Reduction In Respiratory Muscle Strength Research Articles

Rapidly and slowly progressive neuromuscular disease: differences in pulmonary function, respiratory tract infections and response to lung volume recruitment therapy (LVR)

IntroductionReduced lung volumes are a hallmark of respiratory muscle weakness in neuromuscular disease (NMD). Low respiratory system compliance (Crs) may contribute to restriction and be amenable to lung volume recruitment...

Iraq/Afghanistan war lung injury reflects burn pits exposure

This descriptive case series retrospectively reviewed medical records from thirty-one previously healthy, war-fighting veterans who self-reported exposure to airborne hazards while serving in Iraq and Afghanistan between 2003 and the present. They all noted new-onset dyspnea, which began during deployment or as a military contractor. Twenty-one subjects underwent non-invasive pulmonary diagnostic testing, including maximum expiratory pressure (MEP) and impulse oscillometry (IOS). In addition, five soldiers received a lung biopsy; tissue results were compared to a previously published sample from a soldier in our Iraq Afghanistan War Lung Injury database and others in our database with similar exposures, including burn pits. We also reviewed civilian control samples (5) from the Stony Brook University database. Military personnel were referred to our International Center of Excellence in Deployment Health and Medical Geosciences, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell under the auspices of Northwell IRB: 17-0140-FIMR Feinstein Institution for Medical Research “Clinicopathologic characteristics of Iraq Afghanistan War Lung Injury.” We retrospectively examined medical records, including exposure data, radiologic imaging, and non-invasive pulmonary function testing (MGC Diagnostic Platinum Elite Plethysmograph) using the American Thoracic Society (ATS) standard interpretation based on Morgan et al., and for a limited cohort, biopsy data. Lung tissue, when available, was examined for carbonaceous particles, polycyclic aromatic hydrocarbons (Raman spectroscopy), metals, titanium connected to iron (Brookhaven National Laboratory, National Synchrotron Light Source II, Beamline 5-ID), oxidized metals, combustion temperature, inflammatory cell accumulation and fibrosis, neutrophil extracellular traps, Sirius red, Prussian Blue, as well as polarizable crystals/particulate matter/dust. Among twenty-one previously healthy, deployable soldiers with non-invasive pulmonary diagnostic tests, post-deployment, all had severely decreased MEP values, averaging 42% predicted. These same patients concurrently demonstrated abnormal airways reactance (X5Hz) and peripheral/distal airways resistance (D5–D20%) via IOS, averaging − 1369% and 23% predicted, respectively. These tests support the concept of airways hyperresponsiveness and distal airways narrowing, respectively. Among the five soldiers biopsied, all had constrictive bronchiolitis or bronchiolitis or severe pulmonary fibrosis. We detected the presence of polycyclic aromatic hydrocarbons (PAH)—which are products of incomplete combustion—in the lung tissue of all five warfighters. All also had detectable titanium and iron in the lungs. Metals were all oxidized, supporting the concept of inhaling burned metals. Combustion temperature was consistent with that of burned petrol rather than higher temperatures noted with cigarettes. All were nonsmokers. Neutrophil extracellular traps were reported in two biopsies. Compared to our prior biopsies in our Middle East deployment database, these histopathologic results are similar, since all database biopsies have constrictive bronchiolitis, one has lung fibrosis with titanium bound to iron in fixed mathematical ratios of 1:7 and demonstrated polarizable crystals. These results, particularly constrictive bronchiolitis and polarizable crystals, support the prior data of King et al. (N. Engl. J. Med. 365:222–230, 2011) Soldiers in this cohort deployed to Iraq and Afghanistan since 2003, with exposure to airborne hazards, including sandstorms, burn pits, and improvised explosive devices, are at high risk for developing chronic clinical respiratory problems, including: (1) reduction in respiratory muscle strength; (2) airways hyperresponsiveness; and (3) distal airway narrowing, which may be associated with histopathologic evidence of lung damage, reflecting inhalation of burned particles from burn pits along with particulate matter/dust. Non-invasive pulmonary diagnostic tests are a predictor of burn pit-induced lung injury.

Volumes da parede torácica, mobilidade diafragmática e capacidade funcional em pacientes com mucopolissacaridoses

Purpose We investigated respiratory muscle strength, diaphragm mobility, lung function, functional capacity, quality of life, body composition, breathing pattern, and chest wall (V T,CW) and compartmental volumes of Mucopolysaccharidosis (MPS) patients and compared these variables with matched healthy individuals. Methods A cross-sectional study with data analyzed separately according to age group. A total of 68 individuals (34 MPS and 34 matched-healthy subjects) were included. Six-minute walking test assessed functional capacity and ultrasound assessed diaphragm mobility during quiet spontaneous breathing (QB). Optoelectronic plethysmography assessed V T,CW and breathing pattern during QB in two different positions: seated and supine (45° trunk inclination). Results Body composition, lung function, respiratory muscle strength, and functional capacity were reduced in MPS (all p < 0.01). Diaphragm mobility was only reduced in adolescents (p = 0.01) and correlated with body composition and breathing pattern. Upper chest wall compartmental volumes were significantly lower in MPS, while abdominal volume only differed significantly in adolescents. Percentage contribution (%) of upper ribcage compartments to tidal volume was reduced in MPS children, whereas %AB was significantly increased compared with healthy subjects. Conclusion Lung function, respiratory muscle strength, functional capacity, diaphragm mobility, and quality of life are reduced in MPS compared with matched healthy subjects. V T,CW was mainly reduced due to pulmonary and abdominal ribcage impairment. Implications for Rehabilitation Reduction in respiratory muscle strength, functional capacity, diaphragm excursion and low lung volumes were found in individuals with Mucopolysaccharidoses (MPS). Chest wall volumes and the upper chest wall compartmental volumes during quiet spontaneous breathing are reduced in MPS. Assessment and monitoring of the respiratory system for individuals with MPS should be performed periodically through standardized assessments to enable identification of changes and early intervention by rehabilitation protocols. This study may provide the necessary basis for carrying out respiratoty rehabilitation protocols that can improving chest wall mechanics with breathing exercise in this group.

REHABILITATION OF PATIENTS AFTER CARDIAC SURGERY

Background. Patients undergoing cardiac surgery are under a high risk of post-operative reductions in respiratory muscle strength and pulmonary function as well as lowered functional capacity. In-hospital physical inactivity and inappropriate rehabilitation increases the chances for development of these complications and affects patients’ future independence in daily routine. Cardiac rehabilitation is crucial in preventing complications and assisting the early function recovery. However, despite the evidences for its benefits and strong guideline recommendations, the uptake of cardiac rehabilitation remains poor. Objective. this study is aimed at promotion of cardiac rehabilitation and sharing successful experience of using it. Methods. Post-surgical treatment and rehabilitation of 387 patients with cardiovascular pathology in the Department of Vascular and Cardiac Surgery of Municipal Non-Commercial Enterprise “Ternopil Regional Clinical Hospital” of Ternopil Regional Council has been analysed. Results. The experience of successful post-surgical treatment and rehabilitation allowed establishing the basic approaches to perioperative management of patients with cardiovascular surgical pathology. Key principles include minimized ICU stay and artificial ventilation time, early verticalization and beginning of physical activities, early removed drainage tubes, tracheobronchial tree drainage, nutritional balance, lymphatic drainage massage, application of elastic jersey on the lower extremities, early transferring to the surgery ward and returning to the regular daily activities, circumstantial health education, complex work of a multidisciplinary team. Conclusions. This set of rehabilitation measures helps prevent complications after cardiac surgery as well as provide a faster patient’s daily routine.

Are oxidative stress biomarkers and respiratory muscles strength associated with COPD-related sarcopenia in older adults?

Patients with chronic obstructive pulmonary disease (COPD) often present with sarcopenia, a condition marked by the loss in quality and quantity of muscle mass that can affect the strength of respiratory muscles. COPD and sarcopenia are also independently associated with oxidative stress. This study aimed to investigate whether oxidative stress biomarkers and respiratory muscle strength are associated with sarcopenia in COPD patients. In a cross-sectional study, 86 elderly subjects, including subjects with and without COPD were assessed for body composition, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and oxidative stress parameters [substances reactive to thiobarbituric acid (TBARS), ferric reducing ability of plasma (FRAP), superoxide dismutase (SOD), and catalase (CAT)]. The sample was mainly composed by males (72.1%) and eutrophic subjects. COPD-related sarcopenia was evidenced in 51.1% (22/43) of subjects with COPD. The highest TBARS and CAT, and lower MIP and MEP were associated with a high probability of having COPD-related sarcopenia. In the multivariate analysis, TBARS (OR: 4.89, 95% CI 1.52 to 15.54, p=0.006), CAT (OR: 1.22, 95% CI 1.03 to 1.45, p=0.020) and MEP (OR: 0.97, 95% CI 0.95 to 0.99, p=0.020) were independent determinants of COPD-related sarcopenia. The increase in oxidative stress-related factors and the reduction of respiratory muscle strength are associated with COPD-related sarcopenia.

Relação entre força muscular respiratória e funcionalidade em idosos residentes em instituições de longa permanência

No envelhecimento ocorre uma redução gradual da força muscular respiratória e da capacidade funcional, nesta perspectiva, o presente estudo tem por objetivo identificar a relação entre a força muscular respiratória e a funcionalidade em idosos residentes em instituições de longa de permanência. Trata-se de um estudo do tipo analítico com delineamento transversal e abordagem quantitativa, tendo como campo de pesquisa três instituições de longa permanência para idosos nos municípios de Vitória da Conquista e Jequié/BA, com amostra de 62 idosos. O instrumento de pesquisa foi constituído de cinco (5) partes: avaliação cognitiva, informações sociodemográficas, estado de saúde, força muscular respiratória (PImáx e PEmáx) e capacidade funcional (atividades básicas e instrumentais de vida diária). Os dados foram analisados por meio da análise estatística descritiva e aplicação do coeficiente de correlação de Spearman. Verificou-se que houve diferença estatística significativa entre PEmáx e atividades instrumentais de vida diária (p=0,000). Os resultados encontrados no presente estudo sugerem que os valores reduzidos da PEmáx estão associado ao comprometimento das atividades instrumentais de vida diária.

Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report

BackgroundThe prevalence of childhood-onset growth hormone (GH) deficiency (GHD) is estimated to be approximately 1 in 5000 or more, with the cause unknown in most cases (idiopathic isolated GHD). However, additional disorders of secretion of other pituitary hormones reportedly develop over time, with a frequency of 2–94% (median, 16%). Furthermore, median times to development of other anterior pituitary hormone deficiencies have been reported to be 6.4–9.4 years. On the other hand, adult patients affected by childhood-onset GHD reportedly develop impaired ventilation function due to reduced lung volumes and respiratory pressures, probably due to reductions in respiratory muscle strength. In addition, GH is known to play a role in stimulating the glomerular filtration rate (GFR), and the estimated GFR (eGFR) is decreased in patients with GHD.Case presentationThis case involved a 65-year-old woman. Her short stature had been identified at around 3 years of age, but no effective treatments had been provided. The patient was mostly amenorrheic, and hair loss became apparent in her late 30s. She developed hyperuricemia, dyslipidemia, and hypertension at 45 years of age. In addition, the patient was diagnosed with hypothyroidism at 50 years of age. At 58 years of age, endocrinological examination showed impaired secretion of thyroid-stimulating hormone, luteinizing hormone/follicle-stimulating hormone, and growth hormone, and magnetic resonance imaging showed an empty sella turcica. However, secretion ability of adrenocorticotropic hormone was retained. At 63 years of age, respiratory function tests confirmed a markedly restricted ventilation disorder (vital capacity, 0.54 L; percentage predicted vital capacity, 26.9%). Renal function had also decreased (eGFR, 25.0 mL/min/1.73 m2). Furthermore, she was diagnosed with hypothalamic secondary hypoadrenocorticism. The patient developed CO2 narcosis at 65 years of age, and noninvasive positive pressure ventilation was started.ConclusionsThe rare case of a 65-year-old woman with childhood-onset GHD with panhypopituitarism, including late-onset secondary hypoadrenocorticism in her 60s, associated with severely impaired respiratory function and renal dysfunction, was reported. In GHD patients with risk factors for progression from isolated GHD to combined pituitary hormone deficiency, such as empty sella turcica, lifelong endocrinological monitoring may be important.

Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects

ABSTRACT Objectives To assess morphological and functional aspects of the diaphragm by ultrasonography (US) in adults with sickle cell anemia (SCA) and evaluate if the diaphragmatic musculature can play a role in changes found in pulmonary function tests (PFTs) of these patients. Methods This is a cross-sectional observational and single-center study involving 40 adults with SCA who underwent diaphragm US and PFTs with a maximum of 1 month between the two tests. Diaphragm US was performed in B and M modes, and echogenicity, thickness and movement of the muscle was assessed in different respiratory maneuvers. Results Diaphragms had preserved echogenicity and the thickness was not significantly different between the groups. The SCA group exhibited significantly higher movement of the right hemidiaphragm during deep breathing (p = 0.004) and the sniff test (p = 0.0008) and lower movement of the left hemidiaphragm during quiet breathing (p = 0.009). There was a predominance of restrictive pattern (65%) and a global reduction in respiratory muscle strength (RMS) (70%). Conclusions This study shows that adults with SCA had normal morphostructural aspects and absence of diaphragm dysfunction. Otherwise, they presented greater movement of the right hemidiaphragm during deep breathing and sniff test maneuvers. Despite the restrictive pattern and the reduction in RMS found in PFTs, the diaphragm of young adults with SCA did not have weakness or paralysis.

Alteration of Inspiratory Muscle Strength is Related to Change in Deep Breathing Heart Rate Variability in Patients Submitted to Open-Heart Surgery

Aim: Despite the reduction of respiratory muscle strength and cardiac autonomic modulation after open-heart surgery has been demonstrated, the association between changes in both variables has not been investigated. This study aimed to determine the correlation between change in inspiratory muscle strength and change in deep breathing heart rate variability in patients submitted to open-heart surgery.Material and Methods: An observational cross-sectional study was conducted among 32 participants aged between 35 and 60 years who were undergoing coronary artery bypass graft and cardiac valve surgery. Inspiratory muscle strength was assessed by measuring maximal inspiratory pressure using a respiratory pressure meter (RPM 01, Micro Medical Ltd., United Kingdom). Deep breathing heart rate variability was collected using a Polar heart rate monitor (Polar Electro Ltd., Finland) during a slow and deep breathing control. Evaluations were performed on the day of admission and discharge.Results: There was statistically significant reduction in maximal inspiratory pressure and deep breathing heart rate variability indices in discharge period (p&amp;lt;0.05). The difference of expiratory/inspiratory ratio and inspiratory-expiratory differences was significantly correlated with the change in maximal inspiratory pressure in both absolute (r=-0.864, p=0.003 and r=-0.841, p=0.004, respectively) and percentages of predicted values (r=-0.868, p=0.003 and r=-0.834, p=0.005, respectively).Conclusion: Inspiratory muscle weakness was related to impair cardiac vagal modulation in patients who had undergone open-heart surgery. The present study could provide rehabilitation targets to improve inspiratory muscle strength and cardiac vagal tone.

Correlação entre força muscular respiratória, capacidade funcional e qualidade de vida na insuficiência cardíaca congestiva

Introdução: Insuficiência cardíaca congestiva (ICC) é considerada uma síndrome sistêmica caracterizada por fadiga e dispneia. Objetivo: Correlacionar a qualidade de vida, capacidade funcional e força muscular respiratória de pacientes com ICC. Métodos: Pacientes com ICC, internos em hospital referência, foram avaliados. Foram avaliadas a classificação funcional pela New York Heart Association (NYHA), qualidade de vida pelo o questionário Minnesota Living with Heart Failure Questionnaire (MLHFQ), e pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) pela manuvacuometria. Resultados: Quarenta e três pacientes foram incluídos, sendo 26 (60,5%) homens, com média de idade de 73,16 (±10,28) anos. A maioria dos pacientes (44,2%) estavam na classe NYHA 3. Correlação negativa foi encontrada para PImáx e PEmáx com NYHA (rs= -0,478, rs = -0,490, respectivamente), e MLHFQ com a PImáx (rs= -0,393). Conclusão: Conclui-se que a redução da força muscular respiratória leva a diminuição na qualidade de vida e piora na capacidade funcional.

Effects of a Physiotherapeutic Protocol in Respiratory Function, Aerobic Capacity and Quality of Life After Kidney Transplantation

IntroductionChronic kidney disease can lead to dysfunction of the respiratory, cardiac, and musculoskeletal systems, altering the body's metabolism. Renal transplantation and hospital physiotherapy, through specific protocols, can improve these dysfunctions. ObjectivesThis study evaluates the impact of a hospital physiotherapeutic protocol in quality of life (QoL), respiratory muscle strength, peak expiratory flow, and 6-minute walk test (6MWT) in the preoperative, first, and fifth days after renal transplantation. MethodsWe evaluated 39 patients who received a renal transplant at Clinics Hospital of University of Campinas for respiratory muscle strength, expiratory peak flow, and functional capacity by the 6MWT. The short form–36 quality of life questionnaire was applied to 12 patients. ResultsWe observed a significant reduction in respiratory muscle strength and peak expiratory flow in the first postoperative day. On postoperative day 5, there was improvement in respiratory muscle strength and expiratory peak flow. However, aerobic capacity measured by 6MWT remained below predicted. Analysis of QoL showed an improvement in almost all analyzed domains after transplantation. ConclusionA specific physiotherapeutic protocol applied early after transplantation provided recovery of respiratory muscle strength and QoL. However, longer training is necessary to obtain adequate aerobic rehabilitation.

Evaluation of Respiratory Muscle Strength in the Acute Phase of Stroke: The Role of Aging and Anthropometric Variables

During hospitalization, stroke patients are bedridden due to neurologic impairment, leading to loss of muscle mass, weakness, and functional limitation. There have been few studies examining respiratory muscle strength (RMS) in the acute phase of stroke. This study aimed to evaluate the RMS of patients with acute stroke compared with predicted values and to relate this to anthropometric variables, risk factors, and neurologic severity. This is a cross-sectional study in the acute phase of stroke. After admission, RMS was evaluated by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP); anthropometric data were collected; and neurologic severity was evaluated by the National Institutes of Health Stroke Scale. The analysis of MIP and MEP with predicted values was performed by chi-square test, and the relationship between anthropometric variables, risk factors, and neurologic severity was determined through multiple linear regression followed by residue analysis by the Shapiro-Wilk test; P < .05 was considered statistically significant. In the 32 patients studied, MIP and MEP were reduced when compared with the predicted values. MIP declined significantly by 4.39 points for each 1 kg/m2 increase in body mass index (BMI), and MEP declined significantly by an average of 3.89 points for each 1 kg/m2 increase in BMI. There was no statistically significant relationship between MIP or MEP and risk factors, and between MIP or MIP and neurologic severity in acute phase of stroke. There is a reduction of RMS in the acute phase of stroke, and RMS was lower in individuals with increased age and BMI.

Impact of an early physiotherapy program after kidney transplant during hospital stay: a randomized controlled trial.

Cardiorespiratory and musculoskeletal dysfunctions are common in the postoperative period of kidney transplant patients and are often accompanied by low exercise tolerance. The purpose of this study was to evaluate the impact of an early physiotherapy program during hospital stay on functional capacity and peripheral and respiratory muscle strength after kidney transplant. An open, randomized clinical trial was conducted in patients undergoing living donor kidney transplant. Sixty-three patients were included (intervention group-IG: n = 30; control group-CG: n = 33). IG received an early physiotherapy program from first postoperative day until hospital discharge and CG received standard care. The variables of interest were measured preoperatively and at discharge except for respiratory muscle strength and vital capacity (VC), which were also measured on the first postoperative day. Functional capacity was evaluated through six-minute walk test (6MWT); peripheral and respiratory muscle strength using a dynamometer and manovacuometer, respectively; and VC through spirometer. After surgery, there was a reduction in functional walking capacity and peripheral muscle strength without different between groups (p > 0.05); however, respiratory muscle strength was significantly higher in IG (p < 0.001) at hospital discharge, when comparing with CG. An early physiotherapy program during hospitalization for patients undergoing living donor kidney transplant caused a lower reduction in respiratory muscle strength and without additional benefits in the functional capacity, when compared to a control group, although the clinical relevance of this finding is uncertain.

Effects of Ramadan Fasting on Inspiratory Muscle Function.

BackgroundRamadan fasting is a major challenge for exercising Muslims especially in warm seasons. There is some evidence to indicate that Ramadan fasting causes higher subjective ratings of perceived exertion (RPE) in fasting Muslims. The mechanisms of this phenomenon are not known exactly. The role of respiratory muscle strength in this regard has not been studied yet.ObjectivesThe aim of this study was investigation of the effects of Ramadan fasting on respiratory muscle strength.Patients and MethodsIn a before-after study, from 35 fasting, apparently healthy, male adults who had fasted from the beginning of Ramadan, maximal inspiratory muscle pressure (MIP) and peak inspiratory flow (PIF) were measured in the last week of Ramadan month in summer. At the time of test, there was not any sleep problem in participants and all of them had good cooperation. Three months later, after exclusion of incompatible persons mainly because of change in their physical activity level, smoking behavior or drug consumption, the measurements were repeated in 12 individuals.ResultsWeight, MIP and PIF data had normal distribution (Kolmogorov-Smirnov Test). There was a significant increase in MIP (mean 8.3 cm H2O with 95% confidence interval of 2.2 - 14.3) and PIF (mean 0.55 lit/s with 95% confidence interval of 0.02 - 1.07) and weight (mean 3.4 Kg with 95% confidence interval of 2.2 - 4.5) after Ramadan (Paired t test with P < 0.05). When weight difference was used as a covariate in repeated measure ANOVA test, there was no further significant difference between MIP and PIF measurements.ConclusionsRamadan fasting may cause reduction of respiratory muscle strength through reduction of body weight.

The Influence of Physical Fitness on Respiratory Muscle Strength in the Elderly

Background: One of the consequences of aging process is the reduction in respiratory muscle strength. So, this study sought to determine the level of physical fitness that influences respiratory muscle strength among participants in a program for senior citizens. Methods: We evaluated 55 elderly between 60 and 80 years, of both sexes, with no history of respiratory disease. The participants were evaluated measuring the maximal in spiratory (MIP) and expiratory (MEP) pressures and applying the IPAQ questionnaire to assess their level of physical activity. The groups were compared using ANOVA test followed by Tukey’s test with a significance level of 5%. Results: 27.3% of the elderly were classified as active, 43.6% as irregularly active, and 29.1% as sedentary. The MIP values for the active (82.7 cmH2O) and irregularly active groups (80.4 cmH2O) were higher than those observed for the sedentary group (62.5 cmH2O) (p < 0.05), and there was no significant difference between the active and irregularly active groups. Conclusion: This study demonstrated that more active elderly, regardless of the level or duration of activity, have higher inspiratory muscle strength than the sedentary ones.

Reduction of respiratory muscle strength in subjects with rheumatoid arthritis

Objective: To evaluate the respiratory muscle strength in patients with rheumatoid arthritis (RA) compared to healthy subjects and to correlate it with the level of disease activity (DAS- 28) and body mass index (BMI). Method: A cross-sectional study evaluated 18 women (57.94 ± 10.36 years); eight had RA (RA group) and ten were healthy subjects (control group), matched by age. All patients underwent the following evaluations: registration form (identification and clinical data), physical examination (weight, height, and BMI), DAS-28, dosage of C-reactive protein (CRP), and measurement of MIP and MEP with a manometer. Results: There were significant differences between the RA and control groups in relation to the MIP (-46.25 ± 17.67 vs. cmH2O -81.00 ± 19.69 cm H2O) and MEP (58.75 cmH2O ± 17.26 vs. 78.00 ± 6.32 cmH2O). Also there was difference between RA group and predicted age values in relation to the MIP (-46.25 ± 17.67 vs. -81.06 ± 4.11 cmH2O) and MEP (58.75 cmH2O ± 17.26 vs. 78.92 ± 5.33 cmH2O). Moreover, a significant correlation was observed between MEP and BMI. There was no significant correlation between MIP - CRP, DAS- 28 and BMI, and between MEP - DAS and CRP. Conclusion: This data reinforces the systemic nature of RA and points out the need for a comprehensive assessment of the patient, not just focusing on the articular component, but also checking the strength of the respiratory muscles of these individuals to determine more specific therapeutic strategies of treatment.

Efeitos do treinamento aeróbio sobre a capacidade muscular e funcional em pacientes com diabetes mellitus tipo 2

Introduction: Diabetes Mellitus leads to reduced aerobic capacity as well as the reduction of respiratory muscle strength. Objective: To evaluate the impact of aerobic training (AT) on respiratory muscle strength (RMS) measured by maximal inspiratory (MIP) and expiratory (MEP) pressures, thoracic expansibility (TEx), submaximal functional capacity (SFC) by 6-min walk test (6MWT) and muscular endurance (ME) of the lower limbs and flexibility in subjects with type 2 diabetes mellitus (T2DM). Materials and Methods: Prospective trial, non-randomized with 27 subjects with T2DM, which were allocated into AT group (G1) and control group (G2). Evaluations were performed before and after the RMS, TEx, 6MWT, lower limb ME and flexibility interventions. The AT lasted 8 weeks, three times a week, 60 minutes each. The prescription of AT was performed at 60-70% of maximum heart rate monitored by analog Borg scale. Results: The study shows that occurred an increase in the RMS (49% of the MIP and MEP), 6MWT, ME and flexibility in the G1 group. Conclusion: The TA was effective in improving respiratory muscle strength and functional capacity in patients with T2DM.

Respiratory Medicine at McMaster University, Hamilton, Ontario: 1968 To 2013

The medical school at McMaster University (Hamilton, Ontario) was conceived in 1965 and admitted the first class in 1969. John Evans became the founding Dean and he invited Moran Campbell to be the first Chairman of the Department of Medicine. Moran Campbell, already a world figure in respiratory medicine and physiology, arrived at McMaster in September 1968, and he invited Norman Jones to be Coordinator of the Respiratory Programme.At that time, Hamilton had a population of 300,000, with two full-time respirologists, Robert Cornett at the Hamilton General Hospital and Michael Newhouse at St Joseph’s Hospital. From the clinical perspective, the aim of the Respiratory Programme was to develop a network approach to clinical problems among the five hospitals in the Hamilton region, with St Joseph’s Hospital serving as a regional referral centre, and each hospital developing its own focus: intensive care and burns units at the Hamilton General Hospital; cancer at the Henderson (later Juravinski) Hospital; tuberculosis and rehabilitation at the Chedoke Hospital; pediatrics and neonatal intensive care at the McMaster University Medical Centre; and community care at the Joseph Brant Hospital in Burlington (Ontario). The network provided an ideal base for a specialty residency program. There was also the need to establish viable research.These objectives were achieved through collaboration, support of hospital administration, and recruitment of clinicians and faculty, mainly from our own trainees and research fellows. By the mid-1970s the respiratory group numbered more than 25; outpatient clinic visits and research had grown beyond our initial expectations. The international impact of the group became reflected in the clinical and basic research endeavours.ASTHMA: Freddy Hargreave and Jerry Dolovich established methods to measure airway responsiveness to histamine and methacholine. Allergen inhalation was shown to increase airway responsiveness for several weeks, and the late response was shown to be an immunoglobulin E-mediated phenomenon. Paul O’Byrne and Gail Gauvreau showed that the prolonged allergen-induced responses were due to eosinophilic and basophilic airway inflammation and, with Judah Denburg, revealed upregulation of eosinophil/basophil progenitor production in bone marrow and airways. The Firestone Institute became the centre of studies identifying the inflammatory pheno-type of patients with difficult-to-control asthma. Freddy Hargreave and others developed methods for sputum induction to identify persisting eosinophilic airway inflammation and documented its presence in the absence of asthma and in patients with persistent cough. Parameswaran Nair has applied these techniques to the management of asthma in routine clinical practice. The Asthma Quality of Life Questionnaire and the Asthma Control Tests were developed by Drs Liz Juniper and Gordon Guyatt. The first Canadian evidence-based clinical guidelines for asthma management in 1989 were coordinated by Freddy Hargreave, Jerry Dolovich and Michael Newhouse.DISTRIBUTION OF INHALED PARTICLES: Michael Newhouse and Myrna Dolovich used inhaled radiolabelled aerosols to study the distribution of inhaled particles and their clearance in normal subjects, smokers and patients with chronic obstructive pulmonary disease. They developed the aerochamber, and were the first to radiolabel therapeutic aerosols to distinguish the effects of peripheral versus central deposition. Particle deposition and clearance were shown to be impaired in ciliary dyskinesia and cystic fibrosis.DYSPNEA: Moran Campbell and Kieran Killian measured psychophysical estimates of the sense of effort in breathing in studies of loaded breathing and exercise to show that dyspnea increased as a power function of both duration and intensity of respiratory muscle contraction, and in relation to reductions in respiratory muscle strength. These principles also applied to dyspnea in cardiorespiratory disorders.EXERCISE CAPACITY: Norman Jones and Moran Campbell developed a system for noninvasive cardiopulmonary exercise testing using an incremental exercise test, and more complex studies with measurement of mixed venousPCO2by rebreathing. The 6 min walk test was validated by Gordon Guyatt. Kieran Killian and Norman Jones introduced routine muscle strength measurements in clinical testing and symptom assessment in exercise testing. Muscle strength training improved exercise capacity in older subjects and patients with chronic obstructive pulmonary disease.METABOLISM AND ACID-BASE CONTROL IN EXERCISE: After showing that imposed acidosis reduced, and alkalosis improved performance, Norman Jones, John Sutton and George Heigenhauser investigated the interactions between acid-base status and metabolism in exercise.HIGH-ALTITUDE MEDICINE: John Sutton and Peter Powles participated in high-altitude research on Mount Logan (Yukon), demonstrating sleep hypoxemia in acute mountain sickness and its reversal by acetazol-amide, and participated in Operation Everest II.EPIDEMIOLOGY: David Pengelly and Tony Kerrigan followed children living in areas with differing air quality to show that lung development was adversely affected by pollution and maternal smoking. Malcolm Sears and Neil Johnstone showed that the ‘return to school’ asthma exacerbation epidemic was due mainly to rhinoviruses. David Muir investigated the effects of silica exposure in hard-rock miners, and mortality in the nickel industry.SUMMARY: The Respirology Division has grown to more than 50 physicians and PhD scientists, and currently provides the busiest outpatient clinic in Hamilton, and has successful training and research programs.

Respiratory medicine at McMaster University, Hamilton, Ontario: 1968 to 2013.

The medical school at McMaster University (Hamilton, Ontario) was conceived in 1965, and admitted the first class in 1969. John Evans became the founding Dean and he invited EJ Moran Campbell to be the first Chairman of the Department of Medicine. Moran Campbell, already a world figure in respiratory medicine and physiology, arrived at McMaster in September 1968, and he invited Norman Jones to be Coordinator of the Respiratory Programme.At that time, Hamilton had a population of 300,000, with two full-time respirologists, Robert Cornett at the Hamilton General Hospital and Michael Newhouse at St Joseph’s Hospital. From the clinical perspective, the aim of the Respiratory Programme was to develop a network approach to clinical problems among the five hospitals in the Hamilton region, with St Joseph’s Hospital serving as a regional referral centre, and each hospital developing its own focus: intensive care and burns units at the Hamilton General Hospital; cancer at the Henderson (later Juravinski) Hospital; tuberculosis and rehabilitation at the Chedoke Hospital; pediatrics and neonatal intensive care at the McMaster University Medical Centre; and community care at the Joseph Brant Hospital in Burlington. The network provided an ideal base for a specialty residency program. There was also the need to establish viable research.These objectives were achieved through collaboration, support of hospital administration, and recruitment of clinicians and faculty, mainly from our own trainees and research fellows. By the mid-1970s, the respiratory group numbered more than 25; outpatient clinic visits and research had grown beyond our initial expectations. The international impact of the group became reflected in the clinical and basic research endeavours.ASTHMA: Freddy Hargreave and Jerry Dolovich established methods to measure airway responsiveness to histamine and methacholine. Allergen inhalation was shown to increase airway responsiveness for several weeks, and the late response was shown to be an immunoglobulin E-mediated phenomenon. Paul O’Byrne and Gail Gauvreau showed that the prolonged allergen-induced responses were due to eosinophilic and basophilic airway inflammation and, with Judah Denburg, revealed upregulation of eosinophil/basophil progenitor production in bone marrow and airways. The Firestone Institute became the centre of studies identifying the inflammatory phenotype of patients with difficult-to-control asthma. Freddy Hargreave and others developed methods for sputum induction to identify persisting eosinophilic airway inflammation and documented its presence in the absence of asthma, and in patients with persistent cough. Parameswaran Nair has applied these techniques to the management of asthma in routine clinical practice. The Asthma Quality of Life Questionnaire and the Asthma Control Tests were developed by Liz Juniper and Gordon Guyatt. The first Canadian evidence-based clinical guidelines for asthma management in 1989 were coordinated by Freddy Hargreave, Jerry Dolovich and Michael Newhouse.DISTRIBUTION OF INHALED PARTICLES: Michael Newhouse and Myrna Dolovich used inhaled radiolabelled aerosols to study the distribution of inhaled particles and their clearance in normal subjects, smokers and patients with chronic obstructive pulmonary disease. They developed the aerochamber, and were the first to radiolabel therapeutic aerosols to distinguish the effects of peripheral versus central deposition. Particle deposition and clearance were shown to be impaired in ciliary dyskinesia and cystic fibrosis.DYSPNEA: Moran Campbell and Kieran Killian measured psychophysical estimates of the sense of effort in breathing in studies of loaded breathing and exercise to show that dyspnea increased as a power function of both duration and intensity of respiratory muscle contraction, and in relation to reductions in respiratory muscle strength. These principles also applied to dyspnea in cardiorespiratory disorders.EXERCISE CAPACITY: Norman Jones and Moran Campbell developed a system for noninvasive cardiopulmonary exercise testing using an incremental exercise test, and more complex studies with measurement of mixed venousPCO2by rebreathing. The 6 min walk test was validated by Gordon Guyatt. Kieran Killian and Norman Jones introduced routine muscle strength measurements in clinical testing and symptom assessment in exercise testing. Muscle strength training improved exercise capacity in older subjects and patients with chronic obstructive pulmonary disease.METABOLISM AND ACID-BASE CONTROL IN EXERCISE: After showing that imposed acidosis reduced, and alkalosis improved performance, Norman Jones, John Sutton and George Heigenhauser investigated the interactions between acid-base status and metabolism in exercise.HIGH-ALTITUDE MEDICINE: John Sutton and Peter Powles participated in high-altitude research on Mount Logan (Yukon), demonstrating sleep hypoxemia in acute mountain sickness and its reversal by acetazolamide, and participated in Operation Everest II.EPIDEMIOLOGY: David Pengelly and Tony Kerrigan followed children living in areas with differing air quality to show that lung development was adversely affected by pollution and maternal smoking. Malcolm Sears and Neil Johnstone showed that the ‘return to school’ asthma exacerbation epidemic was due mainly to rhinoviruses. David Muir investigated the effects of silica exposure in hard-rock miners, and mortality in the nickel industry.SUMMARY: The Respirology Division has grown to more than 50 physicians and PhD scientists, currently provides the busiest outpatient clinic in Hamilton, and has successful training and research programs.

Reduction of respiratory muscle strength in subjects with rheumatoid arthritis

Objetivo: Avaliar a força muscular respiratória de pacientes com Artrite Reumatoide (AR) em comparação a indivíduos saudáveis e correlacionar com o nível de atividade da doença (DAS-28) e índice de massa corporal (IMC). Método: Estudo transversal onde foram avaliadas 18 mulheres, com média de idade de 57,94 anos, sendo 8 com AR (Grupo AR) e 10 saudáveis (Grupo Controle), pareadas por idade. Todas foram submetidas às seguintes avaliações: ficha cadastral - dados de identificação e clínicos; exame físico - massa corporal, estatura e IMC; DAS-28; dosagem de proteína C-reativa (PCR) e determinação dos valores de Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx), por meio de um manovacuômetro. Foi adotado o nível de significância de 5%. Resultados: Houve diferença estatisticamente significativa entre os grupos AR e Controle em relação à PImáx (-46,25 ± 17,67 cmH2O vs. -81,00 ± 19,69 cmH2O; p ≤ 0,01) e PEmáx (58,75 ± 17,26 cmH2O vs. 78,00 ± 6,32 cmH2O; p ≤ 0,01). Também verificou-se diferença entre o grupo AR e valores preditos para a idade em relação à PImáx (-46,25 ± 17,67 cmH2O vs. -81,06 ± 4,11 cmH2O; p ≤ 0,01) e PEmáx (58,75 ± 17,26 cmH2O vs. 78,92 ± 5,33 cmH2O; p ≤ 0,01). Adicionalmente, foi encontrada correlação significativa entre a PEmáx e IMC (p = 0,03). Não houve correlação significativa entre as variáveis PImáx - PCR, DAS-28 e IMC, e entre PEmáx - DAS e PCR. Conclusão: Esses dados reforçam o caráter sistêmico da AR e levantam a necessidade de uma avaliação global do paciente, que não foque apenas no componente articular, mas verifique também a força dos músculos respiratórios desses indivíduos, para determinação de estratégias terapêuticas mais específicas e adequadas.