AJRCCM Articles in Press. Published on September 01/2003; 18.


We studied 6 patients with COPD (FEV1 = 1.1 ± 0.2 L, 32% of predicted) and 6 age and activity level matched,controls while performing both maximal,bicycle exercise and single leg knee-extensor exercise. Arterial and femoral venous blood sampling, thermodilution blood flow measurements,and needle biopsies allowed the assessment of

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    Article: Vitae

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    ABSTRACT: Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2009. Contexto: A debilidade muscular provocada pela doença tem impacto significativo na qualidade de vida do indivíduo com doença pulmonar obstrutiva crônica (DPOC), correlacionando-se com número de exacerbações e mortalidade. Medir a força muscular torna-se, portanto, de extrema importância para a avaliação desses indivíduos. A ausência de padronização quanto ao número de séries e intervalo de recuperação no protocolo de avaliação isocinética pode gerar resultados díspares, dificultando a compreensão e comparação entre os estudos. Objetivo: Analisar o efeito de duas séries e três intervalos de repouso na medida de força isocinética do quadríceps, a fim de identificar o protocolo adequado para realização do teste. Métodos: Indivíduos com DPOC grave ou muito grave realizaram três testes isocinéticos para avaliação da musculatura extensora do joelho, à velocidade angular de 60°⋅s-1, com intervalos de recuperação de 30, 60 ou 120 segundos. Cada teste consistiu em duas séries de cinco repetições, nas quais foram mensurados pico de torque, trabalho total e índice de fadiga. Resultados: Nos 20 indivíduos estudados (66.1 ± 7.4anos, 70 ± 10.8kg, 167.4 ± 6.2cm, VEF1 36.5 ± 10.1% do predito), não houve diferença significativa nos valores de pico de torque , trabalho total e índice de fadiga, independente do número de séries ou da duração do intervalo de recuperação entre elas. Conclusão: Em indivíduos com DPOC grave ou muito grave, a força muscular do quadríceps pode ser avaliada por meio de protocolo isocinético composto por uma série de contrações com cinco repetições; se forem realizadas duas séries, 30 segundos de intervalo entre elas é suficiente para garantir a recuperação muscular. _____________________________________________________________________________________ ABSTRACT Rationale: Muscle debility due to disease has a significant impact on health-related quality-of-life in subjects with chronic obstructive pulmonary disease (COPD), and it’s correlated to exacerbation and even mortality. Assessing muscle strength became extremely relevant for better evaluate those subjects. Lack of standardization relative to number of sets and rest interval on isokinetic test protocol may lead to distinct results, turning comprehension and comparisons among studies difficult. Aim: To analyze the effect of two sets and three different rest intervals on isokinetic strength measurement of quadriceps, tests, in order to define the adequate test protocol. Methods: Subjects with severe or very severe COPD underwent three isokinetic tests to evaluate knee extensor muscle strength, at an angular velocity of 60°⋅s-1, with rest intervals of 30, 60 and 120 seconds. Each test consisted of two sets of five repetitions, during which peak torque, total work and fatigue index were measured. Results: In 20 studied subjects (66.1 ± 7.4 years, 70 ± 10.8kg, 167.4 ± 6.2cm, FEV1 36.5 ± 10.1%), there were no significant differences in peak torque, total work and fatigue index, independently of number of sets or rest interval between sets. Conclusion: In subjects with severe or very severe COPD, quadriceps muscle strength can be evaluated by an isokinetic protocol with one set of five repetitions; if two sets were done, a rest interval of 30 seconds is enough to ensure muscle recovery between sets.
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    ABSTRACT: "Pulmonary rehabilitation is a process which systemati- cally uses scientifically based diagnostic management and evaluation options to achieve the optimal daily function- ing and health-related quality of life of individual patients, suffering from impairment and disability due to chronic res- piratory disease as measured by clinically and/or physiolog- ically relevant outcome parameters." This recent definition by the European Respiratory Society (ERS) task force "Re- habilitation and chronic care" (1) stresses the aims of a pul- monary rehabilitation treatment: "optimal daily functioning" and "quality of life". It also indicates that outcome parame- ters should be measured, and that they should be clinically and physiologically relevant. The ERS-position paper fur- ther requires that all existing treatment options available for the widest possible range of patients with chronic lung dis- ease should be applied in rehabilitation. Components of such a programme are: exercise training; gymnastic exercise; res- piratory muscle training; chest physiotherapy and breathing retraining; education; psychological counselling; nutritional therapy; ventilatory support, long-term oxygen therapy, and nursing care. Consequently, pulmonary rehabilitation is a very com- plex and expensive treatment, and should be performed by a team of several professionals working in close co-opera- tion in one institute. The cost is such, that a careful selec- tion of motivated patients, a scientifically based diagnosis and a meticulous quantification of the outcome is manda- tory. The place for rehabilitation in asthma, cystic fibrosis, or in the context of lung volume reduction surgery has been outlined by several authors, but remains outside the scope of this editorial. The above suggests that the efficacy of all treatment modalities is unequivocal. This is not always true. Previ- ously, there was an almost universal agreement that the impairment at the level of lung function can hardly be improved by rehabilitation. However, recent findings by C AS A BURI (2) showed that in patients with severe chronic obstructive pulmonary disease (COPD), the forced expira- tory volume in one second (FEV1) can also improve by 9%. This seems to be a small change in FEV1, but consider- ing the hyperbolic relationship between airway resistance and FEV1, this modest improvement in the low ranges of FEV1 means a considerable decrease in airway resistance. It is not clear how and why this change in FEV1 was brought about; it must have contributed to the improve- ment in exercise performance of 36%, probably by a less dynamic hyperinflation during exercise? The latter will contribute to a lower level of exercise dyspnoea (3). Impairment of peripheral muscle function occurs in patients with COPD, due to a reduced amount of oxidative enzymes (4, 5). Apart from the ventilatory limitation due to airway obstruction and limited respiratory muscle function, this peripheral muscle weakness substantially contributes to the exercise limitation in patients with COPD. G OS S E LI N K et al. (6) showed that the maximal oxygen consumption (V 'O2,max) and the 6 min walking distance correlated signifi- cantly with the maximal force of the quadriceps muscle. Nutritional depletion can be one of the factors in the mal- functioning of peripheral and respiratory muscles: the energy expenditure of patients with COPD often exceeds the caloric intake. Nutritional supplementation, anabolic ster- oids, and training can improve the function of these mus- cle groups, and also improve exercise performance (7, 8). Dysfunction of peripheral muscles can be substantially reversed by training in patients with COPD. An increase in oxidative enzyme content in peripheral muscles was shown to occur after endurance training at 60% of pretreatment work loads, in patients with severe COPD (FEV1 36% pred), thus improving oxidative exercise capacity. The lac- tate threshold increased, and exercise hyperpnoea decreas-
    Archives of Environmental Health An International Journal 06/1968; 16(5):614. DOI:10.1080/00039896.1968.10665115
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