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Effects of pulmonary rehabilitation associated with respiratory physiotherapy vs. respiratory physiotherapy on exercise capacity, peripheral muscle strength, and quality of life in patients with bronchiectasis: randomized controlled trial

Grant number: 14/01902-0
Support Opportunities:Scholarships in Brazil - Doctorate
Effective date (Start): June 01, 2014
Effective date (End): August 20, 2014
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Acordo de Cooperação: Coordination of Improvement of Higher Education Personnel (CAPES)
Principal Investigator:Simone Dal Corso
Grantee:Anderson Alves de Camargo
Host Institution: Universidade Nove de Julho (UNINOVE). Campus Vergueiro. São Paulo , SP, Brazil


Introduction: Bronchiectasis (BCT) is characterized by excessive sputum, dyspnea and fatigue leading to reduced exercise tolerance and impairment of quality of life. There is little information about the benefits of airway clearance techniques and pulmonary rehabilitation on exercise capacity, peripheral muscle function and quality of life in this disease. Objectives: To compare the effects of a pulmonary rehabilitation program associated with the respiratory physiotherapy with respiratory physiotherapy alone on physical capacity, peripheral muscle function and quality of life in patients with BCT; secondarily, to correlate inflammatory markers with basal lung function and basal physical capacity and with the physical capacity after pulmonary rehabilitation program associated with the respiratory physiotherapy. Material and methods: Fifty-five adult patients (> 18 years) with diagnosed BCY (high-resolution computed tomography), clinically stable (no change in symptoms of dyspnea, quantity and color of secretion) and not dependent on oxygen at rest will be studied. The exclusion criteria will be smokers or patients with smoking history greater than or equal to 10 years, with other lung diseases (cystic fibrosis, asthma, pulmonary interstitial fibrosis and COPD), with cardiovascular instability and unable to perform the tests proposed by musculoskeletal limitations. Patients will perform spirometry, incremental shuttle walk test, cardiopulmonary exercise testing, peripheral muscle strength test (middle deltoid, biceps brachialis and quadriceps femoris) by one maximum repetition and they will answer to the questionnaire of quality of life. A venous blood sample will be collected for analysis of inflammatory mediators before and after eight weeks of intervention (respiratory physiotherapy and respiratory physiotherapy + pulmonary rehabilitation). Patients will be randomized into two groups: respiratory physiotherapy and respiratory physiotherapy + pulmonary rehabilitation. In respiratory physiotherapy, patients will perform two sessions per week for eight weeks, supervised by a specialist physiotherapist. The techniques will consist of the autogenous drainage, ELTGOL (expiration Lente Totale Glotte Ouverte en Decubitus Lateral) and oral oscillation of high frequency by the Shaker. The total time of these techniques will be 30 to 45 minutes, depending on the amount and location of the secretion and the fatigue of the patient. The pulmonary rehabilitation program will consist of two sessions per week for eight weeks. In addition to the procedures described in respiratory physiotherapy, each session will consist of aerobic training (60 to 80 of the maximum load) on treadmill, strength training (40 to 70 a repetition maximum) and stretching. Expected results: the central hypothesis of this study is that the group of patients who will carry out the rehabilitation program associated with the respiratory physiotherapy will have superior benefits in exercise capacity, peripheral muscle strength, and quality of life in relation to the group performing only respiratory physiotherapy. Additionally, there will be a negative correlation between inflammatory markers and measures of exercise capacity, as well as the magnitude of improvement will be lower after treatment in patients with higher basal inflammation levels. (AU)

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Scientific publications (4)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
DE CAMARGO, ANDERSON ALVES; BOLDORINI, JACQUELINE C.; HOLLAND, ANNE E.; SILVA DE CASTRO, REJANE A.; LANZA, FERNANDA DE CORDOBA; ATHANAZIO, RODRIGO A.; RACHED, SAMIA Z.; CARVALHO-PINTO, REGINA; CUKIER, ALBERTO; STELMACH, RAFAEL; et al. Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis. PHYSICAL THERAPY, v. 98, n. 3, p. 153-161, . (14/01902-0, 13/01863-2)
SILVA DE CASTRO, REJANE AGNELO; MILANI ZANATTA, DRIELLY JESICA; RACHED, SAMIA ZAHI; ATHANAZIO, RODRIGO ABENSUR; DE CAMARGO, ANDERSON ALVES; CUKIER, ALBERTO; STELMACH, RAFAEL; DAL CORSO, SIMONE; LANZA, FERNANDA DE CORDOBA. COPD assessment test (CAT): Validity and reproducibility in patients with non-cystic fibrosis bronchiectasis. European Respiratory Journal, v. 46, p. 2-pg., . (13/11969-2, 14/01902-0)
YAMANE DE OLIVEIRA, CRISTIANE HELGA; JOSE, ANDERSON; DE CAMARGO, ANDERSON ALVES; ZANETTI FELTRIM, MARIA IGNEZ; ATHANAZIO, RODRIGO ABENSUR; RACHED, SAMIA ZAHI; STELMALCH, RAFAEL; DAL CORSO, SIMONE. Dessaturação induzida pelo exercício em pacientes com bronquiectasia não fibrocística: testes laboratoriais versus testes clínicos de campo. Jornal Brasileiro de Pneumologia, v. 47, n. 2, . (14/01902-0)
DE CAMARGO, ANDERSON ALVES; SILVA DE CASTRO, REJANE AGNELO; VIEIRA, RODOLFO P.; OLIVEIRA-JUNIOR, MANOEL CARNEIRO; DE ARAUJO, AMANDA APARECIDA; DE ANGELIS, KATIA; RACHED, SAMIA ZAHI; ATHANAZIO, RODRIGO ABENSUR; STELMACH, RAFAEL; DAL CORSO, SIMONE. Systemic Inflammation and Oxidative Stress in Adults with Bronchiectasis: Association with Clinical and Functional Features. Clinics, v. 76, . (14/14604-8, 10/09732-6, 12/15165-2, 14/01902-0)

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