Fabiano Francisco de Lima

Chronic obstructive pulmonary disease (COPD) is a progressive condition characterised by persistent airflow limitation and abnormal lung inflammation. It is a leading cause of morbidity and mortali...

Aerobic training (AT) or behavioural interventions (BI) to increase physical activity in daily life (PADL) improve clinical control in people with asthma; however, comparisons between these interventions remain poorly known. To compare the effects of AT versus BI on clinical control in people with moderate to severe asthma in the short- and medium-term. This two-arm, randomised, assessor-blinded trial included physically inactive adults with moderate to severe uncontrolled asthma assigned to either an aerobic training group (ATG, n = 27) or a behavioural intervention group (BIG, n = 25). AT was performed on a treadmill (2x/week;45 min/session), and intensity was determined by a cardiopulmonary exercise test (CPET). BI was based on social cognitive theory (1x/week; 90 min/session). At baseline, post-intervention (short-term), and after 4-month follow-up (medium-term) assessments included clinical control (ACQ), quality of life (AQLQ), anxiety and depression symptoms (HADS), and barriers to PADL. Most individuals were women, overweight or obese, with anxiety and depression symptoms, and low quality of life. AT and BI improved clinical control, reaching the minimal clinically important difference (MCID) post-intervention, and maintaining it in follow-up (Δ scores of -1.01 vs. -1.46 and -0.57 vs. -0.94, respectively). Furthermore, both groups achieved the MCID for AQLQ after the interventions and at follow-up (Δ scores of 1.33 vs. 1.40 and 0.97 vs. 0.88, respectively). Both interventions yield similar improvements in clinical control and most outcomes. These results suggest that the choice of intervention should be based on the patient's preferences and the intervention centre's capacity to provide care.

Introduction: Individuals with COPD can be classified according to their levels of physical activity (PA) and physical capacity (PC). The relationship between nutrition and body composition within these classifications remains unclear. Objectives: To compare the body composition and food intake of people with COPD and verify the associations. Methods: Cross-sectional exploratory analysis study in which body composition and food intake were assessed in individuals with COPD. Classification was based on six-minute walk test (PC) and accelerometry (PA): Quadrant can do, dont do (I-preserved PC, low PA); quadrant can do, do do (II-preserved PC, preserved PA). Results: 72 individuals with COPD, 39 in quadrant I and 33 in quadrant II, with mean ages of (69 +- 6) (67 +- 7), respectively. Group I had a higher proportion of males, whereas group II had a higher proportion of females. A positive trend in skeletal muscle mass (p=0.011) (B= 2.883) and a negative trend in basal metabolic rate (p=0.010) (B=-0.092) for group I. Conclusion: Brazilians with COPD classified in quadrants I and II showed similar results in terms of body composition and food intake. A positive trend in skeletal muscle mass was observed for the group I. These findings align with the pathophysiological model of COPD, in which the preservation of muscle mass and adequate protein intake support functional capacity and the maintenance of higher physical activity levels.

Background: Individuals with severe chronic obstructive pulmonary disease (COPD) may exhibit thoracoabdominal asynchrony, which reduces ventilatory efficiency. A novel intervention using elastic tape (ET) applied to the chest wall has been shown to acutely reduce thoracoabdominal asynchrony and dyspnea during exercise among individuals with COPD. We hypothesize that using ET in pulmonary rehabilitation (PR) may increase the benefits of PR in this population. Objective: This study aims to evaluate the additional effects of ET on exercise capacity, symptoms of anxiety and depression, health-related quality of life, and physical activity in daily life among male individuals with moderate to very severe COPD who are undergoing PR. Methods: This is a protocol for a randomized, controlled, 2-arm, parallel, blinded assessor clinical trial. Individuals will be followed for 8 weeks, twice a week, with PR sessions lasting approximately 1 hour. Health status (COPD Assessment Test), health-related quality of life (Chronic Respiratory Questionnaire), and psychological distress (Hospital Anxiety and Depression Scale) will be assessed before and after the intervention. Then, exercise capacity will be assessed via the incremental shuttle walking test and endurance shuttle walking test, and participants will use a triaxial accelerometer (ActiGraph) for 7 days to assess physical activity in daily life. Subsequently, individuals will be randomized into ET or sham groups; both groups will complete a PR program (2 times per week for 8 weeks). The ET group will receive applications of ET, whereas the sham group will receive a nonelastic tape. Data will be presented as means and SDs or medians and IQRs. Intergroup comparisons will be performed using a 2-way ANOVA, followed by the Bonferroni post hoc correction test, or the Kruskal-Wallis test, followed by the Dunn post hoc test. The threshold for statistical significance will be set at 5%. Results: The clinical trial registration was approved in June 2023. Recruitment and data collection for the trial are ongoing; as of November 2025, a total of 10 individuals have been recruited, and the results are expected to be available by the end of November 2026. Conclusions: We hypothesize that the use of ET can enhance the benefits of PR in individuals with moderate to very severe COPD and increase exercise capacity and quality of life, as well as reduce symptoms of anxiety and depression.

Background: Physical activity (PA) is recognized as a nonpharmacological intervention that has benefits for people with asthma; however, motivating this population to engage in PA remains challenging. Aim: To identify barriers and provide strategies in a behavioural intervention (BI) to improve physical activity in daily life (PADL) among people with asthma. Methods: Ninety-six individuals with moderate-to-severe asthma underwent an 8-week BI based on the transtheoretical model. Motivational interviewing, feedback, and encouragement were provided to support the participants in overcoming barriers and reaching their goals. Assessments included PADL (triaxial accelerometer), self-reported barriers to PADL (19-item questionnaire), asthma control (Asthma Clinical Questionnaire, ACQ), quality of life (Asthma Quality of Life Questionnaire, AQLQ), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS). Results: Participants' median age was 53 years, BMI 31.5 kg·cm ⁻² , FEV ₁ 61% of the predicted, and ACQ score 2.0. The most frequently reported barriers were fear of feeling short of breath (38%), a lack of energy (30%), being overweight (27%), physical limitations (27%), financial constraints (21%), laziness (20%), and the absence of professional support (20%). After the BI, most participants reached the minimal clinically important difference in PADL (54% for steps/day), and the prevalence of barriers decreased between 65% and 77%. Conclusion: Our results reveal the barriers that individuals with uncontrolled asthma can overcome when appropriate BI strategies are used to increase PADL. Modifiable barriers following the intervention included fear of feeling short of breath, lack of energy, financial constraints, and inadequate professional support.

Background: Aerobic training (AT) and behavioral intervention (BI) aimed at increasing physical activity provide numerous benefits to patients with asthma. However, the comparison between the two interventions in the clinical control of this disease is poorly understood. Objective: This study aims to compare the effects of AT and BI on disease control in people with moderate to severe asthma. Methods: This is a randomized 2-arm clinical trial with a blinded evaluation. The study will include 56 physically inactive adults with uncontrolled asthma despite optimized medication. Eligible patients will be randomized into either the AT group or the BI group. AT will be performed on a treadmill for 8 weeks (2 sessions per week, 45 minutes each), and the intensity will be determined by the maximum heart rate established in the cardiopulmonary exercise test. BI will be based on social cognitive theory and behavioral change stages that will last 8 weeks (1 session per week, 90 minutes per session). All interventions will last a total of 12 hours. Assessments will be conducted pre- and postintervention and again 16 weeks later and will include physical activity in daily life (PADL; assessed using triaxial accelerometry) level, body composition (measured using octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and number of exacerbations. Time and group interactions will be evaluated using 2-way repeated measures ANOVA. The significance level will be set at P<.05. Results: As of October 2025, 52 participants had been recruited. This study was funded by the São Paulo Research Foundation and the National Council for Scientific and Technological Development. Clinical trial registration was granted in May 2022. Recruitment and data collection for the trial are ongoing, and the results of this study are expected to be available by the end of December 2026. Conclusions: This is the first study to compare the effects of AT versus BI on increasing physical activity for clinical asthma control. Therefore, the results obtained in the proposed protocol may provide essential information for health care professionals when recommending these approaches to people with asthma. Trial Registration: ClinicalTrials.gov NCT05364632; https://clinicaltrials.gov/study/NCT05364632 International Registered Report Identifier (IRRID): DERR1-10.2196/78603

BACKGROUND Aerobic training (AT) and behavioral intervention (BI) aimed at increasing physical activity provide numerous benefits to patients with asthma. However, the comparison between the two interventions in the clinical control of this disease is poorly understood. OBJECTIVE This study aims to compare the effects of AT and BI on disease control in people with moderate to severe asthma. METHODS This is a randomized 2-arm clinical trial with a blinded evaluation. The study will include 56 physically inactive adults with uncontrolled asthma despite optimized medication. Eligible patients will be randomized into either the AT group or the BI group. AT will be performed on a treadmill for 8 weeks (2 sessions per week, 45 minutes each), and the intensity will be determined by the maximum heart rate established in the cardiopulmonary exercise test. BI will be based on social cognitive theory and behavioral change stages that will last 8 weeks (1 session per week, 90 minutes per session). All interventions will last a total of 12 hours. Assessments will be conducted pre- and postintervention and again 16 weeks later and will include physical activity in daily life (PADL; assessed using triaxial accelerometry) level, body composition (measured using octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and number of exacerbations. Time and group interactions will be evaluated using 2-way repeated measures ANOVA. The significance level will be set at P<.05. RESULTS As of October 2025, 52 participants had been recruited. This study was funded by the São Paulo Research Foundation and the National Council for Scientific and Technological Development. Clinical trial registration was granted in May 2022. Recruitment and data collection for the trial are ongoing, and the results of this study are expected to be available by the end of December 2026. CONCLUSIONS This is the first study to compare the effects of AT versus BI on increasing physical activity for clinical asthma control. Therefore, the results obtained in the proposed protocol may provide essential information for health care professionals when recommending these approaches to people with asthma. CLINICALTRIAL ClinicalTrials.gov NCT05364632; https://clinicaltrials.gov/study/NCT05364632 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/78603

BACKGROUND (Actigraph) for seven days to assess daily life physical activity (DLPA). Then, the participants will be randomized into the ET or sham groups, and both groups will complete a PR program (2x/week for 8 weeks). The ET group will receive ET, whereas the sham group will receive a non-elastic tape. Data will be presented as the means and standard. Individuals with severe chronic obstructive pulmonary disease (COPD) may exhibit thoracoabdominal asynchrony (TAA), which reduces ventilatory efficiency. A novel intervention using elastic tape (ET) in the chest wall acutely reduces TAA and dyspnea during exercise among individuals with COPD. We hypothesize that ET associated with a pulmonary rehabilitation (PR) program may increase the benefits of PR in this population. Aim: This study aims to evaluate the additional effects of ET on exercise capacity, symptoms of anxiety and depression, and HRQoL among individuals with moderate to very severe COPD who are undergoing PR. Methods: This is a protocol for a randomized, controlled, two-arm, blinded assessor clinical trial. Individuals will be evaluated during regular medical visits. Health status (CAT), HRQoL (CRQ), and psychological distress (HADS) will be assessed before and after the intervention. Then, exercise capacity will be assessed via incremental and endurance walking tests (ISWT and ESWT), and participants will use triaxial accelerometer deviations or medians and interquartile ranges. Intergroup comparisons will be performed using a two-way analysis of variance (ANOVA) followed by the Bonferroni post hoc correction test or the Kruskal‒Wallis test, followed by Dunn's post hoc test. The threshold for statistical significance will be set at 5%. Results: Data collection is ongoing and will continue until September 2026. OBJECTIVE evaluate the additional effects of ET on exercise capacity, symptoms of anxiety and depression, and HRQoL in individuals with moderate to very severe COPD who are undergoing PR. METHODS STUDY DESIGN AND PARTICIPANTS This is a protocol for a randomized, controlled, two-arm, assessor-blinded clinical trial approved by the Hospital Research Ethics Committee (55617321.2.0000.0068) and registered at clinicalTrials.gov (NCT05939999). Individuals with COPD will be screened and recruited at the Pulmonology outpatient clinic of a tertiary hospital and will be included in the study after signing the informed consent form. INCLUSION AND EXCLUSION CRITERIA The inclusion criteria will be as follows: diagnosed with moderate to very severe COPD according to GOLD 2024; clinically stable (i.e., no exacerbations for at least 30 days); male sex; non-obese (BMI ≤29.9 kg/m2); no musculoskeletal limitations; no participation in another research protocol or a PR program in the past 6 months. The exclusion criteria will be decompensated cognitive, neurological, and/or cardiological dysfunction and receiving home oxygen therapy. RANDOMIZATION AND ALLOCATION CONCEALMENT The randomization will be generated using a computer (www.sealedenvelop.com). An investigator who is not involved in patient recruitment, assessment, or intervention will perform group allocation. Group allocation will be concealed via consecutively numbered, sealed, opaque envelopes. EXPERIMENTAL DESIGN Clinical and anthropometric data will be collected during the patient's interview. Subjects will complete questionnaires to assess health status (COPD Assessment Test, CAT), health-related quality of life (Chronic Respiratory Questionnaire, CRQ), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS). Then, the complete pulmonary function test (body plethysmography), the Incremental Shuttle Walking Test (ISWT), and the Endurance Shuttle Walking Test (ESWT) will be carried out. Finally, individuals will use a triaxial accelerometer (Actigraph GT9X, Pensacola, FL, EUA) for seven days to assess their PADL. Lastly, individuals will be randomly assigned to one of two groups: the elastic tape (ET) group or the sham group. At baseline and postintervention, assessments will be performed by a researcher who is not involved in individual recruitment or intervention. After inclusion, individuals will begin an 8-week PR program twice a week (Figure 1). Individuals in the ET group will have the ET placed before the beginning of the PR program, and the ET will be replaced every seven days throughout the 8-week period. The sham group will receive a non-elastic tape of the same color and size at the same position in the chest wall at the beginning of the PR program, and the tape will be replaced every seven days, similar to the ET group. At the end of the PR program, participants will repeat the same assessments except for the ISWT. The ESWT will be performed at the same level established by the ISWT during the initial evaluation (Figure 2). INTERVENTION Elastic tape (ET) The ET (Kinesio® Brand Tape, Tex Gold, Albuquerque, NM, EUA), made of cotton and elastic, skin-colored, and waterproof, will be positioned with the individual relaxed in the supine position. The individual will lie down on a stretcher so that their torso is extended, thus facilitating the application of the ET (Pinto et al., 2020). The ET positioning will be placed in the origin and insertions of the following muscle groups: rectus abdominis, internal oblique, and intercostal (Figure 3). The ET will be placed at the beginning of the session and replaced every seven days. Sham group The Sham group will receive a non-elastic tape (3M Micropore TM, Saint Paul, MN, USA) placed using an identical procedure to the ET and replaced every seven days. PULMONARY REHABILITATION PROGRAM Both groups will undergo an 8-week PR program, including one-hour sessions twice a week. The program will be divided into 30 minutes of aerobic training on an ergometric treadmill (Technogym Jog 500, Brazil) and 30 minutes of resistance exercises. Aerobic training will be performed with a heart...

Background: Previous studies have shown that increasing physical activity in daily life (PADL) improves asthma clinical control and quality of life. However, the minimal clinically important difference (MCID) to promote those improvements remains unclear. The aim of this study was to estimate the MCID for PADL in people with moderate-to-severe asthma. Methods: Data from consecutive individuals with moderate-to-severe asthma who completed an 8-week (once weekly) face-to-face behavioural intervention to increase PADL were included to compute the MCID. The MCID was estimated based on the number of steps·day⁻¹ and time in moderate-to-vigorous physical activity (MVPA) (min·day⁻¹), which included analyses via anchor-based methods (linear regression and receiver operating characteristic curves) and distribution-based methods (half of the standard deviation and the standard error of the mean). The pooled MCID was estimated by calculating the weighted arithmetic mean of the results from the anchor-based (Asthma Control Questionnaire and Asthma Quality of Life Questionnaire) and distribution-based methods. Results: The MCID estimates for steps·day⁻¹ ranged from 446 to 1995, which were derived from anchor-based and distribution-based methods. With respect to MVPA, MCID estimates ranged from 2 to 13 min·day⁻¹, which were also derived from both methods. The pooled MCIDs were 1413 for steps·day⁻¹ and 8 min·day⁻¹ for MVPA. Conclusion: The MCIDs proposed in this study are 1413 steps for steps·day⁻¹ and 8 min of MVPA per day in people with asthma. These values can be used to interpret the efficacy of intervention programmes to improve health outcomes.