Avaliação dos efeitos do programa de exercício físico aeróbico de curta duração em pacientes hospitalizados por exacerbação aguda da dpoc nos diferentes desfechos clínicos
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2019-02-21
Autores
Knaut, Caroline
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Universidade Estadual Paulista (Unesp)
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Introdução: A exacerbação aguda é uma importante causa de perda de função em pacientes com doença pulmonar obstrutiva crônica (DPOC). Afeta negativamente a qualidade de vida, a função pulmonar, a fraqueza muscular, o uso de recursos de saúde e a sobrevivência. Acredita-se que o exercício físico realizado durante a exacerbação pode melhorar a qualidade de vida e a capacidade física do paciente sem aumento do processo inflamatório. Objetivo: Avaliar a influência do exercício físico aeróbico de curta duração durante a internação em marcadores inflamatórios, qualidade de vida e capacidade física, além de re-hospitalização e taxas de mortalidade seis meses após a alta hospitalar em pacientes com DPOC exacerbada. Pacientes e Métodos: 26 pacientes foram avaliados 24 horas após a hospitalização por características demográficas, história de tabagismo, índice de Charlson, qualidade de vida, marcadores inflamatórios sistêmicos e composição corporal. Após 48 horas de internação, todos os pacientes realizaram o teste de caminhada de 6 minutos e um novo teste de espirometria, sendo calculado o índice BODE. Após 72 horas de internação, os pacientes do grupo de intervenção foram submetidos a exercícios aeróbicos em esteira por 15 minutos, duas vezes ao dia. Por fim, um mês após a alta hospitalar, todos os pacientes foram reavaliados segundo a qualidade de vida, marcadores inflamatórios sistêmicos, composição corporal, espirometria, teste de caminhada de 6 minutos e índice BODE. Resultados: Os pacientes do grupo intervenção e controle não diferiram quanto à gravidade da doença e características gerais. O grupo de intervenção não apresentou piora no processo inflamatório após atividade aeróbica: TNF-α de 1,19 (0,99-1,71) para 1,21 (0,77-1,53) p = 0,58, IL-6 de 2,41 (2,02- 0,58) para 2,66 (1,69-0,48) p=0,21 e PCR de 3,88 (2,26-8,04) para 4,07 (2,65-13,30) p = 0,56. Ambos os grupos não apresentaram melhora quanto a capacidade física após um mês de alta hospitalar (p=0,26) Após um mês de alta hospitalar, o grupo intervenção apresentou melhora do domínio sintomas avaliado pelo SGRQ em relação ao grupo controle (p = 0,04). Conclusão: O presente estudo mostrou que a atividade física aeróbica iniciada durante a internação em pacientes com exacerbação aguda da DPOC pode melhorar significativamente os sintomas respiratórios, sem agravar os marcadores inflamatórios sistêmicos.
Introduction: Acute exacerbation is an important cause of loss of function in patients suffering from chronic obstructive pulmonary disease (COPD). It negatively affects the quality of life, lung function, muscle weakness, use of health resources and survival. It is believed that the physical exercise performed during the exacerbation can improve the quality of life and the physical capacity of the patient without an increase in the inflammatory process. Objective: To evaluate the influence of short-term aerobic physical exercise during hospitalization on inflammatory markers, quality of life and physical capacity, as well re-hospitalization and mortality rates six months after hospital discharge in patients with exacerbated COPD. Patients and Methods: 26 patients were evaluated 24 hours after hospitalization for demographic characteristics, smoking history, Charlson index, quality of life, systemic inflammatory markers and body composition. After 48 hours hospitalization, all patients performed a 6-minute walk test and a new spirometry test, and BODE index was calculated. After 72 hours of hospitalization, patients in the intervention group underwent aerobic exercise on a treadmill for 15 minutes twice daily. Finally, a month after hospital discharge, all patients were re-evaluated according to quality of life, systemic inflammatory markers, body composition, spirometry, 6-minute walk test and BODE index. Results: Patients in the intervention and control group did not differ in severity of disease and general characteristics. The intervention group did not show worsening in the inflammatory process after aerobic activity: TNF-α from 1,19 (0,99-1,71) to 1,21(0,77-1,53) p=0,58, IL-6 from 2,41(2,02- 0,58) to 2,66(1,69-0,48) p=0,21 and CRP from 3,88(2,26-8,04) to 4,07(2,65-13,30) p=0,56. Both groups did not show improvement in physical capacity after one month of hospital discharge (p = 0.26). After one month of hospital discharge, the intervention group showed improvement of the symptom domain evaluated by SGRQ in relation to the control group (p=0,04). Conclusion: The present study showed that the aerobic physical activity initiated during hospitalization in patients with exacerbated COPD can significantly improve respiratory symptoms without worsening systemic inflammatory markers.
Introduction: Acute exacerbation is an important cause of loss of function in patients suffering from chronic obstructive pulmonary disease (COPD). It negatively affects the quality of life, lung function, muscle weakness, use of health resources and survival. It is believed that the physical exercise performed during the exacerbation can improve the quality of life and the physical capacity of the patient without an increase in the inflammatory process. Objective: To evaluate the influence of short-term aerobic physical exercise during hospitalization on inflammatory markers, quality of life and physical capacity, as well re-hospitalization and mortality rates six months after hospital discharge in patients with exacerbated COPD. Patients and Methods: 26 patients were evaluated 24 hours after hospitalization for demographic characteristics, smoking history, Charlson index, quality of life, systemic inflammatory markers and body composition. After 48 hours hospitalization, all patients performed a 6-minute walk test and a new spirometry test, and BODE index was calculated. After 72 hours of hospitalization, patients in the intervention group underwent aerobic exercise on a treadmill for 15 minutes twice daily. Finally, a month after hospital discharge, all patients were re-evaluated according to quality of life, systemic inflammatory markers, body composition, spirometry, 6-minute walk test and BODE index. Results: Patients in the intervention and control group did not differ in severity of disease and general characteristics. The intervention group did not show worsening in the inflammatory process after aerobic activity: TNF-α from 1,19 (0,99-1,71) to 1,21(0,77-1,53) p=0,58, IL-6 from 2,41(2,02- 0,58) to 2,66(1,69-0,48) p=0,21 and CRP from 3,88(2,26-8,04) to 4,07(2,65-13,30) p=0,56. Both groups did not show improvement in physical capacity after one month of hospital discharge (p = 0.26). After one month of hospital discharge, the intervention group showed improvement of the symptom domain evaluated by SGRQ in relation to the control group (p=0,04). Conclusion: The present study showed that the aerobic physical activity initiated during hospitalization in patients with exacerbated COPD can significantly improve respiratory symptoms without worsening systemic inflammatory markers.
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Palavras-chave
Exacerbação aguda, DPOC, Exercício aeróbico, Acute exacerbation, COPD, Aerobic exercise