Innovative assessment tool functional and guiding physical exercise prescription in patients with COPD exacerbated: investigation of clinical applicability and vascular and functional benefits

Abstract

In Chronic Obstructive Pulmonary Disease (COPD), periods of exacerbations are frequent and associated with hospitalizations. During a severe exacerbation, there is an increase in the physical and functional impairment of these patients, reducing tolerance to exercise and negatively impacting quality of life, in addition to the increased risk of cardiovascular events and mortality. In this population, vascular impairment considering aspects of Endothelial Function (EF) has been demonstrated, worsening during the hospitalization period and increasing the vulnerability to cardiovascular events. Additionally, our group was able to identify that EF is associated with the functional capacity of these hospitalized patients. Thus, there is a rationale for the hypothesis that the implementation of exercises may result in vascular benefits to this population, however, there are no guiding protocols for the prescription of exercise at this stage and a proposal for a functional physical assessment is imperative to guide the conduct of physical therapists, in order to improve exercise and functional capacity, with the potential to reduce cardiovascular events. However, to date, there is no valid and feasible tool for assessing functional physical performance in order to conduct an individualized exercise protocol. In addition, the benefit of rehabilitation in this regard is directly related to cardiovascular events. Objective: To propose an innovative tool for assessing the functional physical performance and guiding exercise prescription in patients with exacerbated COPD and hospitalized (COPDMove) and to investigate its clinical applicability and vascular and functional benefits compared to the exercise protocol. Methodology: Prospective intervention study. The total study population will consist of 48 individuals with a diagnosis of exacerbated COPD hospitalized. Of this total, all (n = 48) will be evaluated for the tool, construct validity and 30 patients will be evaluated for the effectiveness of the proposed rehabilitation using the tool (COPDMove). The methodology will consist of the evaluation of measures of functional physical performance (muscular strength and resistance and functional capacity, by means of the walk, sit and stand test and MRC) with the elaborated tool, and a rehabilitation protocol will be prescribed based on this assessment. Endothelial function by measures of vasodilation mediated by brachial artery flow and physical functional capacity at the end of the rehabilitation days will be considered as the main outcomes.The hypothesis for this study is that a functional physical performance tool is feasible for the hospital environment and a rehabilitation protocol guided by it results in better clinical, functional and vascular outcomes. This new knowledge will contribute to better management of this disease, considering aspects of cardiovascular morbidity, according to current recommendations for integrative care, which represents an important cause of disability and mortality worldwide, with a tendency to increase due to the aging of the population. Contributions: This study will contribute to the knowledge of new rehabilitation guiding strategies as well as to provide knowledge about the benefits of rehabilitation during the period of exacerbation of COPD on the endothelial arterial function and the functional physical capacity of this population. If this tool is viable and the intervention it directs demonstrates benefits for this population, it is aimed at improving the care of these patients, since there is a difficulty in approaching this patient during the hospitalization period. (AU)