 [38-62]). When compared with the SOTV<60min group (n = 24), the SOTV≥60min group (n = 31) presented shorter total sleep time (5.1 ± 1.3 h vs. 6.0 ± 1.3 h; p = 0.006), lower sleep efficiency (73 ± 12% vs. 65 ± 13%; p = 0.030), longer wake time after sleep onset (155 ± 66 min vs. 115 ± 52 min; p = 0.023), longer duration of wake bouts (19 [16-28] min vs. 16 [13-22] min; p = 0.025), and higher number of steps at night (143 [104-213] vs. 80 [59-135]; p = 0.002). In general, sleep characteristics were poor regardless of the day of the week, the only significant difference being that the participants woke up about 30 min later on weekends than on weekdays (p = 0.013). CONCLUSIONS: Sleep-onset time varied over 1 h in a standard week in the majority of individuals with COPD in this sample, and a more irregular sleep onset indicated poor sleep quality both on weekdays and weekends. Sleep hygiene guidance could benefit these individuals if it is integrated with their health care.

Do simple and quick functional tests reflect a more comprehensive test or physical activity in daily life in healthy young subjects? / Testes funcionais simples e rápidos refletem um teste mais abrangente ou atividade física na vida diária em jovens saudáveis? / ¿Los tests funcionales simples y rápidos reflejan un test más completo o actividad física en la vida diaria en jóvenes sanos?

ABSTRACT Considering the wide use of functional tests and that faster and simpler evaluations are preferable, this study aimed to verify the association between five protocols of simple functional tests (timed up and go [TUG], four-meter gait speed [4MGS] and sit-to-stand [STS] in five-repetitions [STS5rep], 30-seconds [STS30sec] and one-minute [STS1min] protocols) and the six-minute walk test (6MWT), as well as physical activity in daily life (PADL) in healthy young subjects. In this cross-sectional study, PADL was quantified by a pedometer validated for step counting and we considered the mean of seven consecutive days during the time awake. We assessed functional capacity by the TUG, 4MGS, STS5rep, STS30sec, and STS1min tests and the 6MWT. A total of 79 subjects without lung functional impairments were included (49% male, aged 28 [23-36] years). Performance of simple functional tests correlated with the 6MWT (0.23<r <0.56; P<0.05 for all) and the TUG test showed the best association (R2= 0.34). However, simple functional tests did not correlate with PADL (0.03< r <0.13; P>0.05 for all). The less time-consuming functional tests were weakly-moderately related to the 6MWT in healthy young subjects. The TUG showed the best association and explained up to 34% of the 6MWT. However, the 6MWT cannot be replaced by none of these simple functional tests. Finally, functional capacity showed no association with physical activity in daily life assessed by the pedometers in this population.

RESUMO Considerando o amplo uso de testes funcionais e que avaliações mais rápidas e simples são preferíveis, o objetivo deste estudo foi verificar a associação entre cinco protocolos de testes funcionais, a saber, timed up and go [TUG], 4-meter gait speed [4MGS] and sit to stand [STS] in 5-repetitions [STS5rep], 30-seconds [STS30sec] and 1-minute [STS1min] protocols e o teste de caminhada de 6 minutos (TC6min), bem como com a atividade física na vida diária (AFVD) em jovens saudáveis. Neste estudo transversal, a AFVD foi quantificada por um pedômetro validado para contagem de passos, e a média de sete dias consecutivos durante o tempo acordado foi considerada. A capacidade funcional foi avaliada pelo TUG, 4MGS, STS5rep, STS30sec, STS1min e TC6min. 79 pessoas sem comprometimento pulmonar foram incluídas (49% homens, idade média de 28 anos). O desempenho nos testes funcionais correlacionou-se com o TC6min (0,23< r <0,56; p<0,05 para todos) e o TUG apresentou a melhor associação (R²=0,34). Entretanto, os testes funcionais simples não se correlacionaram com a AFVD (0,03<r<0,13; p>0,05 para todos). Os testes funcionais de curta duração foram fracos, moderadamente relacionados ao TC6min em jovens saudáveis. O TUG apresentou a melhor associação e explicou até 34% do TC6min; no entanto, este não pode ser substituído por nenhum dos testes funcionais simples. Por fim, a capacidade funcional não se relacionou com a atividade física na vida diária avaliada pelos pedômetros nessa população.

RESUMEN Teniendo en cuenta el amplio uso de los tests funcionales y que son preferibles evaluaciones más rápidas y sencillas, el objetivo de este estudio fue verificar la asociación entre cinco protocolos de tests funcionales, a saber, timed up and go [TUG], 4-meter gait speed [4MGS] and sit to stand [STS] in 5-repetitions [STS5rep], 30-seconds [STS30sec] and 1-minute [STS1min] protocols y la prueba de caminata de 6 minutos (6MWT), con la actividad física de la vida diaria (AFVD) en jóvenes sanos. En este estudio transversal, la AFVD se cuantificó mediante un podómetro validado para el conteo de pasos, y se consideró el promedio de siete días consecutivos durante el tiempo acordado. La capacidad funcional se evaluó mediante TUG, 4MGS, STS5rep, STS30sec, STS1min y 6MWT. Se incluyeron a 79 personas sin afectación pulmonar (49% hombres, edad media 28 años). El desempeño en los tests funcionales se correlacionó con la 6MWT (0,23< r <0,56; p<0,05 para todos), y el TUG tuvo la mejor asociación (R²=0,34). Sin embargo, los tests funcionales simples no se correlacionaron con la AFVD (0,03<r<0,13; p>0,05 para todos). Los tests funcionales a corto plazo fueron insuficientes, moderadamente relacionados con la 6MWT en jóvenes sanos. El TUG mostró la mejor asociación y explicó hasta el 34% de la 6MWT, pero este no puede reemplazarse por ninguno de los tests funcionales simples. Por último, la capacidad funcional no se relacionó con la actividad física en la vida diaria evaluada por podómetros en esta población.

Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma.

BACKGROUND: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.

Functional tests for adults with asthma: validity, reliability, minimal detectable change, and feasibility.

OBJECTIVE: To verify the validity, reliability, learning effect, Minimal Detectable Change (MDC), and feasibility of four functional tests (4-Meter Gait Speed [4MGS], Timed Up-and-Go [TUG], Sit-To-Stand [STS], and Short Physical Performance Battery [SPPB]) for adults with asthma. METHODS: In this cross-sectional study, fifty-two subjects with stable asthma underwent three sets of different functional tests protocols (4MGS, TUG, STS, SPPB) in a random order by two raters. For validation analysis, tests were compared with a sex-age matched control group without asthma and correlated with the Six Minute Walking Test (6MWT), and peripheral muscle strength, as well as with quality of life and asthma control questionnaires. Intra-rater and inter-rater reliability, MDC, and feasibility were verified. RESULTS: Adults with asthma presented worse results than controls in the functional tests, except for SPPB. All functional tests were significantly correlated with 6MWT (0.45 < r < 0.67) and peripheral muscle strength (0.32 < r < 0.63), but not with quality of life and asthma control (0.02 < r < 0.17). The tests presented good to excellent intra-rater Intraclass Correlation Coefficients (ICC ≥ 0.75 for all). In all tests, a considerable learning effect and variability of measurement was observed, therefore, the best of two measurements should be used. MDC ranged from 15 to 31% and all tests were performed in a short time, small space, and without clinical adverse events. CONCLUSION: Different protocols of 4MGS, TUG, STS, and SPPB are valid, reliable, and feasible to assess the functional capacity of adults with asthma. These tests are quick and practical new alternatives for assessing functional capacity in this population.

Reference Values for 7 Different Protocols of Simple Functional Tests: A Multicenter Study.

OBJECTIVES: To establish reference values and equations (ages 20-80y) for 7 simple functional tests based on a multicenter study. DESIGN: Cross-sectional data collection in 4 research centers across different regions of a continental dimension country. SETTING: Healthy subjects from general community were assessed in different research laboratories. PARTICIPANTS: Data collection of 296 volunteer subjects (N=296; 45% men; aged 50±18y, forced expiratory volume in the first second 95±13% pred, body mass index 26.9±4.5 kg/m2) aged 20-80 years; representing both sexes; with the ability to understand and perform all proposed assessments; and with no severe and/or unstable condition that could limit functional assessments occurred simultaneously in all centers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All participants randomly performed the following 7 functional tests twice: (1) the 4-meter gait speed test at usual walking speed; (2) the 4-meter gait speed test at maximal walking speed; (3) the Sit-to-Stand test performed with 5 repetitions; (4) the Sit-to-Stand test performed in 30 seconds; (5) the Sit-to-Stand test performed in 1 minute; (6) the Timed Up and Go test at usual speed; and (7) the Timed Up and Go test at maximal speed. Spirometry, quality of life, depression, anxiety, physical activity, and comorbidities were also assessed to better characterize the sample. The best performance of each test was used to propose reference values for men and women and reference equations for all. RESULTS: Participants similarly distributed by age groups from the 4 centers were included. All tests were correlated with age (0.34

Sleep-onset time variability and sleep characteristics on weekday and weekend nights in patients with COPD / Variabilidade do tempo de início do sono e características do sono durante a semana e o fim de semana em pacientes com DPOC

ABSTRACT Objective: To evaluate sleep-onset time variability, as well as sleep characteristics on weekday and weekend nights, in individuals with moderate-to-severe COPD. Methods: Sleep was objectively assessed by an activity/sleep monitor for seven consecutive nights in individuals with COPD. For analysis, individuals were divided into two groups according to sleep-onset time variability results, characterized by intrasubject standard deviation of sleep-onset time (SOTV) ≥ 60 min or < 60 min. Results: The sample comprised 55 individuals (28 males; mean age = 66 ± 8 years; and median FEV1 % of predicted = 55 [38-62]). When compared with the SOTV<60min group (n = 24), the SOTV≥60min group (n = 31) presented shorter total sleep time (5.1 ± 1.3 h vs. 6.0 ± 1.3 h; p = 0.006), lower sleep efficiency (73 ± 12% vs. 65 ± 13%; p = 0.030), longer wake time after sleep onset (155 ± 66 min vs. 115 ± 52 min; p = 0.023), longer duration of wake bouts (19 [16-28] min vs. 16 [13-22] min; p = 0.025), and higher number of steps at night (143 [104-213] vs. 80 [59-135]; p = 0.002). In general, sleep characteristics were poor regardless of the day of the week, the only significant difference being that the participants woke up about 30 min later on weekends than on weekdays (p = 0.013). Conclusions: Sleep-onset time varied over 1 h in a standard week in the majority of individuals with COPD in this sample, and a more irregular sleep onset indicated poor sleep quality both on weekdays and weekends. Sleep hygiene guidance could benefit these individuals if it is integrated with their health care.

RESUMO Objetivo: Avaliar a variabilidade do tempo de início do sono, bem como as características do sono durante a semana e o fim de semana, em indivíduos com DPOC moderada a grave. Métodos: O sono foi avaliado objetivamente por meio de um monitor de atividade/sono durante sete noites consecutivas em indivíduos com DPOC. Para a análise, os indivíduos foram divididos em dois grupos, de acordo com a variabilidade do tempo de início do sono, caracterizada pelo desvio-padrão do tempo de início do sono (TISV) ≥ 60 min ou < 60 min em um mesmo indivíduo. Resultados: A amostra foi composta por 55 indivíduos [28 homens; média de idade = 66 ± 8 anos; mediana do VEF1 em % do previsto = 55 (38-62)]. Em comparação com o grupo TISV<60min (n = 24), o grupo TISV≥60min (n = 31) apresentou menor tempo total de sono (5,1 ± 1,3 h vs. 6,0 ± 1,3 h; p = 0,006), menor eficiência do sono (73 ± 12% vs. 65 ± 13%; p = 0,030), maior tempo de vigília após o início do sono (155 ± 66 min vs. 115 ± 52 min; p = 0,023), blocos de vigília mais longos [19 (16-28) min vs. 16 (13-22) min; p = 0,025] e maior número de passos dados à noite [143 (104-213) vs. 80 (59-135); p = 0,002]. Em geral, as características do sono foram ruins independentemente do dia da semana; a única diferença significativa foi que os participantes acordaram cerca de 30 min mais tarde nos fins de semana do que nos dias de semana (p = 0,013). Conclusões: O tempo de início do sono variou mais de 1 h em uma semana-padrão na maioria dos indivíduos com DPOC da amostra, e um início de sono mais irregular indicou má qualidade do sono tanto nos dias de semana como nos fins de semana. A orientação a respeito da higiene do sono pode ser benéfica se for integrada à atenção à saúde desses pacientes.