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      Functional capacity, pulmonary and respiratory muscle strength in individuals undergoing hemodialysis Translated title: Capacidade funcional, pulmonar e força muscular respiratória de indivíduos submetidos à hemodiálise

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          Abstract

          Abstract Introduction: Individuals with chronic kidney disease (CKD) undergoing hemodialysis (HD) present low cardiorespiratory fitness and functional capacity. Metabolic changes, due to the disease, can result in a variety of pathophysiological conditions that favor the development of respiratory muscle weakness. However, very little is known about the performance of the respiratory muscles and the influence of HD on them. Aim: To evaluate and correlate pulmonary function, functional capacity and respiratory muscle strength in patients with CKD undergoing HD. Methods: Cross-sectional study comprising 23 patients with CKD, that met the following inclusion criteria: patients of both genders, who perform HD three times a week for a minimum period of three months. Respiratory muscle strength was evaluated using a respiratory pressure meter, lung function through spirometry and functional capacity through the 6-minute walk test (6MWT) before the HD session. Results: All patients were male and mean age was 50.2 ± 15.8 years. The median duration of HD was 3 (1.5 to 6.0) years. The mean values obtained in comparison to those predicted were MIP% 36.0 ± 13.6, MEP% 49.5 ± 15.8, FVC% 93.8 ± 21.1, FEV1% 93.7 ± 21.1, FVC/VEF1% 104.1 ± 10.3, and 6MWT% 66.33 ± 20.53. A statistically significant positive correlation was observed between the 6MWT and MIP (r = .63, p =.001) and MEP (r = .67, p < .001), between the MIP and MEP (r =.79, p < .001) and between the FEV1 and FVC (r = .91, p < .001). Conclusion: Patients with CKD undergoing HD present changes in respiratory muscle strength, with the predicted values decreasing for age and gender, as well as the distance covered in the 6MWT, although, with normal spirometric values. Functional capacity was dependent on respiratory muscle strength, as well as the values of MIP and MEP, and the values of FVC and FEV1.

          Translated abstract

          Resumo Introdução: Indivíduos com doença renal crônica (DRC) submetidos a hemodiálise (HD) apresentam baixa capacidade cardiorrespiratória e funcional. As alterações metabólicas, devido a patologia, podem resultar em uma variedade de condições fisiopatológicas que favorecem o desenvolvimento de fraqueza muscular respiratória. No entanto, muito pouco é conhecido sobre o desempenho dos músculos respiratórios e a influência da HD sobre eles. Objetivo: Avaliar e correlacionar à função pulmonar, a capacidade funcional e a força muscular respiratória em pacientes com DRC submetidos à HD. Materiais e métodos: Estudo transversal composto por 23 pacientes com DRC, que se enquadravam nos seguintes critérios de inclusão: pacientes de ambos os sexos, que realizam HD três vezes por semana, por um período mínimo de três meses. Foi avaliada a força muscular respiratória através de manovuometria, função pulmonar por espirometria e a capacidade funcional pelo teste de caminhada dos 6 minutos (TC6) antes da sessão de HD. Resultados: Todos pacientes eram do sexo masculino e idade média de 50,2 ± 15,8 anos. O tempo mediano de HD era 3 (1,5 - 6,0) anos. Os valores médios alcançados de acordo com o previsto foi de %PImáx média foi 36,0±13,6, %PEmáx 49,5 ± 15,8, %CVF 93,8 ± 21,1, %VEF1 93,7 ± 21,1, %CVF/VEF1 104,1±10,3, %TC6 66,33 ± 20,53. Observou-se correlação estatisticamente significativa, positiva, entre o TC6 e PImáx (r = 0,63, p = 0,001), PEmáx (r = 0,67, p < 0,001) e entre PImax e PEmax (r = 0,79, p < 0,001) e VEF1 e CVF (r = 0,91, p < 0,001). Conclusão: Indivíduos portadores de DRC em HD sofrem alterações na força muscular respiratória, com diminuição dos valores previstos para sexo e idade, assim como na distância percorrida no TC6, porém, com os valores espirométricos dentro da normalidade. A capacidade funcional mostrou-se dependente da força muscular respiratória, assim como os valores entre PImáx e PEmáx e VEF1 e CVF.

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          Most cited references76

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          Blood pressure and end-stage renal disease in men.

          End-stage renal disease in the United States creates a large burden for both individuals and society as a whole. Efforts to prevent the condition require an understanding of modifiable risk factors. We assessed the development of end-stage renal disease through 1990 in 332,544 men, 35 to 57 years of age, who were screened between 1973 and 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT). We used data from the national registry for treated end-stage renal disease of the Health Care Financing Administration and from records on death from renal disease from the National Death Index and the Social Security Administration. During an average of 16 years of follow-up, 814 subjects either died of end-stage renal disease or were treated for that condition (15.6 cases per 100,000 person-years of observation). A strong, graded relation between both systolic and diastolic blood pressure and end-stage renal disease was identified, independent of associations between the disease and age, race, income, use of medication for diabetes mellitus, history of myocardial infarction, serum cholesterol concentration, and cigarette smoking. As compared with men with an optimal level of blood pressure (systolic pressure or = 210 mm Hg or diastolic pressure > or = 120 mm Hg) was 22.1 (P < 0.001). These relations were not due to end-stage renal disease that occurred soon after screening and, in the 12,866 screened men who entered the MRFIT study, were not changed by taking into account the base-line serum creatinine concentration and urinary protein excretion. The estimated risk of end-stage renal disease associated with elevations of systolic pressure was greater than that linked with elevations of diastolic pressure when both variables were considered together. Elevations of blood pressure are a strong independent risk factor for end-stage renal disease; interventions to prevent the disease need to emphasize the prevention and control of both high-normal and high blood pressure.
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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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              A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise.

              1. The intensity of breathlessness during exercise was measured in ten normal subjects using a visual analogue scale (VAS) and a Borg scale to compare the use of the scales and their repeatability, both within the duration of a period of exercise and between tests. For each scale, subjects performed two exercise tests separated by a period of 2-6 weeks. Each exercise test consisted of two cycles of progressively increasing and decreasing workload. 2. All subjects felt confidently able to use both scales to quantify their feelings of breathlessness exclusively of other sensation. Equal preference was expressed for use of a particular scale. 3. With both scales there was a large intersubject variation in the relationship between dyspnoea score and minute ventilation (VE) (P less than 0.01), and in the range of the scale used. 4. There was a good correlation between the VAS and Borg scores at each level of VE (r2 = 0.71), but the VAS score was used over a wider range than the Borg score. 5. The relationship between VE and the dyspnoea score measured by the two techniques was predominantly linear. The mean r2 for VAS score/VE was 0.68 (SD 0.19) and for Borg score/VE the mean r2 was 0.75 (SD 0.13). 6. The relationships VAS score/VE and Borg score/VE were unaffected by the direction in which the workload was varied (P greater than 0.05). 7. VE, measured at each work rate, did not differ between the two cycles (P greater than 0.05) or between the 2 days (P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                fm
                Fisioterapia em Movimento
                Fisioter. mov.
                Pontifícia Universidade Católica do Paraná
                1980-5918
                June 2016
                : 29
                : 2
                : 343-350
                Affiliations
                [1 ] Universidade de Passo Fundo Brazil
                Article
                S0103-51502016000200343
                10.1590/0103-5150.029.002.AO13
                becc9830-1698-48ac-a9bb-508c648f03c6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0103-5150&lng=en
                Categories
                ORTHOPEDICS
                REHABILITATION

                Orthopedics,Physiotherapy
                Chronic kidney failure,Renal dialysis,Spirometry,Muscle strength,Physical fitness.,Falência renal crônica,Diálise renal,Espirometria,Força muscular,Aptidão física.

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