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 and Dynamic Hyperinflation Induced by Unsupported Arm Activities Involved in Multiple-Task Activities of Daily Living Test in Patients With COPD.

PURPOSE: This study aimed to analyze the isolated role of unsupported arm activities and the physiological responses and dynamic hyperinflation (DH) induced by activities of daily living in patients with chronic obstructive pulmonary disease. Physiological responses and DH were compared using the Glittre activities of daily living test (TGlittre) and a modified protocol that emphasized unsupported arm activities and excluded squats and bending down to move objects on shelves (TGlittre-M). Data were also compared from the isolated shelf tasks of TGlittre (TSHELF) and TGlittre-M (TSHELF-M). METHODS: This cross-sectional study included 30 patients with chronic obstructive pulmonary disease who performed the TGlittre, TGlittre-M, TSHELF and TSHELF-M. The physiological responses were evaluated during the 4 protocols and inspiratory capacity was measured before and immediately after the tests for evaluation of DH. RESULTS: Patients had higher oxygen uptake, ventilatory demand, dyspnea, and DH in the TGlittre than in the TGlittre-M (mean differences: 123 ± 119 mL/min; 0.11 ± 0.10, 1 [-1 to 3], and - 0.14 ± 0.22, respectively; P < .05 for all). Oxygen uptake, ventilatory demand, and dyspnea were also higher in the TSHELF than in the TSHELF-M (mean differences: 408 ± 185 mL/min; 0.26 ± 0.17; 1 [-1 to 3], respectively; P < .05 for all). However, DH was similar for both tasks (P > .05). CONCLUSIONS: In patients with chronic obstructive pulmonary disease, the physiological demands during unsupported arm activities were lower than during the task performed with squatting and bending down; however, the magnitude of DH did not differ between them. These results suggest that the isolated arm activities contribute less to the TGlittre's physiological requirement than the lower-limb and trunk activities.

Glittre-ADL Multiple Tasks Induce Similar Dynamic Hyperinflation With Different Metabolic and Ventilatory Demands in Patients With COPD.

PURPOSE: This cross-sectional study compared the physiological responses and dynamic hyperinflation (DH) of the Glittre-ADL test (TGlittre) and its specific tasks in patients with chronic obstructive pulmonary disease (COPD). METHODS: Thirty patients with COPD performed the TGlittre. The individual tasks included stand up and sit down (TSS); climb up and down stairs (TSTAIRS); walk on a flat surface (TWALK); and move objects onto and off a shelf (TSHELF). While performing these tasks, the physiological responses were evaluated and inspiratory capacity measured before and immediately after the tests. RESULTS: All physiological variables and inspiratory capacity were different at the end of the TGlittre and its tasks compared with baseline (P < .05). For most of the physiological variables, there were no significant differences between TSHELF and TWALK (P > .05), which were the tasks with the greatest physiological requirement, whereas the TSS represented the lowest metabolic, cardiovascular, and ventilatory demands among TGlittre's tasks. DH did not differ significantly among TGlittre's tasks. CONCLUSIONS: TWALK and TSHELF were the tasks that resulted in greater physiological overload, whereas TSS induced the lowest metabolic and ventilatory demands. Despite this, DH did not differ among the TGlittre's tasks in patients with COPD.