FREDERICO LEON ARRABAL FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- The Mini-Balance Evaluation System Test Can Predict Falls in Clinically Stable Outpatients With COPD A 12-MO PROSPECTIVE COHORT STUDY(2019) PEREIRA, Ana Carolina A. C.; XAVIER, Rafaella F.; LOPES, Aline C.; SILVA, Cibele C. B. M. da; OLIVEIRA, Cristino C.; FERNANDES, Frederico L. A.; STELMACH, Rafael; CARVALHO, Celso R. F.Purpose: This study evaluated the accuracy of the Mini-Balance Evaluation System Test (Mini-BESTest) for predicting falls in patients with chronic obstructive pulmonary disease (COPD) and investigated whether postural balance is a risk factor for falls. Methods: Postural balance was evaluated by the Mini-BESTest at baseline, and the incidence of falls over a 12-mo period was prospectively measured by a self-reported falls diary and confirmed by telephone calls. A discriminative power analysis was performed using receiver operating characteristic (ROC) curve and logistic regression analysis. Results: Sixty-seven outpatients with COPD (mean age SD = 67 +/- 9.3 yr) were included. Twenty-five patients (37.3%) experienced 1 fall, and 28.2% of the falls resulted in injuries. The Mini-BESTest predicted falls in patients with COPD at the 6- and 12-mo follow-ups with a cut-off score of 22.5 (area under the curve = 0.85 and 0.87) with good sensitivity and specificity (85.7% and 66.7%; 84% and 73.8%, respectively). Higher scores on the Mini-BESTest were associated with a lower risk of falls at 12 mo (OR = 0.50; 95% CI, 0.36-0.70; P < .001). Conclusions: Postural balance assessed by the Mini-BESTest is a good predictor of falls in patients with COPD. Our results imply that impaired balance contributes to the risk of falling and that balance training and fall prevention programs may be required for this population.
- Effect of weight-loss on the dynamic hyperinflation in obese asthmatics(2015) SILVA, Aline G.; FREITAS, Patricia D.; FERREIRA, Palmira G.; FERNANDES, Frederico L. A.; SALGE, Joao M.; STELMACH, Rafael; CUKIER, Alberto; MARTINS, Milton A.; CARVALHO, Celso R. F.
- Airway resistance and obesity are independent factors for the occurrence of dynamic hyperinflation in asthmatics(2015) FERREIRA, Palmira G.; FREITAS, Patricia D.; SILVA, Aline G.; FERNANDES, Frederico L. A.; SALGE, Joao M.; STELMACH, Rafael; CUKIER, Alberto; CARVALHO-PINTO, Regina; MARTINS, Milton A.; CARVALHO, Celso R. F.
conferenceObject Dynamic hyperinflation and exercise limitation in obese asthmatics(2014) FERREIRA, Palmira G.; FREITAS, Patricia D.; SILVA, Aline G.; STELMACH, Rafael; CUKIER, Alberto; FERNANDES, Frederico L. A.; MARTINS, Milton A.; CARVALHO, Celso R. F.- The Role of Exercise in a Weight-Loss Program on Clinical Control in Obese Adults with Asthma A Randomized Controlled Trial(2017) FREITAS, Patricia D.; FERREIRA, Palmira G.; SILVA, Aline G.; STELMACH, Rafael; CARVALHO-PINTO, Regina M.; FERNANDES, Frederico L. A.; MANCINI, Marcia C.; SATO, Maria N.; MARTINS, Milton A.; CARVALHO, Celso R. F.Rationale: Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated. Objectives: To examine the effect of exercise training in a weight loss program on asthma control, quality of life, inflammatory biomarkers, and lung function. Methods: Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program plus exercise (WL + E group, n = 28) or a weight-loss program plus sham (WL + S group, n = 27), where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL + E group incorporated aerobic and resistance muscle training, whereas the WL + S group incorporated breathing and stretching exercises. Measurements and Main Results: The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength, and inflammatory/antiinflammatory biomarkers. After 3 months, 51 patients were analyzed. Compared with the WL + S group, the WL + E group demonstrated improved clinical control scores (median [25th to 75th percentile],-0.7 [-1.3 to -0.3] vs. -0.3 [-0.9 to 0.4]; P = 0.01) and greater weight loss (mean +/- SD, -6.8% +/- 3.5 vs. -3.1% +/- 2.6; P < 0.001) and aerobic capacity (median [25th to 75th percentile], 3.0 [2.4 to 4.0] vs. 0.9 [-0.3 to 1.3] ml O-2 X kg(-1) X min(-1); P < 0.001). These improvements in the WL + E group were also accompanied by improvements in lung function, antiinflammatory biomarkers, and vitamin D levels, as well as reductions in airway and systemic inflammation. Conclusions: Adding exercise to a short-term weight-loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients.
- Mechanisms underlying the role of exercise training as part of a weight loss program on asthma control in obese asthmatics(2016) FREITAS, Patricia; FERREIRA, Palmira G.; SILVA, Aline G.; STELMACH, Rafael; CARVALHO-PINTO, Regina; FERNANDES, Frederico L. A.; MARTINS, Milton A.; MANCINI, Marcio C.; SATO, Maria N.; CARVALHO, Celso R. F.
- Dynamic hyperinflation and exercise limitations in obese asthmatic women(2017) FERREIRA, Palmira Gabriele; FREITAS, Patricia Duarte; SILVA, Aline Grandi; PORRAS, Desiderio Cano; STELMACH, Rafael; CUKIER, Alberto; FERNANDES, Frederico Leon Arrabal; MARTINS, Milton Arruda; CARVALHO, Celso R. F.Obese individuals and patients with asthma can develop dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a factor associated with reduced exercise capacity in obese asthmatic women. The aim of the present study was to examine the occurrence of DH and exercise limitations in obese asthmatics. Obese grade II [obese group (Ob-G); BMI 35-39.9 kg/m(2); n = 36] and nonobese [nonobese group (NOb-G); BMI 18.5-29.9 kg/m(2); n = 18] asthmatic patients performed a cardiopulmonary test to quantify peak (V) over dot(O2) and a sub-maximal exercise test to assess DH. Anthropometric measurements, quadriceps endurance, and lung function were also evaluated. A forward stepwise regression was used to evaluate the association between exercise tolerance (wattage) and limiting exercise factors. Fifty-four patients completed the protocol. The Ob-G (n = 36) presented higher peak (V) over dot(O2) values but lower power-to-weight ratio values than the NOb-G (P < 0.05). DH was more common in the Ob-G (72.2%) than in the NOb-G (38.9%, P < 0.05). The Ob-G had a greater reduction in the inspiratory capacity (-18 vs. -4.6%, P < 0.05). Exercise tolerance was associated with quadriceps endurance (r = 0.65; p < 0.001), oxygen pulse (r = 0.52; p = 0.001), and DH (r = -0.46, P = 0.005). The multiple regression analysis showed that the exercise tolerance could be predicted from a linear association only for muscular endurance (r = 0.82 and r(2) = 0.67). This study shows that dynamic hyperinflation is a common condition in obese asthmatics; they have reduced fitness for activities of daily living compared to nonobese asthmatics. However, peripheral limitation was the main factor associated with reduced capacity of exercise in these patients. NEW & NOTEWORTHY This is the first study to investigate the occurrence of dynamic hyperinflation (DH) in obese asthmatics. Our results demonstrate that obese asthmatics present a higher frequency and intensity of DH than nonobese asthmatics. We also show that physical deconditioning in this population is linearly associated with cardiac (O-2 pulse), respiratory (DH), and peripheral muscle (resistance) limitation. However, multiple linear regression demonstrated that peripheral muscle limitation may explain the exercise limitation in this population.
- Identifying COPD patients at risk for worse symptoms, HRQoL, and self-efficacy: A cluster analysis(2019) LOPES, Aline C.; XAVIER, Rafaella F.; PEREIRA, Ana Carolina A. C.; STELMACH, Rafael; FERNANDES, Frederico L. A.; HARRISON, Samantha L.; CARVALHO, Celso R. F.Objectives To identify clusters of chronic obstructive pulmonary disease (COPD) patients with distinct beliefs about their illness in terms of symptoms, health-related quality of life (HRQoL), self-efficacy, and daily life physical activity (DLPA). Methods This cross-sectional study included 150 COPD outpatients. The patients' illness perceptions, clinical control, HRQoL, self-efficacy, and DLPA (accelerometry) were evaluated. A cluster analysis was conducted using data from the Illness Perceptions Questionnaire - Revised to establish groups of patients with distinct illness perceptions. Differences between clusters were tested using a T-test or a Mann-Whitney U test. Results The cluster analysis revealed two groups: distressed (n = 95) and coping (n = 55). Despite the fact that both clusters presented similar pulmonary function, between-cluster differences were observed in their self-efficacy, dyspnea, HRQoL, clinical control (p < 0.001), and educational level (p = 0.002). The levels of DLPA did not differ between the clusters. Discussion We observed that clinically stable COPD patients who displayed higher emotional representations and less coherence had heightened symptoms, poorer HRQoL, worse self-efficacy, and lower educational levels. These results emphasize the need to routinely evaluate illness perceptions in COPD patients to target and tailor the proper treatment to improve these important health outcomes.
- The effects of exercise training in a weight loss lifestyle intervention on asthma control, quality of life and psychosocial symptoms in adult obese asthmatics: protocol of a randomized controlled trial(2015) FREITAS, Patricia D.; FERREIRA, Palmira G.; SILVA, Analuci da; TRECCO, Sonia; STELMACH, Rafael; CUKIER, Alberto; CARVALHO-PINTO, Regina; SALGE, Joao Marcos; FERNANDES, Frederico L. A.; MANCINI, Marcio C.; MARTINS, Milton A.; CARVALHO, Celso R. F.Background: Asthma and obesity are public health problems with increasing prevalence worldwide. Clinical and epidemiologic studies have demonstrated that obese asthmatics have worse clinical control and health related quality of life (HRQL) despite an optimized medical treatment. Bariatric surgery is successful to weight-loss and improves asthma control; however, the benefits of nonsurgical interventions remain unknown. Methods/Design: This is a randomized controlled trial with 2-arms parallel. Fifty-five moderate or severe asthmatics with grade II obesity (BMI >= 35 kg/m(2)) under optimized medication will be randomly assigned into either weight-loss program + sham (WL + S group) or weight-loss program + exercise (WL + E group). The weight loss program will be the same for both groups including nutrition and psychological therapies (every 15 days, total of 6 sessions, 60 min each). Exercise program will include aerobic and resistance muscle training while sham treatment will include a breathing and stretching program (both programs twice a week, 3 months, 60 min each session). The primary outcome variable will be asthma clinical control. Secondary outcomes include HRQL, levels of depression and anxiety, lung function, daily life physical activity, body composition, maximal aerobic capacity, strength muscle and sleep disorders. Potential mechanism (changes in lung mechanical and airway/systemic inflammation) will also be examined to explain the benefits in both groups. Discussion: This study will bring a significant contribution to the literature evaluating the effects of exercise conditioning in a weight loss intervention in obese asthmatics as well as will evaluate possible involved mechanisms.