The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Integrative physiotherapy approach in patients with cardiovascular disease and COPD co-morbidity - a pilot study

Walkyria Oliveira Sampaio, Ingrid de Castro Bolina Faria, Letícia Tertuliano Melo, Juliana Diniz Pereira, Cristiane Cenachi Coelho, Elizabeth Portugal Pimenta Velloso. Uni-BH-Centro Universitário de Belo Horizonte. Minas Gerais - Brazil .   Contact: walkyria.sampaio@gmail.com

Introduction: Cardiovascular diseases (CVD) are the most relevant comorbidity for patients affected by chronic obstructive pulmonary disease (COPD). The CVD-COPD association progressively increases the imbalance between oxygen delivery and oxygen demand, worsing the exercise intolerance. Relatively minor attention has been paid to this congruent status during the physiotherapy approach.

Objective: To evaluate the effect of a cardiorespiratory integrative rehabilitation program on low exercise tolerance in patients with CVD-COPD association.

Methods:  five patients with CVD-COPD and low exercise tolerance were included. The program consisted of a 10 week aerobic training (upper limb cycloergometer exercising followed by a treadmill walking) combined with specific respiratory muscle training. Non-invasive ventilation (NIV, IPAP=10 cmH2O, EPAP=5 cmH20) was used during aerobic training to reach the calculated target heart rate zone (60-70% maximal heart rate). Inspiratory muscle training was performed using a pressure load inspiratory muscle trainer (Threshold®, maximum patient load, 15 min). Evaluations of inspiratory and expiratory endurance (load), maximum inspiratory and expiratory muscle strength (MIP and MEP, respectively, predict values), upper limb endurance (load/time), heart rate, blood pressure and achieved distance during six minute walking test were performed before and after the program completion.

Results:  It was observed a significant increase in the achieved distance during six minute walking test (p<0.05). The MIP (75.65±21.08 to 98.82±26.53 cmH2O, p=0.044) and MEP (89.59±33.49 to 121.09±31.54 cmH2O, p=0.026) also increased significantly.  There was no significant alteration in the other parameters evaluated.

Conclusion: the achievement of adequate target heart rate using NIV during the aerobic training seems to allow these patients to break the inner cycle of inactivity, optimizing the cardio-respiratory conditioning. Overall, this approach could prevent the worsening of the cardiovascular morbidity in COPD patients.

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