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- ItemAcesso aberto (Open Access)Avaliação da capacidade de exercício em portadores de doença pulmonar obstrutiva crônica: comparação do teste de caminhada com carga progressiva com o teste de caminhada com acompanhamento(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-04-01) Rosa, Fernanda Warken [UNIFESP]; Camelier, Aquiles Assunção [UNIFESP]; Mayer, Anamaria [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. METHODS: A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. RESULTS: The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 ± 11.4%) than on the shuttle walk test (76.4 ± 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 ± 89.3 meters on the shuttle walk test and 515.5 ± 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). CONCLUSION: The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.
- ItemSomente MetadadadosAvaliação da capacidade funcional de exercício de pacientes com escoliose idiopática do adolescente no pós-operatório tardio(Universidade Federal de São Paulo (UNIFESP), 2015-09-10) Araujo, Geferson da Silva [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; http://lattes.cnpq.br/0334734747375995; http://lattes.cnpq.br/0206111611571178; Universidade Federal de São Paulo (UNIFESP)Patients with Adolescent Idiopathic Scoliosis (AIS) show reduced exercise functional capacity during the Incremental Shuttle Walk Test (ISWT), however, the effect of surgical procedure about this test isn?t known. Objective: To evaluate the Incremental Shuttle Walk Distance (ISWD) and physiological responses during ISWT in AIS patients in the late postoperative period. Simultaneously, we aimed to assess the respiratory muscle strength, lung function and to correlate the variables with Cobb angles. Methods: This study included twenty two adolescents with AIS in AIS Group (AG) and twenty one healthy subjects in Control Group (CG). In the first instance we evaluated: maximal inspiratory and expiratory pressures (MIP and MEP), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Two ISWT were performed, but only second ISWD was analised. During the second test was used a gas analyzer to assess: Peak oxigen uptake (VO2), carbon dioxide output (VCO2), tidal volume (VT), respiratory rate (RR), heart rate (HR) and relations. Results: Significantly lower values were observed in AG for variables: VO2 (22 ± 5 vs. 27 ± 4 ml/kg/min), ISWD (567 ± 94 vs.604 ± 86m), FVC (2,70 ± 0,47 vs. 3,33 ± 0,52L) e FEV1 (2,41 ± 0,46 vs. 2,84 ± 0,52 L). There were no differences for MIP and MEP. There were significant correlations between ISWD, VO2 (r = 0,70) and VO2/Kg (r = 0,80), moreover, there were correlations between VO2 and OUES (Oxigen Uptake Efficiency Slope) with breathing pattern (r = 0,51 e r = 0,65, respectively), but it was significantly lower in AG. Moderate correlations were observed between VO2 and OUES (r = 0,67), furthermore, there were moderate correlations between main thoracic curve with VO2 (r = -0,41) and VO2/Kg (r= -0,61). Conclusion: AIS patients in the late postoperative period have significantly reduced exercise functional capacity associated with reduced lung function, residual spinal curve and cardiovascular deconditioning.
- ItemSomente MetadadadosCan bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?(Soc Brasileira Pneumologia Tisiologia, 2014-03-01) Scuarcialupi, Maria Enedina Aquino; Berton, Danilo Cortozi; Cordoni, Priscila Kessar; Squassoni, Selma Denis; Fiss, Elie; Neder, Jose Alberto [UNIFESP]; Fac Ciencias Med Paraiba; Univ Fed Rio Grande do Sul; Fac Med ABC; Queens Univ; Kingston Gen Hosp; Universidade Federal de São Paulo (UNIFESP)Objective: To investigate the modulatory effects that dynamic hyperinflation (UFO, defined as a reduction in inspiratory capacity (lC), has on exercise tolerance after bronchodilator in patients with COPD. Methods: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometiy and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed Delta lC(peak-rest) < 0 were considered to present with DH (DH+). Results: In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without Did (DH-). Despite equivalent improvement in FEV1 after bronchodilator, the DH- group showed higher Delta lC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to Delta lC at peak exercise between DH+ and DH- groups (0.19 +/- 0.17 L vs. 0.17 +/- 0.15 L, p > 0.05). in addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60% vs. 10% [3-53%]; p > 0.05). Conclusions: Improvement in TLim was associated with an increase in lC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise.
- ItemAcesso aberto (Open Access)Caracterização da tolerância e das respostas fisiológicas a diferentes protocolos de exercício intervalado de alta intensidade em pacientes com doença pulmonar obstrutiva crônica(Universidade Federal de São Paulo (UNIFESP), 2016-05-31) Bravo, Daniela Manzoli [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; http://lattes.cnpq.br/2605106957934146; http://lattes.cnpq.br/5017859596514768; Universidade Federal de São Paulo (UNIFESP)to the limit of tolerance (Tlim) or up to 30 min: a CWE test at 75-80% of the previously-determined peak work rate (WR); and four HIIE tests with 100% peak WR during high-intensity bouts, in which both duty cycle duration (30s/60s vs. 60s/120s) and relief interval intensity (free wheel (FW) or 40% peak WR) were applied: i) EI 1 - 30s/60s interspersed with FW; ii) EI 2 - 30s/60s interspersed with 40% peak WR; iii) EI 3 - 60s s interspersed with FW and iv)E - s s interspersed with pea W . he following variables were evaluated dyspnoea and leg fatigue symptoms ventilation E and ventilatory reserve E maximal voluntary ventilation (MVV)); operating lung volumes (end inspiratory lung volume (EILV)/total lung capacity (TLC) and inspiratory residual volume (IRV)); respiratory gas exchange (oxygen consumption ( O2) and carbon dioxide production ( O2)); arterialized blood lactate; heart rate (HR) and non-invasive cardiac output. Results: CWE presented with lower Tlim and total work performed than all HIIE protocols and higher metabolic ( O2, O2 and blood lactate), cardiovascular (HR) and ventilatory (higher E, lower E/ CO2) responses, lower SpO2 and a steeper increase in symptoms than EI 1 and EI 3 protocols. Furthermore, CWE lead to higher ventilatory limitation (higher E/MVV and EILV/TLC and lower IRV) than EI 1 protocol. EI 1 presented with lower metabolic O2 O2 and blood lactate), cardiovascular (HR) and ventilatory responses, with lower ventilatory constraints (lower EILV/TLC and higher IRV) than EI 2 and EI 4 protocols. EI 1 and EI 3 were tolerated up to 30 minutes in 14 (87%) and 13 (81%) patients, respectively; with higher time spent at high-intensity bouts than EI 2 protocol. Nine (56%) patients did not tolerate EI 2 and EI 4 protocols, with higher ventilatory constraints (higher EILV/TLC and lower IRV) at the end of exercise and a steeper increase in blood lactate, CO2, E and symptoms during exercise than patients who tolerate these protocols. Conclusions: HIIE protocols were more tolerated than high-intensity CWE in our COPD patients. Duty cycle duration did not affect tolerance to HIIE. However, loaded exercise in-between the high-intensity bouts increased metabolic, cardiovascular and ventilatory responses to exercise and reduced tolerance to HIIE in a substantial percentage of patients who presented with higher ventilatory constraints.
- ItemSomente MetadadadosConstant Work-Rate Test to Assess the Effects of Intradialytic Aerobic Training in Mildly Impaired Patients With End-Stage Renal Disease: A Randomized Controlled Trial(Elsevier B.V., 2011-12-01) Reboredo, Maycon M.; Neder, J. Alberto [UNIFESP]; Pinheiro, Bruno V.; Henrique, Diane M.; Faria, Ruiter S.; Paula, Rogerio B.; Univ Fed Juiz de Fora; Fed Inst Educ Sci & Technol SE Minas Gerais; Universidade Federal de São Paulo (UNIFESP)Objective: To investigate if high-intensity constant work rate (CWR) would constitute a more appropriate testing strategy compared with incremental work rate (IWR) to assess the effectiveness of intradialytic aerobic training in patients with end-stage renal disease (ESRD).Design: Randomized controlled trial.Setting: Nephrology unit at the university hospital.Participants: Patients (N=28; 47.0 +/- 11.9y) under hemodialysis (4.4 +/- 4.3y) were randomly assigned to exercise and control groups.Intervention: Patients included in the exercise group underwent a moderate-intensity intradialytic aerobic training program 3 times per week for 12 weeks.Main Outcome Measures: Cardiopulmonary and perceptual responses were obtained during an IWR and a high-intensity CWR test to the limit of tolerance on a cycle ergometer.Results: Training-induced increases in peak oxygen uptake (Vo(2)peak) and time to exercise intolerance (Tlim). Mean improvement in Tlim (97.4%+/- 75.6%) was significantly higher than increases in Vo(2)peak (12%+/- 11.3%) (P<.01); in fact, while Tlim improved 50% to 200% in 9 of 12 patients, Vo(2)peak increases were typically in the 15% to 20% range. CWR test revealed lower metabolic, ventilatory, cardiovascular, and subjective stresses at isotime; in contrast, submaximal responses during the incremental work rate (at the gas exchange threshold) remained unaltered after training.Conclusions: A laboratory-based measure of endurance exercise capacity (high-intensity CWR test to Thin) was substantially more sensitive than oxygen uptake at the peak IWR test to unravel the physiologic benefits of an intradialytic aerobic training program in mildly impaired patients with ESRD.
- ItemAcesso aberto (Open Access)Effect of L-carnitine on exercise performance in patients with mitochondrial myopathy(Associação Brasileira de Divulgação Científica, 2015-01-01) Gimenes, Ana Cristina Oliveira [UNIFESP]; Bravo, Daniela Manzoli [UNIFESP]; Nápolis, Lara Maris [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Exercise intolerance due to impaired oxidative metabolism is a prominent symptom in patients with mitochondrial myopathy (MM), but it is still uncertain whether L-carnitine supplementation is beneficial for patients with MM. The aim of our study was to investigate the effects of L-carnitine on exercise performance in MM. Twelve MM subjects (mean age±SD=35.4±10.8 years) with chronic progressive external ophthalmoplegia (CPEO) were first compared to 10 healthy controls (mean age±SD=29±7.8 years) before they were randomly assigned to receive L-carnitine supplementation (3 g/daily) or placebo in a double-blind crossover design. Clinical status, body composition, respiratory function tests, peripheral muscle strength (isokinetic and isometric torque) and cardiopulmonary exercise tests (incremental to peak exercise and at 70% of maximal), constant work rate (CWR) exercise test, to the limit of tolerance [Tlim]) were assessed after 2 months of L-carnitine/placebo administration. Patients with MM presented with lower mean height, total body weight, fat-free mass, and peripheral muscle strength compared to controls in the pre-test evaluation. After L-carnitine supplementation, the patients with MM significantly improved their Tlim (14±1.9 vs 11±1.4 min) and oxygen consumption ( V ˙ O 2 ) at CWR exercise, both at isotime (1151±115 vs 1049±104 mL/min) and at Tlim (1223±114 vs 1060±108 mL/min). These results indicate that L-carnitine supplementation may improve aerobic capacity and exercise tolerance during high-intensity CWRs in MM patients with CPEO.
- ItemSomente MetadadadosIncremental shuttle and six-minute walking tests in the assessment of functional capacity in chronic heart failure(Elsevier B.V., 2008-02-01) Pulz, Cristiane [UNIFESP]; Diniz, Rosiane Viana Zuza [UNIFESP]; Alves, Alexandre N. Ferreira [UNIFESP]; Tebexreni, Antonio Sergio [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The incremental shuttle test presents some theoretical advantages over the six-minute walk test in chronic heart failure (CHF), including better standardization and less dependency on collaboration.OBJECTIVES: The present study evaluated test-retest repeatability, test accuracy in predicting a peak oxygen consumption (VO(2)) of 14 mL/kg/min or less, as well as the prognostic value of both walking tests in stable CHF patients.METHODS: Sixty-three patients (44 men; New York Heart Association functional class II to IV) underwent an incremental treadmill exercise test and, on another day, the walk test in duplicate.RESULTS: Patients showed well-preserved functional capacity according to the distance walked in both tests (six-minute walk test 491 +/- 94 in versus incremental shuttle walk test 422 +/- 119 in; P < 0.001). Interestingly, the six-minute and incremental shuttle walk test differences in distance walked were higher in more disabled patients. The mean bias 95% CI of the within,test differences were similar (7 +/- 40 m and 8 +/- 45 in, respectively). Peak VO(2), but not distance walked in either test, was associated with survival (P < 0.05).CONCLUSIONS: The incremental shuttle walk test showed similar repeatability and accuracy in estimating peak VO(2) compared with the six-minute walk test in CHF patients. Direct measurement of peak VO(2), however, remains superior to either walking test in predicting survival - at least in patients with well-preserved functional capacity.
- ItemAcesso aberto (Open Access)Influência do índice de massa corpórea, porcentagem de gordura corporal e idade da menarca sobre a capacidade aeróbia (VO2 máx) de alunas do ensino fundamental(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2014-02-01) Capel, Tiago Leoni; Vaisberg, Mauro [UNIFESP]; Araujo, Maita Poli de; Paiva, Roberta Foster Leonidas de; Santos, Juliana de Melo Batista dos; Bella, Zsuzsanna Ilona Katalin de Jarmy-di; Universidade Federal de São Paulo (UNIFESP)PURPOSE:To identify and relate body fat percentage (skin fold measures), body mass index (BMI) and age at menarcheto aerobic capacity using the indirect VO2 maximum value (VO2 max) of girls in the second cycle of primary school.METHODS:A total of 197 girls aged 13.0±1.2 years on average, students from two public schools in the city of Atibaia in São Paulo, were evaluated. Anthropometric evaluation of skin folds was performed using the Slaughter protocol for teenage girls, and BMI (kg/m2) was based on Z score (graphic of percentile) according to WHO recommendations. The Léger protocol was used to determine VO2 max. Pearson linear regression and the Student t-test were used for statistical analysis.RESULTS:22.3% of the girls were overweight and 3.5% were obese according to the classification proposed by the WHO; 140 (71.1%) girls reported menarche. The average age at menarche was 12.0±1.0 years and was significantly higher in the group with normal BMI (12.2±0.9 years) than in the overweight or obese groups (11.6±1.0 years). The average indirect VO2 max value was 39.6±3.7 mL/kg/min, ranging from 30.3 to 50.5 mL/kg/min. The advance of chronological age and early age at menarche were positively correlated with lower VO2 max values.CONCLUSIONS:This study showed that 25.8% of the girls had aBMI value above WHO recommendations. Girls with higher BMI and higher body fat percentage had lower VO2 max. The earlier age at menarche and the advance of chronological age were the most important factors for the reduction of aerobic capacity. The ageat menarche was higher in girls with adequate BMI compared tooverweight or obese girls.
- ItemAcesso aberto (Open Access)A symptom-limited incremental step test determines maximum physiological responses in patients with chronic obstructive pulmonary disease(W B Saunders Co Ltd, 2013-12-01) Dal Corso, Simone [UNIFESP]; Camargo, Anderson Alves de; Izbicki, Meyer [UNIFESP]; Malaguti, Carla [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Univ Nove Julho UNINOVE; Universidade Federal de São Paulo (UNIFESP); Univ Fed Juiz de ForaBackground: Step tests have been used to evaluate exercise tolerance and effort-related hypoxemia in different diseases. A symptom-limited incremental step test (IST) has never been tested in COPD patients.Aim: To compare maximal physiological responses between an IST and cardiopulmonary exercise testing (CPET), to test the reproducibility of the IST on different days, and to provide a predict equation to estimate VO2 from the IST in patients with COPD.Material and methods: At the same day, thirty-four patients (VEF1 46 +/- 14% of pred) underwent a CPET on cycle ergometer and the first 151 (IST-1) (1 h apart). After 2-5 days, patients repeated the IST (IST-2). Pulmonary gas exchange was measured during all tests.Results: Peak VO2 was significantly higher in IST-1 and IST-2 than in CEPT (Mean +/- SD: 1.19 +/- 0.39 L, 1.20 +/- 0.40 L, 1.07 +/- 0.35 L) with no difference for ventilation (VE), heart rate (HR), and perception of effort. ISTs were highly reproducible, with significant intraclass correlation coefficient (CCI [95% confidence interval]) for number of steps (0.98[0.95-0.99]), VO2 (0.99 [0.98-0.99]), VE (0.97[0.93-0.99]), HR (0.92[0.81-0.97]), and SpO(2) (0.96[0.90-0.98]). Desaturation was significantly higher for IST-1 and IST-2 compared with cycling (Mean +/- SD: -6 +/- 5%, -6 +/- 4%, - 3 +/- 3%). Number of steps and patient weight explained 81% of the variance in peak VO2 (p < 0.001).Conclusion: A symptom-limited incremental step test, externally paced, elicits maximal cardiopulmonary and metabolic responses, and is well tolerated and reproducible in patients with COPD. (C) 2013 Elsevier B.V. All rights reserved.