Fatores associados ao baixo nível de atividade física na vida diária de pacientes com DPOC usuários de oxigenoterapia domiciliar prolongada

Orientadora: Profª. Dra. Silvia Regina ValderramasDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa : Curitiba, 08/06/2018Inclui referênciasResumo: Apesar de primariamente pulmonar, a Doença Pulmonar Obstrutiva Crônica (DPOC) acarreta consequências sistêmicas, dentre elas a redução da atividade física na vida diária (AFVD). Poucos estudos investigaram o nível de AFVD e suas associações, em indivíduos com DPOC usuários de oxigenoterapia domiciliar prolongada (ODP). Os objetivos deste estudo foram verificar a existência de associação entre baixo nível de AFVD com função pulmonar, sensação de fadiga e dispneia, estado funcional, capacidade de exercício e o tempo de uso diário de ODP, em indivíduos com DPOC usuários de ODP, bem como investigar quais destas variáveis poderiam influenciar a inatividade nesses indivíduos. Foram incluídos 39 indivíduos com DPOC usuários de ODP (69 ± 8 anos, VEF1: 32 ± 14% do valor previsto). Eles foram avaliados quanto à AFVD (número de passos/dia), fadiga (Fatigue Severity Scale - FSS), dispneia (Medical Research Council scale - MRC), estado funcional (London Chest Activity of Daily Living - LCADL e Timed Up and Go - TUG) e a capacidade de exercício (teste do degrau de seis minutos - TD6 e teste de sentar e levantar de 1 minuto - STST), e o tempo de uso diário de ODP (horas). Houve importante limitação da AFVD nestes indivíduos (1444 ± 1203 passos/dia), que se associou com o tempo de uso diário de ODP (r= -0,50, p= 0,01), fadiga (r= - 0,36, p= 0,03), estado funcional (r= -0,41, p= 0,01), TD6 (r= 0,48, p<0,01) e STST (r= 0,53, p< 0,01). Na regressão linear múltipla o tempo diário de ODP e o resultado do STST explicaram 39% da variabilidade da AFVD. Embora a fadiga e o estado funcional estejam associados à inatividade física de indivíduos com DPOC usuários de ODP, somente o tempo de uso diário de ODP e a capacidade de exercício foram preditores do baixo nível de AFVD. Palavras-chave: Oxigenoterapia; Exercício; Doença Pulmonar Obstrutiva Crônica.Abstract: Although chronic obstructive pulmonary disease (COPD) is primarily a pulmonary disease, it has systemic consequences, which lead to reduced physical activity in daily life (PADL). Few studies have investigated PADL and its associations in individuals with COPD on long-term oxygen therapy (LTOT). To determine whether there is an association between PADL and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on LTOT and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV1: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale - FSS), dyspnea (Medical Research Council - MRC scale), functional status (London Chest ADL scale - LCADL and Timed Up and Go - TUG) and functional exercise capacity (Six-Minute Step test - 6MST and Sit-to- Stand test - STST). PADL was significantly limited in these individuals (1444 ± 1203 steps/day) and was associated with daily duration of LTOT (r= -0.50, p= 0.01), fatigue (r= -0.36, p= 0.03), LCADL (r= -0.41, p= 0.01), 6MST (r= 0.48, p<0.01) and STST (r= 0.53, p< 0.01). Multiple linear regression revealed that daily duration of LTOT and the result of the STST explained 39% of the variability of PADL. Although fatigue and functional status were associated with physical inactivity in individuals with COPD on LTOT, daily duration of LTOT and exercise capacity were the best predictors of reduced PADL. Keywords: Oxygen Inhalation Therapy; Exercise; Chronic Obstructive Pulmonary Diseas

Association Between the Results of the Timed Up-andGo Test Adjusted for Disease Severity and Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease: a Pilot Study

OBJECTIVES: Loss of muscle mass and/or physical performance, a condition commonly known as sarcopenia, is prevalent in chronic obstructive pulmonary disease (COPD) and is associated with adverse outcomes. The aim of this study was to investigate the association between functional performance and sarcopenia in COPD patients classified by disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. METHODS: The study was a cross-sectional observational and the sample size consisted of 35 COPD patients (69.24±1.54 years, 20 men). Physical performance was assessed with the timed up-and-go (TUG) test. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. RESULTS: The frequency of sarcopenia was 20% and was more prevalent among individuals classified with greater disease severity, GOLD III, n=4 patients (23%) and GOLD IV, n=3 patients (27%), p=0.83. The mean time to complete the TUG test was 11.66±4.78 s. Binary logistic regression revealed an association between the TUG test and sarcopenia adjusted by disease severity (OR=1.55, 95% CI: 1.03-8.23, p=0.04). CONCLUSION: Our findings showed that worse performance in the TUG test leads to a substantial increase in the chance of COPD patients presenting sarcopenia