The presence of a physiotherapist in the intensive care unit contributes decisively to the early recovery of the patient, reducing mechanical ventilation support need, number of hospitalization days, incidence of respiratory infection and risk of mortality.

Impairment of body balance is more frequent in patients with COPD than in healthy persons while performing dynamic activities, and a greater incidence of falls activities was also found for this group.

Patients with chronic obstructive pulmonary disease (COPD) fall frequently, although the risk of falls may seem less important than the respiratory consequences of the disease. Nevertheless, falls are associated to increased mortality, decreased independence and physical activity levels, and worsening of quality of life. The aims of this systematic review was to evaluate information in the literature with regard to whether impaired postural control is more prevalent in COPD patients than in healthy age-matched subjects, and to assess the main characteristics these patients present that contribute to impaired postural control.MethodsFive databases were searched with no dates or language limits. The MEDLINE, PubMed, EMBASE, Web of Science, and PEDro databases were searched using “balance”, “postural control”, and “COPD” as keywords. The search strategies were oriented and guided by a health science librarian and were performed on March 27, 2014. The studies included were those that evaluated postural control in COPD patients as their main outcome and scored more than five points on the PEDro scale. Studies supplied by the database search strategy were assessed independently by two blinded researchers.ResultsA total of 484 manuscripts were found using the “balance in COPD or postural control in COPD” keywords. Forty-three manuscripts appeared more than once, and 397 did not evaluate postural control in COPD patients as the primary outcome. Thus, only 14 studies had postural control as their primary outcome. Our study examiners found only seven studies that had a PEDro score higher than five points. The examiners’ interrater agreement was 76.4%. Six of those studies were accomplished with a control group and one study used their patients as their own controls. The studies were published between 2004 and 2013.ConclusionPatients with COPD present postural control impairment when compared with age-matched healthy controls. Associated factors contributing to impaired postural control were muscle weakness, physical inactivity, elderly age, need for supplemental oxygen, and limited mobility.

The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of these ADLs.

Background. Comprehensive exercise training (CET) is an efficient strategy to decrease dyspnea perception in chronic obstructive pulmonary disease (COPD) and may result in significant improvement in ventilatory muscles function. Our aim was to evaluate the effects of general exercise training on dyspnea perception and on respiratory muscles strength in COPD patients. Methods. Consecutive COPD patients were enrolled to complete a CET programme. The patients underwent a routine that included a global warm up, upper and lower limbs endurance exercise as well as stretching and relaxation. Before and after the CET programme, patients completed maximal inspiratory (PImax) and expiratory (PEmax) pressures measurements, maximal incremental test, endurance test, and 6-min walk distance (6MWD). Results. 71 patients (52 male). Mean age 67.6±8.6 years, FEV1 (%) 44.2±16.2 and Mahler dyspnea scale 6.4±1.8. The results before and after the exercise programme were: PImax 64.7±22.9 vs. 75.5±23.7 cmH2O (p=0.001), PEmax 110.8±28.1 vs. 120.4±28.1 cmH2O (p=0.004), 6MWD 510.6±90.3 vs. 528.2±99.7 metres (p=0.88), time of incremental test 672±135 vs. 856±226 sec (p&lt;0.0001). Compared with the pre exercise programme, we observed a significant reduction on Borg dyspnea scale (6.1±2.8 to 3.6±2.3, p&lt;0.0001) as well as a longer test time (504±218 to 1.038±841, p&lt;0.0001) at the end of the endurance test after CET programme. Improvement of PImax correlated negatively with dyspnea perception at iso-time during the endurance test (r= -0.33, p=0.03). Conclusions. Our results confirm that CET is associated with significant improvement in PImax, PEmax and provide evidence demonstrating that CET reduces dyspnea perception in patients with COPD.

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Exercise with the upper part of the body causes more DH and dyspnea than exercise with the lower part of the body at the same metabolic demand.

Introduction: Fibromyalgia affects 8% of the population over the age of 40 years, and 75% of the patients with fi bromyalgia have poor sleep quality. Objective: To assess the effects of hydrotherapy on the physical function and sleep quality of patients with fi bromyalgia. Methods: Patients were under clinical care at the UNASP Outpatient Clinic. This study assessed 60 female patients with fi bromyalgia aged between 30 and 65 years. Out of the 60 patients assessed, 20 were excluded and 10 left the study because they could not comply with the time schedule. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ); Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Training sessions were performed twice a week for two months, each session lasting 60 minutes. Results: Patients' mean age was 45 years, 66% were active workers, and 34% had quit work. Right after the hydrotherapy program, the patients improved the following aspects assessed by use of the FIQ: physical function, work absenteeism, ability to do job, pain intensity, fatigue, morning tiredness, stiffness (P < 0.0001), anxiety (P = 0,0013), and depression (P < 0.0001). Sleep quality (P < 0.0001) and daytime sleepiness (P = 0.0003) also improved. Conclusion: Hydrotherapy improves sleep quality, physical function, professional status, psychological disorders and physical symptoms in patients with fi bromyalgia.