ABSTRACT Background Airflow limitation frequently leads to the interruption of activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Disease (COPD). These patients commonly show absence of ventilatory reserve, reduced inspiratory reserve volume, and dynamic hyperinflation (DH). Objective To investigate ventilatory response and DH induced by three ADL-based protocols in COPD patients and compare them to healthy subjects. Method Cross-sectional study. COPD group: 23 patients (65±6 years, FEV1 37.2±15.4%pred); control group: 14 healthy subjects (64±4 years) matched for age, sex, and body mass index. Both groups performed all three tests: Glittre-ADL test; an activity test that involved moving objects on a shelf (TSHELF); and a modified shelf protocol isolating activity with upper limbs (TSHELF-M). Ventilatory response and inspiratory capacity were evaluated. Results Baseline ventilatory variables were similar between groups (p>0.05). The ventilatory demand increased and the inspiratory capacity decreased significantly at the end of the tests in the COPD group. Ventilatory demand and DH were higher (p<0.05) in the TSHELF than in the TSHELF–M in the COPD group (p<0.05). There were no differences in DH between the three tests in the control group (p>0.05) and ventilatory demand increased at the end of the tests (p<0.05) but to a lower extent than the COPD group. Conclusion The TSHELF induces similar ventilatory responses to the Glittre-ADL test in COPD patients with higher ventilatory demand and DH. In contrast, the ventilatory response was attenuated in the TSHELF-M, suggesting that squatting and bending down during the Glittre-ADL test could trigger significant ventilatory overload.

ABSTRACT Background The Glittre-ADL test (TGlittre) is a valid and reliable test for the evaluation of functional capacity and involves multiple physical activities of daily living (PADL), which are known to be troublesome to patients with Chronic Obstructive Pulmonary Disease (COPD). However, it is still unknown if this test is also able to reflect the functional performance of patients with COPD. Objective To investigate whether the TGlittre reflects the functional performance of COPD patients and whether the necessary time to complete the TGlittre and the PADL varies according to disease severity. Method Thirty-eight patients with COPD (age 65, SD=7 years; forced expiratory volume in the first second 41.3, SD=15.2% predicted) underwent anthropometric and lung function assessments and were submitted to the TGlittre and PADL measurement. Results TGlittre performance correlated significantly (p<0.05) with PADL variables, such as time sitting (r=0.50), walking (r=-0.46), number of steps taken (r=–0.53), walking movement intensity (r=–0.66), walking energy expenditure (r=-0.50), and total energy expenditure (r=–0.33). TGlittre performance was not significantly different in patients among the Global Initiative for COPD (GOLD) spirometric stages, but walking and sitting time were significantly lower and greater, respectively, in severe and very severe patients compared to those with moderate disease (p<0.05). Conclusion The performance on the TGlittre correlates with walking and sitting time and other real life PADL measurements. The severity of the disease is associated with the differences in the level of physical activity in daily life more than in functional capacity.

CONTEXTUALIZAÇÃO: A avaliação da capacidade funcional em pacientes com doença pulmonar obstrutiva crônica (DPOC) tem sido realizada por métodos simples, de fácil aplicação e que mimetizam as atividades cotidianas, como o teste step Chester (TChester).OBJETIVOS: Investigar se o TChester é capaz de diferenciar a capacidade funcional e a magnitude da resposta cardiorrespiratória de pacientes com DPOC e de indivíduos saudáveis e comparar com a resposta cardiorrespiratória induzida pelos testes de caminhada de seis minutos (TC6min) e Shuttle (TShuttle).MÉTODO: Participaram dez pacientes com DPOC (64±10 anos, volume expiratório forçado no primeiro segundo - VEF1de 38,1±11,8% do predito) e dez saudáveis (63±7 anos, IMC de 24,5±3,1 e VEF1de 95,8±18,0% do predito) que realizaram avaliação da função pulmonar, estado e capacidade funcional.RESULTADOS: O grupo DPOC obteve pior desempenho nos três testes, quando comparado ao controle (TChester 2,1±0,9 vs 4,1±1,1 níveis completos; TC6min: 435±105,1 vs 593±87,3 m; TShuttle 251±84,6 vs 436±55,4 m; p<0,05). O TChester correlacionou-se com o TShuttle e com o TC6min (r=0,67 e 0,83, respectivamente; p<0,05). Não se observaram diferenças na frequência cardíaca (FC) e dispneia nos níveis do TChester entre os grupos (p>0,05). A SpO2 apresentou-se mais reduzida no grupo DPOC já no primeiro nível do TChester (p<0,05).CONCLUSÃO: O TChester é válido na avaliação da capacidade funcional de pacientes com DPOC, sendo capaz de diferenciá-los de indivíduos saudáveis, induzindo similar demanda cardiovascular e maior dessaturação nos pacientes com DPOC.

BACKGROUND: the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester).OBJECTIVES: to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT).METHOD:10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester).RESULTS: COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05).CONCLUSION:TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients.

CONTEXTUALIZAÇÃO: O teste de AVD Glittre (TGlittre) é um teste específico desenvolvido para avaliar a limitação funcional em pacientes com doença pulmonar obstrutiva crônica (DPOC), no entanto não se sabe qual sua capacidade de diferenciar o desempenho de doentes do de indivíduos saudáveis. OBJETIVOS: Investigar se o TGlittre é capaz de diferenciar a capacidade funcional de pacientes com DPOC da de indivíduos normais, além de comparar a resposta cardiorrespiratória induzida pelo TGlittre com a do teste de caminhada de seis minutos (TC6min). MÉTODOS: Participaram do estudo dez indivíduos com DPOC (GOLD 2 a 4) e dez indivíduos saudáveis de mesma faixa etária, realizando as seguintes avaliações: espirometria pré e pós-broncodilatador; um TGlittre e dois TC6min em dois dias consecutivos. RESULTADOS: O grupo DPOC (VEF1%prev = 38,1±11,8, idade = 64±10 anos) apresentou pior desempenho que o grupo controle no TGlittre (5,26±2,9 min vs. 3,3±0,3 min, p<0,05) e no TC6min (434,97±105,18 m vs. 593,25±87,36 m, p<0,05). O TGlittre correlacionou-se com o domínio atividade física da escala London Chest Activity of Daily Living (LCADL) (r=0,67, p<0,05) no grupo DPOC e com o TC6min na amostra total (r=-0,64; p<0,05). Tanto no TGlittre como no TC6min, o grupo DPOC registrou aumento da dispneia (Borg) estatisticamente maior (p<0,05) que no grupo controle, com frequência cardíaca e saturação periférica de oxigênio similares (p>0,05). CONCLUSÕES: Pacientes com DPOC têm pior desempenho que indivíduos saudáveis no TGlittre, com maior dispneia e frequência cardíaca similar.

BACKGROUND: The Glittre ADL (TGlittre) test is a specifically designed to assess functional limitation in chronic obstructive pulmonary disease (COPD) patients. However, it is not known if it can differentiate the performance of these patients from healthy subjects. OBJECTIVES: To investigate whether the Glittre ADL test is able to differentiate the functional capacity of COPD patients from that of healthy subjects and to compare the cardiorespiratory response between Glittre ADL and the six-minute walk test (6MWT). METHODS: The study included 10 patients with COPD (GOLD 2 to 4) and 10 healthy subjects matched by age who performed the following: spirometry pre-and post-bronchodilator, a Glittre ADL test and two 6MWT on two consecutive days. RESULTS: The performance of COPD (FEV1%pred= 38.1±11.8, age=64±10 years, BMI=23.7±5.2 kg/ m²) was worse than the control group on TGlittre (5.26±2.9 min, 3.3±0.3 min, p<0.05) and 6MWT (434.97±105.18 m vs. 593.25±87.36 m, p<0.05). TGlittre correlated with the physical activity domain of the London Chest Activity of Daily Living (LCADL) scale (r=0.67, p<0.05) and with 6MWT when the total sample was analyzed (r=-0.64, p<0.05). The COPD group had a statistically higher (p<0.05) increase in dyspnea (Borg scale) than the control group for both TGlittre and 6MWT, with a similar heart rate and peripheral oxygen saturation variation in both groups (p>0.05). CONCLUSIONS: The performance of COPD patients is worse than that of healthy subjects on the Glittre ADL test, with a greater increase in dyspnea and similar heart rates.

CONTEXTUALIZAÇÃO: A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma doença progressiva que reduz a capacidade funcional, comprometendo as atividades de vida diária (AVD). A morbidade e a mortalidade na DPOC apresentam uma estreita relação com a limitação funcional nesses pacientes. OBJETIVOS: Verificar se há associação entre a limitação nas AVD e o índice preditor de mortalidade BODE em pacientes com DPOC moderada a muito grave e não moderada e grave. MÉTODOS: Trinta e nove pacientes com DPOC GOLD 2 a 4, em uma amostra de conveniência, foram submetidos às avaliações: espirometria, índice de massa corpórea (IMC), escala London Chest Activity of Daily Living (LCADL), teste da caminhada de seis minutos (TC6min); escala Medical Research Council (MRC), e o índice BODE foi calculado. O escore total e o percentual do escore total da LCADL (LCADL%total) foram comparados entre os pacientes dos quatro quartis do BODE utilizando-se ANOVA. O Coeficiente de Correlação de Spearman foi utilizado para verificar a associação entre os escores da LCADL e do índice BODE. RESULTADOS: Os pacientes apresentaram em média VEF1%prev=37,0±12,2%, idade=66±8 anos. A LCADL%total apresentou correlação com o BODE (r=0,65, p<0,05) e com as variáveis VEF1, dispneia e distância no TC6min (r=-0,42; r=0,76 e r=-0,67, respectivamente; p<0,05). Comparando a média dos escores da LCADL%total entre os quartis 1, 2, 3 e 4 do BODE, somente o quartil 4 diferenciou-se estatisticamente dos demais (p<0,05). CONCLUSÕES: A limitação nas AVD apresenta forte associação com o índice BODE em pacientes com DPOC moderada a muito grave e com três das quatro variáveis que o compõem.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that reduces functional capacity, deteriorating the ability to perform activities of daily living (ADL). A close relationship between morbidity and mortality with functional limitation is observed in patients with COPD. OBJECTIVES: To determine if there is a relationship between ADL limitation and the BODE index, which is a predictor of mortality, in patients with moderate to severe COPD. METHODS: Thirty-nine patients with COPD GOLD 2 to 4 recruited by convenience, were submitted to the following tests: spirometry, body mass index (BMI), the London Chest Activity of Daily Living (LCADL) scale, six-minute walking test (6MWT), the Medical Research Council (MRC) scale and the BODE index was calculated. The total score and the percentage of the total score LCADL (LCADL%total) were compared between patients of the four quartiles of the BODE using the Analysis of Variance test. The Spearman correlation coefficient was used to investigate the association between scores of LCADL and BODE index. RESULTS: Patients had an average of FEV1%pred=37±12% and were on average 66±8 years-old. The LCADL%total correlated with the BODE index (r=0.65, p<0.05) as well as with the variables FEV1, dyspnea and walked distance in the 6MWT (r=-0.42, r=0.76 and r=-0.67, p<0.05, respectively). The comparison of the average scores of the LCADL%total between BODE quartiles 1, 2, 3 and 4, demonstrated that only the 4th quartile differed significantly from the others (p<0.05). CONCLUSIONS: ADL limitation has a strong association with the BODE index in patients with moderate to severe COPD and with three of the four variables that composes it.