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- Perfil de atividade física de pessoas com Doença Pulmonar Obstrutiva Crónica (DPOC) em PortugalPublication . Raposo, João; Pimenta, Sara; Alves-Guerreiro, José; Flora, Sofia; Caceiro, Rúben; Morais, Nuno; Oliveira, Ana; Silva, Cândida G.; Ribeiro, José; Silva, Fernando; Januário, Filipa; Carreira, Bruno P.; Rodrigues, Fátima; Marques, Alda; Cruz, JoanaIntrodução e objetivos: A participação em atividade física (AF) regular está associada a um menor risco de mortalidade e melhor qualidade de vida relacionada com a saúde. Apesar de se saber que as pessoas com Doença Pulmonar Obstrutiva Crónica (DPOC) apresentam níveis baixos de AF quando comparadas com indivíduos saudáveis da mesma idade e sexo, desconhece-se ainda a caracterização diária dos níveis de AF destas pessoas em Portugal. Este estudo teve como objetivos caracterizar o perfil de AF de pessoas com DPOC portuguesas e explorar a sua relação com características clínicas. Material e Métodos: Foi realizado um estudo observacional transversal em pessoas com DPOC clinicamente estáveis, nas regiões Centro e Lisboa e Vale do Tejo. Foram recolhidos dados sociodemográficos, antropométricos, função pulmonar [Volume Expiratório Forçado no 1º segundo (FEV1)], sintomas e exacerbações (GOLD ABCD), dispneia (modified Medical Research Council), tolerância ao exercício (teste de marcha dos 6-min) e estado de saúde (COPD Assessment Test). A AF foi avaliada através de acelerometria (ActiGraph GT3X+) durante 7 dias e consistiu em: tempo despendido em AF Moderada a Vigorosa (AFMV) e em AF Total (min/dia), e número de passos/dia. Realizou-se estatística descritiva e correlações de Spearman (ρ) entre as variáveis de AF e as medidas clínicas. Resultados: Os participantes (n=102, 82 do sexo masculino, FEV1=48±19%previsto) apresentaram uma mediana [Q1–Q3] de 20 [9–41] min/dia em AFMV, 144 [100–208] min em AF Total e realizaram 4438 [2821–6944] passos/dia. Apenas 24% dos participantes atingiram ≥7000 passos/dia e 41% os ≥30 min/dia de AFMV recomendados na literatura. O tempo despendido em AFMV e o n.º de passos/dia apresentaram correlações moderadas com a dispneia (ρ=-0.401 e ρ=0.537, respetivamente; p<0.001) e com a tolerância ao exercício (ρ=0.560 e ρ=0.525, respetivamente; p<0.001). O tempo em AFMV apresentou ainda correlação com os graus ABCD (ρ=-0.430, p<0.001). Conclusões: A maioria das pessoas com DPOC é fisicamente inativa. Os sintomas, exacerbações e tolerância ao esforço estão associados à AF nesta população e devem ser considerados em intervenções de promoção de AF.
- Test-retest reliability, agreement and construct validity of the International Physical Activity Questionnaire short-form (IPAQ-sf) in people with COPDPublication . Flora, Sofia; Marques, Alda; Hipólito, Nádia; Morais, Nuno; Silva, Cândida G.; Januário, Filipa; Rodrigues, Fátima; Carreira, Bruno P.; Cruz, J.Introduction This study assessed the test-retest reliability/agreement and construct validity of the International Physical Activity Questionnaire short-form (IPAQ-sf) in patients with chronic obstructive pulmonary disease (COPD). It also explored differences in its validity according to age, sex and GOLD airflow obstruction levels. Methods 62 participants (68 ± 8 years, 53 males, FEV1 51 ± 23%pred) completed the Portuguese IPAQ-sf, wore an accelerometer for 7 days and completed a second IPAQ-sf. Test-retest reliability/agreement was assessed with Intraclass Correlation Coefficient (ICC2,1), 95% Limits of Agreement (LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for continuous variables, and percentage of agreement (%agreement) for categories (“active”/“inactive”). Validity was assessed with 95% LoA and Spearman's correlations (ρ) between IPAQ-sf 2 (METs-min/week, time in vigorous [VPA], moderate PA [MPA] and walking) and accelerometry (time in MVPA, VPA, MPA and step counts) for continuous variables; %agreement, Cohen's kappa, and sensitivity specificity and±predictive values for categories. Correlations were also performed for age, sex and GOLD airflow obstruction grades. Results Reliability was good (ICC2,1 = 0.707) with wide LoA (-6446—6409 METs-min/week). SEM and MDC95 were 1840 and 4971 METs-min/week, respectively. %agreement between the two IPAQ-sf was 84% (kappa = 0.660). Positive, moderate and significant correlations were found between IPAQ-sf and accelerometry (0.396 ≤ ρ ≤ 0.527, p < 0.001), except for VPA (p > 0.05). The strongest correlations were found in age (<65 years) and male (0.466 ≤ ρ ≤ 0.653, p < 0.05). %agreement between tools was 65% (kappa = 0.313), with high sensitivity (0.830) but low specificity (0.500). Conclusions The IPAQ-sf seems valid to be used in COPD but caution on its widespread use is recommended as its accuracy may be limited.
- Validade e fiabilidade teste-reteste de smartbands na monitorização da Atividade FísicaPublication . Silva, Inês; Machado, Pedro; Flora, Sofia; Cruz, JoanaIntrodução e objetivos: A crescente recomendação da prática regular de atividade física por parte dos profissionais de saúde tem levado à necessidade de monitorização da mesma fora do ambiente clínico. Os dispositivos wearables comerciais realizam medições relativas ao número de passos, permitindo ao profissional de saúde acompanhar a atividade do utente, para além de poderem funcionar como ferramentas motivacionais. No entanto, não existe informação disponível acerca da validação da maioria destes dispositivos. Este estudo pretendeu avaliar a precisão da contagem de passos de smartbands de diferente valor comercial, no lado dominante e não-dominante. Material e Métodos: 11 indivíduos saudáveis (34±11 anos, 6 mulheres, dextros) utilizaram quatro smartbands, duas Garmin Vivosmart 4 (~100€/cada) e duas Xiaomi Mi Band 4 (~20€/cada), uma de cada marca no punho esquerdo e direito, enquanto caminhavam durante 3 minutos num corredor de 10 metros a uma velocidade autodeterminada. O número de passos foi obtido através das smartbands e contagem manual. O teste foi realizado duas vezes. Foram utilizados: 1) o erro percentual absoluto médio (MAPE) e os gráficos Bland e Altman (BA) para avaliar o erro das smartbands (critério: contagem manual); 2) o coeficiente de correlação intraclasse (ICC) e os gráficos BA para avaliar a fiabilidade/acordo teste-reteste. Resultados: Foram contabilizados 380±22 passos (contagem manual). Apesar da média do MAPE dos smartbands ser inferior a 10%, o desvio padrão das smartbands Xiaomi variou entre ±7% e ±14% da Garmin entre ±3% e ±16%, com valores menores na Garmin utilizada do lado direito. O ICC variou entre 0,76 e 0,80 na smartband Xiaomi e entre 0,73 e 0,92 na smartband Garmin. Os gráficos BA apresentaram limites largos (variação ~±100 passos) em todas as smartbands (vs. contagem manual e teste-reteste), particularmente para a Xiaomi do lado esquerdo quando comparada com a contagem manual. Conclusões: Os resultados sugerem que as smartbands Garmin apresentam maior precisão e podem ser utilizadas para a monitorização do número de passos na população adulta em geral. São necessários mais estudos com amostras maiores.
- What Motivates Patients with COPD to Be Physically Active? A Cross-Sectional StudyPublication . Pimenta, Sara; Silva, Cândida G.; Flora, Sofia; Hipólito, Nádia; Burtin, Chris; Oliveira, Ana; Morais, Nuno; Brites-Pereira, Marcelo; Carreira, Bruno P.; Januário, Filipa; Andrade, Lília; Martins, Vitória; Rodrigues, Fátima; Brooks, Dina; Marques, Alda; Cruz, JoanaMotivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients’ motives to be physically active, according to three pulmonary rehabilitation (PR) participation groups (Never PR, Previous PR and Current PR) and explored whether these motives were related to the PA levels and clinical characteristics. The motives to be physically active were assessed with the Exercise Motivation Inventory-2 (EMI-2, 14 motivational factors, five dimensions) and PA with accelerometry (PA groups: <5000 steps/day vs. ≥5000 steps/day). The clinical variables included symptoms, impact of the disease, exercise capacity and comorbidities. Ninety-two patients (67.4 ± 8.1 years, 82.6% male, forced expiratory volume in 1s (FEV1) 48.3 ± 18.9% predicted; 30.4% Never PR, 51% Previous PR and 18.5% Current PR) participated. The motivational dimensions related to health/fitness presented the highest scores (3.8 ± 1.1; 3.4 ± 1.3). The motives to be active were not significantly different between PA groups (p > 0.05) but having less symptoms and ≥two comorbidities were associated with higher scores in psychological/health and body-related motives, respectively (p < 0.05). The findings may encourage health professionals to actively explore with patients their motives to be physically active to individualise PA promotion.
- Relationship between fatigue, physical activity and health-related factors in COPDPublication . Vieira, Ana; Dias, Diana; Miguel, Eunice; Matos, Telma; Flora, Sofia; Silva, Cândida G.; Morais, Nuno; Oliveira, Ana; Caceiro, Rúben; Silva, Fernando; Ribeiro, José; Silva, Sónia; Martins, Vitória; Valente, Carla; Burtin, Chris; Brooks, Dina; Marques, Alda; Cruz, JoanaFatigue is highly prevalent in COPD and may be associated with reduced physical activity (PA) and poor outcomes. This study explored the relationship between fatigue, objectively measured PA and health-related factors in people with COPD. Fatigue was assessed with the Checklist of Individual Strength (CIS20) and CIS20-Subjective Fatigue (CIS20-SF) and PA with Actigraph GT3X monitors (moderate-to-vigorous PA, MVPA; total PA; steps/day). Dyspnoea (modified Medical Research Council, mMRC), exercise tolerance (6-min walk distance, 6MWD), lung function (spirometry) and GOLD A-D were collected. Spearman (ρ) and Pearson (r) correlations and multiple regressions were performed. Variables entered the model if correlation≥0.2. 54 patients participated (68±7 years; 82% men) and 69% reported fatigue (CIS20-SF≥27). Fatigue was significantly correlated with MVPA, steps/day, mMRC, 6MWD, GOLD A-D and FEV1pp (Table 1). In regression models for CIS20 (p=.001; r2=.61) and CIS20-SF (p=.003; r2=.56), dyspnoea was the only significant variable. People with higher scores of fatigue present lower PA levels, although the relationship is weak. Dyspnoea appears to have the largest influence on fatigue.
- Efeito de um programa de tiro com zarabatana na função respiratória de adultos com Dificuldades Intelectuais e DesenvolvimentaisPublication . Birsanu, Irina; Correia, Joana; Reis, Mónica; Flora, Sofia; Marcelino, Rita; Diz, Susana; Mourinha, Bruno; Silva, Cândida G.; Barroso, Marisa; Cruz, JoanaIntrodução e Objetivos: A principal causa de morte e de internamento em pessoas com Dificuldades Intelectuais e Desenvolvimentais (DID) é a patologia respiratória. O treino de tiro com zarabatana tem o potencial de melhorar a função respiratória de populações com/sem patologia através de uma atividade lúdica com significado, que envolve todo o ciclo respiratório. No entanto, o seu impacto na população com DID não é claro. Este estudo explorou os efeitos de um programa de tiro com zarabatana na função respiratória de adultos com DID. Material e Métodos: Foram recrutados 16 adultos com DID na Organização de Apoio e Solidariedade para a Integração Social (OASIS) e distribuídos, de acordo com a disponibilidade para participar nas sessões, em 2 grupos: intervenção (tiro com zarabatana, GI, n=8) e controlo (usual care, GC, n=8). O programa de tiro com zarabatana foi realizado na OASIS 1 vez/semana durante 3 meses (início: 30-40 tiros a 4m do alvo; progressão: aumento da distância/n.º tiros). Foram avaliadas: 1) a função pulmonar, através do Volume Expiratório Forçado no 1º segundo (FEV1%previsto), Capacidade Vital Forçada (FVC%previsto) e Pico de Fluxo Expiratório (PEF); 2) a força dos músculos respiratórios através das Pressões Inspiratória (PIM) e Expiratória (PEM) Máximas. Foram analisadas as diferenças: 1) entre GI e GC na baseline (M0) e aos 3 meses (M1) (teste t-student ou teste Mann-Whitney; α=0,05) e 2) entre os momentos de avaliação (M0-M1) em cada grupo (teste Wilcoxon; α=0,05). Resultados: 12 participantes concluíram o estudo, 7 no GI (33,0±14,4 anos; 5 mulheres) e 5 no GC (51,8±9,3 anos; 3 mulheres). Os grupos apresentaram uma diferença estatisticamente significativa em relação à idade (t-student, p=0.029), mas não em relação ao sexo. Os grupos não apresentaram diferenças significativas em M0 (p>0.05). Não foram observadas diferenças significativas na função pulmonar e na força dos músculos respiratórios (p>0,05) em M1 entre o GI e o GC (FEV1-GI=62,3±14,6%previsto FEV1-GC=79,0±17,7%previsto; FVCGI=64,1±17,2%previsto FVCGC=70,8±19,4%previsto; PEFGI=146,3±36,0L/min PEFGC= 279,0±166,9L/min; PIMGI=28,0±22,3cmH2O PIMGC=33,6±13,1cmH2O; PEMGI= 38,4±25,9cmH2O PEMGC= 40,4±16,6cmH2O). Nenhum dos grupos apresentou diferenças entre M0 e M1 (p<0,05). Conclusões: O treino de tiro com zarabatana não parece produzir efeitos significativos na função respiratória em adultos com DID a curto prazo. No entanto, são necessários mais estudos com desenhos robustos para confirmar os resultados.
- Phenotyping Adopters of Mobile Applications Among Patients With COPD: A Cross-Sectional StudyPublication . Flora, Sofia; Hipólito, Nádia; Brooks, Dina; Marques, Alda; Morais, Nuno; Silva, Cândida; Silva, Fernando; Ribeiro, José; Caceiro, Rúben; Carreira, Bruno; Burtin, Chris; Pimenta, Sara; Cruz, Joana; Oliveira, AnaEffectiveness of technology-based interventions to improve physical activity (PA) in people with COPD is controversial. Mixed results may be due to participants' characteristics influencing their use of and engagement with mobile health apps. This study compared demographic, clinical, physical and PA characteristics of patients with COPD using and not using mobile apps in daily life. Patients with COPD who used smartphones were asked about their sociodemographic and clinic characteristics, PA habits and use of mobile apps (general and PA-related). Participants performed a six-minute walk test (6MWT), gait speed test and wore an accelerometer for 7 days. Data were compared between participants using (App Users) and not using (Non-App Users) mobile apps. A sub-analysis was conducted comparing characteristics of PA–App Users and Non-Users. 59 participants were enrolled (73% Male; 66.3 ± 8.3 yrs; FEV1 48.7 ± 18.4% predicted): 59% were App Users and 25% were PA-App Users. Significant differences between App Users and Non-App Users were found for age (64.2 ± 8.9 vs. 69.2 ± 6.3yrs), 6MWT (462.9 ± 91.7 vs. 414.9 ± 82.3 m), Gait Speed (Median 1.5 [Q1–Q3: 1.4–1.8] vs. 2.0 [1.0–1.5]m/s), Time in Vigorous PA (0.6 [0.2–2.8] vs. 0.14 [0.1–0.7]min) and Self-Reported PA (4.0 [1.0–4.0] vs. 1.0 [0.0–4.0] Points). Differences between PA–App Users and Non-Users were found in time in sedentary behavior (764.1 [641.8–819.8] vs. 672.2 [581.2–749.4] min) and self-reported PA (4.0 [2.0–6.0] vs. 2.0 [0.0–4.0] points). People with COPD using mobile apps were younger and had higher physical capacity than their peers not using mobile apps. PA-App Users spent more time in sedentary behaviors than Non-Users although self-reporting more time in PA.
- Technological features of smartphone apps for physical activity promotion in patients with COPD: A systematic reviewPublication . Silva, J.; Hipólito, N.; Machado, P.; Flora, S.; Cruz, J.Introduction: Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD. Methods: A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features). Results: Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories ‘Measuring and monitoring’ and ‘Support and Feedback’ were present in all apps. Overall, the most implemented features were ‘progress in visual format’ (n=13), ‘advice on PA’ (n=14) and ‘data in visual format’ (n=10). Only three apps included social features, and two included a web-based version of the app. Conclusions: The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients’ PA levels.
- Characteristics of patients with COPD using mobile apps in daily lifePublication . Araújo Oliveira, Ana Luisa; Flora, Sofia; Santos, Liliana; Morais, Nuno; Ribeiro, Jose; Silva, Fernando; Silva, Candida; Carreira, Bruno; Caceiro, Ruben; Kumar, Dinesh; Marques, Alda; Brooks, Dina; Burtin, Chris; Cruz, Joana
- Reliability and validity of the QASCI questionnaire to assess caregiving burden in COPDPublication . Hipólito, Nádia; Ruivo, Adriana; Martins, Sara; Flora, Sofia; Marques, Alda; Brooks, Dina; Silva, Cândida G.; Januário, Filipa; Cruz, JoanaIntroduction: Chronic obstructive pulmonary disease (COPD) often leads to an increased dependence on the informal carer, which can result in higher levels of distress, anxiety or depression associated with the burden of caregiving and, consequently, reduced quality of life (1). Several instruments have been used to assess carer burden in COPD; however, their measurement properties have been poorly assessed in this population (2). The Questionário de Avaliação de Sobrecarga do Cuidador Informal (QASCI) is a Portuguese questionnaire, originally created for carers of patients with stroke (3) and later validated in a sample with various chronic diseases, including respiratory diseases (4). However, its reliability and validity in informal carers of patients with COPD have yet to be established. Therefore, this study aimed to assess the reliability and validity of the QASCI questionnaire for informal carers of patients with COPD. Materials and Methods: The Portuguese questionnaire QASCI evaluates the distress associated with burden of caregiving (scores range from 0 to 100, with higher scores indicating higher levels of burden). It has 32 items divided in 7 subscales (emotional burden; personal life implications; financial burden; reactions to demands; mechanism of efficacy and control; familiar support; and satisfaction with the role). Each item is scored with a 5-point Likert scale. Reliability included internal consistency assessment using the Cronbach’s alpha. Construct validity was assessed using the following questionnaires: Zarit Burden Interview (ZBI) for concurrent validity; the Hospital Anxiety and Depression Scale (HADS) (anxiety and depression) and WHOQOL-Bref (quality of life) for convergent validity. Pearson’s (r) or Spearman’s (ρ) correlation coefficients were used according to the distribution of each variable. QASCI was expected to present a stronger (positive) correlation with ZBI than with HADS (r≥0.5) and a negative correlation with WHOQOL-Bref (r≤-.4) (3, 4). Results: Forty-one carers (62.4±10.1 years, 90.2% female; patients’ FEV1=43.7±19.7%pred) completed the questionnaires. Cronbach’s alpha of the full QASCI scale was .767 and the subscales presented values between .633 and .929. QASCI and ZBI had a very strong positive correlation (r=.914; p=.01). QASCI had a strong positive correlation with HADS anxiety (r=.608; p=.01) and depression (ρ=.617; p=.01) subscales and moderate to strong negative correlations with all the WHOQOL-Bref subscales (-.418 to .723, p=.01). Discussion and Conclusions: QASCI presented good internal consistency and construct validity results. QASCI seems to be a promising measure to evaluate distress levels associated with burden of caregiving in informal carers of patients with COPD.