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Home exercises (HE) with minimal resources seem to be useful in individuals with COPD. The objective was to evaluate the effects of HE, on activities of daily living (ADL), dyspnea, on the health status(CAT) and quality of life (HRQoL) of individuals with COPD GOLD II to IV. Quasi-experimental study of the effects of HE, for 2 months, 3 times a week. Individuals with COPD( n  = 45) were recruited, 37 started the protocol(9 did not complete it). 28 individuals (mean age 62.04 ± 5.8 years, FEV1: 44.7 ± 2.25%, FEV1/FVC 59.8 ± 6.9%) were evaluated before and after training. We observed improvements in the ADL-Glittre (4.9 ± 1.4 vs 3.9 ± 1.1 min; mean difference: -0.9 ± 0.2 min [95%CI: -1.3 to -0.2]; p  = 0.008), as well as the mMRC score(2.8 ± 1.1 vs 2.07 ± 0.81; mean difference: 0.7 ± 0.3 [95%CI: -1.20.18 to -0.2]; p  = 0.009), and in the CAT (25.6 ± 4.8 vs 18.9 ± 3.1; mean difference: -6.6 ± 3.4 [95%CI: -10.6 to -1.6]; p  = 0.042). Analyzing the mean change before and after the intervention, a weak correlation was observed between ADL-Glittre and mMRC ( r  = 0.35; [95% CI 0.09; 0.56]; p  = 0.009); moderate between ADL-Glittre and CAT ( r  = 0.52; [95% CI 0.30; 0.69]; p  < 0.001) and between ADL-Glittre and SGRQ ( r  = 0.50; [95% CI 0 .27; 0.67]; p  < 0.001). Individuals with COPD can benefit from HE performed autonomously and with minimal resources, as this proposal improves functional capacity for ADL, health perception and dyspnea.

Results: 59 patients were included (61% with COPD and 39% with ILD). BPNES factor scores were not significantly different between raters' assessments ( p > 0.05). The internal consistency was 0.70 for autonomy, 0.76 for competence, and 0.80 for relatedness. Inter-rater and test-retest reliability were good to very good for autonomy (ICC = 0.78, 95%CI 0.62-0.87; ICC = 0.75, 95%CI 0.57-0.86, respectively), competence (ICC = 0.81, 95%CI 0.68-0.89; ICC = 0.65, 95%CI 0.43-0.80, respectively), and relatedness (ICC = 0.79, 95%CI 0.65-0.88; ICC = 0.70, 95%CI 0.50-0.83, respectively). Significant correlations were observed between BPNES factors and quality of life, anxiety, depression, and functional status. In conclusion, this study confirmed the reliability and construct validity of the Brazilian Portuguese version of the BPNES in patients with COPD and ILD., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Strategies to minimize dynamic hyperinflation (DH) and dyspnea, such as slow chest compression (SCC), are relevant in people with chronic obstructive pulmonary disease (COPD)., Objectives: To analyze the acute effects of SCC after exercise on DH and dyspnea in people with COPD and to identify responders to the technique., Methods: This is a cross-over study with 40 patients. Two six-minute step tests (6MSTs) were performed followed by a one-minute application of SCC (6MST SCC ) or rest (6MST CONTROL ), at random. End-expiratory lung volume (EELV) and dyspnea were assessed. A difference ≥76 ml in ΔEELV between SCC and control characterized the responders., Results: The performance in 6MST SCC and 6MST CONTROL were similar. There was a greater reduction in EELV after 6MST SCC compared to 6MST CONTROL (124 ± 193 ml vs. 174 ± 183 ml; p = .049), while there was no difference in change in dyspnea between the SCC and control groups. Twenty-one participants were SCC responders and had higher functional residual capacity [FRC: 5.36 ± 1.09 vs. 4.58 ± 0.94; p = .02; cutoff point: 4.56; sensitivity = 76%; specificity = 53%; AUC = 0.71 (95%CI: 0.54 to 0.87); p = .02]., Conclusion: SCC applied immediately after exercise reduced DH, but did not reduce dyspnea in people with COPD. The technique is beneficial only for some patients and FRC can help to identify them.

Objective: Verify which test, Glitttre-ADL test (TGlittre) or six-minute walk test (6MWT), better predicts balance, fear, and risk of falling in middle-aged and older adults., Method: Twenty-eight individuals (15 women) completed the study protocol, which included: anthropometric assessment, spirometry, Falls Efficacy Scale-International-Brazil (FES-I-Brazil), Activities-specific Balance Confidence Scale (ABC), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), TGlittre, and 6MWT. The Shapiro Wilk test investigated the distribution of the data. To verify if there was a correlation between the performance in TGlittre and 6MWT and the balance, fear, and risk of falling variables, the Pearson or Spearman correlation coefficient were used. Simple linear regression and stepwise multiple linear regression were conducted to identify which functional capacity test better predicts balance, fear, and risk of falling., Results: Both TGlittre and 6MWT correlated (r = 0.44, p = .02 and r = -0.59, p = .003, respectively) and were able to predict the TUG (R2 = 0.17 and R2 = 0.26, p < .005, respectively). However, when analyzed in a multiple regression model, the 6MWT was better predictor of TUG (26%). Only TGlittre correlated (r = 0.39 and r = -0.38, p = .04) and was able to predict the FES-I-Brazil and BBS scores (17%), suggesting that TGlittre better reflects the worry about falls and balance in multiple ADL contexts., Conclusions: The 6MWT and the TGlittre are able to predict balance assessed by the TUG. However, the 6MWT has proved to be more effective in predicting TUG results.

The relationship between lung function and performance in some functional tests, as the six-minute walk test (6MWT) and Glittre-ADL test (TGlittre) are still discrepant in patients with chronic obstructive pulmonary disease (COPD). This study aimed to verify which test better correlates and is better explained by the pulmonary function, and which test better discriminates patients regarding the severity of the disease. Seventy-four patients with moderate to very severe COPD (54 men; 66 ± 9 years; FEV 1 : 37.2 ± 14.3%pred) were included. Spirometry, 6MWT and TGlittre were performed. The results showed weak to moderate correlation between pulmonary function variables and 6MWT (0.36 ≤ r  ≤ 0.45) and TGlittre (-0.44 ≤  r ≤ -0.53). In patients with performance of ≤400 m in the 6MWT, a strong correlation was observed between TGlittre with FEV 1 (%pred) ( r = -0.82; p  < .001). The pulmonary function variable that better predict the functional tests performance was FEV 1 ( R 2 = 0.17). Both functional tests were able to discriminate patients with COPD GOLD 4 from the other classifications. When compared to GOLD 2 patients, GOLD 4 patients presented higher time spent on TGlittre ( p  < .001). When compared to GOLD 3 patients, GOLD 4 patients had higher TGlittre ( p  = .001). No statistical differences were found in the 6MWT between GOLD 3 and 4, as well as between GOLD 2 and 3. In conclusion, the pulmonary function presents stronger correlations and better explain the variability of TGlittre than of the 6MWT, especially in patients with greater functional impairment. The TGlittre seems to better discriminate patients with COPD regarding the severity of lung function.

Background: The modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) are assessment instruments associated with level of physical activity of daily living (PADL) in patients with COPD. This study aimed to identify mMRC and CAT cutoff points to discriminate sedentary behavior and PADL level of subjects with COPD and verify whether these cutoff points differentiate pulmonary function, health-related quality of life (HRQOL), functional status, and mortality index in subjects with COPD., Methods: Subjects ( N = 131, FEV 1 : 36.7 ± 16.1% predicted) were assessed for lung function, mMRC, CAT, HRQOL, functional status, and mortality index. PADL was monitored using a triaxial accelerometer, and subjects were classified as sedentary/nonsedentary (cutoff point of 8.5 h/d in PADL < 1.5 metabolic equivalent of task [MET]), physically active/inactive (cutoff point of 80 min/d in PADL ≥ 3 METs), and with/without severe physical inactivity (cutoff point of 4,580 steps/d), according to variables provided by accelerometer., Results: ROC curve indicated mMRC cutoff point of ≥ 2 ( P < .05) for physical inactivity (sensitivity = 66%, specificity = 56%, AUC = 0.62), severe physical inactivity (sensitivity = 81%, specificity = 66%, AUC = 0.76), and sedentary behavior (sensitivity = 61%, specificity = 70%, AUC = 0.65). The identified CAT cutoff points were ≥ 16 and ≥ 20, considering severe physical inactivity (sensitivity = 76%, specificity = 54%, AUC = 0.69, P < .001) and sedentary behavior (sensitivity = 51%, specificity = 90%, AUC = 0.71, P = .001), respectively. Subjects who had mMRC ≥ 2 and CAT ≥ 16 or ≥ 20 presented worse pulmonary function, HRQOL, functional status, and mortality index compared with those who scored mMRC < 2 and CAT <16 or < 20., Conclusions: mMRC cutoff point of ≥ 2 is recommended to discriminate PADL level and sedentary behavior, whereas CAT cutoff points of ≥ 16 and ≥ 20 discriminated severe physical inactivity and sedentary behavior, respectively. These cutoff points differentiated subjects with COPD regarding all the outcomes assessed in this study., (Copyright © 2021 by Daedalus Enterprises.)

Objective : To compare the performance of the Six-Minute Walk Test on 20-meter (6MWT 20 ) and 30-meter (6MWT 30 ) tracks and to test the validity and reliability of the 6MWT 20 in middle-aged and older adults. Method : The subjects underwent lung function assessment and performed the 6MWT 30 and 6MWT 20 . Student´s t- tests or Wilcoxon tests were used to compare the variables. The Pearson or Spearman correlation coefficients were used to evaluate the validity of the 6MWT 20 and the reliability of the 6MWT 20 . The 6MWT 30 was tested by the two-way mixed model of the Intraclass Correlation Coefficient (ICC 3,1). Results : Twenty-five subjects (age: 60 ± 10 years) walked, on average, 11.0 ± 21.9 m more in the 6MWT 30 than in the 6MWT 20 ( p < .05). The walking distance, the number of steps, the energy expenditure and the movement intensity between the 6MWT 20 and 6MWT 30 was correlated (r = 0.95; r = 0.81; r = 0.91; r = 0.67; respectively, p < .001). The walking distances showed high reliability and were similar between test and re-test in the 6MWT 30 (544 ± 72.1 vs. 551 ± 70.5; p < .05; ICC = 0.97) and in the 6MWT 20 (533 ± 73.1 vs. 532 ± 59.1; p < .05; ICC = 0.87). Conclusion : The 6MWT 20 performance is lower than the 6MWT 30 However, this difference is not clinically relevant. Additionally, the 6MWT 20 is a valid and reproducible test to assess the functional capacity of middle-aged and older adults.

The Glittre ADL-test (TGlittre) is a multiple-task test designed to assess functional limitation in patients with chronic obstructive pulmonary disease (COPD). Although few studies have investigated the TGlittre learning effect, the results are still conflicting. This study aimed to investigate the test-retest reliability and learning effect on TGlittre and to identify predicting factors of the learning effect in patients with COPD. Patients performed the TGlittre twice with a 30-minutes resting period between trials. TGlittre consists in measuring the time to complete five laps of a multiple ADL-like activities circuit: walking stairs, carrying a backpack, lifting objects, bending down and rising from a seated position. 124 patients with COPD were assessed [81 men; 66 ± 8 years, forced expiratory volume in one second (FEV 1 ) 37.1 ± 15.0%pred; TGlittre 120 ± 60%pred; six-minute walking test 75.5 ± 17.4%pred]. The time spent in TGlittre presented excellent reliability (ICC = 0.96; 95%CI 0.92 - 0.98; p  < 0.001; SEM 0.46 min; MDC 1.28 min) and decreased in the retest (5.24 ± 2.31 min to 4.85 ± 2.02 min; p  < 0.001). Patients presented a learning effect of 6.11 ± 11.1% in TGlittre. A lower FEV 1 (r 2 =0.10; p  < 0.001) and a worse performance in the first TGlittre (r 2 =0.28; p  < 0.001) are related to the improvement in performance of the second TGlittre. Although the TGlittre is reliable, patients improve their performance when performing the second test probably because they underestimate their functional capacity. These results should encourage professionals to assess TGlittre twice when using this test as an outcome measure.

This study aimed to identify baseline variables predicting improvement in ADLs following an exercise training program in subjects with COPD. Sixty-seven patients with COPD underwent assessment of spirometry, modified Medical Research Council scale, COPD Assesment Test (CAT), Six Minute Walk Test (6MWT), London Chest Activity of Daily Living (LCADL) scale and Glittre-ADL test (TGlittre). After 24 sessions, they were reassessed for limitation in ADLs (LCADL and TGlittre). The main outcome was the achieving of minimal important difference (MID) of TGlittre, LCADL and both (ADLs). The cut-off points to discriminate the subjects who achieved the MID of TGlittre, LCADL and ADLs were established using the ROC curve. A cut-off point of 3.7 min in baseline TGlittre was able to discriminate subjects who achieved the MID of TGlittre (AUC = 0.77). Subjects with baseline TGlittre ≥3.7 min were 6.92 (95%CI 2.2-20.9) times more likely to achieve the MID of TGlittre post-exercise training. A cut-off point of 32% in LCADL was able to discriminate subjects who achieved the MID of LCADL (AUC = 0.81) and in ADLs (AUC = 0.78). Subjects with baseline LCADL ≥32% were 12.3 (95% CI 2.50 - 60.7) times more likely to achieve the MID of LCADL. In conclusion, the baseline variables that best predict the improvement of individuals after exercise training are TGlittre and LCADL, showing that subjects with significant functional impairment are more likely to clinically significantly improve their ADLs.

Background: Test-retest reproducibility of the 6-min step test (6MST) is controversial in patients with COPD because the decision to perform a second test is influenced by interruptions, physiological overload, and the patient's exercise tolerance. The aim of this study was to analyze the reproducibility of performance on the 6MST (ie, number of steps climbed and interruptions) and physiological variables in subjects with COPD, with and without poor exercise tolerance, and with and without interruptions during the test., Methods: Subjects performed 2 6MST (6MST 1 , 6MST 2 ) with a minimum of 30 min rest between tests. Physiological variables were assessed with a gas analyzer. Subjects who performed ≤ 78 steps in the 6MST 1 and ≤ 86 steps in the test with the higher number of steps performed (6MST BEST ) were considered to have poor exercise tolerance. Subjects were also stratified according to those who interrupted the 6MST BEST and those who did not interrupt the 6MST BEST ., Results: 40 subjects (31 men; FEV 1 percent of predicted = 50.4 ± 13.5) participated in the study. The number of steps, interruptions, and physiological variables showed moderate to high reliability (intraclass correlation coefficient: 0.70-0.99, P < .001). Thirty-one (77.5%) subjects had a better performance during 6MST 2 than 6MST 1 (mean difference: 4.65 ± 5.59, P < .001). Although the number of times subjects were interrupted was similar between the 2 tests ( P = .66), the duration of these interruptions was shorter during 6MST 2 (mean difference: -0.12 ± 0.39 s, P = .040). The difference in the number of steps (6MST 2 - 6MST 1 ) did not differ between subjects who performed ≤78 steps (mean difference: 5.64 ± 5.32 steps; 10.3%; P < 0.001) and ≥ 79 steps (3.00 ± 5.82 steps; 6.13%; P = 0.08) on the 6MST 1 ( P = 0.15) and between subjects who performed ≤ 86 steps (5.39 ± 5.14 steps; 9.39%; P < 0.001) and ≥ 87 steps (2.92 ± 6.43 steps; 2.74%; P = 0.14) steps on the 6MST BEST ( P = 0.20)., Conclusions: Performance and physiological variables in the 6MST were reproducible, and a second test did not impose greater physiological overload. Two tests were essential for patients with poor exercise tolerance., Competing Interests: This study was supported in part by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Finance Code 001) and Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina (Termo de Outorga 2017TR645). The authors have disclosed no conflicts of interest., (Copyright © 2021 by Daedalus Enterprises.)

Background: Functional capacity assessment is important in patients with chronic obstructive pulmonary disease (COPD). It can be performed by the six-minute walk test (6MWT) on a 30-meter track. However, such space is not always available in clinical settings., Objectives: To compare the performance between the 6MWT on a 30- (6MWT 30 ) and 20-meter (6MWT 20 ) track; to evaluate the validity and reliability of the 6MWT 30 and the 6MWT 20 ; and to determine for which patients track length has the greatest impact on performance., Methods: Patients with COPD randomly performed two 6MWT 30 and two 6MWT 20 on two different days and were also assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale., Results: Thirty patients (23 men; mean ± standard deviation FEV 1 %pred: 45.6 ± 12.1) participated in the study. They walked a greater distance on the 6MWT 30 than on the 6MWT 20 [mean difference: 22.1 m (95% CI: 12, 32 m)]. The longer the 6MWT 30 distance, the greater the difference between the 2 tests (r = 0.51; p = 0.004). The 6MWT 20 showed high reliability [ICC: 0.96 (95% CI: 0.77, 0.99)] and the results were associated with the distance walked on the 6MWT 30 (r = 0.86), CAT (r = -0.53), and mMRC (r = -0.62). Patients who walked ≥430 m in the 6MWT 30 presented a difference between the tests greater than those who walked <430 m (34.5 ± 23.3 m vs. 12.6 ± 24.1 m; respectively; p = 0.01)., Conclusions: Performance was higher on the 6MWT 30 , with the difference increasing as performance improved. Therefore, the 6MWT 20 is valid and reliable to evaluate functional capacity but should not be considered interchangeable with the 6MWT 30 , especially for the less disabled patients with COPD., (Copyright © 2021 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the cut-off point for the London Chest Activity of Daily Living scale in order to better discriminate functional status. Secondarily, to determine which of the scores (total or %total) is better associated with clinical outcomes of a pulmonary rehabilitation program., Methods: Sixty-one patients with chronic obstructive pulmonary disease performed the following tests: spirometry; Chronic Obstructive Pulmonary Disease Assessment Test; Saint George's Respiratory Questionnaire; modified Medical Research Council, the body-mass index, airflow obstruction, dyspnea, and exercise capacity index; six-minute walk test; physical activity in daily life assessment and London Chest Activity of Daily Living scale. Thirty-eight patients were evaluated pre- and post-pulmonary rehabilitation . The cut-off point was determined using the receiver operating characteristic curve with six-minute walk test (cut-off point: 82%pred), modified Medical Research Council (cut-off point: 2), level of physical (in)activity (cut-off point: 80min per day in physical activity ≥3 metabolic equivalent of task) and presence/absence of severe physical inactivity (cut-off point: 4580 steps per day) as anchors., Results: A cut-off point found for all anchors was 28%: modified Medical Research Council [sensitivity=83%; specificity=72%; area under the curve=0.80]; level of physical (in)activity [sensitivity=65%; specificity=59%; area under the curve=0.67] and classification of severe physical inactivity [sensitivity=70%; specificity=62%; area under the curve=0.70]. The patients who scored ≤28% in %total score of London Chest Activity of Daily Living had lower modified Medical Research Council , Chronic Obstructive Pulmonary Disease Assessment Test, Saint George's Respiratory Questionnaire, body-mass index, airflow obstruction, dyspnea and exercise capacity index and sitting time than who scored >28%, and higher forced expiratory volume in the first second, time in physical activity ≥3 metabolic equivalent of task, steps per day and six-minute walk distance. The %total score of London Chest Activity of Daily Living correlated better with clinical outcomes than the total score., Conclusions: The cut-off point of 28% is sensitive and specific to distinguish the functional status in patients with chronic obstructive pulmonary disease. The %total score of the London Chest Activity of Daily Living reflects better outcomes of chronic obstructive pulmonary disease when compared to total score., (Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Purpose: To describe physiological responses during the 6-min step test (6MST) in patients with chronic obstructive pulmonary disease (COPD), to investigate whether COPD severity and test interruptions could determine different physiological responses, and to test the reproducibility of 6MST performance., Methods: Cross-sectional study. Patients with moderate to very severe COPD underwent lung function assessment and 2 6MSTs, with physiological responses measurement by a gas analyzer and a near-infrared spectroscopy device., Results: Thirty-six patients (29 men; forced expiratory volume in the first second of expiration [FEV1] = 51.1 ± 13.6%pred) participated in the study. Most of the physiological variables stabilized between the second and fourth minutes of the 6MST, except the respiratory rate and heart rate (HR), which stabilized after the fifth minute. The patients who interrupted the 6MST showed higher minute ventilation to maximal voluntary ventilation ratio ((Equation is included in full-text article.)E/MVV; all test minutes) and HR (first and second minutes) (P < .05) and worse pulmonary function (FEV1 = 1.37 ± 0.37 L vs 1.82 ± 0.41 L, P = .002, and 47.2 ± 13.2%pred vs 56.6 ± 12.4%pred, P = .04, respectively) than those who did not interrupt the 6MST. However, their performance was similar (P = .11). 6MST performance and physiological variables were reproducible, and there was a learning effect of 6.28%., Conclusions: The 6MST showed a stabilization of the most physiological variables. In addition, interruptions were usually made by patients with a greater impairment of lung function and they presented greater increased ventilatory demand during the 6MST. However, these interruptions do not interfere with 6MST physiological responses. Moreover, the 6MST is a reliable test to evaluate the functional capacity of patients with COPD.

Objectives : To evaluate the reliability and learning effect of the five-repetition sit-to-stand test (5STSt) in severe and very severe chronic obstructive pulmonary disease (COPD) patients on domiciliary oxygen therapy compare the results with those of COPD patients not on such therapy. Methods : Twenty-eight COPD patients were included in the domiciliary oxygen therapy group (DOTG) and 17 in the control group (CG). The participants of the groups were paired by age, sex, body mass index, and lung function. The groups performed two 5STSt (5STSt 1 and 5STSt 2 ). Results : In total, 96% of the patients in the DOTG performed better on the second 5STSt (5STSt 2 ) (17.1 ± 4.63s), with an average reduction of 3.87 ± 3.50 s ( p  < 0.001) and a learning effect of 18.4%. In the CG, 82.3% of patients had better performance on the 5STSt 2 (15.06 ± 3.45 s), with an average reduction of 1.38 ± 2.51 s ( p  = 0.035) and a learning effect of 8.39%. The 5STSt had an ICC of 0.79 (95%CI: 0.02-0.93; p  < 0.001) in the DOTG and of 0.89 (95%CI: 0.65-0.96; p  < 0.001) in the CG. Conclusion : The 5STSt is reliable in patients with severe and very severe COPD on domiciliary oxygen therapy, with learning effect of nearly 18% in the DOTG. Thus, performing two tests is recommended to achieve the patient´s best performance in this population.

Objective: To determine Glittre-ADL test minimal important difference in patients with chronic obstructive pulmonary disease., Methods: This is quasi-experimental study. Sixty patients with moderate to very severe chronic obstructive pulmonary disease (age 64.1, SD=9.09 years; forced expiratory volume in the first second 37.9, SD=13.0% predicted participated in a pulmonary rehabilitation program based on physical training, conducted over 24 sessions supervised, three times a week, including aerobic training in treadmill and resistance training for upper limbs and lower limbs. The main outcomes were the Glittre-ADL test and six-minute walk test, before and after 24 sessions of pulmonary rehabilitation. The minimal important difference was established using the distribution and anchor-based methods., Results: Patients improved their functional capacity after the pulmonary rehabilitation. The effect sizes of Glittre-ADL test and six-minute walk test improvement were similar (0.45 vs 0.44, respectively). The established minimal important differences ranged from -0.38 to -1.05. The reduction of 0.38min (23s) corresponded to a sensitivity of 64% and a specificity of 69% with an area under the curve of 0.66 (95%CI 0.51-0.81; p=0.04). Subjects who achieved the minimal important difference of -0.38min for the Glittre-ADL test had a superior improvement of approximately 42m in the six-minute walk test when compared to patients who did not., Conclusions: The present findings suggest -0.38min as the minimal important difference in the time spent in the Glittre-ADL test after 24 sessions of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease., Trial Registration: NCT03251781 (https://clinicaltrials.gov/ct2/show/NCT03251781)., (Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Chronic hypoxemia in patients with COPD is a limiting factor that is associated with disease progression and significantly contributes to decreased physical activity. Although correction of hypoxemia results in physiological improvements, oxygen therapy may be related to social isolation and inactivity. However, few studies have objectively investigated the level of physical activity in daily life (PADL) in these patients. The objective of this study was to compare the level of PADL in subjects with COPD on home oxygen therapy and in subjects with no oxygen therapy, and to investigate whether home oxygen therapy is associated with the level of PADL., Methods: In this study, 29 subjects with COPD composed the home oxygen therapy group, and 30 subjects with COPD composed the control group. All of them underwent assessment of anthropometric measurements, spirometry, peripheral muscle strength, limitations in activities of dalily living, perception of dyspnea, health status, as well as PADL monitoring., Results: Home oxygen therapy subjects showed less time walking ( P = .001), in active physical activities ( P = .003), in physical activities ≥ 3 METs ( P = .001), and in physical activities < 1.5 METs ( P = .042), as well as fewer steps ( P = .001). Physical inactivity was present in 24 home oxygen subjects (82.8%) and 18 control subjects (60%). Oxygen therapy was associated with severe physical inactivity (Cramer's V = 0.29, P = .040). The time using oxygen therapy (h/d) was the strongest predictor of the level of PADL (r 2 = 0.38-0.43, P < .001)., Conclusion: Subjects with COPD using oxygen at home showed reduced level of PADL. The results indicate that oxygen therapy is associated with severe physical inactivity and may be a predictor of the level of PADL., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2019 by Daedalus Enterprises.)

Background: Knowing the patients with chronic obstructive pulmonary disease (COPD) that increase the physical activity of daily living (PADL) after pulmonary rehabilitation (PR) is a challenge., Aims: to compare baseline characteristics between patients who achieved and failed to achieve the minimal important difference (MID) of PADL post-PR; to verify which baseline variables better predict the change and identify a cut-off point to discriminate MID achievers., Methods: Fifty-three patients with COPD (FEV 1 : 38.3; 95%CI 34.4-42.2%pred) were evaluated for spirometry, dyspnea, quality of life, functional capacity, mortality risk and PADL level. After 24 sessions of PR had their PADL level revaluated., Results: The MID achievers presented lower FEV 1 , functional capacity, time walking, number of steps, active time, energy expenditure (EE) walking, time on PADL≥3 metabolic equivalent of task (METs) and higher time on PADL<1.5MET. Inactive patients and with severe physical inactivity presented a hazard ratio of 4.27 and 6.90 (95%CI: 1.31-13.9, p = 0.02; 95%CI: 1.99-23.9, p = 0.002; respectively) for achieving the MID. The variables of predictive model for the change in the PADL were EE walking and time on PADL<1.5MET (R 2 : 0.37; p = 0.002). The cut-off point of 6525 steps [sensitivity = 95%; specificity = 61%; AUC = 0.82 (95%CI: 0.71-0.93), p < 0.001] was able to discriminate patients who achieved and failed to achieve the MID., Conclusion: Patients with worse lung function, functional capacity and lower PADL level before PR are those that improve the PADL level. EE walking and time on PADL<1.5MET better predict this change. The cut-off point of 6525 steps can help to identify patients with higher chances of improving the PADL level., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: This study aimed to analyze the isolated role of unsupported arm activities and the physiological responses and dynamic hyperinflation (DH) induced by activities of daily living in patients with chronic obstructive pulmonary disease. Physiological responses and DH were compared using the Glittre activities of daily living test (TGlittre) and a modified protocol that emphasized unsupported arm activities and excluded squats and bending down to move objects on shelves (TGlittre-M). Data were also compared from the isolated shelf tasks of TGlittre (TSHELF) and TGlittre-M (TSHELF-M)., Methods: This cross-sectional study included 30 patients with chronic obstructive pulmonary disease who performed the TGlittre, TGlittre-M, TSHELF and TSHELF-M. The physiological responses were evaluated during the 4 protocols and inspiratory capacity was measured before and immediately after the tests for evaluation of DH., Results: Patients had higher oxygen uptake, ventilatory demand, dyspnea, and DH in the TGlittre than in the TGlittre-M (mean differences: 123 ± 119 mL/min; 0.11 ± 0.10, 1 [-1 to 3], and - 0.14 ± 0.22, respectively; P < .05 for all). Oxygen uptake, ventilatory demand, and dyspnea were also higher in the TSHELF than in the TSHELF-M (mean differences: 408 ± 185 mL/min; 0.26 ± 0.17; 1 [-1 to 3], respectively; P < .05 for all). However, DH was similar for both tasks (P > .05)., Conclusions: In patients with chronic obstructive pulmonary disease, the physiological demands during unsupported arm activities were lower than during the task performed with squatting and bending down; however, the magnitude of DH did not differ between them. These results suggest that the isolated arm activities contribute less to the TGlittre's physiological requirement than the lower-limb and trunk activities.

Objective: To translate the Understanding COPD (UCOPD) questionnaire into Portuguese, adapt it for use in Brazil, and assess its reliability., Methods: The UCOPD questionnaire consists of two sections, designated section A and section B. Section A comprises 18 items divided into three domains: "About COPD", "Managing Symptoms of COPD", and "Accessing Help and Support". Section B includes five questions regarding patient satisfaction with the educational component of pulmonary rehabilitation programs. The UCOPD questionnaire was applied twice on the same day by two different raters (with a 10-min interval between applications) and once again 15-20 days later. The Wilcoxon test was used in order to compare the scores among applications. Reliability was assessed by the intraclass correlation coefficient and Bland-Altman plots., Results: The study sample consisted of 50 COPD patients (35 men; mean age, 65.3 ± 7.91 years; mean FEV1, 36.4 ± 16.2% of the predicted value). Inter-rater intraclass correlation coefficients for section A total scores and domain scores ranged from moderate to high. Section A scores and domain scores had no significant differences regarding test-retest reliability (p < 0.05). The test-retest and inter-rater Cronbach's alpha coefficients for section A total scores were 0.93 and 0.86, respectively (p < 0.001). There were no floor or ceiling effects., Conclusions: The Brazilian Portuguese version of the UCOPD questionnaire is reliable.

Background: Pursed-lips breathing (PLB) is a ventilatory strategy frequently adopted spontaneously by patients with chronic obstructive pulmonary disease (COPD) to relieve dyspnoea, and its practice is widely taught as a respiratory strategy to increase exercise tolerance., Objective: To investigate the effects of acute use of PLB in exercise performance, dyspnoea, ventilatory parameters and oxygen saturation during exercise in patients with COPD., Data Sources: PEDro, EMBASE, MEDLINE via OVID, and EBSCO up to May 2016., Study Selection: Crossover, randomized and quasi-randomized controlled trials that studied PLB as a ventilatory strategy for patients with COPD during exercise., Data Extraction and Synthesis: Data extraction included background characteristics of the research reports; participant characteristics; description of the analyzed variables and corresponding instruments; exercise protocol; exercise performance; outcomes and corresponding results; data for "responder" and "non-responder" outcomes., Results: Eight studies were selected. The meta-analysis demonstrated that the use of PLB during exercise reduces minute ventilation and respiratory rate compared to exercise without PLB. No statistically significant differences were found in the 6-minute walk test distance., Limitations: The sample characteristics, exercise protocols, and criteria for "responders" and "non-responders" differed among studies., Conclusion: PLB is effective in reducing minute ventilation and respiratory rate during exercise in patients with COPD. It is still unclear who responds to PLB and how these responders benefit from its use. Further studies with better methodological quality are necessary to understand the implications of its acute use on the functional capacity and symptoms of patients with COPD. Systematic review registration number: PROSPERO CRD42015025903., (Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

The study objective was to determine a cut-off point for the Glittre activities of daily living (ADL)test (TGlittre) to discriminate patients with normal and abnormal functional capacity. Fifty-nine patients with moderate to very severe COPD (45 males; 65 ± 8.84 years; BMI: 26 ± 4.78 kg/m 2 ; FEV 1 : 35.3 ± 13.4% pred) were evaluated for spirometry, TGlittre, 6-minute walk test (6 MWT), physical ADL, modified Medical Research Council scale (mMRC), BODE index, Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT). The receiver operating characteristic (ROC) curve was used to determine the cut-off point for TGlittre in order to discriminate patients with 6 MWT < 82% pred. The ROC curve indicated a cut-off point of 3.5 minutes for the TGlittre (sensitivity = 92%, specificity = 83%, and area under the ROC curve = 0.95 [95% CI: 0.89-0.99]). Patients with abnormal functional capacity had higher mMRC (median difference 1 point), CAT (mean difference: 4.5 points), SGRQ (mean difference: 12.1 points), and BODE (1.37 points) scores, longer time of physical activity <1.5 metabolic equivalent of task (mean difference: 47.9 minutes) and in sitting position (mean difference: 59.4 minutes) and smaller number of steps (mean difference: 1,549 minutes); p < 0.05 for all. In conclusion, the cut-off point of 3.5 minutes in the TGlittre is sensitive and specific to distinguish COPD patients with abnormal and normal functional capacity.

Background: In multidimensional Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the choice of the symptom assessment instrument (modified Medical Research Council dyspnea scale [mMRC] or COPD assessment test [CAT]) can lead to a different distribution of patients in each quadrant. Considering that physical activities of daily living (PADL) is an important functional outcome in COPD, the objective of this study was to determine which symptom assessment instrument is more strongly associated with and differentiates better the PADL of patients with COPD., Methods: The study included 115 subjects with COPD (GOLD 2-4), who were submitted to spirometry, the mMRC, the CAT, and monitoring of PADL (triaxial accelerometer). Subjects were divided into 2 groups using the cutoffs proposed by the multidimensional GOLD classification: mMRC < 2 and ≥ 2 and CAT < 10 and ≥ 10., Results: Both mMRC and CAT reflected the PADL of COPD subjects. Subjects with mMRC < 2 and CAT < 10 spent less time in physical activities < 1.5 metabolic equivalents of task (METs) (mean of the difference [95% CI] = -62.9 [-94.4 to -31.4], P < .001 vs -71.0 [-116 to -25.9], P = .002) and had a higher number of steps (3,076 [1,999-4,153], P < .001 vs 2,688 [1,042-4,333], P = .002) than subjects with mMRC > 2 and CAT > 10, respectively. Physical activities ≥ 3 METs differed only between mMRC < 2 and mMRC ≥ 2 (39.2 [18.8-59.6], P < .001). Furthermore, only the mMRC was able to predict the PADL alone (time active, r 2 = 0.16; time sedentary, r 2 = 0.12; time ≥ 3 METs, r 2 = 0.12) and associated with lung function (number of steps, r 2 = 0.35; walking time, r 2 = 0.37; time < 1.5 METs, r 2 = 0.25)., Conclusions: The mMRC should be adopted as the classification criterion for symptom assessment in the GOLD ABCD system when focusing on PADL., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2018 by Daedalus Enterprises.)

Purpose: This cross-sectional study compared the physiological responses and dynamic hyperinflation (DH) of the Glittre-ADL test (TGlittre) and its specific tasks in patients with chronic obstructive pulmonary disease (COPD)., Methods: Thirty patients with COPD performed the TGlittre. The individual tasks included stand up and sit down (TSS); climb up and down stairs (TSTAIRS); walk on a flat surface (TWALK); and move objects onto and off a shelf (TSHELF). While performing these tasks, the physiological responses were evaluated and inspiratory capacity measured before and immediately after the tests., Results: All physiological variables and inspiratory capacity were different at the end of the TGlittre and its tasks compared with baseline (P < .05). For most of the physiological variables, there were no significant differences between TSHELF and TWALK (P > .05), which were the tasks with the greatest physiological requirement, whereas the TSS represented the lowest metabolic, cardiovascular, and ventilatory demands among TGlittre's tasks. DH did not differ significantly among TGlittre's tasks., Conclusions: TWALK and TSHELF were the tasks that resulted in greater physiological overload, whereas TSS induced the lowest metabolic and ventilatory demands. Despite this, DH did not differ among the TGlittre's tasks in patients with COPD.

The aim of this study was to investigate whether the chronic obstructive pulmonary disease (COPD) assessment test (CAT) reflects the functional status of patients with COPD. Forty-seven patients underwent anthropometric assessment, spirometry, the 6-minute walk test (6MWT), the Glittre-activity of daily living (ADL) test (TGlittre), the London Chest ADL (LCADL) scale, and the CAT. The total score of the CAT correlated with 6MWT distance, TGlittre time spent, and LCADL %total ( r = -0.56, 0.52, and 0.78, respectively; p < 0.05 for all). There was significant difference in 6MWT distance (490 ± 85.4 m vs. 387 ± 56.8 m), TGlittre time spent (3.67 ± 1.07 min vs. 5.03 ± 1.32 min), and LCADL %total (24.2 ± 3.02% vs. 44.4 ± 13.3%) between the low and high impacts of COPD on health status (respectively, p < 0.05 for all) as well as in the LCADL %total between medium and high impact of COPD on health status (31.3 ± 7.35% vs. 44.4 ± 13.3%; p = 0.001). In conclusion, the CAT reflects the functional status of patients with COPD.

Background: This study aimed to investigate the reproducibility of the ventilatory parameters and dynamic hyperinflation (DH) induced by the Glittre ADL-test (TGlittre) in chronic obstructive pulmonary disease (COPD) patients., Methods: Twenty-three patients with COPD underwent anthropometry, spirometry, TGlittre (TGlittre1 and TGlittre2) and pre- and post-test slow vital capacity. During the tests the ventilatory response was evaluated., Results: Regarding the TGlittre reproducibility, 87% of patients had a better performance in TGlittre2, and reduced on average 0.34 minute ± 0.62 (p = 0.01) from TGlittre1 time to TGlittre2, showing a learning effect of 6.34%. The difference average between tests was correlated with the time spent in TGlittre1 (r = -0.52; p < 0.05). The TGlittre time was statistically reproducible (intraclass correlation coefficient = 0.97; p < 0.001). Final ventilation parameters and their variations presented low-to-high reproducibility, except respiratory rate. The DH was similar (p > 0.05) in both tests, with low reproducibility in percentage, while in liters it was not reproducible., Conclusions: The TGlittre time and ventilatory parameters are reproducible, while DH is variable in COPD patients. A 6-7% learning effect was shown, and it is recommended to perform two tests.

Background: Airflow limitation frequently leads to the interruption of activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Disease (COPD). These patients commonly show absence of ventilatory reserve, reduced inspiratory reserve volume, and dynamic hyperinflation (DH)., Objective: To investigate ventilatory response and DH induced by three ADL-based protocols in COPD patients and compare them to healthy subjects., Method: Cross-sectional study. COPD group: 23 patients (65±6 years, FEV1 37.2±15.4%pred); control group: 14 healthy subjects (64±4 years) matched for age, sex, and body mass index. Both groups performed all three tests: Glittre-ADL test; an activity test that involved moving objects on a shelf (TSHELF); and a modified shelf protocol isolating activity with upper limbs (TSHELF-M). Ventilatory response and inspiratory capacity were evaluated., Results: Baseline ventilatory variables were similar between groups (p>0.05). The ventilatory demand increased and the inspiratory capacity decreased significantly at the end of the tests in the COPD group. Ventilatory demand and DH were higher (p<0.05) in the TSHELF than in the TSHELF-M in the COPD group (p<0.05). There were no differences in DH between the three tests in the control group (p>0.05) and ventilatory demand increased at the end of the tests (p<0.05) but to a lower extent than the COPD group., Conclusion: The TSHELF induces similar ventilatory responses to the Glittre-ADL test in COPD patients with higher ventilatory demand and DH. In contrast, the ventilatory response was attenuated in the TSHELF-M, suggesting that squatting and bending down during the Glittre-ADL test could trigger significant ventilatory overload.

Background: The Glittre-ADL test (TGlittre) is a valid and reliable test for the evaluation of functional capacity and involves multiple physical activities of daily living (PADL), which are known to be troublesome to patients with Chronic Obstructive Pulmonary Disease (COPD). However, it is still unknown if this test is also able to reflect the functional performance of patients with COPD., Objective: To investigate whether the TGlittre reflects the functional performance of COPD patients and whether the necessary time to complete the TGlittre and the PADL varies according to disease severity., Method: Thirty-eight patients with COPD (age 65, SD=7 years; forced expiratory volume in the first second 41.3, SD=15.2% predicted) underwent anthropometric and lung function assessments and were submitted to the TGlittre and PADL measurement., Results: TGlittre performance correlated significantly (p<0.05) with PADL variables, such as time sitting (r=0.50), walking (r=-0.46), number of steps taken (r=-0.53), walking movement intensity (r=-0.66), walking energy expenditure (r=-0.50), and total energy expenditure (r=-0.33). TGlittre performance was not significantly different in patients among the Global Initiative for COPD (GOLD) spirometric stages, but walking and sitting time were significantly lower and greater, respectively, in severe and very severe patients compared to those with moderate disease (p<0.05)., Conclusion: The performance on the TGlittre correlates with walking and sitting time and other real life PADL measurements. The severity of the disease is associated with the differences in the level of physical activity in daily life more than in functional capacity.