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Individuals with asthma are more likely to develop sleep-disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms.This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre- and post-intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health-related quality of life and anxiety and depression levels were conducted.Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma-symptom-free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma-related quality of life questionnaire and a reduction in anxiety symptoms.Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms.

Background Higher levels of physical activity have been associated with better asthma clinical control. Research Question Does a behavior change intervention aimed at increasing physical activity change asthma clinical control, physical activity, sedentary time, health-related quality of life (HRQoL), and anxiety and depression symptoms? Study Design and Methods This single-blind, randomized controlled trial included participants who were allocated to an intervention group (IG) or to a control group (CG). Both groups received usual care and disease-specific education. Participants in the IG also underwent an 8-week behavior change intervention aimed at increasing physical activity. Prior to and following the intervention period, measures were made of asthma clinical control (Asthma Control Questionnaire [ACQ]), physical activity, sedentary time and sleep quality (ActiGraph), HRQoL (Asthma Quality of Life Questionnaire), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data on asthma exacerbations were recorded 12 months prior to and throughout the intervention period. Results Fifty-one participants were included (CG, n = 26; IG, n = 25). On completion of the intervention period, compared with the CG, those in the IG exhibited improvements in asthma control (mean difference [95% CI] in ACQ score, –0.8 [–1.1 to –0.4]); in daily step count, 3,605 [1,937 to 8,867] steps/d; in sleep efficiency, 9.2% [–7.1% to 21.9%]; and a reduction in sedentary time, –1.1 [–2.9 to –0.6] h/d). No between-group difference in HRQoL was observed. The percentage of participants who experienced exacerbations during the intervention period was 27% in the IG vs 60% in the CG (P = .04). The change in time spent in moderate-intensity physical activity was inversely associated with change in ACQ (r = –0.60). Compared with the CG, a higher percentage of participants in the IG reported a reduction in anxiety symptoms (43% vs 0%; P Interpretation In adults with moderate to severe asthma, a comprehensive behavior change intervention that increased physical activity also produced improvements in asthma clinical control, sedentary time, sleep quality, and anxiety symptoms. Clinical Trial Registration ClinicalTrials.gov ; No.: NCT03705702; URL: www.clinicaltrials.gov .

Asthma is a disease characterized by reversible bronchoconstriction, but some subjects develop fixed airflow obstruction (FAO). Subjects with FAO present more asthma symptoms and may have increased sedentary behavior; however, the effect of FAO on aerobic fitness and physical activity levels (PAL) remains poorly understood. AIM To compare adolescents with asthma and FAO and adolescents with asthma without FAO in terms of aerobic fitness, PAL, muscle strength, and health-related quality of life (HRQoL). METHODS This cross-sectional study included adolescents with asthma, both sexes, and aged 12-18 years. They were divided into two groups: FAO and non-FAO groups. The adolescents were diagnosed with asthma according to the Global Initiative for Asthma guidelines and underwent optimal pharmacological treatment for at least 12 months. FAO was diagnosed when the forced expiratory volume in the first second/forced vital capacity ratio was below the lower limit of the normal range after optimal treatment. Aerobic fitness, PAL, peripheral and respiratory muscle strength, and HRQoL were evaluated. RESULTS No significant differences were observed between FAO and non-FAO groups regarding the peak oxygen uptake (34.6 ± 8.5 vs. 36.0 ± 8.4 mLO2 /min/kg), sedentary time (578 ± 126 vs. 563 ± 90 min/day), upper limb muscle strength (29.1 ± 5.9 vs. 28.1 ± 5.7 kilograms of force [kgf]), lower limb muscle strength (42.8 ± 8.6 vs. 47.6 ± 9.6 kgf), or HRQoL (5.1 ± 1.3 vs. 4.7 ± 1.4 score; p > .05). However, the FAO group exhibited a higher maximal expiratory pressure than the non-FAO group (111.5 ± 15.5 vs. 101.5 ± 15.0 cmH2 O, respectively). CONCLUSION Our results suggest that FAO does not impair aerobic fitness, PAL, peripheral muscle strength, or HRQoL in adolescents with asthma. Furthermore, adolescents with asthma were physically deconditioned.

This study evaluates the physical activity level at work and leisure time of white-collar and two groups of blue-collar workers from the latex glove industry and the association of physical activity level and musculoskeletal complains and work ability. The workers' sociodemographic and behavioral health characteristics, work ability index, musculoskeletal complains, total step count and caloric expenditure for three consecutive days, were assessed. The blue-collar workers that move most from the workstation (longD) were more physically active at work compared to white-collar and blue-collar that moved close the workstation (shortD). But in leisure-time the result is reversed, white-collar and blue-collar groups were significantly more active. There was no association between physical activity level and musculoskeletal pain intensity and work ability. All the groups of workers exhibited satisfactory physical activity levels, but only blue-collar (longD) were more physically active (10,000 steps per day).

Subjects with severe and very severe chronic obstructive pulmonary disease (COPD) present thoracoabdominal asynchrony (TAA) that reduces ventilatory efficiency and exercise capacity. However, no therapeutic intervention has focused on reducing TAA. The purpose of this study was to evaluate the effects of elastic tape (ET) on thoracoabdominal mechanics, dyspnea symptoms, exercise capacity, and physical activity level in nonobese male subjects with severe-to-very severe COPD. This crossover, randomized trial included nonobese males with severe to very severe COPD. ET was placed on the chest wall and abdomen to reduce TAA. Subjects were evaluated at three hospital visits, each 7 days apart. At visit 1, thoracoabdominal kinematic and pulmonary ventilation were evaluated by optoelectronic plethysmography and electrical impedance tomography, respectively, both at rest and during isoload exercise testing. At visit 2, a cardiopulmonary exercise test (CPET; 10 W/min) was performed until exhaustion. Between the visits, subjects used a physical activity monitor (PAM) (at least 5 days of measurement; 10 h/day). At visit 3, all the tests were repeated in the opposite order of the previous randomization. During the isoload exercise, subjects with ET presented lower tidal and minute volumes (P = 0.01) and reduced TAA (P = 0.02) and dyspnea (P = 0.04). During the CPET, subjects with ET presented an increase in peak oxygen consumption (Vo2peak; L/min and mL·kg-1·min-1; P = 0.01), test duration (P = 0.009), and maximal load (P = 0.03). Moderate and vigorous physical activity (MVPA), which was evaluated by the PAM, was also increased in subjects with ET (P = 0.01). ET reduced TAA and dyspnea and increased exercise capacity and the duration of MVPA in nonobese male subjects with severe-to-very severe COPDNEW & NOTEWORTHY Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.

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.

The postural imbalance is an extra-pulmonary condition, associated with chronic obstructive pulmonary disease (COPD). COPD affects older individuals and it is unclear whether balance abnormalities can be described as pathophysiological mechanism or aging. The present study aimed to evaluate the influence of age or disease on postural balance of patients with COPD. Patients with COPD over 50 years old were compared with age- and sex-matched healthy adults, and with sex-matched younger healthy adults (

Objective: The main purpose of this study was to evaluate whether the %HRR–%VO2R relationship and %HRR–VO2peak relationship are affected in patients with moderate or severe asthma and whether airwa...

Objective: To identify barriers to daily life physical activities (DLPA) and to evaluate physical activity levels for children with asthma and without asthma.Method: This is a cross-sectional study...

We collected peripheral blood from thirty-nine elite male endurance runners at rest (24 hours after the last exercise session) and used the Allergy Questionnaire for Athletes score and plasma specific IgE level to separate them into atopic and non-atopic athletes. Neutrophils obtained from atopic and non-atopic athletes were subsequently stimulated in vitro with fMLP (N-formyl-methionyl-leucyl-phenylalanine), LPS (lipopolysaccharide), or PMA (phorbol 12-myristate 13-acetate). Neutrophils from non-atopic runners responded appropriately to LPS, as evidenced by the production of pro (IL-8, TNF-α, and IL-6) and anti-inflammatory (IL-10) cytokines. Neutrophils from atopic elite runners exhibited lower responses to LPS stimulus as indicated by no increase in IL-1β, TNF-α, and IL-6 production. Neutrophils from non-atopic and atopic runners responded similarly to fMLP stimulation, indicating that migration function remained unaltered. Both groups were unresponsive to PMA induced reactive oxygen species (ROS) production. Training hours and training volume were not associated with neutrophil IgE receptor gene expression or any evaluated neutrophil function. Since non-atopic runners normally responded to LPS stimulation, the reduced neutrophil response to the stimuli was most likely due to the atopic state and not exercise training. The findings reported are of clinical relevance because atopic runners exhibit a constant decline in competition performance and are more susceptible to invading microorganisms.

INTRODUCTION The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was first reported in Wuhan, Hubei Province, China, in late December 2019. In January 2020, the World Health Organization declared COVID-19 as a public health emergency of international concern (). As of March 27, 2021, which was one year after the first case was reported, COVID-19 has already affected 126,726,672 people worldwide and has caused 2,777,337 deaths (). COVID-19 affects all age groups and [...]

Resumo Fundamento: O treinamento de caminhada (TC) melhora a capacidade de caminhar e reduz a pressão arterial (PA) clínica em pacientes com doença arterial periférica (DAP), mas seus efeitos na PA ambulatorial permanecem desconhecidos. Objetivo: Investigar o efeito de 12 semanas de TC na PA ambulatorial e sua variabilidade em pacientes com DAP. Métodos: Trinta e cinco pacientes do sexo masculino com DAP e sintomas de claudicação foram alocados aleatoriamente em dois grupos: controle (n = 16, 30 min de alongamento) e TC (n = 19, 15 séries de 2 minutos de caminhada na frequência cardíaca em que ocorreu limiar de dor intercalados por 2 minutos de repouso em pé). Antes e depois de 12 semanas, a PA ambulatorial de 24 horas foi avaliada. Os índices de variabilidade da PA ambulatorial avaliados em ambos os momentos incluíram o desvio-padrão de 24 horas (DP24), o desvio-padrão ponderado de vigília e sono (DPvs) e a variabilidade real média de 24 horas (VRM24). Os dados foram analisados por ANOVAs mistas de dois fatores, considerando significativo P

Objective: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. Methods: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. Results: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). Conclusions: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.

The novel coronavirus (SARS-CoV-2) has distinct clinical manifestations that can vary from an asymptomatic condition to severe acute respiratory failure. Phenotypes are attributable to different pathophysiological mechanisms and require different treatment strategies. The assessment and identification of different phenotypes can guide therapy configurations such as oxygen therapy, non-invasive ventilation, airway management, and tracheal intubation. Further studies are essential to provide information on the influence of phenotypes in the decision of rehabilitation strategies. The sequelae left in the respiratory system of COVID-19 survivors and its limitations will be a challenge for rehabilitation services worldwide. Lung injuries are directly related to the phenotypes presented, and depending on the degree of these injuries, rehabilitation strategies can be targeted. We believe that differentiating patients, according to their respective phenotypes, can improve decision-making in treatment and individualized rehabilitation.

Aerobic and respiratory exercises are non-pharmacological treatments recommended to improve asthma clinical control; however, the association of both interventions has never been tested. Aim: To assess the effect of aerobic and breathing exercises on the clinical control in subjects with asthma. Methods: Subjects with moderate to severe asthma were randomly assigned to either aerobic+stretching(sham) exercises(AS;n=11) or aerobic+breathing exercises(AB;n=16) for 24 sessions. All patients were assessed before and after the interventions for clinical control (ACQ), health-related quality of life (AQLQ), sleep quality (Pittsburgh), anxiety and depression symptoms (HADS), and hyperventilation symptoms (Nijmegen). Results: There was no difference between groups before intervention. After intervention, no difference was observed on clinical control (-0.27±0.65 vs -0.55±0.59 score), AQLQ (0.76±0.89 vs 0.48±0.75 score), anxiety and depression symptoms (-2.27±4.12 vs -1.13±3.07 score), physical capacity (54.81±97.12 vs 102.12±133.11 meters), and sleep quality (-2.79±6.91 vs. -4.50±9.99 score) between AS and AB (p>0.05 for all outcomes). However, patients from AB improved the hyperventilation symptoms (-1±8.40 vs. -6.73±7.83 score; p=0.02) after intervention compared to AS. Conclusion: The association of aerobic and respiratory exercises seems not to improve asthma control, HRQoL, anxiety and depression symptoms, and sleep quality compared with aerobic exercise alone in patients with moderated and severe asthma. The association of breathing exercise was more effective in improving hyperventilation in this population.

Adults with asthma are more likely to be physically inactive and to develop sleep disorders, which may worsen asthma symptoms. However, it is unknown whether an increase in physical activity levels (PAL) improves sleep quality. Aim: To investigate the effects of a behaviour change intervention aimed to increase PAL on sleep quality. Methods: adults with moderate-to-severe asthma were randomly assigned to either a control (CG) or an intervention group (IG). Both groups received usual care and educational programme. Patients in the IG also underwent an 8-week behaviour change intervention. The face-to-face intervention was delivered once weekly and focused on goal-setting and feedback. Before and after the intervention, subjects were assessed on sleep quality (Actisleep, Pittsburgh and Berlin questionnaire), PAL (GT9X accelerometer), asthma symptoms (daily diary) and psychosocial symptoms (HADS). Results: 49 subjects were included (CG=25; IG=24). At baseline, there was no difference between groups. On the completion of the intervention, was observed an improvement in sleep efficiency (6.8±5.9 vs -2.4± 6.2%) and latency (-3.9±9.1 vs -1.0±8.3min) in the IG compared with CG. The proportion of patients with improvements in the Pittsburg index (50±51% vs 10±31%) and in the depression symptoms (43 vs 0%) was greater in the IG compared with GC (P Conclusion: Our results suggest that the behavioural intervention increased PAL and improved sleep quality in adults with asthma.

Bronchodilators (BD) are prescribed for subjects with bronchiectasis (BCT). BDs improve exercise capacity in subjects with COPD; however, its effect in subjects with BCT remains unknown. Objectives: to evaluate the effect of BD in the exercise capacity and thoracoabdominal mechanics in subjects with BCT. Methods: This randomized crossover, double-blinded, placebo-controlled trial included subjects with BCT clinically stable. Subjects performed a cardiopulmonary exercise test and a constant load exercise test (CLET, 75%Wmax) to assess endurance time (Tlim) concurrently to the thoracoabdominal mechanics. BD or placebo was used in a random order, one week apart. Total and compartmental pulmonary volumes, as well as thoracoabdominal asynchrony (TAA), were evaluated. Tlim time, Borg fatigue (F) and dyspnea (D), and peripheral oxygen saturation (SpO2) were also assessed. Results: Ten subjects were included (48±11yrs, 25.6±4kg/m2). No difference in vital signs, dyspnea and SpO2 was observed before CLET between BD and placebo. At the end of CLET, Tlim and SpO2 were higher using BD compared to placebo (342±119 vs 287±102sec, p Conclusion: BD in subjects with BCT improves exercise capacity and reduces dyspnea and fatigue symptoms. However, the mechanism for such improvement remains unknown.

Conselho Nacional de Pesquisa (CNPq)National Council for Scientific and Technological Development (CNPq)

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.

Immunosenescence are alterations on immune system that occurs throughout an individual life. The main characteristic of this process is replicative senescence, evaluated by telomere shortening. Several factors implicate on telomere shortening, such as smoking. In this study, we evaluated the influence of smoking and Chronic Obstructive Pulmonary Disease (COPD) on cytokines, telomere length and telomerase activity. Blood samples were collected from subjects aged over 60 years old: Healthy (never smokers), Smokers (smoking for over 30 years) and COPDs (ex-smokers for ≥15 years). A young group was included as control. PBMCs were cultured for assessment of telomerase activity using RT-PCR, and cytokines secretion flow cytometry. CD4+ and CD8+ purified lymphocytes were used to assess telomere length using FlowFISH. We observed that COPD patients have accelerated telomere shortening. Paradoxically, smokers without lung damage showed preserved telomere length, suggesting that tobacco smoking may affect regulatory mechanisms, such as telomerase. Telomerase activity showed diminished activity in COPDs, while Smokers showed increased activity compared to COPDs and Healthy groups. Extracellular environment reflected this unbalance, indicated by an anti-inflammatory profile in Smokers, while COPDs showed an inflammatory prone profile. Further studies focusing on telomeric maintenance may unveil mechanisms that are associated with cancer under long-term smoking.

Sejam bem vindos í seção dos trabalhos cientí­ficos apresentados no V Simpósio de Fisioterapia do HCFMUSP, evento organizado pelo Comitê Assistencial Técnico Cientí­fico em Fisioterapia do HCFMUSP (CAFIS). Este Comitê agrega todos os serviços de Fisioterapia do Hospital das Clí­nicas e o Curso de Fisioterapia da Faculdade de Medicina da USP. Aproveitamos também para lançar a I Conferência Nacional de Fisioterapia do ICHC FMUSP em comemoração ao 20° aniversário da Divisão de Fisioterapia do ICHC.Este evento cientí­fico possibilitou rever ou fazer novas amizades, ampliar nosso network e compartilhar experiências, projetos e vasto conhecimento.Com o intuito de integrar as diferentes áreas da fisioterapia, organizamos a participação de renomados palestrantes nacionais e internacionais que compartilharam suas experiências abordando questões inovadoras nas práticas profissionais, buscando a aproximação e participação ativa dos congressistas. Além disso, foram desenvolvidas diversas discussões e reflexões sobre visão de futuro, metas e estratégias para o desenvolvimento sócio-polí­tico contí­nuo da fisioterapia.Os trabalhos cientí­ficos foram analisados e aprovados pelo Comitê Cientí­fico e foram organizados em eixos temáticos da fisioterapia: Fisioterapia Cardiorrespiratória; Funcionalidade e Neurociência; Fisioterapia em Ortopedia, Traumatologia e Esporte; Fisioterapia nas Disfunções do Assoalho Pélvico; Fisioterapeuta Gestor e Outros.Gostarí­amos de agradecer a todos aqueles que vêm contribuindo para a evolução da fisioterapia e esperamos que o material apresentado nesta edição seja base para conhecimento e disseminação de boas práticas e inovação.Até a próxima!

Objectives This study investigated the effects of walking training (WT) on cardiovascular function and autonomic regulation in patents with intermittent claudication (IC). Design Randomized controlled trial. Methods Forty-two male patients with IC (≥50 years) were randomly allocated into two groups: control (CG, n = 20, 30 min of stretching exercises) and WT (WTG, n = 22, 15 bouts of 2 min of walking interpolated by 2 min of upright rest—walking intensity was set at the heart rate of pain threshold). Both interventions were performed twice/week for 12 weeks. Walking capacity (maximal treadmill test), blood pressure (auscultatory), cardiac output (CO2 rebreathing), heart rate (ECG), stroke volume, systemic vascular resistance, forearm and calf vascular resistance (plethysmography), and low (LF) and high frequency (HF) components of heart rate variability and spontaneous baroreflex sensitivity were measured at baseline and after 12 weeks of the study. Results WT increased total walking distance (+302 ± 85 m, p = 0.001) and spontaneous baroreflex sensitivity (+2.13 ± 1.07 ms/mmHg, p = 0.02). Additionally, at rest, WT decreased systolic and mean blood pressures (−10 ± 3 and −5 ± 2 mmHg, p = 0.001 and p = 0.01, respectively), cardiac output (−0.37 ± 0.24 l/min, p = 0.03), heart rate (−4 ± 2 bpm, p = 0.001), forearm vascular resistance (−8.5 ± 2.8 U, p = 0.02) and LF/HF (−1.24 ± 0.99, p = 0.001). No change was observed in the CG. Conclusions In addition to increasing walking capacity, WT improved cardiovascular function and autonomic regulation in patients with IC.

Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD. NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.

Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated.To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers, and lung function.Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program plus exercise (WL + E group, n = 28) or a weight-loss program plus sham (WL + S group, n = 27), where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL + E group incorporated aerobic and resistance muscle training, whereas the WL + S group incorporated breathing and stretching exercises.The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength, and inflammatory/antiinflammatory biomarkers. After 3 months, 51 patients were analyzed. Compared with the WL + S group, the WL + E group demonstrated improved clinical control scores (median [25th to 75th percentile], -0.7 [-1.3 to -0.3] vs. -0.3 [-0.9 to 0.4]; P = 0.01) and greater weight loss (mean ± SD, -6.8% ± 3.5 vs. -3.1% ± 2.6; P 0.001) and aerobic capacity (median [25th to 75th percentile], 3.0 [2.4 to 4.0] vs. 0.9 [-0.3 to 1.3] ml OAdding exercise to a short-term weight-loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients. Clinical trial registered with www.clinicaltrials.gov (NCT 02188940).

Higher levels of physical activity have been associated with better asthma clinical control.Does a behavior change intervention aimed at increasing physical activity change asthma clinical control, physical activity, sedentary time, health-related quality of life (HRQoL), and anxiety and depression symptoms?This single-blind, randomized controlled trial included participants who were allocated to an intervention group (IG) or to a control group (CG). Both groups received usual care and disease-specific education. Participants in the IG also underwent an 8-week behavior change intervention aimed at increasing physical activity. Prior to and following the intervention period, measures were made of asthma clinical control (Asthma Control Questionnaire [ACQ]), physical activity, sedentary time and sleep quality (ActiGraph), HRQoL (Asthma Quality of Life Questionnaire), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data on asthma exacerbations were recorded 12 months prior to and throughout the intervention period.Fifty-one participants were included (CG, n = 26; IG, n = 25). On completion of the intervention period, compared with the CG, those in the IG exhibited improvements in asthma control (mean difference [95% CI] in ACQ score, -0.8 [-1.1 to -0.4]); in daily step count, 3,605 [1,937 to 8,867] steps/d; in sleep efficiency, 9.2% [-7.1% to 21.9%]; and a reduction in sedentary time, -1.1 [-2.9 to -0.6] h/d). No between-group difference in HRQoL was observed. The percentage of participants who experienced exacerbations during the intervention period was 27% in the IG vs 60% in the CG (P = .04). The change in time spent in moderate-intensity physical activity was inversely associated with change in ACQ (r = -0.60). Compared with the CG, a higher percentage of participants in the IG reported a reduction in anxiety symptoms (43% vs 0%; P .02).In adults with moderate to severe asthma, a comprehensive behavior change intervention that increased physical activity also produced improvements in asthma clinical control, sedentary time, sleep quality, and anxiety symptoms.ClinicalTrials.gov; No.: NCT03705702; URL: www.clinicaltrials.gov.