Ventilatory demand and dynamic hyperinflation induced during ADL-based tests in Chronic Obstructive Pulmonary Disease patients

ABSTRACT Background Airflow limitation frequently leads to the interruption of activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Disease (COPD). These patients commonly show absence of ventilatory reserve, reduced inspiratory reserve volume, and dynamic hyperinflation (DH). Objective To investigate ventilatory response and DH induced by three ADL-based protocols in COPD patients and compare them to healthy subjects. Method Cross-sectional study. COPD group: 23 patients (65±6 years, FEV1 37.2±15.4%pred); control group: 14 healthy subjects (64±4 years) matched for age, sex, and body mass index. Both groups performed all three tests: Glittre-ADL test; an activity test that involved moving objects on a shelf (TSHELF); and a modified shelf protocol isolating activity with upper limbs (TSHELF-M). Ventilatory response and inspiratory capacity were evaluated. Results Baseline ventilatory variables were similar between groups (p>0.05). The ventilatory demand increased and the inspiratory capacity decreased significantly at the end of the tests in the COPD group. Ventilatory demand and DH were higher (p<0.05) in the TSHELF than in the TSHELF–M in the COPD group (p<0.05). There were no differences in DH between the three tests in the control group (p>0.05) and ventilatory demand increased at the end of the tests (p<0.05) but to a lower extent than the COPD group. Conclusion The TSHELF induces similar ventilatory responses to the Glittre-ADL test in COPD patients with higher ventilatory demand and DH. In contrast, the ventilatory response was attenuated in the TSHELF-M, suggesting that squatting and bending down during the Glittre-ADL test could trigger significant ventilatory overload.

The Glittre-ADL test reflects functional performance measured by physical activities of daily living in patients with chronic obstructive pulmonary disease

ABSTRACT Background The Glittre-ADL test (TGlittre) is a valid and reliable test for the evaluation of functional capacity and involves multiple physical activities of daily living (PADL), which are known to be troublesome to patients with Chronic Obstructive Pulmonary Disease (COPD). However, it is still unknown if this test is also able to reflect the functional performance of patients with COPD. Objective To investigate whether the TGlittre reflects the functional performance of COPD patients and whether the necessary time to complete the TGlittre and the PADL varies according to disease severity. Method Thirty-eight patients with COPD (age 65, SD=7 years; forced expiratory volume in the first second 41.3, SD=15.2% predicted) underwent anthropometric and lung function assessments and were submitted to the TGlittre and PADL measurement. Results TGlittre performance correlated significantly (p<0.05) with PADL variables, such as time sitting (r=0.50), walking (r=-0.46), number of steps taken (r=–0.53), walking movement intensity (r=–0.66), walking energy expenditure (r=-0.50), and total energy expenditure (r=–0.33). TGlittre performance was not significantly different in patients among the Global Initiative for COPD (GOLD) spirometric stages, but walking and sitting time were significantly lower and greater, respectively, in severe and very severe patients compared to those with moderate disease (p<0.05). Conclusion The performance on the TGlittre correlates with walking and sitting time and other real life PADL measurements. The severity of the disease is associated with the differences in the level of physical activity in daily life more than in functional capacity.

Relação entre força muscular periférica e respiratória e qualidade de vida em pacientes com doença pulmonar obstrutiva crônica / Relationship between peripheral and respiratory muscle strength and quality of life in patients with chronic obstructive pulmonary disease

Investigar se existe associação entre qualidade de vida relacionada à saúde e força muscular periférica e respiratória em pacientes com DPOC, bem como investigar se há diferença no comprometimento da qualidade de vida de pacientes com e sem fraqueza muscular. Metodologia: Vinte pacientes foram submetidos à avaliação antropométrica, função pulmonar, aplicação do Questionário do Hospital Saint George na Doença Respiratória (SGRQ) e avaliação de força de músculos respiratórios, de preensão palmar e quadríceps. Utilizou-se o teste de Shapiro-Wilkpara verificar a normalidade dos dados e coeficiente de correlação de Pearson para testar a correlação dos domínios e do escore total do SGRQ (SGRQtotal) com a força muscular periférica e respiratória e seus percentuais do previsto (%prev). Para comparar o domínio “impacto” entre os subgrupos de força de quadríceps, utilizou-se o teste U de Mann-Whitney. O teste t para amostras independentes foi utilizado para comparar os demais escores de qualidade de vida entre os subgrupos. Resultados: Verificou-se moderada correlação do SGRQtotal e dos domínios “atividades” e “impacto” com o %prev da força de quadríceps (r=-0,51; r=-0,52 e r=-0,46, respectivamente). O domínio “atividades” também correlacionou se com o valor absoluto da força de quadríceps (r=-0,44) enquanto o % prev da pressão expiratória máxima apresentou correlação com o SGRQtotal (r=-0,45) e com o domínio “impacto” (r=-0,49). Conclusões:A força de quadríceps e de músculos expiratórios é capaz de refletir o impacto que a limitação das atividades de vida diária exerce sobre a qualidade de vida de pacientes com DPOC...

Investigate whether there is an association between health related quality of life and peripheral and respiratory muscle strength in patients with COPD. Secondly, it was aimed to investigate if there are differences quality of life in patients with and without muscle weakness. Methods: Twenty patients underwent anthropometric, lung function, quality of life (Saint George’s Respiratory Questionnaire), respiratory, handgrip and quadriceps muscle strength assessments. The normality of the data was verified using the Shapiro-Wilk test. Pearson correlation coefficient test was performed to evaluate the correlation between the total score and domains of the SGRQ (SGRQtotal) and peripheral and respiratory muscle strength and their percentage of predicted (%pred). To compare the domain “impact” between the subgroups of quadriceps strength, it was used the Mann-Whitney test. Thet test for independent samples was used to compare the other scores of quality of life among subgroups. Results: There was a moderate correlation of the SGRQ total and the domains “activities” and “impact” with the quadriceps strength %pred (r=-0.51, r=-0.52 and r=-0.46, respectively). The domain “activities” also correlated with the absolute value of quadriceps strength (r=-0.44) while the maximal expiratory pressure %pred correlated with SGRQ total (r=-0.45) and with the domain “impact” (r=-0.49). Conclusions: Quadríceps and expiratory muscles strengthare able to reflect the impact that the impairment of activities of daily living have on the quality of life of patients with COPD...