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OBJECTIVE The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. METHODS This study involved 23 patients (median age: 61--range, 59-69 years; FEV1: 39% of predicted--range, 34-53%; BMI: 24 kg/m(2)--range, 21-27 kg/m(2)). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). RESULTS Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. CONCLUSION A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether patients are physically inactive in their daily lives.

Circulating levels of testosterone and gonadotrophins of patients with chronic obstructive pulmonary disease (COPD) have never been compared with those of elderly men with normal pulmonary function. Moreover, the relationship of hypogonadism with quadriceps muscle weakness and exercise intolerance has been studied scarcely in men with COPD.To compare circulating levels of hormones of the pituitary-gonadotrophic axis of men with COPD with those of age-matched control subjects. Moreover, to study the relationship of hypogonadism with quadriceps muscle force, 6-min walking distance, and systemic markers of inflammation in the patients.Circulating levels of follicle-stimulating hormone, luteinizing hormone, testosterone, and sex hormone-binding globulin were determined, and free testosterone was calculated in 78 patients (FEV1: 44 +/- 17% of the predicted values) and 21 control subjects. Moreover, quadriceps muscle force, 6-min walking distance, number of pack-yr, and systemic inflammation were determined.Follicle-stimulating hormone and luteinizing hormone were higher in the patients, whereas testosterone was lower (por = 0.05). The latter finding was also present in 48 non-steroid-using patients with normal blood gases. Low androgen status was significantly related to quadriceps muscle weakness (r = 0.48) and C-reactive protein (r = -0.39) in the patients, but not to exercise intolerance, the number of pack-yr, or increased circulating levels of interleukin 8 or soluble receptors of tumor necrosis factor alpha.In contrast to exercise intolerance, quadriceps muscle weakness is related to low circulating levels of testosterone in men with COPD.

Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28r0.64, p0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.

Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the world, represents an important public health challenge that is both preventable and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer from this disease for years and die prematurely due to it or its complications. Worldwide, the COPD burden is projected to increase in coming decades because of the continued exposure to risk factors and population aging. Menezes et al., in a study including data from five Latin American countries, observed that the prevalence of COPD in the general population older than 40 years varied from 7.8% to 19.7% and that it was more prevalent among men, elderly people, and individuals exposed to tobacco. The characteristic symptoms of COPD are progressive dyspnea, cough, and sputum production, associated with frequent fatigue and impairment in exercise capacity and functional performance. There is a large body of evidence showing that pulmonary rehabilitation (PR) is beneficial to patients with chronic respiratory disease, including COPD. Its benefits include increase in exercise tolerance, reduction in symptoms, and improvement of healthrelated quality of life. A more recent definition describes PR as a ‘‘comprehensive intervention based on a thorough patient assessment followed by patienttailored therapies which include, but are not limited to, exercise training, education and behavior change, designed to improve the physical and emotional condition of people with chronic respiratory disease and to promote the long-term adherence to healthenhancing behaviour.’’ Regardless of the clear benefits provided by PR programs, there is a substantial part of the enrolled patients who do not complete the intervention. There is scant published evidence showing the factors that lead patients with COPD to nonadherence to PR. Young et al. used an interviewer administered questionnaire and suggested that nonadherers were more likely to be depressed, widowed, or divorced, live alone, live in rented accommodation, and be smokers. More recently, another study showed that the referring doctor plays a key role in the uptake of PR programs. The authors discussed that a positive doctors’ approach may increase the level of adherence to PR and would be essential to an effective intervention. In addition, a systematic review performed by Keating and colleagues identified travel and transport difficulties as a predominant barrier to attendance at PR. Lack of perceived rehabilitation benefits and the influence of the doctor were also identified as reasons for nonattendance. In order to achieve better understanding of this issue and to answer simple questions about the opinions of patients enrolled in PR programs, the interest in qualitative studies has been growing in the scientific field. In this issue of Chronic Respiratory Disease, Pinto and colleagues contributed to the scientific literature by writing a systematic review of qualitative researches in patients with COPD about their experiences related to PR. First, the review disclosed the lived-experience from the point of view of patients who completed a PR program. Patient’s reports included a feeling of being supported by health-professionals, peer groups and family, as well as the acquisition of knowledge

In this issue of the Respiratory Care, Monteiro and colleagues[1][1] contribute to the scientific literature of COPD by applying in these patients a modality of noninvasive ventilation that has not yet been studied in depth during exercise: expiratory positive airway pressure (EPAP). The authors

IntroductionSpirometry should follow strict quality criteria. The American Thoracic Society (ATS) recommends the use of a noseclip; however there are controversies about its need. ATS also indicates that tests should be done in the sitting position, but there are no recommendations neither about position of the upper limbs and lower limbs nor about who should hold the mouthpiece while performing the maneuvers: evaluated subject or evaluator.ObjectivesTo compare noseclip use or not, different upper and lower limbs positions and who holds the mouthpiece, verifying if these technical details affect spirometric results in healthy adults.MethodsOne hundred and three healthy individuals (41 men; age: 47 [33-58] years; normal lung function: FEV₁/FVC = 83±5, FEV₁ = 94 [88-104]%predicted, FVC = 92 [84-102]%predicted) underwent a protocol consisting of four spirometric comparative analysis in the sitting position: 1) maximum voluntary ventilation (MVV) with vs without noseclip; 2) FVC performed with vs without upper limbs support; 3) FVC performed with lower limbs crossed vs lower limbs in neutral position; 4) FVC, slow vital capacity and MVV comparing the evaluated subject holding the mouthpiece vs evaluator holding it.ResultsDifferent spirometric variables presented statistically significant difference (pConclusionsThere was no relevant variation in spirometric results when analyzing technical details such as noseclip use during MVV, upper and lower limb positions and who holds the mouthpiece when performing the tests in healthy adults.

Contextualizacao: o ciclo ativo da respiracao e uma tecnica de fisioterapia respiratoria utilizada em pacientes com fibrose cistica (FC), mas pouco se conhece sobre seu impacto funcional e cardiovascular. Objetivo: Avaliar as alteracoes cardio-pulmonares e da funcao pulmonar, associadas a aplicacao da tecnica de ciclo ativo da respiracao (CAR) em criancas com fibrose cistica internadas por exacerbacao da doenca pulmonar. Metodo: Estudo prospectivo, realizado entre dez/08 a fev/10 com pacientes com FC internados por exacerbacao respiratoria, idade>10 anos, uso regular de dornase-alfa. As variaveis estudadas foram: frequencia cardiaca (FC), frequencia respiratoria (FR), saturacao de oxigenio (SatO2), em 6 momentos: pre dornase-alfa (T0), pos dornase-alfa (T1) e 1 minuto (T2), 5 minutos (T3), 10 minutos (T4) e 1 hora (T5) apos aplicacao do CAR. Espirometria realizada em T0, T1 e T5, usando espirometro Koko. As diferencas entre os valores foram verificadas usando o teste ANOVA ou KruskalWallis, considerando-se significantes p

SummaryBackgroundReference values for the incremental shuttle walking test (ISWT) which are applicable to the whole population need to be solidly established. This study aimed to determine which anthropometric and demographic variables influence the walking distance achieved in the ISWT in healthy subjects with a broad age range and to establish a reference equation for predicting ISWT for that population.MethodsIn a cross-sectional study, 242 healthy subjects (102 male) performed two ISWT and had their weight, height and body mass index (BMI) measured.ResultsIn general, healthy subjects walked 810 [IQR 25–75%: 572–1030] m in the ISWT, presenting large variability (range 210–1820 m). The walked distance correlated with age (r = −0.76), height (r = 0.49) and BMI (r = −0.23) (p

RESUMO: Observa-se em nosso melo a prescrição de oxigenoterapia através de tenda facial de O2 sem o conhecimento real da Fração insplrada de oxigénio (FiO2) ofertada no ar inspirado e sem fundamentação sobre a influência dessa FiO2 na Saturação de oxigenio (SatO2) e na frequência respirarória (f) do paclente. lsso pode gerar uso desnecessário de O2 por tenda facial em pacientes sem indicação de oxigenoterapia, levando ao desperdíeio e gasto excessivo com oxigenio.Objectivo: Detenninar valores de FiO2 em direrentes fluxos de oxigenoterapla através de tenda racial de O2, além de anallsar a inftuência dessa FiO2 na SatO2 e frequência respiratória de pacientes sem dlagnóstico principal relacionado a causas pulmonares.Metodologia: Foram estudados 20 pacientes em respiração espontânea e sem diagnóstico principal reladonado a causas pulmonares, sendo medidas a FiO2, a SatO2 e a f desses paclentes quando submetidos a oxigenoterapia em tenda facial de O2 com Ouxos de 0, 1, 3, 5, 7, 10 e 15 1/minResultados: A FlO2 variou de 23,95% (± 2,46%) com 1 1/min O2 ate 86,05% (±10,93%) com 15 1/min O2 A SatO2 variou de 96,30% (± 0,86%) com 1 1/min O2 ate 98,75% (± 0,85%) com 15 Vmin O1 A frequenda rapiratória variou de 22,8 cpm (± 6,06) com 1 1/min O1 até 23,15 cpm (± 5,84) com 15 Vmin O2.Condusão: Através desse estudo pudemos obter médias de FiO2 (com respectivos desvios padrões) em tenda facial para fluxos de O2 de 1 1/min (23,95%), 3 1/min (37,25%), 5 1/min (57,05%), 7 1/min (70%), 10 1/min (80,40%) e 15 1/min (86,05%). Além disso, não encontramos variações importantes na SatO2 nem na frequêneia respiratória com diferentes Ouxos de O2 através da tenda facial, o que demonstra seu uso muitas vezes desnecessário em padentes sem diagnóstico principal relacionado a causas pulmonares.REV PORT PNEUMOL 2000; VI (S): 363-372 ABSTRACT: Ifâ s usual to observe the oxygen therapy prescription by means of face tent of oxygen without knowledge of the real fraction concentration of inspired oxygen (FiO2, as well as the influence of the FiO2 in oxygen percent saturation (SaO2) and in respiratory rate (RR) or the patient. This fact can lead to unnecessary use of O2 via facial tent.Objective: The objective of this study was to quantify the variations or FiO2, SatO2 and RR in different oxygen flows through race tent in patients without main diagnostk caused by pulmonary disease.Methodology: We studied the FiO2 SaO2 and RR In 20 patients breathing spontaneously, without main diagnostic caused by pulmonary disease when submited to oxygen therapy in facial tent with flows or 0, 1, 3, 5, 7, 10 and 15 liters/minute of oxygen (1/m O2).Results: The FiO2 varied from 23,95% (±2,46%) with l 1/m O2 from 96,30% (± 0,86%) with 1 1/m O2 to98,75% (±0,85%) with 15 1/m O2 RR varied from 22,8 bpm (± 6,06) with 11/m 0 1 to 23,15 bpm (± 5,84) with 15 1/m O2Conclusion: Through this study was possible to obtain mean values of FiO2 with oxygen flows of 1, 3, 5, 7, 10, l5 1/m O2 administered by facial tent and, based In the variations of SaO2 and RR, it also shows that use of oxygen via face tent is several times unnecessary in patients without main diagnostic caused by pulmonary disease.REV PORT PNEUMOL 2000; VI (5): 363-372 Palavras-chave: Fracção inspirada de oxigénio, Saturação de oxigenio, Frequência respiratória, Oxigenoterapia, Tenda facial, Key-words: Fraction of inspired oxygen, Oxygen saturation, Respiratory rate, Oxygen therapy, Face tent

Resumo: Introdução e objectivo: A eficiência do transporte mucociliar pode variar em diferentes condições, como na exposição a partículas nocivas do fumo do cigarro. O presente estudo avaliou os efeitos do cigarro, tanto imediato quanto a curto prazo, no transporte mucociliar nasal de fumadores por meio da quantificação do tempo de trânsito da sacarina (TTS), e correlacionou-os com a intensidade de consumo tabagístico. Métodos: Dezanove fumadores ativos (11 homens; 51 ± 16 anos; IMC 23 ± 9 kg/m2; 27 ± 11 cigarros/dia; 44 ± 25 anos/maço), participantes de programa de intervenção antitabagismo, responderam a um questionário referente ao histórico tabagístico e foram submetidos à avaliação da função pulmonar (espirometria) e transporte mucociliar (pelo TTS), este imediatamente e após 8 horas do acto de fumar. Para comparação, um grupo pareado composto por 19 indivíduos saudáveis não fumadores foi avaliado por meio dos mesmos testes. Resultados: Quando comparados ao TTS de não fumadores (10 ± 4 min; média ± desvio padrão), os fumadores apresentaram tempo de transporte similar imediatamente após fumar (11 ± 6 min; p = 0,87) e significativamente mais lento 8 horas após fumar (16 ± 6 min; p = 0,005 versus não fumadores e p = 0,003 versus fumadores). Em fumadores, o TTS 8 horas após fumar correlacionou-se positivamente com a idade (r = 0,59; p = 0,007), o número de cigarros/dia (r = 0,53; p = 0,02) e o índice anos/maço (r = 0,74; p = 0,0003). Conclusão: Embora indivíduos fumadores imediatamente após fumar apresentem transporte mucociliar similar ao de indivíduos não fumadores, 8 horas após o consumo tabagístico o transporte mucociliar mostra-se reduzido e relacionado com hábitos tabagísticos. Abstract: Background and objectives: The efficiency of mucociliary transport may vary in different conditions, such as in exposure to harmful particles of the cigarette smoke. The present study evaluated the acute and short term effects of smoking on nasal mucociliary clearance in current smokers by the quantification of the Saccharin Transit Time (STT), and to investigate its correlation with the history of tobacco consumption. Methods: Nineteen current smokers (11 men, 51 ± 16 years; BMI 23 ± 9 kg/m2, 27 ± 11 cigarettes per day, 44 ± 25 pack-years), entering a smoking cessation intervention program, responded to a questionnaire concerning smoking history and were submitted to lung function assessment (spirometry) and the STT test. STT was assessed immediately after smoking and 8 hours after smoking. The STT test was also performed in nineteen matched healthy non-smokersâ who served as control group. Results: When compared to STT in non-smokersâ (10 ± 4 min; mean ± standard deviation), smokers presented similar STT immediately after smoking (11 ± 6 min; p = 0.87) and slower STT 8 hours after smoking (16 ± 6 min; p = 0.005 versus non-smokersâ and p = 0.003 versus immediately after smoking). STT 8 hours after smoking correlated positively with age (r = 0.59; p = 0.007), cigarettes per day (r = 0.53; p = 0.02) and pack-years index (r = 0.74; p = 0.0003). Conclusions: In smokers, although the mucociliary clearance immediately after smoking is similar to non-smokersâ, eight hours after smoking it is reduced, and this reduction is closely related to the smoking habits. Palavras-chave: Transporte mucociliar nasal, Tabagismo, Teste de trânsito de sacarina, Keywords: Mucociliary clearance, Smoking, Saccharin sodium

The objective of this study was to examine if spatio-temporal gait parameters in healthy children can be determined from accelerations measured at the lower trunk as has been demonstrated in adults, previously. Twenty children aged 3-16 years, participated in a protocol that involved repeated walks of different distances in an indoor environment. During walking, accelerations were measured by three orthogonally mounted acceleration sensors in a small wireless device (DynaPort MiniMod) that was attached to the lower back. Based on an inverted pendulum approach, spatio-temporal gait parameters and walking distances were computed from the acceleration signals. Results were compared to video observations and known walking distances and durations. Steps were successfully detected in 99.6+/-0.6% of all observed steps (n=5554). On average, walking distance was accurately estimated (100.6+/-3.3%, range 93-106.7%). No correlation was found between the number of miscounted steps and the total number of steps or the age of the subject. It can be concluded that the use of an inverted pendulum model provides the possibility to estimate spatio-temporal gait parameters in children as well as in adults. The method allows an inexpensive and comfortable assessment of gait parameters in children, is applicable in controlled, indoor environments and could be tested for applicability under free living conditions.

Background This study tested the validity of revolutions per minute (RPM) measurements from the Pennington Pedal Desk™. Forty-four participants (73 % female; 39 ± 11.4 years-old; BMI 25.8 ± 5.5 kg/m2 [mean ± SD]) completed a standardized trial consisting of guided computer tasks while using a pedal desk for approximately 20 min. Measures of RPM were concurrently collected by the pedal desk and the Garmin Vector power meter. After establishing the validity of RPM measurements with the Garmin Vector, we performed equivalence tests, quantified mean absolute percent error (MAPE), and constructed Bland–Altman plots to assess agreement between RPM measures from the pedal desk and the Garmin Vector (criterion) at the minute-by-minute and trial level (i.e., over the approximate 20 min trial period). Results The average (mean ± SD) duration of the pedal desk trial was 20.5 ± 2.5 min. Measures of RPM (mean ± SE) at the minute-by-minute (Garmin Vector: 54.8 ± 0.4 RPM; pedal desk: 55.8 ± 0.4 RPM) and trial level (Garmin Vector: 55.0 ± 1.7 RPM; pedal desk: 56.0 ± 1.7 RPM) were deemed equivalent. MAPE values for RPM measured by the pedal desk were small (minute-by-minute: 2.1 ± 0.1 %; trial: 1.8 ± 0.1 %) and no systematic relationships in error variance were evident by Bland–Altman plots. Conclusion The Pennington Pedal Desk™ provides a valid count of RPM, providing an accurate metric to promote usage.

Introdução: A capacidade vital (CV) é uma soma de volumes pulmonares que pode ser avaliada por meio das manobras lenta (CVL) e forçada (CVF). Em pacientes com doença pulmonar obstrutiva crônica (DPOC) a CVF é menor do que a CVL, sendo que a diferença entre essas duas variáveis (CVL-CVF) está relacionada ao aprisionamento aéreo. A hiperinsuflação pulmonar dinâmica (HD), que ocorre devido ao aprisionamento aéreo, está entre os principais mecanismos limitadores da tolerância ao exercício em pacientes com DPOC. Um dos testes mais comuns para avaliação da tolerância ao exercício em pacientes com DPOC é o teste de caminhada de seis minutos (TC6min). Durante sua execução podem ser utilizados aparelhos que monitoram a ventilação e consequentemente, podem ser obtidos valores seriados de capacidade inspiratória (CI), que refletem a HD. No entanto, a relação entre a diferença CVL-CVF e a HD desenvolvida durante o TC6min ainda não foi estudada. Objetivo: Investigar a relação entre a diferença CVL-CVF com a HD avaliada durante o TC6min em indivíduos com DPOC. Material e Métodos: Vinte e quatro indivíduos com diagnóstico de DPOC (12 homens; 67±6 anos; volume expiratório forçado no primeiro segundo [VEF1] 56±18% predito), realizaram avaliação da função pulmonar por meio de espirometria e pletismografia. A HD (∆CI ≥ 150ml ou 10%) foi mensurada com medidas seriadas de CI por meio da manobra de CVL que foi realizada ao repouso, a cada dois minutos durante o TC6min, quinze segundos antes do final do teste, e imediatamente após o seu término. Resultados: Foi observada redução significativa da CI durante o TC6min (∆CI: -048±-040L; P

INTRODUÇÃO: Existem diferentes protocolos do teste sit-to-stand (STS) para avaliação da capacidade funcional em pacientes com doença pulmonar obstrutiva crônica (DPOC). Entretanto, não existem evidências sobre qual é o melhor protocolo a ser utilizado nessa população. OBJETIVOS: Correlacionar cada protocolo do STS (5-repetições [5-rep], 30-segundos [30-seg] e 1-minuto [1-min]) com desfechos clínicos importantes avaliados em pacientes com DPOC; comparar os três protocolos do STS assim como verificar a associação e a concordância entre eles; verificar se os três protocolos são capazes de predizer a capacidade funcional de exercício e atividade física de vida diária (AFVD). MÉTODOS: Vinte e três pacientes com DPOC (11 homens; VEF1: 53±15%pred) realizaram três protocolos do teste STS de forma aleatorizada. Considerando que os desfechos dos protocolos foram obtidos em unidades de medida diferentes, a velocidade (número de repetições por segundo [rep/seg]) foi utilizada para a análise dos três testes. Além disso, os pacientes foram submetidos às seguintes avaliações: Incremental Shuttle Walking Test (ISWT), Teste de Caminhada de 6 Minutos (TC6min), 4-metre gait speed test (4MGS), 1-repetição máxima (1RM) de quadríceps femoral, avaliação da atividade física de vida diária (AFVD) e questionários de qualidade de vida e estado funcional. RESULTADOS: O protocolo de 1-min correlacionou-se significativamente com o TC6min (r=0,40), 4MGS (r=0,64) e AFVD (r≥0,47). Para os testes de 5-rep e 30-seg, as melhores correlações obtidas foram com o 4MGS (r=0,54 e r=0,52, respectivamente). Foi encontrada diferença na velocidade de execução dos três protocolos (5-rep: 0,53±0,16 rep/seg; 30-seg: 0,48±0,13rep/seg; 1-min: 0,45±0,11rep/seg; P= 0,01), ou seja, entre o STS de 5-rep e 1-min. Apesar dessa diferença, eles apresentaram boa concordância (CCI≥0,73 para todos) e houve moderada associação entre eles (r≥0,68). Foram verificadas maiores mudanças na saturação periférica de oxigênio, frequência cardíaca, pressão arterial e sintomas de dispneia e fadiga após o protocolo de 1-min (P≤0,01 para todos). Além disso, os três protocolos foram capazes de discriminar pacientes com capacidade de exercício baixa e preservada (Área sob a curva [AUC]≥0,71). No entanto, isso não ocorreu com a AFVD (AUC≤0,67). CONCLUSÃO: O teste de 1-min apresenta maior demanda hemodinâmica, e é o que melhor correlaciona-se com importantes desfechos clínicos avaliados em pacientes com DPOC. Apesar de ter sido verificada diferença na velocidade de execução e na resposta fisiológica entre o STS de 5-rep e 1-min, há boa concordância e correlação entre os três diferentes protocolos do STS. Adicionalmente, todos os protocolos possuíram poder discriminativo para pacientes com capacidade de exercício baixa e preservada. BACKGROUND: Different protocols of the sit-to-stand test (STS) are available to assess functional capacity in patients with chronic obstructive pulmonary disease (COPD). However, it is unclear which is the best protocol to assess this population. AIMS: To correlate each protocol of the STS (5-repetition [5-rep], 30-second [30-sec] and 1-minute [1-min]) with important clinical outcomes in patients with COPD; to compare three STS, as well as to verify their association and agreement; and to verify whether the three protocols are able to predict functional exercise capacity and physical activity in daily life (PADL). METHODS: Twenty-three patients with COPD (11 men; FEV1:53±15%pred) performed three protocols of the STS in a randomized sequence. Since the outcomes units of measure were different, the speed (number of repetitions per second [rep/sec]) was used for the analysis of all three tests. Patients also underwent the following assessments: Incremental Shuttle Walking Test (ISWT), 6-minute walk test (6MWT), 4-metre gait speed test (4MGS), 1-repetition maximum (1RM) of quadriceps muscle, PADL and questionnaires of health-related quality of life and functional status. RESULTS: The 1-min presented significant correlations with the 6MWT (r=0.40), 4MGS (r=0.64) and PADL (r≥0.47). Regarding the 5-rep and 30-sec test, the best correlation obtained were with the 4MGS (r=0.54 and r=0.52, respectively). The speed differed among protocols (5-rep:0.53±0.16 rep/sec; 30-sec: 0.48±0.13rep/sec; 1-min: 0.45±0.11rep/sec; P= 0.01), i.e. between the 5-rep and 1-min STS. However, they presented moderate agreement (ICC≥0.73 for all) and correlated well with each other (r≥0.68). More marked changes in peripheral oxygen saturation, heart rate, blood pressure, dyspnea and leg fatigue were observed after the 1-min protocol (P≤0.01 for all). Furthermore, the three protocols were able to discriminate patients with low and preserved exercise capacity (area under the curve [AUC]≥0.71) but did not predict PADL (AUC≤0.67). CONCLUSION: The 1-min STS generates higher hemodynamic demands and correlates better with clinical outcomes in patients with COPD. Although there was difference between the 5-rep and 1-min protocol in terms of speed performance and physiologic demand, there was good level of agreement among the STS. In addition, all three protocols discriminated patients with low and preserved exercise capacity.

Objetivo: Avaliar a aplicabilidade do Teste de Caminhada de Seis Minutos (6MWTmin) para a prescrição de intensidade de exercício de acordo com recomendações internacionais para pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). Métodos: Pacientes com DPOC (n= 27) foram avaliados quanto à função pulmonar (espirometria), capacidade de exercício (TC6min e Incremental Shuttle Walking Test [ISWT]), sensação de dispneia na vida diária (Medical Research Council scale [MRC]), composição corporal (bioimpedância elétrica), e força muscular inspiratória (pressão inspiratória máxima [PImax]) pré e pós um programa de treinamento físico (TF) com duração de 12 semanas e frequência de 3 vezes por semana. Os critérios adotados no estudo foram os seguintes: critério baseado no TC6min (TC6minC): ≥ 75% da velocidade média do TC6min (TC6minVM); critério baseado nas recomendações da ATS/ERS (ISWTC): ≥ 60% da velocidade do último estágio atingido no ISWT (ISWTV). Resultados: Treze (48%) pacientes cumpriram o TC6minC e o ISWTC, e dez (40%) cumpriram o BorgC na primeira semana do TF. O TC6min mostrou boa performance diagnóstica (valores preditivos positivos e negativos de 0,69 e 0,71, respectivamente, e acurácia de 0,70), boa reprodutibilidade (CCI 0,70, 95%IC 0,45-0,85) e moderada concordância (k 0,41, 95%CI 0,13-0,67) para determinar treinamento físico de alta intensidade de acordo com recomendações internacionais (ISWTC). Comparações entre os pacientes nos quais o TC6minC e o ISWTC concordaram (GC) versus pacientes nos quais os critérios não concordaram (GNC) na primeira semana de TF revelaram que o GC apresentou maior velocidade (3,9 ± 2,1 vs. 3,0 ± 0,74 km/h; P= 0,01), maior %TC6minVM (77 [76 - 86] vs. 74 [62 - 75]; P< 0,001), maior %ISWTV (70 ± 4 vs. 52 ± 10; P< 0,001) e maior relação 6MWTVM/ISWTV (0,87 ± 0,08 vs. 0,70 ± 0,09; P=0,04). Adicionalmente, pacientes nos quais 75% da TC6minvm era maior ou igual que 60% da ISWTv foram comparados com os casos que 75% da TC6minVM era menor que 60% da ISWTV. Esses resultados mostraram pior função pulmonar (CVF 65 ± 13 vs. 82 ± 20; VEF1 45 [31 - 55] vs. 61 [44 - 69] %predito, P< 0.05 para todos), maior sensação de dispneia na vida diária (4 [3-4] vs. 2,5 [2-4], pontos na escala MRC; P= 0,04), menor ISWT (379 ± 100 vs. 516 ± 207, m, P= 0.03) e maior relação 6MWTVM/ISWTV (0.89 ± 0.6 vs. 0.72 ± 0.05 P< 0,001) para o grupo no qual 75% da TC6minVM era igual ou maior que 60% da ISWTV. Após TF os pacientes apresentaram aumento da capacidade de exercício (6MWT pré vs pós TF: 464 ± 70,4 vs. 506 ± 85 m; P= 0,003; e 86 ± 14 vs. 94 ± 17 %predito; P= 0.003). Após TF, o grupo GNC teve maior aumento na velocidade em km/h do que o GC (66 [46 - 79] vs. 28 [21 - 40] %∆, P= 0.02), e em %ISWTV pós TF (63 [46 - 67] vs. 27 [14 - 30] %∆; P= 0,01). Conclusão: O TC6min se mostrou uma ferramenta útil para a prescrição de treinamento de alta intensidade em pacientes com DPOC. Objective: To evaluate the applicability of the Six-Minute Walking Test (6MWT) to prescribe exercise intensity in accordance with international guidelines in patients with chronic obstructive pulmonary disease (COPD). Methods: Patients with COPD (n=27) were evaluated concerning lung function (spirometry), exercise capacity (6MWT and Incremental Shuttle Walking Test [ISWT]), dyspnea sensation in daily life (Medical Research Council Scale [MRC]), body composition (bioelectrical impedance), and inspiratory muscle strength (maximal inspiratory pressure [MIP]) before and after a 12-week, 3 times/week, high-intensity exercise training program (ET). High-intensity criteria were: 6MWT criteria (6MWTC): ≥75% of the 6MWT average speed (6MWTAS); ATS/ERS criteria (ISWTC): ≥60% of the speed achieved in the ISWT last stage (ISWTS). Results: According to 6MWTC and ISWTC, 13 (48%) patients achieved the desired training intensity in the first week of the ET whereas ten (40%) patients achieved BorgC. The 6MWT showed good diagnostic performance (positive and negative predictive values of 0.69 and 0.71, respectively, and accuracy of 0.70), good reliability (ICC 0.703, 95%CI 0.447-0.853) and moderate agreement (k 0.41, 95%CI 0.13-0.67) when used to determine high-intensity exercise according to the ATS/ERS guidelines. When comparing patients in which the 6MWTC and ISWTC agreed (GAweek1) versus the cases in which they did not agree (GNAweek1) in the first week of ET, results revealed that GAweek1 had higher speed (3.9 ± 2.1 vs. 3 ± 0.74, km/h, P= 0.01), %6MWTAS (77 [76 - 86] vs. 74 [62 – 75], P< 0.001), %ISWTS (70.4 ± 3.7 vs. 51.8 ± 10.3, P