ClinicalTrials.gov, NCT02103400.

No abstract

No abstract

BACKGROUND: Bronchiectasis leads to reduced functional capacity, which might have implications for physical activity. The impact of dyspnea and long-term oxygen therapy on physical activity has never been investigated in subjects with bronchiectasis. Based on these findings, specific strategies could be applied to allow individuals to be more active in their daily life. In this study we aimed to evaluate physical activity, the impact of dyspnea and long-term oxygen therapy on physical activity, and the determinants of physical activity in subjects with bronchiectasis. METHODS: We performed a cross-sectional study in 139 subjects with bronchiectasis (age 45 ؎ 13 y, FVC 70 ؎ 22% of predicted, FEV 1 54 ؎ 25% of predicted) and 49 healthy subjects as controls. Physical activity was assessed using steps per day (measured with a pedometer), spirometry, incremental shuttle walking test (ISWT), and dyspnea. RESULTS: Reduced physical activity was observed in subjects with bronchiectasis, who recorded a median (interquartile range) of 8,007 (5,131-10,432) steps/d compared with controls, who recorded 10,994 (8,551-14,078) steps/d (P < .001). Significant correlations were observed between physical activity and FVC (r ‫؍‬ 0.43), FEV 1 (r ‫؍‬ 0.36), ISWT (r ‫؍‬ 0.37), and dyspnea (r ‫؍‬ ؊0.48). Determinants for reduced physical activity included pulmonary function (R 2 ‫؍‬ 0.150), dyspnea (R 2 ‫؍‬ 0.075), ISWT (R 2 ‫؍‬ 0.044), and long-term oxygen therapy (R 2 ‫؍‬ 0.038); these factors explained 32% of the physical activity. CONCLUSION: Subjects with bronchiectasis exhibited reduced physical activity compared with healthy peers. Dyspnea has a negative impact on physical activity. Independent factors associated with physical activity included pulmonary function, dyspnea, functional capacity, and long-term oxygen therapy. These findings will guide strategies to enhance daily physical activity and to encourage subjects with bronchiectasis to be more active.

The CST and the MIST are safe and can be used as an alternative test to assess functional capacity in patients hospitalized for acute lung diseases. The worse the performance on the step tests, the lower the pulmonary function and the distance walked on the 6MWT, the greater the dyspnea, and the longer the hospitalization.

Introduction: Cardiac output increases during incremental-load exercise to meet metabolic skeletal muscle demand. This response requires a fast adjustment in heart rate and stroke volume. The heart rate is well known to increase linearly with exercise load; however, data for stroke volume during incremental-load exercise are unclear. Our objectives were to (a) review studies that have investigated stroke volume on incremental load exercise and (b) summarize the findings for stroke volume, primarily at maximal-exercise load.Methods: A comprehensive review of the Cochrane Library’s, Embase, Medline, SportDiscus, PubMed, and Web of Sci-ence databases was carried out for the years 1985 to the present. The search was performed between February and June 2014 to find studies evaluating changes in stroke volume during incremental-load exercise. Controlled and uncontrolled trials were evaluated for a quality score. Results:The stroke volume data in maximal-exercise load are inconsistent. There is evidence to hypothesis that stroke volume increases during maximal-exercise load, but other lines of evidence indicate that stroke volume reaches a plateau under these circumstances, or even decreases.Conclusion:The stroke volume are unclear, include contradictory evidence. Additional studies with standardized reporting for subjects (e.g., age, gender, physical fitness, and body position), exercise test protocols, and left ventricular function are required to clarify the characteristics of stroke volume during incremental maximal-exercise load.

Background:The 6-minute walk test (6MWT) and the Glittre ADL-test (GT) are used to assess functional capacity and exercise tolerance; however, the reproducibility of these tests needs further study in patients with acute lung diseases.Objectives:The aim of this study was to investigate the reproducibility of the 6MWT and GT performed in patients hospitalized for acute and exacerbated chronic lung diseases.Method:48 h after hospitalization, 81 patients (50 males, age: 52±18 years, FEV1: 58±20% of the predicted value) performed two 6MWTs and two GTs in random order on different days.Results:There was no difference between the first and second 6MWT (median 349 m [284-419] and 363 m [288-432], respectively) (ICC: 0.97; P<0.0001). A difference between the first and second tests was found in GT (median 286 s [220-378] and 244 s [197-323] respectively; P<0.001) (ICC: 0.91; P<0.0001).Conclusion:Although both the 6MWT and GT were reproducible, the best results occurred in the second test, demonstrating a learning effect. These results indicate that at least two tests are necessary to obtain reliable assessments.

JUSTIFICATIVA E OBJETIVOS: O desmame da ventilação mecânica é o processo de transição da ventilação mecânica para a espontânea. A prática atual do desmame mostra que o empirismo é insuficiente e inadequado. Em contrapartida, as padronizações de desmame proporcionam melhor condução no processo. O objetivo deste estudo foi avaliar os efeitos da aplicação de um protocolo de desmame da ventilação mecânica em uma unidade de terapia intensiva.