Serviços Personalizados
Journal
Artigo
Indicadores
- Citado por SciELO
- Acessos
Links relacionados
- Similares em SciELO
Compartilhar
Revista Portuguesa de Pneumologia
versão impressa ISSN 0873-2159
Rev Port Pneumol v.13 n.1 Lisboa jan. 2007
Treino de exercício na doença pulmonar crónica
Exercise training in chronic pulmonary disease
Paula Pamplona1
Luísa Morais2
Resumo
O treino de exercício tornou-se a pedra basilar dos programas de reabilitação respiratória. Desde os anos 90, está comprovada a sua eficácia na melhoria da capacidade para o exercício e qualidade de vida. As normas actuais recomendam exercício contínuo de alta intensidade dos membros inferiores, como a modalidade de exercício mais eficaz (evidência A); no entanto, para alguns doentes é por vezes difícil iniciar este tipo de programa, dada a limitação por dispneia ou fadiga dos membros inferiores. Nos últimos anos, têm-se dado especial relevância à integração de outras modalidades de exercício (contínuo versus intervalado, aeróbico versus força, inclusão ou não de treino dos músculos respiratórios). Os autores revêem a actual literatura sobre treino de exercício na doença respiratória crónica, certos de que a dispneia e a inactividade condicionam um ciclo vicioso que pode ser revertido pelo treino de exercício, planeado individualmente e de forma exacta.
Palavras-chave: Treino de exercício, treino aeróbico, treino de força, reabilitação respiratória.
Abstract
Exercise training has become a cornerstone of Pulmonary Rehabilitation. Since the nineties, the effectiveness in clinically relevant improvements in exercise capacity and health-related quality of life has been proved. Current guidelines (Evidence A) recommend high intensity continuous exercise for lower extremities as the most effective exercise modality, however, for some patients it is often difficult to initiate such an exercise programme due to the limitation of dyspnoea or leg fatigue. In recent years, special relevance has been given to the integration of other modalities of exercise (continuous versus interval, aerobic versus strength, inclusion or not of respiratory muscle training). The authors carry out a review of the current literature concerning exercise training in chronic pulmonary disease and this highlights the role of tailored exercise to break the vicious cycle of dyspnoea and inactivity.
Key-words: Exercise training, aerobic training, strenght training, pulmonary rehabilitation.
Texto completo disponível apenas em PDF.
Full text only available in PDF format.
Bibliografia
1. NHLBI/WHO Workshop. Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD Workshop Report (Updated 2005: 74-76) in www.goldcopd.org.
2. ATS/ERS Task Force Report: BR Celli, W MacNee, A Agusti, A Anzueto, B Berg, AS Buist, PMA Calverley, N Chavannes, T Dillard, B Fahy, A Fein, J Heffner, S Lareau, P Meek, F Martinez, W McNicholas, J Muris, E Austegard, R Pauwels, S Rennard, A Rossi, N Siafakas, B Tiep, J Vestbo, E Wouters, R ZuWallack. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper Eur Respir J 2004; 23:932-946.
3. American Thoracic Society/ European Respiratory Society Statement on Pulmonary Rehabilitation. L Nici, C Donner, E Wouters, R Zuwallack, N Ambrosino, J Bourbeau, M Carone, B Celli, M Engelen, B Fahy, C Garvey, R Goldstein, R Gosselink, S Lareau, N MacIntyre, F Maltais, M Morgan, D O’Donnell, C Prefault, J Reardon, C Rochester, A Schols, S Singh, T. Troosters, and on behalf of the ATS/ERS Pulmonary Rehabilitation, Am J Respir Crit Care Med 2006; 173(12):1390-1413.
4. British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation Thorax 2001; 56:827-834.
5. American Thoracic Society – Pulmonary Rehabilitation Am J Respir Crit Care Med 1999;159 (5):1666-1682
6. Novitch R, Thomas H. Rehabilitation of patients with chronic ventilatory limitation from nonobstructive lung diseases. In Casaburi R. Petty T, eds. Principles and practice of pulmonary rehabilitation. Philadelphia:Saunders, 1993; 416-423. [ Links ]
7. Orenstein D, Noyes B. Cystic fibroses. In: Casaburi R. Petty T, eds. Principles and practice of pulmonary rehabilitation. Philadelphia. Saunders, 1993; 439-458.
8. Clark C. The role of physical training in asthma. In: Casaburi R. Petty T, eds. Principles and practice of pulmonary rehabilitation. Philadelphia: Saunders, 1993;424-438.
9. Clark C, Cochrane L, Conroy S. Exercise prescription and training In Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod, Whurr Publishers. London and Philadelphia 2004:36-53.
10. American Association of Cardiovascular and Pulmonary Rehabilitation. Disease – Specific Approaches in Pulmonary Rehabilitation. In: Guidelines for Pulmonary Rehabilitation Programs. Human Kinetics (third edition) 2004; 67-92.
11. Geraldi D, Lovett L, Benoit-Connors M, Reardon J, ZuWallackR. Variables related to increased mortality following out-patient pulmonary rehabilitation. Eur Respir J 1996;9:431-5.
12. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002;121:1434-1440
13. Celli B, C Cote, J Marin, C Casanova, M Oca, R Mendez, V Plata, H Cabral. The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease. N Engl J Med 2004; 350:1005-1012.
14. American Thoracic Society Statement. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991; 144:1202-1218.
15. Landbo C, Prescott E, Lange P, Vestbo J, Almdal T. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am Rev Respir Dis 1999;160:1856-1861.
16. Mahler D, Wells C. Evaluation of clinical methods for rating dyspnea. Chest 1988; 93:580-6.
17. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS Statement: guidelines for the six-minute walk test. Am Rev Respir Dis 2002; 166:111-117.
18. Gomes Pereira. Benefícios da Actividade Física na Condição Física. In Actividade Física e Medicina Moderna. Themudo Barata, ed. Europress 1997: 145-153 19. World Health Organization. Habitual Physical Activity and Health. European 1978 Series n.º 6. Copenhagen.
20. Ries A. Exercise. In Manual of Clinical Problems in Pulmonary Medicine. Richard Bordow, Andrew Ries, Timothy Morris. Eds. Lippincott Williams and Wilkins. 2001:19-22.
21. Clark C, Cochrane L, Mackay E Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD . Eur Respir J 1996; 9: 2590-6.
22. Spruit M, Gosselink R, Troosters T, De Paepe K, Decramer M. Resistence versus endurance training in patients with COPD and peripheral muscle wekness. Eur Respir J 2002; 19:1072-1078.
23. O´Shea S, Taylor N, Paratz J. Peripheral muscle strenght training in COPD – A systematic Rewiew. Chest 2004; 126:903-914.
24. Clark C, Cochrane L, Mackay E, Paton B Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training Eur Respir J 2000; 15:92-7.
25. Saey D, Maltais F. Role of peripheral muscle function in rehabilitation. In Pulmonary Rehabilitation edited by Donner C, Ambrosino N, Goldstein R. Publishers Hodder Arnold 2005: 80-90.
26. Maltais F, Hershfield S, Stubbing D, Wijkstra P, Hatzoglou A, Loveridge B, Pereira G, Golstein R. Exercise Training in Patients with COPD. In Comprehensive management of Chronic Obstrutive Pulmonary Disease. BC Decker Inc 2002: 185-214.
27. Gosselink R. Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD). J Rehabil Res Dev 2003; 40(5 Suppl 2): 25-33.
28. Gosselink R, Houtmeyers E. Physiotherapy. In Pulmonary Rehabilitation. European Respiratory Monograph. C. Donner, M. Decramer. 2000; 13:70-89.
29. Garrod R. Physiotherapy and the management of dyspnoea. In Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod, Whurr Publishers London and Philadelphia, 2004:138-153.
30. American Thoracic Society. Dyspnea- Mechanisms, Assessment, and Management a Consensus Statement. Am J Respir Crit Care Med 1999; 159 (1):321-340.
31. Cooper C. Chronic Obstructive Pulmonary Disease In : ACSM´s Exercise Management for Persons with Chronic diseases and Disabilities. Larry Durstine, Geoffrey Moore Eds Human Kinetics. 2003: 92-98.
32. Christopher Cooper. Exercise in chronic pulmonary disease: limitations and rehabilitation. Med Sci Sports Exerc. 2001(33)7:S643-S646.
33. American College of Sports Medicine. 1990. Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 22:265-274.
34. Celli B. The Importance of Exercise Training in Pulmonary Rehabilitation. In Clinical Exercise Testing. Prog Respir Res. Weisman I, Zeballos R. Eds. Basel, Karger, 2002; 32:159-172.
35. American College of Sports Medicine. General Principles of Exercise Prescription. In ACSM´s Guidelines for exercise testing and prescription. Lippincott Williams and Wilkins 2000:137-164.
36. Gosselink R, Troosters T, Decramer M. Exercise training in COPD patients:the basic questions. Eur Respir J 1997;10:2884-2891.
37. Casaburi R, A Patessio, F Ioli, S Zanaboni, C Donner, Wasserman K. Reductions in exercise lactic acidosis and ventilation
as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis 1991; 143: 9-18.
38. Casaburi R, Wasserman K, A Patessio, F Ioli, S Zanaboni, C Donner. A new perspective in pulmonary rehabilitation: anaerobic threshold as a discriminant in training. Eur Respir J 1989; 2:618s:623s.
39. Cambach W, Chadwick-Straver R, Wagenaar R, Van Keimpema A, Kemper H. The effects of a communitybased pulmonary rehabilitation programme on exercise tolerance and quality o life: a randomized controlled trial. Eur Respir J 1997; 10:104-113.
40. ATS – American Thoracic Society Statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 160:1666-1682.
41. Siafakas N, Vermeire N, Pride N. Optimal assessement and management of chronic obstructive pulmonary disease (COPD): the European Respiratory Society Task Force. Eur Respir J 1995: 1398-1420
42. BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997; 52:(Suppl 5)S1-S28.
43. Cooper C. Exercise in chronic pulmonary disease: aerobic exercise prescription. Med Sci Sports Exerc 2001: S671-679.
44. Casaburi R, Porszarsz J, Burns M, Chang R, Cooper C. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 155:1541-1551.
45. Niederman M, Clemente P, Fein A, et al. Benefits of a multidisciplinary pulmonary rehabilitation program. Improvements are independent of lung function. Chest 1991; 99:798-804.
46. Stubbing D, Barr P, Haalboom P, Vaughan R, Is the effect of respiratory rehabilitation in COPD independent of the degree of impairment, disability or handicap. Am J Respir Crit Care Med 1995;152: 861-4.
47. Decramer M, Gosselink R, Troosters T. Selection of patients: who benefits? In Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod, Whurr Publishers. London and Philadelphia. 2004: 11-21.
48. Young P, Dewese M, Fergusson W, Kolbe J. Respiratory rehabilitation in chronic pulmonary disease: predictors of nonadherence. Eur Respir J 1999; 13:855-859.
49. Troosters T, Gosselink R, Scholier D, Spruit A, Pitta F, Probst M, Decramer M. Pulmonary Rehabilitation in smokers with COPD. ERJ 2004;24 (48s):667s.
50. U S Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta:US Department of Health, 1996:10.
51. American College of Sports Medicine Position Stand The reccommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998; 30:975-991.
52. Bickford L, Hoodgkin J, McInturff. National pulmonary rehabilitation survey. Update. J Cardiopulm Rehabil 1995; 15:406-411.
53. Ringbaek t, Broendum E, Hemmingsen L et al. Rehabilitation of patients with chronic obstructive pulmonary disease : exercise twice a week is not sufficient. Respir Med 2000; 94:150-4.
54. Normandin E, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack R. An Evaluation of Two Approaches to Exercise Conditioning in Pulmonary Rehabilitation. Chest 2002; 121:1085-1091.
55. Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14:377-381.
56. Maltais F, LeBlanc P, Jobin J, Berube C, Bruneau J, Carrier L, Breton M, Falardeau G, Belleau R. Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 155:555-561.
57. Coppoolse R, Schols A, Baarends E, Mostert R, Akkermans M, Janssen P, Wouters E. Interval training in patients with severe COPD: a randomized clinical trial. Eur Respir J 1999; 14:258-263.
58. Puhan M, Busching G, vanOort E, Zaugg C, Schunemann H, Frey M. Interval exercise versus continuous exercise in patients with moderate to severe chronic obstructive pulmonary disease – study protocol for a randomised controlled trial (SRCTNII6II768). BMC Pulmonary Medicine 2004 www.biomedcentral.com/1471-2466/4/5
59. Vogiatzis I, Nanas S, Kastanakis E, Georgiadou O, Papazahou O, Roussos Ch. Dynamic hyperinflation and tolerance to interval exercise in patients with advanced COPD. Eur Respir J 2004;24:385-390.
60. Troosters T, Gayan-Ramirez G, Pitta F, Gosselin N, Gosselink R, Decramer M. Le réntraî nement à léffort des BPCO: bases physiologiques et résultats. Rev Mal Respir 2004;21:319-327.
61. Martinez F, Couser J, Celli B. Factors that determine ventilatory muscle recruitment in patients with chronic airflow obstruction. Am Rev Respir Dis 1990; 142:276-282.
62. Criner G, Celli B. Effect of unsupported arm exercise on ventilatory muscle recruitement in patients with severe chronic airflow obstruction. Am Rev Respir Dis 1988; 138:856-867.
63. Ghassan F, Salman M, Mosier M, Beasley B, Calkins D. Rehabilitation for patients with Chronic Obstructive Pulmonary Disease. Meta-analisys of randomized controlled trials. J Gen Intern Med 2003; 18(3):213-221.
64. Weisman I, Zeballos R, An Integrative Approach to teh Interpretation of Cardiopulmonary exercise Testing. In Clinical Exercise Testing. Prog Respir Res. Weisman I, Zeballos R Eds. Basel, Karger, 2002; 32:300-322.
65. American Thoracic Society/American College of Chest Physicians – ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med 2003; 167:211-277.
66. Rodrigues F. Estudo dos factores limitativos do exercício físico em doentes com doença pulmonar obstrutiva crónica. Rev Port Pneumol 2004: X(1):9-61.
67. Pathophysiology of Disorders Limiting Exercise. In: Principles of exercise testing and interpretation, Wasserman K, Hansen J, Sue D, Casaburi R, Whipp B. Eds. Lippincott Williams and Wilkins, 1999: 95-114.
68. Casaburi R, Gosselink R, Decramer M, Dekhuijzen N, Fournier M, Lewis M, Maltais F, Oelberg D, Reid M, Roca J, Schols M, Sieck G, Systrom D, Wagner P, Williams T, Wouters E. A Statement of the American Thoracic Society and European Respiratory Society. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999: 159:s1-40.
69. Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contribute to muscle weakness in chronic airflow obstruction . Am J Respir Crit Care Med 1996; 153:976-980.
70. Troosters T, Gosselink G, Decramer M. Exercise training: how to distinguish responders from non-responders. J Cardiopulm Rehabil. 2001;21:10-17
71. Gosselink R, Troosters T, Decramer M. Distribution of respiratory and peripheral muscle weakness in patients with stable COPD. J Cardiopulm Rehabil 2000; 20:207-212.
72. Gosselink R, Troosters T, Decramer M. Assessement of muscle function in pulmonary rehabilitation. In Interactive Course on Exercise-based assessement in respiratory medicine. ERS School Courses 2004; 29-49.
73. Saltin B, Blomquist G, Mitchell J, response to exercise after bed rest and training. Circulation 1968;38:1-78
74. Seemungal T, Donaldson G, Bhowmik A, Jeffries D, Wedzicha J. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161:1608-1613.
75. Spencer S, Jones P, for the GLOBE study Group. Time course of recovery of health satus following an infective exacerbation of chronic Bronchitis. Thorax 2003; 58:589-593.
76. Kirsten D, Taube C, Lehnigk B, Jorres R, Magnussen H. Exercise training improves recovery in patients with COPD after an acute exacerbation. Respir Med 1998; 92: 1191-1198.
77. Behnke M, Jorres R, Kirsten D, Magnussen. Clinical benefits of a combined hospital and homebased exercise programme over 18 months in patients with severe COPD. Monaldi Arch Chest Dis 2003; 59(1):44-51.
78. Cirio S, Piaggi E, De Mattia E, Nava S. Muscle retraining in ICU patients. Monaldi Arch Chest Dis 2003; 59:300-303.
79. Man W, Polkey M, Donaldson N, Gray B, Moxham J. Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ 2004: 1209-1214.
80. Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality — a systematic review. Respir Research 2005; 6(1):54.
81. Comissão de Trabalho de Reabilitação Respiratória. Proposta de standardização da avaliação de deficiência, da incapacidade e do handicap no doente respiratório crónico. Arq. SPPR 1994; 11(5):317-352.
82. Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis 1985; 38:27-36.
83. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J 2006; 27(5):1040-55.
84. Enright P, Sherrill D. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158:1384-1387.
85. Leger L, Lambert J. A maximal multi-stage 20-m shuttle run test to predict VO2 max. Eur J Appl Physiol.1982; 49:1-12.
86. Taveira N. Qualidade de vida e doença respiratória crónica. Rev Port Pneumol 1999; V(1):99-100.
87. Redelmeier D, Bayoumi A, Goldstein R, Guyatt G. Interpreting small diferrences in functional status: the six minute walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997; 155:1278-1282.
88. Lacasse Y, Wong E, Guyatt G, King D, Cook D, Goldstein R. Meta-analysis of respiratory in chronic obstructive pulmonary disease. Lancet 1996; 348:1115-1119.
89. O´Donnell D. Exercise limitation and clinical exercise testing in Chronic Obstructive Pulmonary disease. In Clinical Exercise Testing. Prog Respir Res. Weisman I, Zeballos R Eds. Basel, Karger, 2002; 138:158.
90. Hoo GW. Nonpharmacologic adjuncts to training during pulmonary rehabilitation: the role of supplemental oxygen and non-invasive ventilation. J Rehabil Res Dev 2003; 40(5 Suppl 2):81-97.
91. Davidson A, Leach R, George R, Geddes D, Supplemental oxygen and exercise ability in chronic obstructive airways disease. Thorax 1988; 43:965-971.
92. Rooyackers J, Dekhuijzen P, van Herwaarden C, Folgering H. Training with supplemental oxygen in patients with COPDand hypoxaemia at peak exercise. Eur Respir J 1997; 10:1278-1284.
93. Garrod R, Paul E, Wedzicha J. Supplemental oxygen during pulmonary rehabilitation in patients with COPD with exercise hypoxaemia. Thorax 2000; 55:539-543.
94. O´Donnell D, Sanii R, Younes M. Improvement in exercise endurance in patients with Chronic airflow limitation using CPAP. Am Rev Respir Dis 1988; 138:1510-1514.
95. Hawkins P, Johnson L, Nikoletou D, Hamnegard C, Sherwood R, Polkey J, Moxham J. Proportional Assist Ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease. Thorax 2002; 57:853-859.
96. Garrod R, Mikelsons C, Paul E, Wedzicha J, Randomized controlled trial of domicillary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162:1335-1341.
97. Clinical Indications for NIPP Ventilation in Chronic Respiratory Failure due to Restrictive Lung Disease, COPD, and Nocturnal Hypoventilation – A Consensus Conference Report Chest, 1999; 116:521-434.
98. Highcock M, Shneerson J, Smith I. Increased ventilation with NilPPv does not necessarily improve exercise capacity in COPD. Eur Respir J, 2003; 22:100-105.
99. Behnke M, Taube C, Kirsten D, Lehnigk B, Jorres R, Magnussen H. Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease. Respire Med 2000; 94:1184-91.
100. Finnerty J, Keeping I, Bullough I, Jones J. The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest 2001; 119:1705-1710.
101. Green R, Singh S, Williams J, Morgan M. A randomized controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 2001; 56:143-145.
102. Swerts P, Kretzers L, Terpstra-Lindeman E. Exercise reconditionating in the rehabilitation of patients with chronic obstructive pulmonary disease: a short-and long-term analysis. Arch Phys Med Rehabil 1990; 71:550-573.
103. Troosters T, Gosselink R, Decramer M. Short-and Long-term effects of Outpatient Rehabilitation in patients with Chronic Obstructive Pulmonary Disease: a Randomized Trial. Am J Med 2000; 109:207-212.
104. Ries L, Kaplan R, Myers R, Prewitt M. Maintenance after pulmonary rehabilitation in chronic lung disease: randomized trial. Am J Respir Crit Care Med 2003; 167(6):880-808.
105. Epstein L, Role of behavior theory in behavioral medicine. J Consult Clin Psychol 1992; 60:493-504.
106. Miguel M, Borges L. Aspectos Psicológicos da Doença Crónica. Boletim do Hospital Pulido Valente 2002; 3:101-106.
107. Wedzicha J, Bestall J, Garrod R, Garnham R, Jones P. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnea scale. Eur Respir J 1998; 12 (2):363-369.
108. Wijstra P, Van der Mark, Kraan J, Van Altena, Koeter G. Postma J. Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD). Eur Respir J 1996; 9:104-110
109. Strijbos J, Postma D, Altena R, Gimeno F, Koeter G. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest 1996; 109:366-372.
110. Puente-Maestu L, Sanz L, Sanz P, Ona R, Ardenillo A, Casaburi R. Long-term effects of maintenance program after supervised or self-monitored training programs in patients with COPD. Lung 2003; 181(2):67-78.
111. Rhodes RE, Martin AD, Taunton JE, Rhodes EC, Donnelly M, Elliot J. Factors associated with exercise adherence among older adults. An individual perspective. Sports Med 1999; 28(6):397-411.
112. Brooks D, Krip B, Mangovski-Alzamora S, Goldstein RS. The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. Eur Respir J 2002; 20(1):20-9.
113. Bourbeau J, Rouleau M, Julien M, Nault D, Borycki E. Managing acute exacerbation. In Comprehensive management of Chronic Obstrutive Pulmonary Disease. BC Decker Inc 2002; 131-148.
114. Weiner P, McConnell A. Respiratory muscle training in chronic obstructive pulmonary disease:inspiratory, expiratory, or both? Current Opinion in Pulmonary Medicine 2005; 11:140-144.
115. American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines Panel. Pulmonary Rehabilitation. Joint ACCP/AACVPR evidence-based guidelines. Chest 1997; 112:1363-1369.
116. Lötters F, van Tol B, Kwakkel G, Gosselink R. Effects of controled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J 2002; 20:570-576.
117. Weiner P, Azyad Y, Ganam R, Weiner M. Inspiratory muscle training in Asthma. Chest 1992; 102:1357-1361.
118. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Maintenance of inspiratory muscle training in COPD patients:one year follow-up. Eur Respir J 2004; 23(1):61-5.
119. Rodrigues F. Ferreira R. Epidemiologia da DPOC em Portugal. Postgraduate Medicine 2003; 20(4):69-78.
120. European Partnership to Reduce Tobacco Dependence. WHO Evidence Based Recommendations on the Treatment of Tobacco Dependendence, 2001; 1-8.
121. Willemse B, Postma D, Timens W, Ten Hacken N. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J 2004; 23:464-476.
122. Anthonisen R, Melissa A, Skeans M, Robert A, Manfreda J, Richard E, Kanner M, Connett J. The effects of a smoking cessation intervention on 14,5-year mortality. Annals Intern Med 2005; 142(4):233-239.
123. Griffiths T. Cost-effectiveness of pulmonary rehabilitation In Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod, Whurr Publishers London and Philadelphia, 2004; 173-186.
124. Wijkstra P, Hacken N, Wempe J, Koeter G. What is the role of rehabilitation in COPD? 2003 in Chronic Obstructive Pulmonary Disease Edited by Mike Pearson, Wisia Wedzicha Blacwell: 147-167.
125. Griffiths T, Burr M, Campbell I, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000; 355-362-368.
126. Themudo Barata. Benefícios da actividade física na saúde. In Actividade Física e Medicina Moderna. Themudo Barata. Ed. Europress 1997; 145-153.
127. Paffenbarger R, Kampert J, Lee I. Changes in physical activity and other lifeway patterns influencing longevity. Med Sci Sports Exerc 1994; 26:857-865.
128. Blair S, Kohl H, Barlow C. Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men. JAMA 1995; 273:1093-1098.
1 Assistente graduada de Pneumologia
2 Fisioterapeuta
Hospital Pulido Valente, Unidade de Readaptação Funcional Respiratória
Alameda das Linhas de Torres, 117 1769-001 Lisboa
Recebido para publicação/received for publication: 06.07.20
Aceite para publicação/accepted for publication: 06.09.08