COVID-19 e sarcopenia em idosos: revisão integrativa / COVID-19 and sarcopenia in the elderly: integrative review

O número de novos casos de diagnóstico de covid-19 aumentou drasticamente nos últimos tempos, somando aproximadamente 235 milhões de indivíduos confirmados ao redor do mundo. Ao verificar a incidência da doença juntamente com o número de óbitos em decorrência da mesma, é possível observar uma maior mortalidade em idosos O fator influenciador da vulnerabilidade nesta população consiste em alterações fisiológicas dos sistemas orgânicos do corpo, em especial, a sarcopenia referente ao sistema muscular. Objetivo: Analisar o impacto da covid-19 em pessoa idosa e qual a sua relação com o desenvolvimento e agravamento da sarcopenia em indivíduos senis. Método: O estudo é caracterizado como uma revisão integrativa. Resultados: Após a revisão e leitura de acordo com os critérios do estudo, sete artigos foram elegíveis, destes três abordavam a relação direta da diminuição da composição muscular com a covid-19, outros dois artigos expuseram a forma que a pandemia da covid-19 impactou a vida dos idosos e dois demonstraram a influência do exercício físico em idosos e sua importância durante a pandemia Conclusão: Os idosos com diminuição da massa magra estão mais propensos a sintomas graves, internação e até mesmo a óbito, após contaminação covid-19. Além disso, o isolamento social, necessário para a contenção do vírus, proporcionou grande impacto negativo nos aspectos físicos e emocionais da população estudada. Desta forma, fica evidente a necessidade da prática de exercícios físicos, com as devidas precauções, para esse grupo diminuir ao máximo os riscos associados à sarcopenia.

Effectiveness and Safety of Supervised Home-Based Physical Training in Patients With COPD on Long-term Home Oxygen Therapy: A Randomized Trial.

BACKGROUND: Patients with COPD in advanced stages who need long-term home oxygen therapy (LTHOT) have difficulty participating in outpatient pulmonary rehabilitation (PR) programs. This difficulty is due to the severity of their disease, limitations involving transportation and mobility, high costs, and issues related to patients' safety and individual needs. Unsupervised home-based physical training (PT) is frequently used. RESEARCH QUESTION: The main objective of this study was to investigate the effectiveness of a supervised home-based PT program on exercise capacity and other outcomes in patients with COPD receiving LTHOT. STUDY DESIGN AND METHODS: In a randomized clinical trial, patients with COPD who were on LTHOT were allocated into two groups: the supervised physical training (PT) group, consisting of patients who received home-based supervised muscle strength and endurance training in twice-weekly 60-min sessions for 12 weeks; and the unsupervised activity booklet group, consisting of patients who received a booklet advising them to perform exercise twice a week for 12 weeks. All participants were assessed prior to and following the intervention in terms of exercise capacity (6-min step-test and the 1-min sit-to-stand test); dyspnea (Medical Research Council scale); fatigue (Brazilian Portuguese version of the Fatigue Severity Scale); and health status (COPD Assessment Test). RESULTS: A total of 44 patients were assessed (mean age, 70 ± 8 years; FEV1, 33 ± 14% predicted) (PT group, n = 22; booklet group, n = 22). Only the PT group patients presented significant improvement in the 6-min step-test (21 ± 9 vs 14 ± 11; P = .001), Medical Research Council scale (3.3 ± 1.0 vs 3.9 ± 0.9; P = .013), Brazilian Portuguese version of the Fatigue Severity Scale (5.0 ± 1.4 vs 5.2 ± 1.3; P = .015), and COPD Assessment Test (21 ± 8 vs 26 ± 6; P = .001). No adverse effects were observed. INTERPRETATION: Supervised home-based PT was effective and safe in improving exercise capacity, dyspnea, fatigue, and health status in patients with COPD on LTHOT. CLINICAL TRIAL REGISTRATION: Brazilian Registry of Clinical Trials; No.: RBR-535smn; URL: http://www.ensaiosclinicos.gov.br.

Association Between the Results of the Timed Up-and-Go Test Adjusted for Disease Severity and Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease: a Pilot Study.

OBJECTIVES: Loss of muscle mass and/or physical performance, a condition commonly known as sarcopenia, is prevalent in chronic obstructive pulmonary disease (COPD) and is associated with adverse outcomes. The aim of this study was to investigate the association between functional performance and sarcopenia in COPD patients classified by disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. METHODS: The study was a cross-sectional observational and the sample size consisted of 35 COPD patients (69.24±1.54 years, 20 men). Physical performance was assessed with the timed up-and-go (TUG) test. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. RESULTS: The frequency of sarcopenia was 20% and was more prevalent among individuals classified with greater disease severity, GOLD III, n=4 patients (23%) and GOLD IV, n=3 patients (27%), p=0.83. The mean time to complete the TUG test was 11.66±4.78 s. Binary logistic regression revealed an association between the TUG test and sarcopenia adjusted by disease severity (OR=1.55, 95% CI: 1.03-8.23, p=0.04). CONCLUSION: Our findings showed that worse performance in the TUG test leads to a substantial increase in the chance of COPD patients presenting sarcopenia.

Characteristics of long-term home oxygen therapy users in the municipality of Curitiba, Brazil / Características dos usuários de oxigenoterapia domiciliar prolongada do município de Curitiba / Características de los usuarios de oxigenoterapia domiciliar prolongada del municipio de Curitiba

Abstract Introduction: Long-term home oxygen therapy (LTOT) can be successfully used in the treatment and prevention of chronic lung diseases, as it improves quality of life, increases survival, and reduces the lenght of hospital stays. However, to the authors' knowledge there are no descriptive studies with details of the clinical and social profile of patients using LTOT in the state of Paraná. Objective: To analyze the profile of LTOT users in the state of Paraná. Method: All patients registered in the LTOT program of the Curitiba Municipal Department of Health were recruited to the study. Participants answered a questionnaire with questions about their education level, family income, main diagnosis, comorbidities, hours/day of O2 use, and hospitalizations in the previous year. Results: 386 patients (67 ± 20.4 years; 66% females) were interviewed. Chronic obstructive pulmonary disease (COPD) was the most common disease (58.5%); 60.6% were former smokers and 84.5% did not practice any kind of physical activity; dyspnea was the most common symptom (81.3%) and immobility was the most commonly reported inconvenience (33%); 55.7% used O2 24 hours a day; 53.6% had been hospitalized in the previous year; 33.9% had not completed primary school; 31.4% had an income of one minimum monthly wage or less. Conclusion: LTOT users in Curitiba are primarily elderly women with COPD, with low family income and limited schooling. It is extremely important that health professionals provide educational and preventive measures for this population, to minimize the impact of COPD in the community.

Resumo Introdução: No tratamento e prevenção de doenças pulmonares crônica, o uso da Oxigenoterapia Domiciliar Prolongada (ODP) mostra-se favorável, pois melhora a qualidade de vida, aumenta sobrevida e reduz períodos de hospitalização. No entanto, os autores desconhecem estudos descritivos que relatem o perfil clínico e social dos pacientes que usam ODP no estado do Paraná. Objetivo: Analisar o perfil dos usuários do Programa de Oxigenoterapia Domiciliar Prolongada (ODP) no estado do Paraná. Método: Foram recrutados todos os indivíduos cadastrados no Programa de ODP da Secretaria Municipal de Saúde de Curitiba. Os participantes responderam a uma ficha estruturada, com questões relacionadas à escolaridade, renda familiar, diagnóstico principal, comorbidades, horas/dia de O2, internamento no último ano. Resultados: Foram entrevistados 386 pacientes (67 ± 20,4 anos; 66% gênero feminino). A Doença Pulmonar Obstrutiva Crônica (DPOC) foi a doença mais prevalente (58,5%); 60,6% eram ex-tabagistas e 84,5% não praticavam nenhum tipo de atividade física; a dispneia foi o sintoma mais comum (81,3%) e o imobilismo foi o incomodo mais relatado (33%); 55,7% faziam uso de O2 durante 24 horas; 53,6% necessitaram de internamento no último ano; 33,9% escolaridade até Ensino Fundamental Incompleto; 31,4% com renda de até 1 salário mínimo. Conclusão: Usuários de ODP em sua maioria são mulheres, idosas, com DPOC, apresentaram baixa renda familiar e baixo grau de escolaridade. É de extrema importância que os profissionais de saúde levem medidas educativas e preventivas para essa população, a fim de minimizar o impacto da DPOC na comunidade.

Resumen Introducción: En el tratamiento y prevención de enfermedades pulmonares crónicas, el uso de la Oxigenoterapia Domiciliar Prolongada (ODP) se muestra favorable, pues mejora la calidad de vida, aumenta la supervivencia y reduce períodos de hospitalización. Sin embargo, los autores desconocen estudios descriptivos que relatan el perfil clínico y social de los pacientes que usan ODP en el estado de Paraná. Objetivo: Analizar el perfil de los usuarios del ODP en el estado de Paraná. Método: Fueron reclutados todos los individuos registrados en el Programa de ODP de la Secretaría Municipal de Salud de Curitiba. Los participantes respondieron a una ficha con cuestiones relacionadas la escolaridad, ingreso familiar, diagnóstico principal, comorbilidades, horas/día O2, internamiento en el último año. Resultados: Fueron entrevistados 386 pacientes (67 ± 20,4 años; 66% femenino). La enfermedad pulmonar obstructiva crónica (EPOC) fue la enfermedad más prevalente (58,5%); 60,6% eran ex tabaqueros y el 84,5% no practicaba ningúna actividad física; la disnea fue el síntoma más común (81,3%) y el inmovilismo fue el inconveniente más reportado (33%); 55,7% hacía uso de O2 durante 24 horas; 53,6% necesitó de internamiento en el último año; 31,4% con renta de hasta 1 salario mínimo. Conclusión: Los usuarios de ODP en su mayoría son mujeres, ancianas, con EPOC, presentaron baja renta familiar y bajo grado de escolaridad. Es de extrema importancia que los profesionales de la salud lleven medidas educativas y preventivas para esa población, a fin de minimizar el impacto de la EPOC en la comunidad.

Association between the results of the timed up-and-go test adjusted for disease severity and sarcopenia in patients with chronic obstructive pulmonary disease: a pilot study

OBJECTIVES: Loss of muscle mass and/or physical performance, a condition commonly known as sarcopenia, is prevalent in chronic obstructive pulmonary disease (COPD) and is associated with adverse outcomes. The aim of this study was to investigate the association between functional performance and sarcopenia in COPD patients classified by disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. METHODS: The study was a cross-sectional observational and the sample size consisted of 35 COPD patients (69.24±1.54 years, 20 men). Physical performance was assessed with the timed up-and-go (TUG) test. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. RESULTS: The frequency of sarcopenia was 20% and was more prevalent among individuals classified with greater disease severity, GOLD III, n=4 patients (23%) and GOLD IV, n=3 patients (27%), p=0.83. The mean time to complete the TUG test was 11.66±4.78 s. Binary logistic regression revealed an association between the TUG test and sarcopenia adjusted by disease severity (OR=1.55, 95% CI: 1.03-8.23, p=0.04). CONCLUSION: Our findings showed that worse performance in the TUG test leads to a substantial increase in the chance of COPD patients presenting sarcopenia.

Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy.

Chronic obstructive pulmonary disease (COPD) has systemic consequences that lead to reduced physical activity in daily life (PADL). Little is known about PADL and its associations in individuals with COPD on home-based long-term oxygen therapy (LTOT). The objective of the study was to determine whether there is an association between severe physical inactivity and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on home-based LTOT using electric oxygen concentrators and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV1: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale - FSS), dyspnea (Medical Research Council - MRC scale), functional status (London Chest ADL scale [LCADL] and Timed Up and Go [TUG] test) and functional exercise capacity (Six-Minute Step test [6MST] and Sit-to-Stand test [STST]). PADL was markedly low (1444 ± 1203 steps/day) and associated with daily duration of LTOT (r = -0.50), fatigue (r = -0.36), LCADL (r = -0.41), 6MST (r = 0.48), and STST (r = 0.53) (p < .05 for all). Multiple linear regression revealed that daily duration of LTOT and STST explained 39% of the variability of PADL. Longer daily duration of LTOT, fatigue, worse functional status and exercise capacity were all associated with physical inactivity in individuals with COPD on LTOT, whereas daily duration of LTOT and the STST were determinants of reduced physical activity.

Long-term effects of a program to increase physical activity in smokers.

BACKGROUND: Programs aimed at increasing physical activity in daily life (PADL) have generated growing interest to prevent the deleterious effects of physical inactivity. Recent literature has shown that a short-term protocol using pedometers increased PADL in smokers with normal lung function. However, the long-term effects of such a protocol were not yet studied. The objective of this study was to evaluate the results of 1-year follow-up after a program aimed at increasing PADL in smokers with normal lung function. METHODS: Twenty-four smokers were followed (15 men; mean [interquartile range (IQR)], 51 [41-57] years of age; BMI, 26 [22-29] kg/m2; 20 [20-30] cigarettes/d). Subjects were assessed at baseline, immediately after completion of the program, and 1 year later for PADL, lung function, 6-min walking distance (6MWD), smoking habits, quality of life, anxiety, and depression. The 5-month program used pedometers and informative booklets as interventions. RESULTS: The gains achieved after the program were maintained in the long term: steps/d (postprogram vs 1-year follow-up, mean [IQR]: 10,572 [9,804-12,237] vs 10,438 [9,151-12,862]); 6MWD (625 [530-694] m, 88 [81-97] % predicted vs 609 [539-694] m, 89 [81-96] % predicted), anxiety (34 [26-41] points vs 35 [36-47] points) and depression (6 [2-9] points vs 5 [2-11] points) (P > .05 for all). One year after the program, 20% of the subjects had quit smoking. CONCLUSIONS: In smokers with normal lung function, improvements in daily physical activity, exercise capacity, anxiety, and depression obtained through a 5-month program aimed at increasing physical activity are sustained 1 year after completion of the program. Furthermore, such a program can contribute to smoking cessation in this population.

Reduction of physical activity in daily life and its determinants in smokers without airflow obstruction.

BACKGROUND AND OBJECTIVE: In smokers without airflow obstruction, detailed, objective and controlled quantification of the level of physical inactivity in daily life has never been performed. This study aimed to objectively assess the level of physical activity in daily life in adult smokers without airflow obstruction in comparison with matched non-smokers, and to investigate the determinants for daily physical activity in smokers. METHODS: Sixty smokers (aged 50 (39-54) years) and 50 non-smokers (aged 48 (40-53) years) matched for gender, age, anthropometric characteristics, educational level, employment status and seasons of the year assessment period were cross-sectionally assessed regarding their daily physical activity with a step counter, besides assessment of lung function, functional exercise capacity, quality of life, anxiety, depression, self-reported comorbidities carbon monoxide level, nicotine dependence and smoking habits. RESULTS: When compared with non-smokers, smokers walked less in daily life (7923 ± 3558 vs 9553 ± 3637 steps/day, respectively), presented worse lung function, functional exercise capacity, quality of life, anxiety and depression. Multiple regression analyses identified functional exercise capacity, Borg fatigue, self-reported motivation/physical activity behaviour and cardiac disease as significant determinants of number of steps/day in smokers (partial r(2) = 0.10, 0.12, 0.16 and 0.05; b = 15, -997, 1207 and -2330 steps/day, respectively; overall fit of the model R(2) = 0.38; P < 0.001). CONCLUSIONS: Adult smokers without airflow obstruction presented reduced level of daily physical activity. Functional exercise capacity, extended fatigue sensation, aspects of motivation/physical activity behaviour and self-reported cardiac disease are significant determinants of physical activity in daily life in smokers.

Comparison of two strategies using pedometers to counteract physical inactivity in smokers.

INTRODUCTION: This randomized crossover trial aimed to compare the effects of 2 different protocols using pedometers and informative booklets to increase physical activity in daily life (PADL) in smokers. METHODS: PADL level was assessed at baseline (A1), and subjects were randomly assigned to 2 groups for a month: booklet + pedometer (GB + P; n = 13), which started the protocol receiving a booklet with encouragement to walk as much as possible in everyday life; pedometer + booklet (GP + B; n = 18), which started the protocol wearing a pedometer aiming to achieve 10,000 steps/day. PADL was reassessed (A2), and the interventions were crossed over for 1 month, followed by PADL reassessment (A3). After A3, both groups used pedometers for 3 months aiming to reach 10,000 steps/day, and final PADL assessment was performed (A4). For the analysis, each group was subdivided according to baseline PADL as physically active or inactive, according to having reached or not reached 10,000 steps/day at baseline. RESULTS: The physically active subgroups of GB + P and GP + B showed no change in steps/day. The physically inactive subgroup of GP + B significantly increased steps/day at A2 and maintained this increase until A4. The physically inactive subgroup of GB + P initially increased to a lesser extent, reaching borderline statistical significance at A2 and A3 (p = .06) and statistically significant increase only at A4 (p = .02). CONCLUSIONS: Both strategies were effective in increasing the number of steps/day in physically inactive smokers after 5 months, although the increase was more quickly obtained in smokers who used pedometers as the first intervention.

Short-term effects of using pedometers to increase daily physical activity in smokers: a randomized trial.

BACKGROUND: In adults it is recommended that the minimum of 10,000 steps/day should be performed in order to consider an individual as active. The pedometer, a small device that counts steps, has been used to monitor and/or motivate physical activity in various populations. OBJECTIVE: To investigate the short-term effects of a protocol using a pedometer or an informative booklet to increase daily physical activity in apparently healthy smokers who reached or did not reach the minimum public health recommendation of 10,000 steps/day. METHODS: Subjects were randomly assigned to 2 groups: group pedometer (GP, n = 23), who wore a pedometer every day during 1 month, aiming to achieve 10,000 steps/day; and group booklet (GB, n = 17), who received a booklet with encouragement to walk as much as possible in everyday life. Each group was subdivided according to their baseline daily physical activity level: active (subjects who achieved 10,000 steps/day), and inactive (those who did not achieve this minimum). RESULTS: Only the physically inactive GP increased significantly its daily physical activity (pre vs post 7,670 [6,159-9,402] steps/day vs 10,310 [9,483-11,110] steps/day, P < .001), with a concomitant increase in the 6-min walking test (6MWT) distance (mean and interquartile range 540 m [501-586 m] vs 566 m [525-604 m], P = .03). In GP, Δ post-pre steps/day correlated significantly with baseline number of steps/day (r = -0.63, P = .01), but not with 6MWT. In the inactive subjects (summing GP and GB), there were significant correlations between steps/day and cigarettes/day, pack-years, and Fagerström questionnaire (r = -0.55, -0.40, and -0.59, P ≤ .05 for all). Furthermore, improvement in steps/day in the inactive subjects of GP was correlated with baseline cigarettes smoked per day, pack-years, and Fagerström questionnaire (r = 0.51, 0.65 and 0.53, P ≤ .05 for all). CONCLUSIONS: Physically inactive smokers improve their daily physical activity level by using a simple tool (pedometer), and larger improvement occurs in subjects with the lowest levels of physical activity.

Effects of 2 exercise training programs on physical activity in daily life in patients with COPD.

BACKGROUND: The effects of different exercise training programs on the level of physical activity in daily life in patients with COPD remain to be investigated. OBJECTIVE: In patients with COPD we compared the effects of 2 exercise/training regimens (a high-intensity whole-body endurance-and-strength program, and a low-intensity calisthenics-and-breathing-exercises program) on physical activity in daily life, exercise capacity, muscle force, health-related quality of life, and functional status. METHODS: We randomized 40 patients with COPD to perform either endurance-and-strength training (no. = 20, mean ± SD FEV(1) 40 ± 13% of predicted) at 60-75% of maximum capacity, or calisthenics-and-breathing-exercises training (no. = 20, mean ± SD FEV(1) 39 ± 14% of predicted). Both groups underwent 3 sessions per week for 12 weeks. Before and after the training programs the patients underwent activity monitoring with motion sensors, incremental cycle-ergometry, 6-min walk test, and peripheral-muscle-force test, and responded to questionnaires on health-related quality of life and functional status (activities of daily living, pulmonary functional status, and dyspnea). RESULTS: Time spent active and energy expenditure in daily life were not significantly altered in either group. Exercise capacity and muscle force significantly improved only in the endurance-and-strength group. Health-related quality of life and functional status improved significantly in both groups. CONCLUSIONS: Neither training program significantly improved time spent active or energy expenditure in daily life. The training regimens similarly improved quality of life and functional status. Exercise capacity and muscle force significantly improved only in the high-intensity endurance-and-strength group.

Responsiveness of three instruments to assess self-reported functional status in patients with COPD.

The study aimed to compare the responsiveness of three instruments to assess self-reported changes in functional status after exercise training in patients with COPD: Pulmonary Functional Status and Dyspnea Questionnaire -modified version (PFSDQ-M), London Chest Activity of Daily Living (LCADL) and Medical Research Council scale (MRC). Twenty-two patients (11 female, 66[62-71] years, FEV1 42[33-61]%predicted) participated in a 3-month high-intensity exercise program. The three instruments were applied pre- and post-program, as well as assessment of lung function, muscle strength, exercise capacity (6-minute walking test, 6MWT) and quality of life (St. George's Respiratory Questionnaire, SGRQ). SGRQ, 6MWT and quadriceps femoris, biceps and triceps brachialis strength improved significantly after the program (p < 0.05 for all). Training also yielded significant improvement in the LCADL total score and self-care, domestic and leisure domains and in the PFSDQ-M 'change in activities' domain, with no improvement in the MRC (p = 0.11). Calculation of effects sizes also indicated higher responsiveness in the LCADL than the other instruments. There were no significant correlations between changes in the three instruments and changes in lung function, SGRQ or 6MWT. In conclusion, PFSDQ-M's 'change in activity' domain and specially the LCADL (to a higher extent) showed responsiveness to detect changes in functional status after three months of high-intensity exercise training in patients with COPD, whereas the MRC scale did not. In this population, the improvement in functional status was not related with improvement in exercise capacity, lung function or quality of life.

Portuguese-language version of the Chronic Respiratory Questionnaire: a validity and reproducibility study.

OBJECTIVE: To determine the validity and reproducibility of a Portuguese-language version of the Chronic Respiratory Questionnaire (CRQ) in patients with COPD. METHODS: A Portuguese-language version of the CRQ (provided by McMaster University, the holder of the questionnaire copyright) was applied to 50 patients with COPD (70 +/- 8 years of age; 32 males; FEV1 = 47 +/- 18% of predicted) on two occasions, one week apart. The CRQ has four domains (dyspnea, fatigue, emotional function, and mastery) and was applied as an interviewer-administered instrument. The Saint George's Respiratory Questionnaire (SGRQ), already validated for use in Brazil, was used as the criterion for validation. Spirometry and the six-minute walk test (6MWT) were performed to analyze the correlations with the CRQ scores. RESULTS: There were no significant CRQ test-retest differences (p > 0.05 for all domains). The test-retest intraclass correlation coefficient was 0.98, 0.97, 0.98 and 0.95 for the dyspnea, fatigue, emotional function and mastery domains, respectively. The Cronbach's alpha coefficient was 0.91. The CRQ domains correlated significantly with the SGRQ domains (-0.30 < r < -0.67; p < 0.05). There were no significant correlations between spirometric variables and the CRQ domains or between the CRQ domains and the 6MWT, with the exception of the fatigue domain (r = 0.30; p = 0.04). CONCLUSIONS: The Portuguese-language version of the CRQ proved to be reproducible and valid for use in Brazilian patients with COPD.

Versão em português do Chronic Respiratory Questionnaire: estudo da validade e reprodutibilidade / Portuguese-language version of the Chronic Respiratory Questionnaire: a validity and reproducibility study

OBJETIVO: Verificar a validade e a reprodutibilidade de uma versão em português do Chronic Respiratory Questionnaire (CRQ) em pacientes com DPOC. MÉTODOS: A versão em português do CRQ (fornecida pela Universidade de McMaster, detentora dos direitos do questionário) foi aplicada a 50 pacientes portadores de DPOC (32 homens; 70 ± 8 anos; VEF1 = 47 ± 18 por cento predito) em dois momentos, com intervalo de uma semana. O CRQ tem quatro domínios (dispneia, fadiga, função emocional e autocontrole) e foi aplicado em formato de entrevista. O Saint George's Respiratory Questionnaire (SGRQ), já validado em português, foi utilizado como o critério de validação. A espirometria e o teste da caminhada de seis minutos (TC6) foram realizados para a análise das correlações com os valores do CRQ. RESULTADOS: Não foram observadas diferenças significativas entre a aplicação e a reaplicação do CRQ (p > 0.05 para todos os domínios). O coeficiente de correlação intraclasse entre a aplicação e a reaplicação foi de 0,98; 0,97; 0,98 e 0,95 para os domínios dispneia, fadiga, função emocional e autocontrole, respectivamente. O coeficiente alfa de Cronbach foi 0,91. Os domínios do CRQ se correlacionaram significativamente com os domínios do SGRQ (-0.30 < r < -0.67; p < 0,05). Não houve correlação entre as variáveis espirométricas e os domínios do CRQ e nem entre esses domínios e o TC6, exceto para o domínio fadiga (r = 0,30; p = 0,04). CONCLUSÕES: A versão em português do CRQ demonstrou ser reprodutível e válida em pacientes brasileiros portadores de DPOC.

OBJECTIVE: To determine the validity and reproducibility of a Portuguese-language version of the Chronic Respiratory Questionnaire (CRQ) in patients with COPD. METHODS: A Portuguese-language version of the CRQ (provided by McMaster University, the holder of the questionnaire copyright) was applied to 50 patients with COPD (70 ± 8 years of age; 32 males; FEV1 = 47 ± 18 percent of predicted) on two occasions, one week apart. The CRQ has four domains (dyspnea, fatigue, emotional function, and mastery) and was applied as an interviewer-administered instrument. The Saint George's Respiratory Questionnaire (SGRQ), already validated for use in Brazil, was used as the criterion for validation. Spirometry and the six-minute walk test (6MWT) were performed to analyze the correlations with the CRQ scores. RESULTS: There were no significant CRQ test-retest differences (p > 0.05 for all domains). The test-retest intraclass correlation coefficient was 0.98, 0.97, 0.98 and 0.95 for the dyspnea, fatigue, emotional function and mastery domains, respectively. The Cronbach's alpha coefficient was 0.91. The CRQ domains correlated significantly with the SGRQ domains (-0.30 < r < -0.67; p < 0.05). There were no significant correlations between spirometric variables and the CRQ domains or between the CRQ domains and the 6MWT, with the exception of the fatigue domain (r = 0.30; p = 0.04). CONCLUSIONS: The Portuguese-language version of the CRQ proved to be reproducible and valid for use in Brazilian patients with COPD.

Efeitos de um programa de exercícios físicos em pacientes com doença renal crônica terminal em hemodiálise / The effects of physical exercise program in end-stage renal disease patients undergoing hemodialysis

Introdução: O objetivo do presente estudo foi avaliar os efeitos de oito semanas de um programa de exercícios em pacientes com doença renal crônica terminal (DRCT) durante hemodiálise (HD), usando equipamento de baixo custo. Métodos: Cinquenta e oito pacientes com DRCT participaram de um programa de exercícios físicos supervisionados (1 hora/dia, 3 dias/semana) durante as sessões de HD. Os pacientes foram avaliados dois meses antes do início do programa (AVI), imediatamente antes de iniciar (AVII) e após oito semanas de treinamento físico completo (AVIII). As análises incluíram teste de caminhada de seis minutos (DP6min); shuttle teste (SWT), para estimar o consumo máximo de oxigênio (VO2 max); teste de uma repetição máxima (1RM), para mensuração da força muscular do quadríceps; teste de pressão respiratória máxima; espirometria e qualidade de vida pelo questionário Medical Outcomes Study Short-Form 36 (SF-36). Resultados: Os resultados do teste DP6min mostraram que, após oito semanas de exercício, houve aumento na distância percorrida (p < 0,001) e pressão sistólica final (p < 0,001), enquanto a pressão diastólica final diminuiu (p < 0,01). A distância percorrida no SWT e o VO2 max aumentaram significativamente (p < 0,01). A força muscular do quadríceps em ambos os membros inferiores também aumentou (p < 0,001). Além disso, a taxa de adequação da diálise aumentou (p < 0,01) e foi acompanhada de um aumento na creatinina (p < 0,001). A análise do resultado do SF-36 revelou uma significativa melhora na capacidade funcional, vitalidade, aspectos emocionais, saúde mental (p < 0,05), componente mental (p < 0,01) e limitação de aspectos físicos, dor corporal, componente físico, bem como escore geral (p < 0,001). Conclusões: Um programa de dois meses de treinamento com exercícios durante a HD mostrou ser suficiente para...

Introduction: The objective of the present study was to evaluate the effects of an eight-week exercise training program in patients with end-stage renal disease (ESRD) during hemodialysis (HD), using low-cost equipment. Methods: Fifty-eight patients with ESRD participated in a supervised exercise program (1 hr/day, 3 days/week) during HD sessions. Patients were evaluated two months prior to the beginning of the program (T1), immediately before beginning (T2), and after eight weeks of exercise training upon program completion (T3). Analyses included the 6-min walking test (6MWT); a shuttle walk test (SWT), which quantified maximal oxygen consumption (peak VO2); the one-repetition maximum test (1RM), which assessed quadriceps muscle force; the maximal respiratory pressure test; spirometry and health-related quality of life through the Medical Outcomes Study Short-Form 36 (SF-36). Results: The 6MWT after the eight-week exercise program showed increases in the walking distance (p < 0.001) and in the final systolic pressure (p < 0.001), whereas final diastolic pressure decreased (p < 0.01). Both, the distance walked during the SWT and the peak VO2 increased upon program completion (p < 0.01). Quadriceps force in lower limbs also increased (p < 0.001). Moreover, the dialysis adequacy improved (p < 0.01) and was seen a significant increase in serum creatinine (p < 0.001). Analysis of SF- 36 results revealed a significant improvement regarding functional capacity, vitality, emotional aspects, mental health (p < 0.05), mental component (p < 0.01) and limitation by physical aspects, body pain, physical component, and also the general score (p < 0.001). Conclusions: Two months of exercise training during HD showed sufficient to significantly improve the physical capacity and quality of life among ESRD patients using low-cost equipments.

Pulmonary function and respiratory muscle strength in chronic renal failure patients on hemodialysis.

OBJECTIVE: To evaluate pulmonary function and respiratory muscle strength in chronic renal failure patients, correlating these variables with hemodialysis-related weight fluctuation; to study the correlation between the duration hemodialysis and potential respiratory alterations. METHODS: Seventeen patients (median age, 47 years; interquartile range, 41-52 years), submitted to three weekly hemodialysis sessions for a median of 27 months (interquartile range, 14-55) were evaluated. Twelve of the patients were male. The patients underwent spirometry. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured prior to and after the first hemodialysis session of the week. Body weight was quantified prior to and after each of the three weekly sessions. RESULTS: Before the first hemodialysis session of the week, 8 patients presented mild restrictive defect, which normalized after the session in 2 of those patients. After dialysis, there was a significant increase in forced vital capacity (p = 0.02) and a significant decrease in body weight (p = 0.0001). Weight fluctuation over 3 days without hemodialysis tended to correlate with the variation in forced vital capacity in the first weekly session (r = 0.47; p = 0.055). Duration of hemodialysis correlated with predialysis MIP (r = -0.3; p = 0.03) and MEP (r = -0.63; p = 0.006). CONCLUSIONS: More pronounced weight gain in the interdialytic period is associated with worsening of lung function, which is almost fully reversible by hemodialysis. In addition, longer duration of hemodialysis is associated with decreased respiratory muscle strength.

Validação do Modified Pulmonary Functional Status and Dyspnea Questionnaire e da escala do Medical Research Council para o uso em pacientes com doença pulmonar obstrutiva crônica no Brasil / Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease

OBJETIVO: Verificar a validade e a reprodutibilidade do uso de dois instrumentos subjetivos para avaliar a limitação nas atividades da vida diária (AVD) em pacientes com doença pulmonar obstrutiva crônica (DPOC) no Brasil: o Pulmonary Functional Status and Dyspnea Questionnaire - Modified version (PFSDQ-M) e a escala do Medical Research Council (MRC). MÉTODOS: Trinta pacientes com DPOC (17 homens; idade, 67 ± 10 anos; volume expiratório forçado no primeiro segundo, 42 por cento ± 13 por cento do predito) responderam por duas vezes às versões em português dos dois instrumentos com intervalo de uma semana. O PFSDQ-M contém três componentes: influência da dispnéia nas AVD, influência da fadiga nas AVD, e mudança nas AVD em comparação ao período anterior à doença. A escala do MRC é simples, com apenas cinco itens, dentre os quais o paciente escolhe qual o seu nível de limitação nas AVD devido à dispnéia. O tradicional questionário Saint George's Respiratory Questionnaire (SGRQ), já validado para o uso no Brasil, foi utilizado como critério de validação. RESULTADOS: A confiabilidade em reteste do PFSDQ-M utilizando o coeficiente de correlação intraclasse foi de 0,93, 0,92 e 0,90 para os componentes dispnéia, fadiga e mudança, respectivamente, enquanto que esta foi de 0,83 para a escala do MRC. A análise dos gráficos de Bland e Altman mostrou boa concordância entre a aplicação e a reaplicação do PFSDQ-M. Os componentes do PFSDQ-M e a escala do MRC se correlacionaram significativamente com os domínios e o escore total do SGRQ (0,49 < r < 0,80; p < 0,01 para todos). CONCLUSÕES: As versões em língua portuguesa do PFSDQ-M e da escala do MRC demonstraram ser reprodutíveis e válidas para o uso em pacientes com DPOC no Brasil.

OBJECTIVE: To determine the validity and reproducibility of two subjective instruments to assess limitations in activities of daily living (ADLs) in patients with chronic obstructive pulmonary disease (COPD) in Brazil: the Pulmonary Functional Status and Dyspnea Questionnaire - Modified version (PFSDQ-M) and the Medical Research Council (MRC) scale. METHODS: Thirty patients with COPD (age, 67 ± 10 years; males, 17; forced expiratory volume in one second, 42 percent ± 13 percent of predicted) completed the Portuguese-language versions of the two instruments on two occasions, one week apart. The PFSDQ-M has three components: influence of dyspnea on ADLs, influence of fatigue on ADLs change in ADLs experienced by the patient. The MRC scale is simple, with only five items, in which patients report the degree to which dyspnea limits their performance of ADLs. The traditional Saint George's Respiratory Questionnaire (SGRQ), previously validated for use in Brazil, was used as a validation criterion. RESULTS: The test-retest reliability (intraclass correlation coefficient) of the PFSDQ-M was 0.93, 0.92 and 0.90 for dyspnea, fatigue and change components, respectively, compared with 0.83 for the MRC scale. Bland-Altman plots showed good test-retest agreement for the PFSDQ-M. The components of the PFSDQ-M and the MRC scale correlated significantly with all of the domains and the total score of the SGRQ (0.49 < r < 0.80; p < 0.01 for all). CONCLUSIONS: The Portuguese-language versions of the PFSDQ-M and the MRC scale proved reproducible and valid for use in patients with COPD in Brazil.

Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise / Pulmonary function and respiratory muscle strength in chronic renal failure patients on hemodialysis

OBJETIVO: Avaliar a função pulmonar e a força muscular respiratória de pacientes com doença renal crônica e correlacioná-las com a variação de peso ligada à realização de hemodiálise; estudar a correlação entre o tempo de hemodiálise e possíveis alterações respiratórias. MÉTODOS: Foram avaliados 17 pacientes (mediana de idade, 47 anos; intervalo interquartílico, 41-52 anos) submetidos a três sessões semanais de hemodiálise (mediana de tempo, 27 meses; intervalo interquartílico, 14-55). Doze eram do sexo masculino. Realizaram espirometria e mensuração das pressões máximas inspiratória (PImáx) e expiratória (PEmáx) antes e após a primeira sessão semanal de hemodiálise. O peso corporal foi quantificado antes e após as três sessões semanais. RESULTADOS: Oito pacientes apresentaram distúrbio restritivo leve antes da primeira sessão de hemodiálise. Desses, 2 normalizaram após a sessão. Houve aumento da capacidade vital forçada (p = 0,02) e diminuição de peso (p = 0,0001) ao final da primeira sessão semanal. A variação de peso durante três dias sem hemodiálise tendeu a se correlacionar com a variação da capacidade vital forçada na primeira sessão (r = 0,47; p = 0,055). O tempo de hemodiálise correlacionou-se com os valores da porcentagem do predito da PImáx (r = -0,53; p = 0,03) e com a PEmáx (r = -0,63; p = 0,006) pré-diálise. CONCLUSÕES: O maior ganho de peso no período interdialítico está associado com a piora da função pulmonar, que pode ser quase totalmente revertida com hemodiálise. Além disso, o maior tempo de hemodiálise está associado à diminuição da força muscular respiratória.

OBJECTIVE: To evaluate pulmonary function and respiratory muscle strength in chronic renal failure patients, correlating these variables with hemodialysis-related weight fluctuation; to study the correlation between the duration hemodialysis and potential respiratory alterations. METHODS: Seventeen patients (median age, 47 years; interquartile range, 41-52 years), submitted to three weekly hemodialysis sessions for a median of 27 months (interquartile range, 14-55) were evaluated. Twelve of the patients were male. The patients underwent spirometry. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured prior to and after the first hemodialysis session of the week. Body weight was quantified prior to and after each of the three weekly sessions. RESULTS: Before the first hemodialysis session of the week, 8 patients presented mild restrictive defect, which normalized after the session in 2 of those patients. After dialysis, there was a significant increase in forced vital capacity (p = 0.02) and a significant decrease in body weight (p = 0.0001). Weight fluctuation over 3 days without hemodialysis tended to correlate with the variation in forced vital capacity in the first weekly session (r = 0.47; p = 0.055). Duration of hemodialysis correlated with predialysis MIP (r = -0.3; p = 0.03) and MEP (r = -0.63; p = 0.006). CONCLUSIONS: More pronounced weight gain in the interdialytic period is associated with worsening of lung function, which is almost fully reversible by hemodialysis. In addition, longer duration of hemodialysis is associated with decreased respiratory muscle strength.

Relationship between pulmonary function and physical activity in daily life in patients with COPD.

BACKGROUND: It remains unclear how closely the physical inactivity observed in patients with Chronic Obstructive Pulmonary Disease (COPD) relates to the severity of their airflow limitation. Furthermore, it is unknown whether spirometric variables such as maximal voluntary ventilation (MVV) and inspiratory capacity (IC) reflect the level of physical activity in daily life better than the forced expiratory volume in the first second (FEV(1)), the main spirometric variable used to determine the severity of COPD. The objective of the present study was to investigate the relationship between physical activity in daily life and the severity of COPD assessed by different spirometric variables: MVV, IC and FEV(1). METHODS: Forty patients with COPD (21 men; 68+/-7 years; FEV(1) 41+/-14% predicted) were performed spirometry and assessment of the physical activity level in daily life using an accelerometer (SenseWear Armband). RESULTS: MVV was significantly correlated to total energy expenditure per day, energy expenditure per day in activities demanding more than 3 metabolic equivalents (METs), number of steps per day and time spent per day in moderate and vigorous activities (0.42

[Validation of the Portuguese version of the London Chest Activity of Daily Living Scale (LCADL) in chronic obstructive pulmonary disease patients].

INTRODUCTION: While there are several subjective English tools, such as the London Chest Activity of Daily Living scale (LCADL), aimed at assessing dyspnoea during activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Di- sease (COPD), none of these questionnaires has ever been translated into Portuguese. The aim of this study was to investigate the validity and reproducibility of the LCADL's Portuguese version in patients with COPD. METHODS: 31 patients with COPD (17 male; 69+/-7 years; FEV1 44+/-15 %predicted) completed the Portuguese version of the LCADL twice with a 1-week interval. The traditional Saint George Respiratory Questionnaire (SGRQ), already validated in Portuguese, was used as the criterion method. RESULTS: There were no significant differences between test and retest of the LCADL. Intraclass Correlation Coefficient between test and retest concerning the different scale components was Self-care r=0.96; Domestic r=0.99; Physical r=0.92; Leisure r=0.95; Total Score r=0.98. There were significant correlations of the LCADL Total Score with the SGRQ's different components and total score (0.36