Fisioter Bras. 2023;24:(5):580-88

doi: 10.33233/fb.v24i5.5450

ORIGINAL ARTICLE

Resistive exercise training as an effective method to maintain lung function and functional capacity

Exercício físico resistido como método eficaz para manutenção da função pulmonar e capacidade funcional

Rita de Cássia Chitolina da Silva¹, Fabiana do S. da Silva Dias de Andrade¹, Renato da Costa Teixeira², Fabianne de Jesus Dias de Sousa³, Pollyanna Dórea Gonzaga de Menezes⁴, Robson da Silva Almeida⁵, Lilian Rose Mascarenhas², Cristiane Moro dos Santos¹

¹Faculdades Integradas de Taquara (FACCAT), RS, Brasil

²Universidade do Estado do Pará, Belém, PA, Brasil

³Universidade Federal do Pará, Belém, PA, Brasil

⁴Faculdade Anhanguera, PA, Brasil

⁵Faculdade Madre Thaís, Ilhéus, BA, Brasil

Received: April 22, 2023; Accepted: September 27, 2023.

Correspondence: Fabiana do S. da Silva Dias de Andrade, fabi4000@gmail.com

How to cite

Silva RCC, Andrade FSSD,Teixeira RC, Sousa FJD, Menezes PDG, Almeida RS, Mascarenhas LR, Santos CM. Resistive exercise training as an effective method to maintain lung function and functional capacity. Fisioter Bras. 2023;24(5):580580-88. doi: 10.33233/fb.v24i5.5450

Abstract

Objective: To evaluate pulmonary function and functional capacity in bodybuilding practitioners, comparing them with values predicted for the Brazilian population. Methods: This is a cross-sectional, observational study, carried out among bodybuilding practitioners (N = 45) of both genders, aged between 20 and 60 years, with at least 4 weeks of training. Measurements of lung function (peak expiratory flow) and respiratory strength (maximum respiratory pressures) and functional capacity (6 minutes step test) were performed and compared to normal values predicted for the adult population. The significance level adopted was p < 0.05. Results: There was a statistically significant difference for all outcome variables studied, except for peak expiratory flow values (p = 0.8471). Conclusion: Weight training proved to be an effective method for maintaining maximal respiratory pressures and functional capacity.

Keywords: peak expiratory flow; functional capacity; physiotherapy.

Resumo

Objetivo: Avaliar a função pulmonar e a capacidade funcional em praticantes de musculação, comparando-as com valores previstos para a população brasileira. Métodos: Trata-se de um estudo observacional, transversal, realizado entre praticantes de musculação (N = 45) de ambos os gêneros, com idade entre 20 e 60 anos, com pelo menos quatro semanas de treinamento. Foram realizadas medições da função pulmonar (pico de fluxo expiratório) e da força respiratória (pressões respiratórias máximas) e da capacidade funcional (teste do degrau de 6 minutos) e comparadas aos valores normais previstos para a população adulta. O nível de significância adotado foi p < 0,05. Resultados: Houve uma diferença estatisticamente significativa para todas as variáveis de resultado estudadas, exceto para os valores de pico de fluxo expiratório (p = 0,8471). Conclusão: O treinamento com pesos demonstrou ser um método eficaz para manter as pressões respiratórias máximas e a capacidade funcional.

Palavras-chave: pico de fluxo expiratório; capacidade funcional; fisioterapia.

Introduction

The benefits of a routine physical activity have been the target of several randomized clinical studies, which have demonstrated both improvement of the health status and an important ally to prevent serious diseases [1]. For other authors, there is a chance of reducing by up to 30% the occurrence of early death when performing three minutes of moderate to vigorous exercise or twelve minutes of light physical activity for every hour of daily sitting time [2].

Physical and mental health depends directly on cardiorespiratory resistance, which is known through measures of lung function and functional capacity, and should be encouraged even in gym environments, since tests in laboratories or specialized clinics often are not accessible to all professionals and/or the population [3].

It is notorious that weight training is more common today than it was some time ago; however, its effects on pulmonary mechanics and functional capacity are still unknown in the scientific community [4].

In this sense, the objective of this study is to evaluate measures of pulmonary strength, namely maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), pulmonary function, through peak expiratory flow (PEF) and functional capacity, the latter measured through the 6 minutes step test (6MWT), comparing the values obtained with those predicted by the scientific literature, in a population of bodybuilding practitioners, with a minimum time of four weeks of activity.

Methods

This is a cross-sectional observational study, conducted among bodybuilding practitioners (N = 45) of both genders and ages ranging from 20 to 60 years. The study took place from September to October 2022 in two cities in Serra Gaúcha (Parobé and Rolante) and was approved by the Research Ethics Committee FACCAT under opinion number 5.657.184.

The sample was chosen by convenience, provided it met the following inclusion criteria: volunteers enrolled in the sport, with a minimum of four weeks of physical activity, without any physical deficit that would prevent the tests from being performed, and who filled out the socio-epidemiological questionnaire. Volunteers with flu-like conditions, respiratory infections, asthma in the last month, recent thoraco-abdominal surgery (up to three months), and those who did not reach the minimum of three reproducible measurements in the pulmonary test, as well as lower limb orthosis users for whom the functional capacity test had to be adapted, did not participate in the study.

The measures of PEF were measured by means of the Peak Flow Meter instrument, from inspirations at vital capacity level followed by an inspiratory pause and forced expiration, following the recommendations of Conceição [5]. For the measurement of maximal inspiratory pressure (MIP), the volunteer was guided to perform forced expiration, put the device in the mouth and then perform a slow and deep inspiration (at the level of vital capacity), with an inspiratory pause of 2 to 3 seconds to record the measurement reached. For the maximum expiratory pressure (MEP) measurement, in turn, the volunteer was instructed to perform 2 to 3 ventilations at tidal volume followed by a slow and deep inspiration, and finally a maximum and sustained expiration. The procedures and values obtained were compared to those considered normal for the Brazilian population according to the study by Pereira [6].

The evaluation of functional capacity occurred through the 6-minute step test (6MWT): the volunteer was instructed to go up and down a step with width of 25 cm at his own pace and the highest possible speed for 6 minutes, as recommended by Ritt [7]. The value obtained was then checked against the predicted value from the following formula: TD6 = 348.4 + 48.48 x Gender (men=1, women=0) -1.29 x Age (years) -0.98 x Height (cm) [8].

The results obtained were stored in a table in the Excel and then analyzed using the SPSS program. Data normality was tested using the Kolmogorov-Smirmov test. For the comparative analyses of lung function and functional capacity between the physical activity practices, we chose the Student's t test for independent samples. For the correlation analysis between gender, age, and time of activity with the variables studied, Pearson's correlation test was used.

Results

Forty-five volunteers of both genders participated in the research; however, it was observed that there was a predominance of females, the medium level of education was the most prevalent (50%), and other socio-demographic aspects can be seen in Table I.

Table I - Sample profile

When the means between predicted and obtained values were compared for the outcome variables in this study, it was observed that only the PEF measurement did not show a statistically significant difference, as illustrated in Table II.

Table II - Comparison of mean obtained and predicted values for lung function and functional capacity measures

*expiratory flow (PEF); maximal inspiratory pressure (MIP); maximum expiratory pressure (MEP); 6-minute step test (6MWT); p < 0,05

In the study of the correlation of sociodemographic variables with those of the outcome for this research, we found moderate correlation between gender and MIP; strong correlation between gender and PEF, and perfect correlation both between age and time of activities in sports for the same measure of PEF (Table III).

Table III - Correlation of age, sex, and frequency of physical activity with lung and functional capacity variables

* moderate correlation; + strong correlation; **perfect correlation

Discussion

It is known that pollution in large urban centers, the presence of a sedentary lifestyle, the growing number of obese individuals, and professional stress are factors closely related to the increased occurrence of cardiovascular diseases and the consequent increase in morbidity and mortality worldwide. In this sense, numerous studies have been conducted in order to direct public policies. In Canada, for example, a study indicated that only 15% of Canadians perform 150 minutes of moderate to high intensity physical activity per week, which is the minimum acceptable time in that country [9]. A Brazilian survey, in turn, conducted in 2014, revealed that 33.5% of the population exercises during leisure time, but not daily [10].

It is known that the population present in gyms is young, healthy, and the overwhelming majority is unaware of the real benefits of a routine of physical activity on lung function [11]. The people who frequent these spaces do not imagine that moderate to high intensity resistance training not only promotes body weight control, but also exercises influence on the cardiovascular demands [12]. According to Tiler et al. [13], upper and lower limb exercises performed in healthy individuals usually generate neurological stimuli capable of influencing ventilatory mechanics, and thus promote greater chest expansion, lower respiratory rate during exercise and greater oxygen uptake.

Our findings also pointed to a statistically significant difference between the predicted measurement and that obtained for the measurements of maximum respiratory pressures (Table II), reinforcing the idea that physical training performed in a gym environment can maintain or even increasing pulmonary function tests. Similar results have already been reported in scientific literature, such as in the study by Han et al. [15], who observed a statistically significant increase in MEP of elderly women treated with strength training for upper and lower limbs, during a relatively short time of 6 weeks of treatment. Salcedo et al. [16] performed a meta-analysis study from systematic reviews that quantified the effect of physical training on pulmonary function indices in adults with COPD and found significant improvement in spirometric values when compared to the control group.

On the contrary, our study also pointed out that there was no statistically significant difference in the comparison between the predicted and obtained values for PEF measurement. The authors believe that this measurement can be more influenced in a younger age group than the one studied in this sample, as observed in the study by Xavier et al. [17], who applied aerobic exercises combined with resistance exercises among 40 adolescents, over 12 weeks, and observed that the strategy was able to increase both MIP and PEF.

In our study, we found a huge influence of age and frequency of training on PEF and MEP measurements (Table III). This fact had already been mentioned in the work of Earnest et al. [18], who demonstrated that resistance training combined with aerobic training could be an effective strategy both to improve cardiorespiratory fitness and to prevent the consequences of metabolic syndromes, such as type II diabetes, since the preservation of muscle function becomes increasingly important with age. The same is valid for cases of severe diseases, as reported by Dieli-Conwright et al. [19], when treating post-mastectomized women by means of resistance and aerobic exercises, performed three times a week, over 16 weeks and they observed improvement in the quality of life, reduction of depressive factors, and increase in the pulmonary function.

The scientific literature has pointed out that a routine of physical activity can both prevent serious diseases, such as heart attack, and treat them. This is the case of Chronic Obstructive Pulmonary Disease (COPD), which usually presents reduction of symptoms and improvement of pulmonary function when programs composed of resistance exercises of upper and lower limbs are instituted [20]. Another study also emphasized that physical activity, regardless of the modality chosen, when exercised at least four times a week, was effective in improving the complaint of fatigue, raising the quality of life indices, increasing lung function, muscle mass and strength in patients with lung cancer [21].

The authors point out as limitations of this study the sample size considered small, given the number of students enrolled in the invited spaces, and finally, the absence of a control group for further extrapolation of their findings.

Conclusion

Weight training proved to be an effective method for maintaining maximal respiratory pressures and functional capacity. Regarding the only outcome variable that did not show statistical significance (PEF), there was an important influence of gender, age, and the time in which the physical activity is exercised.

Because it was a small sample and in the absence of a control group, the authors point out that the data may not be extrapolated to the general population, and they recommend that other studies be conducted in this regard.

Conflito de interesses

Não há conflito de interesses entre os autores e nem destes com o artigo em questão.

Financiamento

Próprio

Contribuição dos autores

Concepção: Andrade FSSD, Silva RCC; Coleta de dados: Sousa FJD, Menezes PDG; Análise estatística: Andrade FSSD, Teixeira RC; Redação do manuscrito: Andrade FSSD, Silva RCC, Santos CM; Revisão crítica do manuscrito: Mascarenhas LR, Almeida RS

References

1. Stensvold D, Viken H, Steinshamn SL, Dalen H, Stoylen A, Loennechen JP, et al. Effect of exercise training for five years on all-cause mortality in older adults-the Generation 100 study: randomised controlled trial. BMJ. [Internet]. 2020;371:m3485. doi: 10.1093/eurheartj/ehab721 [Crossref]
2. Chastin S, McGregor D, Palarea-Albaladejo J, Diaz KM, Hagströmer M, Hallal PC, et al. Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behavior and sleep and all-cause mortality: a pooled analysis of six prospective cohorts using compositional analysis. Br J Sports [Internet]. 2021; 55(22):1277-85. doi: 10.1136/bjsports-2020-102345 [Crossref]
3. Karloh M, Palu M, Mayer FA. Métodos de avaliação da capacidade funcional em pacientes com DPOC. ConScientiae Saúde. [Internet]. 2014; 13(4):638-649. doi: 10.5585/ConsSaude.v13n4.4830 [Crossref]
4. Hackett DA, Sabag A. Lung function and respiratory muscle strength and their relationship with weightlifting strength and body composition in non-athletic males. Respir Physiol Neurobiol. [Internet].2021; 286:103616. doi: 10.1016/j.resp.2021.103616 [Crossref]
5. Conceição KG, Rodrigues MM, Nunes KCF, Braga LM. Avaliação da capacidade funcional, força muscular e pico de fluxo expiratório em pacientes com apneia obstrutiva do sono. Fisioter Bras. [Internet].2020;21 (6):565-70. /doi: 10.33233/fb.v21i6.4133 [Crossref]
6. Pereira CAC, Satoand T, Rodrigues SC. Novos valores de referência para espirometria forçada em brasileiros adultos de raça branca. J Bras Pneumol. [Internet]. 2007; 33(4): 397–406. doi: 10.1590/S1806-37132007000400008 [Crossref]
7. Ritt LEF, Darzé ES, Feitosa GF, Porto JS, Bastos S, Albuquerque RBL, et al. O teste do degrau de 6 minutos como preditor de capacidade funcional de acordo com o consumo de oxigênio de pico em pacientes cardíacos. Arq Bras Cardiol. [Internet].2020; 116(5):889–95. doi: 10.36660/abc.20190624 [Crossref]
8. Arcuri JF. Validade, reprodutibilidade e valores de referência do teste de degrau de seis minutos [Dissertação]. São Carlos: Universidade Federal de São Carlos; 2012. Disponível em: https://repositorio.ufscar.br/bitstream/handle/ufscar/5291/4181.pdf?sequence=1&isAllowed=y
9. Cole CA, Carlsten C, Koehle M, Brauer M. Particulate matter exposure and health impacts of urban cyclists: a randomized crossover study. Environ Health. [Internet].2018. 14; 17(1):78. doi: 10.1186/s12940-018-0424-8 [Crossref]
10. Aguiar JB, Nascimento INM, Melo MA, Freire, AKU, Saraiva LC, Santos ALB, et al. Espaços públicos de lazer de uma capital brasileira: avaliação da qualidade e uso para prática de atividade física. Licere. [Internet] 2019; 22(4): 31-339. Disponível em: https://periodicos.ufmg.br/index.php/licere/article/view/16271
11. Jahan I, Begum M, Akhter S, Islã MZ, Jahan N, Samad N, et al. Effects of alternate nostril breathing exercise on cardiorespiratory functions in healthy young adults. Ann Afr Med. [Internet].2021; 20(2):69-77. doi: 10.4103/aam.aam_114_20 [Crossref]
12. Järvinen L, Petersdotter SL, Chaillou T. High-intensity resistance exercise is not as effective as traditional high-intensity interval exercise for increasing the cardiorespiratory response and energy expenditure in recreationally active subjects. Eur J Appl Physiol. [Internet].2022;122(2):459-44. doi: 10.1007/s00421-021-04849-4 [Crossref]
13. Tiller NB, Campbell IG, Romer LM. Mechanical-ventilatory responses to peak and ventilation-matched upper- versus lower-body exercise in normal subjects. Exp Physiol. [Internet].2019;104(6):920-31. doi: 10.1113/EP087648 [Crossref]
14. West JS, Guelfi KJ, Dimmock JA, Jackson B. Testing the feasibility and preliminary efficacy of an 8-week exercise and compensatory eating intervention. [Internet].2018;10(7):923. doi: 10.3390/nu10070923 [Crossref]
15. Han JW, Kim JY, Kim K. Effect of resistance exercises applying maximum expiration on the respiratory muscle strength of elderly women. J Back Musculoskelet Rehabil. [Internet].2021;34(2):307-12. doi: 10.3233/BMR-181166 [Crossref]
16. Salcedo PA, Lindheimer JB, Klein-Adams JC, Sotolongo AM, Falvo MJ. Effects of exercise training on pulmonary function in adults with chronic lung disease: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. [Internet].2018;99(12):2561-9. doi: 10.1016/j.apmr.2018.03.014 [Crossref]
17. More VBXS, Avanzi O,Carvalho BDMC, Alves VLS. Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomized trial. J Physiother. [Internet].2019;66(1):33-8. doi: 10.1016/j.jphys.2019.11.012 [Crossref]
18. Earnest CP, Johannsen NM, Swift DL, Gillison FB, Mikus CR, Lucia A, et al. Aerobic and strength training in concomitant metabolic syndrome and type 2 diabetes. Med Sci Sports Exerc. [Internet].2014;46(7):1293-301. doi: 10.1249/MSS.0000000000000242 [Crossref]
19. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. [Internet]. 2018;20(1):124. doi: 10.1186/s13058-018-1051-6 [Crossref]
20. Beaumont M, Péran L, Berriet AC, Le Ber C, Le Mevel P, Courtois-Communier E. Effect of different form of upper limb muscles training on dyspnea in chronic obstructive pulmonary disease: a study protocol. Medicine (Baltimore). [Internet].2020;99(38):e22131. doi: 10.1097/MD.0000000000022131 [Crossref]
21. Avancini A, Sartori G, Gkountakos A, Casali M, Trestini I, Tregnago D, et al. Physical activity and exercise in lung cancer care: will promises be fulfilled? Oncologist. [Internet]. 2020;25(3):e555-e569. doi: 10.1634/theoncologist.2019-0463 [Crossref]