RAFAEL STELMACH
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
171 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 171
- Musculoskeletal Dysfunction and Pain in Adults with Asthma(2011) LUNARDI, Adriana Claudia; MARQUES, Cibele Cristine Berto; MENDES, Felipe Augusto Rodrigues; MARQUES, Amelia Pasqual; STELMACH, Rafael; CARVALHO, Celso Ricardo FernandesBackground. The mechanical alterations related to the overload of respiratory muscles observed in adults with persistent asthma might lead to the development of chronic alterations in posture, musculoskeletal dysfunction and pain; however, these changes remain poorly understood. Objective. This study aimed to assess postural alignment, muscle shortening and chronic pain in adults with persistent asthma. Methods. This cross-sectional and controlled study enrolled 30 patients with mild (n = 17) and severe ( n = 13) persistent asthma. Fifteen non-asthmatic volunteers were also assessed. Asthma was classified by the Global Initiative for Asthma (GINA) guidelines. Postural alignment and muscle shortening were evaluated by head and shoulder positions, chest wall mobility, and posterior ( trunk and lower limb) muscle flexibility. In addition, the measures used were previously tested for their reproducibility. Pain complaints were also assessed. Results. In comparison with non-asthmatic subjects, patients with mild or severe persistent asthma held their head and shoulders more forward and had lower chest wall expansion, decreased shoulder internal rotation, and decreased thoracic spine flexibility. Chronic lower thoracic, cervical, and shoulder pain was significantly increased in patients with mild or severe asthma compared with non-asthmatic subjects (p < 0.05). Conclusion. Adults with persistent asthma have musculoskeletal dysfunction and chronic pain that is independent of the severity of their disease but that might be related to their age at the onset of disease symptoms.
- Exercise training is a determinant of weight-loss and improvement on asthma control, airway inflammation and psychosocial morbidity in obese asthmatics: A RCT(2015) FREITAS, Patricia D.; FERREIRA, Palmira G.; SILVA, Aline G.; CUKIER, Alberto; STELMACH, Rafael; CARVALHO-PINTO, Regina; SALGE, Joao M.; MANCINI, Marcio C.; MARTINS, Milton A.; CARVALHO, Celso R. F.
- High-intensity interval training (HIIT) versus constant-load exercise (CLE) on the short-acute beta agonist (SABA) consumption and peak-expiratory flow (PEF) in subjects with moderate to severe asthma(2023) SILVA, Ronaldo Aparecido Da; FERNANDES, Thiago; STELMACH, Rafael; CUKIER, Alberto; CARVALHO-PINTO, Regina Maria; CARVALHO, Celso R. F.
- Incremental Shuttle Walking Test: A Reproducible and Valid Test to Evaluate Exercise Tolerance in Adults With Noncystic Fibrosis Bronchiectasis(2014) CANNARGO, Anderson Alves de; AMARAL, Tatiane S.; RACHED, Samia Z.; ATHANAZIO, Rodrigo A.; LANZA, Fernanda C.; SAMPAIO, Luciana M.; CARVALHO, Celso R. de; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone DalObjective: To analyze the reliability, validity, and determinants of the incremental shuttle walk test (ISWT) in adults with noncystic fibrosis bronchiectasis. Design: Cross-sectional study. Setting: Outpatient clinic. Participants: Subjects (N=75; 26 men) underwent, on different days, cardiopulmonary exercise testing (CPET) and 2 ISWTs, 30 minutes apart. The number of steps in daily life was recorded. Concurrent validity was tested by the relation between distance walked with peak load and oxygen consumption (V) over doto(2). Interventions: None. Main Outcome Measures: Distance walked (m) was compared between the first and second ISWTs; greatest distance walked was correlated with peak load and Vo(2)peak obtained from CPET, steps per day, and dyspnea evaluated by the Medical Research Council (MRC) scale; and desaturation was compared between CPET and the ISWT. Results: Distance walked was equivalent between the first ISWT (441 +/- 152m) and the second ISWT (445 +/- 153m) with an excellent intraclass correlation coefficient (.995; 95% confidence interval, .99-.997). There were significant correlations between distance walked and peak load (r=.82), (V) over doto(2) (r=.72), steps per day (r=.61), and the MRC scale (r=-.69). Age, body mass index, sex, forced vital capacity (% predicted), dyspnea, and steps per day explained 70% of the variation in distance walked (m) and 60% of the variance when expressed as percent predicted. Higher desaturation was observed during the ISWT (-4%+/- 4%) than cycling (-2 +/- 3%) (P<.001). Conclusions: The ISWT is reliable, represents functional capacity, and induces greater desaturation than cycling. Age, body composition, pulmonary function, dyspnea, and physical activity in daily life are determinants of the distance walked on the ISWT. (C) 2014 by the American Congress of Rehabilitation Medicine
- Pulmonary arterial enlargement is a predictor of higher risk of exacerbations in non-cystic fibrosis bronchiectasis patients(2021) FREITAS, Leonardo Vinicius De; NUNES, Blenda; MIRANDA, Renato; MAIA, Ana Luisa; RACHED, Samia; CUKIER, Alberto; STELMACH, Rafael; PINTO, Regina Carvalho; ATHANAZIO, Rodrigo
- Postural balance assessment in fallers individuals with COPD before and after physical effort(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De
conferenceObject Clinical, Radiological And Functional Features In Mounier Kuhn Syndrome(2013) MAIORANO, M. C. N. T.; RACHED, S. Z.; ATHANAZIO, R. A.; CARVALHO-PINTO, R. M.; STELMACH, R.; CUKIER, A.- Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis(2018) CAMARGO, Anderson Alves de; BOLDORINI, Jacqueline C.; HOLLAND, Anne E.; CASTRO, Rejane A. Silva de; LANZA, Fernanda de Cordoba; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CARVALHO-PINTO, Regina; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone DalBackground. Bronchiectasis is characterized by a progressive structural lung damage, recurrent infections and chronic inflammation which compromise the exertion tolerance, and may have an impact on skeletal muscle function and physical function. Objective. The purpose of this study was to compare peripheral muscle strength, exercise capacity, and physical activity in daily life between participants with bronchiectasis and controls and to investigate the determinants of the peripheral muscle strength and physical activity in daily life in bronchiectasis. Design. This study used a cross-sectional design. Methods. The participants' quadriceps femoris and biceps brachii muscle strength was measured. They performed the incremental shuttle walk test (ISWT) and cardiopulmonary exercise testing, and the number of steps/day was measured by a pedometer. Results. Participants had reduced quadriceps femoris muscle strength (mean difference to control group = 7 kg, 95% CI = 3.8-10.1 kg), biceps brachii muscle strength (2.1 kg, 95% CI = 0.7-3.4 kg), ISWT (227 m, 95% CI = 174-281 m), peak VO2 (6.4 ml/Kg/min, 95% CI = 4.0-8.7 ml/Kg/min), and number of steps/day (3,332 steps/day, 95% CI = 1,758-4,890 steps/day). A lower quadriceps femoris strength is independently associated to an older age, female sex, lower body mass index (BMI), higher score on the modified Medical Research Council scale, and shorter distance on the ISWT (R-2 = 0.449). Biceps brachii strength is independently associated with sex, BMI, and dyspnea (R-2 = 0.447). The determinants of number of daily steps were dyspnea and distance walked in ISWT, explaining only 27.7% of its variance. Limitations. Number of steps per day was evaluated by a pedometer. Conclusion. People with bronchiectasis have reduced peripheral muscle strength, and reduced aerobic and functional capacities, and they also are less active in daily life. Modifiable variables such as BMI, dyspnea, and distance walked on the ISWT are associated with peripheral muscle strength and physical activity in daily life.
- Pulmonary hyperinflation and postural balance in COPD patients(2016) PEREIRA, Ana Carolina Alves Caporali; XAVIER, Rafaella Fagundes; OLIVEIRA, Cristino Carneiro; LOPES, Aline Costa; SILVA, Cibele Cristine Berto Marques da; CLARK, Ross; STELMACH, Rafael; DENEHY, Linda; CARVALHO, Celso Ricardo Fernandes de
- Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers(2018) CRUZ, Alvaro A.; CAMARGOS, Paulo A.; URRUTIA-PEREIRA, Marilyn; STELMACH, Rafael