Impacto da hospitalização por exacerbação da DPOC sobre o nível de atividade física e força muscular de quadríceps – um estudo longitudinal

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) has systemic manifestations. Reductions in the level of physical activity and quadriceps muscle strength are some of the most prevalent systemic manifestations that worsen during the exacerbation of COPD. However, longitudinal studies are necessary in relation to the impact of hospitalization for exacerbation of COPD on the level of physical activity of daily living and quadriceps muscle strength, both during exacerbation and after hospital discharge. Aims: To evaluate the level of physical activity and muscle strength of quadriceps during and after hospitalization due to exacerbation of COPD. Methods: This is a longitudinal observational study in which 24 patients with COPD exacerbation (66 ± 7.61 years) were evaluated 48-72 hours after the start of drug therapy, 30 days and three months after hospital discharge. The assessment at the three moments included a quadriceps muscle strength test using a manual dynamometer (Microfet 2®), AFVD level with an accelerometer for seven days (activPAL3TM PAL Technologies Ltd., Glasgow, United Kingdom). Cognition, dyspnea, general health, physical performance, and lung function were assessed to characterize the sample. Results: Inactive time (sitting / lying time) showed a significant reduction in the 30 days after hospital discharge (1,151 ± 249 - 1,065 ± 198 min; p = 0.02). In addition, there was an increase in active time (standing and walking time) (344 ± 260 - 447 ± 199 min; p = 0.04) and number of steps (4,241 ± 3,744 - 6,216 ± 4,008 steps; p = 0.02 ) after three months. However, the quadriceps muscle strength did not show any significant difference either in 30 days (173 ± 74 –185 ± 51 N; 64 ± 26–64 (57-76) % of predicted; p = 0.97) and in three months (173 ± 74 –190 ± 55 N; 64 ± 26–63 (58-82) % of predicted; p = 0.60) after hospitalization. Conclusion: The level of AFVD improved due to the reduction of inactive time in the 30 days of hospital discharge and an increase in the number of steps after three months of hospital discharge. In addition, there was no improvement in quadriceps muscle strength at 30 days and three months after hospitalization. The results of this study support the importance of identifying functional losses during and after hospitalization and reinforces the development of specific strategies and early interventions aimed at improving quadriceps muscle strength and the level of AFVD.