Translation, cross-cultural adaptation, reliability, and construct validity of the Brazilian Portuguese version of the Basic Psychological Needs in Exercise Scale.

RESULTS: 59 patients were included (61% with COPD and 39% with ILD). BPNES factor scores were not significantly different between raters' assessments (p > 0.05). The internal consistency was 0.70 for autonomy, 0.76 for competence, and 0.80 for relatedness. Inter-rater and test-retest reliability were good to very good for autonomy (ICC = 0.78, 95%CI 0.62-0.87; ICC = 0.75, 95%CI 0.57-0.86, respectively), competence (ICC = 0.81, 95%CI 0.68-0.89; ICC = 0.65, 95%CI 0.43-0.80, respectively), and relatedness (ICC = 0.79, 95%CI 0.65-0.88; ICC = 0.70, 95%CI 0.50-0.83, respectively). Significant correlations were observed between BPNES factors and quality of life, anxiety, depression, and functional status. In conclusion, this study confirmed the reliability and construct validity of the Brazilian Portuguese version of the BPNES in patients with COPD and ILD.

Baseline Characteristics of Subjects with Chronic Obstructive Pulmonary Disease Associated to the Improvement in Activities of Daily Living after Exercise Training.

This study aimed to identify baseline variables predicting improvement in ADLs following an exercise training program in subjects with COPD. Sixty-seven patients with COPD underwent assessment of spirometry, modified Medical Research Council scale, COPD Assesment Test (CAT), Six Minute Walk Test (6MWT), London Chest Activity of Daily Living (LCADL) scale and Glittre-ADL test (TGlittre). After 24 sessions, they were reassessed for limitation in ADLs (LCADL and TGlittre). The main outcome was the achieving of minimal important difference (MID) of TGlittre, LCADL and both (ADLs). The cut-off points to discriminate the subjects who achieved the MID of TGlittre, LCADL and ADLs were established using the ROC curve. A cut-off point of 3.7 min in baseline TGlittre was able to discriminate subjects who achieved the MID of TGlittre (AUC = 0.77). Subjects with baseline TGlittre ≥3.7 min were 6.92 (95%CI 2.2-20.9) times more likely to achieve the MID of TGlittre post-exercise training. A cut-off point of 32% in LCADL was able to discriminate subjects who achieved the MID of LCADL (AUC = 0.81) and in ADLs (AUC = 0.78). Subjects with baseline LCADL ≥32% were 12.3 (95% CI 2.50 - 60.7) times more likely to achieve the MID of LCADL. In conclusion, the baseline variables that best predict the improvement of individuals after exercise training are TGlittre and LCADL, showing that subjects with significant functional impairment are more likely to clinically significantly improve their ADLs.

Physiological Responses to the 6-min Step Test in Patients With Chronic Obstructive Pulmonary Disease.

PURPOSE: To describe physiological responses during the 6-min step test (6MST) in patients with chronic obstructive pulmonary disease (COPD), to investigate whether COPD severity and test interruptions could determine different physiological responses, and to test the reproducibility of 6MST performance. METHODS: Cross-sectional study. Patients with moderate to very severe COPD underwent lung function assessment and 2 6MSTs, with physiological responses measurement by a gas analyzer and a near-infrared spectroscopy device. RESULTS: Thirty-six patients (29 men; forced expiratory volume in the first second of expiration [FEV1] = 51.1 ± 13.6%pred) participated in the study. Most of the physiological variables stabilized between the second and fourth minutes of the 6MST, except the respiratory rate and heart rate (HR), which stabilized after the fifth minute. The patients who interrupted the 6MST showed higher minute ventilation to maximal voluntary ventilation ratio ((Equation is included in full-text article.)E/MVV; all test minutes) and HR (first and second minutes) (P < .05) and worse pulmonary function (FEV1 = 1.37 ± 0.37 L vs 1.82 ± 0.41 L, P = .002, and 47.2 ± 13.2%pred vs 56.6 ± 12.4%pred, P = .04, respectively) than those who did not interrupt the 6MST. However, their performance was similar (P = .11). 6MST performance and physiological variables were reproducible, and there was a learning effect of 6.28%. CONCLUSIONS: The 6MST showed a stabilization of the most physiological variables. In addition, interruptions were usually made by patients with a greater impairment of lung function and they presented greater increased ventilatory demand during the 6MST. However, these interruptions do not interfere with 6MST physiological responses. Moreover, the 6MST is a reliable test to evaluate the functional capacity of patients with COPD.

Impact of Home Oxygen Therapy on the Level of Physical Activities in Daily Life in Subjects With COPD.

BACKGROUND: Chronic hypoxemia in patients with COPD is a limiting factor that is associated with disease progression and significantly contributes to decreased physical activity. Although correction of hypoxemia results in physiological improvements, oxygen therapy may be related to social isolation and inactivity. However, few studies have objectively investigated the level of physical activity in daily life (PADL) in these patients. The objective of this study was to compare the level of PADL in subjects with COPD on home oxygen therapy and in subjects with no oxygen therapy, and to investigate whether home oxygen therapy is associated with the level of PADL. METHODS: In this study, 29 subjects with COPD composed the home oxygen therapy group, and 30 subjects with COPD composed the control group. All of them underwent assessment of anthropometric measurements, spirometry, peripheral muscle strength, limitations in activities of dalily living, perception of dyspnea, health status, as well as PADL monitoring. RESULTS: Home oxygen therapy subjects showed less time walking (P = .001), in active physical activities (P = .003), in physical activities ≥ 3 METs (P = .001), and in physical activities < 1.5 METs (P = .042), as well as fewer steps (P = .001). Physical inactivity was present in 24 home oxygen subjects (82.8%) and 18 control subjects (60%). Oxygen therapy was associated with severe physical inactivity (Cramer's V = 0.29, P = .040). The time using oxygen therapy (h/d) was the strongest predictor of the level of PADL (r2 = 0.38-0.43, P < .001). CONCLUSION: Subjects with COPD using oxygen at home showed reduced level of PADL. The results indicate that oxygen therapy is associated with severe physical inactivity and may be a predictor of the level of PADL.

Modified Medical Research Council Dyspnea Scale in GOLD Classification Better Reflects Physical Activities of Daily Living.

BACKGROUND: In multidimensional Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the choice of the symptom assessment instrument (modified Medical Research Council dyspnea scale [mMRC] or COPD assessment test [CAT]) can lead to a different distribution of patients in each quadrant. Considering that physical activities of daily living (PADL) is an important functional outcome in COPD, the objective of this study was to determine which symptom assessment instrument is more strongly associated with and differentiates better the PADL of patients with COPD. METHODS: The study included 115 subjects with COPD (GOLD 2-4), who were submitted to spirometry, the mMRC, the CAT, and monitoring of PADL (triaxial accelerometer). Subjects were divided into 2 groups using the cutoffs proposed by the multidimensional GOLD classification: mMRC < 2 and ≥ 2 and CAT < 10 and ≥ 10. RESULTS: Both mMRC and CAT reflected the PADL of COPD subjects. Subjects with mMRC < 2 and CAT < 10 spent less time in physical activities < 1.5 metabolic equivalents of task (METs) (mean of the difference [95% CI] = -62.9 [-94.4 to -31.4], P < .001 vs -71.0 [-116 to -25.9], P = .002) and had a higher number of steps (3,076 [1,999-4,153], P < .001 vs 2,688 [1,042-4,333], P = .002) than subjects with mMRC > 2 and CAT > 10, respectively. Physical activities ≥ 3 METs differed only between mMRC < 2 and mMRC ≥ 2 (39.2 [18.8-59.6], P < .001). Furthermore, only the mMRC was able to predict the PADL alone (time active, r2 = 0.16; time sedentary, r2 = 0.12; time ≥ 3 METs, r2 = 0.12) and associated with lung function (number of steps, r2 = 0.35; walking time, r2 = 0.37; time < 1.5 METs, r2 = 0.25). CONCLUSIONS: The mMRC should be adopted as the classification criterion for symptom assessment in the GOLD ABCD system when focusing on PADL.

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.

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.

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

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...