No abstract

BACKGROUND: Patients with COPD may experience respiratory muscle weakness. Two therapeutic approaches to the respiratory muscles are inspiratory muscle training and calisthenics-andbreathing exercises. The aims of the study are to compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion. In addition, these gains were compared between subjects with and without respiratory muscle weakness. METHODS: 25 subjects completed the study: 13 composed the inspiratory muscle training group, and 12 composed the calisthenics-and-breathing exercises group. Subjects were assessed before and after training by spirometry, measurements of respiratory muscle strength and test of inspiratory muscle endurance, thoracoabdominal excursion measurements, and the 6-min walk test. Moreover, scores for the Modified Medical Research Council dyspnea scale were reported. RESULTS: After intervention, there was a significant improvement in both groups of respiratory muscle strength and endurance, thoracoabdominal mobility, and walking distance in the 6-min walk test. Additionally, there was a decrease of dyspnea in the 6-min walk test peak. A difference was found between groups, with higher values of respiratory muscle strength and thoracoabdominal mobility and lower values of dyspnea in the 6-min walk test peak and the Modified Medical Research Council dyspnea scale in the inspiratory muscle training group. In the inspiratory muscle training group, subjects with respiratory muscle weakness had greater gains in inspiratory muscle strength and endurance. CONCLUSIONS: Both interventions increased exercise capacity and decreased dyspnea during physical effort. However, inspiratory muscle training was more effective in increasing inspiratory muscle strength and endurance, which could result in a decreased sensation of dyspnea. In addition, subjects with respiratory muscle weakness that performed inspiratory muscle training had higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity. (ClinicalTrials.gov registration NCT01510041.)

Este estudo teve como objetivo avaliar os elementos da mecânica respiratória, de indivíduos obesos no que se refere á força muscular respiratória, através das medidas de Pressão Respiratória Máxima (PImáx e PEmáx) e, da mobilidade tóraco abdominal, através da Amplitude Tóraco-Abdominal nos níveis: axilar (AAx), xifoidiano (AXf) e abdominal (AAb). Avaliaram-se 29 indivíduos obesos com média de idade de 43 ± 13 anos, divididos em dois grupos: Grupo Experimental (E) e Grupo Controle (C), através das medidas da PImáx e da PEmáx e Amplitude Tóraco-abdominal. O Grupo E foi submetido a 18 sessões de Reeducação Funcional Respiratória (RFR) que constituiu-se de orientação respiratória, exercícios de coordenação da respiração associados aos movimentos de tronco e membros, alongamento geral da musculatura e relaxamento muscular, 2 vezes por semana, durante 9 semanas. Constatou-se, através do Teste-t de Student (p<0.05), que não ocorreram diferenças significativas nos valores da PEmáx em ambos os grupos estudados mas, a PImax, a AXif e a AAbd aumentaram significativamente no E. Esses resultados permitem concluir que a RFR causou um aumento na força muscular inspiratória e das amplitudes tóraco-abdominais desses indivíduos obesos.

Objetivo: Avaliar os efeitos de três programas de fisioterapia respiratória constituídos por treinamento físico (TF) em esteira e/ou treinamento muscular respiratório (TMR) em pacientes com DPOC. Métodos: Participaram deste estudo 25 pacientes com DPOC moderada-grave, de ambos os sexos, que foram divididos aleatoriamente em 3 grupos, sendo o primeiro grupo (G1) submetido a TMR com 30% da pressão inspiratória máxima obtida a cada semana, o segundo grupo (G2) submetido a TF com 70% da freqüência cardíaca atingida no teste de exercício cardiorrespiratório (TECR) sintoma-limitado e o terceiro grupo (G3) associava TMR ao TF com as mesmas intensidades citadas anteriormente. Todos os programas constituíram-se de 3 sessões semanais por 6 semanas consecutivas. Resultados: Após tratamento, foram observados aumentos significativos da força muscular respiratória (FMR) no G1; aumentos significativos da distância percorrida no TECR, redução da freqüência cardíaca e do volume minuto expirado isovelocidade e melhora do domínio da capacidade funcional do questionário de qualidade de vida no G2; aumento significativo da FMR, da distância percorrida no TECR, redução da pressão arterial sistólica e concentração sangüínea de lactato isovelocidade e melhora da qualidade de vida no G3. Conclusão: Os resultados sugerem que o TF associado ao TMR foi a melhor alternativa terapêutica dentre as investigadas no presente estudo; pois, além de proporcionar uma evidente melhora na tolerância ao esforço e na qualidade de vida dos pacientes, promoveu um efeito adicional nas adaptações fisiológicas ao exercício, com uma maior eficácia na remoção e/ou menor produção de lactato sangüíneo durante o esforço.

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH 2 O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.