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Francisco de Lima F, Marçal Camillo CA, Grigoletto I, Uzeloto J, Marques Vanderlei F, Ramos D, Burtin C, Cipulo Ramos EM. Combining functional exercises with exercise training in COPD: a randomized controlled trial. Physiother Theory Pract 2024; 40:952-961. [PMID: 36457177 DOI: 10.1080/09593985.2022.2148146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Increasing physical activity in daily life (PADL) in chronic obstructive pulmonary disease (COPD), mainly in short-term training programs, is still a challenge. The combination of functional exercises with aerobic and resistance training may be a strategy to improve PADL and limitations in activities of daily living (ADL) in COPD. OBJECTIVE To evaluated the short- and medium-term effects of the combination of functional exercises with aerobic and resistance training. METHODS Seventy-six patients were randomized into (1) functional training group who performed resistance and aerobic and functional exercises; (2) conventional training group (CTG) who performed resistance and aerobic exercise; or (3) usual care group who performed respiratory physiotherapy. Patients were evaluated for PADL (activity monitor), ADL limitations (London Chest Activity of Daily Living scale [LCADL]), functional exercise capacity (6-minute walk test [6MWT]), and peripheral muscle strength before and after eight weeks. Medium-term effects were evaluated 12 weeks after the training. RESULTS There were no changes or differences between groups in PADL and in 6MWT post-intervention and 12 weeks post-training. Only CTG showed a reduction in the total score on LCADL scale after the intervention and increase at follow-up (score: 20 ± 8; 17 ± 6; 19 ± 8, pre-intervention, post-intervention, and 12 weeks post-training, respectively, p = 0.001), without differences between groups (p = 0.375). There were increases in the muscle strength of knee flexors (p = 0.016) and extensors (p < 0.001) after the intervention only in CTG. CONCLUSIONS Combined aerobic and resistance training with functional exercises failed to improve PADL and ADL limitations in COPD. Eight weeks of conventional training improved ADL. This, however, was not superior to the results from the other groups and was not sustained at medium-term 12 weeks post-training.
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Affiliation(s)
- Fabiano Francisco de Lima
- Faculty of Science and Technology, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), São Paulo, Brazil
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Carlos Augusto Marçal Camillo
- Department of Physiotherapy, Postgraduate Program in Rehabilitation Sciences, State University of Londrina (UEL), Londrina, Brazil
- Department of Rehabilitation Sciences, University Pitágoras (UNOPAR), Londrina, Brazil
| | - Isis Grigoletto
- Faculty of Science and Technology, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), São Paulo, Brazil
| | - Juliana Uzeloto
- Faculty of Science and Technology, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), São Paulo, Brazil
| | - Franciele Marques Vanderlei
- Faculty of Science and Technology, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), São Paulo, Brazil
| | - Dionei Ramos
- Faculty of Science and Technology, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), São Paulo, Brazil
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ercy Mara Cipulo Ramos
- Faculty of Science and Technology, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), São Paulo, Brazil
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Puzzi VC, Oliveira JMD, Alves TB, Silva JPDC, Pedroso A, Furlanetto KC. Reliability and validity of the London Chest Activity of Daily Living scale for adults with asthma. J Asthma 2024; 61:1-9. [PMID: 37417908 DOI: 10.1080/02770903.2023.2234990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/05/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Dyspnea during activities of daily living (ADL) is frequently reported by adults with asthma. However, instruments that specifically assess that in people with asthma have not yet been validated. OBJECTIVES To investigate the validity and reliability, including standard error of measurement (SEM) and Minimum Detectable Change (MDC), of the London Chest Activity of Daily Living (LCADL) scale for adults with asthma. METHODS Adults with asthma answered the LCADL scale which was performed twice by the same rater. Spirometry, 6-min walk test (6MWT), St George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea scale, Asthma Quality of Life questionnaire (AQLQ), Asthma Control Test (ACT), and Glittre-ADL test were assessed. For statistical analyses, Spearman correlation, Wilcoxon test, Intraclass Correlation Coefficient (ICC), Cronbach's alpha coefficient, SEM, MDC were performed. RESULTS Seventy participants were included (30% men, 44 ± 15 years old, BMI 27[23-31]kg/m2, FEV1 80 ± 17%predicted). For convergent validity, the LCADL scale was moderately correlated with SGRQ, AQLQ, and Glittre-ADL (r = 0.57, -0.46, and 0.41 respectively; p < 0.0001). The LCADL scale correlated weakly with the mMRC scale, ACT, and spirometry measures (-0.23 CONCLUSION The LCADL scale is valid and reliable for assessing dyspnea during ADL in adults with asthma.
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Affiliation(s)
- Vitória Cavalheiro Puzzi
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Brazil
- Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil
| | - Joice Mara de Oliveira
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Brazil
- Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil
| | - Thainá Bessa Alves
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Brazil
- Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil
| | - Jessica Priscila da Conceição Silva
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Brazil
- Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil
| | - Ariele Pedroso
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Brazil
- Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil
| | - Karina Couto Furlanetto
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Brazil
- Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil
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Romano J, Ribeiro P, Alberto J, Almeida P, Dantas D. A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation. ACTA MEDICA PORT 2023; 36:639-646. [PMID: 37466050 DOI: 10.20344/amp.19382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/17/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION New evidence and extrapolated data from other coronaviruses suggest that symptoms and consequences of COVID-19 may persist beyond the cure. The aims of this study were to evaluate persistent symptoms after SARS-CoV-2 infection and its impact on physical condition, activities of daily living, and quality-of-life; establish whether symptom persistence is associated with higher disability; and document the evolution of the multiple domains after a home exercise program. METHODS Prospective study with patients referred to a Physical and Rehabilitation Medicine clinic, after SARS-CoV-2 infection. Patient evaluations, including a symptom questionnaire, the 1-Min Sit-to-stand test (1-MSTS), the EQ-5D questionnaire and the London Chest Activity Daily Living (LCA-DL) questionnaire, were performed before and after a home exercise program. RESULTS Seventy-four patients were included. The majority (n = 71) had been hospitalized (mean stay 19.66 ± 13.35 days), 51% required intensive care. At first evaluation, 54 days after symptom onset, a mean of 18.6 repetitions in the 1-MSTS were performed. The percentage of LCA-DL was above 28% in 23% of the patients. Impairments on EQ-5D were present in 44% for mobility and 44% for anxiety/depression. Mean EQ-5D VAS was 66.5 out of 100. Fifty-one (70%) had at least one persistent symptom (Symptomatic Group), while 22 (30%) were asymptomatic (Asymptomatic Group). The Symptomatic Group had statistically significantly worse mean results on 1-MSTS (16.8 vs 22.9; p < 0.001), % LCA-DL score, EQ-D5 (7.8 vs 5.7; p < 0.001) and EQ-D5-VAS. No patient characteristic, clinical background, comorbidity, or hospitalization characteristics was significantly different between groups. Every patient was given a home exercise program; 47 patients joined an additional rehabilitation program or were clinically discharged and were therefore excluded from the second evaluation. Twenty-seven patients participated in a second evaluation. In the matched analysis, mean 1-MSTS improved by 3.4 repetitions. Mean LCA-DL, mean EQ-5D score (7.1 to 6.6) and EQ-VAS score changed favourably and significantly. CONCLUSION Two months after infection by SARS-CoV-2, persistent symptoms were frequent in patients referred to a Physical Medicine and Rehabilitation clinic. Additionally, the SARS-CoV-2 infection, as well as the persistence of symptoms, had a negative impact in the physical condition and functionality in ADL and quality-of-life. With a home exercise program in place, a statistically significant improvement was observed. Referral of patients with persistent symptoms to Physical and Rehabilitation Medicine may be warranted.
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Affiliation(s)
- Joana Romano
- Serviço de Medicina Física e de Reabilitação. Hospital de Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Pedro Ribeiro
- Serviço de Medicina Física e de Reabilitação. Hospital de Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Joana Alberto
- Serviço de Medicina Física e de Reabilitação. Hospital de Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Paula Almeida
- Serviço de Medicina Física e de Reabilitação. Hospital de Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Duarte Dantas
- Serviço de Medicina Física e de Reabilitação. Hospital de Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
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Mazzarin CM, Silveira BR, Lamezon AC, Cavon Luna B, Valderramas S. Effectiveness and Safety of Multicomponent Physical Training in Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Clinical Trial. Health Serv Insights 2023; 16:11786329231169255. [PMID: 37153879 PMCID: PMC10161291 DOI: 10.1177/11786329231169255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/25/2023] [Indexed: 05/10/2023] Open
Abstract
Background Currently, most Pulmonary Rehabilitation (PR) programs work with conventional physical training, using resources that are not available in public health in Brazil. Multicomponent physical training is a strategy that uses few resources and can reach a larger portion of the population. Objective To investigate the effectiveness and safety of multicomponent physical training on physical-functional performance in patients with COPD. Design Protocol for a randomized clinical trial with 2 groups in parallel (1:1). Setting University-based, outpatient, physiotherapy clinic. Participants 64 patients aged ⩾50 years, clinical-functional diagnosis of COPD, GOLD II and III criteria will participate in the study. Intervention Participants will be randomly allocated into 2 groups: Multicomponent Physical Training-MPT (n = 32): aerobic, strength, balance and flexibility exercises performed in a circuit training format, or Conventional Physical Training-CPT (n = 32): aerobic and strength training. The interventions will be carried out twice a week, for 8 weeks and supervised by the same physiotherapist. Measurements The 3 primary outcomes are the 6-Minute Walk Test (6MWT), the 6-Minute Step Test (6MST) and VO2 consumption as measured during the 6MWT. Secondary outcomes will be exercise capacity, level of physical activity in daily life, peripheral muscle strength, functional status, dyspnea, fatigue and quality of life. Safety will be assessed by recording adverse effects. These outcomes will be evaluated before and after the intervention and the evaluator will be blind. Limitations It will not be possible to perform the blinding of the physiotherapist who will supervise the interventions. Conclusions This study is expected to demonstrate that MPT using simple resources is an effective and safe intervention for the improvement of the aforementioned outcomes and, in addition, to broaden the horizon of research in relation to new methods of physical rehabilitation for patients with COPD.
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Affiliation(s)
- Camila Monteiro Mazzarin
- Graduate Program in Internal Medicine and Health Sciences Universidade Federal do Paraná, Curitiba (PR), Brazil
| | - Bruna Roberta Silveira
- Graduate Program in Internal Medicine and Health Sciences Universidade Federal do Paraná, Curitiba (PR), Brazil
| | - Ana Cristina Lamezon
- Graduate Program in Internal Medicine and Health Sciences Universidade Federal do Paraná, Curitiba (PR), Brazil
| | - Bruna Cavon Luna
- Graduate Program in Internal Medicine and Health Sciences Universidade Federal do Paraná, Curitiba (PR), Brazil
| | - Silvia Valderramas
- Graduate Program in Internal Medicine and Health Sciences Universidade Federal do Paraná, Curitiba (PR), Brazil
- Departament of Prevention and Rehabilitation in Physical Therapy, Universidade Federal do Paraná, Curitiba (PR), Brazil
- Silvia Valderramas, Departamento de Prevenção e Reabilitação em Fisioterapia, Centro Politécnico - Jardim das Américas, Avenida Coronel Francisco H. dos Santos, 100, Caixa Postal 19031, Curitiba (PR) 81531-980, Brazil.
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Tinti S, Parati M, De Maria B, Urbano N, Sardo V, Falcone G, Terzoni S, Alberti A, Destrebecq A. Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties. J Pain Symptom Manage 2022; 63:e46-e58. [PMID: 34358643 DOI: 10.1016/j.jpainsymman.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed. OBJECTIVES Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties. METHODS Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria. RESULTS Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales. CONCLUSION Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.
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Affiliation(s)
- Stefania Tinti
- Department of Biomedicine and Prevention (S.T.), University of Rome ''Tor Vergata'', Rome, Italy.
| | - Monica Parati
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory (M.P.), Politecnico di Milano, Milan, Italy; IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Nicla Urbano
- ASST-Rhodense (N.U.), Garbagnate Milanese, Milan, Italy
| | - Vivian Sardo
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Graziella Falcone
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Stefano Terzoni
- ASST-Santi Paolo e Carlo (S.T.), University of Milan, Milan, Italy
| | - Annalisa Alberti
- ASST-Rhodense Bachelor School of Nursing (A.A.), Rho, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health (A.D.), University of Milan, Milan, Italy
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Sobreira M, Almeida MP, Gomes A, Lucas M, Oliveira A, Marques A. Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury. Phys Ther 2021; 101:6039321. [PMID: 33336700 DOI: 10.1093/ptj/pzaa210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/26/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation. METHODS Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean. RESULTS Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL. CONCLUSION Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI. IMPACT Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.
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Affiliation(s)
- Margarida Sobreira
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Miguel P Almeida
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal.,Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Gomes
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal
| | - Marlene Lucas
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Ana Oliveira
- Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Agras do Crasto, Building 30, 3810-193, Aveiro, Portugal
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Schneider LP, Sartori LG, Machado FVC, Dala Pola D, Rugila DF, Hirata RP, Bertoche MP, Camillo CA, Hernandes NA, Furlanetto KC, Pitta F. Physical activity and inactivity among different body composition phenotypes in individuals with moderate to very severe chronic obstructive pulmonary disease. Braz J Phys Ther 2020; 25:296-302. [PMID: 32792230 DOI: 10.1016/j.bjpt.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The phenotype profiling of individuals with chronic obstructive pulmonary disease (COPD) according to impairments in body composition and level of physical activity in daily life (PADL) needs to be determined. OBJECTIVE To verify if individuals with COPD classified as physically active/inactive present different characteristics within different body composition phenotypes. METHODS Individuals with COPD were cross-sectionally stratified into four groups according to fat-free and fat mass indexes: Normal Body Composition (NBC), Obese (Ob), Sarcopenic (Sarc), and Sarcopenic/Obese (Sarc/Ob). Additionally, individuals had their PADL level objectively assessed through activity monitoring during two weekdays for at least 10h/day, and then were classified as physically active (Act) or inactive (Inact) according to international recommendations. Lung function (spirometry), exercise capacity (6-minute walking test [6MWT]) and peripheral muscle strength (1-repetition maximum [1RM]) were also assessed. RESULTS 176 individuals with COPD (mean±standard deviation age: 67±8 years, body mass index 26±6kg/m2, FEV1 47±16%predicted) were classified as: NBC+Act (17%), NBC+Inact (22%), Ob+Act (6%), Ob+Inact (10%), Sarc+Act (12%), Sarc+Inact (9%), Sarc/Ob+Act (8%) and Sarc/Ob+Inact (16%). The Sarc/Ob+Inact group presented lower 6MWT and 1RM for knee extension compared to NBC+Act, NBC+Inact, and Ob+Act groups (p<0.05). The Sarc/Ob+Inact group also presented lower FEV1% predicted, 1RM for elbow flexion and elbow extension compared to the NBC+Act and NBC+Inact groups and lower 1RM for elbow extension compared to Ob+Inact group (p<0.05). CONCLUSION The combination of sarcopenia, obesity, and physical inactivity was shown to be detrimental in individuals with COPD. Therefore, this profile is a main therapeutic target for improving PADL level and/or body composition.
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Affiliation(s)
- Lorena P Schneider
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Larissa G Sartori
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Felipe V C Machado
- Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Daniele Dala Pola
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Diery Fernandes Rugila
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Raquel P Hirata
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Mariana P Bertoche
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Carlos A Camillo
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Nidia A Hernandes
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Karina C Furlanetto
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Fabio Pitta
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil.
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de Lima FF, Camillo CA, Grigoletto I, Uzeloto JS, Vanderlei FM, Ramos D, Ramos EMC. Effects of combining functional exercises with exercise training on daily physical activities and functionality in patients with COPD: a protocol for a randomized clinical trial. Trials 2019; 20:680. [PMID: 31805981 PMCID: PMC6896339 DOI: 10.1186/s13063-019-3780-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Functional training has been shown to be a viable alternative for the elderly and patients with chronic obstructive pulmonary disease (COPD). However, whether the combination of this type of training with aerobic and resistance training, commonly performed in pulmonary rehabilitation (PR) programs, induces more pronounced effects on daily physical activities and functionality remains unclear. The aims of the study will be to evaluate the short-term and sustained effects of the combination of a functional circuit program with a training program consisting of aerobic and resistance exercise. METHODS In this randomized controlled trial, patients with COPD will be randomly assigned (1:1:1) to an 8-week training program to follow one of the three a priori defined groups: (I) resistance and aerobic and functional exercises, (II) a conventional program including only resistance and aerobic exercises, or (III) a usual care program. Patients will be evaluated before and upon completion of 8 weeks of training regarding physical activity in daily life (PADL) using an activity monitor (accelerometer), activities of daily living (London Chest Activity of Daily Living), functional exercise capacity (6-minute walk test), and muscle strength (dynamometry). Additionally, the sustained effects of the interventions will be evaluated 22 weeks after commencing the study. DISCUSSION The inclusion of a protocol of functional physical training in the training conventionally performed by patients with COPD as an alternative to increase PADL and functionality may provide subsidies for the treatment of these patients, representing an advance and impacting on the physical training of patients with COPD. TRIAL REGISTRATION Brazilian Clinical Trials Registry (ReBEC) ID: RBR-3zmh3r. Registered: March 7, 2018.
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Affiliation(s)
- Fabiano Francisco de Lima
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Roberto Simonsen, No. 305, Presidente Prudente, São Paulo, 19060-900 Brazil
| | - Carlos Augusto Camillo
- Department of Physiotherapy, Postgraduate Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, 60 – Vila Operária, 86038-350 Londrina, Brazil
- Department of Rehabilitation Sciences, University Pitágoras UNOPAR, Avenida Paris, 675 – Jardim Piza, 86041-120 Londrina, Brazil
| | - Isis Grigoletto
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Roberto Simonsen, No. 305, Presidente Prudente, São Paulo, 19060-900 Brazil
| | - Juliana Souza Uzeloto
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Roberto Simonsen, No. 305, Presidente Prudente, São Paulo, 19060-900 Brazil
| | - Franciele Marques Vanderlei
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Roberto Simonsen, No. 305, Presidente Prudente, São Paulo, 19060-900 Brazil
| | - Dionei Ramos
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Roberto Simonsen, No. 305, Presidente Prudente, São Paulo, 19060-900 Brazil
| | - Ercy Mara Cipulo Ramos
- Department of Physiotherapy, Postgraduate Program in Physiotherapy, São Paulo State University (UNESP), Rua Roberto Simonsen, No. 305, Presidente Prudente, São Paulo, 19060-900 Brazil
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9
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Hoffman M, Augusto VM, Eduardo DS, Silveira BMF, Lemos MD, Parreira VF. Inspiratory muscle training reduces dyspnea during activities of daily living and improves inspiratory muscle function and quality of life in patients with advanced lung disease. Physiother Theory Pract 2019; 37:895-905. [DOI: 10.1080/09593985.2019.1656314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mariana Hoffman
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Physiotherapy Discipline, La Trobe Clinical School, La Trobe University, Melbourne, Australia
| | - Valéria M. Augusto
- Department of Internal Medicine, UFMG, 271, Centro, Belo Horizonte, Brazil
| | - Daisy S. Eduardo
- Advanced Lung Disease and Pre Lung Transplantation Ambulatory Clinics, UFMG, 271, Centro, Belo Horizonte, Brazil
| | - Bruna M. F. Silveira
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcela D. Lemos
- Laboratory of Cardiorespiratory Assessment and Research, Department of Physical Therapy, UFMG, Belo Horizonte, Brazil
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10
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Do London Chest Activity of Daily Living Scale and St George's Respiratory Questionnaire Reflect Limitations During Activities of Daily Living in Patients With COPD? J Cardiopulm Rehabil Prev 2019; 39:274-280. [DOI: 10.1097/hcr.0000000000000355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Belo LF, Rodrigues A, Paes T, Machado FVC, Schneider LP, Vicentin AP, Probst VS, Pitta F, Hernandes NA. Functional Status of Patients with COPD Assessed by London Chest Activity of Daily Living Scale: Gender Association and Validity of a Cutoff Point. Lung 2019; 197:509-516. [PMID: 31079224 DOI: 10.1007/s00408-019-00235-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Whether the difference in the impact of chronic obstructive pulmonary disease (COPD) on the functional status of men and women stems from clinical distinctions or to the measuring instrument used is unclear. Like most instruments for assessing functional limitation in COPD, the interpretation of the results of the London Chest Activity of Daily Living (LCADL) scale is limited because a lack of a valid cutoff point to this scale. For that, this study sought to compare the functional status between men and women with COPD; and propose a cutoff point for LCADL capable of discriminating the prognosis of these individuals. METHODS A sample of 138 subjects with moderate-severe COPD was evaluated by the LCADL. The percentage of the individual maximum score was used to obtain a cutoff point capable of discriminating patients with the worse prognosis according to the BODE Index. The cutoff point was also tested in an independent sample (n = 70). RESULTS Regarding the total score, domestic and leisure domains of the LCADL, men had better scores than women (P ≤ 0.01). The cutoff point found was 37% (area under the curve = 0.70, 95% confidence interval = 0.60-0.80, sensitivity = 0.55 and specificity = 0.74). Individuals who scored ≥ 37% had a worse prognosis and level of physical activities of daily living than those who scored below (P ≤ 0.02). CONCLUSION When evaluated by the LCADL, men and women with COPD present difference in the functional status. The established cutoff point (37%) adequately discriminates individuals regarding the prognosis, contributing to improve the interpretation capacity of the LCADL.
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Affiliation(s)
- Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Antenor Rodrigues
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.,Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - Thaís Paes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Felipe Vilaça Cavallari Machado
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Ana Paula Vicentin
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | | | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
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12
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Clinical impact of body composition phenotypes in patients with COPD: a retrospective analysis. Eur J Clin Nutr 2019; 73:1512-1519. [DOI: 10.1038/s41430-019-0390-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 12/28/2018] [Indexed: 11/08/2022]
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13
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Mazzarin C, Kovelis D, Biazim S, Pitta F, Valderramas S. Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy. COPD 2018; 15:271-276. [PMID: 29799297 DOI: 10.1080/15412555.2018.1469608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Camila Mazzarin
- a Postgraduate Program in Internal Medicine , Federal University of Paraná , Curitiba , PR , Brazil
| | - Demetria Kovelis
- a Postgraduate Program in Internal Medicine , Federal University of Paraná , Curitiba , PR , Brazil
| | - Samia Biazim
- a Postgraduate Program in Internal Medicine , Federal University of Paraná , Curitiba , PR , Brazil
| | - Fábio Pitta
- b Laboratory of Research in Respiratory Physiotherapy, Department of Physical Therapy , State University of Londrina , Londrina , PR , Brazil
| | - Silvia Valderramas
- a Postgraduate Program in Internal Medicine , Federal University of Paraná , Curitiba , PR , Brazil.,c Department of Prevention and Rehabilitation in Physical Therapy, Program in Internal Medicine , Federal University of Paraná , Curitiba , PR , Brazil
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14
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Choi JT, Seo JH, Ko MH, Park SH, Kim GW, Won YH. Validation of Korean Version of the London Chest Activity of Daily Living Scale in Patients With Chronic Obstructive Pulmonary Disease. Ann Rehabil Med 2018; 42:329-335. [PMID: 29765887 PMCID: PMC5940610 DOI: 10.5535/arm.2018.42.2.329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To translate the English version of the London Chest Activity of Daily Living scale (LCADL) into a Korean version and to determine the reliability and validity of the Korean version in patients with chronic obstructive pulmonary disease (COPD). Methods The English version of LCADL was translated into Korean and back-translated into English. Subsequently, the back-translated version was reviewed and compared with the original, and thus the final K-LCADL was obtained. To evaluate the validation of the K-LCADL, patients simultaneously completed a pulmonary function test, a 6-Minute Walk Test (6MWT), and questionnaires, including the modified Medical Research Council (mMRC) dyspnea scale, the Korean version of the St. George's Respiratory Questionnaire (K-SGRQ), the Korean version of the COPD Assessment Test (K-CAT), and the Korean version of the EuroQoL-5 Dimensions (K-EQ-5D). To assess test-retest reliability, the K-LCADL was again administered to the same patients within 2 weeks from initial assessment. Results A total of 94 patients participated in the present study. The total K-LCADL score was positively correlated with the K-SGRQ (r=0.802, p<0.001), the mMRC dyspnea scale (r=0.603, p<0.001), and the K-CAT score (r=0.714, p<0.001), and negatively correlated with the K-EQ-5D (r=−0.764, p<0.001), 6MWT (r=−0.635, p<0.001), forced expiratory volume in one second 1 (r=−0.416, p=0.002), and forced vital capacity (r=−0.397, p=0.023). Intraclass correlation coefficient of the K-LCADL was 0.951 (p<0.001). Conclusion The K-LCADL is a reliable and valid questionnaire for evaluating limitation of activities of daily living in patients with COPD.
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Affiliation(s)
- Jun Tak Choi
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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15
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Felcar JM, Probst VS, de Carvalho DR, Merli MF, Mesquita R, Vidotto LS, Ribeiro LRG, Pitta F. Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial. Physiotherapy 2018; 104:408-416. [PMID: 30477678 DOI: 10.1016/j.physio.2017.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD). DESIGN Randomised controlled trial. SETTING University-based outpatient clinic. PARTICIPANTS Thirty-six patients with predominantly moderate-to-severe COPD completed the study. INTERVENTION Patients were evaluated at baseline, at 3 months and at the end of the programme (i.e. 6 months). For both groups, the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and/or workload, totalling 60 sessions. MAIN OUTCOMES Objective monitoring of physical activity in daily life (PADL, primary outcome), lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, and symptoms of anxiety and depression. RESULTS After 6 months of training, a significant improvement in PADL was seen for both groups [mean difference (95% confidence interval): land group 993 (358 to 1628) steps/day; water group 1669 (404 to 2934) steps/day]. Significant improvements were also seen in inspiratory, expiratory and peripheral muscle strength; maximal and submaximal exercise capacity; quality of life and functional status for both groups. There were no significant improvements in lung function, body composition, and symptoms of anxiety and depression for either group. No difference was found in the magnitude of improvement between the two types of training for any outcome. CONCLUSION High-intensity exercise training in water generates similar effects compared with training on land in patients with moderate-to-severe COPD, rendering it an equally beneficial therapeutic option for this population. CLINICAL TRIAL REGISTRATION NUMBER NCT01691131.
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Affiliation(s)
- J M Felcar
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - V S Probst
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - D R de Carvalho
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - M F Merli
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil
| | - R Mesquita
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - L S Vidotto
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil
| | - L R G Ribeiro
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil
| | - F Pitta
- Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil.
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16
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Sant'Anna T, Donária L, Hernandes NA, Furlanetto KC, Barbosa DS, Gosselink R, Pitta F. Oxygen Desaturation in Daily Life and During a Laboratory-Based Protocol of Activities of Daily Living in COPD: Is There Relationship? Lung 2017; 196:19-26. [PMID: 29134264 DOI: 10.1007/s00408-017-0068-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the relationship between oxygen desaturation episodes during a laboratory-based ADL protocol and in real-life routine in patients with stable chronic obstructive pulmonary disease (COPD). METHODS Twenty patients with stable COPD (12 men, 70 ± 7 years, FEV1% 54 ± 15 predicted) with no indication for long-term oxygen therapy (LTOT) were submitted to assessments including ADL performance by the Londrina ADL Protocol (LAP) and level of physical activity in daily life, both while submitted to simultaneous activity and pulse oximeter monitoring. RESULTS Episodes of desaturation ≥ 4% (ED ≥ 4%) during the LAP were correlated both with ED ≥ 4% in daily life (r = 0.45) and number of episodes of SpO2 under 88% (ED < 88%) in daily life (r = 0.59). ED < 88% during the LAP was also correlated with ED < 88% in daily life (r = 0.51), explaining 43% of its variance. CONCLUSION In stable patients with COPD and no indication of LTOT, episodes of desaturation during a lab-based ADL protocol are moderately related to episodes of desaturation in daily (real) life, especially those episodes under 88%.
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Affiliation(s)
- Thaís Sant'Anna
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Leila Donária
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Nidia A Hernandes
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Karina C Furlanetto
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Décio S Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Rik Gosselink
- Respiratory Division and Pulmonary Rehabilitation, University Hospitals, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil.
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17
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Reilly CC, Bausewein C, Garrod R, Jolley CJ, Moxham J, Higginson IJ. Breathlessness during daily activity: The psychometric properties of the London Chest Activity of Daily Living Scale in patients with advanced disease and refractory breathlessness. Palliat Med 2017; 31:868-875. [PMID: 27932629 PMCID: PMC5613804 DOI: 10.1177/0269216316680314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease. AIM To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease. DESIGN A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034). All patients completed the following questionnaires: the London Chest Activities of Daily Living Scale, Chronic Respiratory Questionnaire, the Palliative care Outcome Scale, Palliative care Outcome Scale-symptoms, the Hospital Anxiety and Depression Scale and breathlessness measured on a numerical rating scale. Data quality, scaling assumptions, acceptability, internal consistency and construct validity of the London Chest Activities of Daily Living Scale were determined using standard psychometric approaches. SETTING/PARTICIPANTS Breathless patients with advanced malignant and non-malignant disease. RESULTS A total of 88 patients were studied, primary diagnosis included; chronic obstructive pulmonary disease = 53, interstitial lung disease = 17, cancer = 18. Median (range) London Chest Activities of Daily Living Scale total score was 46.5 (14-67). No floor or ceiling effect was observed for the London Chest Activities of Daily Living Scale total score. Internal consistency was good, and Cronbach's alpha for the London Chest Activities of Daily Living Scale total score was 0.90. Construct validity was good with 13 out of 15 a priori hypotheses met. CONCLUSION Psychometric analyses suggest that the London Chest Activities of Daily Living Scale is acceptable, reliable and valid in patients with advanced disease and refractory breathlessness.
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Affiliation(s)
- Charles C Reilly
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,2 Physiotherapy, King's College Hospital NHS Foundation Trust, London, UK
| | - Claudia Bausewein
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,3 Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Rachel Garrod
- 4 Department of Respiratory Medicine, King's College London, London, UK
| | - Caroline J Jolley
- 5 Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK.,6 Centre of Human & Aerospace Physiological Sciences, King's College London, London, UK
| | - John Moxham
- 5 Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Irene J Higginson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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18
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Klijn P, Legemaat M, Beelen A, Keimpema AV, Garrod R, Bergsma M, Paterson B, Stuijfzand A, van Stel H. Validity, Reliability, and Responsiveness of the Dutch Version of the London Chest Activity of Daily Living Scale in Patients With Severe COPD. Medicine (Baltimore) 2015; 94:e2191. [PMID: 26656349 PMCID: PMC5008494 DOI: 10.1097/md.0000000000002191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study assesses the validity, reliability, and responsiveness of the Dutch version of the London Chest Activity of Daily Living scale (LCADL).The English LCADL version was translated into Dutch and then back-translated to English to check if the translation was conceptually equivalent to the original LCADL.Measurement properties were evaluated in191 patients with chronic obstructive pulmonary disease (COPD) (70 males; age 62 ± 9 years; FEV1 33 ± 10% pred). Construct validity was assessed using disease-specific health status, generic functional status, and functional and peak exercise capacity (Wmax). LCADL was completed twice to assess test-retest reliability. Responsiveness was assessed after 8 to 12 weeks inpatient pulmonary rehabilitation.LCADL correlated significantly with the St. George Respiratory Questionnaire (r = 0.24 to 0.64), functional status (r = 0.45 to 0.82), walking distance (r = -0.3 to -0.58), and Wmax (-0.27 to -0.38) and Wmax % pred (-0.26 to -0.43). Test-retest reliability was high (ICC 0.87 to 0.98). The smallest detectable change for the LCADL total and domain score self-care, domestic, physical, and leisure was 4.5, 2.9, 3.3, 4.9, and 2.2, respectively. Improvement in LCADL after PR correlated significantly with improvement in Chronic Respiratory Questionnaire (-0.43; P < 0.001).The Dutch LCADL is a reliable, valid, and responsive instrument to assess limitations in performing activities of daily living in patients with severe COPD.
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Affiliation(s)
- Peter Klijn
- From the Department of Pulmonology, Merem Asthma Centre Heideheuvel, Hilversum, The Netherlands (PK, ML, AB, AVK); Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands (PK, AVK); Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands (AB, MB); Kings College London, Therapies UK, London, United Kingdom (RG); Erasmus Medical Center, Salem Ermelo, St Jansdal Harderwijk, The Netherlands (BP); Department of Pulmonology, Salem Ermelo, St Jansdal Harderwijk, The Netherlands (AS); and Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands (HVS)
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19
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Amorim PB, Stelmach R, Carvalho CRF, Fernandes FLA, Carvalho-Pinto RM, Cukier A. Barriers associated with reduced physical activity in COPD patients. J Bras Pneumol 2015; 40:504-12. [PMID: 25410838 PMCID: PMC4263331 DOI: 10.1590/s1806-37132014000500006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/07/2014] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE: To evaluate the ability of COPD patients to perform activities of daily living
(ADL); to identify barriers that prevent these individuals from performing ADL;
and to correlate those barriers with dyspnea severity, six-minute walk test
(6MWT), and an ADL limitation score. METHODS: In COPD patients and healthy, age-matched controls, the number of steps, the
distance walked, and walking time were recorded with a triaxial accelerometer, for
seven consecutive days. A questionnaire regarding perceived barriers and the
London Chest Activity of Daily Living (LCADL) scale were used in order to identify
the factors that prevent the performance of ADL. The severity of dyspnea was
assessed with two scales, whereas submaximal exercise capacity was determined on
the basis of the 6MWT. RESULTS: We evaluated 40 COPD patients and 40 controls. In comparison with the control
values, the mean walk time was significantly shorter for COPD patients (68.5 ±
25.8 min/day vs. 105.2 ± 49.4 min/day; p < 0.001), as was the distance walked
(3.9 ± 1.9 km/day vs. 6.4 ± 3.2 km/day; p < 0.001). The COPD patients also
walked fewer steps/day. The most common self-reported barriers to performing ADL
were lack of infrastructure, social influences, and lack of willpower. The 6MWT
distance correlated with the results obtained with the accelerometer but not with
the LCADL scale results. CONCLUSIONS: Patients with COPD are less active than are healthy adults of a comparable age.
Physical inactivity and the barriers to performing ADL have immediate implications
for clinical practice, calling for early intervention measures.
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Affiliation(s)
- Priscila Batista Amorim
- Heart Institute, School of Medicine Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Heart Institute, School of Medicine Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Alberto Cukier
- Heart Institute, School of Medicine Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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20
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Moreira GL, Donária L, Furlanetto KC, Paes T, Sant'Anna T, Hernandes NA, Pitta F. GOLD B-C-D groups or GOLD II-III-IV grades: Which one better reflects the functionality of patients with chronic obstructive pulmonary disease? Chron Respir Dis 2015; 12:102-10. [PMID: 25711468 DOI: 10.1177/1479972315573528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this article is to investigate which global initiative for chronic obstructive lung disease (GOLD) classification (B-C-D or II-III-IV) better reflects the functionality of patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Ninety patients with COPD were classified according to the GOLD B-C-D and II-III-IV classifications. Functionality was assessed by different outcomes: 6-min walk test (6MWT), activities of daily living (ADL) (London Chest ADL Scale), and daily life activity/inactivity variables assessed by activity monitoring (SenseWear armband, Pittsburgh, Pennsylvania, USA). The 6MWT was the only outcome significantly associated with both the GOLD classifications. Good functionality as assessed by the 6MWT was observed in 80%, 69%, and 43.5% (GOLD B, C, and D, respectively) and 81%, 59%, and 29% (GOLD II, III, and IV, respectively) of the patients. Association (V Cramer's) and correlation (Spearman) coefficients of 6MWT with GOLD B-C-D and II-III-IV were V = 0.30, r = -0.35, and V = 0.37, r = -0.25, respectively. Neither GOLD classification showed V or r ≥ 0.30 with any other functionality outcome. Both the GOLD B-C-D and II-III-IV classifications do not reflect well COPD patients' functionality. Despite low association and correlation coefficients in general, both GOLD classifications were better associated with functional exercise capacity (6MWT) than with subjectively assessed ADL and objectively assessed outcomes of physical activity/inactivity.
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Affiliation(s)
| | | | - Karina C Furlanetto
- GLM and LD contributed equally to this work.Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Thais Paes
- GLM and LD contributed equally to this work.Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Thaís Sant'Anna
- GLM and LD contributed equally to this work.Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Nidia A Hernandes
- GLM and LD contributed equally to this work.Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- GLM and LD contributed equally to this work.Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
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Minimal Detectable Change of the London Chest Activity of Daily Living Scale in Patients With COPD. J Cardiopulm Rehabil Prev 2014; 34:213-6. [DOI: 10.1097/hcr.0000000000000047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barriga S, Rodrigues F, Bárbara C. Factors that influence physical activity in the daily life of male patients with chronic obstructive pulmonary disease. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:131-7. [PMID: 24418722 DOI: 10.1016/j.rppneu.2013.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/22/2013] [Accepted: 09/23/2013] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a disease with great impact on the ability to carry out physical activity. OBJECTIVE To identify the main factors that affect physical activity in the daily life of patients with COPD. METHODS Physical activity in daily routine has been evaluated according to the London Chest Activity of Daily Living scale (LCADL) and the pedometer counting the number of steps per day, for a period of three days. Fifty-five male patients with a diagnosis of moderate to very severe COPD were included (aged 67±9.6 years; FEV1 50.8±14.7% predicted). RESULTS Patients walked on average 4972 steps per day. Very severe COPD patients (n=12) walked much less than severe (n=21) and moderate (n=22) patients (respectively 3079.8 versus 4853.5 and 6118.1 steps per day, p<0.001). The number of steps per day had a negative correlation with age, dyspnea (mMRC), depression, BODE index and pulmonary hyperinflation; and a positive correlation with the distance covered in the six-minute walk test (6MWT), forced expiratory volume in the first second (FEV1), carbon monoxide diffusion capacity (DLCO), arterial oxygen saturation (SpO2) and body mass index (BMI). CONCLUSIONS The main factors that correlated with limited physical activity in daily life routine of this group of COPD patients were dyspnea and 6 min walking distance. These patients form a sedentary group, with a low rate of daily physical activity, which is more evident in patients with GOLD spirometry stage IV. Although pedometer is simpler and less accurate than other devices, it can be used to detect significant restraints daily life physical activity of COPD patients.
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Affiliation(s)
- S Barriga
- Centro Hospitalar de Torres Vedras, Torres Vedras, Portugal.
| | - F Rodrigues
- Serviço Pneumologia - Centro Hospitalar Lisboa Norte, Faculdade de Medicina Universidade Lisboa, Portugal
| | - C Bárbara
- Serviço Pneumologia - Centro Hospitalar Lisboa Norte, Faculdade de Medicina Universidade Lisboa, Portugal
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2166] [Impact Index Per Article: 196.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Gianjoppe-Santos J, Nyssen SM, Pessoa BV, Basso-Vanelli RP, Jamami M, Di Lorenzo VAP. Chronic obstructive pulmonary disease Assessment Test na avaliação de pacientes com doença pulmonar obstrutiva crônica em reabilitação pulmonar: há relação com nível de dispneia nas atividades de vida diária e com índice preditor de mortalidade? Estudo transversal. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000400013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi investigar se há relação entre o impacto da Doença Pulmonar Obstrutiva Crônica (DPOC) no estado de saúde com o nível de dispneia nas atividades de vida diária (AVD) e o índice preditor de mortalidade em pacientes em reabilitação pulmonar (RP). Trata-se de um estudo transversal, em que foram avaliados 32 pacientes com DPOC moderada a muito grave (23 homens; 66,6±12,0 anos; VEF1: 40,6±15,6% previsto) por meio do COPD Assessment Test (CAT), Índice de Massa Corpórea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlações positivas moderadas do CAT com o questionário mMRC (r=0,35; p=0,048), a pontuação total da LCADL (r=0,60; p<0,001) e com a porcentagem da pontuação total da LCADL (r=0,57; p=0,001). Apenas a pontuação total da LCADL é capaz de predizer independentemente a pontuação do questionário CAT (p<0,05; r²=0,61). Não foram constatadas correlações significativas entre o CAT e o Índice BODE, IMC, TC6 e VEF1. Dessa forma, quanto maior o nível de dispneia nas AVD, maior o impacto da DPOC no estado de saúde do paciente, entretanto, o mesmo não ocorre em relação ao prognóstico de mortalidade nos pacientes com DPOC em RP.
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Muller JP, Gonçalves PAG, Fontoura FFD, Mattiello R, Florian J. Applicability of the London Chest Activity of Daily Living scale in patients on the waiting list for lung transplantation. J Bras Pneumol 2013; 39:92-7. [PMID: 23503491 PMCID: PMC4075799 DOI: 10.1590/s1806-37132013000100013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/16/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate the applicability of the London Chest Activity of Daily Living
(LCADL) scale in patients on the waiting list for lung transplantation. METHODS: This was a cross-sectional study, conducted between May and September of 2010,
involving 26 male and female patients on the waiting list for lung transplantation
and treated at the Pulmonary Rehabilitation Program in the Complexo
Hospitalar Santa Casa de Misericórdia de Porto Alegre, located in the
city of Porto Alegre, Brazil. We evaluated the patients using the six-minute walk
test (6MWT) and pulmonary function tests. We also obtained the LCADL scores, as
well as the modified Borg scale scores for sensation of dyspnea and leg fatigue.
Cronbach's alpha coefficient was used to determine the internal consistency of the
LCADL scale. Linear regression analysis was used in order to identify associations
between the total LCADL score (expressed as a percentage) and the variables
studied. RESULTS: According to the LCADL scale results, 69% of the patients reported that the
performance of their activities of daily living was significantly impaired by
their dyspnea. The internal consistency of the LCADL scale was 0.89. After
adjusting for age and FEV1, we found that the total LCADL scale score
showed statistically significant negative associations with the six-minute walk
distance (β = −0.087; p < 0.001) and the six-minute walk work (β = −0.285; p
< 0.001). CONCLUSIONS: Our findings suggest that the LCADL scale is a useful tool for assessing patients
on the waiting list for lung transplantation.
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Affiliation(s)
- Jocimar Prates Muller
- Department of Physical Therapy, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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Kovelis D, Zabatiero J, Oldemberg N, Colange AL, Barzon D, Nascimento CHSC, Probst VS, Pitta F. Responsiveness of three instruments to assess self-reported functional status in patients with COPD. COPD 2011; 8:334-9. [PMID: 21774574 DOI: 10.3109/15412555.2011.594463] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Demetria Kovelis
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Brazil
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Hernandes NA, Teixeira DDC, Probst VS, Brunetto AF, Ramos EMC, Pitta F. Profile of the level of physical activity in the daily lives of patients with COPD in Brazil. J Bras Pneumol 2010; 35:949-56. [PMID: 19918626 DOI: 10.1590/s1806-37132009001000002] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 05/22/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate characteristics of physical activities in daily life in COPD patients in Brazil, correlating those characteristics with physiological variables. METHODS Physical activities in daily life were evaluated in 40 COPD patients (18 males; 66 + or - 8 years of age; FEV(1) = 46 + or - 16 % of predicted; body mass index = 27 + or - 6 kg/m(2)) and 30 healthy age- and gender-matched subjects, using a multiaxial accelerometer-based sensor for 12 h/day on two consecutive days. We also assessed maximal and functional exercise capacity, using the incremental exercise test and the six-minute walk test (6MWT), respectively; MIP and MEP; peripheral muscle force, using the one-repetition maximum test and the handgrip test; quality of life, using the Saint George's Respiratory Questionnaire (SGRQ); functional status, using the London Chest Activity of Daily Living questionnaire; and dyspnea sensation, using the Medical Research Council (MRC) scale. RESULTS Mean walking time/day was shorter for COPD patients than for the controls (55 + or - 33 vs. 80 + or - 28 min/day; p = 0.001), as movement intensity was lower (1.9 + or - 0.4 vs. 2.3 + or - 0.6 m/s(2); p = 0.004). The COPD patients also tended to spend more time seated (294 + or - 114 vs. 246 + or - 122 min/day, p = 0.08). Walking time/day correlated with the 6MWT (r = 0.42; p = 0.007) and maximal workload (r = 0.41; p = 0.009), as well as with age, MRC scale score and SGRQ activity domain score (-0.31 < or = r < or = -0.43; p < or = 0.05 for all). CONCLUSIONS This sample of Brazilian patients with COPD, although more active than those evaluated in studies conducted in Europe, were less active than were the controls. Walking time/day correlated only moderately with maximal and functional exercise capacity.
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