The Incremental Shuttle Walk Test in Older Brazilian Adults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection

OBJETIVO: Verificar se os testes: Volume Expiratório Forçado no 1º segundo (VEF1), Teste de Caminhada de 6 minutos (TC6) e Teste de Escada (TE) se alteram proporcionalmente ao pulmão funcionante ressecado. MÉTODOS: Foram incluídos pacientes candidatos a toracotomia para ressecção pulmonar. No pré-operatório (pré) e no mínimo três meses após a cirurgia (pós), realizaram espirometria, TC6 e TE. O TE foi realizado em escada com 12,16m de altura. O tempo para subir todos os degraus o mais rápido possível foi chamado tempo de escada (tTE). Os cálculos dos valores dos testes preditos para o pós-operatório (ppo) foram realizados conforme o número de segmentos funcionantes perdidos. Os valores pré, ppo e pós foram comparados entre si para cada teste. Estatística: foi utilizada a análise de variância para medidas repetidas (ANOVA), com significância de 5%. RESULTADOS: Foram estudados 40 pacientes. A ressecção pulmonar variou desde o ganho de dois segmentos funcionantes até a perda de 9. Os valores pré, ppo e pós foram respectivamente: VEF1 -pré = 2,6±0,8L, ppo = 2,3±0,8L, pós = 2,3±0,8L (VEF1pré > VEF1ppo = VEF1pós), TC6-pré = 604±63m, ppo = 529±103m, pós = 599±74m (TC6pré = TC6pós > TC6ppo), tTE-pré = 32,9±7,6s, ppo = 37,8±12,1s, pós = 33,7±8,5s (tTEpré = tTEpós < tTEppo). CONCLUSÃO: Nas ressecções pulmonares, este grupo de pacientes perdeu função pulmonar medida através da espirometria, mas não perdeu a capacidade de exercício, medida através dos testes de escada e caminhada.

Perfil do nível de atividade física na vida diária de pacientes portadores de DPOC no Brasil

Objective: To evaluate characteristics of physical activities in daily life in COPD patients in Brazil, correlating those Characteristics with physiological variables. Methods: Physical activities in daily life were evaluated in 40 COPD patients (18 males; 66 +/- 8 years of age; FEV(1) = 46 +/- 16 % of predicted; body mass index = 27 +/- 6 kg/m(2)) and 30 healthy age- and gender-matched subjects, using a multiaxial accelerometer-based sensor for 12 h/day on two consecutive days. We also assessed maximal and functional exercise capacity, using the incremental exercise test and the six-minute walk test (6MWT), respectively; MIP and MEP; peripheral muscle force, using the one-repetition maximum test and the handgrip test; quality of life, using the Saint George's Respiratory Questionnaire (SGRQ); functional status, using the London Chest Activity of Daily Living questionnaire; and dyspnea sensation, using the Medical Research Council (MRC) scale. Results: Mean walking time/day was shorter for COPD patients than for the controls (55 +/- 33 vs. 80 +/- 28 min/day; p = 0.001), as movement intensity was lower (1.9 +/- 0.4 vs. 2.3 +/- 0.6 m/s(2); p = 0.004). The COPD patients also tended to spend more time seated (294 +/- 114 vs. 246 +/- 122 min/day, p = 0.08). Walking time/day correlated with the 6MWT (r = 0.42; p = 0.007) and maximal workload (r = 0.41; p = 0.009), as well as with age, MRC scale score and SGRQ activity domain score (-0.31 <= r <= -0.43; p <= 0.05 for all). Conclusions: This sample of Brazilian patients with COPD, although more active than those evaluated in studies conducted in Europe, were less active than were the controls. Walking time/day correlated only moderately with maximal and functional exercise capacity.

Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

Exercise capacity and quality of life (QOL) are important outcome predictors in patients with systolic heart failure (HF), independent of left ventricular (LV) ejection fraction (LVEF). LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA) classification >II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women), with LVEF,0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT). In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis). No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF.

Caracterização do perfil de atividade física na vida diária de pacientes portadores de DPOC do Brasil e comparação com pacientes da Áustria

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evolução de pacientes portadores de peumopatias crônicas e hipoxemia transitória ao esforço tratados com oxigenoterapia domiciliar prolongada durante o sono e ao esforço

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Do muscle strengthening exercises improve performance in the 6-minute walk test in postmenopausal women?

Background: Walking speed seems to be related to aerobic capacity, lower limb strength, and functional mobility, however it is not clear whether there is a direct relationship between improvement in muscle strength and gait performance in early postmenopausal women. Objective: To evaluate the effect of muscle strengthening exercises on the performance of the 6-minute walk test in women within 5 years of menopause. Methods: The women were randomized into control group (n=31), which performed no exercise, and exercise group (n=27), which performed muscle strengthening exercises. The exercises were performed twice a week for 3 months. The exercise protocol consisted of warm-up, stretching, and strengthening of the quadriceps, hamstring, calf, tibialis anterior, gluteus maximus, and abdominal muscles, followed by relaxation. Muscular strength training started with 60% of 1MR (2 series of 10-15 repetitions), reaching 85% until the end of the 3-month period (4 series of 6 repetitions each). Results: The between-group comparisons pre- and post-intervention did not show any difference in distance walked, heart rate or blood pressure (p>0.05), but showed differences in muscle strength post-intervention, with the exercise group showing greater strength (p<0.05). In the within-group comparison, there were differences in final heart rate and quadriceps and hamstring strength pre- and post-intervention in the exercise group (p<0.05). Conclusion: The results suggest that muscle strengthening of the lower limbs did not improve performance in the 6-minute walk test in this population of postmenopausal women. Trial registration ACTRN12609001053213.

Sleep desaturation and its relationship to lung function, exercise and quality of life in LAM

Background: Lymphangioleiomyomatosis (LAM) is characterised by progressive airway obstruction and hypoxaemia in young women. Although sleep may trigger hypoxaemia in patients with airway obstruction, it has not been previously investigated in patients with LAM. Methods: Consecutive women with lung biopsy proven LAM and absence of hypoxaemia while awake were evaluated with pulmonary function test, echocardiography, 6-min walk test, overnight full polysomnography, and Short Form 36 health-related quality-of-life questionnaire. Results: Twenty-five patients with (mean +/- SD) age 45 +/- 10 years, SpO(2) awake 95% +/- 2, forced expiratory volume in the first second (median-interquartile) FEV1 (% predicted) 77 (47-90) and carbonic monoxide diffusion capacity, DLCO (%) 55 (34-74) were evaluated. Six-minute walk test distance and minimum SpO(2) (median-interquartile) were, respectively, 447 m (411 -503) and 90% (82-94). Median interquartile apnoea-hypopnoea index was in the normal range 2 (1-5). Fourteen patients (56%) had nocturnal hypoxaemia (10% total sleep time with SpO(2) <90%), and the median sleep time spent with SpO(2) <90% was 136 (13-201) min. Sleep time spent with SpO(2) <90% correlated with the residual volume/total lung capacity ratio (r(s) = 0.5, p: 0.02), DLCO (r(s) = -0.7, p: 0.001), FEV1 (r(s) = -0.6, p: 0.002). Multivariate linear regression model showed that RV/TLC ratio was the most important functional variable related to sleep hypoxaemia. Conclusion: Significant hypoxaemia during sleep is common in LAM patients with normal SpO(2) while awake, especially among those with some degree of hyperinflation in lung function tests. (C) 2011 Published by Elsevier Ltd.

The utility of preoperative six-minute-walk distance in lung transplantation

RATIONALE The use of 6-minute-walk distance (6MWD) as an indicator of exercise capacity to predict postoperative survival in lung transplantation has not previously been well studied. OBJECTIVES To evaluate the association between 6MWD and postoperative survival following lung transplantation. METHODS Adult, first time, lung-only transplantations per the United Network for Organ Sharing database from May 2005 to December 2011 were analyzed. Kaplan-Meier methods and Cox proportional hazards modeling were used to determine the association between preoperative 6MWD and post-transplant survival after adjusting for potential confounders. A receiver operating characteristic curve was used to determine the 6MWD value that provided maximal separation in 1-year mortality. A subanalysis was performed to assess the association between 6MWD and post-transplant survival by disease category. MEASUREMENTS AND MAIN RESULTS A total of 9,526 patients were included for analysis. The median 6MWD was 787 ft (25th-75th percentiles = 450-1,082 ft). Increasing 6MWD was associated with significantly lower overall hazard of death (P < 0.001). Continuous increase in walk distance through 1,200-1,400 ft conferred an incremental survival advantage. Although 6MWD strongly correlated with survival, the impact of a single dichotomous value to predict outcomes was limited. All disease categories demonstrated significantly longer survival with increasing 6MWD (P ≤ 0.009) except pulmonary vascular disease (P = 0.74); however, the low volume in this category (n = 312; 3.3%) may limit the ability to detect an association. CONCLUSIONS 6MWD is significantly associated with post-transplant survival and is best incorporated into transplant evaluations on a continuous basis given limited ability of a single, dichotomous value to predict outcomes.

Does the 6-minute walk test predicts functional capacity in a sample of elderly women? A pilot study

Introduction: Functional capacity is the capacity to conduct daily activities in an independent way. It can be estimated with the 6-minutes’ walk test (6MWT) and other validated functional tests. Objectives: Verify associations between functional capacity measured with two different instruments (6MWT and Composite Physical Function (CPF) scale) and levels of physical activity and between those and characterization variables. Methods: This sample consisted of 30 apparently healthy elderly women from Loures municipality. Essentially they should be independent and community-dwelling. Characterization data were collected, containing characterization of physical activity levels and anthropometric data. Functional capacity was assessed with CPF scale and distance walked by the 6MWT. Results were analysed using a SPSS v21.0 through correlation tests. Results: The walked distance in 6MWT was positively associated with height (r = 0.406; p = 0.026), physical activity level (r = 0.594; p = 0.001) and functional capacity (r = 0.682; p = 0.000). For each point more obtained in CPF, the distance walked increases on average by 7.5 meters. Relatively to sedentary participants, being insufficiently active increases, on average, the distance walked in 85.8 meters; and being active increases, on average, the distance walked in 108.8 meters. No other associations were observed in our sample. Conclusion: Based on the collected sample, walked distance in 6MWT has a high correlation with results in CPF scale, so this test can be used to predict functional capacity. More attention should be taken to promote strategies to increase walking in older adults.

Efecto de un programa de ejercicio aeróbico y un programa de circuito con pesas sobre la calidad de vida, disnea y resistencia cardiorrespiratoria en sujetos con enfermedad pulmonar crónica

El objetivo de este estudio fue determinar el efecto de un programa de ejercicio aeróbico y un programa de circuito con pesas sobre la calidad de vida, disnea y resistencia cardiorrespiratoria en sujetos con Enfermedad Pulmonar Crónica (EPC). Metodología: el programa de rehabilitación se hizo durante ocho semanas, se realizó un pretest y un postest, se cumplió con una sesión semanal presencial, y las otras dos domiciliarias, se tuvo comunicación directa vía telefónica los días que realizaban el ejercicio en la casa. Instrumentos: el cuestionario St. George Respiratory Questonnaire para medir calidad de vida, la escala de Borg para medir la disnea y el test de caminata de los 6 min. para medir la resistencia cardiorrespiratoria. Sujetos: participaron 38 personas con diagnóstico previo de EPC, 18 hombres y 20 mujeres; 27 sujetos con patología obstructiva y 11 sujetos con restrictiva., con una edad promedio de 69.8 ± 9.34 años, divididos aleatoriamente en dos grupos, uno que realizó ejercicio aeróbico (22 sujetos) y otro que ejecutó ejercicio aeróbico y de contrarresistencia con pesas (16 sujetos). Análisis estadístico: ANOVA mixta de cuatro vías (2x2x2x2) para las variables mediciones, sexo, tratamiento y patología. Resultados: se encontraron diferencias significativas entre mediciones para la variable disnea (pre: 7.18 ± 0.69 puntos y post: 4.89 ± 0.68 puntos) (F = 228.770; p < 0,05), calidad de vida (pre: 59.68 ± 7.50 puntos y post 81.75 ± 7.33 puntos) (F = 228.770; p < 0,05), resistencia cardiorrespiratoria (pre 384,95 ± 51,02 mts. y post 432 ± 37,41 mts.) (F: 59.9; p<0.01), pero no se encontraron diferencias por sexo, actividad ni enfermedad (p>0,05), ni interacción entre las variable (p>0,05). Conclusión: la realización de ejercicio físico aeróbico y anaeróbico mejoran el grado de disnea, la calidad de vida y resistencia cardiorrespiratoria en pacientes con EPC.

Relações entre aptidão fisica, sexo, idade, nivel de atividade fisica e supervisão dos exercicios em individuos fisicamente ativos de 50 a 79 anos de idade

Universidade Estadual de Campinas . Faculdade de Educação Física

Shwachman-Kulczycki score still useful to monitor cystic fibrosis severity

INTRODUCTION: The Shwachman-Kulczycki score was the first scoring system used in cystic fibrosis to assess disease severity. Despite its subjectivity, it is still widely used. OBJECTIVE: To study correlations among forced expiratory volume in one second (FEV1), chest radiography, chest computed tomography, 6-minute walk test, and Shwachman-Kulczycki score in patients with cystic fibrosis and to test whether the Shwachman-Kulczycki score is still useful in monitoring the severity of the disease. METHODS: A cross-sectional prospective study was performed to analyze the correlations (Spearman). Patients with clinically stable cystic fibrosis, aged 3-21 years, were included. RESULTS: 43 patients, 19F/24M, mean age 10.5 + 4.7 years, with a median Shwachman-Kulczycki score of 70 were studied. The median Brasfield and Bhalla scores were 17 and 10, respectively. The mean Z score for the 6-minute walk test was -1.1 + 1.106 and the mean FEV1 was 59 + 26 (as percentage of predicted values). The following significant correlations versus the Shwachman-Kulczycki score were found: FEV1 (r = 0.76), 6-minute walk test (r = 0.71), chest radiography (r = 0.71) and chest computed tomography (r = -0.78). When patients were divided according to FEV1, a statistically significantly correlation with the Shwachman-Kulczycki score was found only in patients with FEV1 <70% (r = 0.67). CONCLUSIONS: The Shwachman-Kulczycki score remains an useful tool for monitoring the severity of cystic fibrosis, adequately reflecting the functional impairment and chest radiography and tomography changes, especially in patients with greater impairment of lung function. When assessing patients with mild lung disease its limitations should be considered and its usefulness in such patients should be evaluated in larger populations.