2nd International Congress of CiiEM - Translational Research and Innovation in Human and Health Science. 11-13 June, 2017, Campus Egas Moniz, Monte de Caparica, PortugalN/

Correia, Ana Rita

Pereira, Ângela Maria

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Cardiorespiratory Fitness in Patients with Chronic Obstructive Pulmonary DiseaseÂngela Maria Pereira1, 2, 3, Ana Rita Correia1Cardiorespiratory fitness (CRF) reflects the integrated ability to transport oxygen from theatmosphere to the mitochondria to perform physical work. It quantifies the individual functionalcapacity and it is directly related to the integrated function of numerous systems as pulmonaryventilation and diffusion, cardiovascular functions and muscle cells capability to receive and use theO2 and nutrients delivered by the blood, as well as to communicate these metabolic demands to thecardiovascular control center and, thus it is considered a reflection of total body health (1). ChronicObstructive Pulmonary Disease (COPD) is a chronic lung disease characterized by a progressiveairflow limitation that is not fully reversible (2). Daily life activities (DLA) in patients with COPD arelimited by exertional dyspnea and reduced exercise capacity with reduction in exercise tolerancemeasured as peak oxygen uptake (V̇O2peak) (3). It has been found to be related to ventilatorylimitations, pulmonary gas exchange abnormalities, peripheral muscle dysfunction or anycombination of these factors (4). The aim of this study was to assess differences in Cardiorespiratoryfitness after a combined exercise program in COPD patients.Materials and Methods: Twenty men with moderate COPD (FEV1 49,8±10,5%) were randomlyassigned; age 65±6,5 yrs; weight, 72.9±10 kg; height, 167±7,8 cm, were included to a combinedexercise (strength and aerobic exercise) training program, for 6 month, three times a week.Cardiopulmonary exercise test (CPET) and 6-min walk distance test (6MWD), were performedbefore and after the training program. The study was approved by the Ethics Committee of theGarcia de Orta Hospital and all participants gave their informed consent. Results. The values of theCRF measured by V̇O2peak increased (p<.001) (15.38±5.0 vs 25.7±5.4 mLkg-1min-1); ventilatoryefficiency improved V̇E/V̇CO2peak (36.7±15.1vs 29.2±6.6), Vt (1.52±0.35 Lmin-1 vs 1.82±0.41 Lmin-1); increased work peak (4.3±1.7 min vs 9.18±1.9 min) and also 6MWD (491.8±74.0 m vs620.2±50.4 m); and peak dyspnea decrease (4.6±2.6 1.2±1.2). Discussion and Conclusions: Anincrease in cardiorespiratory capacity reflects a better integrated response of the pulmonary,cardiovascular and neuromuscular systems in exercise and an improvement in functional fitness forDLA of these subjects, which was observed by an increase in exercise tolerance, in distance of6MWD, and V̇O2peak, accompanied by a decrease in dyspnea at the exercise peak. Theseimprovements demonstrate a good correlation with the capability of effectively perform DLA (5). Inconclusion, combined exercise training provides an increase Cardiorespiratory fitness in COPDsubjects.ABSTRACT BACKGROUNDTwenty men with moderate COPD (6) (FEV1 49,8±10,5%); age 65±6,5 yrs; weight, 72.9±10 kg;height, 167±7,8 cm, were randomly assigned to a combined (strength and aerobic exercise) trainingprogram, for 6 month, 3 times a week.To be eligible, subjects had to be tobacco-free for at least 6 months prior the study, have noexacerbations and no hospital admission 8 months prior the study, no relevant cardiac or muscle-skeletal disease and no use of oxygen therapy. All subjects provided written informed consent priorto participation. The study was approved by the Garcia de Orta Hospital Ethics Board. Muscle strength was determined using the 1-RM method according a protocol previously published(8), on each of the 5 weight exercises using variable resistance machines. Exercise protocols – aerobic training, 30 minutes per session at 60-70% heart rate reserve. Weighttraining: 5 exercises, 1-2 sets, 2 min rest, 6-12 reps, @ 50-70% of 1-RM (9).METHODSRESULTS1. Ross R, Blair SN, Arena R, Church TS., Després JP, Franklin BA., et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134:e653–e699.2. Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185:435–452.3. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188:e13–64.4. Seymour JM, Spruit MA, Hopkinson NS, Natanek SA, Man WD, Jackson A, et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J 2010;36(1):81-88. 5. Zwerink M, van der Palen J, van der Valk P, Brusse-Keizera M, Effingc. T. Relationship between daily physical activity and exercise capacity in patients with COPD. Respir Med 2013; 107: 242–2486. Brito-Mutunayagam R, Appleton SL, Wilson DH, Ruffin RE, Adams RJ. Global Initiative for Chronic Obstructive Lung Disease stage 0 is associated with excess FEV(1) decline in a representative population sample. Chest. 2010;138(3):605-13.7. Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez , et al. Comparison of effects of strength and endurance training in patients with COPD. Am J Res Crit Care Med 2002;166(5):669-74.8. Santa-Clara H, Fernhall B, Mendae M, Sardinha, LB. Effect of 1 year combined aerobic- and weight-training exercise program on aerobic capacity and ventilatory threshold in patients suffering from coronary artery disease. Eur J Appl Physiol 2002,87:568-5759. Pereira AM, Santa-Clara H, Pereira E, Simões S, Remédios I, Cardoso C, et al. Impacto do exercício físico combinado na percepção do estado de saúde da pessoa com doença pulmonar obstrutiva crónica. Rev Port Pneumol. 2016;16(5): 737-757REFERENCESCONCLUSIONSIn this sample combined exercise  improved muscular function with positive impact on pulmonary and cardiovascular function with improvement in cardiorespiratory fitness. An increase in cardiorespiratory capacity reflects a better integrated response of the pulmonary, cardiovascular and neuromuscular systems in exercise and an improvement in functional fitness for DLA , with desensitization of dyspnea. * Differences between groups p<.01Table 1 - Mean and standard deviation values for basal and final values of V̇O2peak, V̇CO2peak, V̇Epeak,V̇E/V̇CO2peak, Vt, work peak, dyspnea peakand 6-minute walk distanceBefor After p*V̇O2peak ( mLkg-1min-1) 15.38±5.0 25.7±5.4 .000V̇CO2peak (L.min-1) 0.88±0.36 1.19±0.45 .005V̇Epeak (L.min-1) 45.1±6.6 37.8±5.4 .002V̇E/V̇CO2peak  36.7±15.1 29.2±6.6 .000Vt (Lmin-1) 1.52±0.35 1.82±0.41 .001Work peak (min.) 4.3±1.7 9.18±1.9 .000Dyspnea peak (Borg) 4.6±2.6 1.2±1.2 .0006-minute walk distance (m) 491.8±74.0 620.2±50.4 .000COPD is a major cause of chronic morbidity and mortality worldwide and it is currently defined as adisease state characterized by airflow limitation that is not fully reversible. This airflow limitation isusually progressive and associated with an abnormal inflammatory response of the lungs to noxiousconditions. The characteristic symptoms of COPD are coughing, sputum production, dyspnea,fatigue, decreased exercise tolerance, skeletal muscles dysfunction, hypoxemia, and deconditioning.These effects have important clinical consequences, as they contribute to the limitation of patients'exercise capacity and the decline of health status (3).Exercise training is currently recognized as a fundamental component of pulmonary rehabilitation.Several studies have been published describing the effects of aerobic, strength and combinedaerobic and strength exercises (7).Aerobic training improves exercise performance and decrease perception of dyspnea in patients withCOPD by improving muscular work rate, muscular oxidative capacity with increased oxidativeenzymes and mitochondrial concentration, but seems to have little effect on muscle atrophy andweakness (4).Strength training has been shown to improve not only muscle strength, but also overall enduranceand perceived dyspnea, however there was no significant improvements in VO2max or 6-minute walktest distances (1,3).According to Ortega et al. (7), combined exercise training (strength + aerobic) it is probably a betterstrategy to treat COPD patients because we can obtain the improvements achieved by the other twostrategies alone.After training there were significant differences (p<0.001), on CRF with an increase of V̇O2peak(15.38±5.0 vs 25.7±5.4 mL kg-1min-1), and V̇CO2peak (0.88±0.36 vs 1.19±0.45 L. min-1 ), associatedwith decreased V̇Epeak (45.1±6.6 vs 37.8±5.4 L.min-1), which reflects a ventilatory efficiencydemonstrated by an improvement of V̇E/V̇CO2peak (36.7±15.1vs 29.2±6.6) and Vt (1.52±0.35 L min-1vs 1.82±0.41 L min-1) (Table 1). Increased distance in 6 minute walk test in the work peak was associated with desensitization ofdyspneaFor strength variables, significant differences were observed, for all muscular groups trained and allmeasurements (Figure 1).020406080100120140160Before AfterKgFigure 1- Muscular strengthArm Curl Pectoralis Leg extension Leg press Vertical traction****** p<.05PURPOSE The aim of this study was to assess differences in Cardiorespiratory fitness after a combined exercise program in COPD patients1Physiotherapy, Escola Superior de Saúde Egas Moniz; 2Hospital Garcia de Orta; 3Centro de Investigação Interdisciplinar Egas Moniz, Almada, PortugalRESULTS

Cardiorespiratory fitness in patients with Chronic Obstructive Pulmonary Disease

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Cardiorespiratory fitness in patients with Chronic Obstructive Pulmonary Disease

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