Physical Capacity in Patients With Bronchiectasis Before and After Rehabilitation Program
Condition: Bronchiectasis
MeSH terms: Bronchiectasis
Study type: Interventional

Summary: 
      The hypothesis of this study is that the group of patients who will carry out the
      rehabilitation program associated with respiratory therapy will have higher benefits in
      physical function, peripheral muscle strength and quality of life compared to the group that
      will only perform chest physiotherapy. Additionally, there will be a negative correlation
      between inflammatory mediators and measures of physical ability as well as the magnitude of
      improvement is lower after treatment in patients with higher baseline levels of inflammation.
      Furthermore, these patients will be reevaluated in 1 and 3 years, as a cohort, studying if
      exercise capacity may be a predictor of clinical and functional outcomes.
    

Detailed description: 
      All patients will have their dyspnea rated according to the Medical Research Council (MRC)
      scale. The Saint George Respiratory Questionnaire (SGRQ) and COPD Assessment test (CAT) will
      also be applied.

      Spirometry will be performed according to recommendations of the American Thoracic
      Society/European Respiratory Society. The forced vital capacity and forced expiratory volume
      values in the first second will be compared with those predicted for the Brazilian
      population.

      The maximal incremental cycle ergometer test will be carried out on an electromagnetically
      braked cycle ergometer with gas exchange and ventilatory variables analyzed breath-by-breath.
      After 2 min at rest and then 2 min pedaling in freewheel, the power (W) will continuously
      increase in a linear "ramp" pattern (1 to 20 W/min).

      The incremental treadmill test will be performed to determine aerobic training load. The
      modified Balke protocol, according to the basal level of physical fitness (a total time
      increment between eight and 12 minutes).

      The incremental shuttle walking test will be conducted according to the description of Singh
      et al.

      The daily physical activity (DPA) will be assessed with an accelerometer for three days.

      Blood sample for inflammatory markers measurements will be collected to analyze of IL-1 beta,
      IL-6, IL-8, IL-10, TNF-alpha, using Duo Set ELISA kits from R & D Systems according to
      manufacturer's instructions.

      Muscle strength with one repetition maximum (1RM) will be performed at middle deltoid (MD),
      biceps brachial (BB) and quadriceps femoris (QF). The following movements will also be
      evaluated: shoulder abduction, elbow flexion and knee extension.

      Patients are going to be randomized to pulmonary rehabilitation or conventional physiotherapy
      program as follow:

      Pulmonary rehabilitation: 8 week, twice weekly exercise program with aerobic treadmill and
      lower limb strength training.

      Conventional program: 8 week, twice weekly conventional program with: L'Expiration Lente
      Totale Glotte Ouverte en decubitus Latéral (Eltgol), autogenous drainage (AD) and shaker with
      duration of 30 minutes each.

      Patients will be reassessed in 1 and 3 years, measuring maximal incremental cycle ergometer
      test, incremental treadmill test, incremental shuttle walking test, accelerometer and muscle
      strength. All tests will follow the same patterns as the first assesment. Adicionally,
      exacerbations, hospitalization and survival in each year will be evaluated.
    

Intervention name(s): pulmonary rehabilitation; conventional program
Intervention type(s): Other; Other
Intervention description(s): Pulmonary rehabilitation: 8 week, twice weekly exercise program with aerobic treadmill training and lower limb strength training.; The conventional program is conducted with duration of 8 week, twice weekly. The techniques used will be: expiration with the glottis open in lateral posture (Eltgol), autogenous drainage (AD) and shaker. Each technique will last for 30 minutes.
Other intervention name(s): exercise; rehabilitation; treatment; pulmonary; physiotherapy; treatment respiratory
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Other
Keywords: bronchiectasis; functional capacity; lung functional