Efeito da estimulação diafragmática elétrica transcutânea em parâmetros respiratórios de pacientes com Doença Pulmonar Obstrutiva Crônica

El objetivo del estudio fue evaluar el efecto de la estimulación diafragmática eléctrica transcutánea (EDET) sobre la fuerza y endurance muscular respiratoria, expansibilidad toracoabdominal y variables espirométricas de individuos con enfermedad pulmonar obstructiva crónica (EPOC). Ocho pacientes con EPOC sometidos a fisioterapia respiratoria recibieron tratamiento con EDET dos veces por semana durante 6 semanas, totalizando 12 sesiones. Antes y después del tratamiento fueron evaluados por los siguientes parámetros: presión inspiratoria máxima (PImáx); presión expiratoria máxima (PEmáx); cirtometría axilar, xifoidea y abdominal; y espirometría. Después del test Shapiro-Wilk, el test t de Student pareado y el test Mann-Whitney fueron aplicados para la comparación de los dos niveles (antes y después de la EDET). Para la comparación de los niveles antes, después (post-1a sesión), 1ª, 2ª, 3ª y 4ª semana, la ANOVA seguida del test de Tukey fueron aplicados (pThe objective of this study was to evaluate the effect of transcutaneous electrical diaphragmatic stimulation (TEDS) on respiratory muscle strength and endurance, thoracic-abdominal expansibility and spirometric variables of subjects with chronic as obstructive pulmonary disease (COPD). Eight COPD patients submitted to respiratory physiotherapy received treatment with TEDS twice a week for 06 weeks, totaling 12 sessions. Before and after TEDS they were evaluated by the following parameters: maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); axillary, xiphoid and abdominal cyrtometry; and spirometry. After the Shapiro-Wilk test, the paired Student's-t test and the Mann-Whitney test were applied for comparison of the two stages (before and after TEDS). For comparison of the before, after (post-1st session), 1st, 2nd, 3rd, 4th week stages, the ANOVA followed by Tukey test were applied (pO objetivo do estudo foi avaliar o efeito da estimulação diafragmática elétrica transcutânea (EDET) sobre a força e endurance muscular respiratória, expansibilidade toracoabdominal e variáveis espirométricas de indivíduos com doença pulmonar obstrutiva crônica (DPOC). Oito pacientes com DPOC submetidos à fisioterapia respiratória receberam tratamento com EDET duas vezes por semana durante 06 semanas, totalizando 12 sessões. Antes e depois do tratamento eles foram avaliados pelos seguintes parâmetros: pressão inspiratória máxima (PImáx); pressão expiratória máxima (PEmáx); cirtometria axilar, xifoideana e abdominal; e espirometria. Após o teste Shapiro-Wilk, o teste t de Student pareado e o teste Mann-Whitney foram aplicados para a comparação dos dois estágios (antes e após a EDET). Para a comparação dos estágios antes, após (pós-1a sessão), 1ª, 2ª, 3ª e 4ª semana, a ANOVA seguida do teste de Tukey foram aplicados (

Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients

INTRODUCTION: Upper limb exercises are frequently used in respiratory physiotherapy, with UL elevation and controlled inspiratory timing. However, the use of expiration during upper limb elevation appears to be a strategy that could minimize the action of accessory muscles in patients with chronic obstructive pulmonary disease. In this context, little is known about the synchrony of upper limb (UL) movements associated with breathing. The aim of this study was to investigate the respiratory pattern of chronic obstructive pulmonary disease patients during different UL exercises associated with respiratory exercises. METHODS: Fifteen chronic obstructive pulmonary disease patients participated in this study. Respiratory pattern analysis by inductance plethysmography was performed during four types of upper limb exercises, two shoulder flexion-extension (one associated with inspiratory time during the concentric phase and the other associated with expiratory time) and two shoulder abduction-adduction (same timing as above). Statistical analysis was performed by the Kolmogorov-Smirnov test and ANOVA with Tukey tests (p< 0.05). RESULTS: The thoracoabdominal coordination measurements increased in the two exercises using both inspiration during shoulder flexion (PhRIB: 172%; PhREB: 131%; PhRTB: 142% and PhAng: 238%) as well as in shoulder horizontal abduction (PhRIB: 145%; PhREB: 109%; PhRTB: 130% and PhAng: 229%), differing from the exercises with expiration at the time of shoulder flexion and horizontal abduction. CONCLUSION: The exercises performed with inverted respiratory time produced less asynchrony and can be used as important strategies during physical exercise programs in these patients

New reference values for maximal respiratory pressures in the Brazilian population

OBJECTIVE: To compare MIP and MEP determined in healthy subjects with those predicted using the equations proposed in another study, and, if necessary, to suggest new equations for MIP and MEP to be used in the Brazilian population. METHODS: The study sample comprised 60 healthy males and 60 healthy females, 20-80 years of age (20 subjects per ten-year age bracket). Maximal respiratory pressures were determined following a standardized protocol. RESULTS: Regarding MIP, the measured values were significantly lower than those predicted for both males (31%) and females (24%). There were no significant differences between measured and predicted MEP in either gender. We found that age presented the greatest power to predict MIP and MEP in both genders. New equations were proposed. CONCLUSIONS: The previously proposed equations were unable to predict MIP and MEP for all of the subjects in our sample. Therefore, the results of this study can facilitate the prediction of respiratory muscle strength in healthy adult subjects in Brazil. Further studies, involving subjects from different regions of the country, could lead to the development of better tables or equations for maximal respiratory pressures in the Brazilian population.OBJETIVO: Comparar PImáx e PEmáx medidas em indivíduos saudáveis com os valores previstos utilizando-se as equações propostas em outro estudo e, se necessário, sugerir novas equações para PImáx e PEmáx para a população brasileira. MÉTODOS: Participaram do estudo 60 homens e 60 mulheres saudáveis com idades entre 20 e 80 anos (20 indivíduos por faixa etária de 10 anos). As pressões respiratórias máximas foram determinadas segundo um protocolo padronizado. RESULTADOS: Os valores medidos de PImáx foram significativamente menores que aqueles previstos tanto para homens (31%) e mulheres (24%). Não houve diferenças significativas entre a PEmáx medida e prevista nos dois gêneros. A idade provou ser a variável com melhor poder preditivo para PImáx e PEmáx nos dois gêneros. Novas equações foram propostas. CONCLUSÕES: As equações propostas no estudo prévio não foram capazes de predizer PImáx e PEmáx de todos os indivíduos de nossa amostra. Portanto, os resultados deste estudo podem facilitar a predição da força muscular respiratória de adultos saudáveis no Brasil. Novos estudos, com indivíduos de diferentes regiões do país, poderão contribuir para o desenvolvimento de melhores tabelas ou equações para as pressões respiratórias máximas na população brasileira.30631

Estimulação diafragmática elétrica transcutânea (EDET) para fortalecimento muscular respiratório: estudo clínico controlado e randomizado

O objetivo do estudo foi demonstrar o efeito de dois protocolos da estimulação diafragmática elétrica transcutânea (EDET) sobre a força muscular respiratória de mulheres saudáveis, sendo um protocolo segundo Geddes et al. (1988) e outro padronizado pelo equipamento Phrenics. Mulheres saudáveis foram divididas em 3 grupos: Controle (n=7); EDET com Phrenics (n=7) e EDET com Dualpex (n=7), sendo o tratamento realizado 2 vezes por semana, durante 6 semanas (12 sessões). Foram avaliadas a pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx), antes e após o tratamento. A análise estatística foi realizada pelo teste Shapiro-Wilk e Kruskal Wallis com pós-hoc de Dunn (pThe objective of this study was to demonstrate the effect of two protocols of transcutaneous electrical diaphragmatic stimulation (TEDS) on the respiratory muscle strength of healthy women, with one protocol according to Geddes et al. (1988) and other protocol standardized by Phrenics equipment. Healthy women were divided in 3 groups: Control (n=7); TEDS with Phrenics (n=7) and TEDS with Dualpex (n=7). The treatment was made twice a week, during 6 weeks (12 sessions). Respiratory muscle strength was evaluated by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) before and after the treatment. The statistical analysis was made by the Shapiro-Wilk and the Kruskal Wallis test with Dunn's post-hoc test (

Happiness around the world: A combined etic-emic approach across 63 countries.

What does it mean to be happy? The vast majority of cross-cultural studies on happiness have employed a Western-origin, or "WEIRD" measure of happiness that conceptualizes it as a self-centered (or "independent"), high-arousal emotion. However, research from Eastern cultures, particularly Japan, conceptualizes happiness as including an interpersonal aspect emphasizing harmony and connectedness to others. Following a combined emic-etic approach (Cheung, van de Vijver & Leong, 2011), we assessed the cross-cultural applicability of a measure of independent happiness developed in the US (Subjective Happiness Scale; Lyubomirsky & Lepper, 1999) and a measure of interdependent happiness developed in Japan (Interdependent Happiness Scale; Hitokoto & Uchida, 2015), with data from 63 countries representing 7 sociocultural regions. Results indicate that the schema of independent happiness was more coherent in more WEIRD countries. In contrast, the coherence of interdependent happiness was unrelated to a country's "WEIRD-ness." Reliabilities of both happiness measures were lowest in African and Middle Eastern countries, suggesting these two conceptualizations of happiness may not be globally comprehensive. Overall, while the two measures had many similar correlates and properties, the self-focused concept of independent happiness is "WEIRD-er" than interdependent happiness, suggesting cross-cultural researchers should attend to both conceptualizations

Efeitos do exercício resistido de membros superiores na força e na funcionalidade do paciente com DPOC

The aim of this study was assess the effect of the resistance exercise in upper limb on the strength and functionality in COPD patients moderate to very severe. Methods: Twelve patients with clinical diagnosis of COPD were distributed into 2 groups: control (GC) and trained (GT). During 6 weeks, with frequency of 3 times a week, the GT carried out strength training with load of 80% of one repetition maximum (1RM) and GC performed bronchial hygiene sessions and functional respiratory reeducation. Before and after the treatment were carried out the 1RM test and the Pegboard and Ring Test (PBRT) in both groups. Results: After treatment observed significant increase of the strength muscular only in GT (increase of 52% in the supine and 22% in the pulley), and in the PBRT there were not significant difference in the number of moved rings in both groups. Conclusion: The upper limb strength training during 6 weeks was be able to improve the upper limb muscle strength, but not the functionality of COPD, assessed by PBRT, in patients with COPD moderate to very severe.Financiadora de Estudos e ProjetosO objetivo desse estudo foi avaliar o efeito do exercício resistido de membros superiores (MMSS) na força e na funcionalidade do paciente com DPOC moderada a muito grave. Métodos: Doze pacientes com diagnóstico clínico de DPOC foram divididos em 2 grupos: controle (GC) e treinado (GT). Durante 6 semanas, com freqüência de 3 vezes por semana, o GT realizou treinamento de força com carga de 80% de uma repetição máxima (1 RM); e o GC foi submetido à sessões de higiene brônquica e reeducação funcional respiratória. Antes e após o tratamento, foram realizados os testes de 1 RM e o Pegboard and Ring Test (PBRT) em ambos os grupos. Resultados: Após o tratamento, verificou-se aumento significativo da força muscular somente no GT (aumento de 52% no supino sentado e 22% no pulley) e, quanto ao PBRT, não foi constatada diferença significativa no número de argolas deslocadas em ambos os grupos. Conclusão: O treinamento de força de MMSS com duração de 6 semanas foi capaz de aumentar a força muscular de MMSS, mas não a funcionalidade, avaliada pelo PBRT, em pacientes com DPOC moderada a muito grave

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 ± 7.3 years and an average body mass index (BMI) of 47.4 ± 6.5 K/m² were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP+TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength