Quais fatores determinam o uso de oxigênio no treinamento físico de pacientes com DPOC?
Which factors determine the need for oxygen supplementation during exercise training in patients with COPD?
Antenor Rodrigues, Aline Gonçalves Nellessen, Fabio Issamu Ikezaki, Mariana B. Di Martino, Thais Sant`Anna, Nidia Aparecida Hernandes, Fabio Pitta
Resumo
Introdução: O treinamento físico (TF) é fundamental na reabilitação pulmonar em pacientes com doença pulmonar obstrutiva crônica (DPOC). Uma parcela desses pacientes apresenta dessaturação periférica de oxigênio durante o exercício, necessitando de oxigênio (O2 ) suplementar. Objetivo: Analisar as diferenças entre pacientes com DPOC que necessitam ou não de oxigenoterapia durante o TF de alta intensidade; e identificar quais fatores influenciam sua necessidade. Métodos: Trinta e dois pacientes com DPOC foram avaliados quanto à função pulmonar (espirometria), força muscular respiratória (manovacuometria) e capacidade de exercício (Incremental Shuttle Walking Test [ISWT] e teste de caminhada de 6 minutos [TC6min]). Posteriormente, os pacientes foram incluídos em um programa de TF de alta intensidade (3 vezes/semana, 12 semanas), sendo separados em dois grupos quanto à necessidade de oxigenoterapia (G_O2 ; n=10) ou não (G_nãoO2 ; n=22). Resultados: O G_ O2 apresentou pior obstrução das vias aéreas (VEF1 26[21-28] vs 52[36-65] %predito; P<0,0001), menor pressão expiratória máxima (PEmax 79[53-91] vs 104[90-115] %predito, P=0,004) e menor capacidade de exercício (ISWT 295±62 vs 444±198m, P=0,03; TC6min 420[372-446] vs 480[433- 516]m, P=0,01; e TC6min em %pred 68[58-72] vs 80[67-86], P=0,01). No modelo de regressão incluindo PEmax em valores absolutos (P=0,02) e TC6min em %predito (P=0,03), apenas a distância percorrida no TC6min (%predito) determinou o uso de O2 durante o TF (Razão de prevalência [RP]=8,1; P=0,03). Conclusões: Pacientes com DPOC que necessitam de O2 durante um programa de treinamento físico de alta intensidade apresentam pior função pulmonar, força muscular expiratória e capacidade de exercício que pacientes que não necessitam de O2 durante o programa. A razão de prevalência de pacientes com pior desempenho no TC6min utilizarem O2 durante o treinamento físico é 8,1 vezes maior do que nos pacientes que apresentam melhor desempenho no teste.
Palavras-chave
Abstract
Introduction: Exercise training (ET) is the “cornerstone” of pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). A portion of these patients experience oxygen desaturation when performing exercise, needing oxygen supplementation. Aim: To analyse the differences between patients with COPD who need or not oxygen supplementation during high intensity ET; and to identify which factors influence this need. Methods: Thirty-two patients with COPD were assessed concerning lung function (spirometry), respiratory muscle strength (manovacuometry) and exercise capacity (Incremental Shuttle Walking Test [ISWT] and 6-Minute Walking Test [6MWT]). Further, patients were included in a high intensity ET program (3 times/week, 12 weeks), and divided into 2 groups: with the need of oxygen supplementation (G_O2 n=10) or not (G_notO2 n=22) during the first week of ET. Results: When compared with G_notO2 , G_O2 group had worse airway obstruction (FEV1 26[21-28] vs 52[36-65] %pred; P<0.0001), maximum expiratory pressure (PEmax 79[53-91] vs 104[90-115] %pred; P=0.004) and exercise capacity (ISWT 295±62 vs 444±198m, P=0.03; 6MWT %predicted of 68[58-72] vs 80[67-86], P=0.01). In a regression model including PEmax in absolute values (P=0.02) and 6MWT %predicted (P=0.03), only 6MWT distance (%predicted) was determinant of oxygen need during ET (prevalent ratio = 8.1; P=0.03). Conclusion: Patients with COPD who need oxygen supplementation during high-intensity ET have worse pulmonary function, expiratory muscle force and exercise capacity in comparison with patients who do not need it. The prevalence ratio for patients with more impaired exercise capacity assessed by the 6MWT distance needing oxygen supplementation during high-intensity ET is 8.1 times higher than patients with better perfomance in the test.
Keywords
References
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