Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Respiratory Muscle Training and Respiratory Exercise in Exercise Tolerance, Performing Daily Life Activities and Quality of Life of Patients With COPD.
Brief Summary: In patients with chronic obstructive pulmonary disease (COPD) breaths at an abnormally high lung volume causes the inspiratory muscle to operate at non-optimal lengths, which reduce their maximal contractile forces. In addition, causes non thoraco abdominal synchronize, reduced inspiratory muscle strength and is associated with dyspnea and decreased exercise capacity. For these patients inspiratory muscle training (IMT) is a widely employed form of rehabilitation also targeting the respiratory muscle. In addition, patients often experience shortness of breath and a decline in exercise tolerance, resulting in disability in the performance of activities of daily living (ADL). The aims of this trial are to evaluate the effects of inspiratory muscle training associated with aerobic training on strength and endurance of inspiratory muscle, thoracic abdominal synchrony, exercise tolerance and quality of life patients with COPD. To compare the responses with the effects of aerobic training plus exercises of the trunk and upper limbs, and stretching of large muscle groups of the trunk. To compare difference in the perception of dyspnea during the ADL set (Borg Scale) with perception of dyspnea self-reported in the Medical Research Council (MRC), the London Chest Activity of Daily Living (LCADL) and the Pulmonary Functional Status and Dyspnea Questionnaire - Modified version (PFSDQ-M) before start the protocol. To investigate changes on perception of dyspnea (Borg scale), metabolic and ventilatory responses during a standard set of ADL tasks after a physical training and to evaluate and compare changes on perception of dyspnea. The hypothesis are that the ventilatory efficiency during the performance of ADL and the dyspnea reported from borg scale, the LCADL and the PFSDQ-M that quantifies the functional performance (change in activity levels) are improved during the IMT in conjunction with general exercise training in patients with COPD. The MIT increases the strength and endurance of inspiratory muscle, the exercise capacity and the quality of life compared to the general physical training. However, compared to the thorax abdominal synchronizes, higher modification is verified in the general physical training group with specific exercise to torso, limbs and stretching of the higher muscle group.


Options:
A: Inclusion Criteria:

* Failure to wean patients in the medial, surgical and intermediate respiratory care units at Shands Hospital
* medically stable
* able to initiate spontaneous breaths
* able to provide informed consent
* able to follow simple instructions

Exclusion Criteria:

* life expectancy \< 12 months due to malignancy
* damaged phrenic nerves
* neuromuscular diseases
* heart or lung transplant
B: Inclusion Criteria:

* individuals over the age of 40
* clinical and functional diagnosis of COPD
* Global Initiative of Chronic Obstructive Lung Disease (GOLD) - stages I to IV
* evidence of inspiratory muscle weakness, defined as a MIP ≤ 80 cmH2O and a SMIP ≤ 427 PTU
* ability to operate a computer, tablet or smartphone
* clinical stability with no history of infections or exacerbation of respiratory symptoms for at least two months prior to study enrollment
* non-participation in exercise programs in the past 12 months.

Exclusion Criteria:

* subjects with history of lung surgery, lung cancer,
* any diagnosed cognitive (i.e. Mini Mental State Examination score \< 24),
* orthopedic, neurological or neuromuscular disorders
C: Inclusion Criteria:

* the patients with clinical diagnosis of COPD presenting FEV1/FVC \< 70% and FEV1 \< 80% predicted by pulmonary function observed and were classified as patients with moderate to very severe obstruction (RABE et al., 2008),
* clinically stable with no history infection or exacerbation of the respiratory symptoms or
* a change in medication for two months preceding the study.
* the patients were non oxygen dependent, smokers or former smokers.

Exclusion Criteria:

* patients with clinical diagnosis of COPD presenting FEV1/FVC ≥ 70% FEV1 ≥ 80% predicted (RABE et al., 2008)
* who present respiratory, cardiac, rheumatic, musculoskeletal, orthopedic and neuromuscular disorders associated that may prevent them of the testing and intervention proposed,
* that are experiencing swelling in lower limbs,
* that change the type of medication during the study,
* uncontrolled hypertension patients,
* saturation below 90% at rest and
* did not agree to sign the formal consent form proposed.
D: Inclusion criteria:

1. diagnosed with moderate COPD with moderate acute exacerbation
2. over 65 years of age
3. conscious clear
4. with shortness of breath or dyspnea that was not caused by heart disease, pneumothorax, or pulmonary edema
5. had received bronchodilator aerosol therapy or antibiotic treatment, but had not been treated with an antitussive

Exclusion Criteria:

1. unstable vital signs
2. blood oxygen concentration lower than 90%
3. unstable psychological status, hemoptysis, pneumothorax, pulmonary edema, or using the respirator

Answer: C