Possíveis conseqüências de não se atingir a mínima atividade física diária recomendada em pacientes com doença pulmonar obstrutiva cronica estável

Daily physical activity and related risk factors in COPD

Background

Factors associated with reduced daily physical activity (DPA) in patients with COPD are still controversial. Physical inactivity in COPD increases risk of cardiovascular disease, frequent exacerbations, reduced health status, and increased symptoms. We hypothesised that reduced DPA in patients with COPD is independent of traditional risk factors including age and spirometry.

Methods

In this cross-sectional study, DPA (over 7 days) was assessed on 88 community stable patients with COPD and 40 controls free from cardiorespiratory disease. Spirometry, body composition, number of exacerbations, handgrip strength (HGS), modified Medical Research Council (mMRC), arterial stiffness, 6-min walking distance (6MWD) and BODE index were also determined. Frequent exacerbation was defined as ≥2 and non-frequent exacerbation < 2.

Results

Patients with COPD had reduced DPA and exercise capacity compared with controls similar in age, BMI and gender, p < 0.001. Frequent exacerbators had less DPA than infrequent exacerbators and both less than controls, p < 0.001. Patients with higher BODE index were less active than those with lower index. Time spent on moderate activity was related to cardiovascular risk factors including arterial stiffness. The DPA in patients was independent of age, gender, spirometry, body composition and HGS, p > 0.05. The level of breathlessness was superior to lung function in predicting the level of DPA.

Conclusion

The level of DPA in COPD was independent of traditional risk factors. Breathlessness score is a better predictor of the DPA than lung function and handgrip strength.

Self-reported walking and associated factors in the Spanish population with chronic obstructive pulmonary disease

Background

The level of physical activity among individuals with chronic obstructive pulmonary disease (COPD) is associated with the disease severity and prognosis. The aim of this study was to describe the prevalence of self-reported walking at least 150 min per week and the associated factors among the Spanish population with COPD.

Methods

Analyses were based on data drawn from the 2009 European Health Interview Survey in Spain (2009 EHIS). Twenty-two thousand one hundred eighty-eight subjects participated in the survey (response rate of 96.5%). Participants were classified according to international physical activity recommendations. The prevalence of walking among participants with and without COPD (≥40 years old) was described. Univariate and multivariate logistic regression models were used to study the association of walking with socio-demographic and health outcome variables.

Results

Of the participants with COPD, 55.0% reached the minimum walking recommendations compared to 59.9% of the general population. The level of walking physical activity of the participants with COPD differed according to sex, age, educational level, area of residence, living as a couple, self-rated health status, mental health, body mass index and hospital admissions. In the multivariate analysis, being male, < 65 years old, living in an area with ≥50,000 inhabitants, no diagnosed depression or anxiety and self-reported good to very good health were factors significantly associated with walking ≥150 min per week.

Conclusions

Sex, age, area of residence, mental disorders and self-rated health are associated with weekly walking time in the Spanish population with COPD.

Verification of a Motion Sensor for Evaluating Physical Activity in COPD Patients

Background

Objective evaluation of the physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is important. We validated a triaxial accelerometer, Active Style Pro HJA-750C® (HJA), and evaluated the necessary conditions for obtaining reproducible data.

Methods

The PA measured by HJA was compared with that measured by two already validated accelerometers in 11 patients with COPD (age: 76.6 ± 6.9, FEV1% predicted: 57.6 ± 18.6). Then, the influence of weather and holidays on the PA and the required number of days to obtain repeatability were examined in 21 patients with COPD (age: 73.0 ± 8.0, FEV1% predicted: 58.7 ± 19.0).

Results

The PA values measured by HJA and those by DynaPort Move Monitor® (DMM) or Actimarker® (AM) were significantly correlated at all intensities (p=0.024 at ≥4.0 METs by DMM and p < 0.0001 at the rest) except at ≥4.0 METs by AM, though the values measured by HJA were higher than those by AM which was reported to underestimate PA. The durations of PA on rainy days were significantly shorter than those on nonrainy days, but those on holidays were not different from those on weekdays. The values of ICC for 3, 4, or 5 days were higher than 0.8 at all intensities. The PA measured by HJA was correlated with the dyspnea scale FVC and age and tended to correlate with FEV1.

Conclusions

The HJA was validated for evaluating the PA in patients with COPD. This trial is registered with UMIN000016363.

Replacement of the 6-Min Walk Test With Glittre ADL Test and Scores From the PFSDQ-M and HAP Questionnaires in the BODE Index

PURPOSE

Chronic obstructive pulmonary disease reduces functional capacity, which is strongly correlated with the morbidity and mortality of patients. The BODE index considers the multifactorial nature of the disease, including the functional capacity measured by the 6-min walk test (6MWT), and this index predicts the mortality in patients with chronic obstructive pulmonary disease. Our aim was to assess whether association exists between the original BODE index and the modified BODE index by replacing the 6MWT with the scores from the Pulmonary Functional Status and Dyspnea Questionnaire-Modified version (PFSDQ-M), Human Activity Profile (HAP) questionnaire, and the results of the Glittre ADL Test (TGlittre).

METHODS

Twenty-eight subjects diagnosed with chronic obstructive pulmonary disease underwent the 6MWT and TGlittre and responded to the PFSDQ-M and HAP questionnaires. Four BODE index scores were obtained: 1 calculated by using the original method (ie, using the 6MWT) and 3 others calculated by using the results obtained from the TGlittre, PFSDQ-M, and HAP (the modified BODE index scores).

RESULTS

High levels of association were observed between the original BODE index and the BODE TGlittre (R = 0.824, P ≤ .0001), BODE PFSDQ-M (R = 0.803, P ≤ .0001), and BODE HAP (R = 0.500, P ≤ .0001).

CONCLUSION

The BODE TGlittre, and BODE PFSDQ-M may be used as alternatives to the 6MWT when physical space is not available to perform the 6MWT or when the condition of a patient does not allow performance of the 6MWT.

Short- and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial

BACKGROUND

We were interested in the effects of a physical activity (PA) counselling programme in three groups of COPD patients from general practice (primary care), outpatient clinic (secondary care) and pulmonary rehabilitation (PR).

METHODS

In this randomized controlled trial 155 COPD patients, 102 males, median (IQR) age 62 (54-69) y, FEV1predicted 60 (40-75) % were assigned to a 12-weeks' physical activity counselling programme or usual care. Physical activity (pedometer (Yamax SW200) and metabolic equivalents), exercise capacity (6-min walking distance) and quality of life (Chronic Respiratory Questionnaire and Clinical COPD Questionnaire) were assessed at baseline, after three and 15 months.

RESULTS

A significant difference between the counselling and usual care group in daily steps (803 steps, p = 0.001) and daily physical activity (2214 steps + equivalents, p = 0.001)) from 0 to 3 months was found in the total group, as well as in the outpatient (1816 steps, 2616 steps + equivalents, both p = 0.007) and PR (758 steps, 2151 steps + equivalents, both p = 0.03) subgroups. From 0 to 15 months no differences were found in physical activity. However, when patients with baseline physical activity>10,000 steps per day (n = 8), who are already sufficiently active, were excluded, a significant long-term effect of the counselling programme on daily physical activity existed in the total group (p = 0.02). Differences in exercise capacity and quality of life were found only from 0 to 3 months, in the outpatient subgroup.

CONCLUSION

Our PA counselling programme effectively enhances PA level in COPD patients after three months. Sedentary patients at baseline still benefit after 15 months. ClinicalTrials.gov: registration number NCT00614796.

Changes in physical activity and all-cause mortality in COPD

Little is known about changes in physical activity in subjects with chronic obstructive pulmonary disease (COPD) and its impact on mortality. Therefore, we aimed to study changes in physical activity in subjects with and without COPD and the impact of physical activity on mortality risk.

Subjects from the Copenhagen City Heart Study with at least two consecutive examinations were selected. Each examination included a self-administered questionnaire and clinical examination.

1270 COPD subjects and 8734 subjects without COPD (forced expiratory volume in 1 s 67±18 and 91±15% predicted, respectively) were included. COPD subjects with moderate or high baseline physical activity who reported low physical activity level at follow-up had the highest hazard ratios of mortality (1.73 and 2.35, respectively; both p<0.001). In COPD subjects with low baseline physical activity, no differences were found in survival between unchanged or increased physical activity at follow-up. In addition, subjects without COPD with low physical activity at follow-up had the highest hazard ratio of mortality, irrespective of baseline physical activity level (p≤0.05).

A decline to low physical activity at follow-up was associated with an increased mortality risk in subjects with and without COPD. These observational data suggest that it is important to assess and encourage physical activity in the earliest stages of COPD in order to maintain a physical activity level that is as high as possible, as this is associated with better prognosis.

Association between peripheral muscle strength and daily physical activity in patients with COPD: a systematic literature review and meta-analysis

BACKGROUND

Patients with chronic obstructive pulmonary disease have skeletal muscle dysfunction and reduced daily physical activity (PA). Whether the reduction in quadriceps strength (QS) is directly linked to physical inactivity remains to be elucidated.

METHODS

A systematic review and a meta-analysis were conducted to determine the potential relationship between QS and the level of PA. The overall estimate of the correlation coefficient (r*) was calculated, and a subgroup analysis was conducted to analyze the association between QS and indices of PA separately.

RESULTS

A total of 8 studies were included in the meta-analysis. The overall association between QS and PA was low but highly significant (r * = 0.288, 95% CI = 0.180-0.389; P < .001). In the subgroup analysis, the association between QS and the number of steps per day was low (r = 0.260; 95% CI = 0.060-0.440) and the association between QS and the time spent walking was moderate (r = 0.418; 95% CI = 0.229-0.576).

CONCLUSIONS

Peripheral muscle strength is associated with PA as assessed by the number of steps per day and the time spent walking in patients with chronic obstructive pulmonary disease. The overall association between QS and PA was low to moderate and highly significant.

Physical activity level and its clinical correlates in chronic obstructive pulmonary disease: a cross-sectional study

Background

Decreased physical activity is associated with higher mortality in subjects with COPD. The aim of this study was to assess clinical characteristics and physical activity levels (PALs) in subjects with COPD.

Methods

Seventy-three subjects with COPD (67 ± 7 yrs, 44 female) with one-second forced expiratory volume percentage (FEV₁%) predicted values of 43 ± 16 were included. The ratio of total energy expenditure (TEE) and resting metabolic rate (RMR) was used to define the physical activity level (PAL) (PAL = TEE/RMR). TEE was assessed with an activity monitor (ActiReg), and RMR was measured by indirect calorimetry. Walking speed (measured over 30-meters), maximal quadriceps muscle strength, fat-free mass and systemic inflammation were measured as clinical characteristics. Hierarchical linear regression was applied to investigate the explanatory values of the clinical correlates to PAL.

Results

The mean PAL was 1.47 ± 0.19, and 92% of subjects were classified as physically very inactive or sedentary. The walking speed was 1.02 ± 0.23 m/s, the quadriceps strength was 31.3 ± 11.2 kg, and the fat-free mass index (FFMI) was 15.7 ± 2.3 kg/m², identifying 42% of subjects as slow walkers, 21% as muscle-weak and 49% as FFM-depleted. The regression model explained 45.5% (p < 0.001) of the variance in PAL. The FEV₁% predicted explained the largest proportion (22.5%), with further improvements in the model from walking speed (10.1%), muscle strength (7.0%) and FFMI (3.0%). Neither age, gender nor systemic inflammation contributed to the model.

Conclusions

Apart from lung function, walking speed and muscle strength are important correlates of physical activity. Further explorations of the longitudinal effects of the factors characterizing the most inactive subjects are warranted.

Reduced level of physical activity in Japanese patients with chronic obstructive pulmonary disease

BACKGROUND

There is increasing interest in the quantification of physical activity (PA) with an accelerometer for the management of chronic obstructive pulmonary disease (COPD). However, a detailed understanding of the PA in Japanese patients with COPD is lacking. We evaluated the levels of PA in terms of intensity in Japanese patients with COPD and evaluated the factors, which could influence the PA.

METHODS

Forty-three outpatients with COPD and 21 age-matched healthy subjects were monitored with a triaxial accelerometer, and their PA was compared. Furthermore, the effects of pulmonary function, ADO index (age, dyspnea, and airflow obstruction) and modified BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity) on the PA were evaluated.

RESULTS

The PA in COPD was significantly reduced at all intensities. The reduced levels of PA in COPD were 23.1% at ≥2.0 metabolic equivalents (METs), 33.0% at ≥2.5 METs, 50.9% at ≥3.0 METs, and 66.9% at ≥3.5 METs, compared with that of healthy subjects, and the reduction was significant at GOLD stage III. The values of FVC, FEV1.0, and DLCO/VA were correlated with that of the PA, but the lung volume parameters were not. The ADO and modified BODE indices were also well correlated with the PA.

CONCLUSIONS

The reduced levels of PA in Japanese patients with COPD were objectively demonstrated in terms of intensity that could provide us a new target for the management of COPD.

Análise da radiografia de tórax de indivíduos com DPOC e sua correlação com os testes funcionais

INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) provoca alterações na função respiratória e altera as estruturas musculoesqueléticas da caixa torácica, limitando, cada vez mais, a capacidade de respiração do indivíduo. OBJETIVOS: analisar quantitativamente as radiografias torácicas de indivíduos com DPOC e estabelecer um comparativo entre a prova de função pulmonar, a força muscular respiratória, a mobilidade torácica, a capacidade funcional e os achados dos exames radiográficos. MÉTODO: Foram avaliados 15 indivíduos com DPOC, os quais realizaram os exames de espirometria, teste da caminhada de seis minutos, manovacuometria e cirtometria. Os valores obtidos nesses testes foram comparados com medidas efetuadas na radiografia de tórax desses pacientes. Os valores obtidos para cada variável foram normalizados dividindo-se tais valores pela altura retroesternal. RESULTADOS: A variável que apresentou correlação mais significativa com as variáveis de espirometria (CVF e PFE) e de cirtometria (Xifoide CR e Axilar CR) foi o ângulo costofrênico. A variável de imagem ALB DIR correlacionou-se positivamente com a variável PI máx. O nível de rebaixamento diafragmático esquerdo e a distância intercostal direita e esquerda não apresentaram correlação com as variáveis dos exames fisioterápicos. CONCLUSÃO: A variável que apresentou correlação mais significativa com os exames foi o ângulo costofrênico, o que indica que o comprometimento do diafragma impacta nas condições gerais do DPOC. Sendo assim, o estudo apontou que o comprometimento do músculo diafragma observado nos exames de fisioterapia em indivíduos com DPOC correlaciona-se com as variáveis de imagem, que avaliam o diafragma nas imagens radiográficas.

Respiratory diseases and muscle dysfunction

Many respiratory diseases lead to impaired function of skeletal muscles, influencing quality of life and patient survival. Dysfunction of both respiratory and limb muscles in chronic obstructive pulmonary disease has been studied in depth, and seems to be caused by the complex interaction of general (inflammation, impaired gas exchange, malnutrition, comorbidity, drugs) and local factors (changes in respiratory mechanics and muscle activity, and molecular events). Some of these factors are also present in cystic fibrosis and asthma. In obstructive sleep apnea syndrome, repeated exposure to hypoxia and the absence of reparative rest are believed to be the main causes of muscle dysfunction. Deconditioning appears to be crucial for the functional impairment observed in scoliosis. Finally, cachexia seems to be the main mechanism of muscle dysfunction in advanced lung cancer. A multidimensional therapeutic approach is recommended, including pulmonary rehabilitation, an adequate level of physical activity, ventilatory support and nutritional interventions.

Validation of a compact motion sensor for the measurement of physical activity in patients with chronic obstructive pulmonary disease

BACKGROUND

The DynaPort Activity Monitor (DAM) has been reported to be useful to evaluate the activity in healthy subjects and patients with chronic obstructive pulmonary disease (COPD). However, it is difficult to estimate the activity of COPD patients using DAM, because its battery works only for several hours and sensors should be worn at two parts of the body. A newly developed compact, single-position triaxial accelerometer (Actimarker) can measure the activity for >1 month, but has not been validated for COPD patients.

OBJECTIVES

The validity of the Actimarker was evaluated in COPD patients.

METHODS

In study 1, the validity of the device was tested in 14 stable COPD patients by comparing it with DAM. In study 2, the influence of the weather on activity was examined. In study 3, the number of measurement days required to ensure repeatability was determined.

RESULTS

The durations of activity measured by the Actimarker and DAM were significantly correlated at intensity values ≥2.0, ≥2.5 and ≥3.0 METs. The duration of activity on rainy days was significantly shorter than that on non-rainy days. The values of intraclass correlation coefficients were >0.8 in 3-, 4- or 5-day measurements, and there was no systematic bias at any number of days or intensities with Bland-Altman plots.

CONCLUSIONS

The validity of the Actimarker was confirmed, and repeatability was obtained when the data from at least 3 non-rainy weekdays were analyzed. Actimarker appears to be useful as a simplified method to evaluate the physical activity of COPD patients.

The relationship of the BODE index to oxygen saturation during daily activities in patients with chronic obstructive pulmonary disease

BACKGROUND

The frequency of oxygen desaturation during daily activities in chronic obstructive pulmonary disease (COPD) is poorly defined. The BODE index predicts survival in COPD. The purpose of this study was to determine the relationship between BODE scores and oxygen saturation during daily activities.

METHODS

Seventy-eight patients with COPD (FEV(1) = 37%) underwent ambulatory oximetry and activity monitoring. We defined four activity categories: Walking, Slow-Intermittent-Walking (SIW), Active-Not-Walking (ANW), and Rest. We quantified oxygen desaturation during activity using a desaturation index (DSI = % time oxygen saturation <90%). BODE scores were categorized into three groups: group I (0-3), II (4-6), and III (7-10).

RESULTS

The percentage of patients demonstrating oxygen desaturation (DSI ≥ 10%) during each activity was 55% for Walking, 35% for SIW, 15% for ANW, and 28% for Rest. There was a strong association between BODE score and desaturation for Walking and SIW. During Walking, 21, 44, and 86% of patients in BODE groups I, II, and III, respectively, demonstrated desaturation. The DSI for Walking and SIW was increased in patients in BODE groups II and III compared to group I (P < 0.006, P < 0.007, respectively). BODE score was also linked to long-term oxygen therapy (LTOT) usage; the majority of patients not on LTOT (89%) had a BODE score <7. The majority of patients on LTOT (84%) demonstrated desaturation during Walking, but 42% of patients not on LTOT also demonstrated desaturation. In this subgroup of patients not on LTOT, all patients with a BODE score ≥ 7 demonstrated desaturation during Walking.

CONCLUSIONS

The link between the BODE index and oxygen desaturation during daily activities suggests that desaturation is linked to disease severity. Our data suggest that patients with a BODE score ≥ 7 should be evaluated for desaturation during daily activities. Use of the BODE index to screen for exertional desaturation may have value as a tool that can lead to the earlier identification of patients who may be candidates for LTOT.

Determinants of frequency, duration, and continuity of home walking in patients with COPD

The purpose of this study was to identify determinants of frequency (days per week), duration (minutes per session), and continuity (persistence over 1 year) of home walking in 103 patients with chronic obstructive pulmonary disease (COPD) who participated in a dyspnea self-management program. Dimensions of home walking exercise were measured by logs and reports of biweekly telephone calls with the intervention nurse. The selection of personal, cognitive, and environmental determinants of home walking was guided by social cognitive theory. Participants walked more frequently if they were exercising before they entered the study, had less depressive symptoms, and were living with friends or family. Duration of walks was influenced by supervised exercise training; living with spouse, friends, or family; and physical conditioning. Participants who walked most consistently over the course of the year had more supervised exercise sessions as part of the dyspnea self-management program, exercised regularly before entering the program, and perceived a gain in social support over the year. These findings can be used to tailor exercise interventions to the specific needs of patients and improve the likelihood of consistent exercise participation.

Consequences of physical inactivity in chronic obstructive pulmonary disease

The many health benefits of regular physical activity underline the importance of this topic, especially in this period of time when the prevalence of a sedentary lifestyle in the population is increasing. Physical activity levels are especially low in patients with chronic obstructive pulmonary disease (COPD). Regular physical activity and an active lifestyle has shown to be positively associated with outcomes such as exercise capacity and health-related quality of life, and therefore could be beneficial for the individual COPD patient. An adequate level of physical activity needs to be integrated into daily life, and stimulation of physical activity when absent is important. This article aims to discuss in more detail the possible role of regular physical activity for a number of well-known outcome parameters in COPD.

Energy expenditure during daily activities as measured by two motion sensors in patients with COPD

BACKGROUND

In patients with chronic obstructive pulmonary disease (COPD), energy expenditure (EE) assessment during the performance of daily activities is not yet studied in depth. The aim of this study was to determine which daily activities are more demanding to patients with COPD and to compare the accuracy of EE estimation given by the pedometer Digiwalker SW701 (DW) and the multisensor SenseWear Armband (SAB).

METHODS

Thirty-six patients with COPD (20 men; FEV1 48 ± 15%predicted; BMI 25.7 ± 8 kg/m(2)) were submitted to a modified version of the Glittre ADL-test, which included five activities performed for 1 min each: walking on the level, walking on the level carrying a backpack, walking up/downstairs, rising/sitting in chairs and moving objects in and out of a shelf. During the protocol subjects wore both devices concomitantly, and indirect calorimetry (IC) was simultaneously performed as the criterion method to assess EE.

RESULTS

The most demanding daily activity for individuals with COPD was walking up/downstairs (4.9 ± 1.7 kcal versus 3.7 ± 1.4 to 4.2 ± 1.8 kcal for the other tasks; p < 0.05). EE estimation by the SAB did not show difference in comparison to IC for the sum of the five activities (SAB = 22.7 ± 7 kcal versus IC = 21 ± 8 kcal; p > 0.05), although overestimation was found in activities involving walking. DW showed significant EE underestimation in the sum of the activities (9.6 ± 4.3 kcal; p < 0.05 versus IC) and for each activity.

CONCLUSION

Walking up/downstairs was the most energy-demanding daily activity for patients with COPD. Furthermore, during daily activities, the multisensor showed adequate overall estimation of energy expenditure, as opposed to the pedometer.

[Oxygen therapy by a portable concentrator with a demand valve: a randomised controlled study of its effectiveness in patients with COPD]

INTRODUCTION

There is doubt concerning the clinical effectiveness of portable oxygen concentrators with a control valve (PCDV) and their appreciation by patients. Objectives. To compare the effectiveness and appreciation of oxygen therapy by PCDV and liquid oxygen by continuous f low (O(2)Liq).

METHODS

Nineteen patients with COPD were randomised to receive PCDV or O(2)Liq at rest and during a 6 minute walk test (6MWT). For each mechanism they assessed, by visual analogue scales, the convenience and portability, the noise, and the discomfort of the nasal oxygen delivery.

RESULTS

The 6MW distance was 315 ± 120 m with PCDV and 325 ± 114 m with O(2)Liq (P>0.05). Dyspnoea and the desaturation induced by the 6MWT were identical with both systems (P>0.05). The time spent with a SaO(2)<90 % was 289 ± 69 s with PCDV and 242 ± 130 s with O(2)Liq (P=0.08). PCDV was noisier than O(2)Liq (P<0.05); there was no difference in convenience and portability or in nasal discomfort.

CONCLUSION

The PCDV model that we tested was equally effective to O(2)Liq. However, the prescription of this type of system is a matter of personal choice.

Step counting and energy expenditure estimation in patients with chronic obstructive pulmonary disease and healthy elderly: accuracy of 2 motion sensors

OBJECTIVE

To compare the accuracy of 2 motion sensors (a pedometer and a multisensor) in terms of step counting and estimation of energy expenditure (EE) in patients with chronic obstructive pulmonary disease (COPD) and in healthy elderly.

DESIGN

In this descriptive study, all participants wore both motion sensors while performing a treadmill walking protocol at 3 different speeds corresponding to 30%, 60%, and 100% of the average speed achieved during a six-minute walk test. As criterion methods, EE was estimated by indirect calorimetry, and steps were registered by videotape.

SETTING

Research laboratory at a university hospital.

PARTICIPANTS

Patients with COPD (n=30; 17 men; mean age +/- SD, 67+/-8 y; mean forced expiratory volume in the first second [FEV(1)] predicted +/- SD, 46%+/-17%; mean body mass index [BMI] +/- SD, 24+/-4 kg.m(2)) and matched healthy elderly (n=30; 15 men; mean age +/- SD, 68+/-7 y; mean FEV(1) predicted +/- SD, 104%+/-21%; mean BMI +/- SD, 25+/-3 kg.m(2)).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Step counting and EE estimation during a treadmill walking protocol.

RESULTS

The pedometer was accurate for step counting and EE estimation in both patients with COPD and healthy elderly at the higher speed. However, it showed significant underestimation at the 2 slower speeds in both groups. The multisensor did not detect steps accurately at any speed, although it accurately estimated EE at all speeds in healthy elderly and at the intermediate and higher speeds in patients with COPD.

CONCLUSIONS

In both patients with COPD and healthy elderly, the multisensor showed better EE estimates during most walking speeds than the pedometer. Conversely, for step counting, accuracy is observed only with the pedometer during the higher walking speed in both groups.

Depression and its relationship with poor exercise capacity, BODE index and muscle wasting in COPD

BACKGROUND

The prevalence of depression in stable COPD patients varies markedly, possibly because of use of different scales. We aimed to assess depression using 2 different depression scales and to examine the association between depression and poor exercise performance, BODE index and muscle wasting in clinically stable COPD patients.

METHODS

122 stable COPD patients were assessed with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Brief Assessment Schedule Depression Cards (BASDEC). We also assessed patients with spirometry, bioelectrical impedance analysis, 6-minute walk distance (6MWD), St George's Respiratory Questionnaire (SGRQ) and MRC dyspnoea and Borg scales.

RESULTS

The CES-D and BASDEC scales detected almost similar prevalence rates of depression (21% vs 17%) with a Kappa coefficient of 0.68, p<0.0001. The BASDEC scale detected more depression in women and was more closely associated with dyspnoea than the CES-D. COPD severity was associated with depression when using BODE scores but not when GOLD categories were used. Each of the CES-D and BASDEC depression scores were associated with 6MWD after adjusting for FEV1% predicted, gender, age and pack-years (p = <0.0001 and 0.001, respectively). Also, patients with a 6MWD<350 scored significantly higher on both depression scales. Wasted patients appeared to have higher depression scores, but the difference was statistically insignificant.

CONCLUSION

The administration of different depression scales may affect some of the characteristics of depressed patients rather than the prevalence rate of depression. Depression was associated with poor exercise performance and BODE index in COPD.

Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: a systematic review of the English-language literature

INTRODUCTION

Despite optimal drug treatment, many patients with congestive heart failure (CHF) or COPD still experience disabling dyspnea, fatigue, and exercise intolerance. They also exhibit significant changes in body composition. Attempts to rehabilitate these patients are often futile because conventional exercise-training modalities are limited by the severity of exertional dyspnea. Therefore, there is substantial interest in new training modalities that do not evoke dyspnea, such as transcutaneous neuromuscular electrical stimulation (NMES).

MATERIALS AND METHODS

In this article, we systematically review the literature that addresses the effects of NMES applied to the muscles of ambulation. We focused on the effects of NMES on strength, exercise capacity, and disease-specific health status in patients with CHF or COPD. We also address the methodological quality of the reported studies as well as the safety of NMES. Manuscripts published prior to December 2007 were identified by searching the Medline/PubMed, Embase, Cochrane Controlled Trials Register, CINAHL, and Physiotherapy Evidence Database (PEDro) databases.

RESULTS

Fourteen trials were identified (nine trials that examined NMES in CHF patients, and five in COPD patients). PEDro scores for methodological quality of the trials were generally moderate to good. Many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status.

DISCUSSION

Nonetheless, the limited number of studies, the disparity in patient populations, and the variability in NMES methodology prohibit the use of metaanalysis. Yet, from the viewpoint of a systematic review, NMES looks promising as a means of rehabilitating patients with CHF and COPD. There is at least sufficient evidence to warrant more large prospective, randomized, controlled trials.

Relationship of BODE Index to functional tests in chronic obstructive pulmonary disease

OBJECTIVE

To determine if there is a correlation between the BODE Index and variables assessed during the Activities of Daily Living assessment, performance on lower limber tests, and peripheral muscle impairment of the upper limb in patients with chronic obstructive pulmonary disease.

MATERIALS AND METHODS

Ten men (aged 58 to 80 years old) with moderate to very severe obstruction were evaluated and classified by the BODE Index. They were evaluated by pulmonary ventilation (VE), oxygen consumption (VO2), and carbonic gas production (VCO2) on the ADL assessment; Distance Walking (DW) in the Six Minute Walking Test (6MWT) and the Six Minute Walking Test on Treadmill (6MWTT); number of repetitions in the Sit-to-Stand Test; and the Hand Grip Strength Test. Correlations were evaluated between the classification and the tests performed (Pearson and Spearman test, p<0.05).

RESULTS

The mean of the total score for the BODE Index was 2.80 (+/-1.03), with three patients scoring in the first quartile (Q1) and seven scoring in the second quartile (Q2). This Index showed a negative correlation with the 6MWTT (r=-0.86), the Sit-to-Stand Test (r=-0.66), and the Hand Grip Strength Test (r=-0.83).

CONCLUSIONS

Our results show that there is no correlation between the BODE Index and the ventilatory and metabolic responses in the Activities of Daily Living assessment. On the other hand, a correlation was observed between the BODE Index and the variables assessed in the 6MWTT, Sit-to-Stand Test, and Hand Grip Strength Test in moderate to very severe Chronic Obstructive Pulmonary Disease patients. This suggests that these tests can be employed as predictors of physical exercise capacity, perhaps as complementary tests to the BODE Index.

Sopro de vida: experiência com a doença pulmonar obstrutiva crônica na pobreza urbana de Fortaleza, Ceará, Brasil

Trata-se de estudo antropológico de pessoas com a doença pulmonar obstrutiva crônica vivenciada na pobreza urbana de Fortaleza, Ceará, Brasil. De março a novembro de 2006, conduzimos com seis pacientes o estudo de casos, a entrevista etnográfica, a narrativa da enfermidade, e a observação participante no atendimento hospitalar e visitas domiciliares. Utilizamos a análise de conteúdo temática e a interpretação semântica contextualizada para interligar a experiência individual aos sistemas de significação, ações tomadas e condicionantes estruturais. Conclui-se que a doença pulmonar obstrutiva crônica provoca sensações, sinais e significados subjetivos. O diagnóstico torna a vida "um sufoco", surgindo limitações e privações de atividades laborais, sexuais, domésticas, familiares e de lazer. Evitar o contato direto com "o catarro" do doente, deixar de fumar ou diminuir a freqüência e evitar fumaça, tratar os sintomas com remédios caseiros e terapias corporais populares, manter a calma durante as crises, rejeitar restrições categóricas e impostas e entregar-se às forças espirituais são estratégias leigas para enfrentar o cansaço, a crise e a baixa auto-estima. A subjetividade da enfermidade, portanto, jamais pode ser excluída na medição da "carga global da doença" no nordeste brasileiro.