RESUMO
O presente estudo teve como objetivo analisar em pacientes portadores de Doença Pulmonar Obstrutiva Crônica (DPOC) a utilização do teste de força (1RM) e correlacionar com a capacidade funcional e a qualidade de vida em um programa de reabilitação pulmonar (PRP). Este estudo observacional do tipo coorte retrospectivo de correlação com amostra consecutiva em portadores de DPOC pré e pós o PRP, utilizando os seguintes instrumentos: o teste de 1RM, o teste da caminhada dos seis minutos (TC6) e o Questionário do Hospital Saint Georges de Qualidade de Vida (QQVSG). A hipótese inicial foi que houvesse uma correlação entre o teste de 1 RM com o TC6´ e o QQVSG. Foram incluídos 112 pacientes de ambos os sexos 61,6% masculino e 38,39% feminino com média de idade de 64,23 ± 8,74 anos, com VEF1 (42,96 ± 19,02% do predito). Os testes de 1RM com maiores aumentos de carga foram: puxada alta (36,61±10,61 vs. 47,25±15,47; ∆=10,64kg), extensão de joelhos (33,91±11,51 vs. 44,57±14,98; ∆=10,66kg) e supino máquina sentado (38,5±13,53 vs. 48,74±15,68; ∆=10,24kg), essas diferenças foram estatisticamente significativas. No TC6, as médias pré e pós PRP foram, respectivamente, 399,98 ± 98,37m vs. 453,42± 93,25m ∆=53,44 metros. Em relação a qualidade de vida obtivemos os seguintes resultados nos domínios do QQVSG: Sintomas pré e pós (48,38 ±20,21 vs. 33,48 ± 18,12; ∆=14,9), Atividade (67,42 ± 21,88 vs. 52,11 ± 21,11; ∆=15,31), Impacto (34,94 ± 17,39 vs. 21,98 ± 18,99; ∆=12,96) e Total (47,76 ± 15,74 vs. 32,67 ± 16,13; ∆=15,09). Em relação à correlação obteve-se somente no exercício abdominal com o QQVSG (r = 0,226 p = 0,017) nas demais variáveis não houve correlação. Pode-se observar que a avaliação e evolução do programa de exercícios físicos pelo teste de 1RM foram eficazes no programa de reabilitação pulmonar, associando-se com os resultados obtidos no QQVSG e TC6 respectivamente.
The present study had the objective of analyzing the use of the strength test (1RM) in patients with Chronic Obstructive Pulmonary Disease (COPD) and correlating to functional capacity and quality of life in a pulmonary rehabilitation program (PRP). This retrospective cohort type observational study of correlation with consecutive sample in patients with COPD pre e post PRP, using the following tools: the 1RM test, the six minute walk test (6MW), and the Saint Georges Respiratory Questionnaire (QQVSG). The initial hypothesis was that there was a correlation between the 1 RM test and the 6´MW test and the QQVSG. 112 patients of both genders were included, 61.6% male and 38.39% female with an average age of 64.23 ± 8.74 years, with VEF1 (42.96 ± 19.02% of predicted). The 1RM tests with the greatest load increase were: pulldown (36.61±10.61 vs. 47.25±15.47; ∆=10.64kg), leg extension (33.91±11.51 vs. 44.57±14.98; ∆=10.66kg), and Bench Press (38.5±13.53 vs. 48.74±15.68; ∆=10.24kg), these differences were statistically significant. In the 6MW, the pre and post PRP means were, respectively, 399.98 ± 98.37m vs. 453.42± 93.25m ∆=53.44 meters. Regarding quality of life we obtained the following results in the domains of the QQVSG: pre and post symptoms (48.38 ±20.21 vs. 33.48 ± 18.12; ∆=14.9), Activity (67.42 ± 21.88 vs. 52.11 ± 21.11; ∆=15.31), Impact (34.94 ± 17.39 vs. 21.98 ± 18.99; ∆=12.96), and Total (47.76 ± 15.74 vs. 32.67 ± 16.13; ∆=15.09). Regarding correlation, it was only obtained in the abdominal exercise with the QQVSG (r = 0.226 p = 0.017), in the other variables there was no correlation. It can be observed that the assessment and evolution of the program of physical exercises with the 1RM test was effective in the pulmonary rehabilitation program, associating with the results obtained in the QQVSG and 6MW respectively.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Teste de Esforço , Força Muscular , Doença Pulmonar Obstrutiva Crônica , Homens , Qualidade de Vida , MulheresRESUMO
INTRODUCTION: Cardiopulmonary exercise testing (CPET) is increasingly used to evaluate the overall impact of the illness on patients with chronic obstructive pulmonary disease (COPD). While laboratory tests of exercise performance are costly, the 6-min walk test (6-MWT) can be more easily performed. Although the main outcome commonly used in this field test is the distance walked in 6 min (6-MWD), this measure does not account for differences in body weight. Previous studies showed a good correlation between the work performed during the 6-MWT with incremental cycling CPET, an exercise modality more associated with quadriceps fatigability and with lower peak oxygen consumption than incremental walking tests. OBJECTIVE: Evaluate the correlation between the 6-MWD and its derivative body weight-walking distance product, an estimation of the work performed during the 6-MWT, with peak from a treadmill CPET. METHODS: Thirty COPD patients [forced expiratory volume in 1 s (FEV1) = 39 ± 13%; peak predicted] performed CPET to the limit of tolerance on a treadmill and 6-MWT, 48 h apart.6-MWD and work were correlated to resting and exercise functional variables. RESULTS: The work of walking during the 6-MWT provided greater associations with peak than observed with 6-MWD. This was the case for FEV1, forced vital capacity, inspiratory capacity, lung diffusion capacity for carbon monoxide, peak , carbon dioxide output, minute ventilation and double product (r = 0.57, r = 0.57, r = 0.73, r = 0.7, r = 0.75, r = 0.65, r = 0.51 and r = 0.4, respectively; all P < 0.05). CONCLUSION: A better association was found between the work estimated from the 6-MWT and peak achieved during CPET, in this case with a treadmill, than the 6-MWD alone.
Assuntos
Teste de Esforço/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Caminhada/fisiologia , Idoso , Estudos Transversais , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Capacidade de Difusão Pulmonar , Doença Pulmonar Obstrutiva Crônica/metabolismo , Espirometria , Avaliação da Capacidade de TrabalhoRESUMO
INTRODUÇÃO: A intolerância ao exercício prejudica a realização das atividades de vida diária em portadores de doença pulmonar obstrutiva crônica (DPOC) e a avaliação dessa limitação é fundamental. Objetivo: Comparar o teste de caminhada dos seis minutos (TC6') com o teste da escada (TE) em portadores de DPOC. MÉTODOS: Prospectivo composto por 21 pacientes portadores de DPOC avaliados para um programa de reabilitação pulmonar que realizaram o TC6' e o TE. As variáveis fisiológicas frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2), além da escala de Borg modificada, foram aferidas antes e após cada teste. A distância percorrida era medida ao término de ambos os testes. RESULTADOS: Comparando os momentos (inicial versus final) das variáveis fisiológicas de ambos os testes, foi observado no TC6' (FC 81,1 ± 2,6 versus 98,4 ± 4,4; SpO2 94,9 ± 2,2 versus 90,4 ± 5,0; PSE Borg 0,5 ± 0,8 versus 3,6 ± 2,5) e no TE (FC 86,9 ± 18,8 versus 119,3 ± 14,5; SpO2 94,7 ± 2,5 versus 90,1 ± 4,5; PSE Borg 0,2 ± 0,4 versus 7,0 ± 2,3), sendo que todas as variações foram estatisticamente significativas (p < 0,001) em ambos os testes. Quando avaliada a alteração das variáveis em ambos os testes, verificou-se que a SpO2 obteve redução semelhante (p = 0,912), a FC aumentou significativamente mais no TE (p = 0,006), bem como a PSE Borg (p < 0,001). Em relação à distância percorrida, o TC6' permitiu que os participantes percorressem uma distância significativamente maior do que o TE (404m versus 153m; p < 0,001) CONCLUSÃO: Ambos os testes promoveram alterações fisiológicas significativas. Apesar de o TE representar uma distância significativamente menor, a sobrecarga, bem como a percepção de trabalho, foi significativamente maior.
INTRODUCTION: Exercise intolerance interposes daily life activities in chronic obstructive pulmonary diseases (COPD); hence, the evaluation of this functional limitation becomes fundamental. Objective: To compare the six-minute walk test (HR6peak) with the stair-climbing test (SCT) in patients with COPD. METHODS: prospective analysis of twenty-one patients with COPD who were part of the - Pulmonary Rehabilitation Program - (PRP). Patients were evaluated from July to October, 2008 when they performed the HR6peak and ET, analyzing the variables physiological (HR, PSO2), and the modified Borg scale before and after each test. The distance was measured at the end of the tests. RESULTS: Comparing the timing (early versus late) of physiological and subjective perception of exertion (RPE) from Borg, we can observe that all changes were statistically significant (p <0.001) tests. However, when the physiological changes were compared, the PSO2 obtained presented similar reduction (p = 0.912) in both tests, the HR increased significantly in ET (p = 0.006) and on Borg RPE (p <0.001). Regarding the walking distance performed, the HR6peak (p <0.001), allowed participants to advance to a distance significantly longer than the ET. CONCLUSION: the tests expressed important physiological and subjective perception of effort (RPE) from Borg (p <0.001).
RESUMO
Introdução: A doença pulmonar obstrutiva crônica (DPOC) é uma doença caracterizada por alterações estruturais no parênquima pulmonar, cursando com manifestações sistêmicas. Como forma de tratamento, é indicado Programa de Reabilitação Pulmonar (PRP). O objetivo da pesquisa foi analisar os resultados de um PRP para portadores de DPOC, avaliando a capacidade de exercício, a qualidade de vida e o estado nutricional. Métodos: Estudo prospectivo tipo antes e depois, com 78 portadores de DPOC. Foram analisadas as seguintes variáveis: Teste de Caminhada de 6 minutos (TC6), Índice de Massa Corporal (IMC) e Questionário de Qualidade de Vida do Hospital Saint George (QQVSG). Resultados: Os pacientes eram na maioria do sexo masculino (56,41%), com uma idade média de 63,56 ± 8,13 anos. A maioria dos pacientes foi classificada no estádio III do GOLD (38,46%). Em relação à qualidade de vida, ocorreu uma melhora clinicamente significativa, com redução de 4% em todos os domínios, conforme os resultados pré e pós-PRP, respectivamente (47,96 ± 15,78 vs 33,65 ± 13,80), no total, no domínio sintomas (46,80 ± 19,16 vs 37,06 ± 17,57), impacto (32,87± 17,26 vs18,74 ± 14,05), atividades (69,21 ± 22,48 vs 56,14 ± 20,53). O IMC não sofreu modificação (25,45 ± 4,92 vs 25,46 ± 4,80). No TC6 obteve-se uma melhora significativa na distância percorrida (375,35 ± 95,84 m vs 420,80 ± 87,92m~ p=0,001). Conclusão: O PRP resultou numa melhora clinicamente significativa da qualidade de vida e na capacidade de exercício neste grupo de pacientes portadores de DPOC
Introduction: Chronic obstructive pulmonary disease (COPD) is a disorder characterized by structural changes to the lung parenchyma, coursing with systemic manifestations. Pulmonary Rehabilitation Program (PRP) is indicated as a form of treatment. The aim of this study was to analyze the outcomes of a PRP for COPD patients by assessing their exercise capacity, quality of life, and nutritional status. Methods: A pre- and post-PRP prospective analysis of 78 patients with COPD. We analyzed the following variables: Six Minutes Walk Test (6MWT), body mass index (BMI), and Saint Georges Respiratory Questionnaire (SGRQ) as a measure of the quality of life. Results: Patients were mostly males (56.41%), with mean age of 63.56 ± 8.13 years. Most patients were classified in stage III GOLD (38.46%). There was a clinically significant improvement in patients quality of life, with a 4% reduction in all domains, according to the results before and after PRP, respectively (47.96 ± 15.78 vs. 33.65 ± 13.80) overall, and in the symptoms (46.80 ± 19.16 vs. 37.06 ± 17.57), impact (32.87 ± 17.26 VS18, 74 ± 14.05), and activity (69.21 ± 22.48 vs 56.14 ± 20.53) domains. BMI remained unchanged (25.45 ± 4.92 vs. 25.46 ± 4.80). In the 6MWT a significant improvement in the walked distance was obtained (375.35 ± 95.84 m vs. 420.80 ± 87.92 m, p = 0.001). Conclusion: The PRP resulted in clinically significant improvement in the quality of life and exercise capacity in this group of patients with COPD
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/terapiaRESUMO
INTRODUCTION: The six-minute walking test distance, despite being considered the main parameter, does not consider body weight which is known to influence exercise capacity. A body of evidence shows the degree of airflow obstruction does not correlate to walking distance and the body weight affects the work/energy required to perform the walk. OBJECTIVE: To verify if the degree of airflow obstruction correlates to six-minute walk work obtained by weight-walking distance product. PATIENT AND METHODS: A total of 60 patients with chronic obstructive pulmonary disease were evaluated. The physiological and functional variables were correlated to distance and body weight walking distance product (WxW). RESULTS: There were no correlations between six- minute walk work and the degree of airflow obstruction. A positive and significant correlation were observed between the distance and Carbon Monoxide Diffusing Capacity (DLCO) (r=0.6; p<0.01) and between the distance and final SatO 2 (r= 0.3 ; p <0.05). Correlation between distance and Borg scale was negative and significant (r= -0.3; p<0.05). The six-minute walk work was positive and significantly correlated to DLCO (r= 0.7; p<0.01) and negative but significantly correlated to Borg scale in the initial (r= - 0.3; p<0.01) and final of the test (r= -0.4; p<0.05). CONCLUSION: Based on this data, there was no correlation between the degree of airflow obstruction and six-minute walk work test. The DLCO was the only respiratory functional parameter significantly correlated to the distance and to the six- minute walk work.