Search

Objetiva-se relatar a experiência realizada em uma Associação de Materiais Recicláveis, que teve como propósito promover medidas preventivas e protetivas de combate ao coronavírus COVID-19. Trata-se de um relato de experiência, desenvolvido no decorrer da disciplina de Interação Cientifico-Social que apresenta caráter extensionista, o qual ocorreu no primeiro semestre de 2020. Atividade foi desenvolvida na Associação de Materiais Recicláveis da região central do Rio Grande do Sul. A experiência realizada demonstrou que as medidas preventivas e protetivas de combate ao coronavírus COVID-19 vão além da reprodução de informações ou saberes teóricos. Para que haja a adesão dos envolvidos é fundamental que ocorra um compartilhamento de saberes e a produção de conhecimentos significativos, capazes de repercutir em mudança de atitudes e comportamentos.

PURPOSE This study evaluated the accuracy of the Mini-Balance Evaluation System Test (Mini-BESTest) for predicting falls in patients with chronic obstructive pulmonary disease (COPD) and investigated whether postural balance is a risk factor for falls. METHODS Postural balance was evaluated by the Mini-BESTest at baseline, and the incidence of falls over a 12-mo period was prospectively measured by a self-reported falls diary and confirmed by telephone calls. A discriminative power analysis was performed using receiver operating characteristic (ROC) curve and logistic regression analysis. RESULTS Sixty-seven outpatients with COPD (mean age ± SD = 67 ± 9.3 yr) were included. Twenty-five patients (37.3%) experienced ≥1 fall, and 28.2% of the falls resulted in injuries. The Mini-BESTest predicted falls in patients with COPD at the 6- and 12-mo follow-ups with a cut-off score of 22.5 (area under the curve = 0.85 and 0.87) with good sensitivity and specificity (85.7% and 66.7%; 84% and 73.8%, respectively). Higher scores on the Mini-BESTest were associated with a lower risk of falls at 12 mo (OR = 0.50; 95% CI, 0.36-0.70; P < .001). CONCLUSIONS Postural balance assessed by the Mini-BESTest is a good predictor of falls in patients with COPD. Our results imply that impaired balance contributes to the risk of falling and that balance training and fall prevention programs may be required for this population.

Objectives To identify clusters of chronic obstructive pulmonary disease (COPD) patients with distinct beliefs about their illness in terms of symptoms, health-related quality of life (HRQoL), self-efficacy, and daily life physical activity (DLPA). Methods This cross-sectional study included 150 COPD outpatients. The patients’ illness perceptions, clinical control, HRQoL, self-efficacy, and DLPA (accelerometry) were evaluated. A cluster analysis was conducted using data from the Illness Perceptions Questionnaire - Revised to establish groups of patients with distinct illness perceptions. Differences between clusters were tested using a T-test or a Mann–Whitney U test. Results The cluster analysis revealed two groups: distressed ( n = 95) and coping ( n = 55). Despite the fact that both clusters presented similar pulmonary function, between-cluster differences were observed in their self-efficacy, dyspnea, HRQoL, clinical control ( p Discussion We observed that clinically stable COPD patients who displayed higher emotional representations and less coherence had heightened symptoms, poorer HRQoL, worse self-efficacy, and lower educational levels. These results emphasize the need to routinely evaluate illness perceptions in COPD patients to target and tailor the proper treatment to improve these important health outcomes.

People with chronic obstructive pulmonary disease (COPD) present high prevalence of falls and sedentary behaviour. Objectives: To identify clusters of COPD patients according to postural balance, quadriceps muscle strength, physical activity and sedentary behaviour. Methods: This observational with a 12-month follow-up study included 70 COPD outpatients. A cluster analysis was conducted using the following variables: postural balance (Mini-BESTest), quadriceps muscle strength (dynamometer), physical activity and sedentary behaviour (accelerometry). Lung function), body composition (body mass index), health status (COPD assessment test), and incidence of falls during 12 months (self-reported falls diary) were also evaluated. Differences between clusters were tested using a T-test or a Mann-Whitney U test. Results: The cluster analysis revealed two groups: “better postural balance” (n=23) and “fallers” (n=47). Both groups presented a similar lung fucntion; however, the “faller cluster” presented higher incidence of falls (46 vs 18%; P Conclusions: Our results show two distinct functional phenotypes in COPD patients based on postural balance, quadriceps muscle strength, physical activity and sedentary behavior.

Made available in DSpace on 2019-10-04T12:42:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction People with chronic obstructive pulmonary disease (COPD) present high prevalence of physical inactivity that leads to a negative effect on health-related quality of life (HRQoL). The present study investigated COPD phenotypes according to their levels of physical activity and sedentary behaviour, as well as body composition and skeletal muscle strength. Methods This is an observational and cross-sectional study. Anthropometric data and COPD clinical control were collected and all participants underwent assessments of lung function, HRQoL, dyspnoea, levels of physical activity and sedentary behaviour, body composition and skeletal muscle strength. Participants were classified using hierarchical cluster analysis. Age, dyspnoea and obstruction (ADO) index was used to determine prognosis and calculated for each cluster. Results One hundred and fifty-two participants were included. Three distinct phenotypes were identified. Participants in phenotype 1 were more physically active, less sedentary and had better body composition and lower ADO index (p < 0.0001 for all variables). Overall, participants in phenotypes 2 and 3 were less physically active, more sedentary having a higher ADO index. However, participants in phenotype 2 were older, whereas participants in phenotype 3 had worse HRQoL, clinical control and body composition. Lung function did not differ across the three phenotypes. Conclusions Our results show that physical activity, sedentary behaviour and body composition should be considered to determine phenotypes in people with COPD and are involved in the prognosis of the disease. Less sedentary patients have better prognosis while age, body composition and clinical control seems to differentiate physically inactive patients. Univ Sao Paulo, Sch Med, Dept Phys Therapy, Sao Paulo, Brazil Curtin Univ, Sch Physiotherapy & Exercise Sci, Perth, WA, Australia Sir Charles Gairdner Hosp, Inst Resp Hlth, Nedlands, WA, Australia Univ Sao Paulo, Med Sch, Clin Hosp, Pulm Div,Heart Inst InCor, Sao Paulo, Brazil State Univ Sao Paulo, Dept Phys Therapy, Sao Paulo, Brazil Univ Sao Paulo, Sch Med, Dept Med, Av Dr Arnaldo 455,Room 1210, BR-01246903 Sao Paulo, SP, Brazil State Univ Sao Paulo, Dept Phys Therapy, Sao Paulo, Brazil FAPESP: 2013/20676-9

The impairment of physical activity on the health status and the high prevalence of sedentary behaviour among patients with COPD are established. The understanding of COPD phenotypes can properbly establish the better treatment strategy. Aim: We investigated the phenotypes in subjects with COPD patients according to physical activity, sedentary behaviour, body composition and muscle force. Methods: One-hundred and ninety subjects with COPD were enrolled in a cohort study. COPD was diagnosed according to GOLD guidelines and patients were under optimal medical treatment for at least 6 months. All patients underwent assessments related to anthropometrical data, clinical history, lung function, COPD clinical control, health-related quality of life, dyspnea, physical activity level, sedentary behavior, skeletal muscle strength and body composition. After that, the patients were followed for 12 months to investigate the occurrence of exacerbation and hospitalization. Patients were classified using hierarchical cluster analysis. Results: Three distinct (clusters) phenotypes were identified. Patients in the phenotype 1 presented more exacerbation, more comorbidities, were younger and with worse clinical control compared to phenotypes 2 e 3. Patients in the phenotype 3 had lower physical activity level, more sedentary behaviour and higher hospitalization. Conclusion: Our results describe a phenotype with higher sedentary behaviour presenting higher hospitalization and while it seems that neither physical activity nor sedentary behaviour is related to exacerbation.

Several COPD phenotypes have been described; however, the influence of physical activity, skeletal muscle strength and bod composition remains unclear. Aim: To investigate the phenotypes in COPD patients according to physical activity, body composition and muscle strength. Methods: 152 COPD patients were enrolled in a cross-sectional study. Patients were assessed by: lung function, clinical control, health related quality of life, physical activity, skeletal muscle strength and body composition. Patients were classified by hierarchical cluster analysis and Kruskall-wallis followed by Dunn9s test for between clusters comparison. P Results: Three distinct (clusters) phenotypes were identified. Patients in phenotype 1 were more physically active (6108[3749-7468] steps.day-1) compared to phenotype 2 (1543[1741-3344] steps.day-1) and phenotype 3 (2919[2117-3639] steps.day-1); and phenotype 1 also presented a better body composition, (68 [61-75] % of muscle mass and 18[10-25] % of fat mass). Although phenotypes 2 and 3 were also less physical active, patients in phenotype 2 were older (73[68-78] years), while patients in phenotype 3, presented a worse quality of life (51[46-61] CRQ total score), clinical control (3[3-4] CCQ total score) and body composition (54[51-60] % of muscle mass and 34[28-38] % of fat mass). There was no difference in the lung function between the three phenotypes. Conclusion: Our results suggest that COPD patients present distinct phenotypes according to body composition, skeletal muscle strength and physical activity independent of the lung function.

COPD patients have an impairment in the postural balance, however, the impact of this deficit on the risk of future falls remains poorly investigated. Aim: To evaluate postural balance as a predictor of falls in COPD patients. Methods: This prospective cohort study included 70 COPD patients classified according to GOLD (1.4% mild, 27.2% moderate, 55.7% severe and 15.7% very severe). Postural balance was evaluated by the Mini BESTest (Balance evaluation systems test) and the incidence of falls was followed for one year, assessed monthly by a calendar of self-report of falls and confirmed by telephone calls. For the statistical analysis, discriminative power analysis by receiver operator characteristic curve (ROC) and logistic regression analysis were used. Results: Sixty-seven individuals completed a one-year follow-up period and were analyzed. Three patients died during the follow-up and were excluded. Twenty-five patients (37.3%) had at least one fall event in the follow-up period. It was found that the Mini BESTest was able to identify falls in COPD patients at 6 and 12 months (area under the curve, AUC = 0.85 and 0.87) with good sensitivity (85.7% and 84%) and specificity (66.7 and 73.8%), respectively. In addition, higher scores of Mini BESTest were strongly associated with a lower risk of falls at 6 and 12 months (OR = 0.66 and 0.51, respectively) after evaluation. Conclusion: The postural balance assessed by Mini BESTest is a good medium and long-term predictor of future falls in COPD patients.

COPD patients have impaired balance and there are studies evaluating the role of isolated factors related to this deficit; however, the assessment of multiple factors in the same patient sample has been poorly evaluated. Aim: To determine the factors associated with balance impairment in COPD patients. Methods: Seventy COPD patients classified according to GOLD were included (1.4% mild, 27.2% moderate, 55.7% severe and 15.7% very severe). Postural balance was evaluated by the Mini BESTest (Balance evaluation systems test) and its total score was associated with: age, physical inactivity (time spent in sedentarism measured by accelerometer, Actigraph GT3x), maximal peripheral muscle strength of the lower limbs (dynamometry), sleep quality (Pittsburgh sleep quality index), fear of falling (Falls efficacy scale-international; FES-I) and maximal respiratory muscle strength (manuvacuometer). Pearson correlation and multiple linear regression analysis were used. Results: Our results show that quadriceps muscle strength, fear of falling, age, maximal inspiratory muscle strength and physical inactivity were linearly associated with postural balance (R=0.44, 0.42, 0.41, 0.41 and 0.35, respectively; p Conclusion: Our data suggest that age, quadriceps muscle strength and fear of falling can predict 49% of the balance impairment in COPD patients.

Introdução: A importância de manter os pacientes DPOC ativos é inquestionável e para que se interfira neste comportamento é essencial compreender os fatores que estão associados ao nível de atividade física na vida diária (AFVD) nesta população. A percepção da própria doença é um fator psicossocial que tem sido estudado em inúmeras doenças crônicas e que apresenta associação com diversos desfechos clínicos relevantes tais como a qualidade de vida e adesão à terapêutica. Porém, sua relação com o nível de AFVD em pacientes com DPOC clinicamente estáveis é pouco conhecido. Objetivo: Identificar possíveis grupos (clusters) de acordo com a percepção da doença e identificar se há diferença no nível de AFVD e nos demais fatores clínicos, demográficos e psicossociais entre estes grupos. Métodos: Estudo transversal no qual foram recrutados 150 pacientes com DPOC e avaliados em relação à percepção da própria doença, auto-eficácia, suporte social, qualidade de vida, controle clínico da doença e nível de AFVD (Actigraph GT3x). Foi realizada uma análise de cluster de acordo com a percepção da doença para identificar grupos de pacientes com perfis semelhantes e investigada as características e diferenças entre os clusters. Resultados: A análise de cluster identificou dois grupos: O cluster 1 apresentou uma percepção mais negativa da doença (PND; n=95) e cluster 2 uma percepção mais positiva da doença (PPD; n=55). O cluster PND apresentou pior escolaridade, dispneia, auto-eficácia, qualidade de vida e controle clínico (p < 0,001 para todas as variáveis) em comparação ao cluster PPD. Não foi observada diferença em relação ao nível de AFVD entre os clusters. Conclusão: Pacientes com uma percepção negativa de sua doença também apresentaram pior dispnéia, autoeficácia, qualidade de vida, controle clinico e nível educacional apesar de não haver diferença na função pulmonar entre os clusters. Estes achados sugerem a relevância de investigar e identificar a percepção da doença para estabelecer melhores estratégias terapêuticas nesta população Rationale: Illness perception (IP) concerns how patients evaluate living with a disease and this perceptions may influence quality of life health and patients\' adherence behaviors. However, how IP is related with daily life physical activity (DLPA) in COPD patients remains poorly known. Objective: To identify possible clusters according to COPD patients IPs and explore associations between IPs with DLPA and psycho-demographic factors. Methods: This cross-sectional study included 150 COPD outpatients in medical treatment from an University hospital. Illness perception, social support, clinical control, health-related quality of life, self-efficacy and DPLA (GT3X, accelerometer) were evaluated. Cluster analysis of IPs was used to establish groups of patients holding distinct beliefs. Differences between clusters were tested using a T-test or a Mann-Whitney-U-test. Results: Cluster analysis revealed two distinct groups. In the cluster NIP (negative illness perception; n=95) patients presented a worst IP than cluster PIP (positive illness perceptions; n=55). The NIP presented the worst education, dyspnea, self-efficacy, quality of life and clinical control (p < 0.0001 for all variables) compared to the cluster PIP. There was no difference in the level of DLPA. Conclusions: Patients with a negative perception of their disease also presented worse dyspnea, self-efficacy, quality of life, clinical control and educational level, although there was no difference in lung function among the clusters. These findings suggest the relevance of investigating and identifying the perception of the disease to establish better therapeutic strategies in this population

COPD patients are susceptible to falls due to balance deficits; however, the sensory impairments due to age or disease remain poorly known. Aim: To investigate the effect of aging and pulmonary disease on the balance in COPD patients in sensory impairment conditions. Methods: 30 COPD patients (64±8 yrs; FEV 1 39±14 %predicted), 30 healthy adults matched for gender and age (64±8 yrs) and 30 young controls (25±5 yrs) were submitted to a computerized dynamic posturography. The assessment of balance control was conducted in four distinct sensory conditions: open eyes-fixed surface, closed eyes-fixed surface, open eyes-sway surface and closed eyes-sway surface. The variables evaluated were: maximal amplitude from the centre of pressure (COPamp), mean velocity of the path of the centre of pressure (COPvm) and COP asymmetry, all in the anteroposterior direction. ANOVA 3-way test was used for comparison among groups. Results: COPD patients had a worse balance compared to the healthy adult and young controls in sway surface in COPamp (8.7±3.8cm, 8.0±4cm and 6.2±3cm, respectively; p Conclusion: COPD patients have more instability in the anteroposterior direction in sensory impairment conditions as a result of age and disease, which implies a greater possibility of falling and suggests the need to therapeutic changes.

Patients with asthma COPD overlap syndrome (ACOS) have frequent exacerbations, poorer quality of life, higher mortality and consume large amounts of health care resources. However, the level of physical activity in this COPD phenotype remains unclear. Aim: To compare the level of daily life physical activity (DLPA) between patients with COPD and ACOS. Methods: Twenty-two patients were evaluated, 11 with ACOS and 11 with COPD (control group) matched by age and body mass index (BMI). Patients were assessed by gender, pack-years index, comorbidities (arterial hypertension and diabetes), dyspnea (MRC scale), body composition (BMI and skeletal muscle mass (SMM%), by octopolar bioimpedance), muscle strength (maximal quadriceps isometric, in %predicted), DLPA (step counts/day, steps per minute and time in moderate and vigorous physical activity (%MVPA), by GT3X accelerometer). For group comparison t-student, Mann-Whitney and Fisher´s tests were used. Results: Patients with ACOS have higher levels of total DLPA than COPD patients (respectively, 5428±1454 vs. 3599±1708 steps/day, p=0.01; 6±1 vs. 4±2 steps per minute, p=0.01;) and perform DLPA at higher intensities (2±1.6 vs. 0.6±0.5 %MVPA, p Conclusion: Our results suggest that, although both groups are sedentary individuals with ACOS are more physically active than those with COPD.

COPD patients have impaired balance and pulmonary hyperinflation could contribute to balance deficits in this population. Aim: To evaluate the relationship between postural balance and pulmonary hyperinflation in COPD patients. Methods: 67 patients were included (12% mild, 44% moderate and 44% severe COPD). Postural balance was evaluated by centre of pressure displacement analysis using a portable force platform in 3 different sensory conditions: standing with eyes open, eyes closed and on a foam surface with open eyes. The variables analysed included total path length, path velocity and amplitude, in both anteroposterior (AP) and mediolateral (ML) directions. Pulmonary hyperinflation was evaluated using body plethysmography. Participants were classified into 2 groups: hyperinflated (Total lung capacity >120% predicted) and non-hyperinflated. The Mann-Whitney-U-test was used for group comparison. Results: The hyperinflated patients (N=23; 64.8±9.7 yrs; FEV 1 35.1±12.0% predicted) presented a smaller postural balance variation compared to non-hyperinflated patients (N=44; 67.5±8.8 yrs; FEV 1 46.7±13.8% predicted) in the total path length (28.7±10.7cm vs. 32.8±8.3cm, p=0.02), in the amplitude (1.95±0.95cm vs. 2.26±0.87cm, p=0.016) and path velocity (0.74±0.26cm/s vs. 0.88±0.24cm/s, p=0.01), respectively, in the AP direction in the condition standing with eyes open. No significant difference between groups were observed in the ML direction or for the more difficult tests (p>0.05). Conclusion: Hyperinflated COPD patients present less displacement in the anteroposterior direction possibly due to change in the centre of pressure. This lower displacement may have implications for falls.

The need for keeping patients with COPD physically active is broadly recognized; however, the factors associated with daily life physical activity (DLPA) in COPD patients in developing countries have not been fully elucidated. Aim: To identify factors associated with DLPA in Brazilian COPD patients. Methods: This cross-sectional study included 153 COPD patients (68±8 years, 68% male and FEV 1 46±16 %predicted) recruited in a tertiary outpatient clinic in a University hospital. Patients were assessed by age, airflow obstruction (FEV 1 ), previous hospitalization, dyspnea (MRC scale), muscle strength (maximal quadriceps isometric force), body composition (skeletal muscle mass (SMM%), by octopolar bioimpedance) and DLPA (step counts per day) by accelerometer (GT3X). Pearson9s correlation was used between DPLA (step counts) and all variables. Multiple linear regression analysis was performed to identify the independent factors associated with DPLA. Results: DLPA was associated with muscle strength, age, dyspnea, hospitalization in last year and airflow obstruction (DLPA = 10424 + 95*quadriceps strength – 117*age – 37*MRC scale – 1044*hospitalization in last year + 23*airflow obstruction) (hospitalization 1=yes; 0=no); (p 2 adjusted =0.32). Conclusion: COPD patients with weaker quadriceps strength, older, having more dyspnea and previous hospitalization and worst airflow obstruction have impaired daily life physical activity. Assessing and improving these variables during the clinical management of COPD patients could help to maintain themselves physically active.

Illness perception(IP) concerns how patients evaluate living with a disease and this perceptions may influence coping, health and well-being. However, how IP is related with psychosocial distress and daily life physical activity (DLPA) in COPD patients remains poorly known. Aim: To identify possible association between patients9 illness perceptions with psycho-demographic factors and DLPA in patients with COPD. Methods: This cross-sectional study included 150 outpatients with moderate to very severe COPD in medical treatment from an University hospital. Illness perception (IPQ), social support (MOSS), clinical control (CCQ), health-related quality of life (CRQ), self-efficacy (GSE) and DPLA (GT3X, accelerometer) were evaluated. Cluster analysis of illness perceptions was used to establish groups of patients holding distinct beliefs.Differences between clusters were tested using a T-test or a Mann-Whitney-U-test. Results: Cluster analysis revealed two distinct groups. In the cluster 1 (n=95) patients presented a worst illness perceptions than cluster 2 (n=55). Between-cluster differences were observed in education level (p=0,002), self-efficacy, dyspnea, health related quality of life and clinic control (p Conclusion: Our data suggest that patients9 perception is associated with education level, self-efficacy, dyspnea, health related quality of life and clinic control in the studied population.

The need for keeping patients with COPD physically active is broadly recognized; however the psychosocial factors related with daily life physical activity (DLPA) in COPD remains poorly known mainly in the developing countries. Aim: To assess whichpsychosocial factors were associated with DLPA in patients with COPD. Methods: 77 consecutive patients with mild to severe COPD under optimized medical treatment were assessed. DPLA was measured with a triaxial accelerometer(Actigraph, GT3X) during 6 days. Self-efficacy (General self-efficacy scale), social support (Medical outcomes study social support survey), illness perception (Illness perception questionnaire) and health-related quality of life (Chronic respiratory questionnaire) were scored. Pearson9s correlation was calculated between DPLA (step counts) and psychosocial factors. Multiple linear regression analysis was performed to identify the independent factors associated with DPLA. Results: Worst understanding of the disease (IPQ-R illness coherence subscale) was associated to higher level of DLPA (p=0.04). Patients with high levels of DLPA (64±8years, %FEV 1 =43±15 and 7,757±1,751 steps/day) also presented higher health-related quality of life (CRQemotional function=4.94±0.75 vs. 4.47±0.80, p= vs. 3.77±1.19, p=0.04; CRQtotal= 61.26 ± 9.28 vs. 55.53±10.09, p= 1 =40±14 and 2,690± 1,037 steps/day), respectively. Conclusion: Our data suggest that the lack of knowledge of the disease is associated with higher physical activity level in COPD patients.

Hospitalizations and exacerbations are related to a decline in lung function, quality of life and increase in mortality in patients with COPD. In addition, hospitalization also reduces acutely the daily life physical activity (DLPA) in COPD patients, however, the later effects remains unclear. Aim: To assess if hospitalization has a long term effect on DLPA in patients with COPD. Methods: This study included 93 patients with moderate and severe COPD during regular medical visit in a University hospital and under optimized medication. It was assessed: hospitalization in the last year as well as time of physical inactivity (in percentual of inactivity time) and step counts per day using an accelerometer (ActiGraph, GT3X) assessed during 6 days. Patients were divided into 2 groups: those that hospitalized during the last year but not in the last 60 days (PH group) and those who did not (NPH group). Mann Whitney test was used to compare both groups. Results: There was no difference in the age (71±7 vs. 67±9 years) and lung function (FEV 1 40±14 vs. 42±14 in % pred., respectively) between PH and NPH groups. However, the PH group presented longer time in physical inactivity and lower number of steps per day compared with the NPH group (respectively, 83 vs. 78%; p= 0.04 and 2,423 vs. 3,639 steps per day; p Conclusion: COPD patients who hospitalized in the last year remains physically inactive for a longer period. Therefore, physical activity should be encouraged in these patients after hospitalization.