Search

PURPOSE Whether the modified shuttle test (MST) achieves maximal effort in children and adolescents with asthma is unclear. The aim was to compare the physiological responses of MST to the cardiopulmonary exercise test (CPET) in pediatric patients with asthma, to observe its convergent validity. PATIENTS AND METHODS A cross-sectional study with volunteers with asthma (6-17 years of age) under regular treatment. The MST is an external-paced test, and the participants were allowed to walk/run. CPET was performed on a cycle ergometer to compare with MST. Gas exchange (VO2 , VCO2 , and VE) and heart rate (HR) were the outcomes and were continuously assessed in both tests. RESULTS Forty-seven volunteers were included, normal lung function expiratory forced volume at 1st second/forced vital capacity (FEV1 /FVC) 88.6 (7.7). VO2peak was higher at MST (2.0 ± 0.6 L/min) compared to CPET (1.6 ± 0.5 L/min), p

Aim To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. Methods Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. Results After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4–143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. Conclusion HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up., Home-based pulmonary rehabilitation (HBPR) delivers improvements in functional capacity, peripheral muscle strength and QoL in people with bronchiectasis. HBPR is safe, well tolerated and can be considered an alternative rehabilitation programme. https://bit.ly/2Q2Bout

BACKGROUND: Single-step tests have been proposed as simple and inexpensive challenges todiagnose exercise-induced bronchoconstriction (EIB) in the pediatric population. Work performed and the resulting ventilation, however, might be substantially lower in stepping than running. This might decrease the diagnostic yield of step-based challenges. METHODS: In a cross-sectional study, 53 children with asthma with exercise-related symptoms (34 boys, age 6–18 y) underwent an incremental stepping test, a 6-min constant stepping test, and a treadmill running test on different days. RESULTS: Constant and incremental stepping tests presented with lower metabolic demands (V˙ O2 1.42 0.48 and 1.34 0.55 L/min, respectively), ventilatory demands (V˙ O2 45 14 and 43 16 L/min, respectively), and cardiovascular demands (160 20 and 161 19 beats/min, respectively) than the treadmill running test (1.65 0.60 L/min, 54 17 L/min, and 172 7 beats/min, respectively) (P < .05). Between-test agreement in diagnosing EIB was poor (kappa 0.217–0.361). Although EIB prevalence was higher after the treadmill running test (60%) compared to constant (53%) and incremental (47%) stepping tests, 7 subjects developed EIB only in stepping. Clinical and resting functional characteristics did not differ in iscordant subjects (ie, EIB negative in a given test but positive in another) versus concordant subjects (ie, EIB negative or positive in both tests). EIB was not related to individual test ability in eliciting high to very-high ventilation (> 40% or > 60% maximum voluntary ventilation, respectively). Moreover, a negative stepping test but a positive treadmill test (and vice versa) was not associated with greater ventilatory demands. CONCLUSIONS: Lower prevalence of EIB in stepping compared to treadmill running is not related to less ventilation demand in the former modality. Although stepping might be useful as a screening EIB test due its portability and low cost, a negative test should be confirmed with a running-based test in symptomatic children.

The performances of healthy individuals in an incremental shuttle walking test performed in a hallway (ISWT-H) and on a treadmill (ISWT-T) were compared to assess their physiological responses during aerobic training sessions with the speeds estimated from both tests. This was a cross-sectional study with 55 healthy subjects, who were randomized to perform the ISWT tests with 24 hours between them. Training sessions were held using a treadmill at 75% of the speeds obtained from the ISWT-H and ISWT-T. Measurements included walking distance, oxygen uptake (VO2), carbon dioxide (VCO2) production, heart rate (HR), and ventilation (VE). There was a significant difference between walking distances (ISWT-T: 823.9±165.2 m and ISWT-H:685.4±141.4 m), but similar physiological responses for VO2 (28.6±6.6 vs. 29.0±7.3 ml-1.kg-1.min-1), VCO2 (1.9±0.7 vs. 1.9±0.5 1), HR (158.3±17.8 vs. 158.6±17.7 bpm), and VE (41.5±10.4 vs. 43.7±12.9 1). The estimated speeds were different for the training sessions (5.5±0.5 km/h and 4.9±0.3 km/h), as well as the VO2, VCO2, VE, and HR. It was concluded that in healthy young adults, ISWTs carried out in a hallway and on a treadmill are not interchangeable. Since the ISWT-H was determined to have lower speed, the training intensity based on this test may underestimate a patient’s responses to aerobic training. RESUMO Comparou-se o desempenho no shuttle walk teste incremental realizado no corredor (SWTI-C) e na esteira (SWTI-E) em indivíduos saudáveis e comparar as respostas fisiológicas durante as sessões de treinamento aeróbio com as velocidades estimadas em ambos os testes. Trata-se de um estudo transversal com cinquenta e cinco participantes saudáveis. Os participantes foram randomizados para realizar os testes com 24 horas de intervalo. As sessões de treinamento foram realizadas na esteira com 75% da velocidade obtida no SWTI-C e no SWTI-E. As avaliações incluíram a distância da caminhada, consumo de oxigênio (VO2), produção de dióxido de carbono (VCO2), frequência cardíaca (FC) e ventilação (VE). Houve uma diferença significante entre as distâncias caminhadas (SWTI-E: 823,9 ± 165,2 m e SWTI-C: 685,4 ± 141,4 m), mas respostas fisiológicas semelhantes para o VO2 (28,6 ± 6,6 vs. 29,0 ± 7,3 ml-1.kg-1.min-1), VCO2 (1,9 ± 0,7 vs. 1,9 ± 0,5 1), HR (158,3 ± 17,8 vs. 158,6 ± 17,7 bpm) e VE (41,5 ± 10,4 vs. 43,7 ± 12,9 1). As velocidades estimadas foram diferentes para as sessões de treinamento (5,5 ± 0,5xkm/h e 4,9 ± 0,3 km/h), assim como o VO2, VCO2, VE e FC. Concluiu-se que em adultos jovens saudáveis, SWTI realizados no corredor e na esteira não são intercambiáveis. Uma vez que o SWTI-E determinou uma menor velocidade, a intensidade do treinamento baseada neste teste pode subestimar as respostas de um paciente ao treinamento aeróbio. RESUMEN Se trata de una comparación del rendimiento en la prueba incremental shuttle walk llevado a cabo en el pasillo (SWPI-P) y en la cinta caminadora (SWPC) entre individuos sanos, para evaluar las respuestas fisiológicas durante las sesiones de entrenamiento aeróbico con velocidades estimadas en ambas pruebas. Estudio transversal con 55 individuos sanos. A los participantes se les eligieron al azar para realizar las pruebas con intervalo de 24 horas. Se llevaron a cabo sesiones de entrenamiento en la cinta caminadora con el 75 % de la velocidad obtenida en SWPI-P y en SWPC. Se incluyen entre las evaluaciones la distancia de la caminata, el consumo de oxígeno (VO2), la producción de dióxido de carbono (VCO2), la frecuencia cardiaca (FC) y la ventilación (VE). Hubo una diferencia significativa entre las distancias recorridas (SWPC: 823,9 ± 165,2 m y SWPI-P: 685,4 ± 141,4 m), pero similares a las respuestas fisiológicas del VO2 (28,6 ± 6,6 vs. 29,0 ± 7,3 ml-1.kg-1. min-1), VCO2 (1,9 ± 0,7 vs. ± 1,9 0,5 1), HR (158,3 ± 17,8 vs. 158,6 ± 17,7 bpm) y VE (41,5 ± 10,4 vs. 43,7 ± 12,9 1). Las velocidades estimadas fueron diferentes en las sesiones de entrenamiento (5,5 ± 0,5 km/h y 4,9 ± 0,3 km/h), así como VO2, VCO2, VE y FC. Se concluyó que, en los adultos jóvenes sanos, la SWPI llevada a cabo en el pasillo y en la cinta caminadora no pueden ser intercambiables. Dado que la SWPC determinó una menor velocidad, la intensidad de entrenamiento de esta prueba puede subestimar las respuestas de un paciente en el entrenamiento aeróbico.

INTRODUCTION: The incremental shuttle walk test was initially developed to be carried out in a hallway (ISWT-H) but has been modified to be performed on a treadmill (ISWT-T). However, it is still unknown whether performance on ISWT-H and ISWT-T are similar in patients with bronchiectasis. In this study, we compared the performance, physiological responses, and perception of effort between the ISWT-T with a handrail and ISWT-H for subjects with bronchiectasis. We also sought to estimate and compare the prescription for training intensity with both tests. METHODS: This was a cross-sectional study in which 24 subjects with bronchiectasis were evaluated on 2 different days (24 h apart). Distance walked (m) was compared between the ISWT-H and ISWT-T. A training session was held on a treadmill at 75% of the speed obtained from both tests. The walking distance, oxygen uptake (VO2), carbon dioxide production (VCO2), heart rate, and ventilation (VE) were measured. RESULTS: There was a difference in the walking distance between the ISWT-T and ISWT-H, but physiological responses for VO2, VCO2, heart rate, and VE were similar. However, the speed estimated for training was different, as were the VO2, VCO2, and heart rate. CONCLUSIONS: The ISWT-T with handrail and the ISWT-H are not interchangeable in subjects with bronchiectasis. A slower speed of training intensity may occur when the test is performed in a hallway, as originally described, and this may underestimate responses to aerobic training

Highlights • Home-based pulmonary rehabilitation (HBPR) has been used in several chronic pulmonary obstructive diseases. • HBPR has never been investigated in patients with bronchiectasis. • Short- and long-term effects of HBPR will be investigated in this population. • The study will provide evidence to guide recommendations about HBPR for bronchiectasis., Background Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis. Objectives To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis. Methods An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. Interventions: The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20 min (intensity: 60–80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). Control: The patients will receive an educational manual and a recommendation to walk three times a week for 30 min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. Main outcome measures: incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization. Discussion The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis. Trial registration:www.ClinicalTrials.gov (NCT02731482). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00060X6&selectaction=Edit&uid=U00028HR&ts=2&cx=1jbszg

Introduction: For adolescents, activities of daily living (ADL) is evaluated by tests developed for adults in which the activities are not suitable for them. Objective: to describe a feasibility study for ADL tasks in adolescents. Method:6 healthy volunteers (12-17 years old) were evaluated. Ten ADLs were performed in randomized order (four minutes each): raising ramp, shelving, jump star, climbing steps, running, jump rope, kick ball (feet), throwing a ball (hands), cycling, and playing basketball. The VO2peak, minute ventilation(VE), and heart rate(HR) assessed at the peak of each task were the outcomes. The cardiopulmonary exercise test (CPET) was also performed. Results: the most difficult activity reported was jump star, the easiest was raising ramp. Activities with higher outcomes were jump star VE:45(41–56L/min), VO2:1.6(1.4–1.9L/min), HR:161(147–187bpm) and jump rope VE:41(33–51L/min), VO2:1.7(1.2–1.9L/min), HR:163(141–185bpm). Activities with lower outcomeswere the rise ramp VE:14(12–15L/min),VO2:0.6(0.5–0.8L/min), HR:123(112–141bpm) and throwing ball VE:17(14–20L/min),VO2:0.7(0.6–0.8L/min), HR:105(102–120bpm). Interestingly, the VE of shelving (29(23-45L/min)) seems to be higher than running(23(18–42L/min)), but not statically(p=0.4), with a similar VO2(1.2(1.0–1.5L/min) vs.1.2(0.8–1.7L/min), respectively. The range of VO2 for all ADLs was from 40 to 113% of the CPET. Conclusion: the tasks are feasible, easily to understand, and the ADLs provide consistent physiological responses.

Background: A home-based pulmonary rehabilitation (HBPR) is a promising alternative to help patients overcome the barriers that cause lack of adherence in pulmonary rehabilitation (PR). However, HBPR has not yet been investigated in patients with bronchiectasis. Objective: To investigate the impact of HBPR on functional capacity, quality of life, and peripheral muscle strength in patients with bronchiectasis. Methods: 39 patients were randomized into two groups: HBPR (n=20, 44±18 years, FEV1: 51±22%): three sessions weekly for eight weeks with aerobic exercise (stepping training during 20 minutes) and resistance training using elastic bands. Controls (n=19, 47±14 years, FEV1: 45±16%): Educational manual and a recommendation for a practice of exercises. All patients received a weekly phone call and the HBPR group received a home visit every 15 days. The incremental shuttle walk test (ISWT), endurance shuttle walk test (ESWT), quality of life (Saint George`s Respiratory Questionnaire, SGRQ) and quadriceps muscle strength were taken at baseline and after the intervention. * = P Results: The HBPR group and controls presented, respectively: difference in ISWT: 89±77m* and -70±122m* [(difference between groups: 160m* (95%CI: 93 to 227m)], ESWT: 5.6±5.7 min* and 0.2±2.2 min [5.4 min* (95%CI: 2.1 to 8.7)], SGRQ: -9±12%* and 4±9% [-12%* (95%CI: -19 to -5)], quadriceps strength: 6.4±8.4 kgf* and -1.0±6.1 kgf [7.4 kgf* (95%CI: 2.6 to 12.3)]. Conclusion: The HBPR improved functional capacity, quality of life and muscle strength in patients with bronchiectasis. The HBPR is safe and can be an alternative for patients who cannot participate in an outpatient PR program.

Background: Visual feedback could optimize the evaluation of chest wall mobility. Objective: To compare chest wall mobility performed with and without visual feedback. Methods: Cross-sectional study, 64 healthy volunteers, average age 24 years old. The thorax circumference was measured at two locations, the axillary and xiphisternum regions, by a tape placed at the anterior axillary line and at the xiphoid process. The evaluations were performed: (i) after verbal explanation (without visual feedback), (ii) after verbal explanation plus visual feedback (with visual feedback); for this evaluation the volunteer remained in front of the computer, which provides visual feedback. Results: There was no difference between axillary measurement with vs. without feedback (7.5 ± 2.4 cm vs. 7.9 ± 3.3 cm, respectively, p = 0.215), but significant difference between xiphisternum measurement 7.1 ± 2.7cm with feedback vs. 6.5 ± 2.3cm without feedback, p = 0.043. Low intraclass correlation coefficients were observe...

Individuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease. The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program. This is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 μcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be used for 5 minutes. The control group: oral high-frequency oscillation device (Flutter®) for 10 minutes followed by the stretching of upper and lower limbs for 40 minutes. It is expected to observe the improvement in aerobic capacity, physical activity in daily life, muscle strength and quality of life of patients in the intervention group, and reduction in inflammatory markers. Clinical Trial Number: NCT02383069 . Data of registration: 03/03/2015

To determine a prediction equation for distance walked of incremental shuttle walk test (ISWT) and test its reliability in children and adolescents.Cross-sectional study, which included 108 healthy volunteers between 6 and 18 years old. Those who had an abnormal spirometry or had a history of chronic disease were excluded. Two ISWT were performed. Heart rate and peripheral capillary oxygen saturation (SpO2) were continuously measured during the test. Dyspnea and lower limb fatigue were assessed by Borg scale before and after the tests.Boys walked longer distances compared with girls (1066.4 ± 254.1 m vs 889.7 ± 159.6 m, respectively, P.0001). Except for dyspnea, there were no significant differences in the other outcomes measured (heart rate, lower limb fatigue, SpO2, and distance walked) at the peak of the two ISWT. The variables included in the predicted equation were age, body mass index, and sex. The predicted equation is: ISWTpred = 845.559 + (sex * 193.265) + (age * 47.850) - (body mass index * 26.179). The distance walked had an excellent reliability between the two ISWT, 0.98 (95% CI 0.97-0.99). The Bland-Altman plot shows agreement between tests (range from -40 to 45 m).We established a prediction equation for ISWT. It can be used as a reference to evaluate exercise capacity for children and adolescents. ISWT has excellent repeatability and it is a maximal-effort field test for this age group.

The following information is missing from the Funding section: This study was supported by the Sao Paulo Research Foundation (FAPESP) grant: 2015/15699-5.

Previous studies have proposed only one prediction equation for respiratory muscle strength without taking into consideration differences between ages in pediatric population. In addition, those researches were single-center studies. The objective of this study was to establish reference equations for maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) in children and teenagers. In a multicenter study, 450 healthy volunteers were evaluated (aged 6–18yrs). There were included volunteers with normal lung function. We excluded volunteers who could not perform the tests; participated in physical activity more than twice a week; were born prematurely; smokers; chronic respiratory, cardiologic, and/or neurologic diseases; had acute respiratory disease during the prior three weeks. The volunteers were divided into two groups: Group 6–11 (6–11yrs) and Group 12–18 (12–18yrs). PImax and PEmax were measured according to statement. The mean PImax value was 85.6 (95%IC 83.6–87.6 cmH2O), and PEmax 84.6 (95%IC 85.5–86.2 cmH2O). The prediction equations for PImax and PEmax for Group 6–11 were 37.458–0.559 + (age * 3.253) + (BMI * 0.843) + (age * gender * 0.985); and 38.556 + 15.892 + (age * 3.023) + (BMI * 0.579) + (age * gender * 0.881), respectively (R2 = 0.34 and 0.31, P

The 2-min walk test (2MWT) has been used in several health conditions, but the interpretation of its results is limited due to a lack of reference values. The aim of this study was to establish a reference equation to predict the distance walked (DW) in the 2MWT for healthy adults and the elderly and to test its reproducibility.We evaluated 390 healthy subjects (195 male), 18-89 y old, with normal spirometry and no history of previous chronic diseases. Two 2MWTs were performed on the same day, 30 min apart. To test the reliability of the prediction equation, 70 subjects (35 male) were prospectively included in the study.Men walked farther than women (221 [202-240] vs 199 [164-222] m, respectively; P.0001). Significant correlations were observed between DW and age (r = -0.50), weight (r = 0.23), height (r = 0.40), and gender (r = 0.35) (P.001 for all). Age and gender persisted in the model to predict DW (R(2) = 0.51). There was no difference between the DW by the subjects (197 [182-216] m) and that estimated by the prediction equation (197 [179-222] m) (P = .68).We established a prediction equation that may be used as a reference to interpret performance on the 2MWT of adults and the elderly with different health conditions.

Chest wall mobility is often measured in clinical practice, but the correlations between chest wall mobility and respiratory muscle strength and lung volumes are unknown. We investigate the associations between chest wall mobility, axillary and thoracic cirtometry values, respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure), and lung volumes (expiratory reserve volume, FEV(1), inspiratory capacity, FEV(1)/FVC), and the determinants of chest mobility in healthy subjects.In 64 healthy subjects we measured inspiratory capacity, FVC, FEV(1), expiratory reserve volume, maximum inspiratory pressure, and maximum expiratory pressure, and chest wall mobility via axillary and thoracic cirtometry. We used linear regression to evaluate the influence of the measured variables on chest wall mobility.The subjects' mean ± SD values were: age 24 ± 3 years, axillary cirtometry 6.3 ± 2.0 cm, thoracic cirtometry 7.5 ± 2.3 cm; maximum inspiratory pressure 90.4 ± 10.6% of predicted, maximum expiratory pressure 92.8 ± 13.5% of predicted, inspiratory capacity 99.7 ± 8.6% of predicted, FVC 101.9 ± 10.6% of predicted, FEV(1) 98.2 ± 10.3% of predicted, expiratory reserve volume 90.9 ± 19.9% of predicted. There were significant correlations between axillary cirtometry and FVC (r = 0.32), FEV(1) (r = 0.30), maximum inspiratory pressure (r = 0.48), maximum expiratory pressure (r = 0.25), and inspiratory capacity (r = 0.24), and between thoracic cirtometry and FVC (r = 0.50), FEV(1) (r = 0.48), maximum inspiratory pressure (r = 0.46), maximum expiratory pressure (r = 0.37), inspiratory capacity (r = 0.39), and expiratory reserve volume (r = 0.47). In multiple regression analysis the variable that best explained the axillary cirtometry variation was maximum inspiratory pressure (R(2) 0.23), and for thoracic cirtometry it was FVC and maximum inspiratory pressure (R(2) 0.32).Chest mobility in healthy subjects is related to respiratory muscle strength and lung function; the higher the axillary cirtometry and thoracic cirtometry values, the greater the maximum inspiratory pressure, maximum expiratory pressure, and lung volumes in healthy subjects.