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Resumen: Introducción: El objetivo del estudio fue evaluar el rendimiento diagnóstico de la pregunta relacionada con la actividad física del cuestionario de control del asma de la Global Initiative for Asthma (GINA) para la detección de la broncoconstricción inducida por el ejercicio (BIE) en niños y adolescentes. Materiales y métodos: Se dividió a pacientes (de seis a 18 años de edad) con diagnóstico de asma en dos grupos de acuerdo con la clasificación de gravedad según el cuestionario GINA: asma leve/moderada (ALM) y asma grave refractaria (AGR). Se recogieron datos antropométricos, clínicos y funcionales (espirometría) y se realizó prueba de broncoprovocación con esfuerzo. Se utilizó la cuarta pregunta del cuestionario GINA, concerniente a los síntomas asociados con el esfuerzo físico, para evaluar el rendimiento diagnóstico de este instrumento. Resultados: Se incluyeron a 40 pacientes (17 con ALM y 23 con AGR) con una edad media de 11,3 años y un z-score medio de FEV1 de -0,33, de los que 13 (32,5%) se clasificaron como casos de asma no controlada. De los pacientes con enfermedad no controlada, siete (53,8%) mostraron caídas en el FEV1 tras la prueba de esfuerzo. Se observó una mayor frecuencia de BIE en sujetos con z-score de FEV1 < -1,0 en comparación con aquellos con un z-score ≥ -1,0 (p = 0,05). No hubo diferencias significativas en la frecuencia de BIE con base en la gravedad o el control de la enfermedad. Tampoco se observó asociación entre la pregunta cuatro (GINA) y la BIE. El área bajo la curva de características operativas del receptor (receiver operating characteristic, ROC) evidenció que el poder discriminatorio del cuestionario GINA resulta insuficiente para detectar la BIE (p = 0,41), con una sensibilidad del 42,1% y una especificidad del 57,1%. Conclusiones: La pregunta concerniente al ejercicio físico en el cuestionario GINA carece del poder diagnóstico necesario para detectar la BIE en niños y adolescentes asmáticos. Abstract: Introduction: The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents. Material and methods: We divided participants (aged 6 to 18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument. Results: We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV1 z-score of -0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV1 after the EIB test. We found a higher frequency of EIB in participants with FEV1 z-score values of less than -1.0 compared to those with a z-score of -1.0 or greater (p = 0.05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (p = 0.41), with sensitivity of 42.1% and specificity of 57.1%. Conclusions: The physical activity related question of GINA has insufficient diagnostic power to detect EIB in children and adolescents with asthma.

To evaluate the exercise capacity of children and adolescents with severe therapy resistant asthma (STRA) aiming to identify its main determinants.Cross-sectional study including individuals aged 6-18 years with a diagnosis of STRA. Clinical (age and gender), anthropometric (weight, height and body mass index) and disease control data were collected. Lung function (spirometry), cardiopulmonary exercise testing (CPET) and exercise-induced bronchoconstriction (EIB) test were performed.Twenty-four patients aged 11.5 ± 2.6 years were included. The mean forced expiratory volume in one second (FEVExercise capacity is impaired in approximately 30% of children and adolescents with STRA. The results indicate that different aspects of aerobic fitness are influenced by distinct determinants, including lung function and EIB.

Background Adherence of patients with cystic fibrosis (CF) to exercise is challenging. Here we compared the physiological responses during the use of interactive video games (VG) with the cardiopulmonary exercise test (CPET) in healthy and CF subjects. Methods Cross-sectional study including CF and healthy (CON) subjects older than 6 years. Individuals were evaluated in two visits. At visit one, anthropometric measures, spirometry and CPET were performed. In the second visit, a physical activity questionnaire was applied and gas analyses performed during the use (10 min) of both Nintendo Wii (Wii Fit Plus: (1) Obstacle Course, (2) Rhythm Boxing and (3) Free Run) and Xbox One (Just Dance 2015: (1) Love Me Again, (2) Summer and (3) Happy). Results Twenty-five CON and 30 CF patients were included. The mean FEV1 (%) was significantly lower in the CF group compared to CON. There were no differences between groups at peak exercise (CPET) for heart rate (HR), oxygen consumption (VO2) and minute ventilation (VE). In the CON group, games 2 and 3 (Xbox) and game 3 (Nintendo) increased HR to values similar to the anaerobic threshold (AT), while for the CF group this occurred for games 2 (Xbox) and 3 (Nintendo). As for VO2 and VE, both groups obtained similar responses as compared to AT values in games 2 (Xbox) and 3 (Nintendo). Conclusion The use of VG generated a cardiorespiratory response similar to AT levels found during CPET, indicating that it may be an alternative for exercise training of CF individuals.

Modelo del estudio: Revision sistematica. Introduccion: Los disturbios ventilatorios obstructivos (DVO) se caracterizan por causar limitaciones persistentes de las vias aereas, aumentando la resistencia debido a la acumulacion de secreciones. Objetivo: Evaluar si los recursos de fisioterapia respiratoria modifican la impedancia pulmonar evaluada por las tecnicas de oscilaciones forzadas (TOF's) en adultos con DVO. Metodo: Se trata de una revision sistematica conducida en las bases de datos Pubmed, Scielo, Lilacs y Pedro, utilizando la siguiente estrategia de busqueda: Obstructive pulmonary disease OR chronic obstructive pulmonary disease OR COPD OR Bronchiectasis OR Bronchial diseases OR Cystic fibrosis OR mucoviscidosis AND impulse oscillometry OR forced oscillation techniques AND physical therapy OR physiotherapy AND Airway Resistance. Resultados: De un total de 216 articulos, solo 3 fueron incluidos. Las muestras totalizaron 64 participantes, incluyendo adultos con fibrosis quistica (FC), enfermedad pulmonar obstructiva cronica (EPOC) y bronquiectasias. Dos estudios utilizaron el flutter® y 1 realizo drenaje autogeno. La impedancia pulmonar fue evaluada en 2 investigaciones por el sistema de oscilometria de impulso (IOS) y en 1 por la TOF modificada (TOF-m). Se observo una reduccion de la resistencia en varias frecuencias, siendo que las mas frecuentes fueron la resistencia total (3/3), la resistencia central (2/3) y la periferica (1/3). Ademas, la reatancia pulmonar presento resultados conflictivos. Conclusion: Se evidencio que los recursos fisioterapeuticos utilizados para la remocion de secreciones de las vias aereas modifican la impedancia pulmonar evaluada por las TOF en adultos con FC, EPOC y bronquiectasias, indicando que estos metodos pueden ser instrumentos sensibles de evaluacion del efecto de la fisioterapia respiratoria en adultos con DVO.

Objective Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma. Study Design Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7–17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated. Results Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p

Aims Individuals with cystic fibrosis (CF) may develop muscle abnormalities, although little is known on its clinical and functional impact. This study aimed to evaluate the association of peripheral muscle strength with aerobic fitness, habitual physical activity, lung function and the use of antibiotics (ATB) in patients with CF. Methods A Cross-sectional study where individuals aged ≥ 6 years underwent peripheral muscle strength evaluation (biceps, quadriceps and hamstrings) and performed a cardiopulmonary exercise test. Demographic, anthropometric, genetic, lung function, and total days of ATB use within one year of tests were also collected. Results Correlation was found for biceps (r=0.45; p=0.002) strength with the peak oxygen consumption (VO2 peak). Muscle strength (biceps and quadriceps) also correlated with the ventilatory equivalent for oxygen consumption (VE /VO2 ) at anaerobic threshold (AT) and with the ventilatory equivalent for carbon dioxide production (VE /VCO2 ) both at AT and peak exercise. Negative correlations were found for quadriceps (r=-0.39) and hamstrings (r=-0.42) with the total days of ATB use in the following year. Patients needing to use ATB presented lower biceps strength (p=0.05) and individuals with VO2 peak lower than 37 mL.kg-1 .min-1 presented lower muscle strength for both biceps (p=0.01) and quadriceps (p=0.02). Conclusions The results have shown that peripheral muscle strength is associated with aerobic fitness and the use of antibiotics in patients with CF.

Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ventilation on exercise capacity in individuals with severe therapy-resistant asthma (STRA) are unknown. This study aimed to evaluate the immediate effect of continuous positive airway pressure (CPAP) on exercise tolerance in children with STRA. We performed a controlled, randomized, crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA. Clinical, anthropometric and lung function data were collected. The participants in the intervention group (IG) used CPAP (PEEP 10cmH2O and FiO2 0.21) for a period of 40 min. Subjects in the control group (CG) used CPAP with minimum PEEP at 1 cmH20 also for 40 min. Afterwards, subjects from both groups underwent cardiopulmonary exercise testing (CPET). After a 15-day washout period, on a subsequent visit, subjects participated in the opposite group to the initial one. Thirteen subjects with a mean age of 12.30 ± 1.7 years were included. The variables of peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) before using CPAP and after performing CPET did not show significant differences. Regarding CPET results, there was no significant difference (P = 0.59) between groups at peak exercise for oxygen consumption—VO2 (CG: 33.4 ± 6.3 and IG: 34.5 ± 5.9, mL kg−1 min−1). However, the IG (12.4 ± 2.1) presented a total test time (min) significantly (P = 0.01) longer than the CG (11.5 ± 1.3). The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.

Introduction: The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents. Material and methods: We divided participants (aged 6–18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument. Results: We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV1 z-score of –0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV1 after the EIB test. We found a higher frequency of EIB in participants with FEV1 z-score values of less than –1.0 compared to those with a z-score of –1.0 or greater (P = .05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (P = .41), with sensitivity of 42.1% and specificity of 57.1%. Conclusions: The item concerning physical activity in the GINA questionnaire has insufficient diagnostic power to detect EIB in children and adolescents with asthma. Introducción: El objetivo del estudio fue evaluar el rendimiento diagnóstico de la pregunta relacionada con la actividad física del cuestionario de control del asma de la Global Initiative for Asthma (GINA) para la detección de la broncoconstricción inducida por el ejercicio (BIE) en niños y adolescentes. Materiales y métodos: Se dividió a pacientes (de 6 a 18 años de edad) con diagnóstico de asma en dos grupos de acuerdo a la clasificación de gravedad según el cuestionario GINA: asma leve/moderado (ALM) y asma grave refractaria (AGR). Se recogieron datos antropométricos, clínicos y funcionales (espirometría) y se realizó prueba de broncoprovocación con esfuerzo. Se utilizó la cuarta pregunta del cuestionario GINA, concerniente a los síntomas asociados al esfuerzo físico, para evaluar el rendimiento diagnóstico de este instrumento. Resultados: Se incluyó a 40 pacientes (17 con ALM y 23 con AGR) con una edad media de 11,3 años y un z-score medio de FEV1 de –0,33, de los que 13 (32,5%) se clasificaron como casos de asma no controlada. De los pacientes con enfermedad no controlada, 7 (53,8%) mostraron caídas en el FEV1 tras la prueba de esfuerzo. Se observó una mayor frecuencia de BIE en sujetos con z-score de FEV1 < –1,0 en comparación con aquellos con un z-score ≥ –1,0 (p = 0,05). No hubo diferencias significativas en la frecuencia de BIE en base a la gravedad o el control de la enfermedad. Tampoco se observó asociación entre la pregunta 4 (GINA) y la BIE. El área bajo la curva ROC evidenció que el poder discriminatorio del cuestionario GINA resulta insuficiente para detectar la BIE (p = 0,41), con una sensibilidad del 42,1% y una especificidad del 57,1%. Conclusiones: La pregunta concerniente al ejercicio físico en el cuestionario GINA carece del poder diagnóstico necesario para detectar la BIE en niños y adolescentes asmáticos. info:eu-repo/semantics/publishedVersion

Objective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU). Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale. Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight

INTRODU??O: A asma induzida pelo exerc?cio (AIE) ? definida como uma obstru??o transit?ria das vias a?reas durante e ap?s o exerc?cio, podendo ser evidenciada pela queda no volume expirat?rio for?ado no primeiro segundo (VEF1). Embora v?rios instrumentos tenham sido criados e testados para detectar a AIE, a maioria possui baixo poder diagn?stico. Nesse sentido, considerando a ampla utiliza??o da Global Initiative for Asthma (GINA) na pr?tica cl?nica e que o mesmo possui uma quest?o espec?fica de atividade f?sica, torna-se relevante a avalia??o do seu desempenho na detec??o de AIE. OBJETIVO: Avaliar o desempenho diagn?stico da quest?o relacionada ? atividade f?sica do GINA na detec??o de AIE em crian?as e adolescentes com asma. M?TODOS: Trata-se de um estudo observacional, do tipo transversal, realizado no Laborat?rio de Atividade F?sica em Pediatria. Foram inclu?das crian?as e adolescentes (6 e 18 anos) com diagn?stico cl?nico de asma. Excluiu-se pacientes com sinais de exacerba??o pulmonar e aqueles que apresentassem limita??es motoras. Os pacientes foram divididos em 2 grupos de acordo com a classifica??o da gravidade: asma leve/moderada (ALM) e asma grave resistente ? terapia (AGRT). Tanto a avalia??o da gravidade como do controle da doen?a seguiram os crit?rios da GINA. Dados antropom?tricos e cl?nicos foram coletados. Al?m disso, foi avaliada a fun??o pulmonar e realizado o teste de broncoprovoca??o induzida por exerc?cio (BIE). O teste de BIE foi realizado em uma esteira, com aumentos de velocidade e inclina??o, de acordo com recomenda??es internacionais. Utilizou-se a quarta quest?o do GINA (Alguma limita??o de atividade f?sica por asma?) para avaliar o poder diagn?stico do instrumento. Para fins estat?sticos, as compara??es foram realizadas pelo teste t de Student e pelo teste de qui-quadrado de Pearson. A an?lise do desempenho diagn?stico da quest?o espec?fica do question?rio da GINA para a detec??o da BIE foi avaliada pela curva ROC. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa e todos os pais e/ou respons?veis assinaram um termo de consentimento livre e esclarecido e os participantes o termo de assentimento do estudo. RESULTADOS: Foram avaliados 40 pacientes, sendo 17 do grupo ALM e 23 do grupo AGRT. A m?dia de idade foi de 11,25 anos, com o VEF1 (escore-z) de 0,33 e 32,5% classificados como doen?a n?o controlada. Destes, 19 (47,5%) apresentaram queda do VEF1 no teste de BIE, sendo 13 (56,5%) do grupo AGRT e 6 (35,2%) no grupo ALM. Houve uma frequ?ncia de AIE significativamente maior (p=0,05) nos sujeitos com VEF1 mais baixo (escore-z -1,0. No entanto, n?o houve diferen?as significativas na frequ?ncia de BIE quando avaliada a influ?ncia da gravidade e do controle da doen?a. Da mesma forma, n?o foi encontrada associa??o da quest?o 4 da GINA com os resultados da AIE (p>0,05). A sensibilidade encontrada foi de 57,9% e a especificidade de 57,1% (n=40). A ?rea sob a curva ROC n?o demonstrou um poder discriminativo da quarta quest?o do GINA para a detec??o de AIE em crian?as e adolescentes com asma (p=0,35). CONCLUS?O: Os resultados do presente estudo demonstraram que a quarta quest?o do question?rio da GINA (atividade f?sica) possui um poder diagn?stico insuficiente do ponto de vista cl?nico para a detec??o de AIE em crian?as e adolescentes com asma (ALM e AGRT). Desta forma, recomenda-se que a avalia??o da AIE seja ainda realizada pelo teste de broncoprovoca??o induzida por exerc?cio, evitando assim, subestimativas e/ou superestimativas nos resultados da avalia??o. INTRODUCTION: Exercise-induced asthma (EIA) is defined as transient airway obstruction during and after exercise and may be evidenced by a decrease in forced expiratory volume in the first second (FEV1). Although several instruments have been designed and tested to detect EIA, most have low diagnostic power. Thus, considering the wide use of the Global Initiative for Asthma (GINA) in clinical practice and that it has a specific question for physical activity, it is relevant to evaluate its performance in the detection of EIA. OBJECTIVES: To evaluate the diagnostic performance of the physical activity related question of GINA in the detection of EIA in children and adolescents with asthma. METHODS: This is a cross-sectional, observational, study performed in the Laboratory of Pediatric Physical Activity. Children and adolescents (6 to 18 years old) with clinical diagnosis of asthma were included. Patients with signs of pulmonary exacerbation and those with motor limitations were excluded. Patients were divided into 2 groups according to severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). Both the assessment of severity and disease control followed GINA criteria. Anthropometric and clinical data were collected. In addition, pulmonary function was evaluated and the exercise-induced bronchoprovocation test (EIB) was performed. The EIB test was performed on a treadmill, with increases in speed and inclination, in accordance with international recommendations. We have used the fourth question of GINA (Any activity limitation due to asthma?) to evaluate the diagnostic power of the instrument. For statistical purposes, the comparisons were performed using the Student t test and the Pearson's chi-square test. The analysis of the diagnostic performance of the GINA questionnaire specific question for the detection of EIB was evaluated using the ROC curve. The study was approved by the Research Ethics Committee and all parents and/or guardians signed a free and informed consent form and the participants the study assent term. RESULTS: We have evaluated 40 patients, 17 of the MMA group and 23 of the STRA group. The mean age was 11.25 years, with a FEV1 (z-score) of 0.33 and 32.5% classified as uncontrolled disease. Of these, 19 (47.5%) presented a decrease in FEV1 in the EIB test, 13 (56.5%) in the STRA group and 6 (35.2%) in the MMA group. There was a significantly higher EIA frequency (p=0.05) in subjects with lower FEV1 (z-score -1.0. However, there were no significant differences in the frequency of EIB when evaluating the influence of disease severity and control. Likewise, no association of question 4 of GINA was found with the EIA results (p>0.05). The sensitivity found was 57.9% and the specificity was 57.1% (n=40). The area under the ROC curve did not demonstrate a discriminative power of the fourth GINA question for the detection of EIA in children and adolescents with asthma (p=0.35). CONCLUSION: The results of the present study demonstrated that the fourth question of the GINA questionnaire (physical activity) has a clinically insufficient diagnostic power for the detection of EIA in children and adolescents with asthma (MMA and STRA). Thus, it is recommended that the evaluation of EIA to be performed by the EIB test, avoiding underestimation and/or overestimation resulting from this evaluation. Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES

AIMS: To evaluate the applicability of the predictive equations of maximum heart rate during exercise tests in non-athlete children and adolescents.METHODS: It is a systematic review, carried out through Pubmed, Lilacs, Scielo and PEDro. We included studies comparing the maximum heart rate measured and estimated by predictive equations during stress tests in non-athlete children and adolescents. The following search strategy was used: Exercise test OR Exercise testing OR Cardiopulmonary exercise test OR Cardiopulmonary exercise testing OR Peak oxygen uptake OR Maximal oxygen consumption OR Exercise tolerance OR Exercise capacity AND Heart rate OR Heart rates OR Pulse rate OR Pulse rates OR Heart rate control OR Cardiac chronotropic OR Predictive value test AND Predictive equations. The methodological quality was assessed by the Agency for Health Care Research and Quality scale.RESULTS: Of a total of 858 articles located, only four were included. The articles totaled 325 participants (seven to 18 years). All studies measured the maximum heart rate by cardiopulmonary stress test. While no study recommended (04/04=100%; 01/01=100%) the formulas “220 - age” and “207 - 0.7 x age”, the equations “208 - (0.7 x age)” and “200 - 0.48 x age” were adequate in 02/03 (66.6%) articles and 01/01 (100%) document, respectively. The methodological quality was considered high in all articles evaluated, ranging from 76 to 97 points.CONCLUSIONS: The findings seem to suggest that the formula “208 - (0.7 x age)” was the most tested and adequate equation to a large extent for estimating maximum heart rate in non-athlete children and adolescents. However, further studies are still needed to confirm these results.