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Objective: To analyze and compare the impact of social isolation due to the COVID-19 pandemic on sleep assessed at two time points (visit 1: during strict social isolation; visit 2: after the relaxation of social isolation measures) in individuals with stable chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD), all of whom were not infected with COVID-19. Method: In a one-year prospective cohort study, individuals were evaluated concerning lung function (via spirometry), demographic and clinical data, and sleep objectively assessed through actigraphy over 7 consecutive days at both visits. Result: A total of 36 individuals (12 with COPD, 10 with asthma and 14 with ILD) were included. There was significant decline in sleep quality at visit 2 compared to visit 1 across all three diseases, primarily in the parameters of sleep efficiency, fragmentation and wake time after sleep onset; however, the total sleep duration did not change. Furthermore, individuals with ILD exhibited a smaller variation in both the number and duration of vigilance blocks compared to those with the other two diseases, indicating lower sleep fragmentation. Conclusion: Regardless of the disease (COPD, asthma, or ILD), individuals with chronic respiratory conditions who were not infected with COVID-19 experienced decline of sleep quality following the period of social isolation. Additionally, individuals with ILD appear to have been less impacted (with lower sleep fragmentation) compared to those with the other diseases.

Objective: to identify factors associated to sedentary behavior and physical inactivity in individuals with stable chronic obstructive pulmonary disease (COPD) non-infected by SARS-CoV-2 during the COVID-19 pandemic, and to identify possible favorable conditions during social isolation in individuals who performed pulmonary rehabilitation in the pre-pandemic period. Method: time/day in sedentary activities and moderate/vigorous physical activities (SA and MVPA, respectively), history of previous rehabilitation, laboural activity, symptoms, insecurity and quality of life (Medical Outcomes Study 36-item Short-Form Health Survey [SF-36]) were assessed during strict social isolation due to the COVID-19 pandemic. Individuals were classified as sedentary if presenting time/day in SA >8.5 h/day and physically inactive if presenting time/day in MVPA

The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern.

Objective The objective of the present study was to define the minimum number of monitoring days required for the adequate cross-sectional assessment of sedentary behaviour in individuals with chronic obstructive pulmonary disease (COPD). Methods In this cross-sectional study, the sedentary behaviour of individuals with COPD was assessed using two physical activity monitors during awake time for seven consecutive days. Time spent per day in activities requiring ≤1.5 metabolic equivalents (METs) and in sitting, lying and sitting+lying positions was calculated taking into account the average of 7 days (as a reference in all analyses) and of all 119 possible combinations of 2­­–6 days. Intraclass correlation coefficients (ICCs) and linear regression analyses were performed for all combinations. Results 91 individuals were analysed (47 female, 66±9 years, forced expiratory volume in 1 s 50±15% predicted). For the variables time spent per day in activities ≤1.5METs and sitting, the average of any combination of at least four assessment days was sufficient to adequately reflect the average of 7 days (adjusted R2≥0.929, ICC≥0.962, p

ABSTRACT Objective: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. Methods: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George’s Respiratory Questionnaire to evaluate criterion validity. Results: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: “amount” domain = 0.87 (95% CI, 0.73-0.94) and “difficulty” domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin’s concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = −0.63). Conclusions: The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

BackgroundThe short form of the International Physical Activity Questionnaire (IPAQ) is widely used to assess PA and has already been used in adults with asthma; however, its validity has not been yet studied in this population. Therefore, the aim of this study was to verify the convergent and discriminative validity of the IPAQ short form in adults with asthma.MethodsFifty-three adults with asthma (36 females; 48±15 years; 29±6 kg/m²) wore the triaxial activity monitor Actigraph for eight days to objectively measure steps/day, time in light physical activity (PA), moderate-to-vigorous PA (MVPA), and sedentary behaviour. Participants filled out the IPAQ matching with the same week they wore the Actigraph, with measures of: time of MVPA and total PA/week; categorization of low, moderate or high PA level; time in seated position.ResultsIPAQ self-reported total time of PA/week was weakly correlated with steps/day. The IPAQ categorization correlated moderately with time in light, MVPA and steps/day. Self-reported time in seated position on weekdays was moderately correlated with objective percentage/day of time in sedentary behaviour in the same period. IPAQ categorization in PA levels was able to differentiate between low to moderate and low to high PA levels.ConclusionsThese results cannot confidently infer the convergent validity of the IPAQ to quantify number of steps/day and time spent in PA of adults with asthma. However, this instrument may be useful to categorize patients into three levels of PA.

ABSTRACT Objective: To identify reference values for handgrip strength through a literature search and compare the agreement of reference values from Brazil with others for handgrip strength in a sample of COPD patients in Brazil, as well as to determine which set of reference values is more discriminative regarding differences in clinical characteristics between individuals with low handgrip strength and normal handgrip strength. Methods: To identify reference values for handgrip strength, a literature search was performed; a retrospective cross-sectional analysis of baseline-only data from two unrelated studies was then performed. Individuals were evaluated for handgrip strength, peripheral muscle strength, respiratory muscle strength, pulmonary function, body composition, exercise capacity, dyspnea, and functional status. Results: Of the 45 studies that were initially selected, 9 met the criteria for inclusion in the analysis, which included 99 COPD patients in Brazil (52% of whom were male with GOLD stage II-IV COPD). The prevalence of low handgrip strength varied across studies (from 9% to 55%), the set of reference values for handgrip strength in a sample of individuals in Brazil having classified 9% of the study sample as having low handgrip strength. The level of agreement between the reference values for a sample of individuals in Brazil and the other sets of reference values varied from weak to excellent. The reference values for a sample of individuals in Brazil showed the highest number of significantly different characteristics between individuals with low and normal handgrip strength. Conclusions: The level of agreement between national and international sets of reference values for handgrip strength varied from weak to excellent in COPD patients in Brazil. Reference values for handgrip strength with higher discriminative capacity are not necessarily those that identify more individuals as having low handgrip strength.

ABSTRACT Objective: To evaluate sleep-onset time variability, as well as sleep characteristics on weekday and weekend nights, in individuals with moderate-to-severe COPD. Methods: Sleep was objectively assessed by an activity/sleep monitor for seven consecutive nights in individuals with COPD. For analysis, individuals were divided into two groups according to sleep-onset time variability results, characterized by intrasubject standard deviation of sleep-onset time (SOTV) ≥ 60 min or < 60 min. Results: The sample comprised 55 individuals (28 males; mean age = 66 ± 8 years; and median FEV1 % of predicted = 55 [38-62]). When compared with the SOTV

Introduction: one of the most prominent extra-pulmonary manifestations in patients with chronic respiratory disease are changes in body weight and composition. However, the frequency and functional consequences of low appendicular lean mass (ALM) or sarcopenic obesity (SO) in patients with asthma is largely unknown. Therefore, the aims of the current study were to assess the frequency and functional consequences of low appendicular lean mass index (ALMI) and SO in patients with asthma. Methods: a retrospectively analyzed cross-sectional study was conducted in 687 patients with asthma (60% female, 58±13 years, FEV1 76±25%pred) referred for comprehensive pulmonary rehabilitation (PR). Body composition, pulmonary function, exercise capacity, quadriceps muscle function, and quality of life were assessed. Patients were classified as presenting low ALMI according to the 10th percentiles of age-sex-body mass index (BMI)-specific reference values and as having SO according to the diagnostic procedure proposed by the 2022 ESPEN/EASO consensus. In addition, clinical outcomes between patients with normal and low ALMI or with and without SO were compared. Results: the frequency of patients classified as low ALMI was 19%, whereas 45% of the patients were obese. Among the obese patients, 29% had SO. In patients with normal weight, those with low ALMI were younger and had worse pulmonary function, exercise capacity and quadriceps muscle function than those with normal ALMI (all p

Abstract Background Cut offs for fat-free mass index (FFMI) and appendicular skeletal muscle mass index (ASMI) are available for diagnosing low muscle mass in patients with COPD. This study aimed to investigate: (1) the frequency of low muscle mass (FFMI and ASMI) applying different cut-offs and (2) the functional translation (clinical impact) of low muscle mass, in patients with COPD stratified into BMI categories. Methods Patients with COPD were assessed regarding body composition, exercise capacity, quadriceps muscle strength, symptoms of anxiety and depression, dyspnea and quality of life upon referral to pulmonary rehabilitation. The proportion of patients with low muscle mass was compared among BMI categories. Clinical outcomes between patients with normal and low muscle mass within each BMI category were compared. Results 469 patients with COPD were included for analyses. The frequency of patients classified as low FFMI varied significantly according to the choice of cut-off (32 to 54%; P

Abstract Background An increasing number of subjects are recovering from COVID-19, raising the need for tools to adequately assess the course of the disease and its impact on functional status. We aimed to assess the construct validity of the Post-COVID-19 Functional Status (PCFS) Scale among adult subjects with confirmed and presumed COVID-19. Methods Adult subjects with confirmed and presumed COVID-19, who were members of an online panel and two Facebook groups for subjects with COVID-19 with persistent symptoms, completed an online survey after the onset of infection-related symptoms. The number and intensity of symptoms were evaluated with the Utrecht Symptom Diary, health-related quality of life (HrQoL) with the 5-level EQ-5D questionnaire, impairment in work and activities with the Work Productivity and Activity Impairment questionnaire and functional status with the PCFS Scale. Results 1939 subjects were included in the analyses (85% women, 95% non-hospitalized during infection) about 3 months after the onset of infection-related symptoms. Subjects classified as experiencing ‘slight’, ‘moderate’ and ‘severe’ functional limitations presented a gradual increase in the number/intensity of symptoms, reduction of HrQoL and impairment in work and usual activities. No differences were found regarding the number and intensity of symptoms, HrQoL and impairment in work and usual activities between subjects classified as experiencing ‘negligible’ and ‘no’ functional limitations. We found weak-to-strong statistical associations between functional status and all domains of HrQoL (r: 0.233–0.661). Notably, the strongest association found was with the ‘usual activities’ domain of the 5-level EQ-5D questionnaire. Conclusion We demonstrated the construct validity of the PCFS Scale in highly-symptomatic adult subjects with confirmed and presumed COVID-19, 3 months after the onset of symptoms.

RESUMO O objetivo do estudo foi correlacionar a diferença entre capacidade vital lenta (CVL) e capacidade vital forçada (CVF) (CVL-CVF) com a atividade física na vida diária (AFVD) em pacientes com doença pulmonar obstrutiva crônica (DPOC); e verificar as diferenças na AFVD entre indivíduos com CVL maior ou menor do que a CVF. Vinte e oito indivíduos com DPOC (18 homens; 67±8 anos; VEF1: 40±13% previsto) tiveram a função pulmonar avaliada pela espirometria e foram divididos em dois grupos: CVL>CVF (n=17) e CVL≤CVF (n=11). Ademais, tiveram a AFVD avaliada objetivamente pelo monitor de atividade física DynaPort®, que quantifica na vida diária, dentre outros, o tempo gasto por dia andando, em pé, sentado e deitado. Não foram encontradas correlações significativas entre CVL-CVF e as variáveis da AFVD no grupo geral. No grupo CVL>CVF foi encontrada significância estatística na correlação entre a CVL-CVF e o tempo gasto por dia em pé (r=−0,56) e sentado (r=0,75). Já no grupo CVL≤CVF, houve correlação significativa somente com o tempo gasto por dia em pé (r=0,57) e deitado (r=−0,62). Ao comparar ambos os grupos, não houve diferença estatisticamente significante para nenhuma das variáveis da AFVD (p>0,05 para todas). No grupo com CVL maior que a CVF houve correlação alta com o tempo gasto sentado, mas não com o tempo andando. Portanto, indivíduos com maior obstrução ao fluxo aéreo segundo a diferença CVL-CVF tendem a gastar mais tempo em atividades de menor gasto energético, que não envolvam caminhar.

ABSTRACT Objective: To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ) in patients with interstitial lung disease (ILD). Methods: Patients with ILD completed the questionnaire at three different time points, one week apart, with the assistance of two independent assessors. Intra- and inter-rater reliability were analysed via the intraclass correlation coefficient (ICC). Internal consistency was assessed with the Cronbach’s alpha coefficient. For the validity analysis, associations between variables were assessed with Spearman’s or Pearson’s correlation coefficient. Results: Thirty patients with ILD (idiopathic pulmonary fibrosis, connective tissue disease-associated pulmonary fibrosis, sarcoidosis, asbestosis or non-specific interstitial pneumonia) were included (15 men; mean age, 59 ± 10 years; DLCO: 46 [33-64] % predicted). UCSD SOBQ scores showed excellent agreement and internal consistency in the intra-rater analysis (ICC: 0.93 [0.85-0.97]; Cronbach alpha: 0.95) and in the inter-rater analysis (ICC: 0.95 [0.89-0.97]; Cronbach alpha: 0.95), as well as correlating significantly with dyspnoea (as assessed by the Medical Research Council scale; r = 0.56); Medical Outcomes Study 36-item Short-Form Health Survey domains bodily pain, general health, vitality and physical functioning (−0.40 ≤ r ≤ −0.74); six-minute walk distance (r = −0.38); and quadriceps muscle strength (r = −0.41). Conclusions: The Brazilian Portuguese version of the UCSD SOBQ is valid, is reliable and has internal consistency in patients with ILD in Brazil.

Building on the core syllabus for postgraduate training in respiratory physiotherapy, published in 2014, the European Respiratory Society (ERS) respiratory physiotherapy task force has developed a harmonised and structured postgraduate curriculum for respiratory physiotherapy training. The curriculum outlines the knowledge, skills and attitudes which must be mastered by a respiratory physiotherapist working with adult or paediatric patients, together with guidance for minimal clinical exposures, and forms of learning and assessment. This article presents the rationale, methodology and content of the ERS respiratory physiotherapy curriculum. The full curriculum can be found in the supplementary material.

Introduction Bioelectrical impedance analysis (BIA) can be used to estimate Fat-Free Mass Index (FFMI). However, the use of directly measured BIA variables, such as phase angle (PhA), has gained attention. The frequency of low FFMI and PhA and its associations with exercise capacity and health-related quality of life (HRQL) in patients with idiopathic pulmonary fibrosis (IPF) have been scarcely studied.Objectives To investigate the frequency of low FFMI and PhA and their associations with exercise capacity and HRQL in patients with IPF.Methods Patients underwent assessment of lung function, body composition, exercise capacity by the 6 min walk distance (6MWD), and HRQL by the Medical Outcomes Study Short-Form 36-item Questionnaire (SF-36). Patients were classified as presenting normal or low PhA or FFMI, accordingly to the 10th percentiles of age-sex-body mass index (BMI)-specific reference values.Results 98 patients (84 males, age: 68±8 years, forced vital capacity: 64%±18%predicted) were included. 24 patients presented low PhA. They were characterised by worse lung function, exercise capacity and HRQL compared with patients with normal PhA. 10 patients presented low FFMI, but despite differences in body composition, no differences were found between these patients and patients with normal FFMI. In a single regression analysis, age, lung function and body composition variables (except FFMI) were related to 6MWD and SF-36 Physical Summary Score (R²=0.06–0.36, p

The association between characteristics of sleep and physical activity in daily life (PADL) has not yet been investigated in depth in subjects with COPD. This study evaluated whether time spent per day in physical activity (PA) and sedentary behaviour are associated with sleep quantity and quality in this population. Sleep and PADL were objectively assessed by an activity monitor for 7 days and analysed on a minute-by-minute basis. Subjects also underwent spirometry and 6-min walking test (6MWT). Fifty-five subjects with moderate-to-severe COPD (28 male, 67±8 years) were studied. Subjects with total time in bed (TIB) per night ≥9 h had higher wake-after-sleep onset than TIB 7–9 h and TIB ≤7 h (195 (147–218) versus 117 (75–167) and 106 (84–156) min) and more fragmented sleep than TIB ≤7 h (8.2 (6.7–14.3) versus 6.3 (5.6–6.9) sleeping bouts; p

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

RESUMO Este estudo analisa a atividade física na vida diária (AFVD) de pacientes com doença pulmonar obstrutiva crônica (DPOC), quantificada em três diferentes períodos de uso diário do sensor de movimento: 8 horas, 12 horas e período de tempo acordado, a fim de identificar se os desfechos de AFVD diferem entre si. Trata-se de um estudo transversal com 45 pacientes (66±8 anos) classificados com DPOC de moderada a grave. A AFVD foi avaliada utilizando-se o monitor de atividade física SenseWear Armband (SAB) durante 7 dias consecutivos, 24 horas por dia. Compararam-se os resultados de AFVD fornecidos pelo monitor nos três períodos de avaliação dentro das 24 horas de uso. Os desfechos de sedentarismo e de atividade física (número de passos e gasto energético total) foram diferentes nos três períodos de utilização do SAB, com maiores valores na avaliação por período de tempo acordado. Quanto aos desfechos de atividade física estratificados por idade - 3 ou 2 equivalentes metabólicos (MET) -, os resultados foram similares na avaliação por 12 horas e por período de tempo acordado. Concluiu-se, afinal, que o uso do monitor de atividade física durante o tempo acordado é o desfecho mais indicado para monitoração acurada e completa de sedentarismo e atividade física em pacientes com DPOC.

AimTo provide a Portuguese version of the Multidimensional Dyspnea Profile (MDP), investigating its validity and reliability in Brazilian patients with COPD.MethodsThis was a cross-sectional study for translation and linguist validation of the Portuguese MDP version for patients with COPD. The process occurred according to the protocol of Mapi Research Trust, Lyon, France. Three scores of MDP were used for the analysis: the immediate unpleasantness of dyspnea (A1); the "immediate perception domain" (S) (sum of A1 plus the sensory descriptors) and the "emotional response domain" (A2) (sum of the emotional descriptors). The questionnaires COPD assessment Test (CAT), Hospital Anxiety and Depression scale (HADS) and Medical Research Council scale (MRC) were used as anchors to investigate MDP's validity. Internal consistency was assessed with Cronbach's alpha. Test-retest reliability was assessed with intraclass correlation coefficient (ICC) and concurrent validity was assessed with Spearman correlation coefficients.ResultsThirty patients with moderate-severe COPD were studied for MDP's validation analysis (43% male, 63±8years, body mass index [BMI] 27±6Kg/m2, forced expiratory volume in the first second [FEV1] 48±15%predicted, six-minute walking test [6MWT] 464±84m and 84±16%predicted), whereas 10 patients were excluded from the test-retest reliability analysis due to missing data, resulting in a sample of 20 subjects for this purpose (50% male, 62±8years, BMI 27±6Kg/m2, FEV1 48±15%predicted, 6MWT 452±93m and 82±19%predicted). Both samples were similar regarding general characteristics (P>0,05 for all variables). MDP presented strong correlations, i.e., ICC intra-rater: A1: 0.77 (0.48-0.90), S: 0.78 (0.52-0.91), and A2: 0.85 (0.66-0.94), with high internal consistency (Cronbach's α 0.86, 0.88 and 0.92 respectively); and ICC inter-rater: A1: 0.74 (0.46-0.89), S: 0.75 (0.48-0.89) and A2: 0.91 (0.78-0.96) with Cronbach's α 0.85, 0.86 and 0.95 respectively.ConclusionThe Portuguese version of the MDP is the first valid and reliable instrument to assess dyspnea multidimensionally in Portuguese-speaking patients with COPD.

RESUMO Os objetivos deste estudo foram verificar a correlação da distância percorrida e comparar a velocidade média durante a caminhada por meio do teste de caminhada de seis minutos (TC6min) realizado em solo com o teste de caminhada de três minutos aquático (TC3minA) em jovens saudáveis, bem como contrastar variáveis fisiológicas (frequência cardíaca, saturação periférica de oxigênio e pressão arterial) e sintomatológicas entre os testes. Estudo transversal com amostragem de vinte indivíduos jovens saudáveis. Todos foram submetidos à espirometria, responderam a um questionário sobre saúde e atividade física, além de realizarem o TC6min e o TC3minA. Na análise estatística foi utilizado teste de Shapiro-Wilk para avaliar normalidade dos dados, o teste t de Student pareado e Wilcoxon nas comparações entre as variáveis e o coeficiente de correlação de Pearson para verificar associações. A significância estatística de p

AbstractObjective: To compare equations for predicting peak quadriceps femoris (QF) muscle force; to determine the agreement among the equations in identifying QF muscle weakness in COPD patients; and to assess the differences in characteristics among the groups of patients classified as having or not having QF muscle weakness by each equation.Methods: Fifty-six COPD patients underwent assessment of peak QF muscle force by dynamometry (maximal voluntary isometric contraction of knee extension). Predicted values were calculated with three equations: an age-height-weight-gender equation (Eq-AHWG); an age-weight-gender equation (Eq-AWG); and an age-fat-free mass-gender equation (Eq-AFFMG).Results: Comparison of the percentage of predicted values obtained with the three equations showed that the Eq-AHWG gave higher values than did the Eq-AWG and Eq-AFFMG, with no difference between the last two. The Eq-AHWG showed moderate agreement with the Eq-AWG and Eq-AFFMG, whereas the last two also showed moderate, albeit lower, agreement with each other. In the sample as a whole, QF muscle weakness (< 80% of predicted) was identified by the Eq-AHWG, Eq-AWG, and Eq-AFFMG in 59%, 68%, and 70% of the patients, respectively (p > 0.05). Age, fat-free mass, and body mass index are characteristics that differentiate between patients with and without QF muscle weakness.Conclusions: The three equations were statistically equivalent in classifying COPD patients as having or not having QF muscle weakness. However, the Eq-AHWG gave higher peak force values than did the Eq-AWG and the Eq-AFFMG, as well as showing greater agreement with the other equations.

The aim of this study was to investigate the relationship between the work in two exercise capacity tests, a maximum and a submaximal exercise, and the level of airflow obstruction in patients with Chronic Obstructive Pulmonary Disease (COPD). Fifty-three subjects with COPD (29 men, 70±9 years old, 65±14 kg, forced expiratory volume in the first second [FEV1] 38[31-54]% predicted) had their lung function assessed by spirometry, and maximal and submaximal exercise capacity were evaluated by the Incremental Shuttle Walking test (ISWT) and the 6-Minute Walk Test (6MWT), respectively. The work in the tests was calculated by multiplying the covered distance and the individual's body weight (W). To evaluate the contribution of weight on the developed work, subjects were separated into two groups: higher weight (n=32), and lower weight (n=21). FEV1 correlated with the distance on the ISWT and with the ISWT*W (r=0.43 and r=0.49, respectively; p

The aim of this article was to provide practical recommendations to healthcare professionals interested in offering a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease (COPD). The latest research findings were brought together and translated into clinical practice. These recommendations focus on the description of useful assessment tests and of the most common exercise modalities for patients with COPD. We provide specific details on the rationale of why and especially how to implement exercise training in patients with COPD, including the prescription of training mode, intensity and duration, as well as suggestions of guidelines for training progression.

OBJETIVO: O presente estudo investigou se pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) atingem a mínima atividade física recomendada pelos guidelines do American College of Sports Medicine (ACSM), assim como as consequências da não-aderência a esses guidelines. MÉTODOS: Atividade física na vida diária (DynaPort activity monitor), função pulmonar, força muscular, capacidade de exercício, qualidade de vida, estado funcional e diferentes índices de severidade (GOLD, BODE, MRC) foram avaliados em 23 pacientes (61[59-69] anos; VEF1 39[34-53]%predito; IMC 24[21-27]kg/m²; mediana [intervalo interquartílico 25-75%]). RESULTADOS: De acordo com a aderência aos guidelines (andar no mínimo 30 minutos todo dia), 12 pacientes foram considerados "fisicamente ativos", e 11 "fisicamente inativos". Não foram observadas diferenças significativas entre os dois grupos em termos de idade, sexo, composição corporal, força muscular, reserva ventilatória, hiperinsuflação e qualidade de vida. O grupo inativo tinha pior função pulmonar, capacidade de exercício, MRC e BODE (pOBJECTIVE: The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. METHODS: This study involved 23 patients (median age: 61 - range, 59-69 years; FEV1: 39% of predicted - range, 34-53%; BMI: 24 kg/m² - range, 21-27 kg/m²). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). RESULTS: Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. CONCLUSION: A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether patients are physically inactive in their daily lives.

IntroductionSpirometry should follow strict quality criteria. The American Thoracic Society (ATS) recommends the use of a noseclip; however there are controversies about its need. ATS also indicates that tests should be done in the sitting position, but there are no recommendations neither about position of the upper limbs and lower limbs nor about who should hold the mouthpiece while performing the maneuvers: evaluated subject or evaluator.ObjectivesTo compare noseclip use or not, different upper and lower limbs positions and who holds the mouthpiece, verifying if these technical details affect spirometric results in healthy adults.MethodsOne hundred and three healthy individuals (41 men; age: 47 [33-58] years; normal lung function: FEV₁/FVC = 83±5, FEV₁ = 94 [88-104]%predicted, FVC = 92 [84-102]%predicted) underwent a protocol consisting of four spirometric comparative analysis in the sitting position: 1) maximum voluntary ventilation (MVV) with vs without noseclip; 2) FVC performed with vs without upper limbs support; 3) FVC performed with lower limbs crossed vs lower limbs in neutral position; 4) FVC, slow vital capacity and MVV comparing the evaluated subject holding the mouthpiece vs evaluator holding it.ResultsDifferent spirometric variables presented statistically significant difference (pConclusionsThere was no relevant variation in spirometric results when analyzing technical details such as noseclip use during MVV, upper and lower limb positions and who holds the mouthpiece when performing the tests in healthy adults.

ABSTRACT 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.

ABSTRACT In this cross-sectional study, we investigated the relationship that levels of vitamin D had with eosinophil counts and IgE levels in 26 children with asthma (6-12 years of age) in the city of Londrina, Brazil. Vitamin D levels were found to correlate significantly, albeit moderately, with age (r = −0.51) and eosinophilia (r = −0.49), although not with IgE levels (r = −0.12). When we stratified the sample into two groups by the median vitamin D level (< or ≥ 24 ng/mL), we found that those in the < 24 ng/mL group were older, had higher eosinophil counts, and had higher IgE levels. To our knowledge, this is the first study to show an association between low levels of vitamin D and more pronounced eosinophilia in children with asthma in Brazil.

Abstract Most current Data Center Interconnects (DCI) use intensity modulation direct detection (IMDD) configurations due to their low complexity and cost. However, significant scaling challenges allow coherent solutions to become contenders in these short reach applications. We present an O-band coherent optical fiber transmission system based on Quantum Dot—Mode Locked Lasers (QD-MLLs) using two independent free-running comb lasers, one each for the carrier and the Local Oscillator (LO). Using a comb-to-comb configuration, we demonstrate a 10 km single mode fiber, O-band, coherent, heterodyne, 12.1 Tbps system operating at 0.47 Tbps/λ using 26 λs. We used fewer comb lines (26 λs), faster symbol rate (56 GBaud) and higher constellation cardinality (32 QAM) relative to the highest capacity C-band systems reported to date. Through design, analysis, and experimentation, we quantify the optimum comb line spacing for this use case. We compare potential configurations for increasing data center interconnect capacities whilst reducing power consumption, complexity, and cost.