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      Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD Translated title: Relação da mobilidade diafragmática com função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária em pacientes com DPOC

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          ABSTRACT

          Objective:

          To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD.

          Methods:

          We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea.

          Results:

          In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL.

          Conclusions:

          In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL.

          RESUMO

          Objetivo:

          Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC.

          Métodos:

          Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia.

          Resultados:

          No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD.

          Conclusões:

          A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percepção de dispneia, mas não com AFVD.

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          Most cited references41

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          Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.

          Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
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            New reference values for forced spirometry in white adults in Brazil.

            To describe spirometric reference equations for healthy Brazilian adults who have never smoked and to compare the predicted values with those derived in 1992. Reference equations for spirometry were derived in 270 men and 373 women living in eight cities in Brazil. Ages ranged from 20 to 85 years in women and from 26 to 86 years in men. Spirometry examinations followed the recommendations of the Brazilian Thoracic Society. Lower limits were derived by the analysis of the fifth percentiles of the residuals. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC and FEV1/forced expiratory volume in six seconds (FEV6) were best fitted by linear regression. Flows were best fitted using log equations. For both genders, greater height resulted in lower values for FEV1/FVC, FEV1/FEV6 and flow/FVC ratios. The reference values for FEV1 and FVC in the present study were higher than those derived for Brazilian adults in 1992. New predicted values for forced spirometry were obtained in a sample of white Brazilians. The values are greater than those obtained in 1992, probably due to technical factors.
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              Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation

              The strength of the respiratory muscles can be evaluated from static measurements (maximal inspiratory and expiratory pressures, MIP and MEP) or inferred from dynamic maneuvers (maximal voluntary ventilation, MVV). Although these data could be suitable for a number of clinical and research applications, no previous studies have provided reference values for such tests using a healthy, randomly selected sample of the adult Brazilian population. With this main purpose, we prospectively evaluated 100 non-smoking subjects (50 males and 50 females), 20 to 80 years old, selected from more than 8,000 individuals. Gender-specific linear prediction equations for MIP, MEP and MVV were developed by multiple regression analysis: age and, secondarily, anthropometric measurements explained up to 56% of the variability of the dependent variables. The most cited previous studies using either Caucasian or non-Caucasian samples systematically underestimated the observed values of MIP (P<0.05). Interestingly, the self-reported level of regular physical activity and maximum aerobic power correlates strongly with both respiratory and peripheral muscular strength (knee extensor peak torque) (P<0.01). Our results, therefore, provide a new frame of reference to evaluate the normalcy of some useful indexes of respiratory muscle strength in Brazilian males and females aged 20 to 80.
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                Author and article information

                Journal
                J Bras Pneumol
                J Bras Pneumol
                jbpneu
                Jornal Brasileiro de Pneumologia
                Sociedade Brasileira de Pneumologia e Tisiologia
                1806-3713
                1806-3756
                Jan-Feb 2017
                Jan-Feb 2017
                : 43
                : 1
                : 32-37
                Affiliations
                [1 ]. Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil.
                [2 ]. Fundação Universidade Regional de Blumenau - FURB - Blumenau (SC) Brasil.
                Author notes
                Correspondence to: Ana Karla Vieira Brüggemann. Laboratório de Fisioterapia Respiratória, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina - CEFID/UDESC - Rua Pascoal Simone, 358, Coqueiros, CEP 88080-350, Florianópolis, SC, Brasil. Tel.: 55 48 3664-8602 or 55 48 9665-8289. E-mail: anakarla_vb@ 123456hotmail.com
                Article
                10.1590/S1806-37562016000000097
                5790674
                28380186
                8bc1f0b1-e23d-4bc9-af74-877b195dddb4

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 22 March 2016
                : 31 October 2016
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 40, Pages: 6
                Categories
                Original Article

                pulmonary disease, chronic obstructive,diaphragm,spirometry,dyspnea,maximal respiratory pressures,doença pulmonar obstrutiva crônica,diafragma,espirometria,dispneia e pressões respiratórias máximas

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