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Shimal H. Hamad, Ammar Hamza Hadi, Bestoon Akram Ahmad. Effect of lower torso training on asthma patients. PHYSICAL REHABILITATION AND RECREATIONAL HEALTH TECHNOLOGIES 2023; 8:13-21. [DOI: 10.15391/prrht.2023-8(1).02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Purpose: the researchers see that this project is significant for asthma patients to help them improve. Therefore, this study hypothesizes that lower torso muscle endurance may affect 6MWT in asthma patients. To test this hypothesis, we examined the effect of decreased thoracic muscular endurance on asthma patients' 6-minute walk test (6MWT).
Material & Methods: this study included two groups (experimental and control), and they used a quantitative descriptive technique and achieved Pre – Post tests research design. The researcher began by administering a pre-test to the two groups. Researchers then carried out the therapy to experiment group, whereas the control group used the hospital protocol. Following the conclusion of the treatment, the researcher conducted a post-test for both groups. The program of the treatment's impact may be determined precisely by comparing the pre-and post-test findings. The trial lasted 24 meetings, with training occurring three times a week. On many occasions, twenty asthmatic patients from Imam Sadiq Hospital who had been hospitalized at a pulmonary rehabilitation center were assessed. Patients were included if they met the global effort for asthma recommendations for asthma diagnosis. The current study employed an experimental design. This study evaluated the maximal inspiratory pressure (PI, max), the pulmonary function test, the baseline dyspnea index (BDI), and the six-minute walk test (6MWT). Each exercise (leg extension and leg press) on gymnasium equipment was assigned a one-minute repetition. Additionally, the St. George Respiratory Questionnaire (SGRQ) was used to determine a person's quality of life. The researchers discovered that a training program had statistically significant favorable impacts on the 6MWT and body weight.
Conclusion: this study's findings demonstrated the critical role of lower torso training in achieving submaximal exercise tolerance. Additionally, they may pave the way for new avenues for training programs aimed at increasing functional activity in asthma patients.
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The Effect of Threshold Loading Training and an Innovative Respiratory Training Devices with Lower Torso Sports Training in Asthma Patients: A Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3049804. [PMID: 36852293 PMCID: PMC9966570 DOI: 10.1155/2023/3049804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/15/2023] [Accepted: 02/06/2023] [Indexed: 02/20/2023]
Abstract
This study investigated the influence of two different devices with lower torso sports training in patients with asthma. Patients with asthma (n = 300) aged 55-60 years with FEV1/FVC ratio < 65%, who were repeatedly admitted to a pulmonary rehabilitation centre, participated. Patients were evaluated and randomized into two groups (experimental group 1; EXP-1, n = 150, who applied a conventional threshold loading device, and experimental group 2; EXP-2, n = 150, who used an innovative respiratory training device). Patients were included only if they met the global criteria for asthma. The experimental intervention period lasted 10 weeks with 3 weekly training sessions lasting 30-40 min. The maximal inspiratory pressure (PI, max), pulmonary function test, baseline dyspnoea index (BDI), oxygen saturation, and 6 min walking test (6MWT) performance were all measured at baseline and postintervention. Also, an assessment of the 1 min repeated exercise performance (leg extension and leg press) was performed. Moreover, St. George Respiratory Questionnaire was used to quantify the quality of life (SGRQ). Statistical analysis displayed significant favourable effects on 6MWT, leg press, and FRV1, for patients using both devices (EXP-1 and EXP-2, respectively) with lower torso athletic training. The other variables, weight SPO2 and SGRO, also showed no significant change in neither EXP-1 nor EXP-2. Thus, the new respiratory training device (EXP-2) appeared to be as effective as the conventional threshold loading device (EXP-1). In conclusion, our findings demonstrated beneficial effects of combining respiratory training with athletic training in asthma patients. Additionally, the validity of a unique respiratory training device for asthma patients was confirmed.
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Fonseca J, Machado FVC, Santin LC, Andrello AC, Schneider LP, Fernandes Belo L, Rodrigues A, Fernandes Rugila D, Furlanetto KC, Hernandes NA, Pitta F. Handgrip Strength as a Reflection of General Muscle Strength in Chronic Obstructive Pulmonary Disease. COPD 2021; 18:299-306. [PMID: 33961519 DOI: 10.1080/15412555.2021.1919608] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Muscle dysfunction is one of the main features in individuals with chronic obstructive pulmonary disease (COPD). Handgrip strength (HS) has been used as a representation of general muscle strength in various populations, and a few studies found correlation between HS and other measures of upper and lower limbs' muscle strength in the general population, although this was not yet studied in depth in COPD. The aims of this study were to verify if HS is cross-sectionally well correlated with upper and lower limbs' muscle strength in individuals with COPD, and to identify a new cutoff for handgrip weakness in this population. HS was assessed by a dynamometer, whereas other muscle strength assessments comprised maximal voluntary contraction (MVC) of the quadriceps femoris and 1-repetition maximum (1RM) of biceps and triceps brachii, pectoralis major, latissimus dorsi and quadriceps femoris. Additional assessments included pulmonary function and volumes, body composition and exercise capacity. Fifty individuals with COPD were studied (65 ± 7 years; FEV1 51 ± 14%pred). HS showed moderate-to-strong correlations with all 1-RM assessments (0.62<r < 0.75) and especially with MVC of the quadriceps femoris (r = 0.83) (p < 0.05 for all). Correlations were stronger for male than female individuals, and the assessment performed on right, left or dominant hand did not present significant differences. A cutoff of 0.3892 for HS/weight yielded an AUC = 0.90 to identify weakness. In conclusion, HS is a good reflection of upper and lower limbs' muscle strength in individuals with COPD. Its usefulness as a surrogate for more complex assessments must be based on the settings and conditions.
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Affiliation(s)
- Jéssica Fonseca
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Felipe Vilaça Cavallari Machado
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laís Carolini Santin
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Ana Carolina Andrello
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Antenor Rodrigues
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Rehabilitation Aimed at Muscle Performance Laboratory - RAMP, Department of Physiotherapy, University of Toronto, Toronto, ON, Canada
| | - Diery Fernandes Rugila
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Biological and Health Sciences Research Center, University Pitágoras UNOPAR, Londrina, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Biological and Health Sciences Research Center, University Pitágoras UNOPAR, Londrina, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
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Rodrigues A, Camillo CA, Furlanetto KC, Paes T, Morita AA, Spositon T, Donaria L, Ribeiro M, Probst VS, Hernandes NA, Pitta F. Cluster analysis identifying patients with COPD at high risk of 2-year all-cause mortality. Chron Respir Dis 2020; 16:1479972318809452. [PMID: 30428721 PMCID: PMC6301836 DOI: 10.1177/1479972318809452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of the article is to identify clusters of patients with COPD according to factors known to be associated with mortality and to verify whether clusters' assignment is associated with 2-year mortality. Patients ( n = 141) were evaluated by bioelectrical impedance, maximal inspiratory pressure (MIP), one-repetition maximum test of the quadriceps femoris (1RMQF) and BODE index (body mass index; airflow obstruction (spirometry); dyspnea (modified Medical Research Council scale); and exercise capacity (6-minute walk test (6MWT) distance). Vital status was retrospectively checked 2 years after the assessments, and time to death was quantified for those deceased in this period. K-means analysis identified two clusters. Patients in cluster one (CL I, n = 69) presented an impaired clinical status in comparison to cluster two (CL II, n = 72). Receiver operating characteristics curves identified the cutoffs discriminating patients composing CL I: forced expiratory volume in the first second <44%pred; 6MWT <479 m; 1RMQF <19 kg; and maximum inspiratory pressures <73 cmH2O (area under the curve range 0.750-0.857). During the follow-up, 19 (13%) patients deceased, 15 in CL I (22%) and 4 in CL II (0.06%) ( p = 0.005). CL I was associated with a higher risk of 2-year mortality (hazard ratio (95% confidence interval): 4.3 (1.40-12.9), p = 0.01). A cluster of patients with COPD highly associated with 2-year mortality was statistically identified, and cutoffs to identify these subjects were provided.
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Affiliation(s)
- Antenor Rodrigues
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil.,2 Departament of Physiotheraphy, Faculdade Pitágoras de Londrina, Londrina, Paraná, Brazil
| | - Carlos Augusto Camillo
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Karina Couto Furlanetto
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil.,3 Center of Health and Biological Sciences, Universidade do Norte do Paraná, Londrina, Brazil
| | - Thais Paes
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Andrea Akemi Morita
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Thamyres Spositon
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Leila Donaria
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil.,3 Center of Health and Biological Sciences, Universidade do Norte do Paraná, Londrina, Brazil
| | - Marcos Ribeiro
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil.,4 Section of Pulmonology, Department of Medicine, Health Science Centre, Universidade Estadual de Londrina, Londrina, Brazil
| | - Vanessa Suziane Probst
- 5 Center for Research and Post-Graduation in Health Sciences (CEPPOS), Health Sciences Center, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Nidia Aparecida Hernandes
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- 1 Laboratory of Research in Respiratory Physiotherapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, Brazil
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Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap? Lung 2019; 198:135-141. [PMID: 31873783 DOI: 10.1007/s00408-019-00311-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/16/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.
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Mesquita CB, Knaut C, Caram LMDO, Ferrari R, Bazan SGZ, Godoy I, Tanni SE. Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year. ACTA ACUST UNITED AC 2019; 44:390-397. [PMID: 30517340 PMCID: PMC6467586 DOI: 10.1590/s1806-37562017000000019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/14/2018] [Indexed: 12/13/2022]
Abstract
Objective: To determine the impact of adherence to long-term oxygen therapy (LTOT) on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia followed for one year. Methods: Patients experiencing severe hypoxemia during a six-minute walk test (6MWT) performed while breathing room air but not at rest were included in the study. At baseline and after one year of follow-up, all patients were assessed for comorbidities, body composition, SpO2, and dyspnea, as well as for anxiety and depression, having also undergone spirometry, arterial blood gas analysis, and the 6MWT with supplemental oxygen. The Saint George’s Respiratory Questionnaire (SGRQ) was used in order to assess quality of life, and the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index was calculated. The frequency of exacerbations and the mortality rate were noted. Treatment nonadherence was defined as LTOT use for < 12 h per day or no LTOT use during exercise. Results: A total of 60 patients with COPD and exertional hypoxemia were included in the study. Of those, 10 died and 11 experienced severe hypoxemia during follow-up, 39 patients therefore being included in the final analysis. Of those, only 18 (46.1%) were adherent to LTOT, showing better SGRQ scores, higher SpO2 values, and lower PaCO2 values than did nonadherent patients. In all patients, SaO2, the six-minute walk distance, and the BODE index worsened after one year. There were no differences between the proportions of adherence to LTOT at 3 and 12 months of follow-up. Conclusions: Quality of life appears to be lower in patients with COPD and exertional hypoxemia who do not adhere to LTOT than in those who do. In addition, LTOT appears to have a beneficial effect on COPD symptoms (as assessed by SGRQ scores). (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-9b4v63 [http://www.ensaiosclinicos.gov.br])
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Affiliation(s)
- Carolina Bonfanti Mesquita
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Caroline Knaut
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Laura Miranda de Oliveira Caram
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Renata Ferrari
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Silmeia Garcia Zanati Bazan
- . Disciplina de Cardiologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Irma Godoy
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Disciplina de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
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Prudente R, Franco EAT, Mesquita CB, Ferrari R, de Godoy I, Tanni SE. Predictors of mortality in patients with COPD after 9 years. Int J Chron Obstruct Pulmon Dis 2018; 13:3389-3398. [PMID: 30410324 PMCID: PMC6198887 DOI: 10.2147/copd.s174665] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years. Patients and methods One hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO2), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI). Results After 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65±9 years old, and FEV1: 52.5 [40%–73%]). Male sex, age, SpO2, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36–5.04; P=0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15–5.61; P=0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11–75.75; P=0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00–1.68; P=0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00–1.76; P=0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index ≤21 kg/m2 showed increased risk of death compared to those with body mass index (BMI)>21 kg/m2 (HR: 2.70, 95% CI: 1.38–5.25; P=0.003). Conclusion After 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI ≤21 kg/m2 showed increased risk of death.
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Affiliation(s)
- Robson Prudente
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | | | - Carolina Bonfanti Mesquita
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | - Renata Ferrari
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | - Irma de Godoy
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | - Suzana Erico Tanni
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
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Fonseca FR, Karloh M, Araujo CLPD, Reis CMD, Mayer AF. Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD. J Bras Pneumol 2018; 44:315-320. [PMID: 30328930 PMCID: PMC6326721 DOI: 10.1590/s1806-37562017000000121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the validity of an eight-contact electrode bioelectrical impedance analysis (BIA) system within a household scale for assessing whole body composition in COPD patients. METHODS Seventeen patients with COPD (mean age = 67 ± 8 years; mean FEV1 = 38.6 ± 16.1% of predicted; and mean body mass index = 24.7 ± 5.4 kg/m2) underwent dual-energy X-ray absorptiometry (DEXA) and an eight-contact electrode BIA system for body composition assessment. RESULTS There was a strong inter-method correlation for fat mass (r = 0.95), fat-free mass (r = 0.93), and lean mass (r = 0.93), but the correlation was moderate for bone mineral content (r = 0.73; p < 0.01 for all). In the agreement analysis, the values between DEXA and the BIA system differed by only 0.15 kg (-6.39 to 6.70 kg), 0.26 kg (-5.96 to 6.49 kg), -0.13 kg (-0.76 to 0.50 kg), and -0.55 kg (-6.71 to 5.61 kg) for fat-free mass, lean mass, bone mineral content, and fat mass, respectively. CONCLUSIONS The eight-contact electrode BIA system showed to be a valid tool in the assessment of whole body composition in our sample of patients with COPD.
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Affiliation(s)
- Fernanda Rodrigues Fonseca
- . Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | - Manuela Karloh
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | - Cintia Laura Pereira de Araujo
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | - Cardine Martins Dos Reis
- . Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | - Anamaria Fleig Mayer
- . Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
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Doña E, Olveira C, Palenque FJ, Porras N, Dorado A, Martín-Valero R, Godoy AM, Espíldora F, Contreras V, Olveira G. Body Composition Measurement in Bronchiectasis: Comparison between Bioelectrical Impedance Analysis, Skinfold Thickness Measurement, and Dual-Energy X-ray Absorptiometry before and after Pulmonary Rehabilitation. J Acad Nutr Diet 2018; 118:1464-1473. [PMID: 29656933 DOI: 10.1016/j.jand.2018.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In individuals with bronchiectasis, fat-free mass depletion may be common despite a low prevalence of underweight and is considered a risk factor for increased morbidity and mortality. Techniques to adequately estimate fat-free mass and its changes over time are needed. OBJECTIVE The purpose of this study was to assess agreement among values obtained with three different body composition techniques: skinfold thickness measurement (STM), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA). DESIGN The study was a secondary analysis of data from a randomized controlled trial. PARTICIPANTS/SETTING A respiratory rehabilitation program was administered for 3 months to individuals with bronchiectasis from the bronchiectasis unit of the Regional University Hospital in Malaga, Spain, from September 2013 to September 2014. Individuals with a body mass index (calculated as kg/m2) >18.5 who were aged 65 years or younger and those with a body mass index >20 who were older than 65 years were included. MAIN OUTCOME MEASURES At baseline and at 3 and 6 months, body composition was determined by DXA and STM. STATISTICAL ANALYSES PERFORMED Statistical concordance was assessed with the intraclass correlation coefficient (ICC), kappa coefficient, and the degree of agreement using the Bland Altman method. For comparison of the quantitative variables at baseline vs at 3 months and 6 months, the paired sample t test (or the Wilcoxon test) was used. RESULTS Thirty participants were included. Strong agreement was observed between body composition values determined by BIA and DXA in fat mass (ICC: 0.92) and fat-free mass (ICC: 0.87). Strong agreement was observed between STM and DXA in the values for fat-free mass (ICC: 0.91) and fat mass (ICC: 0.94), and lower agreement was observed for the longitudinal data and in the regional values. The mean difference between fat-free mass determined by BIA and DXA was + 4.7 with a standard deviation of 2.4 kg in favor of BIA. The mean difference between fat-free mass determined by STM and DXA was +2.3 with a standard deviation of 2.7 kg in favor of STM. Six individuals were classified as having a low fat-free mass index (20%) by DXA vs four by STM (13%; kappa: 0.76) and only two by BIA (6.6%; kappa: 0.44) compared with DXA. CONCLUSIONS Despite good statistical agreement among values obtained with DXA, STM, and BIA, the study findings indicate that STM and BIA, above all, tended to overestimate fat-free mass compared with DXA.
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Felcar JM, Probst VS, de Carvalho DR, Merli MF, Mesquita R, Vidotto LS, Ribeiro LRG, Pitta F. Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial. Physiotherapy 2018; 104:408-416. [PMID: 30477678 DOI: 10.1016/j.physio.2017.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD). DESIGN Randomised controlled trial. SETTING University-based outpatient clinic. PARTICIPANTS Thirty-six patients with predominantly moderate-to-severe COPD completed the study. INTERVENTION Patients were evaluated at baseline, at 3 months and at the end of the programme (i.e. 6 months). For both groups, the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and/or workload, totalling 60 sessions. MAIN OUTCOMES Objective monitoring of physical activity in daily life (PADL, primary outcome), lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, and symptoms of anxiety and depression. RESULTS After 6 months of training, a significant improvement in PADL was seen for both groups [mean difference (95% confidence interval): land group 993 (358 to 1628) steps/day; water group 1669 (404 to 2934) steps/day]. Significant improvements were also seen in inspiratory, expiratory and peripheral muscle strength; maximal and submaximal exercise capacity; quality of life and functional status for both groups. There were no significant improvements in lung function, body composition, and symptoms of anxiety and depression for either group. No difference was found in the magnitude of improvement between the two types of training for any outcome. CONCLUSION High-intensity exercise training in water generates similar effects compared with training on land in patients with moderate-to-severe COPD, rendering it an equally beneficial therapeutic option for this population. CLINICAL TRIAL REGISTRATION NUMBER NCT01691131.
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Affiliation(s)
- J M Felcar
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - V S Probst
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - D R de Carvalho
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - M F Merli
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil
| | - R Mesquita
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil
| | - L S Vidotto
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil
| | - L R G Ribeiro
- Research Centre in Health Sciences, Universidade Norte do Paraná, Londrina, Brazil
| | - F Pitta
- Laboratory of Research in Respiratory Physiotherapy, Universidade Estadual de Londrina, Londrina, Brazil.
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Roumelioti ME, Glew RH, Khitan ZJ, Rondon-Berrios H, Argyropoulos CP, Malhotra D, Raj DS, Agaba EI, Rohrscheib M, Murata GH, Shapiro JI, Tzamaloukas AH. Fluid balance concepts in medicine: Principles and practice. World J Nephrol 2018; 7:1-28. [PMID: 29359117 PMCID: PMC5760509 DOI: 10.5527/wjn.v7.i1.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Robert H Glew
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan Edwards School of Medicine, Marshall University, Huntington, WV 25701, United States
| | - Helbert Rondon-Berrios
- Division of Renal and Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Dominic S Raj
- Division of Renal Disease and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Emmanuel I Agaba
- Division of Nephology, Department of Medicine, Jos University Medical Center, Jos, Plateau State 930001, Nigeria
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Glen H Murata
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
| | | | - Antonios H Tzamaloukas
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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12
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de Blasio F, Santaniello MG, de Blasio F, Mazzarella G, Bianco A, Lionetti L, Franssen FME, Scalfi L. Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease. Eur J Clin Nutr 2017; 71:1336-1340. [DOI: 10.1038/ejcn.2017.147] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/07/2017] [Indexed: 11/09/2022]
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13
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Assessment of Aerobic Exercise Adverse Effects during COPD Exacerbation Hospitalization. Can Respir J 2017; 2017:5937908. [PMID: 28265180 PMCID: PMC5317153 DOI: 10.1155/2017/5937908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/17/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction. Aerobic exercise performed after hospital discharge for exacerbated COPD patients is already recommended to improve respiratory and skeletal muscle strength, increase tolerance to activity, and reduce the sensation of dyspnea. Previous studies have shown that anaerobic activity can clinically benefit patients hospitalized with exacerbated COPD. However, there is little information on the feasibility and safety of aerobic physical activity performed by patients with exacerbated COPD during hospitalization. Objective. To evaluate the effects of aerobic exercise on vital signs in hospitalized patients with exacerbated COPD. Patients and Methods. Eleven COPD patients (63% female, FEV1: 34.2 ± 13.9% and age: 65 ± 11 years) agreed to participate. Aerobic exercise was initiated 72 hours after admission on a treadmill; speed was obtained from the distance covered in a 6-minute walk test (6MWT). Vital signs were assessed before and after exercise. Results. During the activity systolic blood pressure increased from 125.2 ± 13.6 to 135.8 ± 15.0 mmHg (p = 0.004) and respiratory rate from 20.9 ± 4.4 to 24.2 ± 4.5 rpm (p = 0.008) and pulse oximetry (SpO2) decreased from 93.8 ± 2.3 to 88.5 ± 5.7% (p < 0.001). Aerobic activity was considered intense, heart rate ranged from 99.2 ± 11.5 to 119.1 ± 11.1 bpm at the end of exercise (p = 0.092), and patients reached on average 76% of maximum heart rate. Conclusion. Aerobic exercise conducted after 72 hours of hospitalization in patients with exacerbated COPD appears to be safe.
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14
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Ræder H, Kværner AS, Henriksen C, Florholmen G, Henriksen HB, Bøhn SK, Paur I, Smeland S, Blomhoff R. Validity of bioelectrical impedance analysis in estimation of fat-free mass in colorectal cancer patients. Clin Nutr 2017; 37:292-300. [PMID: 28122662 DOI: 10.1016/j.clnu.2016.12.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/21/2016] [Accepted: 12/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Bioelectrical impedance analysis (BIA) is an accessible and cheap method to measure fat-free mass (FFM). However, BIA estimates are subject to uncertainty in patient populations with altered body composition and hydration. The aim of the current study was to validate a whole-body and a segmental BIA device against dual-energy X-ray absorptiometry (DXA) in colorectal cancer (CRC) patients, and to investigate the ability of different empiric equations for BIA to predict DXA FFM (FFMDXA). METHODS Forty-three non-metastatic CRC patients (aged 50-80 years) were enrolled in this study. Whole-body and segmental BIA FFM estimates (FFMwhole-bodyBIA, FFMsegmentalBIA) were calculated using 14 empiric equations, including the equations from the manufacturers, before comparison to FFMDXA estimates. RESULTS Strong linear relationships were observed between FFMBIA and FFMDXA estimates for all equations (R2 = 0.94-0.98 for both devices). However, there were large discrepancies in FFM estimates depending on the equations used with mean differences in the ranges -6.5-6.8 kg and -11.0-3.4 kg for whole-body and segmental BIA, respectively. For whole-body BIA, 77% of BIA derived FFM estimates were significantly different from FFMDXA, whereas for segmental BIA, 85% were significantly different. For whole-body BIA, the Schols* equation gave the highest agreement with FFMDXA with mean difference ±SD of -0.16 ± 1.94 kg (p = 0.582). The manufacturer's equation gave a small overestimation of FFM with 1.46 ± 2.16 kg (p < 0.001) with a tendency towards proportional bias (r = 0.28, p = 0.066). For segmental BIA, the Heitmann* equation gave the highest agreement with FFMDXA (0.17 ± 1.83 kg (p = 0.546)). Using the manufacturer's equation, no difference in FFM estimates was observed (-0.34 ± 2.06 kg (p = 0.292)), however, a clear proportional bias was detected (r = 0.69, p < 0.001). Both devices demonstrated acceptable ability to detect low FFM compared to DXA using the optimal equation. CONCLUSION In a population of non-metastatic CRC patients, mostly consisting of Caucasian adults and with a wide range of body composition measures, both the whole-body BIA and segmental BIA device provide FFM estimates that are comparable to FFMDXA on a group level when the appropriate equations are applied. At the individual level (i.e. in clinical practice) BIA may be a valuable tool to identify patients with low FFM as part of a malnutrition diagnosis.
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Affiliation(s)
- Hanna Ræder
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Ane Sørlie Kværner
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Geir Florholmen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Siv Kjølsrud Bøhn
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Ingvild Paur
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Sigbjørn Smeland
- Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
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15
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Furlanetto KC, Pinto IFS, Sant’Anna T, Hernandes NA, Pitta F. Profile of patients with chronic obstructive pulmonary disease classified as physically active and inactive according to different thresholds of physical activity in daily life. Braz J Phys Ther 2016; 20:517-524. [PMID: 27683835 PMCID: PMC5176198 DOI: 10.1590/bjpt-rbf.2014.0185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/29/2016] [Accepted: 03/05/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the profiles of patients with chronic obstructive pulmonary disease (COPD) considered physically active or inactive according to different classifications of the level of physical activity in daily life (PADL). Method Pulmonary function, dyspnea, functional status, body composition, exercise capacity, respiratory and peripheral muscle strength, and presence of comorbidities were assessed in 104 patients with COPD. The level of PADL was quantified with a SenseWear Armband activity monitor. Three classifications were used to classify the patients as physically active or inactive: 30 minutes of activity/day with intensity >3.2 METs, if age ≥65 years, and >4 METs, if age <65 years; 30 minutes of activity/day with intensity >3.0 METs, regardless of patient age; and 80 minutes of activity/day with intensity >3.0 METs, regardless of patient age. Results In all classifications, when compared with the inactive group, the physically active group had better values of anthropometric variables (higher fat-free mass, lower body weight, body mass index and fat percentage), exercise capacity (6-minute walking distance), lung function (forced vital capacity) and functional status (personal care domain of the London Chest Activity of Daily Living). Furthermore, patients classified as physically active in two classifications also had better peripheral and expiratory muscle strength, airflow obstruction, functional status, and quality of life, as well as lower prevalence of heart disease and mortality risk. Conclusion In all classification methods, physically active patients with COPD have better exercise capacity, lung function, body composition, and functional status compared to physically inactive patients.
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Affiliation(s)
- Karina C. Furlanetto
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Isabela F. S. Pinto
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Thais Sant’Anna
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Nidia A. Hernandes
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Fabio Pitta
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
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16
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Rodrigues A, Di Martino M, Nellessen AG, Hernandes NA, Neder JA, Pitta F. Is the six-minute walk test a useful tool to prescribe high-intensity exercise in patients with chronic obstructive pulmonary disease? Heart Lung 2016; 45:550-556. [PMID: 27639286 DOI: 10.1016/j.hrtlng.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND It is not yet completely known whether the 6MWT can be used to prescribe high-intensity exercise for patients with COPD. OBJECTIVE To evaluate the ability of the six-minute walk test (6MWT) to prescribe high-intensity exercise for patients with chronic obstructive pulmonary disease (COPD). METHODS Lung function, maximal inspiratory strength, symptoms and exercise capacity were evaluated in patients with COPD (n = 27) before and after a 12-week high-intensity exercise program. Criteria for high-intensity training were: 1) ≥75% of the 6MWT average speed; 2) American Thoracic Society/European Respiratory Society (ATS/ERS) criteria (≥60% of the maximal incremental shuttle walk test speed). RESULTS The 6MWT showed good positive and negative predictive values (0.69 and 0.71, respectively), and accuracy (0.70), good reliability (ICC 0.70 [95%CI 0.45-0.85]) and moderate agreement (k 0.41 [95%CI 0.13-0.67]) with the ATS/ERS criteria. CONCLUSION The 6MWT has good predictive ability and accuracy in relation to high-intensity exercise for patients with COPD.
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Affiliation(s)
- Antenor Rodrigues
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - Marianna Di Martino
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - Aline G Nellessen
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - Nidia A Hernandes
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Fabio Pitta
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil.
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17
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Caram LMDO, Ferrari R, Naves CR, Coelho LS, do Vale SA, Tanni SE, Godoy I. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD. J Bras Pneumol 2016; 42:179-84. [PMID: 27383930 PMCID: PMC5569610 DOI: 10.1590/s1806-37562015000000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/03/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. METHODS The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. RESULTS Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively). The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. CONCLUSIONS Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression), appear to be more prevalent in patients with mild-to-moderate COPD. OBJETIVO Avaliar e comparar a prevalência de comorbidades e de fatores de risco de doença cardiovascular (DCV) em pacientes com DPOC de acordo com a gravidade da doença. MÉTODOS O estudo incluiu 25 pacientes com DPOC leve/moderada (homens: 68%; média de idade: 65 ± 8 anos; média de VEF1: 73 ± 15% do previsto) e 25 com DPOC grave/muito grave (homens: 56%; média de idade: 69 ± 9 anos; média de VEF1, 40 ± 18% do previsto). As comorbidades foram registradas com base nos dados dos prontuários médicos e avaliações clínicas. O índice de comorbidades de Charlson foi calculado, e a pontuação na Hospital Anxiety and Depression Scale (HADS) foi determinada. RESULTADOS Dos 50 pacientes avaliados, 38 (76%) receberam diagnóstico de pelo menos uma comorbidade, sendo que 21 (42%) receberam diagnóstico de pelo menos uma DCV. Vinte e quatro pacientes (48%) apresentavam mais de uma DCV. Dezoito pacientes (36%) eram fumantes, 10 (20%) tinham depressão, 7 (14%) apresentavam dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p < 0,001, p = 0,008 e p = 0,02, respectivamente). A prevalência de pressão arterial elevada, diabetes mellitus, alcoolismo, doença isquêmica do coração e insuficiência cardíaca crônica foi semelhante nos dois grupos. O índice de comorbidades de Charlson e a pontuação na HADS não diferiram entre os grupos. CONCLUSÕES Comorbidades são muito prevalentes na DPOC, independentemente da gravidade da doença. Certos fatores de risco de DCV, eles próprios considerados doenças (incluindo tabagismo, dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.
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Affiliation(s)
- Laura Miranda de Oliveira Caram
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Renata Ferrari
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Cristiane Roberta Naves
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Liana Sousa Coelho
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Simone Alves do Vale
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Irma Godoy
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
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18
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Nellessen AG, Donária L, Hernandes NA, Pitta F. Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD. J Bras Pneumol 2016; 41:305-12. [PMID: 26398750 PMCID: PMC4635950 DOI: 10.1590/s1806-37132015000004515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare equations for predicting peak quadriceps femoris (QF) muscle force; to determine the agreement among the equations in identifying QF muscle weakness in COPD patients; and to assess the differences in characteristics among the groups of patients classified as having or not having QF muscle weakness by each equation. Methods: Fifty-six COPD patients underwent assessment of peak QF muscle force by dynamometry (maximal voluntary isometric contraction of knee extension). Predicted values were calculated with three equations: an age-height-weight-gender equation (Eq-AHWG); an age-weight-gender equation (Eq-AWG); and an age-fat-free mass-gender equation (Eq-AFFMG). Results: Comparison of the percentage of predicted values obtained with the three equations showed that the Eq-AHWG gave higher values than did the Eq-AWG and Eq-AFFMG, with no difference between the last two. The Eq-AHWG showed moderate agreement with the Eq-AWG and Eq-AFFMG, whereas the last two also showed moderate, albeit lower, agreement with each other. In the sample as a whole, QF muscle weakness (< 80% of predicted) was identified by the Eq-AHWG, Eq-AWG, and Eq-AFFMG in 59%, 68%, and 70% of the patients, respectively (p > 0.05). Age, fat-free mass, and body mass index are characteristics that differentiate between patients with and without QF muscle weakness. Conclusions: The three equations were statistically equivalent in classifying COPD patients as having or not having QF muscle weakness. However, the Eq-AHWG gave higher peak force values than did the Eq-AWG and the Eq-AFFMG, as well as showing greater agreement with the other equations.
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Affiliation(s)
| | - Leila Donária
- Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina, PR, BR
| | | | - Fabio Pitta
- Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina, PR, BR
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Ferrari R, Caram LMO, Faganello MM, Sanchez FF, Tanni SE, Godoy I. Relation between systemic inflammatory markers, peripheral muscle mass, and strength in limb muscles in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:1553-8. [PMID: 26345641 PMCID: PMC4531022 DOI: 10.2147/copd.s85954] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate the association between systemic inflammatory mediators and peripheral muscle mass and strength in COPD patients. Fifty-five patients (69% male; age: 64±9 years) with mild/very severe COPD (defined as forced expiratory volume in the first second [FEV1] =54%±23%) were evaluated. We evaluated serum concentrations of IL-8, CRP, and TNF-α. Peripheral muscle mass was evaluated by computerized tomography (CT); midthigh cross-sectional muscle area (MTCSA) and midarm cross-sectional muscle area (MACSA) were obtained. Quadriceps, triceps, and biceps strength were assessed through the determination of the one-repetition maximum. The multiple regression results, adjusted for age, sex, and FEV1%, showed positive significant association between MTCSA and leg extension (0.35 [0.16, 0.55]; P=0.001), between MACSA and triceps pulley (0.45 [0.31, 0.58]; P=0.001), and between MACSA and biceps curl (0.34 [0.22, 0.47]; P=0.001). Plasma TNF-α was negatively associated with leg extension (-3.09 [-5.99, -0.18]; P=0.04) and triceps pulley (-1.31 [-2.35, -0.28]; P=0.01), while plasma CRP presented negative association with biceps curl (-0.06 [-0.11, -0.01]; P=0.02). Our results showed negative association between peripheral muscle mass (evaluated by CT) and muscle strength and that systemic inflammation has a negative influence in the strength of specific groups of muscles in individuals with stable COPD. This is the first study showing association between systemic inflammatory markers and strength in upper limb muscles.
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Affiliation(s)
- Renata Ferrari
- Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, São Paulo, Brazil
| | - Laura M O Caram
- Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, São Paulo, Brazil
| | - Marcia M Faganello
- Paulista State University, Department of Physiotherapy and Occupational Therapy, Marilia, São Paulo, Brazil
| | - Fernanda F Sanchez
- Federal University of Amazonas, Department of Physiotherapy, Manaus, Amazonas, Brazil
| | - Suzana E Tanni
- Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, São Paulo, Brazil
| | - Irma Godoy
- Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, São Paulo, Brazil
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Tödt K, Skargren E, Jakobsson P, Theander K, Unosson M. Factors associated with low physical activity in patients with chronic obstructive pulmonary disease: a cross-sectional study. Scand J Caring Sci 2015; 29:697-707. [DOI: 10.1111/scs.12200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kristina Tödt
- Department of Social and Welfare Studies; Linköping University; Norrköping Sweden
- Department of Respiratory Medicine and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Elisabeth Skargren
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Per Jakobsson
- Department of Respiratory Medicine and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Kersti Theander
- Department of Health Sciences; Nursing, Faculty of Health, Science and Technology; Karlstad University; Karlstad Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies; Linköping University; Norrköping Sweden
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Landal AC, Monteiro F, Hevely BCDS, Kanesawa LM, Hernandes N, Pitta F. Fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introdução A redução da massa magra corpórea (MMC) é um fator independente de mortalidade em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) e a literatura mostra que exercícios físicos aumentam a MMC. Objetivo Identificar fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico de alta intensidade. Métodos 37 pacientes com DPOC (19 H; 66 ± 7 anos; IMC = 27 ± 6 kg/m2; VEF1 = 38 ± 16 %pred) foram avaliados segundo sua composição corporal, função pulmonar, força muscular respiratória e periférica, capacidade funcional de exercício (teste de caminhada dos seis minutos, TC6M), nível de atividade física diária (DynaPort®), sensação subjetiva de dispneia (escala Medical Research Council) e qualidade de vida (Saint George Respiratory Questionnaire). O treinamento conteve exercícios de endurance e força muscular (3 vezes por semana por três meses). Após três meses, os pacientes foram reavaliados. Aqueles que apresentaram incremento de MMC incorporaram à estatística. Resultados No pré-treinamento, a MMC se correlacionou significativamente (p ≤ 0,05) com gasto energético total (r = 0,57), TC6M em %predito (r = 0,46), pressão expiratória máxima (PEmax) (r = 0,57), volume expiratório forçado no primeiro segundo em %predito (r = 0,47), força muscular de quadríceps femoral (r = 0,54), bíceps (r = 0,62) e tríceps braquial (r = 0,63). Contudo, o incremento da MMC após treinamento correlacionou-se significativamente somente com a melhora das escalas MRC (r = 0,4; p = 0,05) e PEmax (r = 0,35; p = 0,04). Conclusão Apesar de a MMC de pacientes com DPOC estar relacionada com a capacidade funcional de exercício, força muscular respiratória e periférica, obstrução pulmonar e gasto energético no pré-tratamento, a melhora da composição corporal está relacionada somente ao incremento da força muscular expiratória e sensação de dispneia após treinamento físico de alta intensidade.
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Hronek M, Kovarik M, Aimova P, Koblizek V, Pavlikova L, Salajka F, Zadak Z. Skinfold Anthropometry –The Accurate Method for Fat Free Mass Measurement in COPD. COPD 2013; 10:597-603. [DOI: 10.3109/15412555.2013.781151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Elia M. Body composition by whole-body bioelectrical impedance and prediction of clinically relevant outcomes: overvalued or underused? Eur J Clin Nutr 2013; 67 Suppl 1:S60-70. [PMID: 23299873 DOI: 10.1038/ejcn.2012.166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Body composition calculated using whole-body bioelectrical impedance analysis (BIA), almost invariably with height (H) and often with weight (W), can help patient management and predict clinical outcomes. This study aimed to examine the merits of this approach compared with simple anthropometry (W+H). SUBJECTS/METHODS Use was made of original data and validation studies based on reference body composition methods: water dilution, densitometry, dual-energy X-ray absorptiometry, and more robust methods. Prediction of clinical outcomes, including mortality and length of hospital stay, was examined in six studies of chronic obstructive pulmonary disease and a study with multiple patient groups. Vector analysis, phase angle, multi-frequency BIA and segmental impedance were not considered. RESULTS In a broad range of study populations, from neonates to older people, in health and disease, body composition calculated using BIA with simple anthropometry frequently offered no advantage over W+H alone, but in some situations it was superior and in others inferior. In predicting clinically relevant outcomes, the fat-free mass index (FFMI), established using BIA, had comparable and sometimes greater power than body mass index (BMI), but none of the reviewed papers used FFMI calculated from W+H or BMI to predict clinical outcomes. CONCLUSIONS A variable and generally weak evidence base was found to suggest that BIA with anthropometry is better at predicting body composition than simple anthropometry alone. No evidence was found from the reviewed studies that FFMI calculated from BIA and anthropometry was better at predicting clinical outcomes than FFMI calculated by simple anthropometry alone.
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Affiliation(s)
- M Elia
- Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK.
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Effects of Active Smoking on Airway and Systemic Inflammation Profiles in Patients With Chronic Obstructive Pulmonary Disease. Am J Med Sci 2013; 345:440-5. [DOI: 10.1097/maj.0b013e31825f32a7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Savalle M, Gillaizeau F, Maruani G, Puymirat E, Bellenfant F, Houillier P, Fagon JY, Faisy C. Assessment of body cell mass at bedside in critically ill patients. Am J Physiol Endocrinol Metab 2012; 303:E389-96. [PMID: 22649067 DOI: 10.1152/ajpendo.00502.2011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Critical illness affects body composition profoundly, especially body cell mass (BCM). BCM loss reflects lean tissue wasting and could be a nutritional marker in critically ill patients. However, BCM assessment with usual isotopic or tracer methods is impractical in intensive care units (ICUs). We aimed to modelize the BCM of critically ill patients using variables available at bedside. Fat-free mass (FFM), bone mineral (Mo), and extracellular water (ECW) of 49 critically ill patients were measured prospectively by dual-energy X-ray absorptiometry and multifrequency bioimpedance. BCM was estimated according to the four-compartment cellular level: BCM = FFM - (ECW/0.98) - (0.73 × Mo). Variables that might influence the BCM were assessed, and multivariable analysis using fractional polynomials was conducted to determine the relations between BCM and these data. Bootstrap resampling was then used to estimate the most stable model predicting BCM. BCM was 22.7 ± 5.4 kg. The most frequent model included height (cm), leg circumference (cm), weight shift (Δ) between ICU admission and body composition assessment (kg), and trunk length (cm) as a linear function: BCM (kg) = 0.266 × height + 0.287 × leg circumference + 0.305 × Δweight - 0.406 × trunk length - 13.52. The fraction of variance explained by this model (adjusted r(2)) was 46%. Including bioelectrical impedance analysis variables in the model did not improve BCM prediction. In summary, our results suggest that BCM can be estimated at bedside, with an error lower than ±20% in 90% subjects, on the basis of static (height, trunk length), less stable (leg circumference), and dynamic biometric variables (Δweight) for critically ill patients.
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Obesity and Physical Activity in the Daily Life of Patients with COPD. Lung 2012; 190:403-10. [DOI: 10.1007/s00408-012-9381-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 02/03/2012] [Indexed: 11/26/2022]
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Thibault R, Genton L, Pichard C. Body composition: why, when and for who? Clin Nutr 2012; 31:435-47. [PMID: 22296871 DOI: 10.1016/j.clnu.2011.12.011] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/21/2011] [Accepted: 12/19/2011] [Indexed: 12/22/2022]
Abstract
Body composition reflects nutritional intakes, losses and needs over time. Undernutrition, i.e. fat-free mass (FFM) loss, is associated with decreased survival, worse clinical outcome and quality of life, as well as increased therapy toxicity in cancer patients. In numerous clinical situations, such as sarcopenic obesity and chronic diseases, the measurement of body composition with available methods, such as dual-X ray absorptiometry, computerized tomography and bioelectrical impedance analysis, quantifies the loss of FFM, whereas body weight loss and body mass index only inconstantly reflect FFM loss. The measurement of body composition allows documenting the efficiency of nutrition support, tailoring the choice of disease-specific and nutritional therapies and evaluating their efficacy and putative toxicity. Easy-to-use body composition methods integrated to the routine of care allow sequential measurements for an initial nutritional assessment and objective patients follow-up. By allowing an earlier and objective management of undernutrition, body composition assessment could contribute to reduce undernutrition-induced morbidity, worsening of quality of life, and global health care costs by a timely nutrition intervention.
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Affiliation(s)
- Ronan Thibault
- Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
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Thibault R, Pichard C. The evaluation of body composition: a useful tool for clinical practice. ANNALS OF NUTRITION AND METABOLISM 2011; 60:6-16. [PMID: 22179189 DOI: 10.1159/000334879] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
Undernutrition is insufficiently detected in in- and outpatients, and this is likely to worsen during the next decades. The increased prevalence of obesity together with chronic illnesses associated with fat-free mass (FFM) loss will result in an increased prevalence of sarcopenic obesity. In patients with sarcopenic obesity, weight loss and the body mass index lack accuracy to detect FFM loss. FFM loss is related to increasing mortality, worse clinical outcomes, and impaired quality of life. In sarcopenic obesity and chronic diseases, body composition measurement with dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or computerized tomography quantifies the loss of FFM. It allows tailored nutritional support and disease-specific therapy and reduces the risk of drug toxicity. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up of nutritional status. It could allow objective, systematic, and early screening of undernutrition and promote the rational and early initiation of optimal nutritional support, thereby contributing to reducing malnutrition-induced morbidity, mortality, worsening of the quality of life, and global health care costs.
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Affiliation(s)
- Ronan Thibault
- Centre de Recherche en Nutrition Humaine Auvergne, UMR 1019 Nutrition Humaine, INRA, Clermont Université, Service de Nutrition Clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Sanchez F, Faganello M, Tanni S, Lucheta P, Pelegrino N, Hasegawa S, Ribeiro S, Godoy I. Anthropometric midarm measurements can detect systemic fat-free mass depletion in patients with chronic obstructive pulmonary disease. Braz J Med Biol Res 2011; 44:453-9. [DOI: 10.1590/s0100-879x2011007500024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 02/14/2011] [Indexed: 01/10/2023] Open
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Camillo CA, Laburu VDM, Gonçalves NS, Cavalheri V, Tomasi FP, Hernandes NA, Ramos D, Marquez Vanderlei LC, Cipulo Ramos EM, Probst VS, Pitta F. Improvement of heart rate variability after exercise training and its predictors in COPD. Respir Med 2011; 105:1054-62. [PMID: 21342757 DOI: 10.1016/j.rmed.2011.01.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/20/2011] [Accepted: 01/24/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current literature lacks solid evidence on the improvement of heart rate variability (HRV) after exercise training in patients with COPD. OBJECTIVES We aimed to investigate changes in HRV after two exercise training programs in patients with COPD and to investigate the determinants of these eventual changes. METHODS Forty patients with COPD (FEV(1) 39 ± 13%pred) were randomized into high (n = 20) or low (n = 20) intensity exercise training (3-month duration), and had their HRV assessed by the head-up tilt test before and after either protocols. Baseline spirometry, level of daily physical activity, exercise capacity, body composition, functional status, health-related quality of life and muscle force were also assessed to investigate the determinants of improvement in HRV after the training program. RESULTS There was a significant improvement in HRV only after the high-intensity protocol (pre versus post; SDNN 29 ± 15 ms versus 36 ± 19 ms; rMSSD 22 ± 14 ms versus 28 ± 22 ms; p < 0.05 for both). Higher values of biceps brachialis strength, time spent walking in daily life and SDNN at baseline were determinants of improvement in HRV after the training program. CONCLUSIONS High-intensity exercise training improves HRV at rest and during orthostatic stimulus in patients with COPD. Better baseline total HRV, muscle force and daily physical activity level are predictors of HRV improvements after the training program.
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Affiliation(s)
- Carlos Augusto Camillo
- Laboratório de Pesquisa em Fisioterapia Pulmonar, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
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Patil BR, Patkar DP, Mandlik SA, Kuswarkar MM, Jindal GD. Single prediction equation for bioelectrical impedance analysis in adults aged 22–59 years. J Med Eng Technol 2011; 35:109-14. [DOI: 10.3109/03091902.2010.543751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Ferrari R, Tanni S, Faganello M, Caram L, Lucheta P, Godoy I. Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease. Braz J Med Biol Res 2011; 44:46-52. [DOI: 10.1590/s0100-879x2010007500150] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 12/08/2010] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | - I. Godoy
- Universidade Estadual Paulista, Brasil
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Cavalheri V, Hernandes NA, Camillo CA, Probst VS, Ramos D, Pitta F. Estimation of maximal work rate based on the 6-minute walk test and fat-free mass in chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2010; 91:1626-8. [PMID: 20875524 DOI: 10.1016/j.apmr.2010.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 05/27/2010] [Accepted: 07/08/2010] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To propose a predictive equation of the maximal work rate (Wmax) in patients with chronic obstructive pulmonary disease (COPD) based on the product of 6-minute walking test (6MWT) and fat-free mass (FFM) and to compare it with a previously proposed equation based on the product of 6MWT and body weight (BW). DESIGN Descriptive (cross-sectional) study. SETTING University-based rehabilitation center. PARTICIPANTS Patients with COPD (N=53; 30 men; forced expiratory volume in 1 second, 45%±15% predicted). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three Wmax were produced: Wmax_real (obtained from the maximal cycle ergometry test), Wmax_BW (estimated from the product of 6MWT and BW), previously proposed by Hill et al. (Arch Phys Med Rehabil 2008; 89(9):1782-7); and Wmax_FFM (estimated from the product of 6MWT and FFM). RESULTS The equation derived from a regression model to estimate Wmax_FFM was as follows: -27.9717+3.7792*(6MWT*FFM). Wmax_real correlated better with Wmax_FFM (r=.64) than with Wmax_BW (r=.54). There was no difference between Wmax_FFM (median [interquartile range], 41 [29-50] W) and Wmax_real (40 [20-50] W, P=.88), whereas Wmax_BW (60 [52-69] W) significantly overestimated Wmax_real (P<.0001). CONCLUSIONS In patients with COPD, Wmax is better estimated by an equation including the product of 6MWT and FFM than by a previously proposed equation including the product of 6MWT and body weight.
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Affiliation(s)
- Vinícius Cavalheri
- Departamento de Fisioterapia, Universidade Estadual de Londrina, Paraná, Brazil
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Ferrari R, Tanni SE, Lucheta PA, Faganello MM, do Amaral RAF, Godoy I. Gender differences in predictors of health status in patients with COPD. J Bras Pneumol 2010; 36:37-43. [PMID: 20209306 DOI: 10.1590/s1806-37132010000100008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 09/01/2009] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the health status (HS) of COPD patients and to identify the main predictors of HS in these patients according to gender. METHODS The study included 90 COPD patients (60 males and 30 females; mean age = 64 +/- 9 years) with a wide range of airway obstruction disorders (mean FEV1 = 56 +/- 19% of predicted). The men were individually matched to the women by % of predicted FEV1 (ratio: 2:1). The patients were assessed regarding body composition; six-minute walk distance; perception of dyspnea using the Modified Medical Research Council Dyspnea Scale; Saint George's Respiratory Questionnaire (SGRQ); Charlson comorbidity index; and the multidimensional Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. Multiple linear regression analysis was performed to identify the predictors of HS by gender. RESULTS Impairment of HS was greater among the women than among the men for SGRQ total score and for all SGRQ domains (total: 51 +/- 18% vs. 38 +/- 19%; p = 0.002; symptoms: 61 +/- 22% vs. 42 +/- 21%; p < 0.001; activity: 62 +/- 18% vs. 49 +/- 21%; p = 0.004; and impact: 41 +/- 19% vs. 27 +/- 18%; p = 0.001). The multiple linear regression showed that age and perception of dyspnea correlated with SGRQ total score for both genders (males, r(2) = 0.42; females, r(2) = 0.70; p < 0.05). CONCLUSIONS Our results showed an association between gender and HS in COPD patients. Age and dyspnea are determinants of HS in both genders.
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Affiliation(s)
- Renata Ferrari
- São Paulo State University - Botucatu School of Medicine, Botucatu, Brazil.
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35
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Thibault R, Le Gallic E, Picard-Kossovsky M, Darmaun D, Chambellan A. Évaluation de l’état nutritionnel et de la composition corporelle du patient BPCO : comparaison de plusieurs méthodes. Rev Mal Respir 2010; 27:693-702. [DOI: 10.1016/j.rmr.2010.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 01/21/2010] [Indexed: 11/29/2022]
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Tanni SE, Pelegrino NR, Angeleli AY, Correa C, Godoy I. Smoking status and tumor necrosis factor-alpha mediated systemic inflammation in COPD patients. JOURNAL OF INFLAMMATION-LONDON 2010; 7:29. [PMID: 20534161 PMCID: PMC2891738 DOI: 10.1186/1476-9255-7-29] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 06/09/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking cause airway and systemic inflammation and COPD patients present low grade inflammation in peripheral blood. However, data on the influence of smoking itself on systemic inflammation in COPD patients are scarce. This study investigated the association between inflammation, smoking status, and disease. METHODS A cross-sectional analysis comparing 53 COPD ex-smokers, 24 COPD current smokers, 24 current smoker controls and 34 never-smoker controls was performed. Assessments included medical history, body composition, spirometry, and plasma concentration of tumor necrosis factor-alpha (TNF-alpha), interleukins (IL)-6, IL-8, and C-reactive protein (CRP). RESULTS Our exploratory analysis showed that serum TNF-alpha was higher in COPD current smokers [4.8(4.2-5.8)pg/mL] and in current smoker controls [4.8 (4.2-6.1) pg/mL] when compared to COPD ex-smokers [4.3 (3.9-4.9)pg/mL; p = 0.02] and to never-smoker controls [3.7 (3.4-4.0)pg/mL; p < 0.001]. Multiple regression results with and without adjustment for covariates were consistent with the hypothesis that TNF-alpha levels were associated with smoking status in both models (p < 0.001 and p < 0.001). IL-6 and CRP were significantly higher in COPD patients when compared to smoker and never-smoker controls and the multiple regression analysis confirmed the association of these mediators with disease, but not with smoking status (p < 0.001 and p < 0.001). IL-8 had only a borderline association with disease in both models (p = 0.069 and p = 0.053). No influence of disease severity, inhaled corticosteroid, fat-free mass (FFM) depletion and long term oxygen therapy (LTOT) use on systemic inflammation was found. CONCLUSION Smoking may influence TNF-alpha mediated systemic inflammation, which, in turn, may account for some of the benefits observed in patients with COPD who stop smoking.
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Affiliation(s)
- Suzana E Tanni
- Department of Internal Medicine, Pulmonology Division, Botucatu Medical School. UNESP (Paulista State University). Distrito de Rubião Júnior, s/n. Botucatu, 18618-000, SP, Brazil
| | - Nilva Rg Pelegrino
- Department of Internal Medicine, Pulmonology Division, Botucatu Medical School. UNESP (Paulista State University). Distrito de Rubião Júnior, s/n. Botucatu, 18618-000, SP, Brazil
| | - Aparecida Yo Angeleli
- Department of Internal Medicine, Botucatu Medical School. UNESP (Paulista State University). Distrito de Rubião Júnior, s/n. Botucatu, 18618-000, SP, Brazil
| | - Camila Correa
- Department of Internal Medicine, Botucatu Medical School. UNESP (Paulista State University). Distrito de Rubião Júnior, s/n. Botucatu, 18618-000, SP, Brazil
| | - Irma Godoy
- Department of Internal Medicine, Pulmonology Division, Botucatu Medical School. UNESP (Paulista State University). Distrito de Rubião Júnior, s/n. Botucatu, 18618-000, SP, Brazil
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Sabino PG, Silva BM, Brunetto AF. Nutritional status is related to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients. Clinics (Sao Paulo) 2010; 65:599-605. [PMID: 20613936 PMCID: PMC2898542 DOI: 10.1590/s1807-59322010000600007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 03/10/2010] [Accepted: 03/18/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Being overweight or obese is associated with a higher rate of survival in patients with advanced chronic obstructive pulmonary disease (COPD). This paradoxical relationship indicates that the influence of nutritional status on functional parameters should be further investigated. OBJECTIVE To investigate the impact of nutritional status on body composition, exercise capacity and respiratory muscle strength in severe chronic obstructive pulmonary disease patients. METHODS Thirty-two patients (nine women) were divided into three groups according to their body mass indices (BMI): overweight/obese (25 < or = BMI < or = 34.9 kg/m(2), n=8), normal weight (18.5 < or = BMI < or = 24.9 kg/m(2), n=17) and underweight (BMI <18.5 kg/m(2), n=7). Spirometry, bioelectrical impedance, a six-minute walking distance test and maximal inspiratory and expiratory pressures were assessed. RESULTS Airway obstruction was similar among the groups (p=0.30); however, overweight/obese patients had a higher fat-free mass (FFM) index [FFMI=FFM/body weight(2) (mean+/-SEM: 17+/-0.3 vs. 15+/-0.3 vs. 14+/-0.5 m/kg(2), p<0.01)], exercise capacity (90+/-8 vs. 79+/-6 vs. 57+/-8 m, p=0.02) and maximal inspiratory pressure (63+/-7 vs. 57+/-5 vs. 35+/-8 % predicted, p=0.03) in comparison to normal weight and underweight patients, respectively. In addition, on backward multiple regression analysis, FFMI was the unique independent predictor of exercise capacity (partial r=0.52, p<0.01). CONCLUSIONS Severe chronic obstructive pulmonary disease (COPD) patients who were overweight or obese had a greater FFM, exercise capacity and inspiratory muscle strength than patients with the same degree of airflow obstruction who were of normal weight or underweight, and higher FFM was independently associated with higher exercise capacity. These characteristics of overweight or obese patients might counteract the drawbacks of excess weight and lead to an improved prognosis in COPD.
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Dourado VZ, Antunes LCDO, Tanni SE, Godoy I. Factors associated with the minimal clinically important difference for health-related quality of life after physical conditioning in patients with COPD. J Bras Pneumol 2010; 35:846-53. [PMID: 19820810 DOI: 10.1590/s1806-37132009000900005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 05/21/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify factors associated with the minimal clinically important difference (MCID) for health-related quality of life (HRQoL) after physical conditioning in patients with COPD. METHODS Thirty-five patients were submitted to a 12-week program of physical conditioning (strength training plus low-intensity aerobic exercise). Body composition, incremental treadmill test results, endurance treadmill test results, six-minute walk test results, peripheral muscle strength, MIP, baseline dyspnea index (BDI) and Saint George's Respiratory Questionnaire (SGRQ) scores were assessed at baseline and after the program, thus allowing the variations (Delta) to be calculated. The MCID for HRQoL was defined as a reduction of > 4% in the SGRQ total score. Subjects who responded to the program, achieving the MCID for HRQoL, were allocated to the responders (R) group (n = 24), and the remainder were allocated to the non-responders (NR) group (n = 11). RESULTS The values obtained for the following variables were significantly higher in group R than in group NR (p < 0.05): FEV1 (1.48 + or - 0.54 L vs. 1.04 + or - 0.34 L); VEF1/FVC (47.9 + or - 11.7% vs. 35.5 + or - 10.7%); PaO2 (74.1 + or - 9.7 mmHg vs. 65.0 + or - 8.9 mmHg); and DeltaBDI, expressed as median and interquartile range (2.0 [0.0-3.5] vs. 0.0 [0.0-1.0]). The DeltaBDI correlated significantly with the DeltaSGRQ symptoms domain score, activity domain score and total score (r = 0.44, 0.60 and 0.62, respectively, p < 0.01 for all). After logistic regression, only DeltaBDI remained as a predictor of MCID for HRQoL. CONCLUSIONS Achieving the MCID for HRQoL after physical conditioning is associated with dyspnea reduction in COPD patients. Therefore, there is a need to develop treatment strategies designed to interrupt the dyspnea-inactivity-dyspnea cycle in such patients.
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BODE index and GOLD staging as predictors of 1-year exacerbation risk in chronic obstructive pulmonary disease. Am J Med Sci 2010; 339:10-4. [PMID: 19926966 DOI: 10.1097/maj.0b013e3181bb8111] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index and global initiative for chronic obstructive lung disease (GOLD) staging system are validated measures to define disease severity and to predict survival in chronic obstructive pulmonary disease (COPD). We aimed to investigate the influence of BODE classes (score: 0-2, 3-4, 5-7, and 7-10) and GOLD stages (I, II, III, and IV) on the moderate/severe exacerbation occurrence risk in a cohort of 120 mild/very severe stable patients with COPD. METHODS Demographics, clinical evaluation, spirometry, peripheral oxygen saturation, body composition, 6-minute walking distance, dyspnea, and quality of life measurements were obtained at baseline. Patients were followed up for 1 year or until death, and information on exacerbation was collected. RESULTS The median annual exacerbation rate was 0.8. Logistic regression showed that the relationship between the risk for moderate/severe exacerbations during a 1-year follow-up for the GOLD stage was odds ratio: 2.01; 95% confidence interval: 1.39-2.98 and for the BODE index was odds ratio: 2.08; 95% confidence interval: 1.27-3.61. The area under the receiver-operator curve to predict exacerbation during the 1-year follow-up was 0.69 for the GOLD stage and 0.62 for the BODE index. Adjusted multiple logistic regression selected only older age and lower peripheral oxygen saturation as risk factors for COPD exacerbation in the 1-year follow-up. CONCLUSIONS In summary, our study shows that unidimensional GOLD classification and multidimensional BODE index staging systems seem to have similar clinical utility in predicting exacerbation in ambulatory COPD patients with COPD. However, variables not included in both systems seem to be the main predictors of the exacerbation risk.
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Hitzl AP, Jörres RA, Heinemann F, Pfeifer M, Budweiser S. Nutritional status in patients with chronic respiratory failure receiving home mechanical ventilation: Impact on survival. Clin Nutr 2010; 29:65-71. [DOI: 10.1016/j.clnu.2009.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 06/20/2009] [Accepted: 08/02/2009] [Indexed: 01/10/2023]
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Dourado VZ, Tanni SE, Antunes LCO, Paiva SAR, Campana AO, Renno ACM, Godoy I. Effect of three exercise programs on patients with chronic obstructive pulmonary disease. Braz J Med Biol Res 2009; 42:263-71. [PMID: 19287905 DOI: 10.1590/s0100-879x2009000300007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 01/15/2009] [Indexed: 01/08/2023] Open
Abstract
We compared the effect of three different exercise programs on patients with chronic obstructive pulmonary disease including strength training at 50_80% of one-repetition maximum (1-RM) (ST; N = 11), low-intensity general training (LGT; N = 13), or combined training groups (CT; N = 11). Body composition, muscle strength, treadmill endurance test (TEnd), 6-min walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and baseline dyspnea (BDI) were assessed prior to and after the training programs (12 weeks). The training modalities showed similar improvements (P > 0.05) in SGRQ-total (ST = 13 +/- 14%; CT = 12 +/- 14%; LGT = 11 +/- 10%), BDI (ST = 1.8 +/- 4; CT = 1.8 +/- 3; LGT = 1 +/- 2), 6MWT (ST = 43 +/- 51 m; CT = 48 +/- 50 m; LGT = 31 +/- 75 m), and TEnd (ST = 11 +/- 20 min; CT = 11 +/- 11 min; LGT = 7 +/- 5 min). In the ST and CT groups, an additional improvement in 1-RM values was shown (P < 0.05) compared to the LGT group (ST = 10 +/- 6 to 57 +/- 36 kg; CT = 6 +/- 2 to 38 +/- 16 kg; LGT = 1 +/- 2 to 16 +/- 12 kg). The addition of strength training to our current training program increased muscle strength; however, it produced no additional improvement in walking endurance, dyspnea or quality of life. A simple combined training program provides benefits without increasing the duration of the training sessions.
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Affiliation(s)
- V Z Dourado
- Departamento de Ciências da Saúde, Laboratório de Estudos da Motricidade Humana, Universidade Federal de São Paulo, Campus Baixada Santista, 11030-400 Santos, SP, Brasil.
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Pelegrino NRG, Lucheta PA, Sanchez FF, Faganello MM, Ferrari R, Godoy ID. Influence of lean body mass on cardiopulmonary repercussions during the six-minute walk test in patients with COPD. J Bras Pneumol 2009; 35:20-6. [PMID: 19219327 DOI: 10.1590/s1806-37132009000100004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 06/12/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although lean body mass (LBM) has been associated with mortality in patients with COPD, its influence on functional limitation is not clear. The objective of this study was to analyze the cardiopulmonary variables in COPD patients with or without LBM depletion, prior to and after the six-minute walk test (6MWT). METHODS We evaluated COPD patients, 32 with LBM depletion and 36 without. All patients underwent clinical evaluation, spirometry, evaluation of body mass composition and 6MWT, as well as completing questionnaires related to quality of life and perception of dyspnea. RESULTS No significant differences in the severity of airway obstruction, perception of dyspnea and quality of life scores were found between the groups. The distance covered on the 6MWT was similar in COPD patients with and without LBM depletion (470.3 +/- 68.5 m vs. 448.2 +/- 89.2 m). However, patients with LBM depletion presented significantly greater differences between baseline and final values in terms of heart rate and Borg scale index for lower limb fatigue. There was a significant positive correlation between distance covered on the 6MWT and FEV1 (r = 0.381, p = 0.01). CONCLUSIONS In the patients studied, functional exercise tolerance and quality of life were unaffected by LBM depletion. However, the patients with LBM depletion presented more pronounced lower limb fatigue during the 6MWT, which underscores the importance of the evaluation and treatment of systemic manifestations in COPD patients.
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Sanchez FF, Faganello MM, Tanni SE, Lucheta PA, Padovani CR, Godoy I. Relationship between disease severity and quality of life in patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2009; 41:860-5. [PMID: 19037530 DOI: 10.1590/s0100-879x2008005000043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 09/24/2008] [Indexed: 01/10/2023]
Abstract
Few studies have evaluated the relationship between Airways Questionnaire 20 (AQ20), a measure of the quality of life, scores and physiological outcomes or with systemic markers of disease in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the relationship of forced expiratory volume in 1 s (FEV1), body mass index, fat-free mass index, 6-min walk test (6MWT) results, dyspnea sensation and peripheral oxygen saturation (SpO2) with the quality of life of COPD patients. Ninety-nine patients with COPD (mean age: 64.2 +/- 9.2 years; mean FEV1: 60.4 +/- 25.2% of predicted)were evaluated using spirometry, body composition measurement and the 6MWT. The baseline dyspnea index (BDI) and the Modified Medical Research Council (MMRC) scale were used to quantify dyspnea. Quality of life was assessed using the AQ20and the St. George's Respiratory Questionnaire (SGRQ). The Charlson index was used to determine comorbidity. The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index was also calculated. AQ20 and SGRQ scores correlated significantly with FEV1, SpO2, 6MWT, MMRC and BDI values as did with BODE index. In the multivariate analyses,MMRC or BDI were identified as predictors of AQ20 and SGRQ scores (P < 0.001 in all cases). Thus, the relationship between AQ20 and disease severity is similar to that described for SGRQ. Therefore, the AQ20, a simple and brief instrument, can be very useful to evaluate the general impact of disease when the time allotted for measurement of the quality of life is limited.
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Affiliation(s)
- F F Sanchez
- Departamento de Fisioterapia, Centro Universitário Católico Salesiano Auxilium (Unisalesiano), Araçatuba, SP, Brasil.
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Mourtzakis M, Prado CMM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 2008; 33:997-1006. [PMID: 18923576 DOI: 10.1139/h08-075] [Citation(s) in RCA: 1633] [Impact Index Per Article: 96.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Human body composition is important in numerous cancer research domains. Our objective was to evaluate clinically accessible methods to achieve practical and precise measures of body composition in cancer patients. Dual-energy X-ray absorptiometry (DXA)-based analysis of fat and fat-free mass was performed in 50 cancer patients and compared with bioelectrical impedance analysis (BIA) and with regional computed tomography (CT) images available in the patients' medical records. BIA overestimated or underestimated fat-free mass substantially compared with DXA as the method of reference (up to 9.3 kg difference). Significant changes in fat-free mass over time detected with DXA in a subset of 21 patients (+2.2 +/- 3.2%/100 days, p = 0.003), was beyond the limits of detection of BIA. Regional analysis of fat and fat-free tissue at the 3rd lumbar vertebra with either DXA or CT strongly predicted whole-body fat and fat-free mass (r = 0.86-0.94; p < 0.001). CT images provided detail on specific muscles, adipose tissues and organs, not provided by DXA or BIA. CT presents great practical significance due to the prevalence of these images in patient diagnosis and follow-up, thus marrying clinical accessibility with high precision to quantify specific tissues and to predict whole-body composition.
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Affiliation(s)
- Marina Mourtzakis
- Department of Oncology, University of Alberta, 11560 University Avenue, Cross Cancer Institute, Edmonton, AB T6G1Z2, Canada
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45
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Heart Rate Variability and Disease Characteristics in Patients with COPD. Lung 2008; 186:393-401. [DOI: 10.1007/s00408-008-9105-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 06/09/2008] [Indexed: 12/29/2022]
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Thibault R, Veale D, Chailleux E, Darmaun D, Chambellan A. Évaluation de l'état nutritionnel du patient BPCO. NUTR CLIN METAB 2006. [DOI: 10.1016/j.nupar.2006.10.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lerario MC, Sachs A, Lazaretti-Castro M, Saraiva LG, Jardim JR. Body composition in patients with chronic obstructive pulmonary disease: which method to use in clinical practice? Br J Nutr 2006; 96:86-92. [PMID: 16869995 DOI: 10.1079/bjn20061798] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of the present study was to compare anthropometry with bioelectrical impedance (BIA) in relation to densitometry (dual-energy X-ray absorptiometry; DEXA) as methods of nutritional assessment and body composition in out-patients with chronic pulmonary obstructive disease (COPD). We conducted a cross-sectional clinical study with sixty-one patients with COPD (forty-two men and nineteen women), mean age of 66.5 (sd 7.9) years and forced expiratory volume in 1 s of 1.3 (sd 0.6) litres (52.2 (sd 19.8) % predicted), referred to the Pulmonary Rehabilitation Center. The patients were evaluated regarding nutrition status and body composition as determined by anthropometry, BIA and DEXA. In the results, 34.4 % showed mild obstruction, 31.2 %, moderate and 34.4 %, severe obstruction. According to the BMI (mean 24.5 (sd 4.5) kg/m2), 45.9 % of the patients exhibited normal weight, while 27.9 % were underweight and 26.2 % were obese. Related to fat-free mass (FFM), anthropometry and BIA compared with DEXA presented high correlations (r 0.96 and 0.95 respectively; P < 0.001) and high reliability between the methods (alpha 0.98; P < 0.001). Agreement analysis between the methods shows that anthropometry overestimates (0.62 (sd of the difference 2.89) kg) while BIA underestimates FFM (0.61 (sd of the difference 2.82) kg) compared with DEXA. We concluded that according to the nutritional diagnosis, half of our population of patients with COPD showed normal weight, while the other half comprised equal parts obese and underweight patients. Body composition estimated by BIA and anthropometry presented good reliability and correlation with DEXA; the three methods presented satisfactory clinical accuracy despite the great disparity of the limits of agreement.
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Affiliation(s)
- M C Lerario
- Respiratory Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
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Chan SC, Liu CL, Lo CM, Lam BK, Lee EW, Wong Y, Fan ST. Estimating liver weight of adults by body weight and gender. World J Gastroenterol 2006; 12:2217-22. [PMID: 16610024 PMCID: PMC4087649 DOI: 10.3748/wjg.v12.i4.2217] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To estimate the standard liver weight for assessing adequacies of graft size in live donor liver transplantation and remnant liver in major hepatectomy for cancer. METHODS In this study, anthropometric data of body weight and body height were tested for a correlation with liver weight in 159 live liver donors who underwent donor right hepatectomy including the middle hepatic vein. Liver weights were calculated from the right lobe graft weight obtained at the back table, divided by the proportion of the right lobe on the computed tomography. RESULTS The subjects, all Chinese, had a mean age of 35.8+/-10.5 years, and a female to male ratio of 118:41. The mean volume of the right lobe was 710.14+/-131.46 mL and occupied 64.55%+/-4.47% of the whole liver on computed tomography. Right lobe weighed 598.90+/-117.39 g and the estimated liver weight was 927.54+/-168.78 g. When body weight and body height were subjected to multiple stepwise linear regression analysis, body height was found to be insignificant. Females of the same body weight had a slightly lower liver weight. A formula based on body weight and gender was derived: Estimated standard liver weight (g) = 218 + BW (kg) x 12.3 + gender x 51 (R2 = 0.48) (female = 0, male = 1). Based on the anthropometric data of these 159 subjects, liver weights were calculated using previously published formulae derived from studies on Caucasian, Japanese, Korean, and Chinese. All formulae overestimated liver weights compared to this formula. The Japanese formula overestimated the estimated standard liver weight (ESLW) for adults less than 60 kg. CONCLUSION A formula applicable to Chinese males and females is available. A formula for individual races appears necessary.
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Affiliation(s)
- See Ching Chan
- Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Poulain M, Doucet M, Major GC, Drapeau V, Sériès F, Boulet LP, Tremblay A, Maltais F. The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. CMAJ 2006; 174:1293-9. [PMID: 16636330 PMCID: PMC1435949 DOI: 10.1503/cmaj.051299] [Citation(s) in RCA: 221] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Sedentary lifestyles and increased pollution brought about by industrialization pose major challenges to the prevention of both obesity and chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, obstructive sleep apnea and obesity hypoventilation syndrome. Obesity has emerged as an important risk factor for these respiratory diseases, and in many instances weight loss is associated with important symptomatic improvement. Moreover, obesity may influence the development and presentation of these diseases. In this article, we review the current understanding of the influence of obesity on chronic respiratory diseases and the clinical management of obesity concurrent with asthma, COPD, obstructive sleep apnea or obesity hypoventilation syndrome.
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Affiliation(s)
- Magali Poulain
- Division de kinésiologie, Département de médecine sociale et préventive, Université Laval, Québec, Qué
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Chan SC, Liu CL, Lo CM, Lam BK, Lee EW, Wong Y, Fan ST. Estimating liver weight of adults by body weight and gender. World J Gastroenterol 2006; 12:2217-2222. [DOI: 10.3748/wjg.v12.i14.2217] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate the standard liver weight for assessing adequacies of graft size in live donor liver transplantation and remnant liver in major hepatectomy for cancer.
METHODS: In this study, anthropometric data of body weight and body height were tested for a correlation with liver weight in 159 live liver donors who underwent donor right hepatectomy including the middle hepatic vein. Liver weights were calculated from the right lobe graft weight obtained at the back table, divided by the proportion of the right lobe on the computed tomography.
RESULTS: The subjects, all Chinese, had a mean age of 35.8 ± 10.5 years, and a female to male ratio of 118:41. The mean volume of the right lobe was 710.14 ± 131.46 mL and occupied 64.55% ± 4.47% of the whole liver on computed tomography. Right lobe weighed 598.90 ±117.39 g and the estimated liver weight was 927.54 ± 168.78 g. When body weight and body height were subjected to multiple stepwise linear regression analysis, body height was found to be insignificant. Females of the same body weight had a slightly lower liver weight. A formula based on body weight and gender was derived: Estimated standard liver weight (g) = 218 + BW (kg) x 12.3 + gender x 51 (R2 = 0.48) (female = 0, male = 1). Based on the anthropometric data of these 159 subjects, liver weights were calculated using previously published formulae derived from studies on Caucasian, Japanese, Korean, and Chinese. All formulae overestimated liver weights compared to this formula. The Japanese formula overestimated the estimated standard liver weight (ESLW) for adults less than 60 kg.
CONCLUSION: A formula applicable to Chinese males and females is available. A formula for individual races appears necessary.
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