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Background: The aim of this study was to quantify and compare physical activity (PA) levels of university students from different fields of study, and to investigate its correlates., Methods: 221 students (111 female, 20 [18-23] years), from different study fields were cross-sectionally assessed for daily PA (pedometer), cardiorespiratory fitness (20 m Shuttle Run Test-20mSRT), health-related quality of life (HRQoL), anxiety and depression symptoms., Results: In general, 60% of the students were physically active (>8000 steps/day), presented good HRQoL and cardiorespiratory fitness, minimal symptoms of depression and moderate of anxiety. The highest PA level was observed in students from physical education and sport sciences, and the lowest in those from social sciences (median [IQR]: 9882 [8435-13510] versus 7593 [6070-9753] steps/day, respectively; P<0.01). Male students were more active than female. Steps/day was moderately associated with VO2max (r=0.42), VO2%pred (r=0.41) and distance achieved in the 20mSRT (r=0.43) (P<0.0001 for all), and weakly associated with anxiety symptoms (r=-0.20; P=0.004) and HRQoL domains (0.15

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<0.0001). The cut-off point found in the 4MGS 4m-maximum was 1.27 m/s. Patients with preserved exercise capacity (4MGS 4m-maximum ≥1.27m/s) walker greater distances on the 6MWT in %pred (91±2 vs 76±3; P<0.0001). In the other comparisons involving gender, BMI, FEV1% pred and GOLD index there were no significant differences between the groups. In addition, the agreement of individuals classified as preserved and reduced exercise capacity in the 6MWT and 4MGS 4m-maximum was significant (P = 0.008). Conclusion The 4MGS 4m-maximum test can be used to discriminate preserved exercise capacity in patients with COPD and correlates with the 6MWT.

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 subjects' 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/m 2 , FEV 1 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., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2018 by Daedalus Enterprises.)

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 < .001), blood pressure ( P < .001), dyspnea ( P < .001), and leg fatigue ( P < .001) were found after the 1-min STS protocol. Furthermore, the 3 protocols were equally able to identify subjects with low exercise capacity or preserved exercise capacity., 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., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2018 by Daedalus Enterprises.)

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: Interpretation of the six-minute walk distance (6MWD) is enhanced by using recommended reference equations. Whenever possible, the choice of equation should be region-specific. A potential problem is that different equations for the 6MWD may have been developed for the same population, and it may be complicated to choose the most suitable., Objective: To verify the agreement of different reference equations in classifying patients with Chronic Obstructive Pulmonary Disease (COPD) as having reduced or preserved 6MWD., Methods: 159 patients with COPD performed the six-minute walk test according to international standardization. They were classified as having reduced 6MWD if it was below the lower limit of normal. Five Brazilian equations (Iwama; Britto1; Britto2; Dourado; Soares) and the two non-Brazilian equations most cited worldwide (Troosters; Enright) were used. The agreement for patients classified as reduced or preserved 6MWD was verified by Cohen's Kappa (pair-to-pair) analysis. The proportion of patients classified as having reduced walked distance was compared by the Chi-squared test., Results: Agreement between equations varied largely in classifying subjects as having reduced or preserved 6MWD (Kappa: 0.10-0.82). Brazilian equations with the highest agreement were Iwama, Britto1 and Britto2 (Kappa>0.75). The proportion of patients classified as having reduced 6MWD was statistically similar only between equations in which the agreement was higher than 0.70., Conclusion: Even reference equations from the same country vary considerably in the classification of reduced or preserved 6MWD, and it is recommended that the region-specific ones be used as they give with higher agreement for similar and comparable interpretation of the patients' functional exercise capacity., (Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background/objectives: None of the cutoff points for fat-free mass index (FFMI) were tested for the Brazilian population, and it is unknown whether the available ones are able to discriminate extrapulmonary disease manifestations. This cross-sectional study aims to develop and validate a cutoff point for FFM depletion based on Brazilian patients with chronic obstructive pulmonary disease (COPD) and to verify its association and of previously published cutoffs with extrapulmonary manifestations., Subjects/methods: A new cutoff point was obtained from the best FFMI value for discrimination of preserved exercise capacity in a sample of patients (n=57). The discriminative capacity was assessed in another sample (n=96). The new cutoff point and other previously published ones were tested to discriminate low exercise capacity, physical inactivity, sedentary lifestyle and low quality of life. A receiver operation characteristics curve with area under the curve (AUC) value was plotted and each cutoff points' discriminative capacity was calculated. Cox regression and Kaplan-Meier method assessed the association between the cutoff points and mortality., Results: The new cutoff points for FFMI were 14.65 kg/m 2 for women (AUC=0.744; sensitivity (Se)=0.88; specificity (Sp)=0.60) and 20.35 kg/m 2 for men (AUC=0.565; Se=0.36; Sp=0.81). The new cutoffs were the best to discriminate poor exercise capacity assessed by walked distance in % predicted and quality of life. Only the new cutoff point was associated with mortality (HR=2.123; 95% CI: 1.03-4.33, P=0.039, log rank P=0.035)., Conclusions: Only the new cutoff point was associated with all-cause mortality, and it had the highest discriminating capacity for exercise capacity and quality of life in Brazilian patients with 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.

Introduction: Pulmonary rehabilitation is one of the most effective non-pharmacological management options for individuals with chronic obstructive pulmonary disease (COPD). Exercise training is the cornerstone of pulmonary rehabilitation, however considerable variability exists regarding the way it is delivered across the world. It is widely accepted that efforts should be made to tailor specific therapeutic approaches to individuals' needs. This applies as much to respiratory medicine as it does to respiratory rehabilitation. Areas covered: This narrative review examines the emerging literature evaluating advancements of exercise training modalities targeting peripheral muscle function in people with COPD. It aims to highlight practical considerations regarding the delivery key evidence regarding clinical effectiveness, as well as highlight some of the and evaluation of their effectiveness to inform clinical practice. Expert commentary: Although novel therapies may offer advantages over more 'traditional' training methods under specific circumstances, challenges regarding the potential impact upon clinical rehabilitation, the identification of the best candidates for such therapy and access to equipment may pose realistic barriers to their more widespread clinical implementation. Future directions regarding the ways in which these barriers could be overcome will be discussed, including identification of the key research priorities to optimize evidence-based practice in this area.

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., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Dyspnea and fatigue frequently impair the ability to perform activities of daily living (ADL) in patients with chronic obstructive pulmonary disease. Questionnaires and scales have been used to assess limitations in ADL. The London Chest Activity of Daily Living (LCADL) scale is responsive to intervention to a higher extent when compared with other tools. However, the minimal detectable change (MDC) for this scale remains unknown. The aim of this study was to determine the MDC for functional status improvement measured by the LCADL scale in patients with chronic obstructive pulmonary disease., Methods: Forty patients (20 men, 66 ± 7 years, forced expired volume in 1 second 44 ± 16% predicted) participated in a 3-month high-intensity exercise training program. Before and after the protocol, participants complete the LCADL scale and the Saint George Respiratory Questionnaire. To calculate the MDC, we used the standard error of measurement and the effect size (distribution-based estimates)., Results: There was improvement in the LCADL self-care, domestic and leisure domains, and total score after the training program, with a strong trend for improvement in the physical activity domain. The MDC estimated for the LCADL were 0.89, 2.60, 0.44, 0.58, and 3.88 points for self-care, domestic, physical, and leisure domains, and total score, respectively. Correlations between changes in LCADL and in the Saint George Respiratory Questionnaire were weak (r < 0.4 for all)., Conclusion: This study provided the MDC for the domains and total score of the LCADL. A change of 4 points in the total score of the LCADL can be interpreted as a meaningful change.

Objective: To compare the accuracy of 2 motion sensors (a pedometer and a multisensor) in terms of step counting and estimation of energy expenditure (EE) in patients with chronic obstructive pulmonary disease (COPD) and in healthy elderly., Design: In this descriptive study, all participants wore both motion sensors while performing a treadmill walking protocol at 3 different speeds corresponding to 30%, 60%, and 100% of the average speed achieved during a six-minute walk test. As criterion methods, EE was estimated by indirect calorimetry, and steps were registered by videotape., Setting: Research laboratory at a university hospital., Participants: Patients with COPD (n=30; 17 men; mean age +/- SD, 67+/-8 y; mean forced expiratory volume in the first second [FEV(1)] predicted +/- SD, 46%+/-17%; mean body mass index [BMI] +/- SD, 24+/-4 kg.m(2)) and matched healthy elderly (n=30; 15 men; mean age +/- SD, 68+/-7 y; mean FEV(1) predicted +/- SD, 104%+/-21%; mean BMI +/- SD, 25+/-3 kg.m(2))., Interventions: Not applicable., Main Outcome Measure: Step counting and EE estimation during a treadmill walking protocol., Results: The pedometer was accurate for step counting and EE estimation in both patients with COPD and healthy elderly at the higher speed. However, it showed significant underestimation at the 2 slower speeds in both groups. The multisensor did not detect steps accurately at any speed, although it accurately estimated EE at all speeds in healthy elderly and at the intermediate and higher speeds in patients with COPD., Conclusions: In both patients with COPD and healthy elderly, the multisensor showed better EE estimates during most walking speeds than the pedometer. Conversely, for step counting, accuracy is observed only with the pedometer during the higher walking speed in both groups., (Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)