Functional training improves quality of life in chronic obstructive pulmonary diseaseAbstract
Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by limited airflow that generates impacts on the respiratory and musculoskeletal system, and on quality of life, which can be treated by exercises.
Objective: To evaluate the effects of functional training on peripheral muscle strength, mobility and balance and quality of life in patients with COPD.
Methods: Quasi experimental, prospective, non-randomized study with convenience sample. Patients with COPD were submitted to a 12-week functional training composed of 10 exercises similar to the activities of daily life. Anthropometric varia-bles and pulmonary function tests were assessed at baseline. Quality of life (Saint George Questionnaire), muscular strength (handgrip and lumbar strength test), mobility and balance capacities (Incremental Shuttle Walking, Stair Climb, Time Up and Go and BERG balance scale) tests were evaluated before and after the training. Statistical tests by comparison were used (p < 0.05).
Results: Fourteen patients, 10 (71%) females, with a mean age of 61.71 ± 10.07 years, forced expiratory volume in first second and forced vital capacity relation of 58.78 ± 7.54 participated in this study. There was an improvement in quality of life [symptoms:73.90 (38.02-87.98) to 28.91 (23.50-32.23); activity: 21.40 ± 5.72 to 27.96 ± 7.47; total: 78.33 [36.39-82.99) to 20.22 [15.94-34.33] with maintenance of functional and musculoskeletal conditions.
Conclusion: Functional training may be an alternative for maintaining health conditions and improving the quality of life of patients with COPD. New therapeutic proposals with an increased training volume, duration, and periodicity may promote functional, and musculoskeletal repercussions.
Keywords:
COPD; Physical medicine and rehabilitation; Functional cardiorespiratory capacity; Exercise therapy; Quality of life
Resumo
Introdução: A doença pulmonar obstrutiva crônica (DPOC) ca-racteriza-se pela limitação do fluxo aéreo, que gera impactos nos sistemas respiratório e musculoesquelético e na qualidade de vida, podendo ser tratada com exercícios.
Objetivo: Avaliar os efeitos do treinamento funcional na força muscular periférica, mobilidade, equilíbrio e qualidade de vida em pacientes com DPOC.
Métodos: Trata-se de um estudo quase-experimental, prospectivo, não randomizado, com amostra de conveniência. Pacientes com DPOC foram submetidos a um treinamento funcional de 12 semanas, composto por 10 exercícios semelhantes às atividades da vida diária. Variáveis antropométricas e testes de função pulmonar foram avaliados na linha de base. A qualidade de vida (Questionário de Saint George), a força muscular (teste de força de preensão manual e lombar), a mobilidade e o equilíbrio (Teste de Caminhada Incremental, Teste de Subida de Escadas, Time Up and Go e Escala de Equilíbrio de Berg) foram avaliados antes e após o treinamento. Foram utilizados testes estatísticos de comparação (p < 0,05).
Resultados: Quatorze pacientes, 10 (71%) do sexo feminino, com idade média de 61,71 ± 10,07 anos, relação entre volume expiratório forçado no primeiro segundo e capacidade vital forçada de 58,78 ± 7,54, participaram deste estudo. Houve melhora na qualidade de vida [sintomas: 73,90 (38,02-87,98) para 28,91 (23,50-32,23); atividade: 21,40 ± 5,72 para 27,96 ± 7,47; total: 78,33 (36,39-82,99) para 20,22 (15,94-34,33)], com manutenção das condições funcionais e musculoesqueléticas.
Conclusão: O treinamento funcional pode ser uma alternativa para manter as condições de saúde e melhorar a qualidade de vida de pacientes com DPOC. Novas propostas terapêuticas com aumento do volume, duração e periodicidade do treinamento podem promover repercussões funcionais e musculoesqueléticas.
Palavras-chave:
DPOC; Medicina física e reabilitação; Capacidade cardiorrespiratória funcional; Exercícios terapêuticos; Qualidade de vida
Introduction
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent and progressive airflow limitation as a consequence of the chronic inflammatory response of the airways and lungs to harmful particles or gases. This chronic inflammation causes narrowing of the airways, decreased elastic retraction, destruction of the lung parenchyma, and systemic changes.1 According to the Latin American Pulmonary Obstruction Research Project,2 there are ap-proximately 6 million people with COPD in Brazil, 18% are men and 14% are women. It is also known that, in Brazil, this is the third most common cause of death among chronic non-communicable diseases, demonstrating the concern of public health agencies.3,4
COPD has numerous pulmonary and extrapulmonary alterations, such as those affecting the musculoskeletal system. Musculoskeletal changes lead to limitations in exercise capacity, reduced quality of life, and premature mortality.5 One of the main changes in the musculoskeletal system is the decrease in peripheral muscle strength in both upper limbs and lower limbs. The weakness of the lower limbs causes changes in functional balance6 and consequently increases the risk of falls and trauma, compromising the quality of life of these patients.7 In an attempt to minimize the impacts of COPD and reduce its progression, pharmacological8 and non-pharmacological interventions are carried out through exercises, which im-prove exercise tolerance, lung function, muscle strength, and quality of life.9,10
A network meta-analysis was performed to determine the effects of different physical activity interventions on overall quality of life in COPD. A total of 54 studies were included involving several modalities (active mind-body movement therapy, endurance, combined), and was verified a positive effect in all the quality of life domains, except for social support.11 The protocols include endurance and resistance exercises, with a periodicity of three to five times a week.12 However, these approaches become monotonous and difficult to transpose gains into daily activities.
In this context, one of the alternatives is the functional exercises that consist of the integration of multiple muscles and joints to perform a task similar to everyday life.13,14 Since patients with COPD have decreased functionality and postural balance, functional exercises specific to these changes may be a viable alternative, but should be tested in this population. In this sense, determining the effects of functional training in patients with COPD will allow incorporating them as another physiotherapeutic treatment resource for this population. Thus, the objective of this study was to evaluate the effects of functional training on cardiorespiratory capacity, peripheral muscle strength, mobility and balance and quality of life of patients with COPD.
Methods
This is a prospective and quantitative longitudinal, exploratory, field, non-randomized, convenience sample study (Trial Clinical Registration: REBEC: 557kt34). Ethical approval for this study was obtained from Research Ethics Committee of Universidade Estadual Paulista (UNESP), Marília, São Paulo, Brazil, approval number/ID: 2.611.300.
All patients were properly informed about the nature of the research, its objectives, risks and freedom to give up at any time without causing them any harm. Only participants who previously signed an informed consent form were included. The research was carried out in a properly air-conditioned laboratory. The tests were performed at the same time of the day and by the same evaluator. Specifically, the field stress tests were performed in a corridor and staircase with no flow of people on the premises of the university itself.
We selected patients aged 40 years or older, without distinction of gender, with clinical and functional diagnosis of COPD regardless of time and degree of obstruction, able to walk without the use of gait aids. Patients with a self-reported history of unstable angina, acute myocardial infarction for less than three months and/or neurological and musculoskeletal diseases that prevented the performance of the tests and the functional training protocol were not included. Patients whose obstruction was not confirmed through the pulmonary function test were excluded, as well as those who were unable to perform or complete the proposed tests, who did not complete the entire functional training protocol and/or were absent for more than two sessions (consecutive or not), since the protocol required rigor and continuity in its performance to prove its effects.
Anthropometric variables and pulmonary function tests were assessed at baseline. All patients were interviewed through anamnesis to collect personal data and identify the criteria for participating in the research. Body mass (kg) and height (m) were evaluated using a digital scale (FILIZOLA®). To confirm the presence and degree of obstruction, patients underwent spirometry in a Spirobank II® spirometer from Medical International Research following the standards of the American Thoracic Society.15,16
After a minimum of thirty minutes, the Incremental Shuttle Walking Test (ISWT) was performed. The data were used according to the pre-established values17 in which patients were instructed to walk in a ten-meter corridor limited by cones and the speed was determined by a sound signal, which increased 0.17 m/s every minute. The end of the test was determined when the distance the patient was from the cone was greater than 0.5 m.18
The Stair Climb Test (SCT) was performed on a shaded staircase composed of four flights (46 steps), each step measuring 0.16 m, total of 7.36 meters in height with an inclination of 30°. Patients were instructed to climb as fast as they could and their climbs were timed (SCT). The patients climbed the stairs accompanied by the researcher, who stimulated them with standardized phrases at each flight.19,20 Data were used according to pre-established values of a study not yet published by the research group responsible for this study.
To evaluate peripheral muscle strength, the handgrip strength test was performed using a manual Crown dynamometer. For this purpose, the patients were positioned in an orthostatic position, with the shoulder slightly adducted, the elbow flexed at 90°, the forearm in a neutral position, and the wrist position could vary from 0° to 30° of extension. Then, the maximum handgrip strength was performed in three measurements alternately in each arm, with a rest interval of 15 seconds between them, with the highest value obtained in each limb being recorded.21 A lumbar dynamometer was used to evaluate lumbar muscle strength (Crown Dorsal 200/1 – 200 Kgf). The patients were positioned standing with their hands resting on the anterior region of the thighs holding the handle, semi-flexing the knees. During the test, the individuals were instructed to perform lumbar extension with the greatest possible force. Each patient underwent an initial attempt with the intention of familiarization, and the recorded data was the average of three measurements (excluding familiarization), with a one-minute rest interval between each measurement.22
The Timed Up and Go (TUG) test was used to assess the mobility of patients, measuring in seconds the time spent by the patient to get up from a chair without the help of their arms, walk at a distance of three meters, turn around and return to the starting point. The test was performed once for familiarization and a second time to register the time.23–25 Subsequently, the Berg Balance Scale was applied, which consists of an instrument used for functional assessment of balance and is based on 14 common daily tasks with a maximum score of 56, which assess postural control, dynamic balance and flexibility. Patients were instructed to perform each task, being scored by the researcher on a scale from 0 to 4 (0 being the lowest and 4 being the best function performed) according to the proposal.21
Quality of life was assessed using the Saint George Questionnaire. This questionnaire is designed to measure health impairment in patients with COPD, and four scores are calculated (Symptoms - Part 1, questions 1-8; Activity - Part 2, Sections 2 and 6; Impacts - Part 2, Sections 1, 3, 4, 5, 7 and 8; and Total - uses all questions). Maximum raw scores are: 662.5, 1209.1, 2117.8, 3989.4, respectively; and normal (healthy) mean scores are: 12, 9, 2, 6, respectively. In general, lower scores indicate a better interpretation of health.26 All evaluations were performed before and after the functional training protocol. Functional training lasted 12 weeks and it was performed twice a week, each session lasting one hour and a half.
The patients underwent an adaptation period, and the first week of training was not included in the intervention period, being only a period of familiarization. Patients were divided into three groups, with a maximum of five patients per group. In all sessions, vital signs were evaluated before, during, and after each session. If patients reported discomfort and/or could not perform any of the activities proposed on the day, regardless of the reason, they were referred to the subsequent exercise, not preventing them from participating in the functional training. The patient could be unable to per-form a maximum of two of the ten training stations per session. Initially, there was a five-minute warm-up by walking on an unstable surface (with uphill and downhill) with a comfortable speed of their choice. Then, the patients underwent ten exercise stations related to activities of daily living (ADL). All exercises were controlled through a digital metronome that emitted sounds to control and manage activities. Table 1 shows the stations for functional training and their characteristics regarding execution and prescription.
Throughout the protocol, patients were instructed to perform phrenolabial breathing exercises concomitantly with the exercises.27 All tests and training protocol included monitoring of cardiorespiratory measures – respiratory rate, pulse oxygen saturation, heart rate and systemic blood pressure (data not shown).
The general characteristics of the patients were presented by means of absolute and relative frequency and mean ± standard deviation (normal distribution) and median and interquartile range [25-75%] (non-normal distribution). The test for data distribution analysis was the Shapiro-Wilk test. The pre- and post-training characteristics were compared using the paired t-test (normal variables) and the Wilcoxon test (non-normal variables). To compare the predicted data, pre- and post- protocol of variables with normal distribution, the ANOVA test with Tukey post-test was used, and for variables with non-normal distribution, the Friedman test with Dunns post-test was used. We adopted a significance level of 5%. The analyses were performed using the computer statistical package SigmaSTAT®.
Results
The study included 14 patients, 10 females (71%), with a mean age of 61.71 ± 10.07 years with clinical and/or functional diagnosis of COPD. The results of the anthropometric variables and pulmonary function test of the patients studied are in Table 2.
Patients submitted to SCT did not obtain a statistically significant improvement instair climbing time when comparing the moments before and after the functional training protocol. In both moments, they were above the predicted time as seen in Figure 1A. In the distance covered in the ISWT, there was no statistically significant difference between the moments before and after the functional training, however, both distances were below the predicted value (p < 0.05), as seen in Figure 1B. In summary, the results of the comparison between the three moments: predicted, before and after the results of the exercise tests, SCT and ISWT, showed that their cardiorespiratory capacities are distant from the values predicted for these patients.
Predicted Stair Climb Test (A) and the distance traveled (m) in the Incremental Shuttle Walking Test (B) before and after training.
There was no significant difference in peripheral muscle strength before and after the functional training pro-tocol presented in Table 3. Regarding mobility and balance, the patients studied showed no significant improvement in the variables of the TUG and BERG tests, as shown in Table 4. In the results of the evaluation of the domains of the quality of life tests, the patients studied showed significant improvement in the domains symptoms, activity, impact, and total of the Saint George Questionnaire (Table 4).
Results of the evaluation data of the handgrip strength and lumbar muscle strength of the studied patients (n = 14) before and after training
Results of the mobility (Timed Up and Go), balance assessment (Berg Balance Scale), and quality of life (Saint George Questionnaire domains) of the studied patients (n = 14) before and after training
Discussion
The main objective of this study was to evaluate the effects of functional training on mobility, peripheral mus-cle strength, balance and quality of life of patients with COPD, and significant improvement in the quality of life of patients who participated in the study was showed.
In this study, the sample was predominantly composed of women, which increased participation occurs because women are more concerned with health.28 Al-though the diagnosis of pulmonary disease is more prevalent in men,29 the small number of men in the sample proves the low demand and low adherence to treatment by this population, requiring new public health strategies for greater adherence and demand by men for health services.
The cardiorespiratory effects promoted by exercise are diverse, including in COPD. Supervised incremental exercises improve the cardiorespiratory condition of patients with COPD.30 This fact was not observed in this study, which prioritized the maintenance of the load, since the functional training contained several exercise stations in only one session. Iepsen et al.31 compared the effects of resistance versus endurance exercises in patients with COPD and found significant functional gains when combined the results of both exercises. However, their loads were progressive at each training session through a maximum repetition in resistance exercises, while endurance exercises were of moderate intensity and had their load adjusted individually at each session through a scale of perceived exertion. Short exercises, mostly anaerobic, in high intensity lead to the maximum use of muscle glycogen and, later on, the activation of the aerobic system which allows greater energy consumption.13 In this study, the exercises were of short duration, mostly anaerobic, and of low intensity, therefore, the energy expenditure was lower, which may not have generated responses in the cardiopulmonary tests’ results. Thus, a possible and simple increase in the loads of this study could generate functional gains similar to patients due to the scope of both endurance and resistance exercises, with the advantage of application being performed in a single training modality that prioritizes integral and joint muscle work.13,32,33 Another option would be to increase the time of the functional training or the periodicity of the training. In a study with 90 patients with stable COPD, pulmonary rehabilitation for three to six months improved spirometric variables, quality of sleep and life and exercise tolerance. The benefits become more evident when exercises are performed five times a week.34
Regarding peripheral muscle strength, this was not modified by the current proposal. Its maintenance, even in a brief period, becomes clinically beneficial because it is a case of chronic patients with musculoskeletal dysfunction.35 Another explanation would be the fact that the proposed exercises are considered of low intensity, and to improve strength and localized muscle resistance it is necessary to use a few repetitions with great resistance and high intensity, respectively.13
The muscular impairments of COPD may contribute to the worsening of the balance and functional performance levels. It is known that functional independence is related to a good quality of life, so that the higher the level of balance, the greater the functional independence, because it becomes easier to perform ADL.36 The training performed was not able to improve the mobility and balance of the patients studied, however, there was no clinical worsening during the study period, but the increase in quality of life was notable. Physical exercise improves the quality of life of patients with COPD,37 corroborating the findings of this study, which suggests that functional training influenced the patients’ perception of health despite not significantly improving their lung function, muscle strength, mobility, and balance. Other components in rehabilitation also favor the improvement in the quality of life of patients with COPD, such as respiratory training added to nursing care,38 to comprehensive care through a pulmonary rehabilitation program.39 In fact, traditional Chinese exercises that associate body movements and balance aim to increase body strength and prevent diseases. They influence lung function, endurance capacity and quality of life of COPD patients without presenting significant adverse events.40 In addition, when looking at the current evidence it is possible to evidence that TaiChi, Qigong, or yoga exercises are the most effective exercise modality to improve total quality of life, followed closely by treadmill exercise, cycling or walking, and strength exercises (large upper and lower limb muscle groups) plus resistance exercises, and pulmonar rehabilitation, and home-based pulmonary rehabilitation, respectively.11,41 Exercise programs improve not only total quality of life but also the different domains: physical function (general health, pain, and physical), self-efficacy (different people support and self-efficacy), symptoms (general symptoms, dyspnea, and fatigue), emotions (anxiety and depression), and impact and mastery (impact, impact/cognitive, mental, mental/social, mental/vitality, and mastery).11 Surely, patients with COPD improve their physical capacity and quality of life through exercise and pulmonary rehabilitation.41
The limitations of the present study should be considered in order to assist further research on the use of functional training as a treatment and rehabilitation resource for patients with COPD, namely, the total duration of the functional training protocol, the load increase in each exercise, the number of sessions per week and the number of participants in the sample.
Conclusion
Functional training provided a significant improvement in the quality of life of patients with COPD, without significant improvement in cardiorespiratory capacity, peripheral muscle strength, mobility, and balance of these patients. Thus, functional training may be a new exercise modality to be incorporated into pulmonary rehabilitation protocols due to improved quality of life of patients with COPD.
Further studies should be conducted in this population with different functional training protocols, individual load adjustments, increased intensity and implementation of aerobic exercises to know their effects on muscle strength, exercise capacity and improved cardio-respiratory fitness of patients with COPD. The results of this study will assist in the implementation of new therapeutic strategies for the care of patients with COPD, aiming at improving quality of life.
Data availability statement
Data are available from the corresponding author upon reasonable request.
References
-
1 GOLD - Global Initiative for Chronic Obstructive Lung Di-sease. Global strategy for the diagnosis, management, and pre-vention of chronic obstructive pulmonary disease (2022 Report). Fontana, WI: GOLD; 2021 [cited 2025 May 17]. Available from: https://goldcopd.org/wp-content/uploads/2021/12/GOLD-REPORT-2022-v1.1-22Nov2021_WMV.pdf
» https://goldcopd.org/wp-content/uploads/2021/12/GOLD-REPORT-2022-v1.1-22Nov2021_WMV.pdf -
2 Moreira GL, Manzano BM, Gazzotti MR, Nascimento OA, Perez- Padilla R, Menezes AM, et al. PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis. J Bras Pneumol. 2014;40(1):30-7. https://doi.org/10.1590/S1806-37132014000100005
» https://doi.org/10.1590/S1806-37132014000100005 -
3 Cruz MM, Pereira M. Epidemiology of chronic obstructive pulmonary disease in Brazil: a systematic review and meta-analysis. Cienc Saude Coletiva. 2020;25(11):4547–57. https://doi.org/10.1590/1413-812320202511.00222019
» https://doi.org/10.1590/1413-812320202511.00222019 -
4 Moreira ATA, Pinto CR, Lemos ACM, Assunção-Costa L, Souza GS, Netto EM. Evidence of the association between adherence to treatment and mortality among patients with COPD monitored at a public disease management program in Brazil. J Bras Pneumol. 2021;48(1):e20210120. https://doi.org/10.36416/1806-3756/e20210120
» https://doi.org/10.36416/1806-3756/e20210120 -
5 Ferrari R, Caram LMO, Faganello MM, Sanchez FF, Tanni SE, Godoy I. Relation between systemic inflammatory markers, pe-ripheral muscle mass, and strength in limb muscles in stable COPD patients. Int J Chron Obstruct Pulmon Dis. 2015;10:1553-8. https://doi.org/10.2147/copd.s85954
» https://doi.org/10.2147/copd.s85954 -
6 Gianjoppe-Santos J, Nyssen SM, Arcuri JF, Oliveira Jr AD, Jamami M, Di Lorenzo VAP. Influência da força muscular iso-métrica de membros inferiores sobre equilíbrio e índice BODE em pacientes com DPOC: estudo transversal. Fisioter Mov. 2014; 27(4):621-32. https://doi.org/10.1590/0103-5150.027.004.AO14
» https://doi.org/10.1590/0103-5150.027.004.AO14 -
7 Züge CH, Oliveira MR, Silva ALG, Fleig TCM. Understanding the functionality of people concerned by Chronic Obstructive Pulmonary Disease (COPD) under the perspective and validation of the Comprehensive ICF Core Set of the International Classification of Functionality. Cad Bras Ter Ocup. 2019;27(1): 27-34. https://doi.org/10.4322/2526-8910.ctoAO1582
» https://doi.org/10.4322/2526-8910.ctoAO1582 -
8 Fernandes FLA, Cukier A, Camelier AA, Fritscher CC, Costa CH, Pereira EDB, et al. Recommendations for the pharma-cological treatment of COPD: questions and answers. J Bras Pneumol. 2017;43(4):290-301. https://doi.org/10.1590/s1806-37562017000000153
» https://doi.org/10.1590/s1806-37562017000000153 -
9 Silva CM, Pinto Neto AC, Nepomuceno Jr BRV, Teixeira HP, Saquetto MB, Souza-Machado A. Chronic obstructive pulmo-nary disease: daily life activity and quality of life. Rev Pesq Fisio. 2018;8(2):199-207. http://dx.doi.org/10.17267/2238-270 4rpf.v8i2.1892
» http://dx.doi.org/10.17267/2238-270 4rpf.v8i2.1892 -
10 Wu W, Liu X, Li P, Li N, Wang Z. Effect of Liuzijue exercise combined with elastic band resistance exercise on patients with COPD: a randomized controlled trial. Evid Based Com-plement Alternat Med. 2018;2018:2361962. https://doi.org/10.1155/2018/2361962
» https://doi.org/10.1155/2018/2361962 -
11 Priego-Jiménez S, Lucerón-Lucas-Torres M, Lorenzo-García P, González-Molinero M, Bermejo-Cantarero A, Álvarez-Bueno C. Effect of exercise on quality of life in people with chronic obstructive pulmonary disease: A network meta-analysis of RCTs. Ann Phys Rehabil Med. 2025;68(2):101890. https://doi.org/10.1016/j.rehab.2024.101890
» https://doi.org/10.1016/j.rehab.2024.101890 -
12 Puhan MA, Schünemann HJ, Frey M, Scharplatz M, Bachmann LM. How should COPD patients exercise during respiratory re-habilitation? Comparison of exercising modalities and intensi-ties to treat skeletal muscle dysfunction. Thorax. 2005;60(5):367-75. https://doi.org/10.1136/thx.2004.033274
» https://doi.org/10.1136/thx.2004.033274 -
13 Silva-Gregoletto ME, Brito CJ, Heredia JR. Treinamento funcional: funcional para que e para quem? Rev Bras Cineantropom Desempenho Hum. 2014;16(6):714-9. http://dx.doi.org/10.500 7/1980-0037.2014v16n6p714
» http://dx.doi.org/10.500 7/1980-0037.2014v16n6p714 -
14 Resende-Neto AG, Silva-Grigoletto ME, Santos MS, Cyrino ES. Treinamento funcional para idosos: uma breve revisão. Rev Bras Cienc Mov. 2016;24(3):167-77. https://portalrevistas.ucb.br/index.php/rbcm/article/view/6564
» https://portalrevistas.ucb.br/index.php/rbcm/article/view/6564 -
15 GOLD - Global Initiative for Chronic Obstructive Lung Di-sease. Spirometry For Health Care Providers. GOLD; 2010 [cited 2025 Mar 15]. Available from: https://goldcopd.org/wp-content/uploads/2016/04/GOLD_Spirometry_2010.pdf
» https://goldcopd.org/wp-content/uploads/2016/04/GOLD_Spirometry_2010.pdf -
16 Prata TA, Mancuzo E, Pereira CAC, Miranda SS, Sadigursky LV, Hirotsu C, et al. Valores de referência para espirometria for-çada em adultos negros no Brasil. J Bras Pneumol. 2018;44(6):449-55. https://doi.org/10.1590/S1806-37562018000000082
» https://doi.org/10.1590/S1806-37562018000000082 -
17 Dourado VZ, Guerra RLF, Tanni SE, Antunes LCO, Godoy I. Reference values for the incremental shuttle walk test in healthy subjects: from the walk distance to physiological responses. J Bras Pneumol. 2013;39(2):190-7. https://doi.org/10.1590/s180 6-37132013000200010
» https://doi.org/10.1590/s180 6-37132013000200010 -
18 Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019-24. https://doi.org/10.1136/thx.47.12.1019
» https://doi.org/10.1136/thx.47.12.1019 -
19 Borges H, Raquel DFS, Batista PM, Quitério RJ, Ambrozin ARP. Efeitos do estímulo verbal sobre o desempenho no teste de escada e ajustes cardiorrespiratórios em sujeitos saudáveis. Fisioter Pesq. 2012;19(4):369-74. https://doi.org/10.1590/S1809-29502012000400013
» https://doi.org/10.1590/S1809-29502012000400013 -
20 Cataneo DC, Cataneo AJM. Acurácia do teste de escada utilizando o consumo máximo de oxigênio como padrão-ouro. J Bras Pneumol. 2007;33(2):128-33. https://doi.org/10.1590/S1 806-37132007000200005
» https://doi.org/10.1590/S1 806-37132007000200005 -
21 Shiratori AP, Iop RR, Borges Jr NG, Domenech SC, Gevaerd MS. Protocolos de avaliação da força de preensão manual em indivíduos com artrite reumatoide: uma revisão sistemática. Rev Bras Reumatol. 2014;54(2):140-7. https://doi.org/10.1016/j.rbr.2014.03.009
» https://doi.org/10.1016/j.rbr.2014.03.009 -
22 Eichinger FLF, Soares AV, Carvalho Jr JM, Gevaerd MS, Domenech SC, Borges Jr NG. Lumbar dynamometry: a functional test for the torso. Rev Bras Med Trab. 2016;14(2):120-6. https://dx.doi.org/10.5327/Z1679-443520162415
» https://dx.doi.org/10.5327/Z1679-443520162415 -
23 Ansai JH, Glisoi SFN, Oliveira T, Soares AT, Cabral KN, Sera CTN, et al. Revisão de dois instrumentos clínicos de avaliação para predizer risco de quedas em idosos. Rev Bras Geriatr Gerontol. 2014;17(1):177-89. https://doi.org/10.1590/S1809-98232014000100017
» https://doi.org/10.1590/S1809-98232014000100017 -
24 Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.19 91.tb01616.x
» https://doi.org/10.1111/j.1532-5415.19 91.tb01616.x -
25 Silva NA, Menezes TN. Capacidade funcional e sua asso-ciação com idade e sexo em uma população idosa. Rev Bras Cineantropom Desempenho Hum. 2014;16(3):359-70. https://doi.org/10.5007/1980-0037.2014v16n3p359
» https://doi.org/10.5007/1980-0037.2014v16n3p359 -
26 Morishita-Katsu M, Nishimura K, Taniguchi H, Kimura T, Kondoh Y, Kataoka K, et al. The COPD assessment test and St George's Respiratory Questionnaire: are they equivalent in subjects with COPD? Int J Chron Obstruct Pulmon Dis. 2016; 11:1543-51. https://doi.org/10.2147/copd.s104947
» https://doi.org/10.2147/copd.s104947 -
27 Rossi RC, Pastre CM, Ramos EMC, Vanderlei LCM. A respi-ração frenolabial na doença pulmonar obstrutiva crônica: revi-são da literatura. Fisioter Pesq. 2012;19(3):282-9. https://doi.org/10.1590/S1809-29502012000300015
» https://doi.org/10.1590/S1809-29502012000300015 -
28 Levorato CD, Mello LM, Silva AS, Nunes AA. Fatores asso-ciados à procura por serviços de saúde numa perspectiva re-lacional de gênero. Cienc Saude Coletiva. 2014;19(4):1263–74. https://doi.org/10.1590/1413-81232014194.01242013
» https://doi.org/10.1590/1413-81232014194.01242013 -
29 Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10(5):447-58. https://doi.org/10.1016/s2213-2600(21)00 511-7
» https://doi.org/10.1016/s2213-2600(21)00 511-7 - 30 Lottermann PC, Sousa CA, Liz CM. Programas de exercício físico para pessoas com DPOC: uma revisão sistemática. Arq Cienc Saude. 2017;21(1):65-75.
-
31 Iepsen UW, Munch GD, Rugbjerg M, Rinnov AR, Zacho M, Mortensen SP, et al. Effect of endurance versus resistance training on quadriceps muscle dysfunction in COPD: a pilot study. Int J Chron Obstruct Pulmon Dis. 2016;11:2659-69. https://doi.org/10.2147/copd.s114351
» https://doi.org/10.2147/copd.s114351 -
32 Fastenau A, Van Schayck O, Winkens B, Gosselink R, Muris J. Effectiveness of a physical exercise training programme COPD in primary care: a randomized controlled trial. Eur Respir J. 2015;46(Suppl 59):OA3287. https://doi.org/10.1183/13993 003.congress-2015.OA3287
» https://doi.org/10.1183/13993 003.congress-2015.OA3287 -
33 Pereira PC, Medeiros RD, Santos AA, Oliveira LS, Aniceto RR, Júnior AA, et al. Efeitos do treinamento funcional com cargas sobre a composição corporal: Um estudo experimental em mulheres fisicamente inativas. Motricidade. 2012;8(1):42-52. https://www.redalyc.org/pdf/2730/273023647006.pdf
» https://www.redalyc.org/pdf/2730/273023647006.pdf -
34 Jin L, An W, Li Z, Jiang L, Chen C. Pulmonary rehabilitation training for improving pulmonary function and exercise tole-rance in patients with stable chronic obstructive pulmonary disease. Am J Transl Res. 2021;13(7):8330-6. https://pmc.ncbi.nlm.nih.gov/articles/PMC8340261
» https://pmc.ncbi.nlm.nih.gov/articles/PMC8340261 -
35 Wouters EFM, Wouters BBREF, Augustin IML, Houben-Wilke S, Vanfleteren LEGW, Franssen FME. Personalised pulmonary rehabilitation in COPD. Eur Respir Rev. 2018;27(147):170125. https://doi.org/10.1183/16000617.0125-2017
» https://doi.org/10.1183/16000617.0125-2017 -
36 Crişan AF, Oancea C, Timar B, Fira-Mladinescu O, Tudorache V. Balance impairment in patients with COPD. PLoS One. 2015;10(3):e0120573. https://doi.org/10.1371/journal.pone.0120573
» https://doi.org/10.1371/journal.pone.0120573 -
37 Ambrozin ARP, Paschoal AMJ, Raquel DFS, Borges JBC, Quitério RJ. Associação do treinamento resistido e aeróbico em pacientes com doença pulmonar crônica. Ter Man. 2013;11(53):327-32. http://repositorio.unesp.br/handle/11449/115056
» http://repositorio.unesp.br/handle/11449/115056 -
38 Zhang Q, Liu S, Gu G, Wu L, Zhu Z, Mao Y, et al. Effect of high-quality nursing and respiratory training on pulmonary function and quality of life in patients with chronic obstructive pulmonary disease. Am J Transl Res. 2021;13(11):13209-15. https://pmc.ncbi.nlm.nih.gov/articles/PMC8661238/
» https://pmc.ncbi.nlm.nih.gov/articles/PMC8661238/ -
39 Alharbi MG, Kalra HS, Suri M, Soni N, Okpaleke N, Yadav S, et al. Pulmonary rehabilitation in management of chronic obstructive pulmonary disease. Cureus. 2021;13(10):e18414. https://doi.org/10.7759/cureus.18414
» https://doi.org/10.7759/cureus.18414 -
40 Li L, Huang H, Song J, Yu Y, Jia Y, Wang Y, et al. Network meta-analysis of the effects of different types of traditional Chinese exercises on pulmonary function, endurance capacity and quality of life in patients with COPD. Front Med (Lausanne). 2022;9:806025. https://doi.org/10.3389/fmed.2022.806025
» https://doi.org/10.3389/fmed.2022.806025 -
41 Bishop JA, Spencer LM, Dwyer TJ, McKeough ZJ, McAnulty A, Alison JA. Changes in exercise capacity and health-related quality of life at four and eight weeks of a pulmonary rehabili-tation program in people with COPD. COPD. 2021;18(6):612-20. https://doi.org/10.1080/15412555.2021.2013793
» https://doi.org/10.1080/15412555.2021.2013793
Edited by
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Associate editor:
Emmanuel Souza da Rocha
Note: Data presented as mean ± standard deviation (A) and interquartile range 1-3 [25-75] (B). *p-value < 0.05.