Evaluation of functional exercise capacity using the AVD-Glittre test incorporating pulmonary ventilation measures in obese individuals

Abstract

Introduction: Obesity is known as a global public health problem and its diagnosis can be made in the context of metabolic syndrome. For a long time now, adipose tissue has no longer been seen as a simple energy reserve, but rather as an endocrinologically active organ and effector of inflammatory activity, especially that deposited centrally. In this sense, it is important to understand how the central distribution of fat affects the interaction between thoracoabdominal structures that limit the mobility of the diaphragmatic and intercostal muscles, as well as how the adipokines produced modify the structure of the airways. In this context, respiratory changes can be found independently of primary lung pathologies. Furthermore, it is essential to understand the ventilatory changes that occur during exertion and that can lead to limitations during various activities, culminating in impaired quality of life (QoL). Objective: The objective of the study was to evaluate dynamic hyperinflation (HD) during the AVD-Glittre test (TGlittre) in people with obesity by measuring dynamic ventilation and also correlating it with lung mechanics and QoL. Methods: This is a cross-sectional observational study carried out at the Pulmonary Function Laboratory of the Pulmonology Service of the Piquet Carneiro University Polyclinic of the State University of Rio de Janeiro. 64 people with obesity (42 women and 22 men) aged between 34 and 55 years (median of 43 years) were evaluated. Participants responded to the international physical activity questionnaire International Physical Activity Questionnaire (IPAQ, short version) and the Brazilian version of the QoL questionnaire Short Form-36 (SF-36). Additionally, spirometry and system impulse oscillometry (IOS) were performed. Finally, participants underwent assessment during exercise in the TGlittre, which incorporated pulmonary ventilation measurements using Spiropalm®. Results: The median body mass index (BMI) was 38 (34–45) kg/m², while the median waist circumference (WC), hip circumference (HC) and waist/hip ratio (WHR) were 116 ± 16 cm, 124 ± 15 cm and 0.93 ± 0.10 cm, respectively. At TGlittre, 22 participants underwent HD at the end of the test. TGlittre time (% predicted) significantly correlated with weight (p = 0.004), BMI (p = 0.031), WC (p = 0.003) and WHR (p = 0.046). In the SF-36, participants who presented HD showed worse quality of life in the “emotional role limitations” and “mental health” domains. Conclusion: As conclusions, this study shows that people with obesity have a worse performance during TGlittre. Furthermore, there is an interrelationship between this worse performance and higher anthropometric indices, worse lung mechanics and worse QoL.