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Although patients with chronic obstructive pulmonary disease (COPD) benefit in many ways after participating in pulmonary rehabilitation programs, high dropout rates are still observed among participants. This study aims to analyze the adherence rate and perceived satisfaction in individuals with chronic obstructive pulmonary disease who underwent high-intensity physical training on land (LG) and in water (WG). This study is an additional analysis from a randomized controlled trial. In total, 36 subjects (51%) completed the intervention. All participants underwent six months of high-intensity endurance and strength training. Adherence was assessed by the proportion of patients who completed the training program. Perceived satisfaction was evaluated using a questionnaire composed of structured and semi-structured questions. The interviews were recorded, transcribed, and analyzed according to the criteria of our thematic analysis. The Shapiro-Wilk test was used to assess data normality, and dropout rates were compared using the chi-square test. Statistical significance was set at 5%. Regarding adherence, 59% of WG participants and 44% of LG participants completed the program, with no difference between the groups (p>0.05). Individuals from both groups were equally satisfied after six months of physical training (0,05). Os indivíduos de ambos os grupos estavam igualmente satisfeitos após seis meses de treinamento físico (0,05). Ambos grupos estaban igualmente satisfechos después de seis meses de entrenamiento físico (

Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or “air hunger”, DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners. RESUMO A disfunção respiratória (DR) é um quadro respiratório caracterizado por padrões respiratórios irregulares que ocorrem na ausência de doenças concomitantes ou secundariamente a doenças cardiopulmonares. Embora o principal sintoma seja frequentemente dispneia ou “fome por ar”, a DR também está associada a sintomas não respiratórios, como vertigem e palpitações. A DR pode ser identificada em todas as idades. Sua prevalência entre adultos na atenção primária no Reino Unido é de aproximadamente 9,5%. Além disso, entre indivíduos com asma, um diagnóstico positivo de DR é encontrado em um terço das mulheres e um quinto dos homens. Embora a DR tenha sido investigada por décadas, ela permanece pouco compreendida devido a uma escassez de ensaios clínicos de alta qualidade e de variáveis de desfecho validadas especificamente para essa população. Assim, a DR é frequentemente subdiagnosticada ou diagnosticada incorretamente, devido à similaridade de seus sintomas associados (dispneia, taquicardia e vertigem) aos de outras doenças cardiopulmonares comuns, como DPOC e asma. As altas taxas de diagnóstico incorreto de DR sugerem que os profissionais de saúde não entendam completamente esse quadro e possam, portanto, não fornecer aos pacientes um tratamento adequado. Dada à natureza multifatorial e psicofisiológica da DR, uma avaliação holística e multidimensional parece ser a maneira mais apropriada de melhorar a compreensão e a precisão do diagnóstico. A presente revisão foi desenvolvida como um meio de resumir as evidências disponíveis sobre DB, bem como de melhorar a compreensão do quadro por pesquisadores e profissionais.

Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil

To evaluate if the Incremental Shuttle Walking Test (ISWT) requires maximal effort in healthy subjects of different ages.Cross-sectional.University-based research laboratory.331 healthy subjects separated into six groups according to age: G1, 18 to 28 years; G2, 29 to 39 years; G3, 40 to 50 years; G4, 51 to 61 years; G5, 62 to 72 years and; G6, 73 to 83 years.Two ISWTs were performed and participants were permitted to run and to exceed 12 levels during the test, if necessary. Heart rate (HR) and symptoms of dyspnoea and fatigue were recorded before and after the test, and the percentage of age-predicted maximal HR (HRmax) was calculated. Maximal effort was defined as HRmax90% of age-predicted HRmax.Almost 31% of the subjects exceeded 12 levels in the ISWT. At the end of the test, all groups presented a median [interquartile range] HR greater than 90% of HRmax (G1: 100 [95 to 104]; G2: 100 [96 to 105]; G3: 103 [97 to 108]; G4: 99 [91 to 106]; G5: 96 [87 to 106] and G6: 96 [91 to 109]% HRmax). Regarding symptoms, all groups showed higher values after the test (P0.05). A multiple logistic regression analysis identified female gender, older age and a lower HR before the test as determinants of not achieving 90% of HRmax at the end of the test.The ISWT requires maximal effort in healthy individuals, but for that it is necessary to extend the test beyond twelve levels. Female gender, older age and lower heart rate before the test are the determinants of not reaching maximal effort.

Background: The behaviour of muscle oxygenation and ventilation remains uncharacterised during the 6-minute walking test (6MWT) in healthy adults. Aims: Characterise muscle oxygenation and ventilatory variables throughout a 6MWT in young healthy adults; analyse the relationship between muscle and ventilatory variables and explore whether changes in muscle variables are related to relative exercise intensity during the 6MWT. Methods: 15 young adults took part. Exercise capacity was evaluated with the 6MWT. The vastus lateralis (VL) was assessed using near-infrared spectroscopy (Portamon-Artinis), and the gas exchange using the Oxycon Mobile (Carefusion) before, during and throughout the 6MWT. Results: Muscle variables decreased, while ventilatory variables increased during the 6MWT . Tissue saturation index and deoxihaemoglobin showed a stronger inter-subject association with ventilatory variables and heart rate (r = -0.93 to 0.81) than oxyhaemoglobin and VL blood flow (r = 0.02 to 0.28). Relative exercise intensity (percentage of the predicted maximal heart rate) exhibited a weak relationship with muscular variables (r= 0.19 to 0.40). Conclusions: Walking increased ventilation and decreased VL blood flow. There was a strong negative association between muscle and ventilatory variables. The relative intensity of walking did not influence to the magnitude of changes in muscle variables.

Introduction: In the few studies about exercise performed in water in patients with chronic obstructive pulmonary disease (COPD), training programs vary considerably, making it difficult to compare with the traditional (on land) programs. Objective: To study the effects of two comparable 6-month protocols of high-intensity exercise training in patients with COPD: in water and on land. Methods: Randomized clinical trial involving 36 patients with moderate-to-severe COPD. Assessments performed pre and post-training included monitoring of physical activity in daily life, lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, anxiety, depression and comorbidities. Training protocol in both groups consisted of 6 months of high intensity endurance and strength exercises with time and/or workload gradually increased, summing up 60 sessions. The protocol in water was carefully adapted to generate similar intensity to the protocol on land. Results: After 6 months of training both groups significantly improved inspiratory, expiratory and peripheral muscle strength, exercise capacity, quality of life, functional status and physical activity in daily life (p Conclusion: High-intensity exercise training in water generates similar effects compared to training on land in patients with moderate-to-severe COPD, configuring it as an equally benefitial option to this population.

Objective: To verify whether 30 minutes of rest between two incremental shuttle walking tests (ISWT) are enough for cardiovascular variables and perceived exertion to return to baseline values in healthy subjects in a broad age range. Method: The maximal exercise capacity of 334 apparently healthy subjects (age ≥18) was evaluated using the ISWT. The test was performed twice with 30 minutes of rest in between. Heart rate (HR), arterial blood pressure (ABP), dyspnea, and leg fatigue were evaluated before and after each test. Subjects were allocated to 6 groups according to their age: G1: 18-29 years; G2: 30-39 years; G3: 40-49 years; G4: 50-59 years; G5: 60-69 years and G6: ≥70 years. Results: All groups had a good performance in the ISWT (median >90% of the predicted distance). The initial HR (HRi) of the second ISWT was higher than the first ISWT in the total sample (p

To compare the acute effects of a standardized physiotherapy protocol versus a typical non-standardized physiotherapy protocol on pain and performance of patients undergoing alveolar bone graft (ABG).Sixteen patients (9 males; 12 [11-13] years) with cleft lip and palate undergoing ABG were allocated into two groups: (1) experimental group--EG (standardized physiotherapy protocol); and (2) control group--CG (typical, non-standardized physiotherapy treatment). Range of motion, muscle strength, gait speed, and pain level were assessed prior to surgical intervention (PRE), as well as on the first, second, and third post-operative days (1st, 2nd, and 3rd PO, respectively).Recovery with respect to range of motion of hip flexion was more pronounced in the EG (64.6 ± 11.0°) in comparison to the CG (48.5 ± 17.7° on the 3rd PO; p 0.05). In addition, less pain was observed in the EG (0 [0-0.2] versus 2 [0.7-3] in the CG on the 3rd PO; p 0.05).A standardized physiotherapy protocol appears to be better than a non-standardized physiotherapy protocol for acute improvement of range of motion of hip flexion and for reducing pain in patients undergoing ABG.