Comparação entre o trabalho desenvolvido e a distância percorrida no teste de caminhada de seis minutos para avaliação da capacidade funcional de pneumopatas crônicos
Comparison between the work and distance outcomes in the six minute walk test to the assessment of functional capacity in chronic respiratory diseases
Pedro Henrique Scheidt Figueiredo, Denílson Otavio da Costa, Thiago Diniz Afeitos, Wagner Júnio Oliveiras Reis
Resumo
Introdução: As alterações fisiopatológicas desencadeadas pelas doenças respiratórias crônicas ocasionam dispnéia e redução da capacidade de executar as atividades de vida diária. O teste de caminhada de 6 minutos (TC6) é um teste simples e de fácil execução para estimar a capacidade funcional. A avaliação do trabalho realizado no TC6 (TC6W) tem sido proposta como uma forma mais sensível de estimar a capacidade de realizar exercício que a forma clássica (distância percorrida). Objetivo: Comparar a relação das duas formas de utilização do TC6 (distância percorrida e trabalho), com a intensidade da dispnéia e o nível de lactato em repouso. Métodos: Foram avaliados 16 pacientes pneumopatas crônicos, quanto à dispneia, nível sanguíneo de lactato em repouso e capacidade funcional, por meio do TC6. A distância percorrida e a potência desenvolvida no TC6 foram correlacionadas à magnitude da dispneia e aos níveis de lactato sanguíneo. A correlação entre as variáveis foi realizada pelos coeficientes de correlação de Pearson ou de Spearman, conforme o teste de normalidade. Resultados: O resultado do TC6W apresentou correlação com o lactato sanguíneo de repouso (r = -0,63; p < 0,05), o que não ocorreu com a distância percorrida no TC6. Quanto à dispneia, tanto o TC6W quanto o TC6 não apresentaram correlação significativa (p = 0,07). Conclusão: O TC6W pode ser utilizado como forma complementar ao TC6 para avaliação da capacidade funcional de pacientes com pneumopatias crônicas
Palavras-chave
Abstract
Introduction: The physiologic changes associated to chronic respiratory diseases cause dyspnea and inability to perform the daily living activities. The 6-minute walk test (TC6) is a simple and practical way to evaluate the functional capacity. Conversely, instead of using the TC6 distance to reflect exercise tolerance, the evaluation of the work performed during the TC6 (TC6W) has been proposed as a more sensitive method to estimate the patients’ functionality. Objective: Compare the relationship of two TC6 forms (distance and work) with dyspnea intensity and lactate level at rest. Methods: Sixteen patients with chronic lung diseases were evaluated as to dyspnea, blood lactate level and functional capacity (TC6). The distance and work developed during TC6 were correlated with the dyspnea magnitude and blood lactate level. For the correlation between variables we used the Pearson or Spearman correlation coefficients, according to the data distribution. Results: The result of TC6W correlated with blood lactate at rest (r = -0.63, p <0.05), which did not occur with the 6MWT. Neither TC6W nor 6MWT showed a significant correlation with dyspnea (p = 0.07). Conclusion: The TC6W can be used as a complimentary method to 6MWD for the functional capacity assessment of chronic lung diseases patients.
Keywords
Referências
1. Casburi R. Limitation to exercise tolerance in chronic obstructive pulmonary disease: look to the muscle of ambulation. Am J Respir Crit Care Med. 2003 Aug;168(4):409-10.
2. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007 May;131(5 Suppl):4S-42S.
3. Nici L, Donner, C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American Thoracic Society / European Respiratory society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006 Jun 15;173(12):1390-413.
4. Balke B. A simple field test for the assessment of physical fitness. Rep Civ Aeromed Res Inst US. 1963 Apr;1-8.
5. Skeletal muscle dysfunction in Chronic Obstructive Pulmonary Disease. A statement of the American Thoracic Society and European Respiratory Society. Am J Resp Crit Care Med. 1999 Apr;159(4 Pt 2):S1-40.
6. ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Resp Crit Care Med. 2002 Jul 1;166(1):111-7.
7. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walk tests in respiratory disease. Br Med J (Clin Res Ed). 1982 May 29; 284(6329):1607-8.
8. Solway S, Brooks D, Lau L, Goldstein R. The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD. Chest. 2002 Jul;122(1):56-65.
9. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med. 1999 Jan;159(1):321-40.
10. Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ. Principles of exercise testing and interpretation. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 1999.
11. Weisman, IM, Zeballos, RJ. An integrated approach to the interpretation of cardiopulmonary exercise testing. Clin Chest Med. 1994 Jun;15(2):421-45.
12. Chuang ML, Lin IF, Wasserman K. The body weight-walking distance product as related to lung function, anaerobic threshold and peak VO2 in COPD patients. Respir Med 2001 Jul;95(7):618–26.
13. Carter R, Holiday DB, Nwasuruba C, Stocks J, Grothues Cl, Tiep B. 6- minute Walk Work for assessment of functional Capacity in patients with COPD. Chest. 2003 May;123(5):1408-15.
14. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) despond scale as a measure of disability in patients with chronic pulmonary disease. Thorax. 1999 Jul;54(7):581-6.
15. Borg G, Ljunggren G, Ceci R. The increase of perceived exertion, aches and pain in the legs, heart rate and blood lactate during exercise on a bycicle ergometer. Eur J Appl Physiol Occup Physiol. 1985;54(4):343-9.
16. Passmore R, Durnin JV. Human energy expenditure. Physiol Rev. 1955 Oct;35(4):801-65.
17. Hyatt RE. Expiratory flow limitation. J Appl Physiol. 1983 Jul;55(1 Pt 1):1-7.
18. Pride NB, Macklem PT. Lung mechanics in disease. In: Fishman AP, editor. Handbook of physiology. Bethesda, MD: Oxford University Press. American Physiological Society; 1986. p. 659–692.
19. O’Donnell DE, Revill SM, Webb KA. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001 Sep 1;164(5):770-7.
20. Aliverti A, Stevenson N, Dellaca RL, Lo MA, Pedotti A, Calverley PM. Regional chest wall volumes during exercise in chronic obstructive pulmonary disease. Thorax. 2004 Mar;59(3):210-6.
21. Diaz O, Villafranca C, Ghezzo H, Borzone G, Leiva A, Milic-Emil J, Lisboa C. Role of inspiratory capacity on exercise tolerance in COPD patients with and without tidal expiratory flow limitation at rest. Eur Respir J. 2000 Aug;16(2):269-75.
22. Clanton TL, Klawitter PF. Physiological and Genomic Consequences of Intermittent Hypoxia Invited Review: Adaptive responses of skeletal muscle to intermittent hypoxia: the known and the unknown. J Appl Physiol. 2001 Jun;90(6):2476-87.
23. Wasserman K, Mcllroy MB. Detecting the threshold of anaerobic metabolism in cardiac patients during exercice. Am J Cardiol. 1964 Dec;14:844-52.
24. Simpson K, Killian K, McCartney N, Stubbing DG, Jones NL. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax. 1992 Feb;47(2):70-5.
25. Clark CJ, Cochrane LM, Mackay E, Paton B. Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training. Eur Respir J. 2000 Jan;10(1):92-7.
26. Boas SR. Exercise recommendations for individuals with cystic fibrosis. Sports Med. 1997 Jul;24(1):17-37.
27. Miller BF, Fattor JA, Jacobs KA, Horning MA, Suh SH, Navazio F, Brooks GA. Metabolic and cardiorespiratory responses to lactate infusion during rest and exercise: ‘The Lactate Clamp’. Am J Physiol Endocrinol Metab. 2002 Nov;283(5):E889-98.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email