Acurácia do teste de escada utilizando o consumo máximo de oxigênio como padrão-ouro

Physical fitness and its correlation with handgrip strength in active community-dwelling older adults

In this cross-sectional study, we assessed the physical fitness levels of active community-dwelling older adults. Moreover, we investigated the correlation of their (stratified by age and sex) fitness levels with handgrip strength (HGS). Comprehensive physical fitness tests, including sarcopenia screening, were conducted with a total of 2,130 older adults residing in a rural area of Taiwan. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of age- and sex-specific physical fitness levels were determined. Furthermore, we identified the key parameters for assessing the physical fitness of older adults and performed stepwise multiple linear regression analysis. Both men and women exhibited age-related decreases in all aspects of functional fitness, a trend indicating that older adults in Taiwan may lose their independence in the future. Furthermore, the regression analysis revealed that HGS was positively correlated with sex, body mass index, and the results of 30-s arm curl and back scratch tests but negatively correlated with age and the result of 8-foot up-and-go test. Our reference values for physical fitness may help assess the fitness levels of active community-dwelling older adults and design community-based health programs to prevent the early loss of independence in community-dwelling older adults in Taiwan.

Chest three-dimensional-computed tomography imaging data analysis for the variation of exercise capacity after lung lobectomy

BACKGROUND

Postoperative loss of exercise capacity and pulmonary function is a major concern among lung cancer patients. In this study, the time for a stair-climbing to 12-m height was used to investigate whether preoperative chest 3D-computed tomography (CT) could be a useful tool for predicting postoperative variations in exercise capacity and pulmonary function.

METHODS

Seventy-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. Preoperatively, lobe volume and low attenuation volume (LAV) were evaluated using the SYNAPSE VINCENT system. Preoperative data on stair-climbing time, spirometry, and diffusing capacity of the lung for carbon monoxide (DL_CO ) at baseline and 6-month postoperative data were used to evaluate variations in exercise capacity and pulmonary function. Maximal oxygen uptake (VO₂ t) was evaluated based on the stair-climbing time.

RESULTS

Significant differences in the variation of exercise capacity at 6 months postoperatively were found between the groups categorized by target lobe volume and LAV status: The large volume/LAV (+) group had a greater decline in VO₂ t. Mean loss of VO₂ t was -6.2%, -1.4%, -1.6%, and -0.1% in the large volume/LAV (+), large volume/LAV (-), small volume/LAV (+), and small volume/LAV (-) groups, respectively. The large volume/LAV (-) group had a greater decline in forced expiratory volume in 1 s. The small volume/LAV (+) group showed a reduced decline in the DL_CO .

CONCLUSIONS

Analysis of chest 3D-CT scans is a potential tool for predicting the loss of exercise capacity and pulmonary function after lung lobectomy. This article is protected by copyright. All rights reserved.

Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: the BELL pragmatic controlled trial

The Ballistic Exercise of the Lower Limb (BELL) trial examined the efficacy and safety of a pragmatic hardstyle kettlebell training program in older adults. Insufficiently active men and women aged 59–79 years, were recruited to a 6-month repeated measures study, involving 3-months usual activity and 3-months progressive hardstyle kettlebell training. Health-related physical fitness outcomes included: grip strength [GS], 6-min walk distance [6MWD], resting heart rate [HR], stair-climb [SC], leg extensor strength [LES], hip extensor strength [HES], Sit-To-Stand [STS], vertical jump [CMVJ], five-times floor transfer [5xFT], 1RM deadlift, body composition (DXA), attendance, and adverse events. Sixteen males (68.8 ± 4.6 yrs, 176.2 ± 7.8 cm, 90.7 ± 11.0 kg, 29.2 ± 2.6 kg/m²) and sixteen females (68.6 ± 4.7 yrs, 163.9 ± 5.4 cm, 70.4 ± 12.7 kg, 26.3 ± 4.9 kg/m²) were recruited. Compliance with the supervised exercise program was very high (91.5%). Kettlebell training increased GS (R: MD = 7.1 kg 95% CI [4.9, 9.3], L: MD = 6.3 kg 95% CI [4.1, 8.4]), 6MWD (41.7 m, 95% CI [17.9, 65.5]), 1RM (16.2 kg, 95% CI [2.4, 30.0]), 30 s STS (3.3 reps, 95% CI [0.9, 5.7]), LES (R: MD = 61.6 N, 95% CI [4.4, 118.8]), HES (L: MD = 21.0 N,95% CI [4.2,37.8]), appendicular skeletal lean mass (MD = 0.65 kg, 95% CI [0.08, 1.22]), self-reported health change (17.1%, 95% CI [4.4, 29.8]) and decreased SC time (2.7 s, 95% CI [0.2, 5.2]), 5xFT time (6.0 s, 95% CI [2.2, 9.8]) and resting HR (7.4 bpm, 95% CI [0.7, 14.1]). There were four non-serious adverse events. Mean individual training load for group training sessions during the trial was 100,977 ± 9,050 kg. High-intensity hardstyle kettlebell training was well tolerated and improved grip strength and measures of health-related physical fitness in insufficiently active older adults.

Trial registration: Prospectively registered: 20/08/2019, Australian New Zealand Clinical Trials Registry (ACTRN12619001177145).

Factors associated with changes in the 12-m stair-climbing time after lung lobectomy

OBJECTIVE

Postoperative loss-of-exercise capacity is one of the main concerns for patients undergoing lung cancer surgery. This study was designed to identify the factors associated with loss-of-exercise capacity after lobectomy, using an easy surrogate measure: the 12-m stair-climbing time (SCt).

METHODS

Ninety-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. SCt and pulmonary function test were evaluated preoperatively as baseline and at 6 months postoperatively. At 6 months postoperatively, 20 patients dropped out. Loss-of-exercise capacity was defined as at least a 3.3% decline (lower quartile) in the estimated maximal oxygen uptake (VO₂t: 43.06 - 0.4 × SCt). Factors associated with loss-of-exercise capacity were analyzed.

RESULTS

Median (interquartile range) baseline SCt was 31.5 (28.2-36.7) s. Baseline SCt was not significantly associated with complications. At 6 months postoperatively, SCt increased by + 4.4 (+ 3.2, + 6.8) s in patients with loss-of-exercise capacity. Sex, smoking status, lobe, procedure, and forced expiratory volume in 1 s showed no significant association with loss-of-exercise capacity. In the multivariable logistic regression, older age (≥ 73 years) (odds ratio: 5.25, 95% confidence interval: 1.50-18.43, p = 0.010) and lower baseline diffusing capacity of the lung for carbon monoxide (< 75%) (odds ratio: 9.23, 95% confidence interval: 1.94-43.93, p = 0.005) were significantly associated with loss-of-exercise capacity.

CONCLUSION

Age and the baseline diffusing capacity of the lung for carbon monoxide were identified as significant variables associated with variation of exercise capacity after lung cancer surgery, using pre- and postoperative SCt.

Measuring physical performance in highly active older adults: associations with age and gender?

BACKGROUND

Higher age is associated with reduced physical capability in the general population. The role of age and gender for physical performance in older adults who exercises regularly is, however, not clear, and there is also a lack of recommendations for outcomes to address physical performance for this population.

AIMS

To explore the associations between physical performance, age and gender, and to examine the suitability and feasibility of clinical field tests for physical performance in active older adults.

METHODS

In this cross-sectional study we included 105 persons, 70-90 years of age, who had exercised regularly for ≥ 12 months. The field tests were Short Physical Performance Battery (SPPB), Timed Up and Go and gait speed for mobility; One-leg standing (OLS) test and Mini-BESTest for balance; Stair test for endurance, 30 s sit-to-stand, and grip strength for muscle strength.

RESULTS

We found associations between age and physical performance, and the associations were slightly stronger for women. Men performed better on tests of muscle strength, balance and endurance, while no gender differences were found in mobility. Grip strength was not associated with mobility tests for men. All tests were feasible, while SPPB and OLS had ceiling and floor effects that limit their suitability in this population.

CONCLUSIONS

Both age and gender were associated with physical performance. We recommend using the gait speed, Mini-BESTest, 30 s sit-to-stand, grip strength and stair tests to assess physical performance in physically active older adults.

Incremental step test in patients with pulmonary hypertension

Cardiopulmonary exercise testing (CPET) on a treadmill or cycle ergometer provides an integrated assessment of the cardiorespiratory system during exertion and is widely used in clinical practice. An incremental step test (IST) can be an alternative for eliciting maximal exercise responses. Therefore, 20 patients with pre-capillary PH (65% female, 41 ± 15 yrs) randomly performed a symptom-limited CPET on a cycle ergometer and IST. Metabolic, cardiovascular, ventilatory and gas exchange variables were recorded during both tests. There was a greater desaturation and higher V̇O_2PEAK in IST compared to CPET. The V̇O_2GET, HR _PEAK (% pred), ΔV̇E/ΔV̇CO₂ and ΔHR/ΔV̇O₂ were similar in both IST and CPET. By linear regression analyses, the work performed on IST [W = (mass × 9,8 m/s2 x vertical distance)] was a predictor of peak V̇O₂ independent of the gender and age (r² = 077, p = 0001). In conclusion, IST elicited higher peak cardiopulmonary responses and has a good agreement with known severity markers in patients with pre-capillary PH.

Step oximetry test: a validation study

Introduction

Step climbing is a potentially useful modality for testing exercise capacity. However, there are significant variations between test protocols and lack of consistent validation against gold standard cycle ergometry cardiopulmonary exercise testing (CPET). The purpose of the study was to validate a novel technique of exercise testing using a dedicated device.

Methods

We built a step oximetry device from an adapted aerobics step and pulse oximeter connected to a computer. Subjects performed lung function tests, a standard incremental cycle CPET and also a CPET while stepping on and off the step oximetry device to maximal exertion. Data from the step oximetry device were processed and correlated with standard measurements of pulmonary function and cycle CPET.

Results

We recruited 89 subjects (57 years, 50 men). Oxygen uptake (VO₂) was 0.9 mL/kg/min (95% CI −3.6 to 5.4) higher in the step test compared with the gold standard cycle CPET, p<0.001. VO₂ in the two techniques was highly correlated (R=0.87, p<0.001). Work rate during stair climbing showed the best correlation with VO₂ (R=0.69, p<0.0001). Desaturation during step climbing correlated negatively with diffusion capacity for carbon monoxide (r=−0.43, p<0.005). No adverse events occurred.

Conclusions

The step oximetry test was a maximal test of exertion in the subjects studied, achieving slightly higher VO₂ than during the standard test. The test was safe to perform and well tolerated by the patients. Parameters derived from the step oximetry device correlated well with gold standard measurements. The step oximetry test could become a useful and standardisable exercise test for clinical settings where advanced testing is not available or appropriate.

Validity of the six-minute step test of free cadence in patients with chronic obstructive pulmonary disease

Objectives:

to evaluate the concurrent validity of the six-minute step test (6MST) in assessing exercise capacity of COPD patients using the six-minute walk test (6MWT) as a gold-standard. The predictive validity of the 6MST was assessed to determine a cut-off point for identification of low exercise capacity.

Method:

thirty-two COPD patients (50-87 years old) with mild to very severe obstruction performed the 6MST and 6MWT twice.

Results:

Concurrent validity: a strong positive correlation (Pearson) between the number of ascents on the first (T1), second (T2) and the best of both (T1 or T2) tests during the 6MWT was observed. Although a moderate negative correlation with BODE index and FEV₁ was found, it was considered insufficient to test the validity, therefore ROC curves were not applied. The predictive validity (ROC) of the 6MST to identify low physical capacity (compared with the 6MWT) using the performance of T1 or T2, or solely T1 was considered accurate, and the area under the curve was 0.8 (IC95% 0.62-0.98) and 0.85 (IC95% 0.70-0.99), respectively. To classify patients, the cut-off points of 86 and 78 steps were chosen, with both values showing 90% of sensitivity and specificity of 64% and 68% for T1 or T2, or solely T1, respectively.

Conclusion:

The number of steps on the 6MST was valid to verify exercise capacity in COPD patients and the cut-off point of 78 steps was able to identify patients with poor exercise tolerance. Values under this cut-off point are considered to identify patients with a poorer prognosis.

Implementing international osteoarthritis treatment guidelines in primary health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial

BACKGROUND

Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8-12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model.

METHODS/DESIGN

A cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants' treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER).

DISCUSSION

The results from the present study will add to the current knowledge on tailored strategies, which aims to improve the uptake of evidence-based OA care recommendations and improve the quality of OA care in primary health care. The new knowledge can be used in national and international initiatives designed to improve the quality of OA care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02333656.

Fixed-altitude stair-climbing test replacing the conventional symptom-limited test. A pilot study

INTRODUCTION

The objective of this study was to investigate whether a patient's maximum capacity is comparable in 2 different stair-climbing tests, allowing the simplest to be used in clinical practice.

METHOD

Prospective, observational study of repeated measures on 33 consecutive patients scheduled for lung resection. Stair-climbing tests were: the standard test (climb to 27 m) and the alternative fixed-altitude test (climb to 12 m). In both cases, heart rate and oxygen saturation were monitored before and after the test. The power output of stair-climbing for each test (Watt1 for the standard and Watt2 for the fixed-altitude test) was calculated using the following equation: Power (watt)=weight (kg)*9.8*height (m)/time (sec). Concordance between tests was evaluated using a regression model and the residuals were plotted against Watt1. Finally, power output values were analyzed using a Bland-Altman plot.

RESULTS

Twenty-one male and 12 female patients (mean age 63.2±11.2) completed both tests. Only 12 patients finished the standard test, while all finished the fixed-altitude test. Mean power output values were Watt1: 184.1±65 and Watt2: 214.5±75.1. The coefficient of determination (R(2)) in the linear regression was 0.67. No fixed bias was detected after plotting the residuals. The Bland-Altman plot showed that 32 out of 33 values were within 2 standard deviations of the differences between methods.

CONCLUSIONS

The results of this study show a reasonable level of concordance between both stair-climbing tests. The standard test can be replaced by the fixed-altitude test up to 12 m.

Correlation between functional capacity and health-related quality of life in COPD: a case series

Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson's (parametric data) or Spearman's (non-parametric data) rank tests, with p < 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

Health-related physical fitness measures: reference values and reference equations for use in clinical practice

OBJECTIVE

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice.

DESIGN

Cross-sectional design.

SETTING

General community.

PARTICIPANTS

Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test).

RESULTS

The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age.

CONCLUSIONS

The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.

Measuring health-related physical fitness in physiotherapy practice: reliability, validity, and feasibility of clinical field tests and a patient-reported measure

STUDY DESIGN

A cross-sectional study with a test-retest design.

OBJECTIVES

To assess measurement properties of the physical fitness questionnaire, the 6-minute walk test, the stair test, the hand-grip test, the 30-second sit-to-stand test, and the fingertip-to-floor test in patients with various musculoskeletal conditions (MSCs).

BACKGROUND

Patients suffering from MSCs tend to be more deconditioned and less physically active than healthy people. Physiotherapists should, therefore, focus on health-related physical fitness in addition to their patients' specific MSCs to offer optimal treatment. To enable good decision making, a core set of feasible measures with acceptable measurement properties is needed.

METHODS

Eighty-one patients with MSCs (57.6 ± 14.2 years of age) were recruited from outpatient physiotherapy clinics. Relative reliability was analyzed with intraclass correlation coefficient model 2,1, and absolute reliability with standard error of measurement and smallest detectable change. Construct validity was assessed with a priori hypotheses. Time spent and assistance needed to accomplish the measures were used to assess feasibility.

RESULTS

The 6-minute walk test, the hand-grip test, and the physical fitness questionnaire showed acceptable reliability (49 m, 4 kg, and 2 points, respectively) and construct validity. The stair test showed acceptable reliability (8 seconds) but not validity. The 30-second sit-to-stand test showed acceptable validity but not reliability (4 sit-to-stands), whereas the fingertip-to-floor test showed neither acceptable reliability (9 cm) nor validity.

CONCLUSION

The 6-minute walk test, the hand-grip test, and the physical fitness questionnaire can be recommended as a core set of reliable and valid measures to assess health-related physical fitness in patients with various MSCs.

ADD, Di Lorenzo VAP. Comparação de diferentes testes funcionais de membros inferiores em pacientes com doença pulmonar obstrutiva crônica: há concordância entre eles?

INTRODUÇÃO: Pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) apresentam diminuição da capacidade funcional, tornando imprescindível a sua avaliação por meio de testes físicos funcionais. OBJETIVOS: Comparar, em pacientes com DPOC, saturação periférica de oxigênio (SpO2), dispneia e fadiga de membros inferiores (MMII) nos testes de caminhada de seis minutos em corredor (TC6) e em pista oval (TC6Po), do degrau de seis minutos (TD6) e de sentar-e-levantar da cadeira de dois minutos (TSL). Além disso, pretende-se verificar se há correlação e concordância dessas variáveis entre o TC6 e os demais testes. MATERIAIS E MÉTODOS: Foram avaliados 11 pacientes com DPOC (71 ± 8 anos, VEF1 < 80% previsto) por meio dos testes. RESULTADOS: Na análise intertestes, não se observaram diferenças significativas nos deltas da SpO2, dispneia (Δdispneia) e fadiga de MMII (ΔfadigaMMII). Constatou-se correlação significante, mas não concordância entre os menores valores da SpO2 no TC6 com os menores valores da SpO2 nos TC6Po, TD6 e TSL, sendo a média da diferença entre as médias com ± 1,96 desvio padrão: 0,8 ± 3,5; -1,9 ± 3,5 e -2,5 ± 4,6, respectivamente; entre Δdispneia e ΔfadigaMMII no TC6 com Δdispneia e ΔfadigaMMII no TC6Po: 0,0 ± 1,0 e 0,4 ± 0,8, respectivamente; e do ΔfadigaMMII no TC6 com ΔfadigaMMII no TSL: 0,1 ± 1,1. CONCLUSÃO: Os testes funcionais produziram respostas de oxigenação e perceptuais de esforço semelhantes em magnitude. Entretanto, de acordo com as variáveis analisadas, não foi encontrada concordância entre o TC6 com os demais testes, pelas grandes variações dos limites de concordância e grande variação interindividual, assim o TC6Po, TD6 e TSL não substitui o TC6.

Efeitos do estímulo verbal sobre o desempenho no teste de escada e ajustes cardiorrespiratórios em sujeitos saudáveis

Esta pesquisa teve o objetivo de avaliar os efeitos do estímulo verbal (EV) no tempo do teste de escada (TEsc) e nas variáveis cardiorrespiratórias de adultos saudáveis. Trinta e um adultos saudáveis realizaram dois TEsc (com EV e sem EV). Antes e depois de cada teste, foram avaliados os sinais vitais e a Escala de Borg. Os tempos nos TEsc foram comparados por meio do Teste t de Student para amostras pareadas e as diferenças, de acordo com a ordem de realização dos testes utilizando o Teste de Mann-Whitney. Os sinais vitais e a Escala de Borg foram comparados por meio do Teste de Friedman ou ANOVA com post hoc do Teste de Tukey. As variações foram comparadas utilizando o Teste t Student para amostras independentes ou Teste de Mann-Whitney (p<0,05). O tempo no TEsc sem EV foi de 23,48±8,28 segundos, significativamente maior que o teste com EV, que foi de 21,60±7,18 segundos (p<0,05). Todas as variáveis aumentaram após os testes, e a Escala de Borg foi a única que teve maior variação no TEsc com EV, variando 2,5±1,4 no teste sem estímulo e 3,0±1,8 pontos no com estímulo (p<0,05). O estímulo verbal melhora o desempenho no TEsc e leva à maior sensação de esforço.

Comparação das variáveis fisiológicas no teste de caminhada de seis minutos e no teste da escada em portadores de doença pulmonar obstrutiva crônica

INTRODUÇÃO: A intolerância ao exercício prejudica a realização das atividades de vida diária em portadores de doença pulmonar obstrutiva crônica (DPOC) e a avaliação dessa limitação é fundamental. Objetivo: Comparar o teste de caminhada dos seis minutos (TC6') com o teste da escada (TE) em portadores de DPOC. MÉTODOS: Prospectivo composto por 21 pacientes portadores de DPOC avaliados para um programa de reabilitação pulmonar que realizaram o TC6' e o TE. As variáveis fisiológicas frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2), além da escala de Borg modificada, foram aferidas antes e após cada teste. A distância percorrida era medida ao término de ambos os testes. RESULTADOS: Comparando os momentos (inicial versus final) das variáveis fisiológicas de ambos os testes, foi observado no TC6' (FC 81,1 ± 2,6 versus 98,4 ± 4,4; SpO2 94,9 ± 2,2 versus 90,4 ± 5,0; PSE Borg 0,5 ± 0,8 versus 3,6 ± 2,5) e no TE (FC 86,9 ± 18,8 versus 119,3 ± 14,5; SpO2 94,7 ± 2,5 versus 90,1 ± 4,5; PSE Borg 0,2 ± 0,4 versus 7,0 ± 2,3), sendo que todas as variações foram estatisticamente significativas (p < 0,001) em ambos os testes. Quando avaliada a alteração das variáveis em ambos os testes, verificou-se que a SpO2 obteve redução semelhante (p = 0,912), a FC aumentou significativamente mais no TE (p = 0,006), bem como a PSE Borg (p < 0,001). Em relação à distância percorrida, o TC6' permitiu que os participantes percorressem uma distância significativamente maior do que o TE (404m versus 153m; p < 0,001) CONCLUSÃO: Ambos os testes promoveram alterações fisiológicas significativas. Apesar de o TE representar uma distância significativamente menor, a sobrecarga, bem como a percepção de trabalho, foi significativamente maior.

Teste do degrau e teste da cadeira: comportamento das respostas metábolo-ventilatórias e cardiovasculares na DPOC

OBJETIVOS: Verificar as respostas metabólicas, ventilatórias, cardiovasculares e de percepção de esforço entre o isotime de dois minutos do teste do degrau (TD2) e o teste do degrau de seis minutos (TD6) com o teste de sentar-se e levantar-se da cadeira de dois minutos (TSL) nos indivíduos com DPOC. MATERIAIS E MÉTODOS: Foram avaliados 11 homens com DPOC (71 ± 8 anos, VEF1 = 46,1 ± 15,2% previsto), clinicamente estáveis, por meio do TD6 e TSL associados à análise de gases e à coleta de lactato sanguíneo, realizadas em dias diferentes e não consecutivos. No TD2 e TD6, os indivíduos foram instruídos a subir e descer um degrau de 20 cm de altura o mais rápido possível. O mesmo foi recomendado no TSL, que foi realizado em uma cadeira de 46 cm de altura. RESULTADOS:Na análise intertestes não se observou diferença significativa nas variáveis metábolo-ventilatórias, cardiovasculares e Δdispneia no pico de ambos os testes, bem como no TD2. Quanto ao Δfrequκncia cardíaca e ao Δfadiga nos membros inferiores, constataram-se valores significantemente maiores para o TSL comparado ao TD2; e correlações positivas entre o consumo de oxigênio, Δfrequência cardíaca e os desempenhos no TD2 e TD6, entre os desempenhos no TD6 e TSL, e no TD2 com TSL. CONCLUSÃO:Os testes realizados apresentaram respostas metábolo-ventilatórias, cardiovasculares e dispneia similares; e o TD2 mostrou-se uma alternativa para avaliar as limitações funcionais dos indivíduos com DPOC de obstrução grave, proporcionando menor estresse cardiovascular e fadiga muscular se comparado ao TSL, pelas exigências metabólicas periféricas e ajustes posturais.

Functional performance and muscle strength phenotypes in men and women with Danon disease

Danon disease is a rare X-linked myopathy that is characterized clinically by a triad of cardiomyopathy, skeletal myopathy, and cognitive impairment. The purpose of this investigation was to quantify functional performance, muscle weakness, and quadriceps activation in individuals with Danon disease as compared with healthy individuals. Four males (ages 10-34 years) and 4 females (ages 16-50 years), with the genetic markers of Danon disease, were compared with 8 healthy males (ages 22-34 years) and 8 healthy females (ages 23-41 years) and previously reported norms. Affected males and females had decreased functional performance, significant generalized muscle weakness, and decreased quadriceps strength and activation when compared with healthy individuals. Affected males had larger deficits in function, strength, and activation when compared with affected females. The results indicate that, although the presentation of Danon disease is variable and is typically only described in males, muscle weakness patterns exist in both affected males and females.