Ventilatory efficiency (η⩒E) of the exercise: A detailed method report.

Ventilatory efficiency is a combination of the ventilatory-metabolic response stemming from non-invasive analysis of cardiopulmonary exercise testing. Despite being a recognized marker in exercise physiology, this measure presents considerable limitations, including the imprecise designation of "efficiency", broadly recognized, and recently denominated as "excess ventilation". Herein we present a detailed method, with substantial improvements, and new physiological insights, in order to better define the true ventilatory efficiency of the exercise, according to recommendations for physical/physiological processes.•"Ventilatory efficiency" of the exercise is a remarkable physiological index.•Several limitations are currently debated.•We report a new ventilatory efficiency index that match with recommendations.

Carotid-body modulation through meditation in stage-I hypertensive subjects: Study protocol of a randomized and controlled study.

Adjunctive therapy for hypertension is in high demand for clinical research. Therefore, several meta-analyses have provided sufficient evidence for meditation as an adjunct therapy, without being anchored on reliable physiological grounds. Meditation modulates the autonomic nervous system. Herein, we propose a hierarchical-dependent effect for the carotid body (CB) in attenuating blood pressure (BP) and ventilatory variability (VV) fine-tuning due to known nerve connections between the CB, prefrontal brain, hypothalamus, and solitary tract nucleus. The aim of this exploratory study was to investigate the role of CB in the possible decrease in BP and changes in VV that could occur in response to meditation. This was a prospective, single-center, parallel-group, randomized, controlled clinical trial with concealed allocation. Eligible adult subjects of both sexes with stage 1 hypertension will be randomized into 1 of 2 groups: transcendental meditation or a control group. Subjects will be invited to 3 visits after randomization and 2 additional visits after completing 8 weeks of meditation or waiting-list control. Thus, subjects will undergo BP measurements in normoxia and hyperoxia, VV measurements using the Poincaré method at rest and during exercise, and CB activity measurement in the laboratory. The primary outcome of this study was the detection of changes in BP and CB activity after 8 weeks. Our secondary outcome was the detection of changes in the VV at rest and during exercise. We predict that interactions between hyperoxic deactivation of CB and meditation; Will reduce BP beyond stand-alone intervention or alternatively; Meditation will significantly attenuate the effects of hyperoxia as a stand-alone intervention. In addition, VV can be changed, partially mediated by a reduction in CB activity. Trial registration number: ReBEC registry (RBR-55n74zm). Stage: pre-results.

Pulmonary function and medication effect in mild-stage subjects with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) causes a series of movement disorders, many of them starting in the early stage. OBJECTIVE: To analyze the pulmonary function of mild-stage subjects with PD and to investigate the effects of levodopa on it. METHODS: We included 21 patients with idiopathic PD and 20 healthy control subjects. The participants were submitted to spirometry and impulse oscillometry assessments. The PD patients were evaluated during the "off" and "on" phases of their anti-PD medication, which was was converted to levodopa in an equivalent daily dose. A statistical analysis was performed with cross-sectional (PD patients "off" medication versus controls) and paired (PD patients "off" medication versus PD patients "on" medication) tests. The effect of levodopa was calculated with partial Eta-squared (η2 ρ). Significance was set at 5%. RESULTS: The PD patients presented normal values in the impulse oscillometry. Regarding spirometry, the results indicated an incipient obstructive ventilatory disorder in the PD group - confirmed by patients' flow-volume curves. The PD patients received a daily dose of 354.7 ± 148.2 mg of levodopa. The paired analyses showed a small effect of anti-PD medication on pulmonary parameters (η2 ρ = 0.197 for spirometry and η2 ρ= 0.043 for impulse oscillometry). CONCLUSION: Patients with PD in the mild stage of the disease present pulmonary compliance and resistance compatible with normal parameters. The differences regarding the spirometric results indicate an incipient obstructive ventilatory disorder in patients with PD. Levodopa had small effect on pulmonary function in the mild stage of the disease.

ANTECEDENTES: A doença de Parkinson (DP) causa uma série de distúrbios do movimento, muitos deles se desenvolvendo na fase inicial. OBJETIVO: Analisar função pulmonar de pessoas com DP em estágio leve e investigar o efeito da levodopa nesse processo. MéTODOS: Vinte e um participantes com DP idiopática e vinte controles saudáveis foram incluídos na pesquisa. Todos os sujeitos foram submetidos a avaliações de espirometria e oscilometria de impulso. Participantes com DP foram avaliados nas fases 'on' e 'off' de medicação anti-parkinsoniana. A medicação dos pacientes foi convertida em dose diária de levodopa. A análise estatística foi realizada com testes transversais (Parkinson na fase 'off' da medicação vs controles) e pareados (Parkinson nas fases 'off' vs 'on' da medicação). O efeito da levodopa foi calculado pelo eta ao quadrado parcial (η2 ρ). Significância foi estipulada em 5%. RESULTADOS: Pacientes com DP apresentaram valores normais na oscilometria de impulso. Na espirometria, os resultados indicaram uma desordem ventilatória obstrutiva incipiente no grupo DP ­ confirmada pelas curvas fluxo-volume dos pacientes. Pacientes com DP receberam uma dose diária de 354,7 ± 148,2 miligramas de levodopa. Análises pareadas mostraram baixo impacto da medicação anti-parkinsoniana nos parâmetros pulmonares (η2 ρ = 0,197 na espirometria e η2 ρ = 0,043 na oscilometria de impulso). CONCLUSãO: Pacientes com DP na fase leve apresentam complacência e resistência pulmonares compatíveis com parâmetros normais. Diferenças espirométricas indicam distúrbio ventilatório obstrutivo incipiente em pacientes com DP. A administração de levodopa apresentou baixo efeito na função pulmonar na fase leve da doença.

Pulmonary function and medication effect in mild-stage subjects with Parkinson's disease / Função pulmonar e efeitos da medicação em pessoas com doença de Parkinson em estágio leve

Abstract Background Parkinson's disease (PD) causes a series of movement disorders, many of them starting in the early stage. Objective To analyze the pulmonary function of mild-stage subjects with PD and to investigate the effects of levodopa on it. Methods We included 21 patients with idiopathic PD and 20 healthy control subjects. The participants were submitted to spirometry and impulse oscillometry assessments. The PD patients were evaluated during the "off" and "on" phases of their anti-PD medication, which was was converted to levodopa in an equivalent daily dose. A statistical analysis was performed with cross-sectional (PD patients "off" medication versus controls) and paired (PD patients "off" medication versus PD patients "on" medication) tests. The effect of levodopa was calculated with partial Eta-squared (η2ρ). Significance was set at 5%. Results The PD patients presented normal values in the impulse oscillometry. Regarding spirometry, the results indicated an incipient obstructive ventilatory disorder in the PD group - confirmed by patients' flow-volume curves. The PD patients received a daily dose of 354.7 ± 148.2 mg of levodopa. The paired analyses showed a small effect of anti-PD medication on pulmonary parameters (η2ρ = 0.197 for spirometry and η2ρ = 0.043 for impulse oscillometry). Conclusion Patients with PD in the mild stage of the disease present pulmonary compliance and resistance compatible with normal parameters. The differences regarding the spirometric results indicate an incipient obstructive ventilatory disorder in patients with PD. Levodopa had small effect on pulmonary function in the mild stage of the disease.

Resumo Antecedentes A doença de Parkinson (DP) causa uma série de distúrbios do movimento, muitos deles se desenvolvendo na fase inicial. Objetivo Analisar função pulmonar de pessoas com DP em estágio leve e investigar o efeito da levodopa nesse processo. Métodos Vinte e um participantes com DP idiopática e vinte controles saudáveis foram incluídos na pesquisa. Todos os sujeitos foram submetidos a avaliações de espirometria e oscilometria de impulso. Participantes com DP foram avaliados nas fases 'on' e 'off' de medicação anti-parkinsoniana. A medicação dos pacientes foi convertida em dose diária de levodopa. A análise estatística foi realizada com testes transversais (Parkinson na fase 'off' da medicação vs controles) e pareados (Parkinson nas fases 'off' vs 'on' da medicação). O efeito da levodopa foi calculado pelo eta ao quadrado parcial (η2ρ). Significância foi estipulada em 5%. Resultados Pacientes com DP apresentaram valores normais na oscilometria de impulso. Na espirometria, os resultados indicaram uma desordem ventilatória obstrutiva incipiente no grupo DP - confirmada pelas curvas fluxo-volume dos pacientes. Pacientes com DP receberam uma dose diária de 354,7 ± 148,2 miligramas de levodopa. Análises pareadas mostraram baixo impacto da medicação anti-parkinsoniana nos parâmetros pulmonares (η2ρ = 0,197 na espirometria e η2ρ = 0,043 na oscilometria de impulso). Conclusão Pacientes com DP na fase leve apresentam complacência e resistência pulmonares compatíveis com parâmetros normais. Diferenças espirométricas indicam distúrbio ventilatório obstrutivo incipiente em pacientes com DP. A administração de levodopa apresentou baixo efeito na função pulmonar na fase leve da doença.

A new ventilatory efficiency index and accuracy for early lung diffusion impairment in non-COPD smokers.

In smokers without manifest airway obstruction, early emphysema and endothelial dysfunction has been related to minute-ventilation/carbon dioxide output ratio (V'E/V'CO2). Thus, smokers with reduced lung carbon monoxide diffusion capacity (DLco) have a heightened V'E/V'CO2 ratio. We hypothesized that ventilatory inefficiency could contribute to the suspicion of impaired diffusive capacity in the absence of significant airway obstruction. Thus, 15 smokers with impaired DLco were compared to 15 smokers with normal DLco. Accuracy through sensibility and specificity for V'E/V'CO2 slope and nadir was compared with a new index for ventilatory efficiency (ηV'E,%), to uncover early diffusive changes in smokers without COPD.

Vitamin B12 Supplementation and NT-proBNP Levels in COPD Patients: A Secondary Analysis of a Randomized and Controlled Study in Rehabilitation.

PURPOSE: There is evidence of complex interaction between vitamin B12 (vB12) level, hyperhomocysteinemia (HyCy), and natriuretic peptide secretion. Exercise training could also modulate such interaction. In this secondary analysis of a Randomized Clinical Trial performed in a chronic obstructive pulmonary disease (COPD) rehabilitation setting, our primary objective was to investigate the interaction between vB12 supplementation, exercise training, and changes in NT-proBNP levels after 8 weeks of intervention. Secondary objectives were to explore the correlations between acute changes in NT-proBNP levels with (i) acute exercise and (ii) oxygen uptake (V'O2) kinetics during rest-to-exercise transition. METHODS: Thirty-two subjects with COPD were randomized into four groups: Rehabilitation+vB12 (n = 8), Rehabilitation (n = 8), vB12 (n = 8), or Maltodextrin(n = 8). They were evaluated at baseline and after 8 weeks, during resting and immediately after maximal exercise constant work-rate tests (CWTs, Tlim), for NT-proBNP plasmatic levels. RESULTS: After interaction analysis, the supplementation with vB12 significantly changed the time course of NT-proBNP responses during treatment (p = 0.048). However, the final analysis could not support a significant change in NT-proBNP levels owing to high-intensity constant work-rate exercise (p-value > 0.05). There was a statistically significant correlation between V'O2 time constant and ΔNT-proBNP values (Tlim - rest) at baseline (p = 0.049) and 2 months later (p = 0.015), considering all subjects (n = 32). CONCLUSION: We conclude that vB12 supplementation could modulate NT-proBNP secretion. Moreover, possibly, the slower the initial V'O2 adjustments toward a steady-state during rest-to-exercise transitions, the more severe the ventricular chamber volume/pressure stress recruitment, expressed through higher NT-proBNP secretion in subjects with larger V'O2 time constants, despite unchanged final acute exercise-induced neurohormone secretion.

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial.

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (Tlim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4 cm H2O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30 days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved Tlim (Δ = 111 s) and lower minute-ventilation (Δ = 4 L.min-1) at exhaustion, when comparing the IMT effects within the PAV modality (p = 0.001 and p = 0.036, respectively) and improved Tlim for PAV vs. SHAM (PAV main-effect, p = 0.001; IMT main-effect, p = 0.006; PAV vs. IMT interaction, p = 0.034). In addition, IMT + PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p = 0.009; time main-effect, p < 0.0001; IMT vs. time interaction, p = 0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p = 0.018; time main-effect, p = 0.0001; IMT vs. time interaction, p = 0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz).

Effect of ß-alanine supplementation during high-intensity interval training on repeated sprint ability performance and neuromuscular fatigue.

The study investigated the influence of ß-alanine supplementation during a high-intensity interval training (HIIT) program on repeated sprint ability (RSA) performance. This study was randomized, double-blinded, and placebo controlled. Eighteen men performed an incremental running test until exhaustion (TINC) at baseline and followed by 4-wk HIIT (10 × 1-min runs 90% maximal TINC velocity [1-min recovery]). Then, participants were randomized into two groups and performed a 6-wk HIIT associated with supplementation of 6.4 g/day of ß-alanine (Gß) or dextrose (placebo group; GP). Pre- and post-6-wk HIIT + supplementation, participants performed the following tests: 1) TINC; 2) supramaximal running test; and 3) 2 × 6 × 35-m sprints (RSA). Before and immediately after RSA, neuromuscular function was assessed by vertical jumps, maximal isometric voluntary contractions of knee extension, and neuromuscular electrical stimulations. Muscle biopsies were performed to determine muscle carnosine content, muscle buffering capacity in vitro (ßmin vitro), and content of phosphofructokinase (PFK), monocarboxylate transporter 4 (MCT4), and hypoxia-inducible factor-1α (HIF-1α). Both groups showed a significant time effect for maximal oxygen uptake (Gß: 6.2 ± 3.6% and GP: 6.5 ± 4.2%; P > 0.01); only Gß showed a time effect for total (-3.0 ± 2.0%; P = 0.001) and best (-3.3 ± 3.0%; P = 0.03) RSA times. A group-by-time interaction was shown after HIIT + Supplementation for muscle carnosine (Gß: 34.4 ± 2.3 mmol·kg-1·dm-1 and GP: 20.7 ± 3.0 mmol·kg-1·dm-1; P = 0.003) and neuromuscular voluntary activation after RSA (Gß: 87.2 ± 3.3% and GP: 78.9 ± 12.4%; P = 0.02). No time effect or group-by-time interaction was shown for supramaximal running test performance, ßm, and content of PFK, MCT4, and HIF-1α. In summary, ß-alanine supplementation during HIIT increased muscle carnosine and attenuated neuromuscular fatigue, which may contribute to an enhancement of RSA performance.NEW & NOTEWORTHY ß-Alanine supplementation during a high-intensity interval training program increased repeated sprint performance. The improvement of muscle carnosine content induced by ß-alanine supplementation may have contributed to an attenuation of central fatigue during repeated sprint. Overall, ß-alanine supplementation may be a useful dietary intervention to prevent fatigue.

Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease.

Smoking and physical inactivity are important preventable causes of disability and early death worldwide. Reduced exercise tolerance has been described in smokers, even in those who do not fulfill the extant physiological criteria for chronic obstructive pulmonary disease (COPD) and are not particularly sedentary. In this context, it is widely accepted that exercise capacity depends on complex cardio-pulmonary interactions which support oxygen (O2) delivery to muscle mitochondria. Although peripheral muscular factors, O2 transport disturbances (including the effects of increased carboxyhemoglobin) and autonomic nervous system unbalance have been emphasized, other derangements have been more recently described, including early microscopic emphysema, pulmonary microvascular disease, ventilatory and gas exchange inefficiency, and left ventricular diastolic dysfunction. Using an integrative physiological approach, the present review summarizes the recent advances in knowledge on the effects of smoking on the lung-heart-muscle axis under the stress of exercise. Special attention is given to the mechanisms connecting physiological abnormalities such as early cardio-pulmonary derangements, inadequate oxygen delivery and utilization, and generalized bioenergetic disturbances at the muscular level with the negative sensations (sense of heightened muscle effort and breathlessness) that may decrease the tolerance of smokers to physical exercise. A deeper understanding of the systemic effects of smoking in subjects who did not (yet) show evidences of COPD and ischemic heart disease - two devastating smoking related diseases - might prove instrumental to fight their ever-growing burden.

Faster oxygen uptake, heart rate, and ventilatory kinetics in stepping compared with cycle ergometry in patients with COPD during moderate-intensity exercise.

Step tests are a stressful and feasible cost-effective modality to evaluate aerobic performance. However, the eccentric in addition to concentric muscle contractions of the legs on stepping emerge as a potential speeding factor for cardioventilatory and metabolic adjustments towards a steady-state, since eccentric contractions would prompt an earlier and stronger mechanoreceptor activation, as well as higher heart rate/cardiac output adjustments to the same metabolic demand. Moreover, shorter tests are ideal for exercise-limited subjects. Nine subjects with chronic obstructive pulmonary disease were invited to participate in comprehensive lung function tests and constant work tests performed on different days at a 90% gas exchange threshold for 6 min, in single-step tests or cycle ergometry. After careful monoexponential regression modelling, statistically relevant faster phase II time constants for oxygen uptake (45 ± 18 s vs 53 ± 17 s, p = 0.017) and minute ventilation (61 ± 13 s vs 74 ± 17 s, p = 0.027) were observed in the 6-min step tests compared with cycle ergometry, respectively. Despite an absence of heart rate time constant difference (43 ± 20 s vs 69 ± 46 s, p = 0.167), there was a significantly faster rate constant toward a steady state for heart rate (p = 0.02). In addition, 4-min compared with 6-min analysis presented similar results (p > 0.05), providing an appropriate steady-state. We conclude that step tests might elicit faster time constants compared with cycle ergometry, at the same average metabolic level, and 4-min analysis has similar mean errors compared with 6-min analysis within an acceptable range. New studies, comprising mechanisms and detailed physiological backgrounds, are necessary.

CPAP and EPAP elicit similar lung deflation in a non-equivalent mode in GOLD 3-4 COPD patients.

INTRODUCTION: Lung hyperinflation is associated with inspiratory muscle strength reduction, nocturnal desaturation, dyspnea, altered cardiac function and poor exercise capacity in advanced COPD. OBJECTIVES: We investigated the responses of inspiratory capacity (IC) and inspiratory muscle strength (PImax), comparing continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP) with the main hypothesis that there would be similar effects on lung deflation. METHODS: Eligible patients were submitted to 10 cmH2 O CPAP and EPAP on different days, under careful ECG (HR) and peripheral oxygen saturation (SpO2 ) monitoring. RESULTS: Twenty-one eligible COPD patients were studied (13 male/8 female, FEV1 % predicted of 36.5 ± 9.8). Both CPAP and EPAP demonstrated significant post-pre (Δ) changes for IC and PImax, with mean ΔIC for CPAP and EPAP of 200 ± 100 mL and 170 ± 105 mL (P = .001 for both) in 13 and 12 patients (responders) respectively. There were similar changes in % predicted IC and PImax (∼7%, P = .001 for both) for responders and poor responder/non-responder agreement depending on CPAP/EPAP mode (Kappa = .113, P = .604). There were no differences in CPAP and EPAP regarding intensity of lung deflation (P =.254) and no difference was measured regarding HR (P = .235) or SpO2 (P = .111). CONCLUSIONS: Both CPAP and EPAP presented a similar effect on lung deflation, without guaranteeing that the response to one modality would be predictive of the response to the other.

Ventilatory Inefficiency and Exertional Dyspnea in Early Chronic Obstructive Pulmonary Disease.

Exertional dyspnea is present across the spectrum of chronic obstructive pulmonary disease (COPD) severity. However, without realizing it themselves, patients may decrease daily physical activity to avoid distressing respiratory sensations. Dyspnea also may be associated with deconditioning. Cardiopulmonary exercise testing can uncover exertional dyspnea and its physiological determinants in patients with preserved or only mildly reduced FEV1. Dyspnea in mild COPD can largely be explained by increased "wasted" ventilation in the physiological dead space, which heightens the drive to breathe and worsens the inspiratory mechanical constraints. During incremental exercise testing, this is readily identified as an excessive ventilation-to-metabolic demand, that is, a high ventilation ([Formula: see text]e) to carbon dioxide output ([Formula: see text]co2) relationship. Linking increases in [Formula: see text]e/[Formula: see text]co2 to exertional dyspnea may provide objective evidence that a patient's poor exercise tolerance is not just a consequence of deconditioning. This information should prompt a proactive therapeutic approach to increase the available ventilatory reserve by, for example, giving inhaled bronchodilators. Considering that the structural determinants of ventilatory inefficiency (early emphysema, ventilation-perfusion mismatching, and microvascular disease) may progress despite only modest changes in FEV1, serial [Formula: see text]e/[Formula: see text]co2 measurements might also prove valuable to track disease progression in these symptomatic patients.

Addition of vitamin B12 to exercise training improves cycle ergometer endurance in advanced COPD patients: A randomized and controlled study.

Vitamin B12 is essential in the homocysteine, mitochondrial, muscle and hematopoietic metabolisms, and its effects on exercise tolerance and kinetics adjustments of oxygen consumption (V'O2p) in rest-to-exercise transition in COPD patients are unknown. This randomized, double-blind, controlled study aimed to verify a possible interaction between vitamin B12 supplementation and these outcomes. After recruiting 69 patients, 35 subjects with moderate-to-severe COPD were eligible and 32 patients concluded the study, divided into four groups (n = 8 for each group): 1. rehabilitation group; 2. rehabilitation plus B12 group; 3. B12 group; and 4. placebo group. The primary endpoint was cycle ergometry endurance before and after 8 weeks and the secondary endpoints were oxygen uptake kinetics parameters (time constant). The prevalence of vitamin B12 deficiency was high (34.4%) and there was a statistically significant interaction (p < 0.05), favoring a global effect of supplementation on exercise tolerance in the supplemented groups compared to the non-supplemented groups, even after adjusting for confounding variables (p < 0.05). The same was not found for the kinetics adjustment variables (τV'O2p and MRTV'O2p, p > 0.05 for both). Supplementation with vitamin B12 appears to lead to discrete positive effects on exercise tolerance in groups of subjects with more advanced COPD and further studies are needed to establish indications for long-term supplementation.

Physiological responses at the lactate-minimum-intensity with and without prior high-intensity exercise.

This study examined the physiological responses during exercise-to-exhaustion at the lactate-minimum-intensity with and without prior high-intensity exercise. Eleven recreationally trained males performed a graded exercise test, a lactate minimum test and two constant-load tests at lactate-minimum-intensity until exhaustion, which were applied with or without prior hyperlactatemia induction (i.e., 30-s Wingate test). The physiological responses were significantly different (P < 0.05) between constant-load tests for pulmonary ventilation ([Formula: see text]), blood-lactate-concentration ([La(-)]), pH, bicarbonate concentration ([HCO3]) and partial pressure of carbon dioxide during the initial minutes. The comparisons within constant-load tests showed steady state behaviour for oxygen uptake and the respiratory exchange ratio, but heart rate and rating of perceived exertion increased significantly during both exercise conditions, while the [Formula: see text] increased only during constant-load effort. During effort performed after high-intensity exercise: [Formula: see text], [La(-)], pH and [HCO3] differed at the start of exercise compared to another condition but were similar at the end (P > 0.05). In conclusion, the constant-load exercises performed at lactate-minimum-intensity with or without prior high-intensity exercise did not lead to the steady state of all analysed parameters; however, variables such as [La(-)], pH and [HCO3] - altered at the beginning of effort performed after high-intensity exercise - were reestablished after approximately 30 min of exercise.

Pacientes com doença de Parkinson sob assistência fisioterapêutica apresentam parâmetros pulmonares melhores do que controles sedentários / Pacientes con enfermedad de Parkinson bajo cuidados fisioterapéuticos presentan parámetros pulmonares mejores que los de controles sedentarios / Patients with Parkinson's disease under physiotherapeutic care present better pulmonary parameters than sedentary controls

RESUMO Este estudo teve como objetivo investigar os parâmetros pulmonares (espirometria e oscilometria de impulso) de pacientes com doença de Parkinson (DP) e controles eutróficos, comparando os valores dos sujeitos participantes e os não participantes de um programa de assistência fisioterapêutica. Trinta e sete sujeitos foram divididos em quatro grupos independentes: dois grupos formados por pacientes com DP (praticantes e não praticantes de um protocolo de exercícios fisioterapêuticos realizados com frequência de dois atendimentos semanais durante 6 meses) e dois grupos compostos por sujeitos controles eutróficos (praticantes e não praticantes do mesmo programa terapêutico). Os sujeitos foram submetidos à avaliação de cirtometria torácica, espirometria e oscilometria de impulso, sendo os pacientes com DP avaliados na fase off da medicação. A análise dos dados ocorreu por meio do teste não paramétrico de Kruskal-Wallis, sendo a comparação aos pares realizada pelo pós-teste de Dunett T3. A significância foi estipulada em 5%. Sobre os resultados, com similaridade entre grupos para mobilidade da caixa torácica, os pacientes com DP que realizaram atendimento fisioterapêutico apresentaram parâmetros pulmonares melhores do que os pacientes sedentários. A comparação com os sujeitos eutróficos vislumbra melhores resultados dos participantes com DP em relação a controles sedentários. Não houve diferença significativa entre os sujeitos com DP e controles submetidos ao mesmo protocolo terapêutico. Em conclusão, os achados delimitam resultados promissores do tratamento fisioterapêutico sobre parâmetros pulmonares na DP, e sentenciam a necessidade de novos estudos longitudinais do tipo ensaio clínico para comprovação da relação causa e efeito das variáveis em questão.

RESUMEN En este artículo se propone a investigar los parámetros pulmonares (espirometría y oscilometría de impulso) en pacientes con enfermedad de Parkinson (EP) y controles eutróficos, y comparar las puntuaciones de los sujetos participantes y de los no participantes de un programa de cuidados fisioterapéuticos. Se han divididos 37 participantes en cuatro grupos independientes: dos grupos conformados por personas con EP (practicantes y no practicantes de un protocolo de ejercicios fisioterapéuticos realizados frecuentemente en dos atenciones semanales durante seis meses), y dos grupos controles eutróficos (practicantes y no practicantes del mismo programa terapéutico). A los participantes les sometieron a evaluación de cirtometría torácica, espirometría y oscilometría de impulso, siendo los pacientes con EP evaluados en la etapa en off de medicación. Para el análisis se empleó la prueba no paramétrica de Kruskal-Wallis, siendo aplicada para la comparación con pares la pos-prueba de Dunett T3. Se empleó el nivel de significación del 5%. Acerca de los resultados, igual que entre grupos para movilidad de la caja torácica, los pacientes con EP, que realizaron atención fisioterapéutica presentaron parámetros pulmonares mejores que los sujetos sedentarios. La comparación con los participantes eutróficos vislumbra mejores resultados de los participantes con EP con relación a los controles sedentarios. No hubo diferencias significativas entre los sujetos con EP y los controles sometidos al mismo protocolo terapéutico. Se concluye que los hallazgos delimitan resultados prometedores del tratamiento fisioterapéutico sobre los parámetros pulmonares de la EP, y llaman la atención para la necesidad de hacer nuevos estudios longitudinales del tipo ensayo clínico para comprobar la relación de causa y efecto de las variables estudiadas.

ABSTRACT The aim of this study was to investigate the pulmonary parameters (spirometry and impulse oscillometry) of patients with Parkinson disease (PD) and healthy control peers, comparing the values of the subjects that were participating or not on a physiotherapeutic assistance program. Thirty-seven subjects were divided into four groups: two were formed by patients with PD (practitioners and non-practitioners of a physiotherapeutic protocol performed twice a week during 6 months) and the other two groups were formed by control peers (practitioners and non-practitioners of the same therapeutic protocol). The subjects underwent evaluation of chest cirtometry, spirometry and impulse oscillometry, being all the PD patients evaluated on the "off" state of their anti-PD medication. Data analysis occurred through the use of the non-parametric test of Kruskal-Wallis, with pairwise comparisons being done with Dunett T3 tests. Significance was set at 5%. Regarding the results, with a statistical similarity between groups for chest mobility, patients with PD who underwent the physiotherapeutic protocol showed better pulmonary parameters than sedentary patients. Comparison with control peers indicates better results of the PD group submitted to physiotherapy than sedentary controls. There were no differences in pulmonary parameters of both PD and control groups submitted to physiotherapy. In conclusion, the findings delimit promising results promoted by physiotherapy on pulmonary parameters in subjects with PD, and emphasize the need for more longitudinal studies of the clinical trial type for proof of cause and effect relationships.