Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial

Juliano T Wada,1 Erickson Borges-Santos,1 Desiderio Cano Porras,1 Denise M Paisani,1 Alberto Cukier,2 Adriana C Lunardi,1 Celso RF Carvalho1 1Department of Physical Therapy, 2Department of Cardiopneumology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil Background: Patients with COPD present a major recruitment of the inspiratory muscles, predisposing to chest incoordination, increasing the degree of dyspnea and impairing their exercise capacity. Stretching techniques could decrease the respiratory muscle activity and improve their contractile capacity; however, the systemic effects of stretching remain unknown.Objective: The aim of this study was to evaluate the effects of aerobic training combined with respiratory muscle stretching on functional exercise capacity and thoracoabdominal kinematics in patients with COPD.Design: This study was a randomized and controlled trial.Participants: A total of 30 patients were allocated to a treatment group (TG) or a control group (CG; n=15, each group).Intervention: The TG was engaged in respiratory muscle stretching and the CG in upper and lower limb muscle stretching. Both groups performed 24 sessions (twice a week, 12 weeks) of aerobic training.Evaluations: Functional exercise capacity (6-minute walk test), thoracoabdominal kinematics (optoelectronic plethysmography), and respiratory muscle activity (surface electromyography) were evaluated during exercise. Analysis of covariance was used to compare the groups at a significance level of 5%.Results: After the intervention, the TG showed improved abdominal (ABD) contribution, compartmental volume, mobility, and functional exercise capacity with decreased dyspnea when compared with the CG (P<0.01). The TG also showed a decreased respiratory muscle effort required to obtain the same pulmonary volume compared to the CG (P<0.001).Conclusion: Our results suggest that aerobic training combined with respiratory muscle stretching increases the functional exercise capacity with decreased dyspnea in patients with COPD. These effects are associated with an increased efficacy of the respiratory muscles and participation of the ABD compartment. Keywords: COPD, respiratory muscles, muscular stretching, respiratory mechanics, dyspne

Comparação entre o uso de bocal e máscara facial na avaliação de volumes pulmonares e capacidade vital em indivíduos saudáveis Comparison between the use of mouthpiece and facemask in assessing lung volumes and vital capacity in healthy subjects

Testes de função pulmonar são usados para determinar a gravidade, as conseqüências funcionais e o progresso de disfunções pulmonares e neuromusculares. As variações metodológicas com o bocal e a máscara facial e a cooperação do paciente podem interferir no desempenho das manobras e afetar as medidas. O objetivo deste estudo foi comparar os valores de volumes pulmonares (volume corrente [Vc], volume-minuto [Vm]), freqüência respiratória (FR) e capacidade vital (CV) em indivíduos saudáveis quando avaliados por meio do bocal e da máscara facial. Participaram do estudo 60 voluntários saudáveis, 14 homens e 46 mulheres, com média de idade de 22,9±7,1 anos. Para a avaliação com bocal, utilizou-se uma peça semirrígida descartável e clipe nasal; a máscara usada foi facial plástica com borda pneumática inflável. As medidas obtidas foram comparadas estatisticamente (nível de significância 5%). Os valores obtidos com o bocal e com a máscara facial foram, respectivamente: FR, 15 rpm x 13 rpm (p<0,01); Vm, 14,87 l/min x 10,02 l/min (p<0,01); Vc, 0,93 l x 0,8 l (p<0,01); CV, 3,85 l x 3,52 l (p<0,01). Os valores de volumes pulmonares e capacidade vital mostraram-se pois significativamente inferiores quando avaliados com a máscara facial em comparação ao bocal.<br>Respiratory function tests are used to determinate severity, functional consequences and progress of pulmonary and neuromotor dysfunctions. Methodological variations - by means of a mouthpiece or a facemask - and patient's cooperation may interfere in manoeuvre performance and affect measures. The aim of this study was to compare lung volume values (tidal volume [VT] and minute volume [Vm]), respiratory rate (RR), and vital capacity (VC) in healthy individuals when assessed by using a mouthpiece and a facemask. A total of 60 healthy subjects (14 men and 46 women), mean aged 22.86±7.14 years, were evaluated. Items used were a disposable, semi-rigid mouthpiece, with a nose clip, and a plastic facemask with pneumatic inflatable sealing. Measures obtained were statistically compared, with significance level set at 5%. Mean values obtained with the mouthpiece and the facemask were, respectively: RR, 15 rpm x 13 rpm (p<0.01); Vm, 14.87 l/min x 10.02 l/min (p<0.01); VT, 0.93 l x 0.8 l (p<0.01); and VC, 3.85 l x 3.52 l (p<0.01). Lung volumes and vital capacity values were thus shown to be significantly lower when assessed by means of a facemask than with a mouthpiece