Comparação da redução na força muscular de membros superiores e membros inferiores após um protocolo de fadiga em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC)
Comparison between the reduction in muscle force in upper and lower limbs after a fatigue protocol in patients with Chronic Obstructive Pulmonary Disease (COPD)
Heloíse Valéria Possani, Maria José de Carvalho, Vanessa Suziane Probst, Fabio de Oliveira Pitta, Antonio Fernando Brunetto
Resumo
Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC) tem sido associada a uma disfunção músculoesquelética com diminuição da força muscular (FM) e aumento da fadigabilidade. Essa disfunção, entretanto, não é homogênea havendo relatos na literatura de predomínio em membros inferiores. Objetivos: Quantificar a redução na FM que ocorre após um protocolo de fadiga em membros inferiores (extensores de joelho – Ej) e superiores (flexores de cotovelo – Fc) em pacientes com DPOC e avaliar se essa redução é similar entre Ej e Fc. Materiais e Metodologia: 8 pacientes (5 homens) com DPOC moderada/grave realizaram o teste de 1 Repetição Máxima (1RM) de Fc e Ej. O protocolo de fadiga foi aplicado com 3 séries de 10 contrações com 80% da 1RM. A FM de Fc e Ej foi avaliada utilizando o dinamômetro portátil MicroFet 2 (HogganHealth, EUA) antes do protocolo, imediatamente ao seu final e 5, 10 e 25 minutos após o seu final. A escala de Borg foi utilizada antes e após a coleta dos dados para avaliar a sensação de dispnéia (EBD) e fadiga (EBF) reportada pelos pacientes. Resultados: Houve diferença estatisticamente significante na EBF antes e após o protocolo (p=0.008 tanto para Fc como para Ej). Nos Fc foi observada diferença estatisticamente significante entre a avaliação realizada no 5o e no 10o minuto em relação a antes do protocolo (p<0.01 e p<0.001, respectivamente). Quanto aos Ej, houve apenas tendência de diferença estatística no 5o e no 10o minuto em relação a antes do protocolo (p=0.08 para ambos). Discussão: A FM média de Fc foi similar à de Ej em termos absolutos antes do protocolo, o que indica que os resultados do presente estudo não foram influenciados pela FM basal. Conclusão: Foi observado um predomínio na fadigabilidade dos flexores de cotovelo em relação aos extensores de joelho em pacientes com DPOC.
Palavras-chave
Abstract
Introduction: Chronic Obstructive Pulmonary Disease (COPD) has been associated with a muscle dysfunction with reduction in muscle force (MF) and increased fatigability. This dysfunction, however, is not homogeneous, with reports in the literature indicating predominance in lower limbs. Objective: To quanfity the MF reduction occuring after a fatigue protocol in lower limbs (knee extensors – Ke) and upper limbs (elbow flexors – Ef) in patients with COPD and to assess whether this reduction is similar between Ke and Ef. Materials and Methods: 8 patients (5 men) with moderate/severe COPD performed a 1 repetitium maximum test (1RM) of Ke and Ef. The fatigue protocol was performed with 3 series of 10 contractions with 80% of the 1RM. MF of Ke and Ef was assessed with a portable dynamometer MicroFet 2 (HogganHealth, United States) before the protocol, immediatly after its completion and 5, 10 e 25 minutes after its completion. The Borg scale was applied before and after data collection in order to assess the sensation of dyspnea (BSD) and fatigue (BSF) reported by the patients. Results: There was statistically significant difference in BSF before and after the protocol (p=0.008 both for Ke and Ef). There was statistically significant difference in MF of the Ef assessed in the 5th and 10th minute when compared to before the protocol (p<0.01 and p<0.001, respectively). Concerning the Ke, there was only a trend of statistical difference in the 5th and 10th minute when compared to before the protocol (p=0.08 for both). Discussion: Mean MF of the Ef was similar to the Ke in absolute terms before the protocol, indicating that the present results were not influenced by the baseline MF. Conclusion: Fatigability was more pronounced in elbow flexors than in knee extensors in patients with COPD.
Keywords
Referências
1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55.
2. Castagna O, Boussuges A, Vallier JM, Prefaut C, Brisswalter J. Is impairment similar between arm and leg cranking exercise in COPD patients? Respir Med. 2007 Mar;101(3):547-53.
3. Dourado VZ, Tanni SE, Vale SA, Faganello MM, Sanchez FF, Godoy I. Systemic manifestations in chronic obstructive pulmonary disease (review). J Bras Pneumol. 2006 Mar-Apr;32(2):161-71.
4. Coronell C, Orozco-Levi M, Méndez R, Ramírez-Sarmiento A, Gáldiz JB, Gea J. Relevance of assessing quadriceps endurance in patients with COPD. Eur Respir J. 2004 Jul;24(1):129-36.
5. Janaudis-Ferreira T, Wadell K, Sundelin G, Lindström B. Thigh muscle strength and endurance in patients with COPD compared with healthy controls. Respir Med. 2006 Aug;100(8):1451-7.
6. Mador MJ, Bozkanat E. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. Respir Res. 2001;2(4):216-24.
7. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005 May 1;171(9):972-7.
8. Gosselink R, Troosters T, Decramer M. Distribution of muscle weakness in patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2000 Nov-Dec;20(6):353-60.
9. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999 Jul;54(7):581-6.
10. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al. Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319-38.
11. Knudson RJ, Slatin RC, Lebowitz MD, Burrows B. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis. 1976 May;113(5):587-600.
12. DeLorme TL, Watkins AL. Technics of progressive resistance exercise. Arch Phys Med Rehabil. 1948 May;29(5):263-73.
13. Pereira MIR, Gomes PSC. Muscular strength and endurance tests: reliability and prediction of one repetition maximum - Review and new evidences. Rev Bras Med Esporte. 2003 Sep-Oct;9(5):325-35. Portuguese.
14. O’Shea SD, Taylor NF, Paratz JD. Measuring muscle strength for people with pulmonary disease: retest reliability of hand-held dynamometry. Arch Phys Med Rehabil. 2007 Jan;88(1):32-6.
15. Nollet F, Beelen A. Strength assessment in postpolio syndrome: validity of a hand-held dynamometer in detecting change. Arch Phys Med Rehabil. 1999 Oct;80(10):1316-23.
16. Martin HJ, Yule V, Syddall HE, Dennison EM, Cooper C, Aihie Sayer A. Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard biodex dynamometry. Gerontology. 2006;52(3):154-9.
17. Maffiuletti NA, Bizzini M, Desbrosses K, Babault N, Munzinger U. Realiability of Knee Extension and Flexion Measurements using the Con-Trex Isokinetic Dynamometer. Clin Physiol Funct Imaging 2007 Nov;27(6):346-53.
18. Probst, VS, Troosters T, Pitta F, Decramer M, Gosselink R. Cardiopulmonary stress during exercise trainig in patients with COPD. Eur Respir J. 2006 Jun;27(6):1110-8.
19. Bohannon RW. Hand-held Compared with isokinetic dynamometry for measurement of static knee extensio torque (parallel reliability of dynamometers). Clin Phys Physiol Meas. 1990 Aug;11(3):217-22.
20. Agre JC, Magness JL, Hull SZ, Wright KC, Baxter TL, Patterson R et al. Strength testing with a portable dynamometer: reliability for upper and lower extremities. Arch Phys Med Rehabil. 1987 Jul;68(7):454-68.
21. Hayes KW, Falconer J. Reliability of Hand-held Dynamometry and its relationship with manual muscle testing in patients with osteoarthritis in the knee. J Orthop Sports Phys Ther 1992;16(3):145-
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email