No description available.

Background: Blood flow restriction training (BFRT) is an effective way of training that enables training with low external load while receiving similar effects to high load training. The lack of knowledge of BFRT for people with chronic obstructive pulmonary disease (COPD) or heart failure (HF) led to the making of this scoping review.  Objective: This scoping review aims to map the existing knowledge, effects, safety, and feasibility of BFRT for people with COPD or heart failure HF. Method: The review followed PRISMAs structure for scoping review. Selection involved title and abstract screening, followed by full text analysis and peer-review by both authors.  Results: A wide variety of study designs was included in this scoping review. Of 11 included studies all were original intervention studies-, whereof 8/11 studies were focused on HF. A large majority of participants were male. Training methods used in intervention studies varied from exercises like leg extensions, leg press and cycling, all while using vascular blood flow restriction. All studies followed different training protocols. The reported outcomes indicated promising improvements like increased functional exercise capacity, muscle strength, reduced symptom burden, and several positive physiological changes for both people with COPD and HF. Some concerns remain regarding the safety of BFRT, but no serious adverse events were reported directly linked to BFRT.  Conclusion: With many reported improvements, BFRT could be a safe and feasible alternative rehabilitation method for people with COPD or HF. Furthermore, with minimal reported adverse events, the method appears safe for both groups. Despite this, the included studies all had small sample sizes, so more high-quality studies with larger sample sizes are needed to give a better understanding on BFRTs effects on both short- and long term. Better studies including females are also needed.

No description available.

The aim of this thesis was to describe fatigue, functional limitations due to fatigue and health in patients with chronic obstructive pulmonary disease (COPD), as well as to compare patients with individuals from the general population and to test if pulmonary rehabilitation can reduce fatigue and functional limitations, and thus improve health. A further aim was to test the Fatigue Impact Scale (FIS) among patients with COPD. Two studies (I, II) had a descriptive comparative design with data from 36 and 151 patients with COPD respectively, and 37 and 95 individuals respectively, randomly selected from the general population. One study (III) was a randomised pre-test post-test study with 12 patients with COPD randomised to 12 weeks’ pulmonary rehabilitation and 14 patients in a control group. In a further study (IV), the FIS was tested for validity and reliability among 296 patients with COPD who reported fatigue. Assessments: Structured questions frequency, duration and severity of fatigue, functional limitations due to fatigue with FIS, six minutes’ walking distance, hand grip strength, functional performance and satisfaction with Canadian Occupational Performance Measure and health with St George’s Hospital Respiratory Questionnaire and Short Form-36. Almost half of the patients with COPD had a problem with fatigue every day and experienced fatigue as a severe symptom. More than 44% reported that fatigue was one of the worst symptoms. The experience of fatigue was related to the patients’ functional performance and health perceptions. Patients with COPD experienced a higher frequency, longer daily duration and greater severity of fatigue than individuals from the general population. After a 12 week pulmonary rehabilitation programme, there were no statistically significant differences between the patients randomised to the rehabilitation group and those in the control group. The patients in the rehabilitation group improved walking distances, performance and satisfaction with regard to their own selected activities compared with baseline. Confirmatory factor analysis on the three-factor model proposed for FIS showed that the fit of the model was not acceptable. Further validation of the FIS resulted in a removal of 15 items (FIS-25) and support for Pipers´ theoretical framework of subjective manifestations of fatigue including physical, emotional and cognitive dimensions and a general behavioural factor. The internal consistency, sensitivity and stability correlations of FIS-25 were satisfactory. In conclusion, fatigue is a major concern among patients with COPD, impacting on functioning and health. Interventions with 12 weeks’ pulmonary rehabilitation might not be effective enough to reduce fatigue and the functional limitations due to fatigue. More research is needed to solve the symptom burden of fatigue and its impact on functioning and health in patients with COPD.

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

O aumento no número de células inflamatórias, a produção anormal de citocinas pró-inflamatórias e o desequilíbrio entre a formação de radicais livres e a capacidade antioxidante geram alterações locais e sistêmicas na doença pulmonar obstrutiva crônica (DPOC), associada com disfunção e perda da massa muscular. A reabilitação pulmonar é uma modalidade de tratamento com evidência A, cujos desfechos são medidos através da melhora da capacidade de exercício físico e qualidade de vida, mas estudos recentes demonstram uma redução no estresse oxidativo induzido pelo exercício, o que potencialmente também reduziria o dano tecidual. A análise do dano de DNA em linfócitos de sangue periférico foi utilizada como possível medida de desfecho em 13 de 39 portadores de DPOC submetidos a um programa de reabilitação pulmonar (PRP) com duração de 4 meses. Todos os pacientes foram submetidos ao teste da caminhada dos seis minutos (TC6) e ao questionário de qualidade de vida Saint George (QQVSG), sendo que 13 pacientes coletaram sangue antes e depois do PRP para análise do dano de DNA pela técnica de micronúcleos. Do total de 39 portadores de DPOC, 69,23% eram do sexo masculino com idades de 63,33 ± 8,60 anos e média de VEF1 de 1,06 ± 0,55L. Após o PRP, ocorreu aumento significativo na distância percorrida no TC6 (366,84±108,42 [pré PRP] vs. 400,76±94,55 [pós PRP], p=0,001) e melhora em todos os domínios do QQVSG (Sintomas: 47,05±21,28 [pré PRP] vs. 35,28±16,92 [pós PRP], p=0,005; Atividades: 62,84±27,07 [pré PRP] vs. 56,02±24,09 [pós PRP], p=0,038; Impacto: 33,30±18,71 [pré PRP] vs. 19,97±12,11 [pós PRP], p<0,001; Total: 49,41±21,99 [pré PRP] vs. 37,61±18,96 [pós PRP], p<0,001). Quanto à avaliação do dano genético, obteve-se uma diminuição estatisticamente significativa (p=0,014) na freqüência de micronúcleos (5,53±2,14 [pré PRP] vs. 3,07±2,13 [pós PRP] ), o que não ocorreu na análise das pontes nucleoplasmáticas e buds nucleares (1,15±0,89 [pré PRP] vs. 0,76±1,01 [pós PRP], p=0,244 e 1,69±1,43 [pré PRP] vs. 1,69±2,13 [pós PRP], p=0,804, respectivamente). A redução na freqüência de micronúcleos demonstrou que o PRP não somente melhorou a qualidade de vida e o desempenho na capacidade de exercício, mas também foi capaz de reduzir o dano de DNA. / Pulmonary rehabilitation is a treatment supported by level A evidence, and its outcomes are measured by the improvement in physical exercise capacity and quality of life. The objective of this study is to investigate if pulmonary rehabilitation reduces DNA damage in peripheral blood of patients with chronic obstructive pulmonary disease. DNA damage in peripheral blood lymphocytes was used as an outcome measure in 13 of 39 patients with chronic obstructive pulmonary disease who underwent a 4-month pulmonary rehabilitation program. All patients underwent the 6- minute walk test and answered the Saint George’s respiratory questionnaire to assess quality of life. Blood was collected from 13 patients before and after pulmonary rehabilitation program to analyze DNA damage using the micronucleus technique. After pulmonary rehabilitation program, there was a significant increase in 6- minute walk distance and improvement in all the Saint George’s respiratory questionnaire domains. The evaluation of genetic damage revealed a statistically significant decrease (p = 0.014) of micronucleus frequency. No significant differences were found in the analysis of nucleoplasmic bridges or nuclear buds. The decrease of micronucleus frequency demonstrated that PRP not only improved quality of life and performance in work capacity exercises, but also reduced DNA damage.

Objetivos: analisar os efeitos, após um período de 24 meses, de um Programa de Reabilitação Pulmonar sobre os níveis de ansiedade, depressão, qualidade de vida e desempenho no teste de caminhada em 30 pacientes com DPOC (idade: 60,8±10 anos; 70% do sexo masculino). Pacientes e Métodos: os participantes do estudo realizaram um Programa de Reabilitação Pulmonar com 12 semanas de duração, incluindo 24 sessões de exercício físico, 24 sessões de fisioterapia, 12 sessões de psicoterapia e 3 sessões educacionais. Todos os pacientes foram avaliados na linha de base (pré-teste) e ao término (pós-teste) do PRP através de quatro instrumentos: Inventário de Ansiedade de Beck, Inventário de Depressão de Beck , Questionário Respiratório de Saint George e Teste da Caminhada de 6 minutos. Vinte e quatro meses após a conclusão do PRP os pacientes foram reavaliados com os mesmos instrumentos de medida (teste atual). Resultados: Os pacientes demonstraram na comparação entre pré e pósteste, redução significativa dos níveis de ansiedade (pré: 10,7±6,3; pós: 5,5±4,4; p=0,0005), depressão (pré:11,7±6,8; pós:6±5,8; p=0,001) e melhora no índice de qualidade de vida (pré: 51±15,9; pós: 34,7±15,1; p=0,0001). No teste de caminhada houve um aumento significativo (pré: 428,6±75; pós: 474,9±86,3; p=0,03). Na comparação do pós-teste com o teste atual, os índices não demonstraram diferença estatística em nenhum dos critérios avaliados. Ansiedade (pós: 5,5±4,4; atual: 7,3±4,8; p=0,127), depressão (pós: 6±5,8; atual:7,8±5,7; p= 0,228), qualidade de vida ( pós: 34,7±15,1; atual: 40±13,3; p=0,157) e teste de caminhada (pós: 474,9±86,3; atual: 451±74,2; p=0,254) Conclusões: os benefícios obtidos pelos pacientes com a reabilitação pulmonar sobre os índices de ansiedade, depressão, qualidade de vida e teste de caminhada, persistiram ao longo dos 24 meses. / Study Objectives: to verify the long-term outcome of a pulmonary rehabilitation program on the levels of anxiety, depression and quality of life, as well, the six-minute walking test performance of 30 COPD patients (mean±SD, 60.8±10 years; 70% male). Design: the participants under went a 12-week treatment program: 24 session of physical exercises, 24 sessions of physiotherapy, 12 psychological sessions and three educational sessions. All patients were evaluated at baseline (pretest), at completion of the rehabilitation program (post-test), and two years later (current test) through four instruments: Beck Anxiety Inventory, Beck Depression Inventory, The St. George’s Respiratory Questionnaire and the Six- Minute Walk Test. Results: the comparison between pre and post-test demonstrated significant statistical improvements, including reduced anxiety (pre: 10.7±6.3; post: 5.5±4.4; p=0.0005) and depression (pre: 11.7±6.8; post: 6±5.8; p=0.001), increase endurance (pre: 428.6±75; post: 474.9±86.3; p=0.03), and better quality of life (pre: 51±15.9; post: 34.7±15.1; p=0.0001). There were no statistic differences when the results of the post-test were analyzed against the data of the current test. Anxiety (post: 5.5±4.4; current: 7.3±4.8; p=0.127), depression (post: 6±5.8; current: 7.8±5.7; p=0.228), endurance (post: 474.9±86.3; current: 451±74.2; p= 0.254) and quality of life (post: 34.7±15.1; current: 40±13.3; p=0.157). Conclusions: COPD patients are able to maintain the psychological and physical improvements acquired during a pulmonary rehabilitation program for two years.

INTRODUÇÃO: A doença pulmonar obstrutiva crônica (DPOC) é uma doença respiratória com comprometimento sistêmico, que cursa com dispneia, intolerância ao exercício e dificuldade para realizar as atividades de vida diária (AVDs). Uma importante medida terapêutica é a reabilitação pulmonar (RP), porém os efeitos desta intervenção sobre as AVDs são pouco conhecidos. OBJETIVOS: Estudar os efeitos da RP sobre a capacidade de exercício, a qualidade de vida, as alterações do humor, as AVDs e avaliar a relação entre as mudanças neste diferentes desfechos em pacientes com DPOC. MATERIAL e MÉTODOS: Pacientes com diagnóstico de DPOC foram submetidos a um programa de RP de 12 semanas. Foram realizados as seguintes avaliações antes e depois da intervenção: teste de caminhada de seis minutos (TC6), Saint George’s Respiratory Questionnaire (SGRQ), inventário de ansiedade (BAI) e depressão de Beck (BDI) e testes que reproduzem AVDs como levantar da cadeira (TSL), levantar do chão, subir escadas e equilíbrio. Um valor de p ≤ 0,05 foi considerado como significativo. RESULTADOS: Foram estudados 52 pacientes com DPOC, com volume expiratório forçado no primeiro segundo (VEF1) de 0,99±0,43 l e 38,1±8,4 % do previsto e idade de 66,2 ±8,5 anos. Com a RP houve melhora na distância percorrida no TC6 (367,6 ± 87,4 vs 412,5 ± 82,6 metros; p<0,001), nos escores do BAI e BDI (10 vs 5 pontos; p<0,001 e 10,5 vs 6 pontos; p<0,001), no escore total do SGRQ (49,4 vs 39,5 pontos; p<0,001). Após a RP aumentou o número de repetições no TSL (10 vs 11 vezes; p<0,001), reduziu o tempo para levantar do chão (5,9 vs 5,4 segundos; p = 0,003) e subir escadas (9,0 vs 7,9 segundos; p<0,001) e aumentou o tempo de equilíbrio (10,1 vs 14,5 segundos; p = 0,014). O TSL se relacionou com todos os domínios do SGRQ (rs entre -0,282 e 0,370, p<0,05). Não houve associação entre testes de AVDs e distância percorrida no TC6 ou escores do BAI e BDI. CONCLUSÕES: A capacidade física, a qualidade de vida, os sintomas depressivos, a ansiedade e os testes de AVDs melhoraram com a RP. A melhora observada nas AVDs (no tempo de equilíbrio, para levantar do chão e no TSL) se associou com mudanças na qualidade de vida. / BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a respiratory disease with systemic involvement that leads to dyspnea, exercise intolerance, and difficulty in performing activities of daily living (ADL). An important therapeutic measure is pulmonary rehabilitation (PR), but the effects of this intervention on ADL have not been studied. OBJECTIVES: To study the effects of PR on exercise capacity, quality of life, mood changes, ADL and assess the relationship between changes in the different outcomes in patients with COPD. MATERIAL AND METHODS: Patients diagnosed with COPD underwent a PR program for 12 weeks. The following tests were performed before and after intervention: the six-minute walk test (6MWT), the Saint George's Respiratory Questionnaire (SGRQ), the Beck anxiety (BAI) and depression Inventory (BDI) and tests that reproduce ADL as rising from a chair (TSL), rising from the floor, stair climbing and balance. A value of p ≤ 0.05 was considered significant. RESULTS: We studied 52 COPD patients with forced expiratory volume in one second (FEV1) of 0.99 ± 0.43 l, 38.1 ± 8.4 % predicted and age of 66.2 ± 8.5 years. PR induced an improvement in 6MWT distance (367.6 ± 87.4 vs 412.5 ± 82.6 meters, p <0.001), BAI and BDI scores (10 vs 5 points, p <0.001 and 10,5 vs. 6 points, p <0.001) and in SGRQ total score (49.4 vs. 39.5 points, p <0.001). The number of repetitions in TSL increased (10 vs 11 fold, p <0.001), the time to rise from the floor (5.9 vs 5.4 seconds, P = 0.003) and to climb stairs reduced (9.0 vs 7.9 seconds, p <0.001) and the balance improved (10.1 vs. 14.5 seconds, p = 0.014) after PR. The STS was related to all domains of the SGRQ (rs between -0.282 and 0.370, p <0.05). The balance and the time to rise from the floor were associated with symptoms domain of the SGRQ (rs-0.421 and 0.302 respectively, p <0,05). There was no association between ADL tests and walked distance or BAI and BDI scores. CONCLUSIONS: Physical capacity, quality of life, depressive symptoms, anxiety as well as ADL improved with RP. The changes in ADL (balance, to rise from the floor and STS) were associated with changes in quality of life.

O aumento no número de células inflamatórias, a produção anormal de citocinas pró-inflamatórias e o desequilíbrio entre a formação de radicais livres e a capacidade antioxidante geram alterações locais e sistêmicas na doença pulmonar obstrutiva crônica (DPOC), associada com disfunção e perda da massa muscular. A reabilitação pulmonar é uma modalidade de tratamento com evidência A, cujos desfechos são medidos através da melhora da capacidade de exercício físico e qualidade de vida, mas estudos recentes demonstram uma redução no estresse oxidativo induzido pelo exercício, o que potencialmente também reduziria o dano tecidual. A análise do dano de DNA em linfócitos de sangue periférico foi utilizada como possível medida de desfecho em 13 de 39 portadores de DPOC submetidos a um programa de reabilitação pulmonar (PRP) com duração de 4 meses. Todos os pacientes foram submetidos ao teste da caminhada dos seis minutos (TC6) e ao questionário de qualidade de vida Saint George (QQVSG), sendo que 13 pacientes coletaram sangue antes e depois do PRP para análise do dano de DNA pela técnica de micronúcleos. Do total de 39 portadores de DPOC, 69,23% eram do sexo masculino com idades de 63,33 ± 8,60 anos e média de VEF1 de 1,06 ± 0,55L. Após o PRP, ocorreu aumento significativo na distância percorrida no TC6 (366,84±108,42 [pré PRP] vs. 400,76±94,55 [pós PRP], p=0,001) e melhora em todos os domínios do QQVSG (Sintomas: 47,05±21,28 [pré PRP] vs. 35,28±16,92 [pós PRP], p=0,005; Atividades: 62,84±27,07 [pré PRP] vs. 56,02±24,09 [pós PRP], p=0,038; Impacto: 33,30±18,71 [pré PRP] vs. 19,97±12,11 [pós PRP], p<0,001; Total: 49,41±21,99 [pré PRP] vs. 37,61±18,96 [pós PRP], p<0,001). Quanto à avaliação do dano genético, obteve-se uma diminuição estatisticamente significativa (p=0,014) na freqüência de micronúcleos (5,53±2,14 [pré PRP] vs. 3,07±2,13 [pós PRP] ), o que não ocorreu na análise das pontes nucleoplasmáticas e buds nucleares (1,15±0,89 [pré PRP] vs. 0,76±1,01 [pós PRP], p=0,244 e 1,69±1,43 [pré PRP] vs. 1,69±2,13 [pós PRP], p=0,804, respectivamente). A redução na freqüência de micronúcleos demonstrou que o PRP não somente melhorou a qualidade de vida e o desempenho na capacidade de exercício, mas também foi capaz de reduzir o dano de DNA. / Pulmonary rehabilitation is a treatment supported by level A evidence, and its outcomes are measured by the improvement in physical exercise capacity and quality of life. The objective of this study is to investigate if pulmonary rehabilitation reduces DNA damage in peripheral blood of patients with chronic obstructive pulmonary disease. DNA damage in peripheral blood lymphocytes was used as an outcome measure in 13 of 39 patients with chronic obstructive pulmonary disease who underwent a 4-month pulmonary rehabilitation program. All patients underwent the 6- minute walk test and answered the Saint George’s respiratory questionnaire to assess quality of life. Blood was collected from 13 patients before and after pulmonary rehabilitation program to analyze DNA damage using the micronucleus technique. After pulmonary rehabilitation program, there was a significant increase in 6- minute walk distance and improvement in all the Saint George’s respiratory questionnaire domains. The evaluation of genetic damage revealed a statistically significant decrease (p = 0.014) of micronucleus frequency. No significant differences were found in the analysis of nucleoplasmic bridges or nuclear buds. The decrease of micronucleus frequency demonstrated that PRP not only improved quality of life and performance in work capacity exercises, but also reduced DNA damage.