O objetivo deste estudo foi avaliar a capacidade funcional e o desempenho da musculatura respiratória e periférica e relacioná-los com o estado nutricional e volume expiratório forçado no primeiro segundo (VEF1). MATERIAIS E MÉTODOS: Foram avaliados 12 pacientes com doença pulmonar obstrutiva crônica (DPOC) moderada a grave (70±7 anos, VEF1 de 52±17% previsto, índice de massa corpórea (IMC) de 23±4kg/m²) e sete indivíduos saudáveis (69±8 anos, VEF1 de 127±12% previsto, IMC de 27±3kg/m²). Todos realizaram análise da composição corporal, medida da força muscular respiratória (pressão inspiratória máxima, PImax, e pressão expiratória máxima, PEmax), teste de exercício cardiorrespiratório (TECR), avaliação da força de preensão palmar, pico de torque e trabalho total ou endurance do quadríceps femoral. RESULTADOS: Os pacientes com DPOC tiveram valores reduzidos do índice de massa magra corpórea (IMMC) (18±1 versus 21±1kg/m², p<0,05), da carga máxima atingida no TECR (60±20 versus 102±18watts, p<0,01), da PImax (58±19 versus 87±21cmH2O, p<0,05), da força de preensão palmar (38±6 versus 47±5kg, p<0,05), do pico de torque (103±21 versus 138±18Nm, p<0,05) e do trabalho total do quadríceps femoral (1570±395 versus 2333±568J, p<0,05) quando comparado com o grupo controle (teste t de Student não pareado). Não houve correlação entre VEF1 e as variáveis estudadas; o IMMC correlacionou-se com o trabalho total do quadríceps (Pearson, r=0,6290, p<0,05). CONCLUSÕES: Estes resultados indicam que os pacientes com DPOC apresentam fraqueza muscular inspiratória e periférica e menor capacidade funcional, quando comparados com o grupo saudável. Além disso, sugere que o grau de obstrução ao fluxo aéreo não é um bom preditor para quantificar as debilidades nutricionais e musculares dos pacientes com DPOC.

The aim of this study was to evaluate the functional capacity and the performance of respiratory and quadriceps muscles in patients with chronic obstructive pulmonary disease (COPD) and relate them to nutritional status and forced expiratory volume in the first second (FEV1). METHODS: Twelve patients with moderate COPD (70±7 years, FEV1 52±17% predicted, body mass index (BMI) 23±4kg/m²) and seven healthy volunteers (69±8 years, FEV1 127±12% predicted, BMI 27±3kg/m²) were evaluated. All of them underwent body composition analysis, measurement of respiratory muscle strength (maximum inspiratory pressure, MIP, and maximum expiratory pressure, MEP), cardiorespiratory exercise test (CET) and evaluation of palm grip strength, peak torque and total work or endurance of the quadriceps femoris. RESULTS: The patients with COPD had lower values for the free-fat mass (FFM) index (18±1 versus 21±1kg/m², p<0.05), maximum load attained in the CET (60±20 versus 102±18 watts, p<0.01), MIP (58±19 versus 87±21cmH2O, p<0.05), palm grip strength (38±6 versus 47±5kg, p<0.05), peak torque (103±21 versus 138±18Nm, p<0.05) and total work of the quadriceps femoris (1570±395 versus 2333±568J, p<0.05) when compared with the control group (independent Student’s t test). There was no correlation between FEV1 and the variables studied, while the FFM correlated with the total work of the quadriceps (Pearson, r=0.6290, p<0.05). CONCLUSIONS: These results indicate that patients with COPD show weakness of the inspiratory and quadriceps muscles and lower functional capacity, when compared with a healthy group. Moreover, they suggest that the degree of airflow obstruction is not a good predictor for quantifying the nutritional and muscle impairments in patients with COPD.

OBJETIVO: Avaliar os efeitos de três programas de fisioterapia respiratória constituídos por treinamento físico (TF) em esteira e/ou treinamento muscular respiratório (TMR) em pacientes com DPOC. MÉTODOS: Participaram deste estudo 25 pacientes com DPOC moderada-grave, de ambos os sexos, que foram divididos aleatoriamente em 3 grupos, sendo o primeiro grupo (G1) submetido a TMR com 30% da pressão inspiratória máxima obtida a cada semana, o segundo grupo (G2) submetido a TF com 70% da freqüência cardíaca atingida no teste de exercício cardiorrespiratório (TECR) sintoma-limitado e o terceiro grupo (G3) associava TMR ao TF com as mesmas intensidades citadas anteriormente. Todos os programas constituíram-se de 3 sessões semanais por 6 semanas consecutivas. RESULTADOS: Após tratamento, foram observados aumentos significativos da força muscular respiratória (FMR) no G1; aumentos significativos da distância percorrida no TECR, redução da freqüência cardíaca e do volume minuto expirado isovelocidade e melhora do domínio da capacidade funcional do questionário de qualidade de vida no G2; aumento significativo da FMR, da distância percorrida no TECR, redução da pressão arterial sistólica e concentração sangüínea de lactato isovelocidade e melhora da qualidade de vida no G3. CONCLUSÃO: Os resultados sugerem que o TF associado ao TMR foi a melhor alternativa terapêutica dentre as investigadas no presente estudo; pois, além de proporcionar uma evidente melhora na tolerância ao esforço e na qualidade de vida dos pacientes, promoveu um efeito adicional nas adaptações fisiológicas ao exercício, com uma maior eficácia na remoção e/ou menor produção de lactato sangüíneo durante o esforço.

OBJECTIVE: To evaluate the effects of three respiratory physical therapy programs consisting of physical training on a treadmill and/or respiratory muscle training (RMT), on patients with COPD. METHODS: Twenty-five patients of both sexes with moderate-to-severe COPD were randomized into three groups: the first group (G1) underwent RMT at 30% of the maximal inspiratory pressure obtained each week; the second group (G2) underwent physical training at 70% of the heart rate achieved in the symptom-limited cardiorespiratory exercise test (CRET); and the third group (G3) underwent RMT together with physical training, at the same intensities mentioned above. All of the programs consisted of three sessions per week for six consecutive weeks. RESULTS: Following treatment, significantly increased respiratory muscle strength was observed in G1. In G2, there was significantly increased walking distance and decreased heart rate and expiratory minute ventilation in CRET at the same velocity (isovelocity), and improvement in the functional capacity domain of the quality of life (QOL) questionnaire. In G3, there was significantly increased respiratory muscle strength, increased walking distance, decreased systolic arterial pressure and decreased blood lactate in CRET at the same velocity, and improvement in QOL. CONCLUSION: These findings suggest that physical training together with RMT was the best therapeutic alternative among the programs investigated in the present study. As well as providing an evident improvement in effort tolerance and QOL in the patients, it provided an additional effect regarding physiological adaptations to exercise with greater efficacy in clearance and/or lower production of blood lactate during effort.

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH2O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.