Does the Incremental Shuttle Walking Test require maximal effort in healthy subjects of different ages?

OBJECTIVE: To evaluate if the Incremental Shuttle Walking Test (ISWT) requires maximal effort in healthy subjects of different ages. DESIGN: Cross-sectional. SETTING: University-based research laboratory. PARTICIPANTS: 331 healthy subjects separated into six groups according to age: G1, 18 to 28 years; G2, 29 to 39 years; G3, 40 to 50 years; G4, 51 to 61 years; G5, 62 to 72 years and; G6, 73 to 83 years. MAIN OUTCOME MEASURES: Two ISWTs were performed and participants were permitted to run and to exceed 12 levels during the test, if necessary. Heart rate (HR) and symptoms of dyspnoea and fatigue were recorded before and after the test, and the percentage of age-predicted maximal HR (HRmax) was calculated. Maximal effort was defined as HRmax >90% of age-predicted HRmax. RESULTS: Almost 31% of the subjects exceeded 12 levels in the ISWT. At the end of the test, all groups presented a median [interquartile range] HR greater than 90% of HRmax (G1: 100 [95 to 104]; G2: 100 [96 to 105]; G3: 103 [97 to 108]; G4: 99 [91 to 106]; G5: 96 [87 to 106] and G6: 96 [91 to 109]% HRmax). Regarding symptoms, all groups showed higher values after the test (P<0.05). A multiple logistic regression analysis identified female gender, older age and a lower HR before the test as determinants of not achieving 90% of HRmax at the end of the test. CONCLUSIONS: The ISWT requires maximal effort in healthy individuals, but for that it is necessary to extend the test beyond twelve levels. Female gender, older age and lower heart rate before the test are the determinants of not reaching maximal effort.

Efeito de um programa de exercícios direcionados à mobilidade torácica na DPOC / The effect of an exercise program directed to the thoracic mobility in COPD

Introdução: A Doença Pulmonar Obstrutiva Crônica produz alterações mecânicas na caixa torácica que desencadeiam disfunções físicas limitantes das atividades de vida diária e da qualidade de vida. Objetivos:Avaliar os efeitos de um programa de exercícios para readequação do complexo toracopulmonar na mobilidade da caixa torácica, capacidade de exercício e qualidade de vida em pacientes com DPOC. Materiais e métodos: Este estudo avaliou 13 pacientes com DPOC por meio de Espirometria, Teste da Caminhada dos Seis Minutos (TC6min), Cirtometria e Questionário de Qualidade de Vida Saint George (SGRQ). O programa foi elaborado com base em exercícios que objetivam o aumento da mobilidade de caixa torácica, tolerância ao exercício e melhora na resposta subjetiva em relação à qualidade de vida. Resultados: Após 12 semanas de tratamento, verificou-se um aumento significativo na mobilidade da região inferior da caixa torácica (expansibilidadeda região xifoide: de 3 ± 2 cm para 7 ± 4 cm, p = 0,01), na região abdominal (expansibilidade umbilical: de 2 ± 1 cm para 6 ± 4 cm, p = 0,01) e melhora na distância percorrida no TC6min (391 ± 117 minicial para final de 442 ± 124 m, p = 0,04). Na avaliação pelo SGRQ, houve uma tendência sem significância estatística de melhora nos três domínios (sintomas: 37 ± 22 para 26 ± 21; atividades: 64 ± 15 para 62 ±19; e impacto: 42 ± 16 para 38 ± 16). Conclusão: O programa de exercícios respiratórios direcionados ao aumento da mobilidade da caixa torácica melhorou a expansibilidade torácica e abdominal e a capacidadede exercício

BACKGROUND: Chronic Obstructive Pulmonary Disease produces mechanical changes in chest wall and this physical disability reduces the daily life activities and quality of life levels.OBJECTIVES: To assess the effects of an exercise program for Thoracopulmonary Complex Re-Adaptation in the chest wall mobility, exercise capacity and quality of life in COPD patients. MATERIALS AND METHODS: Thirteen COPD patients were studied. Spirometry, Six Minutes Walk Test, Thoracic Mobility and Quality of Life by Saint George Respiratory Questionnaire (SGRQ) were the variables. The exercise program was created based on physical exercises that aim at increasing the thoracic mobility and a better exercise tolerance, as well as improving the subjective response related to quality of life. RESULTS: After a 12-week program, it was observed a significant improvement in chest wall mobility in lower chest region (xiphoid level mobility: from 3 ± 2 cm to 7 ± 4 cm; p = 0.01) and in the abdominal region (umbilical level mobility: from 2 ± 1 cm to 6 ± 4 cm; p = 0.01). There was a statistically significant improvement of exercise capacity (walk distance: from 391 ± 117 m to 442 ± 124 m; p = 0.04). In quality of life assessment by SGRQ, there was a tendency of improving in three domains (symptom: from 37 ± 22 to 26 ± 21; activity: from 64 ± 15 to 62 ± 19; and impacts: from 42 ± 16 to 38 ± 16), but with no statistic significances.CONCLUSION: Respiratory exercises aimed at increasing the chest wall mobility improve abdominal and lower chest expansibility and exercise tolerance.

Pulmonary function, respiratory muscle strength and quality of life in patients submitted to elective thoracotomies.

OBJECTIVE: To evaluate pre-and postoperative pulmonary function, respiratory muscle strength and quality of life in patients submitted to elective thoracotomy. METHODS: We selected 19 patients undergoing elective thoracotomy to assess the following parameters: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and quality of life through implementation of the SF-36. The examinations were performed preoperatively and in the second, 10th, 15th, 30th and 60th days postoperatively. We conduced data normality analyzes were made with the Shapiro-Wilk test, descriptive analysis of the study variables, as well as analysis of variance with multiple comparisons using ANOVA and Friedman, p-value <0.05 . RESULTS: There was a significant decrease in spirometric levels and in maximal respiratory pressures in the second postoperative day. FVC returned to preoperative values between the 15th and 30th postoperative days, whereas FEV1, between the 10th and 15th. MIP and MEP returned to preoperative values between the 10th and 15th postoperative days. There was a decrease in quality of life as for functional capacity and physical aspects, which returned to preoperative values within two months after surgery. CONCLUSION: There was significant reduction in lung function and respiratory muscle strength, which returned to baseline within 30 days after surgery. There was a decrease in quality of life that persisted for up to 60 days after the operation.

Comportamento da função pulmonar, força muscular respiratória e qualidade de vida em pacientes submetidos às toracotomias eletivas / Pulmonary function, respiratory muscle strength and quality of life in patients submitted to elective thoracotomies

OBJETIVO: Avaliar o comportamento da função pulmonar, força muscular respiratória e qualidade de vida no pré e pós-operatório de pacientes submetidos às toracotomias eletivas. MÉTODOS: Foram avaliados 19 pacientes submetidos à toracotomia eletiva para obtenção dos parâmetros: capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1), pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax) e qualidade de vida mediante aplicação do questionário SF-36. Os exames foram realizados no pré-operatório, 2°, 10°, 15°, 30° e 60° dia de pós-operatório. Foram feitas análises de normalidade dos dados utilizando-se o teste de Shapiro-Wilk, análise descritiva das variáveis de estudo, bem como, análise de variância com comparações múltiplas utilizando-se os testes ANOVA e Friedman, com valor de p <0,05. RESULTADOS: Houve significativa redução nas variáveis espirométricas e nas pressões respiratórias máximas no 2° pós-operatório. CVF retornou aos valores pré-operatórios entre o 15° e o 30° pós-operatório, enquanto que VEF1 retornou entre o 10° e 15°. PImax e PEmax retornam aos valores pré-operatórios entre o 10° e 15° pós-operatório. Houve redução da qualidade de vida nos domínios capacidade funcional e aspectos físicos, que retornaram aos valores pré-operatórios em até dois meses após o procedimento cirúrgico. CONCLUSÃO: Foi verificada significativa redução na função pulmonar e na força muscular respiratória, que retornaram aos valores basais em até 30 dias após o procedimento cirúrgico. Houve queda na qualidade de vida, que persistiu por até 60 dias após a operação.

OBJECTIVE: To evaluate pre-and postoperative pulmonary function, respiratory muscle strength and quality of life in patients submitted to elective thoracotomy. METHODS: We selected 19 patients undergoing elective thoracotomy to assess the following parameters: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and quality of life through implementation of the SF-36. The examinations were performed preoperatively and in the second, 10th, 15th, 30th and 60th days postoperatively. We conduced data normality analyzes were made with the Shapiro-Wilk test, descriptive analysis of the study variables, as well as analysis of variance with multiple comparisons using ANOVA and Friedman, p-value <0.05 . RESULTS: There was a significant decrease in spirometric levels and in maximal respiratory pressures in the second postoperative day. FVC returned to preoperative values between the 15th and 30th postoperative days, whereas FEV1, between the 10th and 15th. MIP and MEP returned to preoperative values between the 10th and 15th postoperative days. There was a decrease in quality of life as for functional capacity and physical aspects, which returned to preoperative values within two months after surgery. CONCLUSION: There was significant reduction in lung function and respiratory muscle strength, which returned to baseline within 30 days after surgery. There was a decrease in quality of life that persisted for up to 60 days after the operation.

Efeito do treinamento muscular respiratório em pacientes submetidos à colecistectomia / Effect of respiratory muscle training in patients undergoing cholecystectomy

As cirurgias abdominais altas, como as colecistectomias, tendem a evoluir no pós operatório com distúrbios ventilatórios restritivos. O objetivo deste trabalho foi avaliar a evolução da força muscular inspiratória após o treinamento da musculatura respiratória, por meio do uso de aparelho com carga linear pressórica em pacientes submetidos à colecistectomia convencional. Foram estudados 10 pacientes do sexo feminino, com indicação de colecistectomia, e elas realizaram avaliação da força muscular inspiratória através da medida da Pressão Inspiratória Máxima (PImáx). Deles, seis foram avaliados no pré e pós-operatório (G1 – grupo 1) e realizaram o Treinamento Muscular Respiratório (TMR) com uso do Theshold® (2 vezes ao dia no 1º e no 2º pós-operatório utilizando 40% da PImáx), e quatro pacientes foram acompanhados no pós-operátorio como grupo controle (G2 – grupo 2). Os resultados indicam que, apesar da diminuição da PImáx no pós-operatório, houve recuperação da força muscular inspiratória já no primeiro dia de TRM, de 36,7 ± 13,7 cmH2O para 48,0 ± 13,7 cmH2O e este aumento foi estatisticamente significante (p<0,05), o que não ocorreu no grupo controle. Conclui-se que há uma redução na força muscular respiratória após colecistectomia e que o TMR foi satisfatório na melhora de força muscular respiratória.

The upper abdominal surgeries such as cholecystectomy, tend to evolve postoperatively with restrictive ventilatory disorders. The aim of this study was to evaluate the evolution of inspiratory muscle strength after training the respiratory muscles through the use of linear load device with pressure in patients undergoing conventional cholecystectomy. We studied 10 female patients with indication for cholecystectomy who underwent assessment of inspiratory muscle strength by means of the Maximal Inspiratory Pressure (MIP). Of these, six were evaluated preoperatively and postoperatively (G1 - group 1) and conducted Respiratory Muscle Training (RMT) using the Theshold ® (twice a day on the 1st and 2nd postoperative day using 40% MIP) and four patients were observed in the post-surgery as a control group (G2 - group 2). The results indicate that despite the decrease in MIP postoperatively, there was recovery of inspiratory muscle strength on the first day of RMT, from 36.7 ± 13.7 cmH2O to 48.0 ± 13.7 cmH2O, and this increase was statistically significant (p <0.05), which did not occur in the control group. We conclude that there is a reduction in respiratory muscle strength after cholecystectomy and that the RMT was considered satisfactory in the improvement of the respiratory muscle strength.