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1.
Respir Med ; 181: 106389, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33831730

RESUMO

PURPOSE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with an elevated risk of cardiovascular events, which can be linked to endothelial dysfunction. In this study, we aimed to investigate whether noninvasive ventilation (NIV) acutely changes endothelial function in hospitalized AECOPD patients. METHODS: Twenty-one AECOPD patients were assessed in a hospital ward setting from 24 to 48 h after admission. NIV was applied using a ventilator with bilevel pressure support. Before and after NIV protocol, patients were evaluated regarding (1) endothelium-dependent function, assessed non-invasively using the flow-mediated dilation (FMD) method; (2) arterial blood gas analysis. Other baseline evaluations included clinical and anthropometric data, and laboratory tests. RESULTS: The total group showed a significant improvement in FMD as a result of NIV effect (P = 0.010). While arterial carbon dioxide and oxygen were not altered, oxygen saturation increased after NIV (P = 0.045). The subgroup comparison of responders (FMD ≥ 1%) and non-responders (FMD < 1%) showed significant baseline differences in body mass index (BMI) (P = 0.019) and predicted forced expiratory volume in one second (FEV1) (P = 0.007). In univariate and multivariate analyses, both BMI and FEV1 were determinant for endothelial response to NIV. CONCLUSION: NIV acutely improves endothelial function in hospitalized AECOPD patients. Overweight and COPD severity may represent important characteristics for the magnitude of peripheral vascular response.

2.
Expert Rev Anti Infect Ther ; : 1-12, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33852807

RESUMO

Introduction: The coronavirus disease-2019 (COVID-19) is a highly contagious respiratory viral disease for both the general population and healthcare professionals caring for infected patients. Of particular concern is the potential for significant respiratory, cardiovascular, physical, and psychological dysfunctions.Areas covered: In this context, the current review will focus on the following areas: 1) staying physically active during the COVID-19 pandemic; 2) highlighting the importance of understanding COVID-19 mechanisms; 3) preventing infections for healthcare workers by using personal protective equipment; 4) highlighting importance of respiratory care and physical therapy during hospitalization in patients with COVID-19; and 5) facilitating referral to a rehabilitation program in patients recovering from COVID-19.Expert opinion: We recommend daily physical exercise, outdoors or at home, as physical exercise increases the synthesis of anti-inflammatory cytokines; Patients with COVID-19 may develop severe acute respiratory syndrome, hypoxemia, diffuse alveolar damage, ACE2 reduction in the cardiovascular system and muscle weakness acquired through a prolonged hospital stay; The role of the physiotherapist in the hospital environment is of fundamental importance-early mobilization is highly recommended in severe cases of COVID-19.

3.
Int J Obes (Lond) ; 2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33927333

RESUMO

BACKGROUND/OBJECTIVES: Bariatric surgery (BS) is a successful, long-lasting treatment option for obese. The early postoperative (PO) period is followed by dietary restriction and physical inactivity, leading to declines in muscle mass and functional capacity. Whole-body electromyostimulation (WB-EMS) may be a feasible and potential early rehabilitation strategy post BS. The aim was to evaluate the effects of WB-EMS with exercise training (Fe) on functional capacity, body composition, blood biomarkers, muscle strength, and endurance post BS. SUBJECTS/METHODS: This is a randomized, triple-blind, sham-controlled trial. Thirty-five volunteers underwent a Roux-en-Y gastric bypass and were randomized into a WB-EMS (WB-EMSG) or control group (ShamG). Preoperative evaluations consisted of maximal and submaximal exercise testing, body composition, blood biomarkers, quadriceps strength, and endurance. After discharge, functional capacity and body composition were obtained. Exercise training protocols in both groups consisted of 14 dynamic exercises, 5 days per week, completing 30 sessions. The WB-EMSG also underwent an electrical stimulation protocol (Endurance: 85 Hz, 350 ms, 6 s of strain, 4 f of rest; Strength: 30 Hz, 350 ms, 4 s of strain, 10 seconds of rest, with bipolar electrical pulse). After intervention, subjects were reevaluated. RESULTS: The protocol started on average 6.7 ± 3.7 days after discharge. Both groups presented with a decline in functional capacity after BS (p < 0.05) and a reduction in all body composition measurements (p < 0.05). The exercise training program led to significant improvements in functional capacity (ShamG - PO: 453.8 ± 66.1 m, Post: 519.2 ± 62.8 m; WB-EMSG- PO: 435.9 ± 74.5, Post: 562.5 ± 66.4 m, p < 0.05), however, only the WB-EMSG demonstrated significant changes of distance walked (interaction time vs group effect, p < 0.05). In addition, adiponectin significantly increased only in the WB-EMSG (p < 0.05). The WB-EMSG was also able to preserve muscle strength, endurance, and fatigue index, while the ShamG demonstrated significant decline (p < 0.05). CONCLUSION: WB-EMS + Fe can be an attractive and feasible method following BS to enhance functional capacity and prevent deterioration of muscle function in the early PO. CLINICAL TRIAL REGISTRATION: ReBEC, RBR-99qw5h, on 20 February 2015.

4.
Clinics (Sao Paulo) ; 76: e2172, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624706

RESUMO

OBJECTIVES: To identify the clinical discriminative value and determinants of arterial stiffness in individuals with type 2 diabetes mellitus (T2DM). METHODS: This prospective cohort study included 51 individuals (53.57±9.35 years) diagnosed with T2DM (stage glucose≥126 mg/dL; diagnostic time: 87.4±69.8 months). All participants underwent an initial evaluation of personal habits, medications, and history; arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor; and blood laboratory analysis. A statistical analysis was performed using SPSS software, and values of p≤0.05 were considered significant. RESULTS: A cut-off cfPWV value of 7.9 m/s was identified for T2DM [Sensitivity (SE): 90% and Specificity (SP): 80%]. A subgroup analysis revealed higher glycated hemoglobin (Hb1Ac) (p=0.006), obesity (p=0.036), and dyslipidemia (p=0.013) than those with cfPWV ≥7.9 m/s. Multivariate analysis identified higher stage glucose (p=0.04), Hb1Ac (p=0.04), hypertension (p=0.001), and dyslipidemia (p=0.01) as determinant factors of cfPWV; positive and significant correlation between cfPWV and glucose (r=0.62; p=0.0003) and Hb1Ac (r=0.55; p=0.0031). CONCLUSIONS: In T2DM, an indicator of the discriminative value of arterial stiffness was cfPWV of 7.9 m/s. Clinical findings and comorbidities, such as hypertension, glucose, poor glycemic control, and dyslipidemia, were associated with and were determinants of arterial stiffness in T2DM. Reinforcement of monitoring risk factors, such as hypertension, dyslipidemia, and glycemic control, seems to be essential to the process of arterial stiffening. Confirmation of this discriminative value in larger populations is recommended.


Assuntos
Diabetes Mellitus Tipo 2 , Rigidez Vascular , Diabetes Mellitus Tipo 2/complicações , Humanos , Estudos Prospectivos , Análise de Onda de Pulso , Fatores de Risco
5.
Expert Rev Respir Med ; : 1-14, 2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33606567

RESUMO

INTRODUCTION: It has become increasingly evident that COVID-19 contributes to multiorgan pathophysiology. The systemic inflammatory response increases both pro-inflammatory cytokine and chemokine levels, leading to immune dysregulation and increasing the likelihood of incurring cardiac and pulmonary injuries. AREAS COVERED: Longer periods of hospitalization (~20 days) increase susceptibility to ICU-acquired muscle weakness and deconditioning, which decreases muscle function and functional capacity. These conditions affect the quality of life in the post-COVID-19 period and require multi-disciplinary approaches to rehabilitate the cardiopulmonary and musculoskeletal systems of these patients. In this context, this narrative review, which included articles published in the Embase, PEDro and PubMed databases up to December 2020, is focused on discussing the essential role of exercise and rehabilitation health professionals in the COVID-19 recovery process, from hospitalization to hospital discharge, addressing strategies for professionals to mitigate the cardiac and pulmonary impairments associated with hospitalization to home or ambulatory rehabilitation, purposing ways to conduct rehabilitation programs to restore their functional status and quality of life after the infection. EXPERT OPINION: In the current environment, these findings further point to the vital role of rehabilitation health professionals in the coming years and the urgent need to develop strategies to assist COVID-19 survivors.

6.
Artigo em Inglês | MEDLINE | ID: mdl-33568904

RESUMO

Aim: Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness. Methods: The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Results: Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e' ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: -0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: -0.62; p: 0.001) in the CHF+COPD group. Conclusion: Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.

7.
Sci Rep ; 11(1): 461, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33432116

RESUMO

Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with significant poor outcomes including an increased risk of cardiovascular (CV) events and exercise intolerance. Endothelial dysfunction might contribute to an impaired vascular homeostasis and consequently to CV events and exercise capacity. This study aimed to evaluate the association between exercise capacity and endothelial function in patients with severe AECOPD. Forty-five COPD patients diagnosed with severe AECOPD and admitted to the University Hospital of São Carlos from 2017 to 2019 were enrolled in this observational clinical study. Endothelial Function was assessed by brachial artery ultrasonography (M-Turbo, Sonosite, Bottle, WA, USA) and Flow Mediated Dilatation (FMD) technique in absolute (mm) and percentage values (%). Walking distance (6MWD) obtained by six-minute walk test was considered to characterize the exercise capacity. Pearson's correlation analysis and linear regression model were applied and a significance level of 5%. There was a significant positive correlation between exercise capacity and endothelial function. Pearson correlation coefficient were 0.36 (p = 0.02) and 0.40 (p = 0.01) between 6MWD and FMD in mm and %, respectively. Linear regression model revealed 6MWD (p = 0.007), accounting for 15% of FMD (%) variance (R2 adjusted). FMD (%) = 2.11 + (0.0081*6MWD). Exercise capacity is associated with endothelial function in patients with severe AECOPD. FMD was found to be increasing with increasing walked distance. Further research is needed to provide evidence of effectiveness of rehabilitation on exercise capacity and endothelial function in these patients and its prognostic value.

8.
Clinics ; 76: e2172, 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1153940

RESUMO

OBJECTIVES: To identify the clinical discriminative value and determinants of arterial stiffness in individuals with type 2 diabetes mellitus (T2DM). METHODS: This prospective cohort study included 51 individuals (53.57±9.35 years) diagnosed with T2DM (stage glucose≥126 mg/dL; diagnostic time: 87.4±69.8 months). All participants underwent an initial evaluation of personal habits, medications, and history; arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor; and blood laboratory analysis. A statistical analysis was performed using SPSS software, and values of p≤0.05 were considered significant. RESULTS: A cut-off cfPWV value of 7.9 m/s was identified for T2DM [Sensitivity (SE): 90% and Specificity (SP): 80%]. A subgroup analysis revealed higher glycated hemoglobin (Hb1Ac) (p=0.006), obesity (p=0.036), and dyslipidemia (p=0.013) than those with cfPWV ≥7.9 m/s. Multivariate analysis identified higher stage glucose (p=0.04), Hb1Ac (p=0.04), hypertension (p=0.001), and dyslipidemia (p=0.01) as determinant factors of cfPWV; positive and significant correlation between cfPWV and glucose (r=0.62; p=0.0003) and Hb1Ac (r=0.55; p=0.0031). CONCLUSIONS: In T2DM, an indicator of the discriminative value of arterial stiffness was cfPWV of 7.9 m/s. Clinical findings and comorbidities, such as hypertension, glucose, poor glycemic control, and dyslipidemia, were associated with and were determinants of arterial stiffness in T2DM. Reinforcement of monitoring risk factors, such as hypertension, dyslipidemia, and glycemic control, seems to be essential to the process of arterial stiffening. Confirmation of this discriminative value in larger populations is recommended.

9.
Int J Sports Med ; 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33307554

RESUMO

Inspiratory muscle training represents a recommended clinical practice to improve physical performance of healthy individuals, athletes, and those with chronic diseases. This study aimed to evaluate whether high- and low-intensity inspiratory muscle training interferes with the aerobic capacity of indoor soccer players. Volunteers were equally and randomly divided into CON (control group, no inspiratory muscle training); HIG (high-intensity group, inspiratory muscle training at 80% of maximal inspiratory pressure, 3 sets of 12 repetitions); and LIG (low-intensity group, inspiratory muscle training at 50% of maximal inspiratory pressure, 2 sets of 20 repetitions). Before and after inspiratory muscle training, maximal inspiratory and expiratory pressures, the incremental shuttle run test, and the 3-min step test were evaluated. Both inspiratory muscle training protocols improved maximal inspiratory and expiratory pressures, and indirect maximal oxygen consumption and distance traveled in the shuttle test compared to CON. However, only HIG achieved significant increases of indirect oxygen consumption and frequency of step rise in the 3-min step test (p<0.05). Inspiratory muscle training is an important tool to enhance maximal inspiratory pressure and exercise tolerance with potential benefits on submaximal aerobic capacity. However, high-intensity inspiratory muscle training improved aerobic capacity in amateur indoor soccer players in both submaximal tests.

10.
PLoS One ; 15(11): e0241872, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166347

RESUMO

Post-stroke individuals presented deleterious changes in skeletal muscle and in the cardiovascular system, which are related to reduced oxygen uptake ([Formula: see text]) and take longer to produce energy from oxygen-dependent sources at the onset of exercise (mean response time, MTRON) and during post-exercise recovery (MRTOFF). However, to the best of our knowledge, no previous study has investigated the potential mechanisms related to [Formula: see text] kinetics response (MRTON and MRTOFF) in post-stroke populations. The main objective of this study was to determine whether the MTRON and MRTOFF are related to: 1) body composition; 2) arterial compliance; 3) endothelial function; and 4) hematological and inflammatory profiles in chronic post-stroke individuals. Data on oxygen uptake ([Formula: see text]) were collected using a portable metabolic system (Oxycon Mobile®) during the six-minute walk test (6MWT). The time to achieve 63% of [Formula: see text] during a steady state (MTRON) and recovery (MRTOFF) were analyzed by the monoexponential model and corrected by a work rate (wMRTON and wMRTOFF) during 6MWT. Correlation analyses were made using Spearman's rank correlation coefficient (rs) and the bias-corrected and accelerated bootstrap method was used to estimate the 95% confidence intervals. Twenty-four post-stroke participants who were physically inactive took part in the study. The wMRTOFF was correlated with the following: skeletal muscle mass (rs = -0.46), skeletal muscle mass index (rs = -0.45), augmentation index (rs = 0.44), augmentation index normalized to a heart rate of 75 bpm (rs = 0.64), reflection magnitude (rs = 0.43), erythrocyte (rs = -0.61), hemoglobin (rs = -0.54), hematocrit (rs = -0.52) and high-sensitivity C-reactive protein (rs = 0.58), all p < 0.05. A greater amount of oxygen uptake during post-walking recovery is partially related to lower skeletal muscle mass, greater arterial stiffness, reduced number of erythrocytes and higher systemic inflammation in post-stroke individuals.

11.
Respir Med ; 173: 106173, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33007709

RESUMO

AIM: Evaluate the acute effects of non-invasive positive pressure ventilation (NiPPV) during high-intensity exercise on endothelial function in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF). METHODS: This is a randomized, double blinded, sham-controlled study involving 14 COPD-HF patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NiPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). Endothelial function was evaluated by flow mediated vasodilation (FMD) at three time points: 1) Baseline; 2) immediately post-exercise with NiPPV; and 3) immediately post-exercise with Sham. RESULTS: Our patients had a mean age of 70 ± 7 years, FEV1 1.9 ± 0.7 L and LVEF 41 ± 9%. NIPPV resulted in an increased Tlim (NiPPV: 130 ± 29s vs Sham: 98 ± 29s p = 0.015) and SpO2 (NiPPV: 94.7 ± 3.5% vs Sham: 92.7 ± 5.2% p = 0.03). Also, NiPPV was able to produce a significant increase in FMD (%) (NiPPV: 9.2 ± 3.1 vs Sham: 3.6 ± 0.7, p < 0.05), FMD (mm) (NiPPV: 0.41 ± 0.18 vs Sham: 0.20 ± 0.11, p < 0.05), Blood flow velocity (NiPPV: 33 ± 18 vs Baseline: 20 ± 14, p < 0.05) and Shear Stress (SS) (NiPPV: 72 ± 38 vs Baseline: 43 ± 25, p < 0.05). We found correlation between Tlim vs. ΔSS (p = 0.03; r = 0.57). Univariate-regression analysis revealed that increased SS influenced 32% of Tlim during exercise with NiPPV. CONCLUSION: NiPPV applied during high-intensity exercise can acutely modulate endothelial function and improve exercise tolerance in COPD-HF patients. In addition, the increase of SS positively influences exercise tolerance.

12.
J Cardiopulm Rehabil Prev ; 40(6): 414-420, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33074848

RESUMO

PURPOSE: Oxygen uptake (V˙o2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V˙o2, heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD. METHODS: Nineteen males (10 HF/9 age- and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (Tlim), receiving either sham ventilation or NIPPV. RESULTS: Despite greater V˙o2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4 ± 14.0 sec vs 62.8 ± 15.2 sec, P < .05) and mean response time (MRT) (86.1 ± 19.1 sec vs 68.8 ± 12.0 sec, P < .05) with NIPPV and greater ΔNIPPV-sham (τ: 5.6 ± 19.5 vs -25.2 ± 22.4, P < .05; MRT: 4.1 ± 32.2 vs -26.0 ± 19.2, P < .05) compared with HF. There was no difference regarding Tlim between sham and NIPPV in both groups (P < .05). CONCLUSION: Our results suggest that NIPPV accelerated the V˙o2 recovery kinetics following high-intensity CLE to a greater extent in patients with coexisting HF and COPD compared with HF alone. NIPPV should be considered when the objective is to apply high-intensity interval exercise training as an adjunct intervention during a cardiopulmonary rehabilitation program.

14.
J Sports Med Phys Fitness ; 60(8): 1159-1166, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32955842

RESUMO

BACKGROUND: Endothelial function assessment may provide important insights into the cardiovascular function and long-term effects of exercise training. Many studies have investigated the possible negative effects on cardiovascular function due to extreme athletic performance, leading to undesirable effects. The purposes of this study were to investigate the acute effects of maximal intensity exercise on endothelium-dependent vasodilation, and to understand the patterns of flow-mediated dilation (FMD) change following maximal exercise in elite female athletes with a high-volume training history. METHODS: Twenty-six elite female soccer players (mean age, 22±4 years; BMI, 21±2 kg/m2; VO2max, 41±4 mL/kg/min) were evaluated. Brachial artery FMD was determined using high-resolution ultrasound at rest, and after 15 and 60 min of maximal cardiopulmonary exercise (CPX) testing on a treadmill. Flow velocity was measured at baseline and during reactive hyperemia at the same periods. RESULTS: Rest FMD was 12.4±5.5%. Peak diameter in response to reactive hyperemia was augmented after 15 min of CPX (3.5±0.4 vs. 3.6±0.4 mm, P<0.05), returning to resting values after 60 min. However, %FMD did not change among time periods. There were two characteristic patterns of FMD response following CPX. Compared to FMD at rest, half of the subjects responded with an increased FMD following maximum exercise (10.5±6.1 vs. 17.8±7.5%, P<0.05). The other subjects demonstrated a reduced FMD response following maximum exercise (14.2±4.3 vs. 10.9±3.2%, P<0.01). CONCLUSIONS: These results indicate that elite female soccer players presented robust brachial artery FMD at rest, with a heterogeneous FMD response to acute exercise with a 50% FMD improvement rate.


Assuntos
Endotélio Vascular/fisiologia , Exercício Físico/fisiologia , Condicionamento Físico Humano/fisiologia , Futebol/fisiologia , Vasodilatação/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiologia , Teste de Esforço , Feminino , Humanos , Fluxo Sanguíneo Regional/fisiologia , Adulto Jovem
15.
Int J Chron Obstruct Pulmon Dis ; 15: 1977-1986, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884254

RESUMO

Background: The heart rate (HR) kinetics as well as other predictors of functional capacity such as the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), the Duke Activity Status Index (DASI) and the handgrip strength (HGS) represent important tools in assessing the impact of COPD on exercise performance and health status of individuals with COPD. Purpose: To verify the relationship between functional capacity, measured using the six-minute walking test (6MWT), with the HR off-kinetics, HGS and the DASI and CAT scores. Methods: For this cross-sectional study, 29 subjects with COPD underwent body composition, pulmonary function and cardiac function tests. Subsequently, the DASI and CAT questionnaires and HGS test were performed. The beat-to-beat R-R intervals (IRR) were collected in rest, during the test and in recovery after the 6MWT. The HR off-kinetics was obtained during a 360-second period in post-exercise recovery through the HR mono-exponential decay. Results: Moderate correlations were observed between: 1) walked distance (WD) in the 6MWT and the CAT and DASI scores (r= -0.58, p=0.001 and r= 0.58, p=0.001, respectively); 2) WD and HGS (r=0.37, p=0.05); 3) and WD and HR off-kinetics (τ; r= -0.54, p=0.002 and MRT; r= -0.55, p=0.002, respectively). Conclusion: The 6MWT performance is a direct measurement to evaluate functional capacity. Additionally, it is related to other direct and indirect markers for functional evaluation in patients with COPD. These results suggest the application of these tools in clinical practice, based on the accessibility, non-invasive character and easy applicability of these methods.

16.
J Cardiopulm Rehabil Prev ; 40(5): 341-344, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804795

RESUMO

PURPOSE: Chronic obstructive pulmonary disease (COPD) and abnormalities of left ventricular (LV) geometry often coexist. This study aimed to verify whether LV geometry is associated with airflow obstruction, functional capacity, and grip strength in COPD patients. METHODS: Thirty-seven COPD patients (GOLD II, III, and IV) were allocated to three groups according to LV geometry as assessed by transthoracic echocardiography: normal (n = 13), concentric LV remodeling (n = 8), and concentric LV hypertrophy (LVH) (n = 16). Lung function was assessed using spirometry. The Duke Activity Status Index (DASI) was used to estimate functional capacity, and grip strength measurement was performed using a hydraulic hand dynamometer. RESULTS: The concentric LVH group presented lower DASI scores (P = .045) and grip strength (P = .006) when compared with the normal group. Correlations analysis showed the following: relative wall thickness negatively correlated with forced expiratory volume in the first second (r = -0.380; P = .025) and DASI score (r = -0.387, P = .018); LV mass index negatively correlated with grip strength (r = -0.363, P = .038). CONCLUSIONS: In COPD patients, LV geometry is associated with airflow limitation, functional capacity, and grip strength. Specifically, concentric LV remodeling is associated with increased airflow limitation and decreased functional capacity whereas increased LV mass is associated with decreased grip strength.

17.
An Acad Bras Cienc ; 92(2): e20190361, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32696842

RESUMO

AIM: to evaluate the acute effects of expiratory positive airway pressure on cardiac autonomic modulation in chronic obstructive pulmonary disease patients during spontaneous breathing and slow deep breathing. METHODS: 17 patients were evaluated. The R-R intervals were collected (Polar® S810i) during spontaneous breathing (10 minutes) and slow deep breathing (4 minutes), with and without 5 cmH2O expiratory positive airway pressure. Stable signals were analyzed by Kubios®. Heart rate variability indices were computed in time domain and in frequency domain. RESULTS: Expiratory positive airway pressure application affected low frequency (spontaneous breathing: 62.5±4.1 vs slow deep breathing: 28.2±4.2, p<0.001) and high frequency (spontaneous breathing: 37.4±17.3 vs slow deep breathing: 58.9±18.1, p<0.001). Interactions were observed between expiratory positive airway pressure effect and slow deep breathing effect for low frequency (p<0.001), high frequency (p<0.001) and low frequency/high frequency ratio (p<0.001). When patients were stratified by disease's severity, we identified a significant low frequency reduction (p<0.001) and high frequency increase (p<0.001) for all stages when slow deep breathing was associated with expiratory positive airway pressure. CONCLUSION: A 5 cmH2O expiratory positive airway pressure during spontaneous and slow deep breathing can elicit an acute response, resulting in a cardiac autonomic control improvement in moderate-to-very severe patients.


Assuntos
Sistema Nervoso Autônomo , Doença Pulmonar Obstrutiva Crônica , Coração , Frequência Cardíaca , Humanos
19.
Respir Physiol Neurobiol ; 281: 103488, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32622904

RESUMO

Respiratory limitation can be a primary mechanism for exercise cessation in female athletes. This study aimed to assess the effects of inspiratory loading (IL) on intercostal muscles (IM), vastus lateralis (VL) and cerebral (Cox) muscles oxygenation in women soccer players during high-intensity dynamic exercise. Ten female soccer players were randomized to perform in order two constant-load tests on a treadmill until the exhaustion time (Tlim) (100 % of maximal oxygen uptake- V˙O2). They breathed freely or against a fixed inspiratory loading (IL) of 41 cm H2O (∼30 % of maximal inspiratory pressure). Oxygenated (Δ[OxyHb]), deoxygenated (Δ[DeoxyHb]), total hemoglobin (Δ[tHb]) and tissue saturation index (ΔTSI) were obtained by NIRs. Also, blood lactate [La-] was obtained. IL significantly reduced Tlim (224 ± 54 vs 78 ± 20; P < 0.05) and increased [La-], V˙O2, respiratory cycles and dyspnea when corrected to Tlim (P < 0.05). IL also resulted in decrease of Δ[OxyHb] of Cox and IM during exercise compared with rest condition. In addition, decrease of Δ[OxyHb] was observed on IM during exercise when contrasted with Sham (P < 0.05). Furthermore, significant higher Δ[DeoxyHb] of IM and significant lower Δ[DeoxyHb] of Cox were observed when IL was applied during exercise in contrast with Sham (P < 0.05). These results were accompanied with significant reduction of Δ[tHb] and ΔTSI of IM and VL when IL was applied (P < 0.05). High-intensity exercise with IL decreased respiratory and peripheral muscle oxygenation with negative impact on exercise performance. However, the increase in ventilatory work did not impact cerebral oxygenation in soccer players.

20.
Heart Lung ; 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32709499

RESUMO

OBJECTIVE: To investigate cerebral oxygenation (Cox) responses as well as respiratory (Res) and active peripheral muscle (Pm) O2 delivery during high-intensity cycling exercise and contrast responses between patients with coexistent chronic obstructive pulmonary disease (COPD)-heart failure (HF) and HF alone. METHODS: Cross-sectional study involving 11 COPD-HF and 11 HF patients. On two different days, patients performed maximal incremental cardiopulmonary exercise testing (CPET) and constant load exercise on a cycle ergometer until the limit of tolerance (Tlim). The high-intensity exercise session was 80% of the peak CPET work rate. Relative blood concentrations of oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]) of Res, Pm (right vastus lateralis) and Cox (pre-frontal) were measured using near infrared spectroscopy. RESULTS: We observed a greater decrease in [O2Hb] at a lower Tlim in COPD-HF when compared to HF (P < 0.05). [HHb] of Res was higher (P < 0.05) and Tlim was lower in COPD-HF vs. HF. Pm and Cox were lower and Tlim was higher in (P < 0.05) HF vs. COPD-HF. In HF, there was a lower ∆[O2Hb] and higher ∆ [HHb] of Pm when contrasted to Cox observed during exercise, as well as a lower ∆ [O2Hb] and higher ∆ [HHb] of Res when contrasted with Cox (P < 0.05). However, COPD-HF patients presented with a higher ∆ [HHb] of Res and Pm when contrasted with Cox (P < 0.05). CONCLUSION: The coexistence of COPD in patients with HF produces negative effects on Cox, greater deoxygenation of the respiratory and peripheral muscles and higher exertional dyspnea, which may help to explain an even lower exercise tolerance in this multimorbidity phenotype.

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