Article information
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
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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.]
R. Novitch, H. Thomas.
Rehabilitation of patients with chronic ventilatory limitation from nonobstructive lung diseases.
Principles and practice of pulmonary rehabilitation, pp. 416-423
[7.]
D. Orenstein, B. Noyes.
Cystic fibroses.
Principles and practice of pulmonary rehabilitation, pp. 439-458
[8.]
C. Clark.
The role of physical training in asthma.
Principles and practice of pulmonary rehabilitation, pp. 424-438
[9.]
C. Clark, L. Cochrane, S. Conroy.
Exercise prescription and training In Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod.
Whurr Publishers, (2004),
[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.]
D. Geraldi, L. Lovett, M. Benoit-Connors, J. Reardon, R. ZuWallack.
Variables related to increased mortality following out-patient pulmonary rehabilitation.
Eur Respir J, 9 (1996), pp. 431-435
[12.]
K. Nishimura, T. Izumi, M. Tsukino, T. Oga.
Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD.
Chest, 121 (2002), pp. 1434-1440
[13.]
B. Celli, 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, 350 (2004), pp. 1005-1012
[14.]
American Thoracic Society Statement.
Lung function testing: selection of reference values and interpretative strategies.
Am Rev Respir Dis, 144 (1991), pp. 1202-1218
[15.]
C. Landbo, E. Prescott, P. Lange, J. Vestbo, T. Almdal.
Prognostic value of nutritional status in chronic obstructive pulmonary disease.
Am Rev Respir Dis, 160 (1999), pp. 1856-1861
[16.]
D. Mahler, C. Wells.
Evaluation of clinical methods for rating dyspnea.
Chest, 93 (1988), pp. 580-586
[17.]
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories.
ATS Statement: guidelines for the six-minute walk test.
Am Rev Respir Dis, 166 (2002), pp. 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.° 6. Copenhagen.
[20.]
A. Ries.
Exercise.
Manual of Clinical Problems in Pulmonary Medicine, pp. 19-22
[21.]
C. Clark, L. Cochrane, E. Mackay.
Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD.
Eur Respir J, 9 (1996), pp. 2590-2596
[22.]
M. Spruit, R. Gosselink, T. Troosters, K. De Paepe, M. Decramer.
Resistence versus endurance training in patients with COPD and peripheral muscle wekness.
Eur Respir J, 19 (2002), pp. 1072-1078
[23.]
S. O'Shea, N. Taylor, J. Paratz.
Peripheral muscle strenght training in COPD – A systematic Rewiew.
Chest, 126 (2004), pp. 903-914
[24.]
C. Clark, L. Cochrane, E. Mackay, B. Paton.
Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training.
Eur Respir J, 15 (2000), pp. 92-97
[25.]
D. Saey, F. Maltais.
Role of peripheral muscle function in rehabilitation.
Pulmonary Rehabilitation, pp. 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.]
R. Gosselink.
Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD).
J Rehabil Res Dev, 40 (2003), pp. 25-33
[28.]
R. Gosselink, E. Houtmeyers.
Physiotherapy.
European Respiratory Monograph. C. Donner, M. Decramer, (2000),
[29.]
R. Garrod.
Physiotherapy and the management of dyspnoea. In Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod.
Whurr Publishers London and Philadelphia, (2004),
[30.]
American Thoracic Society.
Dyspnea- Mechanisms, Assessment, and Management a Consensus Statement.
Am J Respir Crit Care Med, 159 (1999), pp. 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.]
Cooper Christopher.
Exercise in chronic pulmonary disease: limitations and rehabilitation.
Med Sci Sports Exerc, 33 (2001), pp. S643-S646
[33.]
American College of Sports Medicine.
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 (1990), pp. 265-274
[34.]
B. Celli.
The Importance of Exercise Training in Pulmonary Rehabilitation.
pp. 159-172
[35.]
American College of Sports Medicine.
General Principles of Exercise Prescription.
ACSM's Guidelines for exercise testing and prescription, Lippincott Williams and Wilkins, (2000),
[36.]
R. Gosselink, T. Troosters, M. Decramer.
Exercise training in COPD patients:the basic questions.
Eur Respir J, 10 (1997), pp. 2884-2891
[37.]
R. Casaburi, A. Patessio, F. Ioli, S. Zanaboni, C. Donner, K. Wasserman.
Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease.
Am Rev Respir Dis, 143 (1991), pp. 9-18
[38.]
R. Casaburi, K. Wasserman, A. Patessio, F. Ioli, S. Zanaboni, C. Donner.
A new perspective in pulmonary rehabilitation: anaerobic threshold as a discriminant in training.
Eur Respir J, 2 (1989), pp. 618s-623s
[39.]
W. Cambach, R. Chadwick-Straver, R. Wagenaar, A. Van Keimpema, H. Kemper.
The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality o life: a randomized controlled trial.
Eur Respir J, 10 (1997), pp. 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, 160 (1995), pp. 1666-1682
[41.]
N. Siafakas, N. Vermeire, N. Pride.
Optimal assessement and management of chronic obstructive pulmonary disease (COPD): the European Respiratory Society Task Force.
Eur Respir J, (1995), pp. 1398-1420
[42.]
BTS guidelines for the management of chronic obstructive pulmonary disease.
Thorax, 52 (1997), pp. S1-S28
[43.]
C. Cooper.
Exercise in chronic pulmonary disease: aerobic exercise prescription.
Med Sci Sports Exerc, (2001), pp. S671-S679
[44.]
R. Casaburi, J. Porszarsz, M. Burns, R. Chang, C. Cooper.
Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 155 (1997), pp. 1541-1551
[45.]
M. Niederman, P. Clemente, A. Fein, et al.
Benefits of a multidisciplinary pulmonary rehabilitation program. Improvements are independent of lung function.
Chest, 99 (1991), pp. 798-804
[46.]
D. Stubbing, P. Barr, P. Haalboom, R. Vaughan.
Is the effect of respiratory rehabilitation in COPD independent of the degree of impairment, disability or handicap.
Am J Respir Crit Care Med, 152 (1995), pp. 861-864
[47.]
M. Decramer, R. Gosselink, T. Troosters.
Selection of patients: who benefits?.
Pulmonary Rehabilitation – an Interdisciplinary approach, pp. 11-21
[48.]
P. Young, M. Dewese, W. Fergusson, J. Kolbe.
Respiratory rehabilitation in chronic pulmonary disease: predictors of nonadherence.
Eur Respir J, 13 (1999), pp. 855-859
[49.]
T. Troosters, R. Gosselink, D. Scholier, A. Spruit, F. Pitta, M. Probst, M. Decramer.
Pulmonary Rehabilitation in smokers with COPD.
ERJ, 24 (2004),
[50.]
US Department of Health and Human Services.
Physical Activity and Health: A Report of the Surgeon General.
US Department of Health, (1996),
[51.]
American College of Sports Medicine.
Position Stand The reccommended quantity, quality of exercise for developing, maintaining cardiorespiratory, muscular fitness, flexibility in healthy, adults.
Med Sci Sports Exerc, 30 (1998), pp. 975-991
[52.]
L. Bickford, J. Hoodgkin, McInturff.
National pulmonary rehabilitation survey. Update.
J Cardiopulm Rehabil, 15 (1995), pp. 406-411
[53.]
t. Ringbaek, E. Broendum, L. Hemmingsen, et al.
Rehabilitation of patients with chronic obstructive pulmonary disease : exercise twice a week is not sufficient.
Respir Med, 94 (2000), pp. 150-154
[54.]
E. Normandin, C. McCusker, M. Connors, F. Vale, D. Gerardi, R. ZuWallack.
An Evaluation of Two Approaches to Exercise Conditioning in Pulmonary Rehabilitation.
Chest, 121 (2002), pp. 1085-1091
[55.]
G. Borg.
Psychophysical bases of perceived exertion.
Med Sci Sports Exerc, 14 (1982), pp. 377-381
[56.]
F. Maltais, P. LeBlanc, J. Jobin, C. Berube, J. Bruneau, L. Carrier, M. Breton, G. Falardeau, R. Belleau.
Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 155 (1997), pp. 555-561
[57.]
R. Coppoolse, A. Schols, E. Baarends, R. Mostert, M. Akkermans, P. Janssen, E. Wouters.
Interval training in patients with severe COPD: a randomized clinical trial.
Eur Respir J, 14 (1999), pp. 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.]
I. Vogiatzis, S. Nanas, E. Kastanakis, O. Georgiadou, O. Papazahou, C.H. Roussos.
Dynamic hyperinflation and tolerance to interval exercise in patients with advanced COPD.
Eur Respir J, 24 (2004), pp. 385-390
[60.]
T. Troosters, G. Gayan-Ramirez, F. Pitta, N. Gosselin, R. Gosselink, M. Decramer.
Le réntraî nement à léffort des BPCO: bases physiologiques et résultats.
Rev Mal Respir, 21 (2004), pp. 319-327
[61.]
F. Martinez, J. Couser, B. Celli.
Factors that determine ventilatory muscle recruitment in patients with chronic airflow obstruction.
Am Rev Respir Dis, 142 (1990), pp. 276-282
[62.]
G. Criner, B. Celli.
Effect of unsupported arm exercise on ventilatory muscle recruitement in patients with severe chronic airflow obstruction.
Am Rev Respir Dis, 138 (1988), pp. 856-867
[63.]
F. Ghassan, M. Salman, M. Mosier, B. Beasley, D. Calkins.
Rehabilitation for patients with Chronic Obstructive Pulmonary Disease. Meta-analisys of randomized controlled trials.
J Gen Intern Med, 18 (2003), pp. 213-221
[64.]
I. Weisman, R. Zeballos.
An Integrative Approach to teh Interpretation of Cardiopulmonary exercise Testing.
pp. 300-322
[65.]
American Thoracic Society/American College of Chest Physicians – ATS/ACCP Statement on Cardiopulmonary Exercise Testing.
Am J Respir Crit Care Med, 167 (2003), pp. 211-277
[66.]
F. Rodrigues.
Estudo dos factores limitativos do exercício físico em doentes com doença pulmonar obstrutiva crónica.
Rev Port Pneumol, X (2004), pp. 9-61
[67.]
Pathophysiology of Disorders Limiting Exercise.
Principles of exercise testing and interpretation, pp. 95-114
[68.]
R. Casaburi, R. Gosselink, M. Decramer, N. Dekhuijzen, M. Fournier, M. Lewis, F. Maltais, D. Oelberg, M. Reid, J. Roca, M. Schols, G. Sieck, D. Systrom, P. Wagner, T. Williams, E. Wouters.
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, 159 (1999), pp. s1-s40
[69.]
R. Gosselink, T. Troosters, M. Decramer.
Peripheral muscle weakness contribute to muscle weakness in chronic airflow obstruction.
Am J Respir Crit Care Med, 153 (1996), pp. 976-980
[70.]
T. Troosters, G. Gosselink, M. Decramer.
Exercise training: how to distinguish responders from non-responders.
J Cardiopulm Rehabil, 21 (2001), pp. 10-17
[71.]
R. Gosselink, T. Troosters, M. Decramer.
Distribution of respiratory and peripheral muscle weakness in patients with stable COPD.
J Cardiopulm Rehabil, 20 (2000), pp. 207-212
[72.]
R. Gosselink, T. Troosters, M. Decramer.
Assessement of muscle function in pulmonary rehabilitation. In Interactive Course on Exercise-based assessement in respiratory medicine.
ERS School Courses, (2004), pp. 29-49
[73.]
B. Saltin, G. Blomquist, J. Mitchell.
response to exercise after bed rest and training.
Circulation, 38 (1968), pp. 1-78
[74.]
T. Seemungal, G. Donaldson, A. Bhowmik, D. Jeffries, J. Wedzicha.
Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 161 (2000), pp. 1608-1613
[75.]
S. Spencer, P. Jones, for the GLOBE study Group.
Time course of recovery of health satus following an infective exacerbation of chronic Bronchitis.
Thorax, 58 (2003), pp. 589-593
[76.]
D. Kirsten, C. Taube, B. Lehnigk, R. Jorres, H. Magnussen.
Exercise training improves recovery in patients with COPD after an acute exacerbation.
Respir Med, 92 (1998), pp. 1191-1198
[77.]
M. Behnke, R. Jorres, D. Kirsten, H. Magnussen.
Clinical benefits of a combined hospital and homebased exercise programme over 18 months in patients with severe COPD.
Monaldi Arch Chest Dis, 59 (2003), pp. 44-51
[78.]
S. Cirio, E. Piaggi, E. De Mattia, S. Nava.
Muscle retraining in ICU patients.
Monaldi Arch Chest Dis, 59 (2003), pp. 300-303
[79.]
W. Man, M. Polkey, N. Donaldson, B. Gray, J. Moxham.
Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study.
BMJ, (2004), pp. 1209-1214
[80.]
M.A. Puhan, M. Scharplatz, T. Troosters, J. Steurer.
Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality — a systematic review.
Respir Research, 6 (2005), pp. 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.]
B. Kirshner, G. Guyatt.
A methodological framework for assessing health indices.
J Chronic Dis, 38 (1985), pp. 27-36
[83.]
F. Pitta, T. Troosters, V.S. Probst, M.A. Spruit, M. Decramer, R. Gosselink.
Quantifying physical activity in daily life with questionnaires and motion sensors in COPD.
Eur Respir J, 27 (2006), pp. 1040-1055
[84.]
P. Enright, D. Sherrill.
Reference equations for the six-minute walk in healthy adults.
Am J Respir Crit Care Med, 158 (1998), pp. 1384-1387
[85.]
L. Leger, J. Lambert.
A maximal multi-stage 20-m shuttle run test to predict VO2 max.
Eur J Appl Physiol, 49 (1982), pp. 1-12
[86.]
N. Taveira.
Qualidade de vida e doença respiratória crónica.
Rev Port Pneumol, V (1999), pp. 99-100
[87.]
D. Redelmeier, A. Bayoumi, R. Goldstein, G. Guyatt.
Interpreting small diferrences in functional status: the six minute walk test in chronic lung disease patients.
Am J Respir Crit Care Med, 155 (1997), pp. 1278-1282
[88.]
Y. Lacasse, E. Wong, G. Guyatt, D. King, D. Cook, R. Goldstein.
Meta-analysis of respiratory in chronic obstructive pulmonary disease.
Lancet, 348 (1996), pp. 1115-1119
[89.]
D. O'Donnell.
Exercise limitation and clinical exercise testing in Chronic Obstructive Pulmonary disease.
pp. 158
[90.]
G.W. Hoo.
Nonpharmacologic adjuncts to training during pulmonary rehabilitation: the role of supplemental oxygen and non-invasive ventilation.
J Rehabil Res Dev, 40 (2003), pp. 81-97
[91.]
A. Davidson, R. Leach, R. George, D. Geddes.
Supplemental oxygen and exercise ability in chronic obstructive airways disease.
Thorax, 43 (1988), pp. 965-971
[92.]
J. Rooyackers, P. Dekhuijzen, C. van Herwaarden, H. Folgering.
Training with supplemental oxygen in patients with COPDand hypoxaemia at peak exercise.
Eur Respir J, 10 (1997), pp. 1278-1284
[93.]
R. Garrod, E. Paul, J. Wedzicha.
Supplemental oxygen during pulmonary rehabilitation in patients with COPD with exercise hypoxaemia.
Thorax, 55 (2000), pp. 539-543
[94.]
D. O'Donnell, R. Sanii, M. Younes.
Improvement in exercise endurance in patients with Chronic airflow limitation using CPAP.
Am Rev Respir Dis, 138 (1988), pp. 1510-1514
[95.]
P. Hawkins, L. Johnson, D. Nikoletou, C. Hamnegard, R. Sherwood, J. Polkey, J. Moxham.
Proportional Assist Ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease.
Thorax, 57 (2002), pp. 853-859
[96.]
R. Garrod, C. Mikelsons, E. Paul, J. Wedzicha.
Randomized controlled trial of domicillary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 162 (2000), pp. 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.]
M. Highcock, J. Shneerson, I. Smith.
Increased ventilation with NilPPv does not necessarily improve exercise capacity in COPD.
Eur Respir J, 22 (2003), pp. 100-105
[99.]
M. Behnke, C. Taube, D. Kirsten, B. Lehnigk, R. Jorres, H. Magnussen.
Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease.
Respire Med, 94 (2000), pp. 1184-1191
[100.]
J. Finnerty, I. Keeping, I. Bullough, J. Jones.
The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial.
Chest, 119 (2001), pp. 1705-1710
[101.]
R. Green, S. Singh, J. Williams, M. Morgan.
A randomized controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease.
Thorax, 56 (2001), pp. 143-145
[102.]
P. Swerts, L. Kretzers, E. Terpstra-Lindeman.
Exercise reconditionating in the rehabilitation of patients with chronic obstructive pulmonary disease: a short-and long-term analysis.
Arch Phys Med Rehabil, 71 (1990), pp. 550-573
[103.]
T. Troosters, R. Gosselink, M. Decramer.
Short-and Long-term effects of Outpatient Rehabilitation in patients with Chronic Obstructive Pulmonary Disease: a Randomized Trial.
Am J Med, 109 (2000), pp. 207-212
[104.]
L. Ries, R. Kaplan, R. Myers, M. Prewitt.
Maintenance after pulmonary rehabilitation in chronic lung disease: randomized trial.
Am J Respir Crit Care Med, 167 (2003), pp. 808-880
[105.]
L. Epstein.
Role of behavior theory in behavioral medicine.
J Consult Clin Psychol, 60 (1992), pp. 493-504
[106.]
M. Miguel, L. Borges.
Aspectos Psicológicos da Doença Crónica.
Boletim do Hospital Pulido Valente, 3 (2002), pp. 101-106
[108.]
P. Wijstra, Van der Mark, J. Kraan, Van Altena, G. Koeter, J. Postma.
Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD).
Eur Respir J, 9 (1996), pp. 104-110
[109.]
J. Strijbos, D. Postma, R. Altena, F. Gimeno, G. Koeter.
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, 109 (1996), pp. 366-372
[110.]
L. Puente-Maestu, L. Sanz, P. Sanz, R. Ona, A. Ardenillo, R. Casaburi.
Long-term effects of maintenance program after supervised or self-monitored training programs in patients with COPD.
Lung, 181 (2003), pp. 67-78
[111.]
R.E. Rhodes, A.D. Martin, J.E. Taunton, E.C. Rhodes, M. Donnelly, J. Elliot.
Factors associated with exercise adherence among older adults. An individual perspective.
Sports Med, 28 (1999), pp. 397-411
[112.]
D. Brooks, B. Krip, S. Mangovski-Alzamora, R.S. Goldstein.
The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease.
Eur Respir J, 20 (2002), pp. 20-29
[113.]
J. Bourbeau, M. Rouleau, M. Julien, D. Nault, E. Borycki.
Managing acute exacerbation.
Comprehensive management of Chronic Obstrutive Pulmonary Disease, BC Decker Inc, (2002),
[114.]
P. Weiner, A. McConnell.
Respiratory muscle training in chronic obstructive pulmonary disease:inspiratory, expiratory, or both?.
Current Opinion in Pulmonary Medicine, 11 (2005), pp. 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, 112 (1997), pp. 1363-1369
[116.]
F. Lötters, B. van Tol, G. Kwakkel, R. Gosselink.
Effects of controled inspiratory muscle training in patients with COPD: a meta-analysis.
Eur Respir J, 20 (2002), pp. 570-576
[117.]
P. Weiner, Y. Azyad, R. Ganam, M. Weiner.
Inspiratory muscle training in Asthma.
Chest, 102 (1992), pp. 1357-1361
[118.]
P. Weiner, R. Magadle, M. Beckerman, M. Weiner, N. Berar-Yanay.
Maintenance of inspiratory muscle training in COPD patients:one year follow-up.
Eur Respir J, 23 (2004), pp. 61-65
[119.]
F. Rodrigues, R. Ferreira.
Epidemiologia da DPOC em Portugal.
Postgraduate Medicine, 20 (2003), pp. 69-78
[120.]
European Partnership to Reduce Tobacco Dependence. WHO Evidence Based Recommendations on the Treatment of Tobacco Dependendence, 2001; 1-8.
[122.]
R. Anthonisen, A. Melissa, M. Skeans, A. Robert, J. Manfreda, E. Richard, M. Kanner, J. Connett.
The effects of a smoking cessation intervention on 14,5-year mortality.
Annals Intern Med, 142 (2005), pp. 233-239
[123.]
T. Griffiths.
Cost-effectiveness of pulmonary rehabilitation.
Pulmonary Rehabilitation – an Interdisciplinary approach edited by Rachel Garrod, pp. 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.]
T. Griffiths, M. Burr, I. Campbell, V. Lewis-Jenkins, J. Mullins, K. Shiels, et al.
Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial.
Lancet, (2000), pp. 355-362
[126.]
Barata Themudo.
Benefícios da actividade física na saúde. In Actividade Física e Medicina Moderna.
Themudo Barata. Ed. Europress, (1997),
[127.]
R. Paffenbarger, J. Kampert, I. Lee.
Changes in physical activity and other lifeway patterns influencing longevity.
Med Sci Sports Exerc, 26 (1994), pp. 857-865
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