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Investigation of the effect of combined physical training on the inflammatory profile and functional capacity of COPD patients: randomized clinical study

Grant number: 18/04870-3
Support type:Scholarships in Brazil - Doctorate
Effective date (Start): March 01, 2019
Effective date (End): October 31, 2020
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal Investigator:Ercy Mara Cipulo Ramos
Grantee:Juliana Souza Uzeloto
Home Institution: Faculdade de Ciências e Tecnologia (FCT). Universidade Estadual Paulista (UNESP). Campus de Presidente Prudente. Presidente Prudente , SP, Brazil


Introduction: Chronic systemic inflammation has been the focus of discussion in COPD because it causes extrapulmonary changes such as atrophy, weakness, and muscle fatigue that are associated with reduced physical and functional capacity. In addition, the adaptive immune system is impaired in these patients contributing to recurrent respiratory infections consequently aggravating the disease. On the other hand, it is known that physical exercise is able to reduce symptoms such as fatigue and dyspnea and consequently improve exercise capacity and quality of life in this population. However, it is not clear in the literature the effect of physical training on the inflammatory profile of patients such as COPD. Objective: To investigate the systemic inflammatory profile of patients with COPD and the influence of combined physical training and the insertion of functional exercises on the behavior of inflammatory biomarkers. Also, investigate factors that may be related to the immune response to training. Methods: Patients with COPD will be evaluated for pulmonary function (spirometry), food consumption (food registry), dyspnea (MRC scale), quality of life (CRQ questionnaire), clinical control of COPD, limitations in daily life activities (LCADL scale), body composition (electrical bioimpedance), inflammatory biomarkers (IL-13, -17, -6, -8, -10, TNF-± and IL-2), metabolic profile, functional capacity six minutes and T-Glittre test) and muscle strength (dynamometry). Patients will be randomized into 3 groups: combined training group (CTG), functional circuit training group (CTG) and usual care group (UCG). The CTG will perform sessions consisting of global stretches, followed by aerobic physical training on a moderate intensity treadmill with a duration of 30 minutes, associated with resistance training of upper and lower limbs of moderate intensity with duration of 20 minutes. The CTG will perform two weekly sessions as described for the combined training and in a weekly session the aerobic physical training will be replaced by the training in functional circuit that will be structured based on previous interview of the main difficulties encountered during the accomplishment of the ADL of the patients. The UCG will perform only usual care involving respiratory physiotherapy techniques. The protocols will be performed for 8 weeks. After the intervention all initial evaluations will be repeated. For data analysis the statistical program SPSS 22.0 will be used. Two-way ANOVA will be used to evaluate the possible inter-group differences in the pre- and post-intervention moments. The level of significance adopted will be 5%.