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.

Minimally Important Difference of the 20-m 6-Minute Walk Test in Individuals With COPD.

BACKGROUND: The 20-m 6-min-walk test (6MWT20) is a valid, reliable alternative for functional capacity assessment; however, its responsiveness and minimally important difference (MID) have yet to be investigated. The aim of this study was to assess the responsiveness and MID of the 6MWT20 in individuals with COPD. METHODS: Fifty-three subjects completed the study from August 2011-March 2020. The following were assessed: lung function, activities of daily living (ADLs), functional capacity 6MWT20, dyspnea, health status, quality of life, and limitations in ADLs. The primary outcome was the 6MWT20 distance. RESULTS: The study demonstrated that the 6MWT20 is responsive to pulmonary rehabilitation (PR), with an average improvement of 39 ± 36.3 m (P < .001) and an effect size of 1.07. The learning effect declined to 1.45% after PR, with an intraclass correlation coefficient of 0.99 (95% CI 0.98-0.99). The receiver operating characteristic curve indicated a cutoff point of 20 m for the MID of the 6MWT20 based on the MIDs for the modified St George Respiratory Questionnaire (sensitivity 87%, specificity 69%, area under the curve 0.80 [95% CI 0.66-0.90], P < .001, Youden index 0.56) and the number of steps (sensitivity 92%, specificity 73%, area under the curve 0.83 [95% CI 0.70-0.92], P < .01, Youden index 0.56). CONCLUSIONS: The 6MWT20 is responsive to PR, and the MID for the test is 20 m (17-47 m).

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.

Comparison of the physiological responses induced by different pediatric exercise field tests in children.

OBJECTIVE: This study aimed to compare the physiological responses induced by the modified shuttle walk test (MSWT), the 6-minute walk test (6MWT), and the pediatric Glittre activities of daily living test for children (TGlittre-P) in healthy children. METHOD: This was an analytical observational cross-sectional study. All subjects underwent an anthropometric evaluation, pulmonary function test, TGlittre-P, 6MWT, and MSWT using a portable gas analyzer. Each test was conducted on the same day, and a maximum period of 15 days was considered for completion of the 3 days of data collection. RESULTS: Overall, 24 subjects were included (mean age, 9.78 ± 1.27 years). The peak oxygen consumption (VO2peak ) during the MSWT (1409.94 ± 285.13 mL/kg/min) was significantly higher than that during the TGlittre-P (982.19 ± 205.95 mL/kg/min) and 6MWT (982.85 ± 257.09 mL/kg/min) (P < .001 for both). There was no difference in VO2peak  as well as most of the physiological variables between the 6MWT and TGlittre-P (P = .987). The MSWT VO2peak correlated with the 6MWT VO2peak (r = 0.67; P = .00) and the TGlittre-P VO2peak (r = 0.43; P = .04). The VO2peak values achieved in the 6MWT and TGlittre-P were also correlated (r = 0.68; P = .00). Unlike in the MSWT, in which the physiological measurements show an incremental response, the VO2 , heart rate, minute ventilation, and respiratory exchange ratio were stabilized in the TGlittre-P and 6MWT. CONCLUSION: The TGlittre-P and 6MWT showed similar physiological responses and required less metabolic, respiratory, and cardiovascular overload than the MSWT. The performance measures and VO2peak values obtained in the three tests were correlated.

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.

Reference Equations for the ADL-Glittre Test in Pediatric Subjects.

BACKGROUND: The ADL-Glittre test (TGlittre) was initially proposed to evaluate the activities of daily life (ADL) of adults with COPD that involve activities with the upper limbs in addition to walking. Recently, the test has been adapted for children (TGlittre-P), but no reference values have been proposed for its use in this population. The main objective of this study was to develop reference equations for the pediatric adaptation of the TGlittre. METHODS: A cross-sectional study carried out over a period of 19 months. Children 6-14 y old participated in the study. The study was rigorously controlled based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and on normal spirometry. Study subjects were evaluated for their biometric data (ie, weight, height, body mass index, body surface area, and length of the lower limbs) and spirometric data. Subjects then performed 2 TGlittre-P tests with an interval of 30 min between them. Statistical analysis included a Pearson correlation test to verify a correlation between time spent on the TGlittre-P and biometric variables such as gender and age. Subsequently, a multiple regression analysis was conducted for those variables. The level of signficance was set at a P of 0.05. RESULTS: Eighty-seven children (44 girls) participated in the study. Age was the predictive variable with the greatest influence on the time spent on the TGlittre-P (male: adjusted R2 = 39.6%; female: adjusted R2 = 25.2%). The following equations were established: time spent on the TGlittre-P = 3.781 - 0.083 × age (female), and time spent on the TGlittre-P = 4.025 - 0.123 × age (male). CONCLUSIONS: TGlittre-P reference equations were developed for females and males, with age being the most influential predictive variable in the test performed by children.

The validity and reliability of the ADL-Glittre test for children.

Objective: The ADL-Glittre was created to assess more comprehensively the essential activities of daily living in adults with chronic obstructive pulmonary disease. The aim of this study was to validate the ADL-Glittre test adapted for children (TGlittre-P) and verify its reliability. Methods: This is a cross-sectional study with 87 healthy children aged 6 to 14 years (mean 10.36 ± 2.32 years). Biometric and spirometry data were collected from all participants. On the same day, part of the sample (36 children included in the validation process) performed two 6MWT and two TGlittre-P (30-minute interval between them). The other part of the sample just performed two TGlittre-P for the reliability process. Pearson and Spearman correlation tests were used to verify the correlation between the time spent on the TGlittre-P and the distance walked in the 6MWT. The intraclass correlation coefficient (ICC) was also used to assess the reproducibility of the TGlittre-P. Results: The TGlittre-P showed a moderate negative correlation with the 6MWT (r = -0.490; p = 0.002; 95%CI -0.712 to -0.233). However, the behavior of the physiological variables that were monitored during the tests was similar and showed to be reproducible (ICC = 0.843; p = 0.000; 95%CI 0.695 to 0.911). Conclusion: The TGlittre-P proved to be a valid and reliable assessment of the functional capacity of healthy children aged 6 to 14 years.

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...

Crianças com história de displasia broncopulmonar. Repercussões na capacidade funcional / Children with a history of bronchopulmonary dysplasia. Repercussions on functional capacity

Introdução: Displasia broncopulmonar (DBP) é uma complicação clínica grave observada nos sobreviventes de doenças ventilatórias neonatais e é a enfermidade pulmonar crônica mais frequente em crianças prematuras. Objetivo: Analisar as repercussões da DBP na capacidade funcional (CF) de escolares e comparar com crianças hígidas. Métodos: Estudo de caráter transversal com crianças de 6 a 12 anos, divididas em: grupo DBP (GDBP) - dependentes de oxigênio no período neonatal; e controle (GC) - saudáveis. Foram registrados dados pessoais, perinatais e antropométricos. Após, realizaram o Teste de Caminhada de Seis Minutos (1TC6 e 2TC6) e o Shuttle Walk Test (SWT) e analisados: velocidade média TC6, frequência cardíaca (FC) e respiratória (FR), pressão arterial (PA), distância percorrida, percepção subjetiva do esforço (Borg), saturação periférica de oxigênio (SpO2). Resultados: Participaram 18 crianças (6 com DBP) com média de idade de 7,83 anos no GDBP e 9,08 anos no GC. Frequência de gênero, idade e variáveis antropométricas não diferiram entre os grupos. O GDBP permaneceu em média 30,67dias no oxigênio, apresentou menor peso ao nascer (p=0,025) e idade gestacional (p=0,021), percorreu menor distância no SWT (p=0,027) e 2TC6 (p=0,01). No 1TC6 apresentou maior esforço (Borg) no terceiro (p=0,05) e sexto minutos (p=0,036). Ainda apresentou menor FR no início e final de ambos os testes e a PA no sexto minuto do 2TC6 foi maior (p=0,007). No SWT, GDBP apresentou queda na SpO2 e maior sensação de dispneia. Conclusão: O grupo estudado de DBP apresentou redução da CF (menor distância percorrida, maior cansaço e queda da saturação em ambos os testes).

Physiological responses to the Glittre-ADL test in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The aim of this study was to investigate the physiological responses induced by the Glittre-ADL test (TGlittre) test in patients with chronic obstructive pulmonary disease (COPD) and compare them with those induced by the 6-minute walk test (6MWT). DESIGN: Cross-sectional observational study. SUBJECTS: Eighteen patients with COPD 66 years (standard deviation (SD) 8) and forced expiratory volume in 1 s of 40.4% (SD 16.8) predicted) who performed in randomized order the 6MWT and TGlittre on 2 separate days. RESULTS: Baseline cardiopulmonary variables were similar between the 6MWT and TGlittre (p > 0.05). TGlittre induced slightly higher final VO2 than 6MWT 83.6 ml/min (SD 163.9); p < 0.05) and oxygen consumption (VO2) reached a plateau after the third lap during TGlittre. The other physiological variables, except respiratory exchange rate, were similar at the end of both tests (p > 0.05). All measured variables were significantly correlated between the 2 tests (p < 0.05). CONCLUSION: TGlittre can induce slightly higher oxygen uptake than the 6MWT with similar cardiovascular and ventilatory demand and ventilatory efficiency.

Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility.

The aim of this study was to assess the reproducibility of the ultrasound (US) measurement of craniocaudal displacement of the left branch of the portal vein as an indirect method of measuring right hemidiaphragm mobility in healthy young adults. Forty-one healthy participants were selected, ranging from 20 to 30 years of age. The US tests were conducted and interpreted by two observers (A and B) on two separate occasions (Test 1 and Test 2). Intra-observer and interobserver reproducibility and repeatability of US measurements were determined by the intraclass correlation coefficient (ICC[2,1] ) using a 95% confidence interval (CI). Interobserver reproducibility assessment showed 'high correlation' for Test 1 and Test 2 (ICC[2,1]  = 0·83, 95% CI = 0·70-0·91, and ICC[2,1]  = 0·79, 95% CI = 0·61-0·89, respectively). Intra-observer reproducibility assessment showed 'moderate correlation' for observer A (ICC[2,1]  = 0·69, 95% CI = 0·45-0·84) and for observer B (ICC[2,1]  = 0·65, 95% CI = 0·39-0·81). Repeatability assessment showed 'high correlation' for all tests performed (ICC[2,1]  = 0·86, 0·80, 0·74, 0·79, P<0·001). In conclusion, US measurement of craniocaudal displacement of the left branch of the portal vein is a reproducible method of measuring right hemidiaphragm mobility in healthy young adults.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects.

BACKGROUND: the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES: to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD: 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS: COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION: TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects / Teste step Chester: avaliação da capacidade funcional e magnitude da resposta cardiorrespiratória em pacientes com DPOC e indivíduos saudáveis

BACKGROUND: the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES: to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD: 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS: COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION: TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients. .

CONTEXTUALIZAÇÃO: A avaliação da capacidade funcional em pacientes com doença pulmonar obstrutiva crônica (DPOC) tem sido realizada por métodos simples, de fácil aplicação e que mimetizam as atividades cotidianas, como o teste step Chester (TChester). OBJETIVOS: Investigar se o TChester é capaz de diferenciar a capacidade funcional e a magnitude da resposta cardiorrespiratória de pacientes com DPOC e de indivíduos saudáveis e comparar com a resposta cardiorrespiratória induzida pelos testes de caminhada de seis minutos (TC6min) e Shuttle (TShuttle). MÉTODO: Participaram dez pacientes com DPOC (64±10 anos, volume expiratório forçado no primeiro segundo - VEF1 de 38,1±11,8% do predito) e dez saudáveis (63±7 anos, IMC de 24,5±3,1 e VEF1 de 95,8±18,0% do predito) que realizaram avaliação da função pulmonar, estado e capacidade funcional. RESULTADOS: O grupo DPOC obteve pior desempenho nos três testes, quando comparado ao controle (TChester 2,1±0,9 vs 4,1±1,1 níveis completos; TC6min: 435±105,1 vs 593±87,3 m; TShuttle 251±84,6 vs 436±55,4 m; p<0,05). O TChester correlacionou-se com o TShuttle e com o TC6min (r=0,67 e 0,83, respectivamente; p<0,05). Não se observaram diferenças na frequência cardíaca (FC) e dispneia nos níveis do TChester entre os grupos (p>0,05). A SpO2 apresentou-se mais reduzida no grupo DPOC já no primeiro nível do TChester (p<0,05). CONCLUSÃO: O TChester é válido na avaliação da capacidade funcional de pacientes com DPOC, sendo capaz de diferenciá-los de indivíduos saudáveis, induzindo similar demanda cardiovascular e maior dessaturação nos pacientes ...

Can the Glittre ADL test differentiate the functional capacity of COPD patients from that of healthy subjects? / O teste de AVD-Glittre é capaz de diferenciar a capacidade funcional de indivíduos com DPOC da de saudáveis?

BACKGROUND: The Glittre ADL (TGlittre) test is a specifically designed to assess functional limitation in chronic obstructive pulmonary disease (COPD) patients. However, it is not known if it can differentiate the performance of these patients from healthy subjects. OBJECTIVES: To investigate whether the Glittre ADL test is able to differentiate the functional capacity of COPD patients from that of healthy subjects and to compare the cardiorespiratory response between Glittre ADL and the six-minute walk test (6MWT). METHODS: The study included 10 patients with COPD (GOLD 2 to 4) and 10 healthy subjects matched by age who performed the following: spirometry pre-and post-bronchodilator, a Glittre ADL test and two 6MWT on two consecutive days. RESULTS: The performance of COPD (FEV1 percentpred= 38.1±11.8, age=64±10 years, BMI=23.7±5.2 kg/ m²) was worse than the control group on TGlittre (5.26±2.9 min, 3.3±0.3 min, p<0.05) and 6MWT (434.97±105.18 m vs. 593.25±87.36 m, p<0.05). TGlittre correlated with the physical activity domain of the London Chest Activity of Daily Living (LCADL) scale (r=0.67, p<0.05) and with 6MWT when the total sample was analyzed (r=-0.64, p<0.05). The COPD group had a statistically higher (p<0.05) increase in dyspnea (Borg scale) than the control group for both TGlittre and 6MWT, with a similar heart rate and peripheral oxygen saturation variation in both groups (p>0.05). CONCLUSIONS: The performance of COPD patients is worse than that of healthy subjects on the Glittre ADL test, with a greater increase in dyspnea and similar heart rates.

CONTEXTUALIZAÇÃO: O teste de AVD Glittre (TGlittre) é um teste específico desenvolvido para avaliar a limitação funcional em pacientes com doença pulmonar obstrutiva crônica (DPOC), no entanto não se sabe qual sua capacidade de diferenciar o desempenho de doentes do de indivíduos saudáveis. OBJETIVOS: Investigar se o TGlittre é capaz de diferenciar a capacidade funcional de pacientes com DPOC da de indivíduos normais, além de comparar a resposta cardiorrespiratória induzida pelo TGlittre com a do teste de caminhada de seis minutos (TC6min). MÉTODOS: Participaram do estudo dez indivíduos com DPOC (GOLD 2 a 4) e dez indivíduos saudáveis de mesma faixa etária, realizando as seguintes avaliações: espirometria pré e pós-broncodilatador; um TGlittre e dois TC6min em dois dias consecutivos. RESULTADOS: O grupo DPOC (VEF1 por centoprev = 38,1±11,8, idade = 64±10 anos) apresentou pior desempenho que o grupo controle no TGlittre (5,26±2,9 min vs. 3,3±0,3 min, p<0,05) e no TC6min (434,97±105,18 m vs. 593,25±87,36 m, p<0,05). O TGlittre correlacionou-se com o domínio atividade física da escala London Chest Activity of Daily Living (LCADL) (r=0,67, p<0,05) no grupo DPOC e com o TC6min na amostra total (r=-0,64; p<0,05). Tanto no TGlittre como no TC6min, o grupo DPOC registrou aumento da dispneia (Borg) estatisticamente maior (p<0,05) que no grupo controle, com frequência cardíaca e saturação periférica de oxigênio similares (p>0,05). CONCLUSÕES: Pacientes com DPOC têm pior desempenho que indivíduos saudáveis no TGlittre, com maior dispneia e frequência cardíaca similar.