Rehabilitation of Patients With Lung Chronic Obstructive Pulmonary Disease
Rehabilitation of Patients With Lung Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is characterized by the obstruction is not fully
 reversible airway, where the severity of the disease and the prognosis is not determined
 solely by changes in lung function. Pulmonary rehabilitation is a multidisciplinary program
 of care for patients with chronic respiratory diseases, individually designed to optimize
 physical and social performance and autonomy of these patients, promoting improvement in
 functional exercise capacity, quality of life, reducing dyspnea, frequency and duration of
 hospitalizations and reduce the frequency of exacerbations of the disease. The overall
 objective of the research is to evaluate the effects of pulmonary rehabilitation program on
 exercise capacity, lung function, quality of daily life and reduction of dyspnea in patients
 with COPD. A study type randomized, open-label trial following the recommendations of the
 CONSORT (Consolidated Standards of Reporting Trials) will be held. The study will be
 conducted at the Clinic Physiotherapy Course of the School with a sample of 58 patients. The
 intervention will be performed sessions three times a week for 16 weeks (8 weeks for
 assessment and 8 weeks for adaptation and (pulmonary rehabilitation training). The PR
 (pulmonary rehabilitation) will last 60-120 minutes each.O group A (control) will receive
 treatment of traditional pulmonary rehabilitation and without resistive training for upper
 limb (UL) and group B will receive the same treatment control with additional training of
 upper limb strength.
Chronic obstructive pulmonary disease (COPD) is characterized by the obstruction is not fully
 reversible airway, where the severity of the disease and the prognosis is not determined
 solely by changes in lung function. Pulmonary rehabilitation is a multidisciplinary program
 of care for patients with chronic respiratory diseases, individually designed to optimize
 physical and social performance and autonomy of these patients, promoting improvement in
 functional exercise capacity, quality of life, reducing dyspnea, frequency and duration of
 hospitalizations and reduce the frequency of exacerbations of the disease. It is still
 reported in the survey improved ability to perform activities of daily life, exercise
 capacity, quality of life, reduction in respiratory symptoms, anxiety and depression in
 patients with chronic lung diseases. The overall objective of the research is to evaluate the
 effects of pulmonary rehabilitation program on exercise capacity, lung function, quality of
 daily life and reduction of dyspnea in patients with COPD. A study type randomized,
 open-label trial following the recommendations of the CONSORT (Consolidated Standards of
 Reporting Trials) will be held. The study will be conducted at the Clinical Department of
 Physical Therapy School The calculation of the sample held at LEE program (epidemiology
 laboratory and statistics) with 95% confidence interval and allowing a loss of 20% the sample
 then goes to 58 patients. Inclusion criteria: Patients with COPD eligible to moderate COPD
 according to the criteria of gold GOLD (Global Initiative for Chronic Obstructive Lung
 Disease) as well as being ex-smokers and no exacerbation of the disease in the last three
 months. Accompanied by a pulmonologist. Age between 40-85 years. Be not practicing physical
 activity and without cardiovascular or orthopedic disease, make use of bronchodilators and
 oral theophylline, oxygen therapy or corticosteroids. Exclusion criteria: Patients who have
 comorbidities musculoskeletal, peripheral saturation of oxygen fall lower than 90% during the
 6 minute walk test (six) minutes. Difficulty cognitive understanding of body awareness. The
 evaluation procedure will be: functional independence measure (FIM); london chest activity of
 daily living (LCADL); scale medical research council (MRC); the world health organization
 disability assessment schedule 2.0 (WHODAS 2.0); anthropometric examination; walk test of six
 (6) minutes; step test; As the repetition maximum (RM); muscle activation - electromyography;
 grip strength of the upper limbs (DMS); ultrasound diaphragm dynamometer; spirometry;
 respiratory muscle strength; saint george in respiratory disease questionnaire (SGRQ). The
 intervention will be performed sessions three times a week for 16 weeks (8 weeks for
 assessment and 8 weeks for adaptation and PR training). PR will last from 60 to 120 minutes
 each. Patients who agree to participate and the PR will be divided into two groups randomly
 through enveloped draw. Group A (control) will receive treatment from traditional pulmonary
 rehabilitation and without resistive training for upper limb (UL) and group B will receive
 the same treatment control with additional upper limb resistance training. For data analysis
 continuous variables will be analyzed with central tendency and dispersion measures, data or
 dichotomous categorical variables will be analyzed frequently measures. For the realization
 of inferential statistics are. Since the data are normally distributed, the Student t test
 for independent samples. The Mann-Whitney test is used to compare the differences in the
 means of the variables between the groups. To analyze the correlation between the functional
 capacity variables and QOL will be used in calculating the Pearson correlation coefficient
 (r) if the data are normally distributed and the calculation of the Spearman correlation
 coefficient was not distributed normally. To evaluate the reliability will be used the
 coefficient of intra-class correlation coefficient (ICC). Statistical analysis will be
 performed using the Statistical Package for Social Sciences for Windows (version 17.0).
Inclusion Criteria:

 -  Patients with COPD eligible to moderate COPD according to the criteria of gold GOLD
 (Global Initiative for Chronic Obstructive Lung Disease) and who had
 post-bronchodilator spirometry results in the last year of FEV1 (forced expiratory
 volume in one second) / FVC (forced vital capacity) <0.7 and FEV1 between 50% and 80%
 of previsto.

 -  Besides being former smokers for at least three months and were clinically stable, no
 disease exacerbation in the past three months.

 -  Accompanied by a pulmonologist.

 -  Age between 40-85 years.

 -  They are not practicing physical activity.

 -  Without cardiovascular or orthopedic disease that makes it impossible to perform the
 exercises of the RP protocol.

 -  Without presenting other comorbidities that put them at risk during the exercises .

 -  Use of bronchodilators and oral theophylline, oxygen therapy or corticosteroids.

 Exclusion Criteria:

 -  Patients who have musculoskeletal comorbidities that interfere with walking or
 performing upper extremity exercises.

 -  lower peripheral saturation decrease of oxygen lower than 90% during the 6 minute walk
 test (six) minutes.

 -  Presenting difficulty of cognitive understanding of body awareness and the ability to
 recall information for the questionnaire responses applied in the evaluation and
 re-evaluation in addition to this also children, adolescents and legally incapable