Can functional exercise capacity discriminate older individuals with poor postural control?

Postural instability can be related to functional limitations as a result of the aging process. This study aimed to compare functional exercise capacity and postural control in older adults. Participants were allocated into three groups according to their functional exercise capacity based on the six minute walking test (6MWT): 1) Low performance group (LP: distance walked ≤ 80% of the predicted value n = 19), 2) Normal performance group (NP: distance walked 81-100% of the predicted value n = 21) and, 3) High performance group (HP: distance walked >100% of the predicted value n = 23). All groups performed three trials of a one-leg stance for 30s on a force platform. LP showed worse postural control in comparison to NP and HP, and significant differences (p < .05) were found between groups for area, velocity antero-posterior of center of pressure and time limit variables during the one-leg stance task. These results have implications for rehabilitation management with regard to exercise, balance assessment and intervention in older adults. Instabilidade postural pode estar relacionada com as limitações funcionais, como um resultado do processo de envelhecimento. Este estudo teve como objetivo comparar a capacidade funcional de exercício e o controle postural em indivíduos idosos. Os participantes foram separados em três grupos de acordo com sua capacidade funcional de exercício baseada no teste de caminhada de seis minutos (TC6min): 1) grupo baixo desempenho (BD: distância caminhada ≤ 80% do valor predito n = 19), 2) grupo normal desempenho (ND : distância caminhada 81-100% do valor predito n = 21) e, 3) grupo alto desempenho (AD: distância caminhada >100% do valor predito n = 23). Todos os grupos realizaram três testes com apoio unipodal permanecendo por 30s sobre a plataforma de força. BD apresentou pior equilíbrio postural em comparação com ND e AD; com diferenças significativas (p < 0,05) encontradas entre os grupos para os parâmetros de área e velocidade antero-posterior do centro de pressão e a variável tempo-limite durante a posição unipodal. Estes resultados têm implicações para estratégias de reabilitação no que diz respeito ao exercício, avaliação do equilíbrio e intervenção em idosos. Inestabilidad postural puede estar relacionada con las limitaciones funcionales como resultado del proceso de envejecimiento. Este estudio tuvo como objetivo evaluar la comparación entre la capacidad funcional del ejercicio en el control postural de las personas de edad avanzada. Los participantes fueron divididos en tres grupos de acuerdo a su capacidad de ejercicio funcional basado en la Prueba de Caminada de seis minutos (PC6M): 1) grupo Bajo Rendimiento (BR: distancia recorrida ≤ 80% del valor predijo, n = 19), 2) grupo Normal Rendimiento (NR: distancia recorrida 81-100% del valor predijo, n = 21) y 3) grupo Alto Rendimiento (AR: distancia recorrida >100% del valor predijo, n = 23). Todos los grupos realizaron tres pruebas sobre un solo pie por 30s en la plataforma de fuerza. BR presentó un mal equilibrio postural en comparación con NR y AR; con diferencias significativas (p < 0,05) encontrado entre los grupos de los parámetros área y velocidad antero-posterior del centro de presión y el límite de tiempo para la postura de una sola pierna. Estos resultados tienen implicaciones para las estrategias de rehabilitación en relación con el ejercicio, la evaluación del equilibrio y la intervención en los ancianos

Relationship between pulmonary function and physical activity in daily life in patients with COPD

SummaryBackgroundIt remains unclear how closely the physical inactivity observed in patients with Chronic Obstructive Pulmonary Disease (COPD) relates to the severity of their airflow limitation. Furthermore, it is unknown whether spirometric variables such as maximal voluntary ventilation (MVV) and inspiratory capacity (IC) reflect the level of physical activity in daily life better than the forced expiratory volume in the first second (FEV1), the main spirometric variable used to determine the severity of COPD. The objective of the present study was to investigate the relationship between physical activity in daily life and the severity of COPD assessed by different spirometric variables: MVV, IC and FEV1.MethodsForty patients with COPD (21 men; 68±7 years; FEV1 41±14% predicted) were performed spirometry and assessment of the physical activity level in daily life using an accelerometer (SenseWear® Armband).ResultsMVV was significantly correlated to total energy expenditure per day, energy expenditure per day in activities demanding more than 3 metabolic equivalents (METs), number of steps per day and time spent per day in moderate and vigorous activities (0.42≤r≤0.52; p<0.01 for all). Correlation of these variables with IC and especially FEV1 was more modest, borderline or not statistically significant. There was no difference in time spent in vigorous activities among patients classified according to the FEV1-based GOLD stages II, III and IV, differently than that observed when patients were classified in groups according to their MVV.ConclusionIn COPD patients, MVV better reflects the physical activity level in daily life than FEV1 and IC

Physical activity in daily life in physically independent elderly participating in community-based exercise program

BACKGROUND: It is unclear whether participation in exercise programs specifically developed for elderly translates into a more active lifestyle. OBJECTIVES: To compare the objectively measured level of physical activity in daily life (PADL) between physically independent elderly who participate or do not participate in community-based exercise programs; and to evaluate which factors are associated with the higher level of PADL in these subjects. METHOD: 134 elderly participants in community-based exercise programs (PG) and 104 non-participants (NPG) had their level of PADL measured using pedometers during 7 days. Other measurements: 6-minute walking test (6MWT), incremental shuttle walking test (ISWT), muscle strength, flexibility and balance. RESULTS: The PG had higher 1-week mean daily step count than NPG (8314 [IQR 5971-10060] vs. 6250 [IQR 4346-8207] steps/day, p8000 steps/day) in PG than in NPG (37% vs. 16%, respectively; p<0.001), as well as the proportion of sedentary subjects (<5000 steps/day) (14% vs. 33%, respectively; p<0.001). Participation in exercise programs, 6MWT and ISWT explained a higher daily steps count (model r2=0.56, p<0.0001). CONCLUSIONS: In physically independent elderly, a higher level of physical activity in daily life occurs in those who participate in community-based exercise programs, regardless of the weekday and including non-program days. Participation of elderly in community-based exercise programs should be more systematically available and encouraged due to its close link to higher activity levels and better exercise capacity

O índice BODE reflete o nível de atividade física na vida diária de pacientes com DPOC?

Objectives: To study the relationship between the level of physical activity in daily life and disease severity assessed by the BODE index in patients with chronic obstructive pulmonary disease (COPD). Methods: Sixty-seven patients with COPD (36 men) with forced expiratory volume in the first second (FEV(1)) of 39 (27-47)% predicted and age of 66 (61-72) years old were evaluated by spirometry, dyspnea levels (measured by the Medical Research Council scale, MRC) and by the 6-minute walking test (6MWT). The BODE index was calculated based on the body mass index (weight/height(2)), FEV(1), MRC and 6MWT, and then the patients were divided in four quartiles according to their scores (Quartile I: 0 to 2 points, n=15; Quartile II: 3 to 4 points, n=20; Quartile III: 5 to 6 points, n=23; Quartile IV: 7 to 10 points, n=9). Two activity monitors (DynaPort (R) and SenseWear (R)) were used to evaluate the level of physical activity in daily life. The Kruskal-Wallis test (Dunns's post-hoc test), the Mann-Whitney test and the Spearman Correlation Coefficient were used for statistical analysis. Results: There were modest correlation between the BODE index and the time spent walking per day, the total daily energy expenditure and the time spent in moderate and vigorous activities per day (-0.32 <= r <=- 0.47; p <= 0.01 for all variables). When comparing the pooled quartiles I+II with III+IV, there were significant difference between the time spent walking per day, the total daily energy expenditure and the time spent in moderate activities per day (p <= 0.05). Conclusion: The level of physical activity in daily life has a modest correlation with the classification of COPD severity assessed by the BODE index, reflecting only differences between patients with classified as mild-moderate and severe-very severe COPD

Artigo Original Original Article Validação da versão em português da escala London Chest Activity of Daily Living (LCADL) em DOentes com Doença Pulmonar Obstrutiva Crónica

Resumo Introdução: Diversos questionários desenvolvidos em língua inglesa visam avaliar especificamente a limitação pela dispnéia durante actividades da vida diá ria (AVD) em doentes com doença pulmonar obstrutiva crónica (DPOC), como a escala London . A estreita relação entre actividade física, morbidade e mortalidade em doentes com DPOC 6-9 demonstra a importância da avaliação adequada das limitações na realização de AVD. O método mais simples e mais comummente utilizado para avaliação das limitações em AVD é o uso de questionários específicos para esse fim 10 . A literatura científica internacional mostra diversos questionários desenvolvidos especificamente para avaliação das limitações em AVD de doentes com DPO