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Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. Methods: This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). Results: Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = −0.584), FRT (r = −0.542), MBT (r = −0.530), BBS (r = −0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted R2 = 0.318, p < 0.001). Conclusions: Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Because impulse oscillometry (IOS) can detect changes in the small airways and is safer to perform during the COVID-19 pandemic than other pulmonary function tests, it may have value in investigating pulmonary sequelae in COVID-19 survivors. This study evaluated the performance of IOS in detecting lung abnormalities in COVID-19 survivors and investigated the associations of the findings with those of lung ultrasound (LUS) and spirometry. METHODS: In this cross-sectional study, 117 subjects underwent IOS at a frequency range of 4--20 Hz 2 months after COVID-19 diagnosis. They also underwent spirometry and LUS, and their aeration scores were calculated. RESULTS: On IOS, the resonance frequency was > 12 Hz, and the area under the reactance curve was > 3.60 cm H2O/L/s in 70 (59.8%) and 55 (47.0%) subjects, respectively. A heterogeneity of resistance between R4 and R20 (R4-R20) > 20% was observed in 60 (51.3%) participants. Based on their abnormalities in resistive and reactive parameters, 76 (65.0%) participants had abnormal IOS. Spirometry abnormalities were detected in 40 (34.2%) cases. LUS was abnormal in 51 (43.6%) participants, and the median aeration score was 0 (0--8) points. Abnormal IOS was associated with abnormal LUS (P < .001) and abnormal spirometry (P = .002). Abnormal spirometry had a significant but weaker association with abnormal LUS (P = .031). In participants who reported hospitalization, abnormal IOS was associated with both abnormal LUS (P = .001) and abnormal spirometry (P = .006). In participants who did not report hospitalization, abnormal IOS was associated with abnormal LUS (P < .001) but not abnormal spirometry (P = .063). CONCLUSIONS: In COVID-19 survivors, IOS detected changes even when spirometry is normal. In these individuals, IOS parameters were more strongly associated with abnormalities on LUS than with abnormalities on spirometry. [ABSTRACT FROM AUTHOR]

Abstract Background Early detection of the effects of smoking is of the utmost importance in the prevention of chronic obstructive pulmonary disease (COPD). The forced oscillation technique (FOT) is easy to perform since it requires only tidal breathing and offers a detailed approach to investigate the mechanical properties of the respiratory system. The FOT was recently suggested as an attractive alternative for diagnosing initial obstruction in COPD, which may be helpful in detecting COPD in its initial phases. Thus, the purpose of this study was twofold: (1) to evaluate the ability of FOT to detect early smoking-induced respiratory alterations; and (2) to compare the sensitivity of FOT with spirometry in a sample of low tobacco-dose subjects. Methods Results from a group of 28 smokers with a tobacco consumption of 11.2 ± 7.3 pack-years were compared with a control group formed by 28 healthy subjects using receiver operating characteristic (ROC) curves and a questionnaire as a gold standard. The early adverse effects of smoking were adequately detected by the absolute value of the respiratory impedance (Z4Hz), the intercept resistance (R0), and the respiratory system dynamic compliance (Crs, dyn). Z4Hz was the most accurate parameter (Se = 75%, Sp = 75%), followed by R0 and Crs, dyn. The performances of the FOT parameters in the detection of the early effects of smoking were higher than that of spirometry (p < 0.05). Conclusion This study shows that FOT can be used to detect early smoking-induced respiratory changes while these pathologic changes are still potentially reversible. These findings support the use of FOT as a versatile clinical diagnostic tool in aiding COPD prevention and treatment.

BACKGROUND: With increased survival rates and the consequent emergence of an adult population with cystic fibrosis (CF), developing novel tools for periodic evaluations of these patients has become a new challenge. Thus, we sought to determine the contribution of lung-volume quantification using multidetector computed tomography (CT) in adults with CF and to investigate the association between structural changes and functional abnormalities. METHODS: This was a cross-sectional study in which 21 adults with CF and 22 control subjects underwent lung-volume quantification using multidetector CT. Voxel densities were divided into 4 bands: -1,000 to -900 Hounsfield units (HU) (hyperaerated region), -900 to -500 HU (normally aerated region), -500 to - 100 HU (poorly aerated region), and -100 to 100 HU (non-aerated region). In addition, all participants performed pulmonary function tests including spirometry, body plethysmography, diffusion capacity for carbon monoxide, and the forced oscillation technique. RESULTS: Adults with CF had more non-aerated regions and poorly aerated regions with lung-volume quantification using multidetector CT than controls. Despite these abnormalities, total lung volume measured by lung-volume quantification using multidetector CT did not differ between subjects and controls. Total lung capacity (TLC) measured by body plethysmography correlated with both total lung volume (rs = 0.71, P < .001) and total air volume (rs = 0.71, P < .001) as measured with lungvolume quantification using multidetector CT. While the hyperaerated regions correlated with the functional markers of gas retention in the lungs (increased residual volume (RV) and RV/TLC ratio), the poorly aerated regions correlated with the resistive parameters measured by the forced oscillation technique (increased intercept resistance and mean resistance). We also observed a correlation between normally aerated regions and highest pulmonary diffusion values (rs = 0.68, P < .001). CONCLUSIONS: In adults with CF, lung-volume quantification using multidetector CT can destimate the lung volumes of compartments with different densities and determine the aerated and non-aerated contents of the lungs; furthermore, lung-volume quantification using multidetector CT is clearly related to pulmonary function parameters. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is a growing interest in identifying markers of pulmonary function that are predictive of peripheral muscle dysfunction in chronic obstructive pulmonary disease (COPD); however, studies of this relationship have yielded contradictory results in the literature. OBJECTIVES: To evaluate the strength and endurance of the quadriceps and hamstring muscles according to gender and to evaluate the associations between lower limb muscle function and lung function, health-related quality of life (HRQoL) and 25-hydroxivitamin D3 (25(OH)D 3 ) levels in patients with COPD. METHODS: Forty-two patients with COPD and 42 matched healthy controls underwent knee isokinetic dynamometry at 75 and 240 ∘ /s as well as isometric handgrip strength testing. All patients underwent pulmonary function tests and measurement of 25(OH)D 3. HRQoL was evaluated using the COPD Assessment Test (CAT), the 36-Item Short-Form Health Survey (SF-36) and the Saint George's Respiratory Questionnaire (SGRQ). RESULTS: Most isokinetic parameters showed differences between males and females as well as between COPD patients and controls; the greatest differences were observed among females with COPD and their matched controls. The strongest correlations were observed between the isokinetic parameters and the SF-36 physical component summary (PCS) and SGRQ and pulmonary function variables, especially at the higher velocity. At this velocity, the agonist/antagonist ratio was positively correlated with the SF-36 PCS (r = 0.65), 25(OH)D 3 levels (r = 0.76) and forced expiratory volume in one second (r = 0.65) and was negatively correlated with the CAT (r = - 0.53) and the SGRQ (r = - 0.64) ( P < 0.001 for all correlations). The associations between the isokinetic parameters and 25(OH)D 3 levels were stronger when endurance was tested. CONCLUSIONS: Patients with COPD show a reduction in both strength and endurance, especially in females. The relationships between muscle function, lung function, HRQoL and 25(OH)D 3 levels are most striking when endurance and hamstring/quadriceps muscle balance are tested. In COPD, forced expiratory volume in one second is the strongest marker of lung function that predicts muscle dysfunction. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the effects of a 6-month treatment with intragastric balloon (IGB) on body composition and depressive/anxiety symptoms in obese individuals with metabolic syndrome (MS). Methods: Fifty patients (aged 18-50 years) with obesity and MS were selected for treatment with IGB for 6 months. Body composition was verified with dual-energy X-ray absorptiometry (DXA) at baseline and right after IGB removal. Anxiety/depressive symptoms were assessed with the Beck Depression Inventory (BDI) and the hospital anxiety and depression scale (HADS) at baseline and after 6 months of treatment. Results: In total, 39 patients completed the study. After 6 months, there were significant decreases in weight (11.7 ±9.6 kg, p < 0.0001) and waist circumference (9.3 ±8.2 cm, p < 0.0001). Weight loss was also demonstrated by DXA and corresponded to decreases of 3.0 ±3.4% in body fat percentage, 7.53 ±7.62 kg in total body fat, and 3.70 ±4.89 kg in lean body mass (p < 0.001 for all comparisons). Depressive symptoms scores decreased by a mean of 4.57 ±10.6 points when assessed with the BDI (p = 0.002) and 1.82 ±5.16 points when assessed with the HADSDepression (p = 0.0345). Anxiety symptoms scores decreased by a mean of 1.84 ±4.04 points when determined with the HADS-anxiety (p = 0.0066). The decrease in body fat percentage was the parameter that best correlated with improvements in depressive (p = 0.008) and anxiety symptoms (p = 0.014). Conclusions: In obese individuals with MS, fat mass reduction was associated with short-term improvements in depressive and anxiety symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Individuals with acromegaly (IwA) may have alterations in skeletal muscles. Isokinetic testing is the standard method to assess muscle performance through objective, reliable, and reproducible measures. OBJECTIVES: To assess knee muscles performance of IwA with active and controlled disease and to correlate the findings with hormone levels, handgrip strength (HGS), general fatigue, and quality of life. METHODS: Sixteen men with acromegaly (MwA), 21 women with acromegaly (WwA), and 21 healthy controls (nine men and 12 women) underwent knee isokinetic dynamometry at 75 and 240°/s as well as isometric dynamometry to assess HGS. The subjects were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Fatigue Impact Scale (FIS), and the Acromegaly Quality of Life Questionnaire (AcroQoL). RESULTS: Compared with healthy controls, MwA and WwA exhibited significant reductions in the peak moment (PM), maximum work repetition, and total work for both extension and flexion at both angular velocities. There were significant differences for the agonist/antagonist ratio at 75°/s in MwA (44% for active disease vs. 53% for controlled disease vs. 67% for the control group; P = 0.0002) and in WwA (48% for active disease vs. 58% for controlled disease vs. 66% for the control group; P = 0.0003). These patients also exhibited decreased HGS values and FACIT-F scores and increased FIS scores compared with healthy controls. There were significant correlations between measures obtained by isokinetic dynamometry, growth hormone (GH) levels, HGS values, and scores on the general fatigue questionnaires. However, GH levels were more strongly correlated with the isokinetic variables in MwA than in WwA. CONCLUSIONS: MwA and WwA exhibit decreased muscle performance in the upper and lower limbs, as well as excessive imbalances between the PM of the hamstrings and quadriceps. In addition, poorer muscle performance is associated with higher levels of GH and increased general fatigue. High GH levels have a more negative impact on the isokinetic parameters in MwA than in WwA. [ABSTRACT FROM AUTHOR]

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Objective: Our purpose was to compare the findings of CT pulmonary densitovolumetry and pulmonary function in patients with active acromegaly and controlled acromegaly and, secondarily, to correlate these findings. Methods: 11 patients with active acromegaly, 18 patients with controlled acromegaly and 17 control subjects, all non-smokers, underwent quantification of lung volume using multidetector CT (Q-MDCT) and pulmonary function tests. Results: Patients with active acromegaly had larger total lung mass (TLM) values than the controls and larger amounts of non-aerated compartments than the other two groups. Patients with active acromegaly also had larger amounts of poorly aerated compartments than the other two groups, a difference that was observed in both total lung volume (TLV) and TLM. TLV as measured by inspiratory Q-MDCT correlated significantly with total lung capacity, whereas TLV measured using expiratory Q-MDCT correlated significantly with functional residual capacity. Conclusion: Patients with active acromegaly have more lung mass and larger amounts of non-aerated and poorly aerated compartments. There is a relationship between the findings of CT pulmonary densitovolumetry and pulmonary function test parameters. Advances in knowledge: Although the nature of our results demands further investigation, our data suggest that both CT pulmonary densitovolumetry and pulmonary function tests can be used as useful tools for patients with acromegaly by assisting in the prediction of disease activity. [ABSTRACT FROM AUTHOR]

Background: The Forced Oscillation Technique (FOT) has the potential to increase our knowledge about the biomechanical changes that occur in Cystic Fibrosis (CF). Thus, the aims of this study were to investigate changes in the resistive and reactive properties of the respiratory systems of adults with CF. Methods: The study was conducted in a group of 27 adults with CF over 18 years old and a control group of 23 healthy individuals, both of which were assessed by the FOT, plethysmography and spirometry. An equivalent electrical circuit model was also used to quantify biomechanical changes and to gain physiological insight. Results and discussion: The CF adults presented an increased total respiratory resistance (p < 0.0001), increased resistance curve slope (p < 0.0006) and reduced dynamic compliance (p < 0.0001). In close agreement with the physiology of CF, the model analysis showed increased peripheral resistance (p < 0.0005) and reduced compliance (p < 0.0004) and inertance (p < 0.005). Significant reasonable to good correlations were observed between the resistive parameters and spirometric and plethysmographic indexes. Similar associations were observed for the reactive parameters. Peripheral resistance, obtained by the model analysis, presented reasonable (R = 0.35) to good (R = 0.64) relationships with plethysmographic parameters. Conclusions: The FOT adequately assessed the biomechanical changes associated with CF. The model used provides sensitive indicators of lung function and has the capacity to differentiate between obstructed and non-obstructed airway conditions. The FOT shows great potential for the clinical assessment of respiratory mechanics in adults with CF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC protocol in ventilated patients with pulmonary infection. METHODS: In a randomized crossover study, sputum production and respiratory mechanics were evaluated in 20 mechanically ventilated subjects submitted to 2 interventions. ERCC intervention consisted of a series of manual bilateral ERCCs, followed by a hyperinflation maneuver. Control intervention (CTRL) followed the same sequence, but instead of the compressive maneuver, the subjects were kept on normal ventilation. Static (Cst) and effective (Ceff) compliance and total (Rtot) and initial (Rinit) resistance of the respiratory system were measured pre-ERCC (baseline), post-ERCC or CTRL (POST1), and post-hyperinflation (POST2). Peak expiratory flow (PEF) and the flow at 30% of the expiratory tidal volume (flow 30% VT) were measured during the maneuver. RESULTS: ERCC cleared 34.4% more secretions than CTRL (1 [0.5-1.95] vs 2 [1-3.25], P < .01). Respiratory mechanics showed no differences between control and experimental intervention in POST1 for Cst, Ceff, Rst, and Rinit. In POST2, ERCC promoted an increase in Cst (38.7 ± to10.3 vs 42.2 ± 12 mL/ cm H2O, P = .03) and in Ceff (32.6 ± 9.1 vs 34.8 ± 9.4 mL/cm H2O, P = .04). During ERCC, PEF increased by 16.2 L/min (P < .001), and flow 30% VT increased by 25.3 L/min (P < .001) compared with CTRL. Six subjects (30%) presented expiratory flow limitation (EFL) during ERCC. The effect size was small for secretion volume (0.2), Cst (0.15), and Ceff (0.12) and negligible for Rtot (0.04) and Rinit (0.04). CONCLUSIONS: Although ERCC increases expiratory flow, it has no clinically relevant effects from improving the sputum production and respiratory mechanics in hypersecretive mechanically ventilated patients. The maneuver can cause EFL in some patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although there is some evidence that the progression of lung disease associated with protein malnutrition and metabolic impairments contribute to muscle mass atrophy and dysfunction, the causes of exercise limitation in patients with Cystic Fibrosis (CF) are still poor understood. OBJECTIVE: The primary aim of this study was to characterize the functional aspects of CF adult patients. Secondarily, we aimed to evaluate the association between pulmonary function, nutritional status and functional capacity variables. METHODS: In a cross-sectional study, twenty-one adult patients with CF underwent spirometry, whole-body plethysmography, carbon dioxide diffusion capacity, bioelectrical impedance analysis, cardiopulmonary exercise testing (CPET), six-minute walk test (6MWT) and quadriceps maximal isometric strength and endurance. According to data distribution (Shapiro-Wilk test), statistical analysis used Student's t-test or Mann-Whitney test for comparisons, and Pearson's test for correlations. The significance level was set at 5%. RESULTS: The patients presented with reduced peak VO_{2}, distance in the 6MWT (6MWD), fat-free mass, peripheral and respiratory muscle strength, and quadriceps endurance. There were associations between pulmonary function variables and the results of exercise tests (CPET and 6MWD), as well as between static hyperinflation and CPET variables, and peripheral muscle function (force and endurance) and 6MWD.CONCLUSIONS: Adult patients with CF have impaired exercise tolerance, nutritional status, and peripheral muscles' strength and endurance. There are associations between exercise capacity, pulmonary function and skeletal muscles' performance in these patients. [ABSTRACT FROM AUTHOR]

Background Several studies point to a correlation between obesity and the severity of depressive and anxiety symptoms in children and adults, but there are still some controversial points about this association. The aim of this study is to investigate the relationship between body composition and the severity of anxiety/depressive symptoms in overweight and obese individuals with Metabolic Syndrome (MS). Methods Fifty patients, 18-50 years old, overweight or obese and with the diagnosis of MS based on the International Diabetes Federation (IDF) criteria were selected for this study. Body composition was evaluated using Dual Energy X-ray Absorptiometry (DXA). Depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADSDepression) and the Beck Depression Inventory (BDI). Anxiety symptoms were evaluated using HADS-Anxiety. Results No correlation was found between depressive symptoms (HADS-Depression or BDI) and Body Mass Index (BMI) (r = 0.01; p = 0.94 and r = -0.12, p = 0.38; respectively), Waist Circumference (WC) (r = -0.06, p = 0.67 and r = -0.22, p = 0.12; respectively), and Waistto- Hip Ratio (WHR) (r = -0.12, p = 0.40 and r = -0.17, p = 0.23; respectively). Additionally, no correlation was found among anxiety symptoms (HADS-Anxiety) and BMI (r = -0.15, p = 0.27), and WHR (r = -0.17, p = 0.24). In contrast, a significant correlation was found between percentage of total fat (DXA) and HADS-Depression (r = 0.34, p = 0.019) and HADS-Anxiety (r = 0.30, p = 0.039). Additionally, an inverse and strong correlation was found between lean mass (in grams) and HADS-Depression (r = -0.42, p = 0.004), HADS anxiety (r = -0.57, p < 0.0001), and BDI (r = -0.44, p = 0.026). Conclusions In individuals with MS, the percentage of body fat, and not central fat, BMI, WC, or WHR, was associated with an increased severity of anxiety and depressive symptoms. In contrast, total lean mass was strongly associated with fewer anxiety/depressive symptoms, suggesting that body composition might be related to psychiatric comorbidity in overweight individuals with MS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tuberculosis (TB) remains an important public health problem worldwide, as its residual lesions result in functional and quality of life impairments. Few studies have investigated multiple-drug-resistant pulmonary TB (MDR-TB), and the literature regarding the functional parameters of this group of patients is scarce. Functional characterization may point to the need for post-treatment intervention measures that optimize the quality of life in patients with MDR-TB. Thus, this study sought to analyze the respiratory function, functional capacity, and quality of life of patients who were treated for MDR pulmonary TB. METHODS: This study investigated a cross-sectional cohort of MDR-TB patients who underwent drug treatment for at least 18 months. Patients who had associated diseases (human immunodeficiency virus [HIV], severe heart disease, and hypertension) or disabilities that prevented them from walking were excluded. The subjects underwent the following assessments: forced spirometry, a chest radiograph, the 6-min walk test, a bioelectrical impedance analysis, maximal inspiratory and expiratory pressures, and a health- related quality of life questionnaire. RESULTS: Eighteen patients who met the eligibility criteria were enrolled. Spirometric evaluation showed that 78% of the subjects had abnormal patterns. The maximal respiratory pressures were significantly decreased in all subjects, despite the fact that their nutritional status was within the normal range. The distance completed in the 6-min walk test was less than expected in 72% of the subjects. All of the subjects who were evaluated had residual lesions, and 78% reported a worsening in their quality of life. CONCLUSIONS: In conclusion MDR-TB cured subjects exhibit impaired respiratory function and a mildly reduced functional capacity and quality of life, suggesting that a portion of these patients may require a pulmonary rehabilitation approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery. The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection, as well as to evaluate if CPAP prolongs air leak through the chest drain. METHODS: Thirty patients in the postoperative period of lung resection were allocated into 2 groups: an experimental group, consisting of 15 patients who underwent a 10 cm H2O CPAP, and a 15 patient control group, who performed breathing exercises. Arterial blood gas analysis, peak expiratory flow (PEF), respiratory muscle strength, spirometry, and 6-min walk test (6MWT) were assessed in the preoperative period, and repeated postoperatively on the first and on the seventh day (6MWT was repeated only on the seventh day). RESULTS: Significant increases in PEF, muscle strength, and FEV1 between the first and seventh postoperative day were observed, both in the experimental and in the control group, whereas FVC and PaO2 increased significantly between the first and seventh postoperative day only in the experimental group. The average loss in 6-min walk distance (6MWD) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group. When comparing the 2 groups, only 6MWD was statistically different (P < .001). There was no air leakage increase through the drain with the early use of CPAP. CONCLUSION: When compared to breathing exercises, CPAP increases the 6MWD in postoperative lung resection patients, without prolonging air leak through the chest drain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dynamic hyperinflation, caused by expiratory flow limitation, markedly increases resting end-expiratory lung volume (functional residual capacity) in many COPD patients. OBJECTIVE: To determine the impact and duration of impact of CPAP on hyperinflation and airway resistance in patients with stable COPD. METHODS: In a case series, 21 patients underwent CPAP at 8 cm H2O for 15 min, then whole-body plethysmography immediately after, and at 15 and 30 min after CPAP. RESULTS: The cohort's mean ± SD age was 70 ± 9 y, and the mean FEV1 was 41 ± 8% of predicted. Residual volume, functional residual capacity, total lung capacity, the ratio of residual volume to total lung capacity, and airway resistance decreased after CPAP and did not significantly change at 15 min (P < .001), but returned to baseline at 30 min. CONCLUSIONS: In patients with severe to very severe stable COPD, CPAP reduces lung volumes and airway resistance for 15 min, but the lung volumes return to baseline by 30 min. [ABSTRACT FROM AUTHOR]

The scientific and clinical value of a measure of complexity is potentially enormous because complexity appears to be lost in the presence of illness. The authors examined the effect of elevated airway obstruction on the complexity of the airflow (Q) pattern of asthmatic patients analyzing the airflow approximate entropy (ApEnQ). This study involved 11 healthy controls, 11 asthmatics with normal spirometric exams, and 40 asthmatics with mild (14), moderate (14), and severe (12) airway obstructions. A significant (P < 0.02) reduction in the ApEnQ was observed in the asthmatic patients. This reduction was significantly correlated with spirometric indexes of airway obstruction [FEV1 (%): R = 0.31, P = 0.013] and the total respiratory impedance (R = -0.39; P < 0.002). These results are in close agreement with pathophysiological fundamentals and suggest that the airflow pattern becomes less complex in asthmatic patients, which may reduce the adaptability of the respiratory system to perform the exercise that is associated with daily life activities. This analysis was able to identify respiratory changes in patients with mild obstruction with an adequate accuracy (83%). Higher accuracies were obtained in patients with moderate and severe obstructions. The analysis of airflow pattern complexity by the ApEnQ was able to provide new information concerning the changes associated with asthma. In addition, this analysis was also able to contribute to the detection of the adverse effects of asthma. Because these measurements are easy to perform, such a technique may represent an alternative and/or a complement to other conventional exams to help the clinical evaluations of asthmatic patients. [ABSTRACT FROM AUTHOR]

A letter to the editor and a reply from the author of the article "Expiratory rib cage compression in mechanically ventilated subjects: a randomized cross-over trial" in the 2014 issue is presented.

Breathing is a complex rhythmic motor act, which is created by integrating different inputs to the respiratory centres. Analysing nonlinear fluctuations in breathing may provide clinically relevant information in patients with complex illnesses, such as asbestosis. We evaluated the effect of exposition to asbestos on the complexity of the respiratory system by investigating the respiratory impedance sample entropy (SampEnZrs) and recurrence period density entropy (RPDEnZrs). Similar analyses were performed by evaluating the airflow pattern sample entropy (SampEnV') and recurrence period density entropy (RPDEnV'). Groups of 34 controls and 34 asbestos-exposed patients were evaluated in the respiratory impedance entropy analysis, while groups of 34 controls and 30 asbestos-exposed patients were investigated in the analysis of airflow entropy. Asbestos exposition introduced a significant reduction of RPDEnV' in non-smoker patients (p < 0.0004), which suggests that the airflow pattern becomes less complex in these patients. Smoker patients also presented a reduction in RPDEnV' (p < 0.05). These finding are consistent with the reduction in respiratory system adaptability to daily life activities observed in these patients. It was observed a significant reduction in SampEnV' in smoker patients in comparison with non-smokers (p < 0.02). Diagnostic accuracy evaluations in the whole group of patients (including non-smokers and smokers) indicated that RPDEnV' might be useful in the diagnosis of respiratory abnormalities in asbestos-exposed patients, showing an accuracy of 72.0%. In specific groups of non-smokers, RPDEnV' also presented adequate accuracy (79.0%), while in smoker patients, SampEnV' and RPDEnV' presented adequate accuracy (70.7% and 70.2%, respectively). Taken together, these results suggest that entropy analysis may provide an early and sensitive functional indicator of interstitial asbestosis. [ABSTRACT FROM AUTHOR]

Background: Complaints of peripheral muscle weakness are quite common in patients with systemic sclerosis (SSc). It is likely that the muscle impairments may reduce the patients' exercise performance, which in turn may decrease their functional capacity and exert a direct impact on their quality of life. Objectives: To assess the peripheral and respiratory muscle strength in individuals with SSc and to investigate their correlation with the 6-min walk distance (6MWD) and quality of life measurements. Moreover, we aimed to characterize their nutritional status, pulmonary function, functional capacity, and quality of life compared to the controls. Method: The present cross-sectional study included 20 patients with SSc and 20 control subjects. All of the participants were subjected to isometric dynamometry, surface electromyography, bioelectrical impedance analysis, pulmonary function testing, and the 6-min walk test. Patients with SSc also responded to the Medical Outcomes Study 36-I tem Short-Form Health Survey (SF-36) and the Health Assessment Questionnaire Disability Index (HAQ-DI). Results: The individuals with SSc exhibited a reduction in quadriceps strength (p=0.0001), increased quadriceps fatigability (p=0.034), impaired pulmonary function, and a reduced 6MWD (p=0.0001) compared to the controls. Quadriceps strength was significantly correlated with the 6MWD (Rho=0.719; p=0.0004) and the HAQ-DI (Rho=-0.622; p=0.003). We also found significant correlations between quadriceps fatigability and maximal inspiratory (Rho=0.684; p=0.0009) and maximal expiratory (Rho=0.472; p=0.035) pressure. Conclusions: Patients with SSc exhibited reduced respiratory muscle and quadriceps strength and an increase in its fatigability. In these individuals, there was a relationship between quadriceps strength, functional capacity, and quality of life. [ABSTRACT FROM AUTHOR]

Background: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. Objective: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. Method: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). Results: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=-0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. Conclusions: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition. [ABSTRACT FROM AUTHOR]

Background: Although respiratory physical therapy is considered fundamental in the treatment of hypersecretive patients, there is little evidence of its physiological and therapeutic effects in bronchiectasis patients. Objective: To evaluate the acute physiological effects of ELTGOL and Flutter VRP1® in dynamic and static lung volumes in patients with bronchiectasis and, secondarily, to study the effect of these techniques in sputum elimination. Methods: Patients with clinical and radiological diagnosis of bronchiectasis were included. Patients underwent three interventions in a randomized order and with a one-week washout interval between them. Before all interventions patients inhaled two puffs of 100 μcg of salbutamol. There was a cough period of five minutes before and after the control protocol and the interventions (ELTGOL and Flutter VRP1®). After each cough series patients underwent assessments of dynamic and static lung volumes by spirometry and plethysmography. The expectorated secretions were collected during the interventions and during the second cough series, and quantified by its dry weight. Results: We studied 10 patients, two males and eight females (mean age: 55.9±18.1 years). After using Flutter VRP1®and ELTGOL there was a significant decrease in residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) (p<0.05). There was a higher sputum production during ELTGOL compared with Control and Flutter VRP1® (p<0.05). Conclusion: The ELTGOL and Flutter VRP1® techniques acutely reduced lung hyperinflation, but only the ELTGOL increased the removal of pulmonary secretions from patients with bronchiectasis. Trial Registration ClinicalTrials.gov NCT01300403. [ABSTRACT FROM AUTHOR]

Background: Although respiratory physical therapy is considered fundamental in the treatment of hypersecretive patients, there is little evidence of its physiological and therapeutic effects in bronchiectasis patients. Objective: To evaluate the acute physiological effects of ELTGOL and Flutter VRP1® in dynamic and static lung volumes in patients with bronchiectasis and, secondarily, to study the effect of these techniques in sputum elimination. Methods: Patients with clinical and radiological diagnosis of bronchiectasis were included. Patients underwent three interventions in a randomized order and with a one-week washout interval between them. Before all interventions patients inhaled two puffs of 100 μcg of salbutamol. There was a cough period of five minutes before and after the control protocol and the interventions (ELTGOL and Flutter VRP1®). After each cough series patients underwent assessments of dynamic and static lung volumes by spirometry and plethysmography. The expectorated secretions were collected during the interventions and during the second cough series, and quantified by its dry weight. Results: We studied 10 patients, two males and eight females (mean age: 55.9±18.1 years). After using Flutter VRP1®and ELTGOL there was a significant decrease in residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) (p<0.05). There was a higher sputum production during ELTGOL compared with Control and Flutter VRP1® (p<0.05). Conclusion: The ELTGOL and Flutter VRP1® techniques acutely reduced lung hyperinflation, but only the ELTGOL increased the removal of pulmonary secretions from patients with bronchiectasis. Trial Registration ClinicalTrials.gov NCT01300403. [ABSTRACT FROM AUTHOR]

Background: Chronic heart failure (CHF) is a multifaceted syndrome associated with endothelial dysfunction and increased inflammation. Despite the existing controversies regarding the appropriate training modality, it is widely accepted that supervised cardiac rehabilitation (CR) interventions lead to proinflammatory biomarkers reduction and cellular adhesion molecules in patients with CHF., Aim: The aim of the study was to quantify the effects of 12-week group-based high-intensity aerobic interval training (HIAIT)/modified group-based HIAIT intervention (m-Ullevaal) vs. moderate continuous training (MICT) on serum levels of proinflammatory biomarkers., Design: Single-blind, two-arm, prospective randomized controlled trial conducted on CHF outpatients performing group-based CR interventions throughout a 12-week period., Setting: The setting of the study was the Medical Center of Outpatient Rehabilitation and Sports Medicine, Plovdiv, Bulgaria., Population: The population included a total of 120 outpatients of both genders, mean age of 63.73±6.68 years, with stable CHF (NYHA classes II to IIIB, were randomly assigned to HIAIT/ m-Ullevaal (N.=60) or to MICT (N.=60) group., Methods: Functional exercise capacity (FEC) of the eligible subjects was evaluated through 6-minute walk test (6MWT) and peak oxygen uptake. Blood samples were drawn at baseline, after 12 weeks follow-up for analyses of C-reactive protein (CRP), tumor necrosis factor-α (TNFα) and cellular adhesion molecules (CAM)., Results: Significant decreases in the serum levels of CRP (P=0.029), TNF-α (P=0.036), and vascular cell adhesion molecule-1 (VCAM-1) (P=0.040), were observed after 48 training sessions in the group-based HIAIT/m-Ullevaal intervention, except for intercellular adhesion molecule-1 (ICAM-1), which was higher in the MICT (P=0.034). FEC was significantly inversely related to CRP (r=-0.72, P<0.05), and the levels of VCAM-1 (r=-0.68, P<0.05)., Conclusions: Both group-based CR interventions (HIAIT/m-Ullevaal and MICT) significantly reduced the serum levels of CRP, TNF- α, ICAM-1 and VCAM in patients with CHF. However, selected proinflammatory biomarkers changes and CAMs favorably decreased in the group-based HIAIT/m-Ullevaal intervention. The responses on serum levels of proinflammatory biomarkers and CAMs are dependent upon the type, intensity, and CR intervention duration., Clinical Rehabilitation Impact: The group-based high-intensity aerobic interval training reduces significantly the proinflammatory biomarkers and cellular adhesion molecules in patients with chronic heart failure.

Background: Pulmonary rehabilitation (PR) is recognized as a multidisciplinary intervention designed to reduce symptoms, improve functional status, and prevent acute exacerbations in patients with chronic obstructive pulmonary disease (COPD)., Aim: This study was aimed at evaluating the effects of a long-term PR program on the hospitalization rate and mortality of patients with severe and very severe COPD., Design: Longitudinal, prospective study., Setting: Pulmonary rehabilitation program at our institution., Population: A cohort of 195 patients undergoing a PR program was followed up for 5 years. They were divided into three groups: control (PR<3 months), partial adherence (PR>6 and ≤18 months) and adherence (PR=24 months)., Methods: This was a prospective study where All patients were evaluated every 6 months (D0, D6, D12, D18 and D24, and mapped annually concerning hospitalizations and mortality). Data were analyzed by medians and interquartile ranges, and Kruskal-Wallis non-parametric comparative tests were applied. Comparisons of time to first admission and time to death were made using the Kaplan-Meier estimators, and the factors associated with these outcomes were modeled using semi-parametric Cox models., Results: The results demonstrated a significant reduction in the rate of hospitalization and mortality. The protective effect seems to be dependent on the lengths of stay of patients in the PR program., Conclusions: A multi-disciplinary, long-term PR program with individually tailored 96-week supervised interventions, reduces hospitalization rates and mortality in patients with severe and very severe COPD in a 5-year follow-up period. This protective effect on hospitalization and mortality is obtained from at least 18 months of intervention. Patients who stay longer in the PR program appear to experience a longer protective effect at the end of treatment., Clinical Rehabilitation Impact: This long-term PR program for patients with severe and very severe COPD produced progressively favorable clinical effects, thus reducing the frequency of hospitalizations and mortality in this population.

Background: In recent decades, many studies are focused on different training modalities comparison in patients with cardiac diseases. High intensity aerobic interval training (HIAIT) has been considered as an alternative approach to moderate-intensity continuous training (MICT) in rehabilitation of patients with chronic heart failure (CHF)., Aim: To highlight the superiority of the modified group-based HIAIT intervention (m-Ullevaal) compared to the moderate-intensity continuous training (MICT), also to encourage physical and rehabilitation medicine (PRM) physicians to apply the m-Ullevaal intervention in routine cardiac rehabilitation (CR) practice., Design: А single-blind, prospective randomized controlled trial., Setting: Medical Center of Rehabilitation and Sports Medicine, Plovdiv, Bulgaria outpatients were enrolled., Population: One hundred and twenty subjects of both genders, mean age of 63.73±6.68 years, with stable CHF, NYHA classes II to IIIB, were randomly assigned to m-Ullevaal group (N.=60) or to MICT (N.=60) group. Both CR protocols were conducted throughout a 12-week period., Methods: Functional exercise capacity (FEC), assessed with six-minute walk test, and peak oxygen uptake (VO2peak), left ventricular ejection fraction (LVEF), m-Borg's perceived exertion scale (mBPES), and quality of life (QoL) were outcome measures evaluated., Results: Significant improvement in FEC (P<0.001), LVEF (P<0.001), mBPES and QoL (P<0.001), was observed 12 weeks after both CR interventions (T2). However, the participants performed m-Ullevaal protocol achieved a greater improvement compared to those performed MICT (P<0.001)., Conclusions: The m-Ullevaal protocol seems to be more beneficial and more effective compared to MICT. PRM physicians can efficiently apply the m-Ullevaal protocol in CHF patients rehabilitation., Clinical Rehabilitation Impact: Group-based HIAIT interventions can be widely applied by PRM physicians in CHF patients rehabilitation.

Background: In recent decades, space limitations in the clinical environment have forced health professionals to administer the six-minute walk test (6MWT) using a 20-m or even a 10-m course. However, course length and physical activity level (PAL) affect the test outcomes., Aim: To develop a reference equation for the 6MWT that takes into account the effects of course length and PAL on the walking distance., Design: Cross-sectional study., Setting: Federal University of the State of Rio de Janeiro., Population: Two hundred fifteen healthy adults., Methods: All subjects performed the 6MWT on 10-, 20- and 30-m courses. Eight regression models were constructed considering the association between the six-minute walking distance (6MWD) and heart rate, perceived effort (scores from the Borg's Perceived Exertion Scale-BPES), PAL (classification according to the International Physical Activity Questionnaire, IPAQ), as well as anthropometric and demographic variables. The models were analyzed for the coefficients of determination (R2) and statistical significance at P<0.05., Results: A nonlinear increase in the means of the 6MWDs obtained using the three course lengths was observed (591±70, 652±79 and 678±85 m for course lengths of 10, 20 and 30 m, respectively, with P<0.001). The 6MWD correlated positively with the following variables: sex (r=0.20), body height (r=0.30), IPAQ classification (r=0.14), ΔBPES rating (r=0.25) and Δheart rate (HR, r=0.23), with P<0.001 for all. In contrast, the 6MWD correlated negatively with age (r=-0.23) and Body Mass Index (BMI, r=-0.18), with P<0.001 for both. The regression model with the highest coefficient of determination (adjusted R2=0.36) included the following variables: sex, age, BMI, course length (CL), BPES, HR, and IPAQ., Conclusions: The length of the course strongly impacts individual performance on the 6MWT in a predominantly young adult population. Furthermore, IPAQ-assessed PAL is an important independent predictor of 6MWD., Clinical Rehabilitation Impact: The incorporation of course length in the prediction of 6MWD allows the use of a prediction equation that includes the effects of different course sizes. PAL should be used in the prediction of 6MWD.

Background: Subjects with spinal cord injuries (SCI) have impaired autonomic cardiac regulation and increased risk of cardiovascular disease. In face of the insufficient research data on the autonomic control of physically active subjects with SCI, this study aimed at describing the chronotropic response, as well as the heart rate recovery behavior of a cohort of elite wheelchair rugby athletes., Methods: This is a cross-sectional study including a convenience sample of 17 elite wheelchair rugby athletes with tetraplegia. The subjects underwent a maximal arm ergometry exercise test. Heart rate (HR) was computed at five time points: at rest (before the test), peak exercise, and 1, 2, and 3 minutes after exercise. Data distribution was assessed by using the Shapiro-Wilk Test and correlations were measured by Pearson's correlation coefficient. The level of statistical significance was set at P<0.05., Results: The subjects presented with HR at rest=69.53±8.3 bpm; HR reserve=66.9±8.3%; Chronotropic Index=47.9±11.8%; HRR at 1'=15.2±7.5 bpm; HRR at 2'=25.2±7.4 bpm; HRR at 3'=37±8.4 bpm. 82.3% of the athletes had HRR at 1'>12 bpm, and 64.7% had HRR at 2"> 22 bpm. There were associations between duration of injury and HRR at 1' (r=-0.5; P=0.0398), peak HR (HRpeak) and total weekly training time (r=-0.591; P=0.0125) and HRpeak and weekly physical training time (r=-0.519; P=0.032)., Conclusions: Tetraplegic elite athletes present with reduced chronotropic response. Most of them exhibit an HRR within the values considered normal for the general population.

Background: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC protocol in ventilated patients with pulmonary infection., Methods: In a randomized crossover study, sputum production and respiratory mechanics were evaluated in 20 mechanically ventilated subjects submitted to 2 interventions. ERCC intervention consisted of a series of manual bilateral ERCCs, followed by a hyperinflation maneuver. Control intervention (CTRL) followed the same sequence, but instead of the compressive maneuver, the subjects were kept on normal ventilation. Static (Cst) and effective (C(eff)) compliance and total (R(tot)) and initial (R(init)) resistance of the respiratory system were measured pre-ERCC (baseline), post-ERCC or CTRL (POST1), and post-hyperinflation (POST2). Peak expiratory flow (PEF) and the flow at 30% of the expiratory tidal volume (flow 30% VT) were measured during the maneuver., Results: ERCC cleared 34.4% more secretions than CTRL (1 [0.5-1.95] vs 2 [1-3.25], P < .01). Respiratory mechanics showed no differences between control and experimental intervention in POST1 for Cst, Ceff, R(tot), and R(init). In POST2, ERCC promoted an increase in Cst (38.7 ± 10.3 vs 42.2 ± 12 mL/cm H2O, P = .03) and in C(eff) (32.6 ± 9.1 vs 34.8 ± 9.4 mL/cm H2O, P = .04). During ERCC, PEF increased by 16.2 L/min (P < .001), and flow 30% VT increased by 25.3 L/min (P < .001) compared with CTRL. Six subjects (30%) presented expiratory flow limitation (EFL) during ERCC. The effect size was small for secretion volume (0.2), Cst (0.15), and C(eff) (0.12) and negligible for R(tot) (0.04) and R(init) (0.04)., Conclusions: Although ERCC increases expiratory flow, it has no clinically relevant effects from improving the sputum production and respiratory mechanics in hypersecretive mechanically ventilated patients. The maneuver can cause EFL in some patients. (ClinicalTrials.gov registration NCT01525121).

Background: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied., Objective: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity., Method: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC)., Results: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=-0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables., Conclusions: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition.

Background: Although respiratory physical therapy is considered fundamental in the treatment of hypersecretive patients, there is little evidence of its physiological and therapeutic effects in bronchiectasis patients., Objective: To evaluate the acute physiological effects of ELTGOL and Flutter VRP1® in dynamic and static lung volumes in patients with bronchiectasis and, secondarily, to study the effect of these techniques in sputum elimination., Methods: Patients with clinical and radiological diagnosis of bronchiectasis were included. Patients underwent three interventions in a randomized order and with a one-week washout interval between them. Before all interventions patients inhaled two puffs of 100 mcg of salbutamol. There was a cough period of five minutes before and after the control protocol and the interventions (ELTGOL and Flutter VRP1®). After each cough series patients underwent assessments of dynamic and static lung volumes by spirometry and plethysmography. The expectorated secretions were collected during the interventions and during the second cough series, and quantified by its dry weight., Results: We studied 10 patients, two males and eight females (mean age: 55.9±18.1 years). After using Flutter VRP1®and ELTGOL there was a significant decrease in residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) (p<0.05). There was a higher sputum production during ELTGOL compared with Control and Flutter VRP1® (p<0.05)., Conclusion: The ELTGOL and Flutter VRP1® techniques acutely reduced lung hyperinflation, but only the ELTGOL increased the removal of pulmonary secretions from patients with bronchiectasis.

The scientific and clinical value of a measure of complexity is potentially enormous because complexity appears to be lost in the presence of illness. The changes introduced by asthma in respiratory mechanics and control of breathing may result in modifications in the airflow pattern. These changes may be interesting clinically, since they can reduce the ability of the patient to perform daily life activities. In this paper, we examine the effect of elevated airway obstruction on the complexity of the airflow pattern of asthmatic patients using the approximate entropy method (ApEnQ). This study involved 5 healthy and asthmatics with normal spirometric exam (5), mild (5), moderate (6) and severe (5) airway obstruction. A significant (p〈0.002) reduction in ApEnQ was observed in asthmatic patients. This reduction was significantly correlated with spirometric indices of airway obstruction (R=0.60; p〈0.001). These results are in close agreement with pathophysiological fundamentals, and suggest that in asthmatic patients the airflow pattern becomes less complex, which may reduce the adaptability of the respiratory system to perform exercise associated with daily life activities. Furthermore, our findings also suggest that ApEnQ may help the clinical evaluation of asthmatic patients.