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Objetivo: Avaliar os efeitos de três programas de fisioterapia respiratória constituídos por treinamento físico (TF) em esteira e/ou treinamento muscular respiratório (TMR) em pacientes com DPOC. Métodos: Participaram deste estudo 25 pacientes com DPOC moderada-grave, de ambos os sexos, que foram divididos aleatoriamente em 3 grupos, sendo o primeiro grupo (G1) submetido a TMR com 30% da pressão inspiratória máxima obtida a cada semana, o segundo grupo (G2) submetido a TF com 70% da freqüência cardíaca atingida no teste de exercício cardiorrespiratório (TECR) sintoma-limitado e o terceiro grupo (G3) associava TMR ao TF com as mesmas intensidades citadas anteriormente. Todos os programas constituíram-se de 3 sessões semanais por 6 semanas consecutivas. Resultados: Após tratamento, foram observados aumentos significativos da força muscular respiratória (FMR) no G1; aumentos significativos da distância percorrida no TECR, redução da freqüência cardíaca e do volume minuto expirado isovelocidade e melhora do domínio da capacidade funcional do questionário de qualidade de vida no G2; aumento significativo da FMR, da distância percorrida no TECR, redução da pressão arterial sistólica e concentração sangüínea de lactato isovelocidade e melhora da qualidade de vida no G3. Conclusão: Os resultados sugerem que o TF associado ao TMR foi a melhor alternativa terapêutica dentre as investigadas no presente estudo; pois, além de proporcionar uma evidente melhora na tolerância ao esforço e na qualidade de vida dos pacientes, promoveu um efeito adicional nas adaptações fisiológicas ao exercício, com uma maior eficácia na remoção e/ou menor produção de lactato sangüíneo durante o esforço.

Este estudo teve como objetivo avaliar os elementos da mecânica respiratória, de indivíduos obesos no que se refere á força muscular respiratória, através das medidas de Pressão Respiratória Máxima (PImáx e PEmáx) e, da mobilidade tóraco abdominal, através da Amplitude Tóraco-Abdominal nos níveis: axilar (AAx), xifoidiano (AXf) e abdominal (AAb). Avaliaram-se 29 indivíduos obesos com média de idade de 43 ± 13 anos, divididos em dois grupos: Grupo Experimental (E) e Grupo Controle (C), através das medidas da PImáx e da PEmáx e Amplitude Tóraco-abdominal. O Grupo E foi submetido a 18 sessões de Reeducação Funcional Respiratória (RFR) que constituiu-se de orientação respiratória, exercícios de coordenação da respiração associados aos movimentos de tronco e membros, alongamento geral da musculatura e relaxamento muscular, 2 vezes por semana, durante 9 semanas. Constatou-se, através do Teste-t de Student (p<0.05), que não ocorreram diferenças significativas nos valores da PEmáx em ambos os grupos estudados mas, a PImax, a AXif e a AAbd aumentaram significativamente no E. Esses resultados permitem concluir que a RFR causou um aumento na força muscular inspiratória e das amplitudes tóraco-abdominais desses indivíduos obesos.

BACKGROUND: Patients with COPD may experience respiratory muscle weakness. Two therapeutic approaches to the respiratory muscles are inspiratory muscle training and calisthenics-andbreathing exercises. The aims of the study are to compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion. In addition, these gains were compared between subjects with and without respiratory muscle weakness. METHODS: 25 subjects completed the study: 13 composed the inspiratory muscle training group, and 12 composed the calisthenics-and-breathing exercises group. Subjects were assessed before and after training by spirometry, measurements of respiratory muscle strength and test of inspiratory muscle endurance, thoracoabdominal excursion measurements, and the 6-min walk test. Moreover, scores for the Modified Medical Research Council dyspnea scale were reported. RESULTS: After intervention, there was a significant improvement in both groups of respiratory muscle strength and endurance, thoracoabdominal mobility, and walking distance in the 6-min walk test. Additionally, there was a decrease of dyspnea in the 6-min walk test peak. A difference was found between groups, with higher values of respiratory muscle strength and thoracoabdominal mobility and lower values of dyspnea in the 6-min walk test peak and the Modified Medical Research Council dyspnea scale in the inspiratory muscle training group. In the inspiratory muscle training group, subjects with respiratory muscle weakness had greater gains in inspiratory muscle strength and endurance. CONCLUSIONS: Both interventions increased exercise capacity and decreased dyspnea during physical effort. However, inspiratory muscle training was more effective in increasing inspiratory muscle strength and endurance, which could result in a decreased sensation of dyspnea. In addition, subjects with respiratory muscle weakness that performed inspiratory muscle training had higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity. (ClinicalTrials.gov registration NCT01510041.)

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The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH 2 O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

BACKGROUND: Six-minute step test (6MST) has been used to assess functional capacity in chronic conditions; however, its reproducibility in the COPD population has not been evaluated. Our study objective was to evaluate 6MST reproducibility. METHODS: The test was performed in a single 20-cm height step, and subjects were instructed to step up and down (cadence-free) for 6 min. Subjects underwent three tests. The first and second were controlled by the same assessor with a 30-min interval. The third test was controlled by a different assessor one week later. For intrarater comparison, the first and second performances of the test were used, and for inter-assessor comparison, the better performance of the first two tests was compared with the third test. RE-SULTS: Excellent intra-rater and inter-rater relative reproducibility was observed (intraclass correlation coefficient > 0.8), and there was no statistical difference (repeated measures of analysis of variance) among the performances of the three tests. Intra-rater error values were acceptable (mean error of 5.7 steps and limits of agreement between ؊7 and 18 steps). Inter-rater error values were not acceptable (mean error of 4.4 steps and limits of agreement between ؊20 and 29 steps. CONCLUSIONS: 6MST proved to be reproducible in the COPD population when performed by the same assessor.

BackgroundSickle Cell Disease (SCD), which is characterized by a mutation in the gene encoding beta hemoglobin, causes bodily dysfunctions such as impaired pulmonary function and reduced functional capacity. ObjectiveTo assess changes in pulmonary function and functional capacity in patients with SCD and to identify the relationships between these variables.MethodWe evaluated sociodemographic, anthropometric, lung function (spirometry), respiratory (manovacuometer), peripheral muscle strength (Handgrip strength - HS) and functional capacity (i.e., the six-minute walk test) parameters in 21 individuals with SCD (average age of 29±6 years). Shapiro-Wilk, paired Student's, Wilcoxon, Pearson and Spearman correlation tests were used for statistical analyses, and the significance threshold was set at p<0.05. ResultsA total of 47.6% of the study subjects exhibited an altered ventilation pattern, 42.8% had a restrictive ventilatory pattern (RVP) and 4.8% exhibited a mixed ventilatory pattern (MVP). The observed maximal inspiratory pressure (MIP) values were below the predicted values for women (64 cmH2O), and the maximum expiratory pressure (MEP) values, HS values and distance walked during the 6MWT were below the predicted values for both men (103 cmH2O, 39 Kgf and 447 m, respectively) and women (64 cmH2O; 27 Kgf; 405 m, respectively). Positive correlations were observed between maximum voluntary ventilation (MVV) and MEP (r=0.4; p=0.046); MVV and BMI (r=0.6; p=0.003); and between HS and MIP (r=0.7; p=0.001), MEP (r=0.6; p=0.002), MVV (r=0.5; p=0.015), distance walked in the 6MWT (r=0.4; p=0.038) and BMI (r=0.6; p=0.004). ConclusionsSCD promoted changes in lung function and functional capacity, including RVPs and a reduction in the distance walked in the 6MWT when compared to the predictions. In addition, significant correlations between the variables were observed.