Reliability and validity of the London Chest Activity of Daily Living scale for adults with asthma.

INTRODUCTION: Dyspnea during activities of daily living (ADL) is frequently reported by adults with asthma. However, instruments that specifically assess that in people with asthma have not yet been validated. OBJECTIVES: To investigate the validity and reliability, including standard error of measurement (SEM) and Minimum Detectable Change (MDC), of the London Chest Activity of Daily Living (LCADL) scale for adults with asthma. METHODS: Adults with asthma answered the LCADL scale which was performed twice by the same rater. Spirometry, 6-min walk test (6MWT), St George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea scale, Asthma Quality of Life questionnaire (AQLQ), Asthma Control Test (ACT), and Glittre-ADL test were assessed. For statistical analyses, Spearman correlation, Wilcoxon test, Intraclass Correlation Coefficient (ICC), Cronbach's alpha coefficient, SEM, MDC were performed. RESULTS: Seventy participants were included (30% men, 44 ± 15 years old, BMI 27[23-31]kg/m2, FEV1 80 ± 17%predicted). For convergent validity, the LCADL scale was moderately correlated with SGRQ, AQLQ, and Glittre-ADL (r = 0.57, -0.46, and 0.41 respectively; p < 0.0001). The LCADL scale correlated weakly with the mMRC scale, ACT, and spirometry measures (-0.23

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change.

BACKGROUND: Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners. OBJECTIVE: This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models. METHODS: This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy. RESULTS: The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression. CONCLUSION: These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Comparison of Physical Activity Patterns among Three Major Chronic Respiratory Diseases.

Although the level of physical activity in daily life (PADL) plays a vital role concerning the health of subjects with chronic lung diseases, it remains uncertain how PADL patterns compare among different conditions. This study's objective was to compare the PADL levels of subjects with COPD, asthma and idiopathic pulmonary fibrosis (IPF); and to investigate PADL behaviour in different diseases' severity. Stable subjects who had not undergone pulmonary rehabilitation in the previous year were included. Subjects were divided into two subgroups according to disease severity: mild/moderate and severe/very severe. The primary outcome was time spent in moderate-to-vigorous physical activities (MVPA) (Actigraph GT3x) measured during one week over 12 h/day; other assessments included pulmonary function, peripheral muscle strength and exercise capacity. Comparisons among subgroups were corrected for age, BMI and sex. The analysis involved 119 subjects (47 asthma, 48 COPD and 24 IPF). Subjects with asthma had higher PADL levels than those with COPD and IPF (MVPA 18(14-22) vs. 8(4-12) vs. 7(1-12) min/day, respectively; p ancova = 0.002). Subjects with severe/very severe IPF had the lowest PADL level among all subgroups. Adult subjects with asthma have higher PADL levels than those with COPD and IPF, whereas patients with severe and very severe IPF are the most physically inactive subjects.

Validity, Reproducibility, and Minimal Detectable Difference of the Functional Upper Extremity Function Test - Simplified Version - for Adults With Moderate to Severe Asthma and COPD.

BACKGROUND: Upper-limbs (ULs) functional tests which are valid and reliable for individuals with chronic respiratory disease (CRD) are scarce. The aim of this study was to investigate the intra-rater reproducibility, validity, minimal detectable difference (MDD), and learning effect of the Upper Extremity Function Test - simplified version (UEFT_S) functional test and to characterize its performance for adults with moderate-severe asthma and COPD. METHODS: The UEFT_S was performed twice, and the number of elbow flexions in 20 s was the outcome. In addition, spirometry, 6-min walk test (6MWT), handgrip dynamometry (HGD), and usual and maximum timed-up-and-go tests (TUG_usual and TUG_max) were also performed. RESULTS: Eighty-four individuals with moderate-severe CRD and 84 control individuals matched by anthropometric data were analyzed. Individuals with CRD presented better performance in the UEFT_S than controls (P = .023). UEFT_S correlated significantly with HGD, TUG_usual, TUG_max, and 6MWT (P < .047 for all). The test-retest intraclass correlation coefficient was 0.91 [0.86-0.94], and the MDD was 0.4%. CONCLUSIONS: The UEFT_S is a valid and reproducible tool to assess the functionality of the ULs in people with moderate-severe asthma and COPD. When applied in the modified form, the test can be considered simple, fast, and inexpensive, with an easy outcome to interpret.

Do Functional Tests Estimate Physical Activity in COPD?

The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern.

Validity of the International Physical Activity Questionnaire (short form) in adults with asthma.

BACKGROUND: The short form of the International Physical Activity Questionnaire (IPAQ) is widely used to assess PA and has already been used in adults with asthma; however, its validity has not been yet studied in this population. Therefore, the aim of this study was to verify the convergent and discriminative validity of the IPAQ short form in adults with asthma. METHODS: Fifty-three adults with asthma (36 females; 48±15 years; 29±6 kg/m²) wore the triaxial activity monitor Actigraph for eight days to objectively measure steps/day, time in light physical activity (PA), moderate-to-vigorous PA (MVPA), and sedentary behaviour. Participants filled out the IPAQ matching with the same week they wore the Actigraph, with measures of: time of MVPA and total PA/week; categorization of low, moderate or high PA level; time in seated position. RESULTS: IPAQ self-reported total time of PA/week was weakly correlated with steps/day. The IPAQ categorization correlated moderately with time in light, MVPA and steps/day. Self-reported time in seated position on weekdays was moderately correlated with objective percentage/day of time in sedentary behaviour in the same period. IPAQ categorization in PA levels was able to differentiate between low to moderate and low to high PA levels. CONCLUSIONS: These results cannot confidently infer the convergent validity of the IPAQ to quantify number of steps/day and time spent in PA of adults with asthma. However, this instrument may be useful to categorize patients into three levels of PA.

An online behavior change intervention to promote physical activity in adults with asthma: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Behavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention. METHODS: This double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 h). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote an increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2, and the Hospital Anxiety and Depression Scale. DISCUSSION: The intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has the potential to improve physical activity levels and asthma management and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient's attendance, and has the potential to be largely offered elsewhere. TRIAL REGISTRATION: ClinicalTrials.gov NCT05241223 . Registered on January 22, 2022.

Do simple and quick functional tests reflect a more comprehensive test or physical activity in daily life in healthy young subjects? / Testes funcionais simples e rápidos refletem um teste mais abrangente ou atividade física na vida diária em jovens saudáveis? / ¿Los tests funcionales simples y rápidos reflejan un test más completo o actividad física en la vida diaria en jóvenes sanos?

ABSTRACT Considering the wide use of functional tests and that faster and simpler evaluations are preferable, this study aimed to verify the association between five protocols of simple functional tests (timed up and go [TUG], four-meter gait speed [4MGS] and sit-to-stand [STS] in five-repetitions [STS5rep], 30-seconds [STS30sec] and one-minute [STS1min] protocols) and the six-minute walk test (6MWT), as well as physical activity in daily life (PADL) in healthy young subjects. In this cross-sectional study, PADL was quantified by a pedometer validated for step counting and we considered the mean of seven consecutive days during the time awake. We assessed functional capacity by the TUG, 4MGS, STS5rep, STS30sec, and STS1min tests and the 6MWT. A total of 79 subjects without lung functional impairments were included (49% male, aged 28 [23-36] years). Performance of simple functional tests correlated with the 6MWT (0.23<r <0.56; P<0.05 for all) and the TUG test showed the best association (R2= 0.34). However, simple functional tests did not correlate with PADL (0.03< r <0.13; P>0.05 for all). The less time-consuming functional tests were weakly-moderately related to the 6MWT in healthy young subjects. The TUG showed the best association and explained up to 34% of the 6MWT. However, the 6MWT cannot be replaced by none of these simple functional tests. Finally, functional capacity showed no association with physical activity in daily life assessed by the pedometers in this population.

RESUMO Considerando o amplo uso de testes funcionais e que avaliações mais rápidas e simples são preferíveis, o objetivo deste estudo foi verificar a associação entre cinco protocolos de testes funcionais, a saber, timed up and go [TUG], 4-meter gait speed [4MGS] and sit to stand [STS] in 5-repetitions [STS5rep], 30-seconds [STS30sec] and 1-minute [STS1min] protocols e o teste de caminhada de 6 minutos (TC6min), bem como com a atividade física na vida diária (AFVD) em jovens saudáveis. Neste estudo transversal, a AFVD foi quantificada por um pedômetro validado para contagem de passos, e a média de sete dias consecutivos durante o tempo acordado foi considerada. A capacidade funcional foi avaliada pelo TUG, 4MGS, STS5rep, STS30sec, STS1min e TC6min. 79 pessoas sem comprometimento pulmonar foram incluídas (49% homens, idade média de 28 anos). O desempenho nos testes funcionais correlacionou-se com o TC6min (0,23< r <0,56; p<0,05 para todos) e o TUG apresentou a melhor associação (R²=0,34). Entretanto, os testes funcionais simples não se correlacionaram com a AFVD (0,03<r<0,13; p>0,05 para todos). Os testes funcionais de curta duração foram fracos, moderadamente relacionados ao TC6min em jovens saudáveis. O TUG apresentou a melhor associação e explicou até 34% do TC6min; no entanto, este não pode ser substituído por nenhum dos testes funcionais simples. Por fim, a capacidade funcional não se relacionou com a atividade física na vida diária avaliada pelos pedômetros nessa população.

RESUMEN Teniendo en cuenta el amplio uso de los tests funcionales y que son preferibles evaluaciones más rápidas y sencillas, el objetivo de este estudio fue verificar la asociación entre cinco protocolos de tests funcionales, a saber, timed up and go [TUG], 4-meter gait speed [4MGS] and sit to stand [STS] in 5-repetitions [STS5rep], 30-seconds [STS30sec] and 1-minute [STS1min] protocols y la prueba de caminata de 6 minutos (6MWT), con la actividad física de la vida diaria (AFVD) en jóvenes sanos. En este estudio transversal, la AFVD se cuantificó mediante un podómetro validado para el conteo de pasos, y se consideró el promedio de siete días consecutivos durante el tiempo acordado. La capacidad funcional se evaluó mediante TUG, 4MGS, STS5rep, STS30sec, STS1min y 6MWT. Se incluyeron a 79 personas sin afectación pulmonar (49% hombres, edad media 28 años). El desempeño en los tests funcionales se correlacionó con la 6MWT (0,23< r <0,56; p<0,05 para todos), y el TUG tuvo la mejor asociación (R²=0,34). Sin embargo, los tests funcionales simples no se correlacionaron con la AFVD (0,03<r<0,13; p>0,05 para todos). Los tests funcionales a corto plazo fueron insuficientes, moderadamente relacionados con la 6MWT en jóvenes sanos. El TUG mostró la mejor asociación y explicó hasta el 34% de la 6MWT, pero este no puede reemplazarse por ninguno de los tests funcionales simples. Por último, la capacidad funcional no se relacionó con la actividad física en la vida diaria evaluada por podómetros en esta población.

Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma.

BACKGROUND: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.

Functional tests for adults with asthma: validity, reliability, minimal detectable change, and feasibility.

OBJECTIVE: To verify the validity, reliability, learning effect, Minimal Detectable Change (MDC), and feasibility of four functional tests (4-Meter Gait Speed [4MGS], Timed Up-and-Go [TUG], Sit-To-Stand [STS], and Short Physical Performance Battery [SPPB]) for adults with asthma. METHODS: In this cross-sectional study, fifty-two subjects with stable asthma underwent three sets of different functional tests protocols (4MGS, TUG, STS, SPPB) in a random order by two raters. For validation analysis, tests were compared with a sex-age matched control group without asthma and correlated with the Six Minute Walking Test (6MWT), and peripheral muscle strength, as well as with quality of life and asthma control questionnaires. Intra-rater and inter-rater reliability, MDC, and feasibility were verified. RESULTS: Adults with asthma presented worse results than controls in the functional tests, except for SPPB. All functional tests were significantly correlated with 6MWT (0.45 < r < 0.67) and peripheral muscle strength (0.32 < r < 0.63), but not with quality of life and asthma control (0.02 < r < 0.17). The tests presented good to excellent intra-rater Intraclass Correlation Coefficients (ICC ≥ 0.75 for all). In all tests, a considerable learning effect and variability of measurement was observed, therefore, the best of two measurements should be used. MDC ranged from 15 to 31% and all tests were performed in a short time, small space, and without clinical adverse events. CONCLUSION: Different protocols of 4MGS, TUG, STS, and SPPB are valid, reliable, and feasible to assess the functional capacity of adults with asthma. These tests are quick and practical new alternatives for assessing functional capacity in this population.

Pulmonary Function, Functional Exercise Capacity and Quality of Life in Chemical Dependents in Rehabilitation Process / Função Pulmonar, Capacidade Funcional de Exercício e Qualidade de Vida de Dependentes Químicos em Processo de Reabilitação

The use of illicit substances can lead to several changes in physical and mental health, which can directly reflect on functional capacity and quality of life. However, there is a lack in the literature on the comparison of these variables between drug addicts and healthy individuals. To compare lung function, functional exercise capacity and quality of life of chemical dependents in rehabilitation process (CDRP) and apparently healthy individuals (AHI). Cross-sectional study that evaluated two groups (CDRP and AHI) matched by gender, age and BMI. Both groups were assessed for lung function (spirometry), quality of life (Short Form 36 questionnaire - SF-36), functional exercise capacity (6-minute walk test - 6MWT, 4-meter gait speed, Timed up-and-go, Sit-to-Stand and Short Physical Performance Battery). Fifteen men in the CDRP group (31[26-39] years; BMI 23±3 kg/m2) and fifteen men in the AHI group (30[22-34] years; BMI 24±3 kg/m2) were analyzed. The CDRP group had a shorter distance covered in the 6MWT in meters (P=0.0002) and percentage of predicted (P=0.005). There was no difference in the performance of the other functional tests (P≥0.20) and in the pulmonary function (P≥0.46). The CDRP group had worse results in the functional capacity, pain, social aspects and mental health domains of SF-36 (P≤0.04), while in the domains general status, vitality, emotional and physical aspects there was no difference (P≥0.08). CDRP present similar lung function to AHI. However, the first have impaired functionalexercise capacity, as well as some aspects of quality of life. (AU)

O uso de substâncias ilícitas pode levar a diversas alterações da saúde física e mental, o que pode refletir diretamente na capacidade funcional e na qualidade de vida. Porém, há uma escassez na literatura sobre a comparação dessas variáveis entre dependentes químicos e indivíduos saudáveis. Comparar função pulmonar, capacidade funcional de exercício e qualidade de vida de dependentes químicos em processo de reabilitação (DQPR) e indivíduos aparentemente saudáveis (AS). Estudo transversal que avaliou dois grupos (DQPR e AS) pareados por gênero, idade e IMC. Ambos os grupos foram avaliados quanto à função pulmonar (espirometria), qualidade de vida (questionário Short Form 36 ­ SF36), capacidade funcional de exercício (Teste de Caminhada de 6 minutos - TC6, 4-metre gait speed, Timed-up-and-go, Sit-to-Stand e Short Physical Performace Battery). Foram analisados 15 homens no grupo DQPR (31[26-39] anos; IMC 23±3 kg/m2) e 15 homens no grupo AS(30[22-34] anos; IMC 24±3 kg/m2). O grupo DQPR apresentou uma menor distância percorrida no TC6 em metros (P=0,0002) e porcentagem do predito (P=0,005). Não houve diferença no desempenho dos demais testes funcionais (P≥0,20) e na função pulmonar (P≥0,46). O grupo DQPR apresentou piores resultados nos domínios capacidade funcional, dor, aspectos sociais e saúde mental do SF-36 (P≤0,04), enquanto que nos domínios estado geral, vitalidade, aspectos emocionais e físicos não houve diferença (P≥0,08). Homens dependentes químicos em processo de reabilitação apresentam função pulmonar semelhante a indivíduos aparentemente saudáveis. Entretanto, apresentam capacidade funcional de exercício prejudicada, assim como alguns aspectos da qualidade de vida. (AU)

Identification of asthma phenotypes based on extrapulmonary treatable traits.

Asthma is a heterogeneous and complex disease, and a description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.The objective of this study was to identify and characterise clusters based on clinical, functional, anthropometrical and psychological characteristics in participants with moderate-to-severe asthma.This was a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (n=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function and psychological and health status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal--Wallis and Chi-squared tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.We identified four clusters: 1) participants with controlled asthma who were physically active; 2) participants with uncontrolled asthma who were physically inactive and more sedentary; 3) participants with uncontrolled asthma and low physical activity, who were also obese and experienced anxiety and/or depression symptoms; and 4) participants with very uncontrolled asthma who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex and anxiety symptoms were associated with increased odds of exacerbation risk, while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity and health status.Physical inactivity, obesity and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably associated with asthma control. This cluster analysis highlights the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.

The Gini Coefficient: A New Approach to Assess Physical Activity Inequality in COPD.

Increasing physical activity (PA) is a complex and challenging task in patients with chronic obstructive pulmonary disease (COPD). However, some questions are raised regarding the evaluation of PA in these patients: Have all aspects of PA evaluation in patients with COPD already been explored in the scientific literature and clinical practice? What is the clinical importance of assessing PA inequality? PA inequality is defined as the Gini coefficient (Ginicoef) of the PA distribution of a population and is already shown to have implications for public health in the general population. It is a simple tool that might allow a better understanding of PA disparities among different COPD populations, although to our knowledge there is no previous investigation of PA inequality in patients with COPD using the Ginicoef. In this perspective study we have provided examples of the Ginicoef use in different scenarios. Future studies might try to apply it in order to identify subpopulations with higher PA inequality, and perhaps are therefore more prone to benefit most from interventions specifically tailored to promote PA. In summary, we propose the quantification of PA inequality with the Ginicoef as a tool that might allow us to see PA even more comprehensively than we already do, expanding our perspective on PA in patients with COPD.

Vitamin D: association with eosinophil counts and IgE levels in children with asthma.

In this cross-sectional study, we investigated the relationship that levels of vitamin D had with eosinophil counts and IgE levels in 26 children with asthma (6-12 years of age) in the city of Londrina, Brazil. Vitamin D levels were found to correlate significantly, albeit moderately, with age (r = -0.51) and eosinophilia (r = -0.49), although not with IgE levels (r = -0.12). When we stratified the sample into two groups by the median vitamin D level (< or ≥ 24 ng/mL), we found that those in the < 24 ng/mL group were older, had higher eosinophil counts, and had higher IgE levels. To our knowledge, this is the first study to show an association between low levels of vitamin D and more pronounced eosinophilia in children with asthma in Brazil.

Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?

PURPOSE: This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS: Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS: The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION: High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

Alterações físicas decorrentes do envelhecimento na perspectiva de idosos institucionalizados / Physical changes resulting from the aging from the perspective of institutionalized elderly

Este trabalho objetivou verificar a perspectiva de idosos institucionalizados sobre as alterações físicas decorrentes do envelhecimento. Como aspectos metodológicos: vinte e um participantes de uma Instituição de Longa Permanência para Idosos, em uma pesquisa qualitativa e transversal, com roteiro elaborado pelos próprios autores; análise de dados pelo método hermenêutico-dialético. Como resultados, pôdese verificar que os principais relatos dos participantes foram a perda da beleza da juventude, a diminuição do desempenho musculoesquelético, o declínio de alguns dos sentidos, a redução da memória e da capacidade cognitiva, e a diminuição do nível de atividade, além da saudade da juventude, principalmente em relação à capacidade funcional para o trabalho e lazer. Concluiu-se que as alterações relatadas abordam uma diminuição geral do desempenho físico, ocupacional e cognitivo, entre outros.

Objective: Verify the prospect of institutionalized elderly about the physical changes associated with aging. Methods: There were 21 elderly in a Home for the Aged in Londrina-PR. Qualitative Research and cross-sectional, in which was held a single interview unstructured supported by a script with six questions developed by the authors was performed. Data analysis was performed using the hermeneuticdialectic method. Results: The main reports of the participants were the loss of the beauty of youth, the decrease in musculoskeletal performance, the decline of some of the ways the reduction of memory and cognitive ability, the decrease in activity level, plus the youth longing, especially in regarding the functional capacity for work and leisure. Conclusion: Just a few elderly considered old age as a good condition. The vast majority showed a negative view of the aging process, which can be associated to poor health and / or institutionalization.

Alterações físico-sociais decorrentes do envelhecimento na perspectiva de idosos institucionalizados / Physical and social changes resulting from theaging from the perspective of institutionalized elderly

Este trabalho objetivou verificar a perspectiva de idosos institucionalizados sobre as alterações físicas e sociais decorrentes do envelhecimento. Como aspectos metodológicos: vinte e um participantes de uma Instituição de Longa Permanência para Idosos, em uma pesquisa qualitativa e transversal, com roteiro elaborado pelos próprios autores; análise de dados pelo método hermenêutico-dialético. Como resultados, pôde-se verificar que os principais relatos dos participantes foram a perda da beleza da juventude, a diminuição do desempenho musculoesquelético, o declínio de alguns dos sentidos, a redução da memória e da capacidade cognitiva, e a diminuição do nível de atividade, além de sentimentos como o de saudades da juventude, principalmente em relação à capacidade funcional para o trabalho e lazer. Concluiu-se que as alterações relatadas abordam uma diminuição geral do desempenho físico, ocupacional, cognitivo e social entre outros aspectos.(AU)

Objective: Verify the prospect of institutionalized elderly about the physical and social changes associated with aging. Methods: There were 21 elderly in a Home for the Aged in Londrina-PR. Qualitative Research and cross-sectional, in which was held a single interview unstructured supported by a script with six questions developed by the authors was performed. Data analysis was performed using the hermeneutic-dialectic method. Results: The main reports of the participants were the loss of the beauty of youth, the decrease in musculoskeletal performance, the decline of some of the ways the reduction of memory and cognitive ability, the decrease in activity level, plus the youth longing, especially in regarding the functional capacity for work and leisure. Conclusion: Just a few elderly considered old age as a good condition. The vast majority showed a negative view of the aging process, which can be associated to poor health and / or institutionalization.(AU)