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Background: The assessment of functional capacity in individuals with cardiovascular disease is closely related to lower limb function. The Glittre-ADL test is a global test to evaluate this patients. Objective: We aimed to verify whether the Glittre-ADL test discriminates functional status while evaluating individuals with cardiovascular disease. Methods: A total of 42 participants were evaluated using the Glittre-ADL test Incremental Shuttle Walking Test (shuttle test), Human Activity Profile, and Duke Activity Status Index. Data from the shuttle test, Human Activity Profile, and DASI were divided into tertiles for statistical analysis. The time required to complete the Glittre-ADL test was compared among tertiles of the shuttle test, Duke Activity Status Index and Human Activity Profile using analysis of variance. Results: There were significant differences between the tertiles of the shuttle test. Tertile 1 was different from tertiles 2 (mean difference, 47.63; 95% CI, 19.86-75.39) and 3 (mean difference, 67.15; 95% CI, 41.25-93.05). For the Duke Activity Status Index there were significant between-group differences. Tertile 1 was different from tertiles 2 (mean difference, 42.45; 95% CI, 8.82-76.09) and 3 (mean difference, 43.56; 95% CI, 13.68-73.44). For the Human Activity Profile there were significant between-group differences. Tertile 3 was different from tertiles 1 (mean difference, 51.46; 95% CI, 21.27-81.64) and 2 (mean difference, 33.01; 95% CI, 3.52-62.51). Conclusion: The Glittre-ADL test is able to discriminate the functional status in individuals with cardiovascular disease, most of whom have hypertension. The Glittre-ADL test was sensitive to discriminate more functionally affected individuals. [ABSTRACT FROM AUTHOR]

Background: It is important to include large sample sizes and different factors that influence the sixminute walking distance (6MWD) in order to propose reference equations for the six-minute walking test (6MWT). Objective: To evaluate the influence of anthropometric, demographic, and physiologic variables on the 6MWD of healthy subjects from different regions of Brazil to establish a reference equation for the Brazilian population. Method: In a multicenter study, 617 healthy subjects performed two 6MWTs and had their weight, height, and body mass index (BMI) measured, as well as their physiologic responses to the test. Delta heart rate (ΔHR), perceived effort, and peripheral oxygen saturation were calculated by the difference between the respective values at the end of the test minus the baseline value. Results: Walking distance averaged 586±106m, 54m greater in male compared to female subjects (p<0.001). No differences were observed among the 6MWD from different regions. The quadratic regression analysis considering only anthropometric and demographic data explained 46% of the variability in the 6MWT (p<0.001) and derived the equation: 6MWDpred=890.46–(6.11×age)+(0.0345×age2)+(48.87×gender)–(4.87×BMI). A second model of stepwise multiple regression including ΔHR explained 62% of the variability (p<0.0001) and derived the equation: 6MWDpred=356.658–(2.303×age)+(36.648×gender)+(1.704×height)+(1.365×ΔHR). Conclusion: The equations proposed in this study, especially the second one, seem adequate to accurately predict the 6MWD for Brazilians. [ABSTRACT FROM AUTHOR]

To evaluate the acute effects of expiratory positive airway pressure (EPAP) on exercise tolerance, dyspnea, leg discomfort, and breathing pattern in patients with COPD. Fifteen patients with COPD were assessed with the following three different protocols: EPAP of 7.5 cmH2O used during a constant cycle ergometer exercise test (Protocol-1); EPAP of 7.5 cmH2O used for 15 minutes before the test (Protocol-2); and a sham system without pressure used for 15 minutes before the test (Protocol-3). Dyspnea and leg discomfort were assessed using Borg scale, whereas breathing pattern by optoelectronic plethysmography. Statistical analyses were performed using generalized estimating equations and Bonferroni tests (α = 5%), considering the protocols (1, 2, and 3) and moment (resting and the end of exercise). Exercise tolerance was lower in protocol 1: 108 ± 45 seconds compared to protocols 2: 187 ± 99 seconds (p=.011) and 3: 183 ± 101 seconds (p=.021). No difference was observed between protocols 2 and 3 (p>.999). Dyspnea in protocol 1: 7.0 ± 2.08 was higher than protocols 2: 4.10 ± 2.45 (p=.001) and 3: 3.90 ± 2.21 (p<.001), but no differences were observed between protocols 2 and 3 (p>.999). No significant difference was observed for leg discomfort among the protocols (p=.137). There were no statistically significant differences for most variables of breathing pattern among the protocols. A reduction on exercise tolerance and an increase in dyspnea were found with EPAP of 7.5 cm H2O during a constant cycle ergometer exercise test in patients with COPD. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation (CR) is insufficiently available; even less so in low-resource settings. Health care administrators (HAs) are responsible for ensuring CR programs are offered and resourced. This study compared HA CR attitudes in North and South America, the contextual factors associated with these attitudes, and developed a scale/survey to assess them with global applicability.Methods: Data were retrospectively analysed from three cross-sectional studies: in (1) 195 HAs from Canada (i.e., North America), (2) 44 HAs from seven South American countries, and (3) 43 HAs from Brazil (all South America). Contextual and perceptual/attitudinal items (five-point Likert scale, with higher scores indicating more positive attitudes) were compared by region. Psychometric properties of items were tested. A literature review was performed, and items generated for content validation by experts.Results: The most negative CR attitudes related to government funding models (mean=2.46±1.14/5), and that patients have responsibility for their disease management (3.03±1.25). North American HAs rated their institutions' perceptions of the importance of CR (p<0.001) and quality of the local program (p<0.001) higher than their South American counterparts, but rated the utility of CR in lowering length of stay (p<0.001), promoting behaviour change (p<0.05) and the need for more government funding (p<0.05) lower, among others. Total attitude scores were positively associated with CR knowledge/awareness in both cohorts (all p<0.01). North American HAs more often perceived CR should be funded by hospitals (p<0.001) than South Americans. A 39-item HA CR Attitudes (HACRA-R) scale was developed.Conclusions: Health care administrators' perceptions vary by context, which could impact CR resourcing. [ABSTRACT FROM AUTHOR]

Background: Multiple factors can influence the severity of chronic obstructive pulmonary disease (COPD) and the functioning of patients with COPD, such as personal characteristics and systemic manifestations. Objective: To evaluate the different factors that can influence the activity and psychosocial impact domains of the Saint George's Respiratory Questionnaire (SGRQ) in COPD patients. Method: Participants, recruited in a university-based hospital, responded to the SGRQ, and in addition, personal, anthropometric, and clinical data were collected. The study was approved by the Institutional Ethics Committee. Data were analyzed using multiple linear regression models, with the SGRQ activity and psychosocial impact scores as outcome variables, and 10 explanatory variables (age, gender, forced expiratory volume in the first second--FEV1, smoking load, body mass index, oxygen therapy, associated diseases, regular physical activity, participation in a formal rehabilitation program, and SGRQ symptoms score) were considered. Results: The best regression model for predicting the SGRQ activity score (r2=0.477) included gender, FEV1, and SGRQ symptoms. In contrast, the predictive model with the highest proportion of explained variance in psychosocial impact score (r2=0.426) included the variables gender, oxygen therapy, and SGRQ symptoms. Conclusions: The results indicate that the outcomes, while based on functioning parameters in COPD patients, could be partly explained by the personal and clinical factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it appears that the health conditions of these patients cannot be described by isolated variables, including pulmonary function parameters. [ABSTRACT FROM AUTHOR]

Abstract: We studied systematically, for the first time, the utility of the six-minute walk test (6MWT) in Chagas disease. The walked distance at 6MWT correlated negatively with the increased circulating levels of monocyte chemoattractant protein (MCP-1, r =−0.358, p =0.04) and natriuretic peptide type B (BNP, r =−0.349, p =0.04), as well as positively with ejection fraction deterioration (r =0.451, p =0.004), indicating that submaximal functional capacity of chagasic patients is related to the severity of the cardiopathy. 6MWT may constitute an auxiliary tool in the evaluation of the clinical status of Chagas disease patients. [Copyright &y& Elsevier]

Background: The six-minute walk test (6MWT) is a simple, low cost, reliable, and valid method for evaluating the functional capacity of cardiac patients. However, its early use and safety following acute myocardial infarction (AMI) is recent and has been little investigated. Objective: To evaluate and to compare the safety and the cardiac behavior of early performance of the 6MWT in patients following uncomplicated AMI up to 4 days or more than 4 days after the event. Methods: Following discharge from the Coronary Care Unit, 152 stable asymptomatic patients diagnosed with uncomplicated AMI performed the 6MWT. During the test, in addition to the distance walked, heart rate (HR), blood pressure (BP), and adverse events were also recorded. Electrocardiography was recorded using a Holter monitor in 105 patients. Patients were allocated considering two groups according to the number of days since AMI: Up to 4 Days Group and After 4 Days Group. Results: All patients completed the 6MWT, 66 in the Up to 4 Days Group and 86 in the After 4 Days Group. The walking distance was similar in both groups (85% of the predicted value), as well as the physiological responses (increase in systolic BP and HR), reaching 63% (median) of maximum HR. Only 3.9% of patients had major complications (angina, drop in BP, or ventricular tachycardia), with no difference between the groups. None of the complications regarded as severe led to truly significant complications or death. Conclusion: The 6MWT was proven to be safe and feasible for early functional evaluation following uncomplicated AMI. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the agreement between the measured peak oxygen uptake (VO2peak) and the VO2peak estimated by four prediction equations based on the six-minute walk test (6MWT) in chronic heart failure patients. Method: Thirty-six chronic heart failure patients underwent cardiopulmonary exercise testing and the 6MWT to assess their VO2peak. Four previously published equations that include the variable six-minute walk distance were used to estimate the VO2peak: Cahalin, 1996a (1); Cahalin, 1996b (2); Ross, 2010 (3); and Adedoyin, 2010 (4). The agreement between the VO2peak in the cardiopulmonary exercise testing and the estimated values was assessed using the Bland-Altman method. A p-value of <0.05 was considered statistically significant. Results: All estimated VO2peak values presented moderate correlation (ranging from 0.55 to 0.70; p <0.001) with measured VO2peak values. Equations 2, 3, and 4 underestimated the VO2peak by 30%, 15.2%, and 51.2%, respectively, showing significant differences from the actual VO2peak measured in the cardiopulmonary exercise testing (p < 0.0001 for all), and the limits of agreement were elevated. The VO2peak estimated by equation 1 was similar to that measured by the cardiopulmonary exercise testing, and despite the agreement, bias increased as VO2peak increased. Conclusions: Only equation 1 showed estimated VO2peak similar to the measured VO2peak; however, a large limits of agreement range (~3 METs) does not allow its use to estimate maximal VO2peak. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular Disease (CVD) is the leading burden of disease worldwide. Moreover, CVD-related death rates are considered an epidemic in low- and middle-income countries (LMICs). Research shows that cardiac rehabilitation (CR) participation reduces death and improves disability and quality of life. Given the growing epidemic of CVD in LMICs and the insufficient evidence about CR programs in these countries, a Randomized Control Trial (RCT) in Latin America is warranted. Objective: To investigate the effects of comprehensive CR on functional capacity and cardiovascular risk factors. Method: The design is a single-blinded RCT with three parallel arms: comprehensive CR (exercise + education) versus exercise-based CR versus wait-list control (no CR). The primary outcome will be measured by the Incremental Shuttle Walk Test. Secondary outcomes are risk factors (blood pressure, dyslipidemia, dysglycemia, body mass index and waist circumference); tertiary outcomes are heart health behaviors (exercise, medication adherence, diet, and smoking), knowledge, and depressive symptoms. The CR program is six months in duration. Participants randomized to exercise-based CR will receive 24 weeks of exercise classes. The comprehensive CR group will also receive 24 educational sessions, including a workbook. Every outcome will be assessed at baseline and 6-months later, and mortality will be ascertained at six months and one year. Conclusion: This will be the first RCT to establish the effects of CR in Latin America. If positive, results will be used to promote broader implementation of comprehensive CR and patient access in the region and to inform a larger-scale trial powered for mortality. [ABSTRACT FROM AUTHOR]

Background: The mechanisms underlying breathing exercises have not been fully elucidated. Objectives: To evaluate the impact of four on breathing exercises (diaphragmatic breathing, inspiratory sighs, sustained maximal inspiration and intercostal exercise) the on breathing pattern and thoracoabdominal motion in healthy subjects. Method: Fifteen subjects of both sexes, aged 23±1.5 years old and with normal pulmonary function tests, participated in the study. The subjects were evaluated using the optoelectronic plethysmography system in a supine position with a trunk inclination of 45° during quiet breathing and the breathing exercises. The order of the breathing exercises was randomized. Statistical analysis was performed by the Friedman test and an ANOVA for repeated measures with one factor (breathing exercises), followed by preplanned contrasts and Bonferroni correction. A p<0.005 value was considered significant. Results: All breathing exercises significantly increased the tidal volume of the chest wall (Vcw) and reduced the respiratory rate (RR) in comparison to quiet breathing. The diaphragmatic breathing exercise was responsible for the lowest Vcw, the lowest contribution of the rib cage, and the highest contribution of the abdomen. The sustained maximal inspiration exercise promoted greater reduction in RR compared to the diaphragmatic and intercostal exercises. Inspiratory sighs and intercostal exercises were responsible for the highest values of minute ventilation. Thoracoabdominal asynchrony variables increased significantly during diaphragmatic breathing. Conclusions: The results showed that the breathing exercises investigated in this study produced modifications in the breathing pattern (e.g., increase in tidal volume and decrease in RR) as well as in thoracoabdominal motion (e.g., increase in abdominal contribution during diaphragmatic breathing), among others. [ABSTRACT FROM AUTHOR]

Highlights: [•] The validity of OEP system has been evaluated in different populations and experimental protocols. [•] The present study showed that OEP presents adequate intra- and inter-rater reliability at rest and during exercise. [•] Further studies are needed to assess populations with cardiopulmonary dysfunction. [Copyright &y& Elsevier]

Background: The assessment of strength and its relationships with functional capacity could contribute to more specific and effective disability management of stroke survivors. Objective: To compare and investigate associations between measures of strength and functional capacity of 98 chronic stroke survivors, stratified into three groups, according to their physical activity levels. Method: The physical activity levels were classified as impaired, moderately active, and active, based on their Human Activity Profile (HAP) scores. Strength was assessed by the maximal inspiratory (MIP) and expiratory (MEP) pressures and by the residual deficits (RDs) of work of the lower limb and trunk muscles, whereas functional capacity was evaluated by the distance covered during the six-minute walking test (6MWT). Results: One-way analyses of variance revealed significant differences between the groups, except between the active and moderately active groups regarding the RDS of the hip and knee flexors/extensors and ankle dorsiflexors (2.91

Background: Optoelectronic plethysmography (OEP) is an innovative method of indirect measurement of pulmonary ventilation, capable of breath-by-breath, three-dimensional, real time assessment of absolute lung volumes and their variations in the three compartments of the chest wall (pulmonary rib cage, abdominal rib cage, and abdomen). OEP allows the measurement of variables of breathing pattern, breathing asynchrony, and contribution of each chest wall compartment and hemithorax to the tidal volume. Objectives: To review the literature on the following aspects related to OEP: history, operating principle, advantages, psychometric properties, variables, and method of system analysis, highlighting information about its handling. In a second part, the objective is to analyze the applicability of OEP in different health conditions/situations such as: chronic obstructive pulmonary disease (COPD; acute effects of exercise, pulmonary rehabilitation, breathing exercise, and lung transplantation), asthma, patients in intensive care, neuromuscular diseases, and stroke. Method: A search was performed in MedLine, SciELO and Lilacs with the term 'optoelectronic plethysmography'. Forty-three papers were included. Conclusion: Based on the literature reviewed, OEP has been shown to be an assessment tool that can provide information about ventilatory parameters in healthy subjects and subjects with various dysfunctions in different positions, situations, and settings. The main results of studies on OEP in COPD are shown, representing the largest body of knowledge to date. The results of studies on OEP in other health conditions are also shown. [ABSTRACT FROM AUTHOR]

Background: Optoelectronic plethysmography (OEP) is an innovative method of indirect measurement of pulmonary ventilation, capable of breath-by-breath, three-dimensional, real time assessment of absolute lung volumes and their variations in the three compartments of the chest wall (pulmonary rib cage, abdominal rib cage, and abdomen). OEP allows the measurement of variables of breathing pattern, breathing asynchrony, and contribution of each chest wall compartment and hemithorax to the tidal volume. Objectives: To review the literature on the following aspects related to OEP: history, operating principle, advantages, psychometric properties, variables, and method of system analysis, highlighting information about its handling. In a second part, the objective is to analyze the applicability of OEP in different health conditions/situations such as: chronic obstructive pulmonary disease (COPD; acute effects of exercise, pulmonary rehabilitation, breathing exercise, and lung transplantation), asthma, patients in intensive care, neuromuscular diseases, and stroke. Method: A search was performed in MedLine, SciELO and Lilacs with the term "optoelectronic plethysmography". Forty-three papers were included. Conclusion: Based on the literature reviewed, OEP has been shown to be an assessment tool that can provide information about ventilatory parameters in healthy subjects and subjects with various dysfunctions in different positions, situations, and settings. The main results of studies on OEP in COPD are shown, representing the largest body of knowledge to date. The results of studies on OEP in other health conditions are also shown. [ABSTRACT FROM AUTHOR]

Background: Obesity is a worldwide health problem that may also induce respiratory dysfunction. Literature linking weight loss and maximum respiratory pressures is inconclusive. Objective: To evaluate longitudinally the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) of morbidly obese individuals before and after gastric bypass surgery, and to compare them to a control group matched by sex and age. Methods: A vacuum manometer (GeRar®, SP, Brazil) was used to assess the MIP and MEP of 30 morbidly obese participants (24 women), aged 32±8 years and with body mass index (BMI) of 43±4 kg/m2, both before and then one and six months after gastric bypass surgery. After an average of 36 months, 17 patients were reevaluated. A control group of 30 individuals with normal lung function (aged 30±8 with a BMI of 22±2 kg/m2) was also studied. An unpaired t-test and ANOVA for repeated measures were used for statistical analysis, with p<0.05 considered as significant. Results: No significant differences were observed in the baseline evaluation between the two groups. A significant increase was found in MIP after approximately 36 months of surgery in the obese group. A significant decrease in MEP was observed after one month, as well as a significant increase after 36 months compared with one and six months post-surgery. Conclusion: The data showed a significant long-term increase in MIP, as well as a significant decrease in MEP after one month followed by a return to pre-operative values, which indicates that gastric bypass surgery has a positive influence on the strength of inspiratory muscles. [ABSTRACT FROM AUTHOR]

Background: Obesity is a worldwide health problem that may also induce respiratory dysfunction. Literature linking weight loss and maximum respiratory pressures is inconclusive. Objective: To evaluate longitudinally the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) of morbidly obese individuals before and after gastric bypass surgery, and to compare them to a control group matched by sex and age. Methods: A vacuum manometer (GeRar®, SP, Brazil) was used to assess the MIP and MEP of 30 morbidly obese participants (24 women), aged 32±8 years and with body mass index (BMI) of 43±4 kg/m2, both before and then one and six months after gastric bypass surgery. After an average of 36 months, 17 patients were reevaluated. A control group of 30 individuals with normal lung function (aged 30±8 with a BMI of 22±2 kg/m2) was also studied. An unpaired t-test and ANOVA for repeated measures were used for statistical analysis, with p<0.05 considered as significant. Results: No significant differences were observed in the baseline evaluation between the two groups. A significant increase was found in MIP after approximately 36 months of surgery in the obese group. A significant decrease in MEP was observed after one month, as well as a significant increase after 36 months compared with one and six months post-surgery. Conclusion: The data showed a significant long-term increase in MIP, as well as a significant decrease in MEP after one month followed by a return to pre-operative values, which indicates that gastric bypass surgery has a positive influence on the strength of inspiratory muscles. [ABSTRACT FROM AUTHOR]

Background: Respiratory muscle strength is influenced by aging. Objectives: To assess, in a healthy elderly population, the influence ol physical activity and functional performance on the pulmonary function parameters, on respiratory muscle strength and on coughing Methods: Observation study that sixty one elderly with age equal or more than 60 years (72.3±7.2 years), with normal spirometry were included. Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Peak Expiratory Flow (PEF), Peak Cough Flow (PCF) and Human Activity Profile (HAP) were evaluated. The elderly were separated in two groups (active and moderately active) according to HAP. Student's test was used for univariate analysis and regression analysis models was used for multivariate analysis. Results: Elderly participants who were classified as active presented on average 13.5 cmH20 higher MEP (88±21.4 cmH20), and 16.2 cmH20 higher MIP (76±17.7 cmH2O). Maximal respiratory pressure decreases 1 cmH20 per year. The PEF and PCF were higher for male (p<0.001) and active elderly (p=0.046 e p=0.004 respectively). A positive correlation was observed between HAP and the following variables MEP MIP and PCF (r=0.527, p<0.001; r=0.498, p<0.001 and r=0.365, p=0.004, respectively). Conclusions: The active life style can positively affect the respiratory muscle strength and PCF values. Aging is associated to respiratory muscle strength reduction (both inspiratory and expiratory). Women showed lower PEmax. [ABSTRACT FROM AUTHOR]

Background: Respiratory muscle strength is influenced by aging. Objectives: To assess, in a healthy elderly population, the influence ol physical activity and functional performance on the pulmonary function parameters, on respiratory muscle strength and on coughing Methods: Observation study that sixty one elderly with age equal or more than 60 years (72.3±7.2 years), with normal spirometry were included. Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Peak Expiratory Flow (PEF), Peak Cough Flow (PCF) and Human Activity Profile (HAP) were evaluated. The elderly were separated in two groups (active and moderately active) according to HAP. Student's test was used for univariate analysis and regression analysis models was used for multivariate analysis. Results: Elderly participants who were classified as active presented on average 13.5 cmH20 higher MEP (88±21.4 cmH20), and 16.2 cmH20 higher MIP (76±17.7 cmH2O). Maximal respiratory pressure decreases 1 cmH20 per year. The PEF and PCF were higher for male (p<0.001) and active elderly (p=0.046 e p=0.004 respectively). A positive correlation was observed between HAP and the following variables MEP MIP and PCF (r=0.527, p<0.001; r=0.498, p<0.001 and r=0.365, p=0.004, respectively). Conclusions: The active life style can positively affect the respiratory muscle strength and PCF values. Aging is associated to respiratory muscle strength reduction (both inspiratory and expiratory). Women showed lower PEmax. [ABSTRACT FROM AUTHOR]

Objective: To describe the breathing pattern and thoracoabdominal motion of healthy individuals, taking age and sex into consideration. Methods: The study included 104 individuals aged 20 to 39, 40 to 59, and 60 to 80 years (41 males and 63 females), with normal body mass index and spirometric values. Participants were evaluated at rest in the supine position, by means of respiratory inductive plethysmography. The following variables were measured: tidal volume (Vt), respiratory frequency (f), minute ventilation (VE), inspiratory duty cycle (Ti/Ttot), mean inspiratory flow (Vt/Ti), rib cage motion (%RC), inspiratory phase relation (PhRIB), expiratory phase relation (PhREB), and phase angle (PhaseAng). Comparisons between the age groups were performed using one-way ANOVA or Kruskal- Wallis H, while comparisons between the sexes were performed using Student's t test or the Mann-Whitney U test, depending on the data distribution; p<0.05 was taken to be significant. Results: Comparison between the sexes showed that, in the age groups 20 to 39 and 60 to 80 years, women presented significantly lower values for Vt, VE, and Ti/Ttot than men, and there was no significant difference in the age group 40 to 59 years. Comparisons between the age groups showed that participants aged 60 to 80 presented significantly greater PhRIB and PhaseAng than participants aged 20 to 39 years, without significant differences in the breathing pattern. Conclusion: The data suggest that breathing pattern is influenced by sex whereas thoracoabdominal motion is influenced by age. [ABSTRACT FROM AUTHOR]

Aims: The effects of exercise training in chronic heart failure are well established, however, they have not been evaluated in Chagas cardiomyopathy (ChC). We sought to determine the effects of exercise training on functional capacity, health-related quality of life (HQoL), and brain natriuretic peptide (BNP) levels in patients with ChC. [ABSTRACT FROM PUBLISHER]

Introduction: Patients with chronic obstructive pulmonary disease (COPD) report dyspnea when performing activities of daily living (ADLs) with elevated upper limbs. To elucidate the determinants of dyspnea, it is important to study the changes in the respiratory pattern of these patients and the electromyographic activity of their accessory muscles of respiration during ADLs. In the literature, there are no reports of a normative parameter, therefore it is necessary to study how these variables behave in healthy subjects. Objectives: To verify, in healthy subjects, the existence of changes in the respiratory pattern and activation of the sternocleidomastoid (SCM) muscle during an ADL with unsupported arm elevation. Methods: Thirteen male subjects, 60.57 (±6.42) years old, with normal spirometry values for age and sex, were evaluated using surface electromyography (EMG) and respiratory inductive plethysmography (RIP) collected at rest and during the activity of combing their hair with elevated and unsupported upper limbs. The data distribution was assessed using Shapiro-Wilk's test. ANOVA was used to compare the phases, and when the difference was significant (p<0.05), Tukey's test was applied. Results: The RIP during the ADL showed a significant increase in tidal volume, minute ventilation, respiratory frequency and mean inspiratory flow. Thoracoabdominal asynchrony was identified in percentage of asynchrony in inspiration, expiration, and Phase Angle (p<0.05). The EMG showed an increase in SMC muscle recruitment (p<0.05). Conclusions: Healthy subjects increased their SCM muscle activation and changed their breathing pattern when performing the ADL with unsupported arm elevation, resulting in thoracoabdominal asynchrony. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the quality of life (QOL) of patients with chronic venous disease (CVD) and to analyze the relationship between QOL and disease severity. Methods: This was a cross-sectional study with a convenience sample of 50 participants with a diagnosis of CVD. The participants were classified according to disease severity using the CEAP clinical classification (Clinical manifestations, Etiological factors, Anatomical distribution of disease, Pathophysiological findings). They were then divided into two groups: CEAP 1, 2 and 3 (less clinically compromised) and CEAP 4, 5 and 6 (more clinically compromised). QOL was evaluated using the SF-36 questionnaire. The Mann-Whitney U test was used to compare the SF-36 scores between the groups. The Spearman correlation was used to evaluate the association between QOL and the CEAP. Differences were considered statistically significant with p < 0.05. The SPSS statistical software version 16.0 was used for the analyses. Results: Seventy-four percent of the sample was female. The mean age was significantly higher (p<0.001) among participants classified as CEAP 4, 5 and 6 (56.6±10.3) than among those classified as CEAP 1, 2 and 3 (40.6±10.7). All the domains of the physical component of the SF-36 presented significantly lower scores in the CEAP 4, 5 and 6 group (p<0.05), thus showing greater physical and functional impairment. Only the domains of the physical component presented statistically significant negative correlations with the CEAP. Conclusions: The physical and functional characteristics were more impaired, especially in the more severe forms of CVD. These findings may contribute to a better understanding of the effects of CVD on QOL and better management of therapeutic interventions in this population. [ABSTRACT FROM AUTHOR]

Sarcopenia is the most significant factor in the decline of peripheral and respiratory muscle strength. It can lead to progressive disability, loss of independence and impaired functional capacity. Objectives: To determine the strength of respiratory muscles (maximal inspiratory pressure -- MIP and maximal expiratory pressure -- MEP) and lower limb muscles, and to explore the possible relationships between these variables and the functional capacity of the elderly. Methods: Sixty-five elderly patients (71.7±4.9 years old) took part in the study. Isokinetic dynamometry was used to assess the knee flexors and extensors, an analog vacuum manometer was used to assess the respiratory muscles, and the six-minute walking test was used as an outcome of functional capacity. The Mann-Whitney test and Student's t-test were used for gender comparison. The relationships were investigated using Pearson's correlation. The significance level was p<0.05. Results: The lower limb and respiratory muscle strength variables and the walking distance variables were higher in men than women (p<0.05). Moderate and significant correlations were found between these variables (p<0.001). The higher values were between right knee extensor average peak torque (APT) and MIP (r=0.587), left knee flexor APT and MEP (r=0.638), as well as between walking distance and left knee extensor average power (AP; r=0.614), right knee flexor AP (r=0.539), MIP (r=0.508) and MEP (r=0.541) respectively. Conclusions: The relationship between walking distance and respiratory and lower limb muscle strength found in this study suggests that optimizing these functions may contribute to maintaining and improving functional capacity in the elderly. [ABSTRACT FROM AUTHOR]

Corrections to the article "Effects of comprehensive cardiac rehabilitation on functional capacity and cardiovascular risk factors in Brazilian patients assisted by public health care: Protocol for a randomized controlled trial" are presented.