Compartilhar
Informação da revista
Vol. 89. Núm. 6.
Páginas 588-594 (novembro - dezembro 2013)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Vol. 89. Núm. 6.
Páginas 588-594 (novembro - dezembro 2013)
ARTIGO ORIGINAL
Open Access
Evaluation of functional capacity for exercise in children and adolescents with sickle cell disease through the Six Minute Walk Test
Avaliação da capacidade funcional para o exercício de crianças e adolescentes com doença falciforme pelo teste da caminhada de seis minutos
Visitas
4467
Sandro V. Hostyna, Werther B. de Carvalhob, Cíntia Johnstonc,
Autor para correspondência
cintiajohnston@terra.com.br

Corresponding author.
, Josefina A.P. Bragad
a Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
b Universidade de São Paulo, São Paulo, SP, Brasil
c Serviço de Fisioterapia Pediátrica e Neonatal, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
d Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
Conteúdo relacionado
J Pediatr (Rio J). 2013;89:517-910.1016/j.jpedp.2013.08.001
Asuncion Mejias, Octavio Ramilo
Este item recebeu

Under a Creative Commons license
Informação do artigo
Resume
Bibliografia
Baixar PDF
Estatísticas
Abstract
Objective

to evaluate lung functional capacity (FC) for physical exercise in children and adolescents with sickle cell disease (SCD) through the six-minute walk test (6MWT).

Method

a cross-sectional prospective study was performed to evaluate the FC of 46 patients with SCD through the 6MWT. The following parameters were assessed: heart rate (HR), respiratory rate (RR), peripheral pulse oxygen saturation (SpO2), peak expira- tory flow (PEF), blood pressure (systolic and diastolic), dyspnea, and leg fatigue (modi- fied Borg scale) at rest, in the end of the test, and ten minutes after the 6MWT. The total distance walked was also recorded. For statistical analysis, the parametric varia- bles were analyzed using the paired Student's t-test, analysis of variance (ANOVA), and Bonferroni multiple comparisons, with a significance level set at p ≤ 0.05.

Results

the 46 patients were aged age 9.15 ± 3.06 years, presented baseline Hb of 9.49 ± 1.67g/dL, and walked 480.89 ± 68.70 m. SCD diagnosis was as follows: group 1- HbSS (n = 20)/HbSβ0-thalassemia (n = 3) and group 2 - HbSC (n = 20)/HbSβ+-thalassemia (n = 3). Regarding total distance walked, patients in group 1 walked a shorter distance than patients in group 2 (459.39 ± 57.19 vs. 502.39 ± 73.60 m; p = 0.032). There was no statistical difference regarding PEF in the three moments of evaluation. The SpO2 in ambient air and SpO2 with O2 differed between groups 1 and 2 (p < 0.001 vs. p = 0.002), as well as the RR (p = 0.001).

Conclusion

these patients showed a lower FC for exercise than that predicted for the age range in the literature. Patients diagnosed with HbSS/Sβ0-thalassemia had a lower performance in the test than those with HbSC/Sβ+-thalassemia regarding total distance walked, RR, and SpO2 after the 6MWT.

Keywords:
Sickle cell anemia
Acute chest syndrome
Exercise
Nutritional status
Resumo
Objetivo

: avaliar a capacidade funcional pulmonar (CF) para o exercício físico de crianças e adolescentes com doença falciforme (DF) pelo teste da caminhada de seis minutos (TC6’).

Métodos

: estudo transversal prospectivo avaliando a CF pelo TC6’ de 46 pacientes com DF. Foram avaliados: frequência cardíaca (FC), frequência respiratória (FR), saturação de pulso de oxigênio (SpO2), pico de fluxo expiratório (PFE), pressão arterial (PA) sistó- lica e diastólica, dispneia e cansaço em membros inferiores (escala de Borg modificada) em repouso, ao término e 10 minutos após o TC6’ e a distância percorrida. Análise estatística: test t-Student pareado, análise de variância e comparações múltiplas de Bonferroni, significância p ≤ 0,05.

Resultados

: dos 46 pacientes, a média ± dp da idade foi 9,15 ± 3,06 anos, hemoglobina basal 9,4 ± 1,67g/dL e distância percorrida 480,89 ± 68,70 m. Diagnóstico da DF: Grupo 1– HbSS (n = 20)/HbSβ0-talassemia (n = 3); e Grupo 2 – HbSC (n = 20)/HbSβ+-talassemia (n = 3). O Grupo 1 apresentou menor distância percorrida do que o Grupo 2 (459,39 ± 57,19 vs 502,39 ± 73,60m; p = 0,032). Não houve diferença estatística em relação ao PFE. A SpO2 em ar ambiente e a SpO2 com O2 (1 L/min) após o teste foi maior no Grupo 2 (p < 0,001 e p = 0,002, respectivamente). A FR foi maior no Grupo 1 ao final do TC6’ (p < 0,001).

Conclusão

: esta amostra apresentou CF para o exercício abaixo do predito para a faixa etária na literatura. Os pacientes com HbSS/Sβ0-talassemia apresentaram desempenho inferior na distância percorrida, FR e SpO2 após o TC6’, comparativamente aos pacientes com HbSC/Sβ+-talassemia.

Palavras-chave:
Anemia falciforme
Síndrome torácica aguda
Exercício
Estado nutricional
O texto completo está disponível em PDF
Referências
[1]
A.P. Fernandes, J.N. Januário, C.B. Cangussu, D.L. de Macedo, M.B. Viana.
Mortality of children with sickle cell disease: a population study.
J Pediatr (Rio J)., 86 (2010), pp. 279-284
[2]
M.H. Steinberg.
Pathophysiologically based drug treatment of sickle cell disease.
TRENDS in Pharmacological Sciences., 27 (2006), pp. 204-210
[3]
D.C. Rees, T.N. Williams, M.T. Gladwin.
Sickle-cell disease.
Lancet., (2010), pp. 2018-2031
[4]
K.R. Minter, M.T. Gladwin.
Pulmonary complications of sickle cell anemia: an need for increased recognition, treatment, and research.
Am J Respir Crit Care Med., 164 (2001), pp. 2016-2019
[5]
A.K. Siddiqui, S. Ahmed.
Pulmonary manifestations of sickle cell disease.
Postgrad Med J., 79 (2003), pp. 384-390
[6]
S.F.M. Gualandro, G.H.H. Fonseca, D.M. Gualandro.
Complicações cardiopulmonares das doenças falciformes.
Rev Bras Hematol Hemoter., 29 (2007), pp. 291-298
[7]
E.P. Vichinsky, L.D. Neumayr, A.N. Earles, R. Williams, E.T. Lennette, D. Dean, et al.
Causes and outcomes of the acute chest syndrome in sickle cell disease.
N Engl J Med., 342 (2000), pp. 1855-1865
[8]
J.R. Mesa Cuervo, L.O. Chagéz, M.J. Hechavarria, T.A. Placencia, B.R. Losada, L.R. Rodríguez, et al.
Modificaciones funcionales ventilatorias en pacientes con anemia drepanocítica y antecedentes de síndrome torácico agudo.
Rev Cuba Hematol Inmunol Hemoter., (2002), pp. 18
[9]
J.E. MacLean, E. Atenafu, M. Kirby-Allen, I.B. MacLusky, D. Stephens, H. Grasemann, et al.
Longitudinal decline in lung volume in a population of children with sickle cell disease.
Am J Respir Crit Care Med., 178 (2008), pp. 1055-1059
[10]
C.S.V. Fonseca, C.A. Araújo-Melo, R.M. Carvalho, J. Barreto-Neto, J.G. Araújo, R. Cipolotti.
Função pulmonar em portadores de anemia falciforme.
Rev Paul Pediatr., 29 (2011), pp. 85-90
[11]
R.I. Liem, M.A. Nevin, A. Prestridge, L.T. Yong, A.A. Thompson.
Functional capacity in children and young adults with sickle cell disease undergoing evaluation for cardiopulmonary disease.
Am J Hematol., 84 (2009), pp. 645-649
[12]
American Thoracic Society Statement: guidelines for six minute walk test. Am J Respir Crit Care Med. 2002;166:111-7.
[13]
P.L. Enright.
The six minute walk test.
Respir Care., 48 (2003), pp. 783-785
[14]
A. Anthi, R.F. Machado, M.L. Jison, A.M. Taveira-Da Silva, L.J. Rubin, L. Hunter, et al.
Hemodynamic and functional assessment of patients with sickle cell disease and pulmonary hypertension.
Am J Respir Crit Care Med., 175 (2007), pp. 1272-1279
[15]
World Health Organization. WHO AnthroPlus 2011; v.3.2.2. Disponível em: http://www.who.int/childgrowth/software/en.[acessado em 4 Abr 2013].
[16]
S.P. Jürgensen, L.C.O. Antunes, S.E. Tanni, M.C. Banov, P.A. Lucheta, A.F. Bucceroni, et al.
The incremental shuttle walk test in older brazilian adults.
Respiration., 81 (2011), pp. 223-228
[17]
A.B. Chatterjee, R.W. Rissmiller, K. Meade, C. Paladenech, J. Conforti, N.E. Adair, et al.
Reproducibility of the 6-minute walk test for ambulatory oxygen prescription.
Respiration., 79 (2010), pp. 121-177
[18]
B.P. Benzo, F.C. Sciurba.
Oxygen consumption, shuttle walking test and the evaluation of lung resection.
Respiration., 80 (2010), pp. 19-23
[19]
S.J. Singh, M.D. Morgan, S. Scott, D. Walters, A.E. Hardman.
Development of a shuttle walking test of disability in patients with chronic airways obstruction.
Thorax., 47 (1992), pp. 1019-1024
[20]
C.C. Coelho, E.S. Aquino, D.C. Almeida, G.C. Oliveira, R.C. Pinto, I.M. Rezende, et al.
Análise comparativa e reprodutibilidade do teste de caminhada com carga progressiva (modificado) em crianças normais e em portadoras de fibrose cística.
J Bras Pneumol., 33 (2007), pp. 168-174
[21]
A.A. Parente, M.F. March, L.A. Evangelista, A.L. Cunha.
Perception of dyspnea in childhood asthma crisis by the patients and those in charge of them.
J Pediatr (Rio J)., 87 (2011), pp. 541-546
[22]
C.T. Quinn, Z.T. Rogers, G.R. Buchanan.
Survival of children with sickle cell disease.
Blood, 103 (2004), pp. 4023-4117
[23]
E.J. Van Beers, C.F. van Tuijn, M.R. Mac Gillavry, A. van der Giessen, J.J.B. Schnog, B.J. Biemond.
on behalf of the CURAMA study group Sickle cell disease-related organ damage occurs irrespective of pain rate: implications for clinical practice.
Haematologica., 93 (2008), pp. 757-760
[24]
S.R. Pires, A.C. Oliveira, V.F. Parreira, R.R. Brito.
Teste da caminhada de seis minutos em diferentes faixas etárias e índices de massa corporal.
Rev Bras Fisioter., 11 (2007), pp. 147-151
[25]
C.M. Silva, M.B. Viana.
Growth deficits in children with sickle cell disease.
Arch Med Res., 33 (2002), pp. 308-312
[26]
A.W. Al-Saqladi, R. Cipolotti, K. Fijnvandraat, B.J. Brabin.
Growth and nutritional status of children with homozygous sickle cell disease.
Ann Trop Paediatr., 28 (2008), pp. 165-189
[27]
A.M. Li, J. Yin, C.W. Yu, T. Tsang, D. Chan, E.K. Hon, et al.
The six- minute walk test in healthy children – reliability and validity.
Eur Respir J., 25 (2005), pp. 1057-1060
[28]
R. Geiger, A. Strasak, B. Treml, K. Gasser, A. Kleinsasser, V. Fisher, et al.
Six-Minute walk test in children and adolescents.
J Pediatr., 150 (2007), pp. 395-399
[29]
C.V. Priesnitz, G.H. Rodrigues, C.S. Stumpf, G. Viapiana, C.P. Cabral, SteinRT, et al.
Reference values for the 6-min walk test in healthy children aged 6-12 years.
Pediatr Pulmonol., 44 (2009), pp. 1174-1179
[30]
National Institutes of Health – National Heart, Lung and Blood Institute – NIH Publication No 96-2117. The management and therapy of sickle cell disease. 3ª ed. 1995.
[31]
J. Knight, T.M. Murphy, I. Browning.
The lung in sickle disease.
Pediatr Pulmonol., 28 (1999), pp. 205-216
[32]
A. Campbell, C.P. Minniti, M. Nouraie, M. Arteta, S. Rana, O. Onyekwere, et al.
Prospective evaluation of haemoglobin oxygen saturation at rest and after exercise in paediatric sickle cell disease patients.
Br J Haematol., 147 (2009), pp. 352-359
[33]
A.E. Lammers, A.A. Hislop, Y. Flynn, S.G. Haworth.
The 6-minute walk test: normal values for children of 4-11 years of age.
Arch Dis Child., 93 (2008), pp. 464-468
[34]
C.H. Pegelow, L. Colangelo, M. Steinberg, E.C. Wright, J. Smith, G. Phillips, et al.
Natural history of blood pressure in sickle cell disease: risks for stroke and death associated with relative hypertension in sickle cell anemia.
Am J Med., 102 (1997), pp. 171-177
[35]
D.S. Barden, W.A. Covitz, P.F. Milner.
Cardiovascular function during rest and exercise in patients with sickle cell anemia and co- existing a thalassemia-2.
[36]
Y.A. Wali, P.O. Venugopalan, E.A. Rivera, Z.M. Al-Lamki.
Cardiovascular function in Omani children with sickle cell anemia.
Ann Trop Pediatr., 20 (2000), pp. 243-246
[37]
R. Grad, L. McClure, S. Zhang, J. Mangan, L. Gibson, L. Gerald.
Peak flow measurements in children with asthma: what happens at school?.
J Asthma., 46 (2009), pp. 535-540
[38]
L.P. Cahalin, M.A. Mathier, M.J. Semigran, G.W. Dec, T.G. DiSalvo.
The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.
Chest., 110 (1996), pp. 325-332
[39]
C. Rostagno, G. Olivo, M. Comeglio, V. Boddi, M. Banchelli, G. Galanti, et al.
Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation.
Eur J Heart Fail., 5 (2003), pp. 247-252
[40]
F. Sciurba, G.J. Criner, S.M. Lee, Z. Mohsenifar, D. Shade, W. Slivka, et al.
National Emphysema Treatment Trial Research Group Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length.
Am J Respir Crit Care Med., 167 (2003), pp. 1522-1527

Como citar este artigo: Hostyn SV, de Carvalho WB, Johnston C, Braga JA. Evaluation of functional capacity for exercise in children and adolescents with sickle-cell disease through the six-minute walk test. J Pediatr (Rio J). 2013;89:588-94.

Copyright © 2013. Brasileira de Pediatria
Baixar PDF
Idiomas
Jornal de Pediatria
Opções de artigo
Ferramentas
en pt
Taxa de publicaçao Publication fee
Os artigos submetidos a partir de 1º de setembro de 2018, que forem aceitos para publicação no Jornal de Pediatria, estarão sujeitos a uma taxa para que tenham sua publicação garantida. O artigo aceito somente será publicado após a comprovação do pagamento da taxa de publicação. Ao submeterem o manuscrito a este jornal, os autores concordam com esses termos. A submissão dos manuscritos continua gratuita. Para mais informações, contate assessoria@jped.com.br. Articles submitted as of September 1, 2018, which are accepted for publication in the Jornal de Pediatria, will be subject to a fee to have their publication guaranteed. The accepted article will only be published after proof of the publication fee payment. By submitting the manuscript to this journal, the authors agree to these terms. Manuscript submission remains free of charge. For more information, contact assessoria@jped.com.br.
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.