Confiabilidade da medida de força muscular isométrica de quadríceps e os efeitos de uma intervenção na sua recuperação e no nível de atividade física a curto e longo prazo em pacientes hospitalizados pela exacerbação da DPOC

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic airflow limitation, dynamic hyperinflation, deterioration of pulmonary function, and systemic manifestations such as peripheral muscle dysfunction. Chronic sedentarism, due to increased ventilatory demand and dyspnea symptom, insert the patients in a vicious cycle of dyspnea-sedentarism-dyspnea. Thus, there is a level of physical activity in daily life (PADL) impairment, as well as of peripheral muscular strength, mainly in the quadriceps femoral muscle (QFM). The patients affected by the disease may present exacerbations that contribute even more to the worsening of these alterations, especially in hospital admission. Therefore, it is important to measure the muscular strength of the QF muscle in a practical and reliable way, even as to verify the level of PADL in this population. In addition, the interventions should be practical and applicable to reduce the impact of hospitalization for COPD exacerbation. It is relevant to verify the benefits of the intervention during the period of hospitalization and post-discharge to see if they are maintained or not, and to know how the changes behave over time. Objectives: To evaluate the intra- and inter-rater reliability of QFM strength assessment by a portable dynamometer in COPD subjects and their tolerance to the protocol; to verify the short- and long-term impact of an intervention with lower limb elastic resistance to improve the level of PADL, length of hospital stay and muscle strength of COPD exacerbation inpatients. Methods: Inter and intra-rater reliability study of QFM strength with a portable dynamometer in 50 COPD patients and their tolerance to protocol was performed; a randomized clinical study of 21 COPD exacerbation inpatients who assessed the effect of elastic resistance intervention for short and long term on QFM strength and level of PADL. Results: Excellent intra- and inter-rater reliability were found in QFM strength (ICC>0.95 e p<0.001) in both lower limbs and the protocol was well tolerated by the patients. The intervention did not have a significant short-term impact on the PADL level, but there was. In the long term, both groups improved the level of PADL, but there was interaction between the intervention and the time in the recovery of QFM strength in both lower limbs (right: p<0.001; left p<0.001). Conclusion: There is an excellent intra- and inter-rater reliability in the portable dynamometer strength test for the QFM and the protocol was tolerated by patients. Finally, there was no short- and long-term impact of elastic resistance training on PADL level. However, there was a long-term impact on recovery of QFM strength.