Chronic Disease Obstructive Pulmonary Clinical Trial
Official title:
Effects of a Protocol Of Rehabilitation in Patients With Chronic Disease Obstructive Pulmonary (COPD) Improvement Modulation Autonomic Heart Rate, Oxidative Stress, Quality of Life and Function
Chronic obstructive pulmonary disease (COPD) is a condition in which the lung is in chronic state due to an inflammatory response that leads to limitation in lung function of the individual, providing symptoms such as dyspnea, nutritional changes, decreased strength respiratory muscle, low capacity to exercise, dynamic insufflation and altered autonomic function with decreased heart rate variability. Have objective to evaluate and compare the effects of a rehabilitation protocol on autonomic modulation of heart rate. Participate in the study, 10 volunteers with COPD and 10 apparently healthy individuals, of both sexes, between 50 and 70 years old. Data collection and application of the Protocol will take place at the Clinical School of Physiotherapy and Occupational Therapy at the University of the Amazon (UNAMA). Between January and February 2015.
The study is being conducted in the physiotherapy clinic of HUJBB. The sample is composed of
26 volunteers with moderate to severe COPD, of both genders, recruited from the population
that will start the treatment in pulmonology HUJBB physiotherapy clinic.
All participants will undergo the assessment base used in HUJBB, blood analysis, heart rate
variability, AQ20 questionary, 6-minute walk test and Pulmonary Rehabilitation Program.
The evaluation will be carried out by pre-existing general assessment form and used in
hospital outpatient. The sheet contains: identification data; medical history; diagnosed
diseases; Drug use; Use of oxygen; nutrition and exercise habits; Physical exam;
Investigations; functional kinetic evaluation; Goals; treatment/management. Since these will
only be used: identification data; diagnosed diseases; Use of Oxygen; nutrition and exercise
habits and goals.
Morphological assessment of EOX in blood plasma is performed according to the test known as
Optical Microscopy for cell analysis in vitro or HLB test, also known under the name Dry
layer oxidative test, which the investigators refer to as microscopic morphology EOX in
plasma (EEW). The EEW provides indirect information concerning EOX, among others, using the
following grading system percentage of discontinuous area of the clot, present in the
microscope slide: grade I (normal EOX rate, with total area of discontinuity of the
extracellular matrix (ME) less than 10%), grade II (light EOX with ME discontinuity area
between 10 to 20%), grade III (moderate EOX with ME discontinuity area between 20 to 30%),
grade IV ( serious EOX with ME discontinuity area between 30 to 40%) and the grade V (very
serious EOX with ME discontinuity area above 40%) 18. By lancing on the medial side of the
digital pulp of the fourth finger of the left hand previously sanitized with alcohol,
collecting the blood drop will be next to a microscope slide by five light touches this blade
with the drop. After this procedure, the blade will be kept in place protected from contact
with the blood and at room temperature (23 ° C) for the nine-minute period for the
realization of the collected blood clotting process. At the end of this period, the
morphological patterns of these clots are seen in an increase of 40 times as set out in
protocolo18 and their assigned qualitative graduation will be logged into a spreadsheet for
further statistical analysis.
The coagulated blood will be studied by Videomicroscopy (microscope NIPOM brand), which will
be selected the best histological field, then a picture which will be analyzed by Image Pro
Plus you see the fields where there is no blood coagulation will be made, and from this
discontinuity the program will provide the percentage of oxidative stress. This analysis test
allows you to have an indirect notion of oxidative stress level in the studied patient and to
evaluate its therapeutic development.
The uptake of HRV is performed via a heart rate monitor Polar ® brand of, RS800CX model where
the FC signal is received by a strap to the signal receiver which is placed in the voluntary
thorax at the level of the xiphoid the sternum. This funding is recorded in the Polar RS800CX
monitor and transferred to the Software Polar ProTrainer program through a broadcast
interface infrared signals, which are stored and subsequently exported to txt format so that
later can be analyzed by a mathematical routine in Kubios HRV program. In the program will be
selected 5 minutes from the passage that has better signal stability.
HRV will be analyzed at rest in the supine position. This test is to evaluate the variability
of the heart rate response to check the modulation of autonomic control over it at rest in
the supine position.
Volunteers will be asked to remain at rest for a period of 10 minutes, avoiding talking to
the researcher so that the heart rate does not undergo changes. Then will begin the
collection of heart rate with duration of 10 minutes in the supine position while maintaining
spontaneous breathing.
The AQ20 is applied twice to the same patient, once in the first day and a second time after
the end of the program. Only two researchers participated in the questionnaire.
The hall used to perform the 6MWT should have a comfortable temperature, and can be a closed
or outdoor environment, since it is flat, and little traveled so there are no interruptions
while walking by people who move there. Usually you use a corridor 30 meters long, with no
obstacles where the time to make a turn must be marked with a cone. The test objective is to
walk in itself alone pace as far as possible during the six minutes and guiding possible
cardiorespiratory changes that may arise, being allowed to walk slowly, stop, relax when
needed returning to walk when you feel able to resume the walk. You must walk without talking
to the people who are around you to the cone and will back quickly around it so continuing to
walk without hesitation. The path must be shown to the patient by the examiner and can start
walking.
The training will run 2 times a week (Monday and Wednesday or Tuesday and Thursday ), lasting
approximately 50 minutes of specific training ( aerobic and strengthening), for 10 weeks,
making a total of 20 days of exercise.
During this period volunteers will be told not to perform complementary physical activities
and/or addition to another rehabilitation program.
strengthening exercises involve large muscle groups of the regions of the shoulder, knee and
hip in closed and open chain using the Neuromuscular Facilitation ( PNF) with upper extremity
exercises within the movements of the diagonals of Kabat method (flexion -adduction -rotation
external / foreign flexion - abduction -rotation / internal extension - abduction - rotation
/ internal extension - adduction - rotation ). The exercises follow the protocol 3 sets of 10
repetitions at intervals of 30 seconds of rest.
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