Preoperative physical activity has a protective effect against postoperative pulmonary complications after abdominal surgery / Atividade física pré-operatória tem efeito protetor contra complicações pulmonares após cirurgia abdominal

Physical activity level and fitness condition seem to be related with pulmonary surgical risk in thoracic and cardiac surgeries; however, in abdominal surgery this relation is not clear. Objective: To compare the physical activity level in daily life and during hospitalization before surgery between patients who developed and did not develop postoperative pulmonary complications (PPC) after abdominal surgery and to relate to this outcome. Methods: This prospective cohort enrolled 191 hospitalized candidates (52 ± 14yrs; BMI = 29 ± 11 kg/m2) for upper abdominal surgery. Two different tools related to two distinct moments were used to assess preoperatively the physical activity level. First, to assess life physical activity level, the questionnaire Human Activity Profile (HAP) was administered for all patients. During hospitalization, the accelerometry was performed during 4 consecutive days to assess the time in activity. In addition, lung function, muscle strength and resting energy expenditure were assessed. PPC (pneumonia, atelectasis or severe hypoxemia) were checked until discharge. Multivariate analyses were used. Results: 92% of patients were classified as moderately to physically active in daily life. During hospitalization, patients were inactive during 90% ± 5% of time. There was no association with HAP score and acelerometry. 10.5% of patients developed PPC. Being physically active in daily life and during hospitalization have a protective effect against PPC. Our results show that the physical activity behavior in hospital do not reflect the daily life even in patients not restricted to bed and on preoperative period, patients physically actives on daily life and during hospitalization present less chance to develop PPC after abdominal surgery. (AU)

O nível de atividade física e o condicionamento físico parecem estar relacionados ao risco cirúrgico pulmonar em cirurgias torácicas e cardíacas; no entanto, na cirurgia abdominal, essa relação não é clara. Objetivo: Comparar o nível de atividade física na vida diária e durante a hospitalização antes da cirurgia entre pacientes que desenvolveram e que não desenvolveram complicações pulmonares pós-operatórias (CPP) após cirurgia abdominal e relacionar esses desfechos. Métodos: Esta coorte prospectiva recrutou 191 pacientes hospitalizados não restritos ao leito e candidatos a cirurgia abdominal (52 ± 14 anos; IMC = 29 ± 11 kg/m2 ; VEF1 = 98 ± 19% do predito; CVF = 96 ± 16% do predito). Duas ferramentas diferentes relacionadas a dois momentos distintos foram utilizadas para avaliar o nível no pré-operatório de atividade física. Primeiro, para avaliar o nível de atividade física da vida diária, o questionário Perfil de Atividade Humana (PAH) foi aplicado a todos os pacientes. O PAH possui 94 perguntas sobre a execução de atividades gradualmente mais intensas. O PAH classifica o paciente como inativo (<54 pontos), moderadamente ativo (54 a 73 pontos) e ativo (>73 pontos). Segundo, a acelerometria foi realizada durante 4 dias consecutivos para avaliar o tempo de atividade durante a hospitalização. As CPP (pneumonia, atelectasia ou hipoxemia grave) foram verificadas até a alta. Análises multivariadas foram utilizadas. Resultados: 92% dos pacientes foram classificados como moderados a fisicamente ativos na vida diária. Durante a hospitalização, os pacientes ficaram inativos em 90% ± 5% do tempo. Não houve associação com escore do PAH e acelerometria. Cerca de 10,5% dos pacientes desenvolveram CPP. Ser fisicamente ativo na vida diária e durante a hospitalização tem um efeito protetor contra CPP (Odds ratio [OR] = 0,69, IC 95% 0,01- 0,93; OR=0,61, IC 95% 0,12-0,87, respectivamente). Nossos resultados mostram que o comportamento da atividade física no hospital não reflete o da vida diária, mesmo em pacientes não restritos ao leito e no período pré-operatório, e os pacientes ativos fisicamente na vida diária e durante a internação apresentam menor chance de desenvolver CPP após cirurgia abdominal. (AU)

Measurement properties of the Human Activity Profile questionnaire in hospitalized patients.

OBJECTIVE: To test the measurement properties (reproducibility, internal consistency, ceiling and floor effects, and construct validity) of the Human Activity Profile (HAP) questionnaire in hospitalized patients. METHODS: This measurement properties study recruited one-hundred patients hospitalized for less than 48h for clinical or surgical reasons. The HAP was administered at baseline and after 48h in a test-retest design). The International Physical Activity Questionnaire (IPAQ-6) was also administered at baseline, aiming to assess the construct validity. We tested the following measurement properties: reproducibility (reliability assessed by type 2,1 intraclass correlation coefficient (ICC2,1)); agreement by the standard error of measurement (SEM) and by the minimum detectable change with 90% confidence (MDC90), internal consistency by Cronbach's alpha, construct validity using a chi-square test, and ceiling and floor effects by calculating the proportion of patients who achieved the minimum or maximum scores. RESULTS: Reliability was excellent with an ICC of 0.99 (95% CI=0.98-0.99). SEM was 1.44 points (1.5% of the total score), the MDD90 was 3.34 points (3.5% of the total score) and the Cronbach's alpha was 0.93 (alpha if item deleted ranging from 0.94 to 0.94). An association was observed between patients classified by HAP and by IPAQ-6 (χ2=3.38; p=0.18). Ceiling or floor effects were not observed. CONCLUSION: The HAP shows adequate measurement properties for the assessment of the physical activity/inactivity level in hospitalized patients.