Search

INTRODUÇÃO: O quadro de exacerbação aguda da doença pulmonar obstrutiva crônica (DPOC) gera impacto negativo na qualidade de vida, função pulmonar, mortalidade e funcionalidade. Sabe-se que aspectos físicos e funcionais estão deteriorados nesses indivíduos durante a hospitalização por exacerbação. Além da funcionalidade, é importante avaliar a fragilidade, componente este que está intimamente relacionado ao quadro de vulnerabilidade da doença. Estudos recentes têm mostrado que exacerbações frequentes podem estar associadas à fragilidade. Portanto, a presente tese foi desenvolvida no intuito de verificar, em profundidade, a fragilidade e a funcionalidade em indivíduos hospitalizados por exacerbação aguda da DPOC. MÉTODOS: Dois estudos transversais e observacionais foram desenvolvidos. O primeiro estudo (artigo 1) teve por objetivo verificar a prevalência de fragilidade em indivíduos com exacerbação da DPOC, comparar dois métodos de avaliação: o fenótipo de fragilidade de Fried e a escala de Edmonton e ainda, associar a fragilidade com a funcionalidade. O segundo artigo (artigo 2) verificou a associação entre funcionalidade e atividade física de vida diária (AFVD) em indivíduos hospitalizados por exacerbação aguda da DPOC e analisou-se a influência da funcionalidade na AFVD nesses sujeitos. RESULTADOS: Foi possível verificar por meio do estudo 1, que existe alta prevalência de fragilidade em indivíduos com DPOC hospitalizados por exacerbação aguda da doença. Além disso, os métodos de avaliação de fragilidade, ou seja, a escala de Edmonton e o fenótipo de Fried, se correlacionam, mas não concordam entre si. Adicionalmente, existe associação entre fragilidade e funcionalidade nesses indivíduos. O segundo estudo (artigo 2) mostrou que a funcionalidade está associada à AFVD e essa funcionalidade influencia a AFVD. CONCLUSÃO: A partir dos dois estudos realizados nesta tese, foi possível verificar que a fragilidade e a funcionalidade estão reduzidas em indivíduos internados por exacerbação aguda da DPOC. Esses aspectos podem ser avaliados com a utilização de testes simples e rápidos, que podem ser realizados à beira leito. Portanto, a avaliação desses desfechos faz-se necessária para que o fisioterapeuta possa traçar um plano terapêutico adequado no intuito de minimizar as sequelas decorrentes desse quadro. INTRODUCTION: The acute exacerbation of chronic obstructive pulmonary disease (COPD) has a negative impact on quality of life, pulmonary function, mortality and functioning. It is known that physical and functional aspects are deteriorated in these individuals during hospitalization for exacerbation. In addition to functioning, it is important to assess frailty, a component that is closely related to the vulnerability of the disease. Recent studies have demonstrated this issue and demonstrate that frequent exacerbations may be associated with frailty. Therefore, the present thesis was developed in order to verify the frailty and functionality in depth in individuals hospitalized for acute exacerbation of COPD. METHODS: Two cross-sectional and observational studies were carried out in this thesis. The first study (article 1) aimed to verify the prevalence of frailty in individuals with COPD exacerbation, to compare two assessment methods: Fried's frailty phenotype and the Edmonton frailty scale, and also to associate frailty with functioning. The second article (article 2) verified the association between functioning and physical activity in daily live (PADL) in subjects hospitalized with acute exacerbation od COPD and analyzed the influence of this functioning on PADL in these individuals. RESULTS: It was possible to verify through study 1 that there is a high prevalence of frailty in individuals with exacerbated hospitalized with acute exacerbation of the disease. In addition, frailty assessment methods, that is, the Edmonton scale and the Fried phenotype, correlate but do not agree with each other. Additionally, there is an association between frailty and functionality in these individuals. The second study (article 2) showed that functioning is associated with PADL and that functioning influences PADL. CONCLUSION: Based on the two studies carried out in this thesis, it was possible to verify that frailty and functioning are reduced in subjects hospitalized for acute exacerbation of COPD. These aspects can be evaluated using simple and quick tests, which can be performed at the bedside. Therefore, the need to evaluate these outcomes is necessary, in order to the physical therapist can draw up an appropriate therapeutic plan to minimize the sequelae resulting from this condition.

Introduction Despite its clinical relevance in several populations, there is no evidence on applicability of the 6-min walk test (6MWT) in burned subjects. Objectives To verify the applicability and reproducibility of the 6MWT in burned individuals and to analyze patients’ performance in this test at hospital discharge. Methods In a cross-sectional study, burned individuals performed two 6MWT at hospital discharge, according to international standardization. In addition to walked distance, physiological and symptomatic variables were collected. Clinical history and demographic data were also recorded. Results One hundred individuals were evaluated (70 men, 10 [6–18]% total body surface area burned). There was excellent agreement between the two 6MWT (ICC = 0.97). However, 73% of subjects increased the walked distance in the second test (23 [−9–47]m or 5 [−2–10]%; P = 0.001). Considering the best 6MWT, the walked distance was 488 [396–718]m (80 [65–92]%pred), and 51% of the individuals had limited functional exercise capacity. Additionally, participants without lower limb involvement presented better 6MWT than others (P Conclusion The 6MWT was applicable, well tolerated and reproducible at hospital discharge in burned individuals. However, there was considerable learning effect between the first and second test. Finally, the reduced exercise capacity observed reinforces need for early rehabilitation in this population.

We determined the total energy expenditure (TEE) of healthy overweight or obese people, and those with impaired glucose tolerance and/or impaired fasting glycemia (IGT/IFG), or type 2 diabetes (T2DM) using the doubly-labeled water method. As a second purpose, we compared the measured TEE with the target energy intake recommended in the treatment guidelines for diabetes. The participants were normal glucose tolerance (NGT), and IGT/IFG (n=11) and T2DM (n=9) patients, who were 50-59 y and had a body mass index >25 kg/m2. The median TEE/body mass (BM) values were 32.6, 33.3, and 34.4 kcal/kg BM and the TEE/target BM values (target BM: BM at a BMI of 22 kg/m2) were 43.7, 50.2, and 46.5 kcal/kg target BM for each group, respectively, and did not differ significantly among them. Obese Japanese participants with T2DM in this study had lower TEE/BM than previously studied in non-obese participants with T2DM. In IGT/IFG or T2DM patients, if 30 kcal/kg target BM was used as the energy coefficient, on the basis of the treatment guidelines, the difference between TEE and the target energy intake would be -1,174±552 kcal (-38±11%). When 35 kcal/kg target BM was used as the energy coefficient, the difference between TEE and the target energy intake would be -877±542 kcal (-27±13%). Thus, the energy coefficients used to estimate target energy intake during lifestyle modification in obese/overweight patients with T2DM are considered to be quite low during the first step of diet therapy.

This article examined the association between social capital of fathers and child undernutrition using a community-based survey in Myanmar in 2018. The anthropometric measurements of 1546 children aged 6 to 59 months and face-to-face interviews of 1546 respective biological fathers were performed. The three social capital indicators (institutional trust, social supports, and collective action) were included in 2-level logistic regression models for child wasting and child stunting. Social supports from fathers’ social networks were protective measures for child wasting and child stunting at individual and community levels, respectively. The collective action of fathers was positively associated with child stunting at individual level. No association was found between institutional trust and both indicators of child undernutrition at all levels. The individual-level collective action on child stunting was conditional on the community-level social supports. Our findings suggest that existing nutritional strategies in Myanmar may be strengthened by targeting fathers to increase their support in child nutrition and by targeting the community to engage in the nutritional programs with their full support.

This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21–32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

Background/Objectives Abnormal body composition is an independent determinant of COPD outcomes. To date, it is already known that patient stratification into body composition phenotypes are associated with important outcomes, such as exercise capacity and inflammation, but there are no data comparing physical activity and muscle strength among these phenotypes. Thus, the aim of this study was to compare clinical characteristics and physical function in patients with COPD stratified into body composition phenotypes.Subjects/Methods Two-hundred and seventy stable COPD patients were classified according to the 10th and 90th percentiles of sex-age-BMI-specific reference values for fat-free and fat mass indexes into four groups: Normal body composition (NBC), Obese, Sarcopenic, and Sarcopenic-obese (SO). Patients underwent assessment of exercise capacity, peripheral and respiratory muscle strength, physical activity, dyspnea severity, functional status, and symptoms of anxiety and depression.Results The prevalence of patients classified as NBC, Obese, Sarcopenic, and SO was 39%, 13%, 21%, or 27%, respectively. SO presented lower 6MWT compared with NBC (P 0.16). Sarcopenic and SO groups had, respectively, 7.8 [95% CI: 1.6-37.7] and 9.5 [2.2-41.7] times higher odds to have a 6MWT equal or lower to 350 meters.Conclusions Body composition phenotypes are associated with physical function in patients with COPD. Sarcopenic-obese patients were the most impaired.

Anemia is a major public health concern among children aged

Introduction. Anemia continues to be a major public health problem significant among women of reproductive age (WRA) in developing countries, including Lao People’s Democratic Republic (Lao PDR), where the prevalence of anemia among women remains high. This study aimed to assess the prevalence of anemia and its associated factors among WRA 15–49 years in Lao PDR. Methods. We conducted a cross-sectional study, using the Lao Social Indicator Survey II, 2017 dataset. A total of 12,519 WRA tested for anemia were included in this study, through multistage sampling approaches. Binary logistic regression was used to determine the associated factors of anemia. Results. Of 12,519 women, 4,907 (39.2%) were anemic. Multivariate logistic regression revealed that living in central provinces (aOR: 2.16, 95% CI: 1.96–2.38), rural area (aOR: 1.1, 95% CI: 1.00–1.20), large family size with more than 6 persons (aOR: 1.14, 95% CI: 1.01–1.29), pregnancy (aOR: 1.46, 95% CI: 1.22–1.74), having any adverse pregnancy outcomes (aOR: 1.14, 95% CI: 1.03–1.25), poor drinking water (aOR: 1.24, 95% CI: 1.10–1.39), and poor sanitation facility (aOR: 1.15, 95% CI: 1.03–1.28) were significantly associated with an increased risk of anemia. Conversely, four factors were associated with anemia preventively, including being aged 25–34 years (aOR: 0.81, 95% CI: 0.74–0.90), postsecondary education (aOR: 0.76, 95% CI: 0.60–0.97), Hmong-Mien ethnicity (aOR: 0.48, 95% CI: 0.39–0.59), and watching television almost daily (aOR: 0.84, 95% CI: 0.75–0.95). Conclusion. Anemia continues to be a major public health challenge in Lao PDR. Interventions should be considered on geographic variations, improving safe water and sanitation facility, promoting of iron supplements during pregnancy, and health education through mass media for women in rural areas.

Objectives To establish reference values and equations (ages 20-80y) for 7 simple functional tests based on a multicenter study. Design Cross-sectional data collection in 4 research centers across different regions of a continental dimension country. Setting Healthy subjects from general community were assessed in different research laboratories. Participants Data collection of 296 volunteer subjects (N=296; 45% men; aged 50±18y, forced expiratory volume in the first second 95±13% pred, body mass index 26.9±4.5 kg/m2) aged 20-80 years; representing both sexes; with the ability to understand and perform all proposed assessments; and with no severe and/or unstable condition that could limit functional assessments occurred simultaneously in all centers. Interventions Not applicable. Main Outcome Measures All participants randomly performed the following 7 functional tests twice: (1) the 4-meter gait speed test at usual walking speed; (2) the 4-meter gait speed test at maximal walking speed; (3) the Sit-to-Stand test performed with 5 repetitions; (4) the Sit-to-Stand test performed in 30 seconds; (5) the Sit-to-Stand test performed in 1 minute; (6) the Timed Up and Go test at usual speed; and (7) the Timed Up and Go test at maximal speed. Spirometry, quality of life, depression, anxiety, physical activity, and comorbidities were also assessed to better characterize the sample. The best performance of each test was used to propose reference values for men and women and reference equations for all. Results Participants similarly distributed by age groups from the 4 centers were included. All tests were correlated with age (0.34 Conclusions Reference values and equations for 7 widely used simple functional tests were provided in this study and might help researchers and clinicians to identify and quantify functional impairments using easy-to-perform assessments.

Introduction Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area. Objectives To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility. Methods We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts. Results Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments’ measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility. Conclusion This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.

RESUMO Objetivo Verificar o poder discriminativo e o ponto de corte de diferentes protocolos do teste 4-metre gait speed (4MGS) para identificar capacidade de exercício preservada ou reduzida no teste de caminhada de 6 minutos (TC6min) em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC); comparar os protocolos do 4MGS; e comparar as características dos indivíduos de acordo com o melhor ponto de corte encontrado. Métodos Foram avaliados 56 pacientes com DPOC. Todos os pacientes foram submetidos à avaliação das características antropométricas, função pulmonar (espirometria) e capacidade funcional de exercício (TC6min e 4 protocolos do 4MGS). No teste 4MGS, os pacientes foram instruídos a caminhar em velocidade usual e máxima em percursos de 4 metros (4MGS 4m – usual e máximo) e 8 metros (4MGS 8m – usual e máximo). Resultados Somente o protocolo 4MGS 4m-máximo foi capaz de identificar capacidade de exercício preservada no TC6min (AUC=0,70) com correlação moderada entre os testes (r=0,52; P

Objectives One of the diversity indicators of food intake in the elderly Japanese population is the Dietary Variety Score (DVS). Studies on elderly people have reported the relationship of food intake with health outcomes, such as body function, higher-level functional capacity, fall risk, and sarcopenia. However, the index have not been studied enough whether it is suggestive of nutrients and the characteristics of the meal by various food intakes. The purpose of this study was to clarify the DVS and its relationship with nutrient intakes and meal days consisting of staple foods, main dishes, and side dishes among elderly adults.Methods The participants were 182 community-dwelling elderly adults (65-84 years) in Itabashi city, Tokyo. For the food diversity indicator, we used the DVS developed by Kumagai et al. and classified the patients as follows: the low score group (0-3 points), the medium score group (4-6 points), and the high score group (7-10 points). Dietary intakes were assessed using a 3-day dietary record. The daily amounts from foods and nutrients, and days of balanced diet with staple foods, main dishes, and side dishes greater than twice a day (hereafter "balanced meal days") were calculated. The relationships between the DVS classification and each dietary index were evaluated by the general linear model adjusted for sex, age, and energy levels. Additionally, we calculated the percentage of people with intakes below the estimated average requirement (EAR) of each nutrient and estimated the risk of below the EAR in the groups by multiple logistic regression analysis.Results The low DVS group had significantly fewer balanced meal days (low 1.4 [1.2-1.6] days, medium 1.8 [1.6-1.9] days, high 1.9 [1.7-2.1] days, p for trend=0.001) than the high DVS group. The low DVS group showed significantly low energy ratios of protein and fat, as well as lower intakes of protein, dietary fiber, phosphorus, magnesium, potassium, vitamin K, and vitamin B12. In contrast, the low DVS group showed significantly higher energy ratios of carbohydrates and grains and higher carbohydrate intake. Compared to the high DVS group, the odds ratio for inadequate vitamin C intake (below the EAR) was significantly high in the low DVS group, and the odds ratios for inadequate intakes of magnesium, zinc, and vitamin B6 were significantly high in the middle DVS group.Conclusion The high DVS group had significant associations with increased intake of protein and micronutrients, as well as balanced meal days. DVS can be a dietary indicator that leads to the intake of a desirable variety of food and nutrients in old age.

Introduction The perception of health professionals about chronic obstructive pulmonary disease (COPD) has not been thoroughly investigated. Objective To analyze the perception of health professionals about the impact of COPD on the lives of affected individuals. Materials and methods Qualitative and cross-sectional study with five health professionals: two nurses, two physiotherapists, and one medical doctor. They participated in a focus group (FG) session, with semistructured questions covering: definition of COPD, activities of daily living (ADL), and physical activity of daily living (PADL), as well as the importance of these outcomes in the lives of individuals with COPD. Data analysis The FG was recorded, transcribed, and analyzed according to the content analysis. Results The FG highlighted four main themes: physical-functional and emotional impairment of individuals, the importance of patient-health professional contact, repercussions of COPD on the patients' physical activity, and strategies for promoting physical activity. Based on the four themes exposed, the health professionals reported that there is a progression in the lives of individuals' with COPD, which is divided into three phases: adaptation, reluctance, and dependence. Conclusion There was a negative perception of the health professionals regarding the functionality and emotion of patients with COPD. Emotional aspects, family support, and architectural structure can positively or negatively influence patients' ADL and PADL. Finally, there was a perception of progression in the life of patients with COPD, since their initial adaptation, evolving to physical and emotional dependence.

Summary Background Quantitative evaluation of visceral fat mass and skeletal muscle mass is important for health promotion. Recently, some studies suggested the existence of adipocyte–myocyte negative crosstalk. If so, abdominal skeletal muscles may easily and negatively affected not only by the age but also the visceral fat because age-related reduction in abdominal region is greater compared with limbs. Objective We cross-sectionally examined the existence of quantitative associations between visceral fat area and abdominal skeletal muscle distribution in overweight people. Methods A total of 230 Japanese males and females who aged 40–64 years and whose body mass index (BMI) was 28.0–44.8kg/m 2 participated in this study. The cross-sectional area (CSA) of the visceral fat, subcutaneous fat, and abdominal skeletal muscles, namely, the rectus abdominis, abdominal oblique, erector spinae, and iliopsoas muscles were measured by the computed tomography images. Results Stepwise regression analyses revealed the existence of sex difference in the relation between visceral fat CSA and other morphological variables. In males, BMI was a positive, and the iliopsoas muscle group CSA was a negative contributor of the visceral fat CSA. In females, both age and BMI were selected as positive contributors. Conclusion These data suggested that the visceral fat CSA may negatively associated with iliopsoas muscle group CSA in males. In females, the visceral fat CSA was not significantly related to the distribution of the abdominal skeletal muscle groups.

Purpose 4-meter gait speed (4MGS) is increasingly used to assess functional performance in patients with chronic obstructive pulmonary disease. However, the current literature lacks information regarding some technical standards for this test. Therefore, the purpose of this study was to compare and to evaluate the interrater reliability between a stopwatch and video recording used as timing systems for the 4MGS in patients with chronic obstructive pulmonary disease, as well as to verify the interrater reliability between 2 observers measuring the 4MGS time using a manual stopwatch. Methods Fifty-one patients performed the 4MGS using 4 different protocols (random order): walking at the usual and maximum speed in a 4-meter course and walking at the same 2 speeds on an 8-m course using a 2-m acceleration zone, a 4-meter timing area, and a 2-m deceleration zone. Gait speed was measured simultaneously using a stopwatch and a video recording. In a subanalysis (n = 24), 2 independent observers timed the 4MGS using a stopwatch. Results There was no significant difference in comparison between the 2 timing methods (P > .05 for all), and the reliability between video recording and stopwatch was excellent in all 4MGS studied protocols (intraclass correlation coefficient ≥ 0.91). Moreover, when comparing gait speed measured by 2 observers using a stopwatch, no significant difference was found among all proposed protocols (P > .05 for all), and there was also excellent reliability between the 2 independent observers (intraclass correlation coefficient ≥ 0.94). Conclusion The stopwatch, a low-cost and feasible tool, is reliable as a timing device for the 4MGS in patients with chronic obstructive pulmonary disease.

BACKGROUND: A normal heart rate reflects the balance between the sympathetic and parasympathetic autonomic nervous system. When the difference between heart rate at the end of an exercise test and after 1 min of recovery, known as the 1-min heart rate recovery, is ≤ 12 beats/min, this may indicate an abnormal delay. We sought to compare physical activity patterns and subjects9 functional status with COPD with or without delayed 1-min heart rate recovery after the 6-min walk test (6MWT). METHODS: 145 subjects with COPD (78 men, median [interquartile range (IQR)] age 65 [60–73] y, body mass index 25 [21–30] kg/m2, FEV1 45 ± 15% predicted) were underwent the following assessments: spirometry, 6MWT, functional status, and physical activity in daily life (PADL). A delayed heart rate recovery of 1 min was defined as ≤ 12 beats/min. RESULTS: Subjects with delayed 1-min heart rate recovery walked a shorter distance in the 6MWT compared to subjects without delayed heart rate recovery (median [IQR] 435 [390–507] m vs 477 [425–515] m, P = .01; 81 [71–87] vs 87 [79–98]% predicted, P = .002). Regarding PADL, subjects with delayed heart rate recovery spent less time in the standing position (mean ± SD 185 ± 89 min vs 250 ± 107 min, P = .002) and more time in sedentary positions (472 ± 110 min vs 394 ± 129 min, P = .002). Scores based on the self-care domain of the London Chest Activity of Daily Living questionnaire and the activity domain of the Pulmonary Functional Status and Dyspnea questionnaire were also worse in the group with delayed heart rate recovery (6 ± 2 points vs 5 ± 2 points; P = .039 and 29 ± 24 points vs 19 ± 17 points; P = .037, respectively). CONCLUSIONS: Individuals with COPD who exhibit delayed 1-min heart rate recovery after the 6MWT exhibited worse exercise capacity as well as a more pronounced sedentary lifestyle and worse functional status than those without delayed heart rate recovery. Despite its assessment simplicity, heart rate recovery after the 6MWT can be further explored as a promising outcome in COPD.

Objective: To evaluate whether a six-minute walk distance (6MWD) of < 80% of the predicted value can predict the occurrence of acute exacerbations of COPD in patients in Brazil over a 2-year period. Methods: This was a retrospective cross-sectional study involving 50 COPD patients in Brazil. At enrollment, anthropometric data were collected and patients were assessed for pulmonary function (by spirometry) and functional exercise capacity (by the 6MWD). The patients were subsequently divided into two groups: 6MWD ≤ 80% of predicted and 6MWD > 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. Results: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). Conclusions: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted. RESUMO Objetivo: Avaliar se a distância percorrida no teste de caminhada de seis minutos (DTC6) < 80% do valor previsto pode predizer a ocorrência de exacerbações agudas da DPOC ao longo de 2 anos em pacientes brasileiros. Métodos: Estudo transversal, retrospectivo, com 50 pacientes brasileiros com diagnóstico de DPOC. Após a admissão, os pacientes foram submetidos à coleta de dados antropométricos, avaliação da função pulmonar (resultados espirométricos) e da capacidade funcional de exercício (DTC6), sendo posteriormente divididos em dois grupos: DTC6 ≤ 80% do predito e DTC6 > 80% do predito. A ocorrência de exacerbações agudas da DPOC ao longo de 2 anos foi identificada por meio de registros de prontuários e contato telefônico. Resultados: A amostra geral apresentou obstrução moderada/grave ao fluxo aéreo (média de VEF1 = 41 ± 12% do predito) e média de DTC6 de 469 ± 60 m (86 ± 10% do predito). Nos 2 anos de seguimento após a realização do teste, 25 pacientes (50%) apresentaram exacerbação aguda da DPOC. O método de Kaplan-Meier mostrou que os pacientes com DTC6 ≤ 80% do predito apresentaram exacerbação mais frequentemente que pacientes com desempenho > 80% do predito (p = 0,01), enquanto o modelo de regressão de Cox mostrou que os pacientes no primeiro grupo apresentavam 2,6 mais chances de apresentar exacerbação em 2 anos em comparação ao segundo grupo (p = 0,02). Conclusões: A DTC6 é capaz de predizer exacerbações agudas da DPOC em pacientes brasileiros ao longo de 2 anos. Pacientes com DTC6 ≤ 80% do valor predito têm mais que o dobro de chances de apresentar exacerbação em 2 anos.

BACKGROUND: It is important to assess activities of daily living (ADL) in older adults due to impairment of independence and quality of life. However, there is no objective and standardized protocol available to assess this outcome. Thus, the aim of this study was to verify the reproducibility and validity of a new protocol for ADL assessment applied in physically independent adults age ≥50 y, the Londrina ADL protocol, and to establish an equation to predict reference values of the Londrina ADL protocol. METHODS: Ninety-three physically independent adults age ≥50 y had their performance in ADL evaluated by registering the time spent to conclude the protocol. The protocol was performed twice. The 6-min walk test, which assesses functional exercise capacity, was used as a validation criterion. A multiple linear regression model was applied, including anthropometric and demographic variables that correlated with the protocol, to establish an equation to predict the protocol9s reference values. RESULTS: In general, the protocol was reproducible (intraclass correlation coefficient 0.91). The average difference between the first and second protocol was 5.3%. The new protocol was valid to assess ADL performance in the studied subjects, presenting a moderate correlation with the 6-min walk test (r = −0.53). The time spent to perform the protocol correlated significantly with age (r = 0.45) but neither with weight (r = −0.17) nor with height (r = −0.17). A model of stepwise multiple regression including sex and age showed that age was the only determinant factor to the Londrina ADL protocol, explaining 21% ( P pred (s) = 135.618 + (3.102 × age [y]). CONCLUSIONS: The Londrina ADL protocol was reproducible and valid in physically independent adults age ≥50 y. A reference equation for the protocol was established including only age as an independent variable (r 2 = 0.21), allowing a better interpretation of the protocol9s results in clinical practice.

Background Silver sulfadiazine (SSD) has been widely used in burned patients for the prevention of local infections. To be biologically active and exert antimicrobial properties, silver needs to be present in the form of silver ions (Ag1+) that bind to negatively charged proteins, namely, the RNA and DNA in microorganisms. However, previous published studies conducted with SSD in the 1990s reported a high level of silver absorption through damaged skin and noted the potential cytotoxicity of Ag1+ to human cells. SSD toxicity, however, had been described in cell cultures using arbitrary silver concentrations. In the present study, we determined the serum silver levels in burned patients treated with SSD and, taking into account the molar Ag1+ concentrations found in these patients, we evaluated the Ag1+ toxicity effects on inflammatory cells (ROS and cytokine production) in vitro. Methods Twenty patients with an average burned body surface area of 27.68% were included in this study. Results Patients’ Ag1+ serum levels reached up to 558 times those of the unexposed controls. Ag1+ was then added to inflammatory cells in vitro at levels up to 2000 times the level of the control, and there was no effect on the viability of the cells nor on the rate of apoptosis. We observed a decrease in reactive oxygen species production by mononuclear (MN) and polymorphonuclear (PMN) cells, as well as a substantial decrease in cytokines IL-1β, IL-6, IL-8, IL-10, and TNF-α production by leukocytes (MN and PNM). Conclusion These findings suggest that Ag1+ may contribute to negative outcomes after burns, decreasing the primary defense mechanism (respiratory burst) and altering cytokine production.

Objective To determine the discriminative capacity and cut-off point of different 4-metre gait speed test (4MGS) protocols in identifying preserved or reduced exercise capacity using the six-minute walk test (6MWT) in patients with Chronic Obstructive Pulmonary Disease (COPD); also, to compare 4MGS protocols and characteristics of individuals according to the best cut-off point. Methods We evaluated fifty-six patients with COPD, all of which were submitted to the assessment of anthropometric characteristics, pulmonary function (spirometry) and functional exercise capacity (6MWT and four protocols of the 4MGS). In the 4MGS test, patients were instructed to walk at normal pace and at maximum speed in a 4 meters course (4MGS 4m - usual pace and at maximum) and 8 meters course (4MGS 8m - usual pace and at maximum). Results Only the 4MGS 4m-maximum protocol was able to identify preserved exercise capacity in the 6MWT (AUC=0.70) with moderate correlation between them (r=0.52; P=0

Limited information is available on how weight loss intervention programs affect skeletal muscle mass especially in trunk.A total of 235 overweight Japanese men and women aged 40-64 years with a body mass index of 28.0 to 44.8 kg/m2 participated in this randomized controlled intervention study. They were randomly divided into a lifestyle intervention group and control group. Before and after the one-year lifestyle intervention for weight loss an abdominal transverse image was acquired by computed tomography. The cross-sectional areas (CSAs) of visceral fat, subcutaneous fat, and skeletal muscle of rectus abdominis, abdominal oblique, iliopsoas, and erector spinae muscle were calculated.The body weight changed by approximately -5% in the intervention groups. The corresponding values for subcutaneous fat and visceral fat CSAs were -10.8 to -17.5% in both sexes. The reductions observed in skeletal muscle CSAs were significantly less (-6.0% and -7.2% in the men and women intervention groups respectively) than those in fat tissue CSAs. The CSA of each of the four skeletal muscle groups also significantly decreased; however, after adjustments for body weight at each time point, only reductions in the iliopsoas muscle in both sex and abdominal oblique muscles in men remained significant.The lifestyle weight loss intervention might reduce the relative amount of the abdominal skeletal muscles especially in iliopsoas muscle.

Adipocytokines arebioactive substances synthesizedand secretedbyfat cell. Previous studies have reported an association between weight loss and adipocytokines. However, these studies are inconsistent and they have not clarified the relationship between weight regain and changes in circulating levels of adipocytokines. In this study, we analyzed the relationship between weight and fat volume changes and adipocytokines. The subjects were 235obese people recruited in the Saku Control Obesity Program (SCOP). Participants were randomly assigned to either immediate (Group A) or delayed (Group B, control group). Group A participants were followed for another two years after completion of the one year intervention. As controls, Group B participants received the same intervention as Group A after a delay of one year. Then they were followed up for one year. The intervention consisted in a one-year lifestyle program to induce weight loss, based on a cognitive-behavioral approach. After the first year of the study, body weight, BMI, body fat and abdominal fat areas were significantly lower in group A participants, compared to controls. After the intervention, leptin levels were significantly lowered both in men and women. After one year follow-up, both men and women re-gained about 1.5 kg body weight on average. BMI, waist circumference, fat areas by CT and HBA1c significantly increased during the follow-up period. The change of adipocytokine levels by analysis of the quartile of body weight decrease and regain revealed that increased adiponectin and decreased leptin was noteworthy for weight reduction, while increase of leptin influenced the weight regain. In conclusion, our results suggest that leptin could have broad effects on the distribution off at tissues and on lipid metabolism. Leptin inversely associated with adiponectin, which in turn was necessary to decrease body weight. In particular, leptin decreased remarkably in the process of weight reduction, and its increase seemed to be related in weight regain. The observed increase of adiponectin seemed to be induced by reduction in fat volume.

Background The mechanisms underlying impaired balance in chronic obstructive pulmonary disease (COPD) are poorly understood, which makes it difficult to choose the best therapeutic approaches. Therefore, this study aimed to investigate patterns of muscular activation to maintain balance and its determinants in this population. Methods Thirty-three subjects with COPD and 33 controls were assessed by a force platform in four tasks: standing with eyes opened (FHEO) and closed (FHEC); standing on unstable surface (SUS) and one-legged stance (OLS). Electromyographic activity of lower limb, trunk and neck muscles was concomitantly recorded. To asses functional balance, Brief-balance evaluation systems and timed up & go (TUG) tests were applied. Lung function, exercise capacity and muscle force were also assessed. Results Subjects with COPD presented worse balance and higher scalene activation than controls in OLS (mean difference 23.0 [95%CI 1.7–44.3] %Δ μVRMS; P = 0.034), besides presenting also higher activation of gluteus medius during FHEC task (mean difference 1.5 [95%CI 0.2–2.8] %Δ μVRMS; P = 0.023) and taking longer to complete the TUG (mean difference 0.6 [95%CI 0.1–1.2] seconds; P = 0.042). Exercise capacity and peripheral muscle force were determinants of functional balance (r2 = 0.505), whereas age (OR = 1.24; 95%CI 1.02–1.52) and total lung capacity (OR = 2.42; 95%CI 1.05–5.56) were determinants of static balance. Conclusion Individuals with COPD have worse static and functional balance in comparison with controls, besides presenting higher activation of scalene and gluteus medius during static balance tasks. Exercise capacity and peripheral muscle force emerged as determinants of functional balance, whereas age and lung hyperinflation contributed to poor static balance.

Background: Exercise-induced oxygen desaturation (EID) verified by the six-minute walk test (6MWT) is an important predictor of mortality in subjects with COPD, however, little is known about other predictors of desaturation in this population. Aims: To identify predictors of EID during the 6MWT as well as to compare the characteristics of patients with COPD who present desaturation or not during the 6MWT. Methods: A cross-sectional study was performed, in which 163 subjects with COPD (87 men; 66±8 years; FEV1 46±15%pred) were included and underwent the following assessments: spirometry, 6MWT, 1-repetition maximum test (1RM), physical activity in daily life (PADL), maximal inspiratory (MIP) and expiratory pressure (MEP) and questionnaires of dyspnea and health-related quality of life. Results: The FEV1, MIP and variables of PADL (total energy expenditure [TEE] and activity-related energy expenditure [AEE]) were found as predictors of EID during the 6MWT (r2=0.49). Moreover, subjects who desaturated (n=87) showed lower FEV1%pred (39±14% vs 54±13%; P Conclusion: Pulmonary function, respiratory muscle strength and PADL are predictors of EID during the 6MWT in subjects with COPD. Furthermore, patients who present desaturation had worse pulmonary function, exercise capacity, muscle strength, dyspnea and PADL.

BACKGROUND: Different protocols for the sit-to-stand test (STS) are available for assessing functional capacity in COPD. We sought to correlate each protocol of the STS (ie, the 5-repetition [5-rep STS], the 30-s STS, and the 1-min STS) with clinical outcomes in subjects with COPD. We also aimed to compare the 3 protocols of the STS, to verify their association and agreement, and to verify whether the 3 protocols are able to predict functional exercise capacity and physical activity in daily life (PADL). METHODS: 23 subjects with COPD (11 men; FEV 1 53 ± 15% predicted) performed 3 protocols of the STS. Subjects also underwent the following assessments: incremental shuttle walking test, 6-min walk test (6MWT), 4-m gait speed test (4MGS), 1-repetition maximum of quadriceps muscle, assessment of PADL, and questionnaires on health-related quality of life and functional status. RESULTS: The 1-min STS showed significant correlations with the 6MWT (r = 0.40), 4MGS (r = 0.64), and PADL (0.40 ≤ r ≤ 0.52), and the 5-rep STS and 30-s STS were associated with the 4MGS (r = 0.54 and r = 0.52, respectively). The speed differed for each protocol (5-rep STS 0.53 ± 0.16 rep/s, 30-s STS 0.48 ± 0.13 rep/s, 1-min STS 0.45 ± 0.11 rep/s, P = .01). However, they presented good agreement (intraclass correlation coefficient ≥ 0.73 for all) and correlated well with each other (r ≥ 0.68 for all). More marked changes in peripheral oxygen saturation ( P = .004), heart rate ( P P P P CONCLUSIONS: The 1-min STS generated higher hemodynamic demands and correlated better with clinical outcomes in subjects with COPD. Despite the difference in speed performance and physiological demands between the 5-rep STS and 1-min STS, there was a good level of agreement among the 3 protocols. In addition, all 3 tests were able to identify subjects with low exercise capacity or preserved exercise capacity.

Objectives To evaluate the characteristics and available evidence on the measurement properties of the gait speed (GS) test, timed Up and Go test (TUG), sit-to-stand (STS) test, and step test; to investigate their relation with clinical outcomes in chronic obstructive pulmonary disease (COPD); and to provide recommendations for clinical practice and future research. Data Sources Studies were systematically identified from a literature search using PubMed, PEDro, CINAHL, and Cochrane Library databases and the reference lists of the included articles. Study Selection Studies including ≥1 of these 4 lower limb functional tests (GS test, TUG, STS test, and step test) as an outcome in patients with COPD were selected. No limits were applied for language and study design. Data Extraction Two researchers independently performed data extraction and, by using the COnsensus-based standards for the Selection of health status measurement INstruments, assessed the quality of those studies that described measurement properties. Data Synthesis Forty-two articles met the selection criteria. GS test, STS test, and step test are valid, reproducible, and responsive tests, especially the 4-meter GS, 5-repetition STS test, and 6-minute step test (6MST). The TUG is reliable; however, studies on other measurement properties of this test are lacking. Outcomes of these tests are correlated with mortality, physical activity in daily life, exercise capacity, dyspnea, and quality of life. Conclusions Simple and functional lower limb tests provide information about important clinical outcomes in patients with COPD. The 4-meter GS, 5-repetition STS test, and 6MST are tests with well-established psychometric properties, whereas the properties of the TUG need to be studied further.

Introduction: Factors associated with improvement in the incremental shuttle walking test (ISWT), in COPD patients, are not clear. Objective: To identify the profile of patients with better performance in the ISWT after physical training. Methods: Forty-two patients with COPD were separated into two groups: im-provement (IG) in the ISWT (≥20 meters), and no improvement (NIG). Spirometry, ISWT, six-minute walk test (6MWT), sensations of dyspnea, anthropometric data and disease severity were evaluated. Results: After training, there was an improvement in the ISWT (P = 0.03). Patients from the IG showed poorer per-formance in the ISWT (P