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- ItemAcesso aberto (Open Access)Addition of tiotropium to formoterol improves inspiratory muscle strength after exercise in COPD(W B Saunders Co Ltd, 2012-10-01) Canto, Nívea Dias do; Ribeiro, Jorge Pinto; Neder, José Alberto [UNIFESP]; Chiappa, Gaspar Rogério da; Hosp Clin Porto Alegre; Univ So Santa Catarina; Univ Fed Rio Grande do Sul; Universidade Federal de São Paulo (UNIFESP)Background: the addition of tiotropium bromide (110) to formoterol fumarate (FOR) improves exercise performance in patients with chronic obstructive pulmonary disease (COPD). in this study, we test the hypothesis that the addition of TIO to for may improve respiratory muscle performance and oxygen uptake kinetics after exercise in patients with COPD.Methods: Thirty eight patients with COPD were randomized to a 2 week treatment with for 12 mu g twice a day plus TIO 18 mu g once a day (FOR + TIO) or for 12 mu g twice a day plus placebo (FOR + PLA) once a day, using a double-blind crossover design. Inspiratory muscle. Strength was measured before, immediately after, as well as 2, 5, and 10 min during recovery of exercise. Time to limit of tolerance on a constant work load exercise test and oxygen uptake kinetics during recovery were evaluated before and after intervention.Results: Only for + TIO improved resting (63 +/- 10 cm to 84 +/- 11 cmH(2)O) and post-exercise (49 +/- 7 cm to 84 +/- 11 cmH(2)O) maximal inspiratory pressure. Time to limit of tolerance on the constant work load test was increased by for + PLA and by for + TIO, but the size of the increment was significantly larger with for + TIO (40.7 +/- 7.6% vs. 84.5 +/- 8.2%; p < 0.05). Only for + TIO improved oxygen uptake kinetics during recovery (69 +/- 21 to 60 +/- 18s). the improvement in maximal inspiratory pressure (0.78, p < 0.001) and in oxygen uptake kinetics (-0.91, p < 0.001) correlated with the change in time to the limit of tolerance.Conclusions: the addition of TIO to for improves inspiratory muscle strength and oxygen uptake kinetics after exercise in COPD patients. (C) 2012 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Efeitos da aplicação da Kinesio Taping nos músculos respiratórios: revisão integrativa(Universidade Federal de São Paulo, 2023-01-06) Schiavoni, Larissa Cristina [UNIFESP]; Yamauchi, Liria Yuri [UNIFESP]; Oliveira, Daianny Seoni de [UNIFESP]; http://lattes.cnpq.br/4811679938448350; http://lattes.cnpq.br/3898949209852523; http://lattes.cnpq.br/8129243788327888; Universidade Federal de São Paulo (UNIFESP)Introdução. O diafragma é o principal músculo respiratório e doenças que interferem em sua inervação, propriedade contrátil ou em seu acoplamento mecânico à caixa torácica podem ocasionar a disfunção diafragmática. Vários mecanismos fisiopatológicos da DPOC assim como tempo prolongado de ventilação mecânica se envolvem neste processo de comprometimento da função diafragmática. A técnica de Kinesio tape (KT) , desenvolvida pelo quiropraxista japonês Kenzo Kase, quando colocada sobre a pele fornece sustentação às articulações e aos músculos. Estudos acerca dos efeitos da Kinesio, em condições variadas, tem mostrado resultados benéficos de sua aplicação na musculatura respiratória. Objetivo. Realizar uma revisão integrativa de projetos experimentais e não experimentais para a compreensão completa dos efeitos da aplicação técnica de Kinesio taping nos músculos respiratórios. Método. Foi realizada uma busca nas bases de dados: LILACS, BVS, PubMed, Web of Science e PEDro. Foram utilizados, para busca dos artigos, os seguintes descritores e suas combinações nas línguas portuguesa e inglesa: “função respiratória”, “disfunção respiratória”, “insuficiência respiratória” e “kinesio tape”. Os critérios de inclusão definidos para a seleção dos artigos foram: artigos publicados em português, inglês e espanhol; artigos na íntegra que retratassem a temática referente a revisão integrativa e artigos publicados e indexados nos referidos bancos de dados nos últimos 30 anos. Resultados. Foram incluídos 6 artigos, dos quais 3 estudaram a população com DPOC, 2 estudaram pacientes oncológicos e 1 estudou com pacientes saudáveis. Os artigos mostram influência da KT nos valores de VEF1 e pico de fluxo expirarório, dispneia e dor , mas não em força muscular respiratória, saturação de oxigênio, e capacidade inspiratória. Conclusão. Essa revisão conclui que a KT parece melhorar valores de pico de fluxo, assim como os de VEF1. Não foram encontradas evidências de efeitos acerca da força muscular respiratória ou na capacidade inspiratória. Os efeitos placebos da intervenção também necessitam de mais investigações.
- ItemAcesso aberto (Open Access)Força dos músculos respiratórios em crianças e adolescentes com asma: similar à de indivíduos saudáveis?(Sociedade Brasileira de Pneumologia e Tisiologia, 2012-06-01) Oliveira, Cilmery Marly Gabriel de [UNIFESP]; Lanza, Fernanda de Cordoba [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas; Universidade Nove de Julho Programa de Pós-Graduação em Ciências da Reabilitação; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To compare children/adolescents with mild or moderate asthma and healthy subjects in terms of respiratory muscle strength, correlating it with spirometric variables in the former group. METHODS: This was a cross-sectional study involving individuals 6-16 years of age and clinically diagnosed with mild/moderate asthma, together with a group of healthy, age- and gender-matched subjects. We determined spirometric values, as well as MIP and MEP, and we selected three reproducible measurements (variation < 10%). RESULTS: We evaluated 75 patients with asthma and 90 controls. The mean age was 10.0 ± 2.6 years. There were no statistically significant differences between the controls and the asthma group regarding MIP (-89.7 ± 26.7 cmH2O vs. -92.2 ± 26.3 cmH2O; p = 0.541) or MEP (79.2 ± 22.9 cmH2O vs. 86.4 ± 24.0 cmH2O; p = 0.256). The groups were subdivided by age (children and adolescents: 6-12 and 13-16 years of age, respectively). Within the asthma group, there was a significant difference between the child and adolescent subgroups in terms of MEP (74.1 ± 24.1 cmH2O vs. 92.1 ± 21.9 cmH2O; p < 0.001) but not MIP (p = 0.285). Within the control group, there were significant differences between the child and adolescent subgroups in terms of MIP (-79.1 ± 17.7 cmH2O vs. -100.9 ± 28.1 cmH2O; p < 0.001) and MEP (73.9 ± 18.7 cmH2O vs. 90.9 ± 28.1cmH2O; p < 0.001). In the asthma group, spirometric variables did not correlate with MIP or MEP. CONCLUSIONS: In our sample, asthma was found to have no significant effect on respiratory muscle strength.
- ItemSomente MetadadadosFunctional aerobic exercise capacity limitation in adolescent idiopathic scoliosis(Elsevier B.V., 2014-10-01) Sperandio, Evandro Fornias [UNIFESP]; Alexandre, Anderson Sales [UNIFESP]; Yi, Liu Chiao [UNIFESP]; Poletto, Patrícia Rios [UNIFESP]; Gotfryd, Alberto O.; Vidotto, Milena Carlos [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa da Misericordia Santos HospBACKGROUND CONTEXT: Exercise limitation has been described in patients with adolescent idiopathic scoliosis (AIS); however, whether the walking performance is impaired in these patients should be elucidated.PURPOSE: Thus, we aimed to evaluate the physiologic responses to the incremental shuttle walk test (ISWT) in patients with AIS.STUDY DESIGN/SETTING: Cross-sectional study.PATIENT SAMPLE: Twenty-nine patients with AIS and 20 healthy adolescents aged between 11 and 18 years old.OUTCOME MEASURES: Oxygen uptake (VO2), incremental shuttle walk distance (ISWD), Delta VO2/Delta walking velocity, Delta HR/Delta VO2, Delta VE/Delta VCO2, and linearized Delta tidal volume (VT)/Delta lnVE, forced expiratory volume in the first second of expiration (FEV1), and forced vital capacity (FVC).METHODS: We performed two ISWTs, and the data used were acquired in the second test. We also evaluated the lung function and respiratory muscle strength through spirometry test and manovacuometry, respectively. All authors confirm that there are no conflicts of interest. To compare the means or medians of variables between patients and healthy subjects, we used the unpaired t test or Mann-Whitney U test, respectively. the correlations were assessed by Pearson or Spearman coefficients according to the distribution of the studied variables. the probability of alpha error was set at 5% for all analyses.RESULTS: Adolescent idiopathic scoliosis patients showed significant lower values of ISWD, VO2, and ventilation at the end of the ISWT, as well as lower FEV1 and FVC; they also presented significantly shallower slope of Delta VT/Delta lnVE, whereas VO2 related significantly with ISWD (r = 0.80), FVC (r = 0.78), FEV1 (r = 0.73), and Delta VT/Delta lnVE (r = 0.58).CONCLUSIONS: Adolescent idiopathic scoliosis correlated to walking limitation and was associated to reduced pulmonary function and worse breathing pattern during exercise. Our results suggest that walking-based aerobic exercises should be encouraged in these patients. (C) 2014 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosInspiratory resistive loading after all-out exercise improves subsequent performance(Springer, 2009-05-01) Chiappa, Gaspar R.; Ribeiro, Jorge P.; Alves, Cristiano N.; Vieira, Paulo J. C.; Dubas, Joao [UNIFESP]; Queiroga, Fernando [UNIFESP]; Batista, Laura D. [UNIFESP]; Silva, Antonio C. [UNIFESP]; Neder, J. Alberto [UNIFESP]; Hosp Clin Porto Alegre; Univ Fed Rio Grande do Sul; Universidade Federal de São Paulo (UNIFESP)We have previously shown that post-exercise inspiratory resistive loading (IRL) reduces blood lactate ([Lac (b) (-) ]). in this study, we tested the hypothesis that IRL during recovery could improve subsequent exercise performance. Eight healthy men underwent, on different days, two sequential 30-s, cycle ergometer Wingate tests. During the 10-min recovery period from test 1, subjects breathed freely or through an inspiratory resistance (15 cm H(2)O) with passive leg recovery. Arterialized [Lac (b) (-) ] values, perceptual scores (Borg), cardiac output by impedance cardiography (QT), and changes in the deoxygenation status of the M. vastus lateralis by near-infrared spectroscopy (Delta HHb), were recorded. [Lac (b) (-) ] was significantly reduced after 4 min of recovery with IRL (peak [Lac (b) (-) ] 12.5 +/- A 2.3 mmol l(-1) with free-breathing vs. 9.8 +/- A 1.5 mmol l(-1) with IRL). Effort perception was reduced during late recovery with IRL compared with free-breathing. Cardiac work was increased with IRL, since heart rate and QT were elevated during late recovery. Peripheral muscle reoxygenation, however, was significantly impaired with IRL, suggesting that post-exercise convective O(2) delivery to the lower limbs was reduced. Importantly, IRL had a dual effect on subsequent performance, i.e., improvement in peak and mean power, but increased fatigue index (P < 0.05). Our data demonstrate that IRL after a Wingate test reduces post-exercise effort perception and improves peak power on subsequent all-out maximal-intensity exercise.
- ItemAcesso aberto (Open Access)Novas terapias ergogênicas no tratamento da doença pulmonar obstrutiva crônica(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-02-01) Villaça, Debora Strose [UNIFESP]; Lerario, Maria Cristina [UNIFESP]; Dal Corso, Simone [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Chronic obstructive pulmonary disease is currently considered a systemic disease, presenting structural and metabolic alterations that can lead to skeletal muscle dysfunction. This negatively affects the performance of respiratory and peripheral muscles, functional capacity, health-related quality of life and even survival. The decision to prescribe ergogenic aids for patients with chronic obstructive pulmonary disease is based on the fact that these drugs can avert or minimize catabolism and stimulate protein synthesis, thereby reducing the loss of muscle mass and increasing exercise tolerance. This review summarizes the available data regarding the use of anabolic steroids, creatine, L-carnitine, branched-chain amino acids and growth hormones in patients with chronic obstructive pulmonary disease. The advantage of using these ergogenic aids appears to lie in increasing lean muscle mass and inducing bioenergetic modifications. Within this context, most of the data collected deals with anabolic steroids. However, to date, the clinical benefits in terms of increased exercise tolerance and muscle strength, as well as in terms of the effect on morbidity and mortality, have not been consistently demonstrated. Dietary supplementation with substances of ergogenic potential might prove to be a valid adjuvant therapy for treating patients with advanced chronic obstructive pulmonary disease, especially those presenting loss of muscle mass or peripheral muscle weakness.
- ItemAcesso aberto (Open Access)Pressões inspiratória e expiratória máximas em crianças e adolescentes com asma(Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Oliveira, Cilmery Marly Gabriel de [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: The objective of this study was to evaluate the strength of respiratory muscles in children and adolescents with asthma by measurement of maximal respiratory pressures and compare them with those observed in control subjects with the same anthropometric characteristics. Methods: Cross-sectional study, which included anthropometric measures (weight, height and arm circumference), pulmonary function tests and measurement of maximal respiratory pressures inspiratory (MIP) and expiratory (MEP) of patients whith asthma and healthy controls aged between 6 and 16 years, regardless of gender. Results: We evaluated the maximal respiratory pressure of 75 asthmatics and 90 healthy individuals (controls) of both sexes, divided by chronological age in children and adolescents. The groups had similar physical characteristics. There was no statistically significant difference in the values of MIP and MEP (p> 0.05) between asthmatics and healthy. There was no statistically significant difference between the maximum pressure of asthmatic males and females. In the control group, MEP was higher in males (p = 0.004). Both groups (asthmatics and controls) adolescents have higher values of maximal respiratory pressures higher than children. There was a weak correlation between FEV1 and MIP (r = 0.247) and moderate between FEV1 and MEP (r = 0.385) of asthma patients, however, the MEP was higher in adolescents with more severe disease. Maximal respiratory pressures were not affected by the nutritional condition of individuals evaluated. Conclusion: The incidence of asthma do not determinate significant alterations in respiratory muscle strength in children and adolescents, regardless of gender. However, the severity of the disease may be associated with an increase in expiratory muscle strength in adolescents with asthma probably by the exacerbated recruitment to the fibers of these muscles are often subjected during periods of crisis is higher in males, which may be associated with greater muscle area common in boys.
- ItemSomente MetadadadosRespiratory Muscle Assessment in Predicting Extubation Outcome in Patients With Stroke(Ediciones Doyma S A, 2012-08-01) Castro, Antonio A. M. [UNIFESP]; Cortopassi, Felipe; Sabbag, Russell; Torre-Bouscoulet, Luis; Kuempel, Claudia [UNIFESP]; Porto, Elias Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Adventist Univ; Fed Univ Pampa Unipampa; Yale Univ; Tufts Univ; Inst Nacl Enfermedades RespBackground: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients.Methods: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. the maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO2/FiO(2) were measured.Results: the group who presented success to the extubation process presented 12.5 +/- 2.2 = days in mechan-ical ventilation and the group who failed presented 13.1 +/- 2 = days. the mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4 +/- 0.08 (0.36-0.44) and 0.5 +/- 0.7 (0.43-0.56), respectively. the Ti/Ttot ratio was 0.37 +/- 0.05 (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25 +/- 0.05 for the success group (0.21-0.28; p < 0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r = 0.55; p = 0.009) and PaO2/FiO(2) (r = -0.59; p = 0.005). Patients who presented a high RSRI (OR, 3.66; p = 0.004) and Pdi (OR, 7.3; p = 0.002), and low PaO2/FlO(2) (OR, 4.09; p = 0.007), Pdi/Pdimax (OR, 4.12; p = 0.002) and RAW (OR, 3.0; p = 0.02) developed mechanical ventilation extubation failure.Conclusion: Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients. (C) 2012 SEPAR. Published by Elsevier Espana, S.L. All rights reserved.