Handgrip strength and its relation to isokinetic dynamometry in COPD / Força de Preensão Palmar e sua relação com dinamometria isocinética na DPOC

Abstract Introduction: Muscle dysfunction is one of the major changes found in chronic obstructive pulmonary disease (COPD) and associated with loss of functionality, morbidity and mortality. Objective: correlate two strength assessment methods: manual dynamometry for handgrip strength and isokinetic dynamometry for quadriceps strength in patients with COPD, and assess the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE), quality of life and muscle strength. Method: twenty-five patients with moderate to very severe COPD were evaluated by pulmonary function parameters, anthropometric variables, functional capacity, via the six-minute walk test, dyspnea, applying the modified Medical Research Council (mMRC) scale, BODE, quality of life, using the Saint George's Respiratory Questionnaire (SGRQ), handgrip strength with manual dynamometer and quadriceps force using an isokinetic dynamometer. Muscle strength was assessed with a manual portable dynamometer and isokinetic dynamometer. For statistical analysis, ANOVA with Bonferroni's post-test, the chi-squared test and Pearson's correlation coefficient were used. Results: There was a strong correlation between the strength measurements and the two instruments (torque and quadriceps extension power with right handgrip strength: r = 0.74; p <0.001). The patients classified as very severe exhibited worse performance in the strength tests when compared to the moderate group, albeit with no statistically significant difference. Conclusion: In muscle strength measurements, a strong correlation was detected between the isokinetic dynamometer for quadriceps and the manual dynamometer for handgrip strength. These findings indicate that, in clinical practice, the manual dynamometer for handgrip strength could be used to assess peripheral muscle strength in patients with COPD.

Resumo Introdução: Disfunção muscular é uma das principais alterações encontradas na Doença Pulmonar Obstrutiva Crônica (DPOC), estando relacionada com perda da funcionalidade, morbidades e mortalidade. Objetivo: Correlacionar dois métodos de avaliação de força: dinamometria manual para força de preensão palmar (FFP) e dinamometria isocinético para força de quadríceps em pacientes com DPOC, e avaliar dispneia, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE), qualidade de vida e força muscular. Método: Foram avaliados 25 pacientes com DPOC moderada a muito severa quanto a espirometria e antropometria; capacidade funcional através da distância percorrida no teste de caminhada de seis minutos (DTC6); dispneia através da escala modificada Medical Research Council; BODE; e qualidade de vida através do Saint George's Respiratory Questionnaire. A força muscular foi avaliada através de dinamômetro portátil manual e dinamômetro isocinético. Para estatística utilizou-se ANOVA e pós-teste de Bonferroni, teste de Qui-quadrado e Coeficiente de Correlação de Pearson. Resultados: Houve correlação entre medidas de força com os dois instrumentos (torque e potência de extensão do quadríceps com FPP direita: r=0,74; p<0,001). Não houve diferença nos testes de força em relação à gravidade da doença. Além disso, o DTC6 não mostrou diferença significativa entre os grupos e a qualidade de vida mostrou-se pior no grupo muito severo, tendo diferença significativa em relação ao grupo moderado. Conclusão: Foi encontrada forte correlação entre as medidas de força realizadas com dinamômetro isocinético para o quadríceps e dinamômetro manual para FPP. Esses achados indicam que, na prática clínica, o dinamômetro manual pode ser utilizado para avaliação da musculatura periférica em pacientes com DPOC.

Efeito do sobrepeso e da obesidade sobre função pulmonar e qualidade de vida de idosos vinculados ao Programa Estratégia da Saúde da Família no município de Cruz Alta­RS / Effect of overweight and obesity on lung function and quality of life in elderly linked to the Family Health Strategy Program in Cruz Alta-RS city

O presente estudo tem por objetivo avaliar o efeito do sobrepeso e da obesidade sobre a função pulmonar (FP) e a qualidade de vida (QV) em idosos vinculados ao Programa Estratégia de Saúde da Família (ESF) em Cruz Alta-RS. Foram avaliados cem idosos, sendo noventa mulheres. A FP foi avaliada através da Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no Primeiro Segundo (VEF1 ) e Pico de Fluxo Expiratório (PFE). O questionário Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) foi utilizado para avaliar a QV. Observaram-se 54 indivíduos com sobrepeso ou obesos. A FP apresentou-se dentro da normalidade. As maiores pontuações de QV foram nos domínios Capacidade Funcional (CF), Estado Geral de Saúde (EGS) e Aspectos Sociais (AS). Os indivíduos com sobrepeso e obesos apresentaram escore inferior nos domínios Vitalidade e AS quando comparado aos eutróficos (p = 0,01 e p = 0,03, respectivamente). Foram encontradas correlações inversas entre IMC e os Domínios Vitalidade (r = -0,23, p = 0,01), AS (r = -0,23, p = 0,01) e AE (r = -0,27, p = 0,01). Conclui-se que os idosos avaliados apresentaram níveis satisfatórios de FP e QV, entretanto o sobrepeso e a obesidade influenciaram negativamente a QV. (AU)

The present study aims to evaluate the influence of overweight and obesity on the pulmonary function (PF), and quality of life (QoL) in elderly people linked to the Family Health Strategy Program in Cruz Alta-RS. We evaluated hundred elderly, ninety women. The PF was measured by forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ) and peak expiratory flow (PEF). The Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) was used to assess QoL. It was observed 54 people with overweight or obesity. The PF was within the normal range. The higher QL scores were in the Functional Capacity (FC), General Health (EGS), and Social Aspects (SA). The overweight, and obese individuals showed lower scores in the Vitality and SA domains when compared to the eutrophic ones (p = 0.01 and p = 0.03, respectively). There was an inverse correlation between the Pain domain and the PF. Furthermore, inverse correlations were found between BMI and Vitality (r = -0.23, p = 0.01), AS (r = -0.23, p = 0.01) and EA (r = -0.27, p = 0.01) domains. Then, it was conclude that the evaluated subjects presented satisfactory levels of PF and QoL. However, high levels of BMI negatively influence their QoL. (AU)

Acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease / Efeitos agudos do exercício aeróbio intradialítico sobre a remoção de solutos, gasometria e estresse oxidativo em pacientes com doença renal crônica

Abstract Introduction: Hemodialysis contributes to increased oxidative stress and induces transitory hypoxemia. Compartmentalization decreases the supply of solutes to the dialyzer during treatment. The aim of this study was to investigate the acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease during a single hemodialysis session. Methods: Thirty patients were randomized to perform aerobic exercise with cycle ergometer for lower limbs during 30 minutes with intensity between 60-70% of maximal heart rate, or control group (CG). Blood samples were collected prior to and immediately after exercise or the equivalent time in CG. Analysis of blood and dialysate biochemistry as well as blood gases were performed. Mass removal and solute clearance were calculated. Oxidative stress was determined by lipid peroxidation and by the total antioxidant capacity. Results: Serum concentrations of solutes increased with exercise, but only phosphorus showed a significant elevation (p = 0.035). There were no significant changes in solute removal and in the acid-base balance. Both oxygen partial pressure and saturation increased with exercise (p = 0.035 and p = 0.024, respectivelly), which did not occur in the CG. The total antioxidant capacity decreased significantly (p = 0.027). Conclusion: The acute intradialytic aerobic exercise increased phosphorus serum concentration and decreased total antioxidant capacity, reversing hypoxemia resulting from hemodialysis. The intradialytic exercise did not change the blood acid-base balance and the removal of solutes.

Resumo Introdução: A hemodiálise contribui para aumentar o estresse oxidativo e induz a hipoxemia transitória. A compartimentalização dos solutos diminui sua oferta para o dialisador durante o tratamento. O objetivo deste estudo foi investigar os efeitos agudos do exercício aeróbio intradialítico sobre a remoção de solutos, gasometria e estresse oxidativo em pacientes com doença renal crônica durante uma sessão de hemodiálise. Métodos: Trinta pacientes foram randomizados para realizar exercício aeróbio com cicloergômetro para membros inferiores durante 30 minutos com intensidade entre 60-70% da frequência cardíaca máxima, ou grupo controle (GC). Amostras sanguíneas foram coletadas antes e imediatamente após o término do exercício ou no período equivalente no GC. Análises da bioquímica do sangue e dialisato e gasometria foram realizadas. A massa removida e a depuração dos solutos foram calculadas. O estresse oxidativo foi determinado pela peroxidação lipídica e capacidade antioxidante total. Resultados: As concentrações séricas dos solutos aumentaram com o exercício, mas somente o fósforo mostrou elevação significativa (p = 0.035). Não houve modificações significantes na remoção de solutos e no equilíbrio ácido-básico. A pressão parcial e a saturação de oxigênio aumentaram com o exercício (p = 0.035 e p = 0.024, respectivamente), o que não ocorreu no GC. A capacidade antioxidante total diminuiu significativamente (p = 0.027). Conclusão: O exercício aeróbico intradialítico agudo aumentou a concentração sérica de fósforo e diminuiu a capacidade antioxidante total, revertendo a hipoxemia resultante da hemodiálise. O exercício intradialítico não alterou o equilíbrio ácido-básico e a remoção de solutos.

Acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease.

INTRODUCTION: Hemodialysis contributes to increased oxidative stress and induces transitory hypoxemia. Compartmentalization decreases the supply of solutes to the dialyzer during treatment. The aim of this study was to investigate the acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease during a single hemodialysis session. METHODS: Thirty patients were randomized to perform aerobic exercise with cycle ergometer for lower limbs during 30 minutes with intensity between 60-70% of maximal heart rate, or control group (CG). Blood samples were collected prior to and immediately after exercise or the equivalent time in CG. Analysis of blood and dialysate biochemistry as well as blood gases were performed. Mass removal and solute clearance were calculated. Oxidative stress was determined by lipid peroxidation and by the total antioxidant capacity. RESULTS: Serum concentrations of solutes increased with exercise, but only phosphorus showed a significant elevation (p = 0.035). There were no significant changes in solute removal and in the acid-base balance. Both oxygen partial pressure and saturation increased with exercise (p = 0.035 and p = 0.024, respectivelly), which did not occur in the CG. The total antioxidant capacity decreased significantly (p = 0.027). CONCLUSION: The acute intradialytic aerobic exercise increased phosphorus serum concentration and decreased total antioxidant capacity, reversing hypoxemia resulting from hemodialysis. The intradialytic exercise did not change the blood acid-base balance and the removal of solutes.

The Pilates Method increases respiratory muscle strength and performance as well as abdominal muscle thickness.

The aim of this study was to verify the effects of the Pilates Method (PM) training program on the thickness of the abdominal wall muscles, respiratory muscle strength and performance, and lung function. This uncontrolled clinical trial involved 16 sedentary women who were assessed before and after eight weeks of PM training. The thickness of the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles was assessed. The respiratory muscle strength was assessed by measuring the maximum inspiratory (MIP) and expiratory (MEP) pressure. The lung function and respiratory muscle performance were assessed by spirometry. An increase was found in MIP (p = 0.001), MEP (p = 0.031), maximum voluntary ventilation (p = 0.020) and the TrA (p < 0.001), IO (p = 0.002) and EO (p < 0.001) thickness after the PM program. No alterations in lung function were found. These findings suggest that the PM program promotes abdominal wall muscle hypertrophy and an increase in respiratory muscle strength and performance, preventing weakness in abdominal muscles and dysfunction in ventilatory mechanics, which could favor the appearance of illnesses.

Cytokine response to the 6-min walk test in individuals with different degrees of COPD.

BACKGROUND AND AIM: Physical exercise is a key part of rehabilitation programs in chronic obstructive pulmonary disease (COPD) patients, although it could modulates immune system responses by altering the cytokine profile of such individuals. Furthermore, the degree of severity of COPD could influence the inflammatory response induced by exercise. To evaluate the cytokine profile of individuals with different degrees of COPD in response to a 6-min walk test (6MWT). METHODS: Forty-one patients with COPD were classified according to the severity of the disease by Global Initiative for Chronic Obstructive Lung Disease method: moderate = 14 individuals; severe = 14 individuals; very severe = 13 individuals. Blood sample collection was performed in the subjects pre and post a 6MWT. Cytokine plasma levels were analyzed to determine the cytokine profile using a Cytometric Bead Array technique (Becton Dickinson, San Jose, CA, USA) assay in flow cytometry. RESULTS: A significant difference was observed in the interleukin (IL)-6 levels after test between very severe and severe groups (P = 0.036). Also, lower levels of IL-4 were observed in the severe group compared with the very severe and the moderate groups in the pretest (P = 0.029; P = 0.003, respectively), and different values between the moderate and severe groups in the post-test (P = 0.044). A significant time pre-post effect was found in the IL-4 levels on the very severe group (P = 0.046). CONCLUSION: After the 6MWT, a discrete inflammatory response was observed in COPD patients, independent of the degree of severity. The results concerning IL-4 and IL-6 levels can be indicative of an attempt to control inflammation after the 6MWT in COPD patients.

Effects of intradialytic exercise on systemic cytokine in patients with chronic kidney disease.

BACKGROUND: Immunological dysfunctions and a pro-inflammatory environment are associated with higher risk of cardiovascular diseases in chronic kidney disease (CKD). Physical exercise can be an important anti-inflammatory strategy, but the effects in CKD remain poorly investigated. OBJECTIVE: Evaluate the acute inflammatory response to intradialytic exercise in the peripheral blood of individuals with CKD. METHODS: Nine patients, of both genders, with CKD and allocated in the ambulatory of hemodialysis of Hospital Ernesto Dornelles (Brazil), performed two sessions of hemodialysis (HD) in random form: aerobic intradialytic exercise sessions (EX, 20 min of moderate exercise in cycle-ergometer) and a control hemodialysis session (CON). Peripheral blood collection was made at the baseline, during and immediately after HD to evaluate the cytokine profile: interleukin-6, interleukin-10 (IL-10), interleukin-17a (IL-17a), interferon-gamma (INF-γ) and tumoral necrosis factor-alpha (TNF-α). RESULTS: INF-γ decreased during HD when compared with the pre moment in both sessions, while an increase in post HD was only found in the CON session. IL-17 was higher in post when compared with during HD in both sessions. In addition to the time effect, IL-10 presented a time × group interaction and the relative changes were significantly higher in EX when compared with the CON session. The relative changes in TNF-α tended to be higher in CON when compared with EX immediately post HD session. CONCLUSIONS: These data indicate that 20 min of intradialytic exercise have modest effect in systemic inflammation. However, the significant increase in IL-10 may indicate an immunoregulatory effect of physical exercise.

Effects of intradialytic exercise on systemic cytokine in patients with chronic kidney disease.

BACKGROUND: Immunological dysfunctions and a pro-inflammatory environment are associated with higher risk of cardiovascular diseases in chronic kidney disease (CKD). Physical exercise can be an important anti-inflammatory strategy, but the effects in CKD remain poorly investigated. OBJECTIVE: Evaluate the acute inflammatory response to intradialytic exercise in the peripheral blood of individuals with CKD. METHODS: Nine patients, of both genders, with CKD and allocated in the ambulatory of hemodialysis of Hospital Ernesto Dornelles (Brazil), performed two sessions of hemodialysis (HD) in random form: aerobic intradialytic exercise sessions (EX, 20 min of moderate exercise in cycle-ergometer) and a control hemodialysis session (CON). Peripheral blood collection was made at the baseline, during and immediately after HD to evaluate the cytokine profile: interleukin-6, interleukin-10 (IL-10), interleukin-17a (IL-17a), interferon-gamma (INF-γ) and tumoral necrosis factor-alpha (TNF-α). RESULTS: INF-γ decreased during HD when compared with the pre moment in both sessions, while an increase in post HD was only found in the CON session. IL-17 was higher in post when compared with during HD in both sessions. In addition to the time effect, IL-10 presented a time × group interaction and the relative changes were significantly higher in EX when compared with the CON session. The relative changes in TNF-α tended to be higher in CON when compared with EX immediately post HD session. CONCLUSIONS: These data indicate that 20 min of intradialytic exercise have modest effect in systemic inflammation. However, the significant increase in IL-10 may indicate an immunoregulatory effect of physical exercise.

[Assessment of functional capacity and pulmonary in pediatrics patients renal transplantation].

INTRODUCTION: Pediatric patients undergoing kidney transplantation can present changes in pulmonary function and functional capacity for exercise. OBJECTIVE: To evaluate the functional capacity and pulmonary function in children and adolescents undergoing kidney transplantation. METHOD: Children and adolescents aged six to 18 years of age were evaluated in Outpatient Clinic of Nephrology, Hospital da Criança Santo Antônio, Santa Casa de Porto Alegre, RS, Brazil in period the june of 2010 the march of 2011. Pulmonary capacity was assessed by spirometry and maximal respiratory pressures and functional capacity through 6-minute walk test (6MWT). RESULTS: The sample comprised 25 patients, 14 (56%) males with a mean age of 13.5 ± 3.3 years. From, 19 (76%) underwent dialysis before transplantation. Mean forced vital capacity (FVC) was 97.91 + 24.32% and forced expiratory volume in one second (FEV1) 100.53 + 17.66% from predicted value. In the 6MWT, the patients walked 229.14 meters less than predicted (p < 0.001). The maximum inspiratory pressure (MIP) was significantly lower than predicted, and the difference in cmH2O -24.63 (p = 0.03), as the maximum expiratory pressure (MEP), with a difference of 49.27 cmH2O (p < 0.001). By correlating, functional capacity, spirometry and maximal respiratory pressures, find an association between FVC and 6MWT (r = 0.52, p = 0.01) and FVC and MIP (r = 0.54, p = 0.01). CONCLUSION: Reduced functional capacity and maximum respiratory pressures were diagnosed in a small cohort of pediatric patients after kidney transplantation. Better the functional capacity and PiMáx better the FVC.

Effect of exercise performed during hemodialysis: strength versus aerobic.

RATIONAL: Patients under regular dialysis can also present alterations in the cardiovascular, musculoskeletal, and metabolic systems. OBJECTIVES: The aim of this study is to compare the effects of strength and aerobic exercises performed during hemodialysis (HD) in individuals with chronic renal disease. MATERIALS AND METHODS: Randomized clinical trial. It was developed as a program of exercises three times a week, in the first 2 h of HD for 8 weeks. The patients were divided into three groups: control (Group 1, n: 11), strength (Group 2, n: 11), and aerobic (Group 3, n: 10). G1 has not developed any type of physical training; G2 utilized a training load of 40% of one repetition maximum (1RM) with anklets, and developed three series of 15 repetitions. G3 pedaled seated in the dialysis seat, during 20 min, in an ergometric bicycle, with intensity regulated by the perceived effort scale. Before and after 8 weeks, the following variables were evaluated: respiratory muscular strength, pulmonary function, functional capacity, blood biochemistry, and quality of life. MAIN FINDINGS: In the pre- and post-training comparison, there was statistically significant improvement (p < 0.05) in the maximal inspiratory pressure (MIP), number of steps achieved (NSA), and quality of life (QoL) in the trained groups, as compared to the non-exercised group (G1). CONCLUSIONS: The strength and aerobic exercises developed during HD can improve the respiratory muscular strength, functional performance, and quality of life, when compared to individuals presenting the disease who have not developed any type of physical training.

Avaliação da capacidade funcional e pulmonar em pacientes pediátricos transplantados renais / Assessment of functional capacity and pulmonary in pediatrics patients renal transplantation

INTRODUÇÃO: Pacientes pediátricos submetidos a transplante renal podem apresentar alterações na função pulmonar, bem como na capacidade funcional para o exercício. OBJETIVO: Avaliar a capacidade funcional e capacidade pulmonar de crianças e adolescentes submetidas a transplante renal. MÉTODO: Foram avaliadas crianças e adolescentes com idade entre 6 e 18 anos em acompanhamento no ambulatório de Nefrologia do Hospital da Criança Santo Antônio, Santa Casa de Porto Alegre-RS, Brasil, no período de junho de 2010 a março de 2011. A capacidade pulmonar foi avaliada por meio da espirometria e das pressões respiratórias máximas e a capacidade funcional pelo Teste da Caminhada dos 6 minutos (TC6). RESULTADOS: A amostra foi composta por 25 pacientes, sendo 14 (56%) do sexo masculino, com média de idade de 13,5 ± 3,3 anos. Destes, 19 (76%) realizaram hemodiálise anterior ao transplante. A média da Capacidade Vital Forçada (CVF) foi 97,91 ± 24,32% e o Volume Expiratório Forçado no primeiro segundo (VEF1) foi 100,53 ± 17,66% do valor predito. No TC6, os pacientes caminharam 229,14 metros menos do que o predito (p < 0,001). A Pressão Inspiratória Máxima (PiMáx) foi significativamente menor que o predito, com uma diferença de -24,63 cmH2O (p = 0,03), assim como a Pressão Expiratória Máxima (Pe-Máx), com uma diferença de 49,27 cmH2O (p < 0,001). Ao correlacionarmos capacidade funcional, espirometria e pressões respiratórias máximas, encontramos associação entre CVF e TC6 (r = 0,52, p = 0,01) e CVF e PiMáx (r = 0,54 e p = 0,01). CONCLUSÃO: Os pacientes transplantados apresentaram diminuição da capacidade funcional, bem como das pressões respiratórias máximas. Quanto melhor a capacidade funcional e a PiMáx, melhor a CVF.

INTRODUCTION: Pediatric patients undergoing kidney transplantation can present changes in pulmonary function and functional capacity for exercise. OBJECTIVE: To evaluate the functional capacity and pulmonary function in children and adolescents undergoing kidney transplantation. METHOD: Children and adolescents aged six to 18 years of age were evaluated in Outpatient Clinic of Nephrology, Hospital da Criança Santo Antônio, Santa Casa de Porto Alegre, RS, Brazil in period the june of 2010 the march of 2011. Pulmonary capacity was assessed by spirometry and maximal respiratory pressures and functional capacity through 6-minute walk test (6MWT). RESULTS: The sample comprised 25 patients, 14 (56%) males with a mean age of 13.5 ± 3.3 years. From, 19 (76%) underwent dialysis before transplantation. Mean forced vital capacity (FVC) was 97.91 + 24.32% and forced expiratory volume in one second (FEV1) 100.53 + 17.66% from predicted value. In the 6MWT, the patients walked 229.14 meters less than predicted (p < 0.001). The maximum inspiratory pressure (MIP) was significantly lower than predicted, and the difference in cmH2O -24.63 (p = 0.03), as the maximum expiratory pressure (MEP), with a difference of 49.27 cmH2O (p < 0.001). By correlating, functional capacity, spirometry and maximal respiratory pressures, find an association between FVC and 6MWT (r = 0.52, p = 0.01) and FVC and MIP (r = 0.54, p = 0.01). CONCLUSION: Reduced functional capacity and maximum respiratory pressures were diagnosed in a small cohort of pediatric patients after kidney transplantation. Better the functional capacity and PiMáx better the FVC.

[Effects of aerobic exercise during haemodialysis in patients with chronic renal disease: a literature review]. / Efeitos do exercício aeróbio durante a hemodiálise em pacientes com doença renal crônica: uma revisão da literatura.

INTRODUCTION: Patients with chronic kidney disease (CKD) have reduced physical and functional capacity when compared with the general population. Hemodialysis (HD) restricts patients activities, favoring a sedentary lifestyle and leading to functional limitations. HD patients are less active, present low exercise tolerance and have high physical deconditioning. Physical exercise programs have been proposed as a strategy not only to treat clinical symptoms, but also to reduce physical limitations and improve the quality of life of these patients. OBJECTIVES: The purpose of this study was to review the literature on the effects of physical exercise (aerobic exercise on a cycle ergometer for the lower limbs) on CKD undergoing HD. METHODS: The Medline, PubMed, Scielo, Embase and DirectScience databases were searched. RESULTS: Fourteen randomized controlled clinical trials were analyzed as regards the timing of the intervention during the HD session, exercise intensity and frequency, the duration of the intervention and the main results. CONCLUSION: The studies demonstrated that aerobic exercises performed during HD improve the aerobic capacity and physical conditioning, reduce fatigue and anxiety, improve muscle capillarization and resting blood pressure, increase exercise duration and improve urea clearance.

Efeitos do exercício aeróbio durante a hemodiálise em pacientes com doença renal crônica: uma revisão da literatura / Effects of aerobic exercise during haemodialysis in patients with chronic renal disease: a literature review

INTRODUÇÃO: Pacientes com doença renal crônica (DRC) têm capacidade física e funcional reduzida quando comparados à população geral. O tratamento hemodialítico torna as atividades desses pacientes restritas, favorecendo o estilo de vida sedentário e a limitação funcional. Pacientes em hemodiálise (HD) são menos ativos, apresentam baixa tolerância ao exercício e alto descondicionamento físico. Em virtude dessas alterações, têm sido propostos programas de exercício físico que visam não somente ao tratamento dos sinais clínicos da doença, mas de suas repercussões na função e na qualidade de vida. OBJETIVOS: Realizar uma revisão da literatura sobre os efeitos do exercício físico em pacientes portadores de DRC submetidos a programas de exercício aeróbio em cicloergômetro para membros inferiores durante a HD. MÉTODOS: Foram realizadas consultas às bases de dados Medline, PubMed, Scielo, Embase e ScienceDirect. RESULTADOS: Analisaram-se 14 estudos experimentais randomizados controlados, considerando o período de realização da intervenção na HD, a intensidade e a frequência do exercício, a duração da intervenção e os principais resultados. CONCLUSÃO: Os estudos demonstraram que exercícios aeróbios realizados durante a HD promovem a melhora da capacidade aeróbia e o condicionamento físico, além de redução da fadiga e ansiedade, melhora da capilarização muscular e pressão arterial de repouso, aumento no tempo de duração dos exercícios e melhora na depuração da ureia.

INTRODUCTION: Patients with chronic kidney disease (CKD) have reduced physical and functional capacity when compared with the general population. Hemodialysis (HD) restricts patients activities, favoring a sedentary lifestyle and leading to functional limitations. HD patients are less active, present low exercise tolerance and have high physical deconditioning. Physical exercise programs have been proposed as a strategy not only to treat clinical symptoms, but also to reduce physical limitations and improve the quality of life of these patients. OBJECTIVES: The purpose of this study was to review the literature on the effects of physical exercise (aerobic exercise on a cycle ergometer for the lower limbs) on CKD undergoing HD. METHODS: The Medline, PubMed, Scielo, Embase and DirectScience databases were searched. RESULTS: Fourteen randomized controlled clinical trials were analyzed as regards the timing of the intervention during the HD session, exercise intensity and frequency, the duration of the intervention and the main results. CONCLUSION: The studies demonstrated that aerobic exercises performed during HD improve the aerobic capacity and physical conditioning, reduce fatigue and anxiety, improve muscle capillarization and resting blood pressure, increase exercise duration and improve urea clearance.

Effects of expiratory positive airway pressure on dynamic hyperinflation during exercise in patients with COPD.

BACKGROUND: Expiratory positive airway pressure (EPAP) is a form of noninvasive positive-pressure ventilatory support that, in spite of not unloading respiratory muscles during inspiration, may reduce the inspiratory threshold load and attenuate expiratory dynamic airway compression, contributing to reduced expiratory air-flow limitation in patients with COPD. We sought to determine the effects of EPAP on operational lung volumes during exercise in COPD patients. METHODS: This was a nonrandomized, experimental comparison of 2 exercise conditions (with and without EPAP); subjects completed a treadmill exercise test and performed, before and immediately after exercise, lung volume measurements. Those who overtly developed dynamic hyperinflation (DH), as defined by at least a 15% reduction from pre-exercise inspiratory capacity (IC), were invited for an additional research visit to repeat the same exercise protocol while receiving EPAP through a spring loaded resistor face mask. The primary outcome was IC variance (pre-post exercise) comparison under the 2 exercise conditions. RESULTS: Forty-six subjects (32 males), a mean 65.0 ± 8.2 years of age, and with moderate to severe COPD (FEV(1) = 38 ± 16% predicted) were initially enrolled. From this initial sample, 17 (37%) presented overt DH, as previously defined. No significant difference was found between these subjects and the rest of the initial sample. Comparing before and after exercise, there was significantly less reduction in IC observed when EPAP was used (-0.18 ± 0.35 L vs -0.57 ± 0.45 L, P = .02), allowing greater IC final values (1.45 ± 0.50 L vs 1.13 ± 0.52 L, P = .02). CONCLUSIONS: The application of EPAP reduced DH, as shown by lower operational lung volumes after submaximal exercise in COPD patients who previously manifested exercise DH.

Capacidade funcional e força muscular respiratória de candidatos ao transplante hepático / Functional capacity and respiratory muscle strength of candidates to hepatic transplant

INTRODUÇÃO: A doença hepática crônica resulta em grande impacto funcional, causando perda de massa e função muscular com consequente redução da capacidade funcional. OBJETIVO: Avaliar e comparar a força muscular respiratória e a capacidade funcional dos candidatos ao transplante hepático que possuem classe B ou C segundo o Child-Pugh Score e correlacionar estas variáveis dentro de cada grupo. MÉTODOS: Estudo transversal, com amostra de conveniência composta por 35 pacientes, divididos em dois grupos a partir da pontuação obtida no Child-Pugh Score, sendo B (19 pacientes) e C (16 pacientes). Todos os indivíduos foram avaliados em um único momento, sendo mensuradas as pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) e a distância percorrida no teste de caminhada de seis minutos (TC6M). RESULTADOS: Os indivíduos classificados com Child-Pugh Score B apresentaram maiores valores na PImáx (-86,05 ± 23,89 vs. -57,94 ± 14,14), p = 0,001, na PEmáx (84,16 ± 28,26 vs. 72,00 ± 16,94), p = 0,142, e na distância percorrida no TC6M (473,63 ± 55,276 vs. 376,13 ± 39,00), p = 0,001. Encontramos, ainda, correlação positiva entre os valores da PImáx e a distância percorrida no TC6M dentro grupo Child-Pugh Score B, r = 0,64 e p = 0,003. CONCLUSÃO: O progresso da doença hepática contribui para o surgimento de diversas complicações que, em conjunto, parecem contribuir para a redução da capacidade funcional dos indivíduos. Em nosso trabalho, isso ficou evidenciado pelo pior desempenho do grupo Child-Pugh Score C. Isto pode sugerir que a espera para o transplante hepático (TxH) pode agravar a capacidade funcional e a força muscular respiratória desses indivíduos.

INTRODUCTION: Chronic liver disease results in large functional impact, causing loss of muscle mass and function with consequent reduction of functional capacity. OBJECTIVE: To evaluate and compare the respiratory muscle strength and functional capacity of candidates for liver transplantation who are under Class B or C according to Child Pugh Score and to correlate these variables within each group. METHODS- Cross-sectional study with a convenience sample of 35 patients divided into two groups based on the score obtained in the Child Pugh Score B (19 patients) and Child Pugh Score C (16 patients). All subjects were evaluated in a single moment, and the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as well as the distance walked during the 6-minute walk test (6MWT) were measured. RESULTS: Individuals classified with Child Pugh Score B showed higher values in the MIP (- 86.05 vs. 23.89 - 57.94 14.14), p = 0.001, in MEP (84.16 vs. 28.26 72.00 16 1994), p = 0.142, and the distance walked in 6MWT (473.63 vs 376.13 39.00 55.276), p = 0.001. We also found a positive correlation between the values of MIP and distance walked during 6MWT in group B of the Child Pugh Score, r = 0.64 and p = 0.003. CONCLUSION: The progress of liver disease contributes to the onset of several complications, which together appear to contribute to the reduction of functional capacity of individuals. In our study this was evidenced by the worse performance of Child Pugh score C group. This may suggest that the wait for liver transplantation (LTx) can worsen the functional capacity of these individuals.

A classe da NYHA tem relação com a condição funcional e qualidade de vida na insuficiência cardíaca / The relationship between NYHA class and the functional condition and quality of life in heart failure

A insuficiência cardíaca (IC) é uma síndrome que se apresenta com crescente prevalência, podendo limitar o indivíduo quanto à capacidade físico-funcional, condição pulmonar e qualidade de vida. Este estudo tem como objetivo verificar as limitações pulmonares e físicas, bem como a qualidade de vida dos pacientes e compará-las com as classes funcionais da New York Heart Association (NYHA). Estudo transversal, com amostra de 66 pacientes (45 homens). Foram aplicados uma ficha de avaliação padronizada e o questionário de qualidade de vida Short Form-36 (SF-36). Foram realizados espirometria, manovacuometria e o teste da caminhada de seis minutos (TC6M). Os pacientes (classe I: 24 indivíduos, classe II: 27 e classe III: 15) possuíam uma média de idade de 57,95±10,96 anos e representaram uma amostra com características antropométricas homogêneas. Para a condição pulmonar, observou-se diferença estatística quanto a Capacidade Vital Forçada (CVF), Pico de Fluxo Expiratório e Pressão Expiratória Máxima (Pemáx). Na distância do TC6M houve diferença entre classe I e III e entre II e III (classe I: 439,27±58,85 m, classe II: 370,96±74,41 m e classe III: 268,96±83,88 m), com p<0,001. Para o SF-36, houve decréscimo da qualidade de vida conforme o agravo das classes funcionais. Pacientes com IC apresentam diminuição da condição pulmonar, capacidade físico-funcional e qualidade de vida relacionada ao aumento da classe funcional da NYHA.

Heart failure (HF) is a syndrome that presents with increasing prevalence, and can restrict the individual as to the physical-functional, lung condition and quality of life. Check the quality of life, lung and physical limitations of patients and compare them with those in New York Heart Association (NYHA) functional class. Cross-sectional study, a sample of 66 patients (45 men). It applied a form of standardized assessment, spirometry, manovacuometry, of the six minute walk test (6MWT) and questioning the quality of life Short-Form 36 (SF-36). Patients average age of 57.95±10.96 years (Class I: 24, Class II: 27 and Class III: 15) and represented a sample with anthropometric characteristics homogeneous. For the lung condition, we observed a statistical difference in forced vital capacity (FVC), expiratory peak flow and maximal expiratory pressure (MEP). In 6MWT distance significant difference between Class I and III and between II and III (Class I: 439.27±58.85 m, Class II: 370.96±74.41 m and 268.96±83.88 m Class III), with p<0001. For the SF-36, there was a decrease in quality of life as functional disorder of the classes. Patients with IC have decreased lung condition, physical and functional capacity and quality of life proportional to the increase in the NYHA functional class.

Effects of inspiratory muscle training in hemodialysis patients.

INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40% of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

Efeitos do treinamento muscular inspiratório nos pacientes em hemodiálise / Effects of inspiratory muscle training in hemodialysis patients

INTRODUÇÃO: A doença renal crônica associada ao tratamento hemodialítico pode apresentar uma diversidade de complicações músculo-esqueléticas, além de trazer repercussões à função pulmonar. OBJETIVO: Avaliar os efeitos do treinamento muscular inspiratório na força muscular inspiratória, função pulmonar e capacidade funcional em pacientes com insuficiência renal crônica submetidos à hemodiálise. MÉTODO: Ensaio clínico não controlado, composto por 15 indivíduos com diagnóstico médico de insuficiência renal crônica, submetidos à hemodiálise. Foram avaliados pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) através da manovacuometria; função pulmonar pela espirometria e a capacidade funcional através da distância percorrida e consumo de oxigênio obtido no teste da caminhada dos seis minutos (TC6M). No período de oito semanas, foi aplicado o protocolo de treinamento muscular respiratório (TMI) durante a sessão de hemodiálise, com carga estabelecida de 40 por cento da PImáx e uma frequência semanal de três dias alternados. RESULTADOS: Houve um aumento significativo na variável distância percorrida após o treinamento (455 ± 98 versus 558 ± 121; p = 0,003). Não foram encontradas diferenças estatísticas na comparação antes e após treinamento nas demais variáveis do estudo. CONCLUSÃO: O estudo não apresentou diferença estatística na força muscular respiratória, na função pulmonar e no consumo de oxigênio. Observou-se apenas um aumento na distância do TC6M.

INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40 percent of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.