Resistance exercise training improves mucociliary clearance in subjects with COPD: A randomized clinical trial.

INTRODUCTION: Elastic tubing was recently investigated as an alternative to the conventional resistance training (RT) in chronic obstructive pulmonary disease (COPD). The effects of RT on the mucociliary system have not yet been reported in the literature. OBJECTIVE: The aim of this study was to evaluate the effects of two RT programs on mucociliary clearance in subjects with COPD. METHODS: Twentyeight subjects with COPD were randomly allocated by strata, according to individual strength of lower limbs, to defined groups: conventional resistance training (GCT) or resistance training using elastic tubing (GET). Nineteen subjects (GET: n=9; GCT: n=10) completed the study and were included in the analysis. The measurement of vital signs (blood pressure, heart rate and respiratory rate), lung function (spirometry) and the primary outcome mucociliary clearance analysis (saccharin transit time test (STT)) were performed before and after the 12 weeks of RT. RESULTS: In relation to the mucociliary transportability analysis, no differences were observed between the baseline evaluations of the training groups (p=0.05). There was a significant reduction in the STT values in both training groups, GET (10.64±5.06 to 6.01±4.91) and GCT (12.07±5.10 to 7.36±2.54) with p=0.03. However, no differences between groups were observed on the magnitude of SST changes after interventions (GET: -43.51%; GCT: -38.94%; p=0.97). CONCLUSION: The present study demonstrated that both RT with elastic tubing and conventional training with weights promoted similar gains in the mucociliary transportability of subjects with COPD.

Is walking in daily life a moderate intensity activity in patients with chronic obstructive pulmonary disease?

BACKGROUND: So far there are no studies investigating whether the time spent walking in daily life by patients with COPD corresponds to an activity of at least moderate intensity according to the recommendations of the American College of Sports Medicine (ACSM). AIM: To quantify in patients with COPD the time spent/day in physical activity of at least moderate intensity according to the ACSM (TPA>moderate); and to compare their TPA>moderate with the total time spent walking/day in daily life (TW). DESIGN: Cross-sectional study. SETTING: Patients entering in a pulmonary rehabilitation program at a University Hospital in Brazil. POPULATION: Seventy-three patients with COPD (FEV1 40±15% pred; 65±9 years). METHODS: TW and TPA>moderate were respectively assessed with the DynaPort and SenseWear activity monitors for 12 hours/day during 2 days. RESULTS: There was significant difference between TW and TPA>moderate (53 [36-80] versus 12 [3-33] minutes/day, respectively; P<0.0001). Although 84% of patients reached more than 30 minutes/day of TW, only 29% reached more than 30 minutes/day of TPA>moderate. TPA>moderate correlated modestly with TW (r= 0.52; P<0.0001). CONCLUSION: The majority of patients with moderate-very severe COPD walk more than 30 minutes/day; however this does not mean that they are physically active, since less than 1/4 of their time spent walking can be considered as moderate-intensity activity. CLINICAL REHABILITATION IMPACT: Moderate-intensity physical activity in patients with COPD is more reduced than previously known. There is a clear need to increase their daily physical activity and lead a higher proportion of this population to comply with the minimum recommendations.

Effects of arm bracing posture on respiratory muscle strength and pulmonary function in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To analyze the effect of arm bracing posture on respiratory muscle strength and pulmonary function in patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS: 20 patients with COPD (11 male; 67 ± 8 years; BMI 24 ± 3 Kg · m⁻²) were submitted to assessments of Maximal Inspiratory and Expiratory Pressures (MIP and MEP, respectively) and spirometry with and without arm bracing in a random order. The assessment with arm bracing was done on standing position and the height of the support was adjusted at the level of the ulnar styloid process with elbow flexion and trunk anterior inclination of 30 degrees promoting weight discharge in the upper limbs. Assessment without arm bracing was also performed on standing position, however with the arms relaxed alongside the body. The time interval between assessments was one week. RESULTS: MIP, MEP and maximal voluntary ventilation (MVV) were higher with arm bracing than without arm bracing (MIP 64 ± 22 cmH2O versus 54 ± 24 cmH2O, p = 0,00001; MEP 104 ± 37 cmH2O versus 92 ± 37 cmH2O, p = 0,00001 and MVV 42 ± 20 L/min versus 38 ± 20 L/min, p = 0,003). Other variables did not show statistical significant difference. CONCLUSION: The arm bracing posture resulted in higher capacity to generate force and endurance of the respiratory muscles in patients with COPD.