Handgrip strength and its relation to isokinetic dynamometry in COPD

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

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

BACKGROUND

Immunological dysfunctions and a pro-inflammatory environment are associated with higher risk of cardiovascular diseases in chronic kidney disease (CKD). Physical exercise can be an important anti-inflammatory strategy, but the effects in CKD remain poorly investigated.

OBJECTIVE

Evaluate the acute inflammatory response to intradialytic exercise in the peripheral blood of individuals with CKD.

METHODS

Nine patients, of both genders, with CKD and allocated in the ambulatory of hemodialysis of Hospital Ernesto Dornelles (Brazil), performed two sessions of hemodialysis (HD) in random form: aerobic intradialytic exercise sessions (EX, 20 min of moderate exercise in cycle-ergometer) and a control hemodialysis session (CON). Peripheral blood collection was made at the baseline, during and immediately after HD to evaluate the cytokine profile: interleukin-6, interleukin-10 (IL-10), interleukin-17a (IL-17a), interferon-gamma (INF-γ) and tumoral necrosis factor-alpha (TNF-α).

RESULTS

INF-γ decreased during HD when compared with the pre moment in both sessions, while an increase in post HD was only found in the CON session. IL-17 was higher in post when compared with during HD in both sessions. In addition to the time effect, IL-10 presented a time × group interaction and the relative changes were significantly higher in EX when compared with the CON session. The relative changes in TNF-α tended to be higher in CON when compared with EX immediately post HD session.

CONCLUSIONS

These data indicate that 20 min of intradialytic exercise have modest effect in systemic inflammation. However, the significant increase in IL-10 may indicate an immunoregulatory effect of physical exercise.

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

BACKGROUND AND AIM

Physical exercise is a key part of rehabilitation programs in chronic obstructive pulmonary disease (COPD) patients, although it could modulates immune system responses by altering the cytokine profile of such individuals. Furthermore, the degree of severity of COPD could influence the inflammatory response induced by exercise. To evaluate the cytokine profile of individuals with different degrees of COPD in response to a 6-min walk test (6MWT).

METHODS

Forty-one patients with COPD were classified according to the severity of the disease by Global Initiative for Chronic Obstructive Lung Disease method: moderate = 14 individuals; severe = 14 individuals; very severe = 13 individuals. Blood sample collection was performed in the subjects pre and post a 6MWT. Cytokine plasma levels were analyzed to determine the cytokine profile using a Cytometric Bead Array technique (Becton Dickinson, San Jose, CA, USA) assay in flow cytometry.

RESULTS

A significant difference was observed in the interleukin (IL)-6 levels after test between very severe and severe groups (P = 0.036). Also, lower levels of IL-4 were observed in the severe group compared with the very severe and the moderate groups in the pretest (P = 0.029; P = 0.003, respectively), and different values between the moderate and severe groups in the post-test (P = 0.044). A significant time pre-post effect was found in the IL-4 levels on the very severe group (P = 0.046).

CONCLUSION

After the 6MWT, a discrete inflammatory response was observed in COPD patients, independent of the degree of severity. The results concerning IL-4 and IL-6 levels can be indicative of an attempt to control inflammation after the 6MWT in COPD patients.

Sex-specific associations of variants in regulatory regions of NADPH oxidase-2 (CYBB) and glutathione peroxidase 4 (GPX4) genes with kidney disease in type 1 diabetes

Oxidative stress is involved in the pathophysiology of diabetic nephropathy. The superoxide-generating nicotinamide adenine dinucleotide phosphate-oxidase 2 (NOX2, encoded by the CYBB gene) and the antioxidant enzyme glutathione peroxidase 4 (GPX4) play opposing roles in the balance of cellular redox status. In the present study, we investigated associations of single nucleotide polymorphisms (SNPs) in the regulatory regions of CYBB and GPX4 with kidney disease in patients with type 1 diabetes. Two functional SNPs, rs6610650 (CYBB promoter region, chromosome X) and rs713041 (GPX4 3'untranslated region, chromosome 19), were genotyped in 451 patients with type 1 diabetes from a Brazilian cohort (diabetic nephropathy: 44.6%) and in 945 French/Belgian patients with type 1 diabetes from Genesis and GENEDIAB cohorts (diabetic nephropathy: 62.3%). The minor A-allele of CYBB rs6610650 was associated with lower estimated glomerular filtration rate (eGFR) in Brazilian women, and with the prevalence of established/advanced nephropathy in French/Belgian women (odds ratio 1.75, 95% CI 1.11-2.78, p = 0.016). The minor T-allele of GPX4 rs713041 was inversely associated with the prevalence of established/advanced nephropathy in Brazilian men (odds ratio 0.30, 95% CI 0.13-0.68, p = 0.004), and associated with higher eGFR in French/Belgian men. In conclusion, these heterogeneous results suggest that neither CYBB nor GPX4 are major genetic determinants of diabetic nephropathy, but nevertheless, they could modulate in a gender-specific manner the risk for renal disease in patients with type 1 diabetes.

[Effects of aerobic exercise during haemodialysis in patients with chronic renal disease: a literature review]

INTRODUCTION

Patients with chronic kidney disease (CKD) have reduced physical and functional capacity when compared with the general population. Hemodialysis (HD) restricts patients activities, favoring a sedentary lifestyle and leading to functional limitations. HD patients are less active, present low exercise tolerance and have high physical deconditioning. Physical exercise programs have been proposed as a strategy not only to treat clinical symptoms, but also to reduce physical limitations and improve the quality of life of these patients.

OBJECTIVES

The purpose of this study was to review the literature on the effects of physical exercise (aerobic exercise on a cycle ergometer for the lower limbs) on CKD undergoing HD.

METHODS

The Medline, PubMed, Scielo, Embase and DirectScience databases were searched.

RESULTS

Fourteen randomized controlled clinical trials were analyzed as regards the timing of the intervention during the HD session, exercise intensity and frequency, the duration of the intervention and the main results.

CONCLUSION

The studies demonstrated that aerobic exercises performed during HD improve the aerobic capacity and physical conditioning, reduce fatigue and anxiety, improve muscle capillarization and resting blood pressure, increase exercise duration and improve urea clearance.

Capacidade funcional e força muscular respiratória de candidatos ao transplante hepático

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

A classe da NYHA tem relação com a condição funcional e qualidade de vida na insuficiência cardíaca

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

Effects of inspiratory muscle training in hemodialysis patients

INTRODUCTION

Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function.

OBJECTIVE

To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis.

METHOD

Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40% of PImax and weekly frequency of three alternate days.

RESULTS

A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values.

CONCLUSION

The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

Relationship between MELD severity score and the distance walked and respiratory muscle strength in candidates for liver transplantation

The model end-stage liver disease (MELD) severity scoring system is used in the allocation of organs for liver transplantation. However, there is no evidence of its relationship with the functionality and respiratory muscle strength in these patients. The aim of this study was to analyze the correlation of MELD with distance walked and respiratory muscle strength in patients awaiting liver transplantation. We performed a cross-sectional analysis of 24 individuals (16 male and 8 female) with mean age of 51.8 +/- 10.4 years. The MELD score inversely correlated with the 6-minute walking test (6MWT) (r = -0.85; P < .001) and with the maximal inspiratory pressure (MIP) (r = -0.69; P < .001). In addition, there was a correlation between 6MWT and MIP (r = 0.77; P < .001). Thus, MELD scores can be considered to be effective tools to predict the functional capacity and respiratory muscle strength in candidates for liver transplantation.

Correlations between respiratory and functional variables in heart failure

BACKGROUND

Respiratory alterations can impact on the functional performance of patients with heart failure.

AIM

To correlate maximum inspiratory muscular force and lung function variables with functional capacity in heart failure patients.

METHODS

A transversal study January-July 2007 with 42 chronic heart disease patients (28 males) with no prior pulmonary illness. The patients were in New York Heart Association Functional Class I, II and III. The variables used were maximum inspiratory pressure, forced vital capacity and forced expiratory volume in the first second. Respiratory variables measured were distance covered in the six-minute walk test, NYHA functional class and the physical functioning domain of the Short Form-36 Quality of Life Questionnaire.

RESULTS

Maximum inspiratory pressure correlated with the six-minute walk test (r=0.543 and p<0.001), functional capacity (r=-0.566 and p<0.001) and the physical functioning domain score of the Short Form- 36 (r=0.459 and p=0.002). The same was true of forced vital capacity and the six-minute walk test (r=0.501 and p=0.001), functional capacity (r=-0.477 and p=0.001) and Short Form-36 (r=0.314 and p=0.043) variables. Forced expiratory volume correlated with the distance covered in the six-minute walk test (r=0.514 and p<0.001) and functional capacity (r=-0.383 and p=0.012).

CONCLUSION

Lung function and inspiratory muscular force respiratory variables correlated with functional variables in patients with heart failure.

Physical therapy in the immediate postoperative period after abdominal surgery

A series of pulmonary complications can occur after abdominal surgery. Therefore, it is necessary to introduce appropriate treatment early in order to minimize postoperative complications. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period. This was a randomized clinical trial, in which one group of patients was submitted to physical therapy in the postoperative recovery room and, subsequently, in the infirmary, whereas another group was submitted to physical therapy in the infirmary exclusively. We conclude that physical therapy performed in the immediate postoperative period minimizes losses in lung function and respiratory muscle strength, as well as shortening recovery room stays.

Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal

A cirurgia abdominal causa uma série de complicações pulmonares após o processo cirúrgico. Assim, faz-se necessário um tratamento precoce adequado objetivando minimizar as complicações no período pós-operatório. Objetivamos avaliar o efeito do atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal. Este foi um ensaio clínico randomizado, no qual um grupo recebeu atendimento fisioterapêutico na sala de recuperação e, posteriormente, nas enfermarias, e outro grupo o recebeu somente nas enfermarias. Concluímos que a fisioterapia realizada no pós-operatório imediato reduziu a perda da função pulmonar, a perda da força muscular ventilatória e o tempo de internação na sala de recuperação.

Transplante hepático: repercussões na capacidade pulmonar, condição funcional e qualidade de vida

RACIONAL: O transplante hepático é utilizado para o tratamento de doenças hepáticas em estado avançado, quando a sobrevida e a função hepática são aumentadas após o procedimento. OBJETIVO: Avaliar e comparar a função pulmonar, a condição funcional e a qualidade de vida de pacientes candidatos ao transplante hepático e após a realização do procedimento cirúrgico no período de 1, 3, 6, 9 e 12 meses de pós-operatório. MÉTODOS: Trabalho transversal, observacional, com amostra de conveniência, composta por 30 pacientes, divididos em seis grupos (com cinco indivíduos em cada grupo), nos seguintes tempos: pré-transplante, 1, 3, 6, 9 e 12 meses de pós-operatório. Todos os indivíduos foram avaliados em um único momento, quando foram mensurados a capacidade vital forçada, o volume expiratório forçado no primeiro segundo, as pressões inspiratória e expiratória máxima, a distância percorrida no teste de caminhada de 6 minutos e os domínios relacionados à qualidade de vida através do questionário de qualidade de vida auto-aplicativo "Short Form 36". RESULTADOS: Houve melhora em todas as variáveis ao comparar o período pré-transplante com os consecutivos meses de pós-operatório, onde a pressão inspiratória máxima, a distância percorrida e o domínio da capacidade funcional apresentaram mudanças estatisticamente significantes. CONCLUSÃO: O transplante hepático é uma alternativa para o tratamento das doenças hepáticas avançadas e proporciona aos pacientes benefícios nas condições respiratórias e funcionais, contribuindo para melhora da qualidade de vida.

Evaluation of respiratory muscle strength and pulmonary function in heart failure patients

BACKGROUND

Heart failure (HF) is the inability of the heart to pump enough blood to supply the necessities of the body. Pulmonary function and respiratory muscles can be affected and typical symptoms presented by the patients include discomfort at a minimal exertion.

OBJECTIVE

To verify pulmonary function and respiratory muscle strength in patients with class II and III HF as defined by the New York Heart Association (NYHA).

METHODS

The study was descriptive and observational, and comprised 12 class II and III HF patients in follow-up at the out-patient. Pulmonary function assessments [Forced Expiratory Volume in the first second (FEV1) and Forced Vital Capacity (FVC)] were performed using microspirometry and respiratory muscle strength [Maximal Expiratory Pressure (MEPmax) and Maximal Inspiratory Pressure (MIPmax)] were evaluated using a pressure transducer (Globalmed).

RESULTS

Differences were found between the functional classes II and III in relation to pulmonary function: FEV1 (II: 91.17 +/- 19.87; III: 68.17 +/- 21.78); FVC (II: 68.17 +/- 21.78; III: 73.67 +/- 22.94); and respiratory muscle strength: MIPmax (II: 71.67 +/- 40.70; III: 53.33 +/- 29.27) and MEPmax (II: 98.83 +/- 34.56; III: 58.33 +/- 15.06). The class II were higher for all study parameters, only MEPmax revealed a statistically significant difference.

CONCLUSION

The pulmonary function and respiratory muscle strength are impaired in heart failure patients class III patients, particularly in relation to MEPmax.

[Behavior of the lung mechanics after the application of protocol of chest physiotherapy and aspiration tracheal in patients with invasive mechanical ventilation]

BACKGROUND AND OBJECTIVES

The chest physiotherapy (CP) in patients submitted to invasive support ventilation acts directly in the breathing system, and it could alter the lung mechanics through the dynamic lung compliance (DynC) and resistance of the breathing system (Rbs). However the alterations after the accomplishment of CP are still controversy. The objective of this study was to evaluate the alterations of the lung mechanics in patients in invasive mechanical ventilation (IMV).

METHODS

It was a prospective, randomized, and controlled and crossover study, with patient with more than 48 hours in IMV. The protocol of chest physiotherapy and isolated tracheal aspiration they were randomized for the application order with a window of 24 hours among them. Data of lung mechanics and its varied cardiorespiratory were collected moments before the protocol, immediately after the application of the protocol, 30 minutes and 120 minutes after the application of the protocols.

RESULTS

Twelve patients completed the study. Pneumonia was the mean cause respiratory failure (RF). There was not statistical difference among the groups in relation to Cdyn, volume tidal (Vt) and volume minute (Ve). Rbs decreased in a significant way immediately after (of 10.4 ± 3 cmH2O/L/seg for 8.9 ± 2 cmH2O/L/seg; p < 0.02), 30 minutes after (of 10.4 ± 3 cmH2O/L/seg for 9 ± 2 cmH2O/L/seg; p < 0.01) and 120 minutes after (of 10.4 ± 3 cmH2O/L/seg for 9 ± 2 cmH2O/L/seg; p < 0.03) application the protocol of chest physiotherapy. When compared with the protocol of isolated tracheal aspiration it was significantly smaller in the 30 (9 ± 2 cmH2O/L/seg versus10.2 ± 2 cmH2O/L/seg; p < 0.04) and 120 minutes (9 ± 2 cmH2O/L/seg versus 10.4 ± 3 cmH2O/L/seg; p < 0.04).

CONCLUSIONS

The protocol of chest physiotherapy was effective in the decrease of Rsr when compared with the aspiration protocol. That decrease was maintained for two hours after its application, what did not happen when only the just accomplished the tracheal aspiration was performed isolated.

Early intervention with Portuguese mothers: a 2-year follow-up

Results of a 2-year follow-up after an early intervention with low-middle-class primiparous Portuguese mothers are presented. On the 3rd day of their infants' lives, 40 mothers underwent a structured intervention using selected items of the Brazelton Neonatal Behavioral Assessment Scale. An additional 20 mothers randomized to the control group had a talk with a pediatrician about general problems of infant health care. On Day 28, the "sensory orientation" and "cuddliness" competencies of the infants in the experimental group were significantly enhanced when compared with the same competencies among the infants in the control group. In addition, dyads in the experimental group had established a more favorable pattern of interaction, particularly after short stressful situations (these situations included short separations from the mother in which a stranger was present, short separations in which no one was present, and a stillface situation). Short-term effects (the first month of life) were particularly noticeable, especially in terms of the babies' neurobehavioral development and mother-infant interaction. Long-term effects (3, 6, 9, 12, 15, 18, and 24 months), though less clear, were evident in the form of better interactive patterns among the dyads in the experimental group. This was particularly evident after the stressful situations to which they were submitted. These results are discussed in terms of both their scope and their clinical impact.