Rehabilitation Cardiorrespiratory Improvement in Patients With Chronic Disease Obstructive Pulmonary
Rehabilitation Cardiorrespiratory Improvement in Patients With Chronic Disease Obstructive Pulmonary
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.
Inclusion Criteria:

 -  individuals who have been diagnosed with COPD , stage II and III disease

 -  are undergoing treatment at the hospital João de Barros Barreto in the period January
 and February 2016

 -  both sexes

 -  50 to 70 years of age

 -  hemodynamically stable

 Exclusion Criteria:

 -  were not diagnosed with COPD

 -  present associated diseases that may interfere with cardiac autonomic control,

 -  had less than 50 years or over 70 years old

 -  are in stage I of the COPD

 -  in intensive care unit

 -  present muscle skeletal deformities

 -  hemodynamic instability

 -  make use of pacemakers

 -  in need of supplemental O2

 -  who do not tolerate the practice of exercises