Corrigendum: Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): a study protocol for a randomized clinical trial.

[This corrects the article DOI: 10.3389/fmed.2022.1087188.].

The association of exercise test variables with long-term mortality in patients with chronic Chagas disease.

Background: The identification of variables obtained in the exercise test (ET) associated with increased risk of death is clinically relevant and would provide additional information for the management of Chagas disease (CD). The objective of the present study was to evaluate the association of ET variables with mortality in patients with chronic CD. Methods: This retrospective longitudinal observational study included 232 patients (median age 46.0 years; 50% women) with CD that were followed at the Evandro Chagas National Institute of Infectious Diseases (Rio de Janeiro, Brazil) and performed an ET between 1989 and 2000. The outcome of interest was all-cause mortality. Results: There were 103 deaths (44.4%) during a median follow-up of 21.5 years (IQR 25-75% 8.0-27.8), resulting in 24.5 per 1,000 patients/year incidence rate. The ET variables associated with mortality after adjustments for potential confounders were increased maximal (HR 1.02; 95% CI 1.00-1.03 per mmHg) and change (HR 1.03; 95% CI 1.01-1.06 per mmHg) of diastolic blood pressure (DBP) during ET, ventricular tachycardia at rest (HR 3.95; 95% CI 1.14-13.74), during exercise (HR 2.73; 95% CI 1.44-5.20), and recovery (HR 2.60; 95% CI 1.14-5.91), and premature ventricular complexes during recovery (HR 2.06; 1.33-3.21). Conclusion: Our findings suggest that ET provides important prognostic value for mortality risk assessment in patients with CD, with hemodynamic (increased DBP during exercise) and electrocardiographic (presence of ventricular arrhythmias) variables independently associated with an increased mortality risk in patients with CD. The identification of individuals at higher mortality risk can facilitate the development of intervention strategies (e.g., close follow-up) that may potentially have an impact on the longevity of patients with CD.

Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial.

Background: Chagas disease (CD) is a neglected endemic disease with worldwide impact due to migration. Approximately 50-70% of individuals in the chronic phase of CD present the indeterminate form, characterized by parasitological and/or serological evidence of Trypanosoma cruzi infection, but without clinical signs and symptoms. Subclinical abnormalities have been reported in indeterminate form of CD, including pro-inflammatory states and alterations in cardiac function, biomarkers and autonomic modulation. Moreover, individuals with CD are usually impacted on their personal and professional life, making social insertion difficult and impacting their mental health and quality of life (QoL). Physical exercise has been acknowledged as an important strategy to prevent and control numerous chronic-degenerative diseases, but unexplored in individuals with the indeterminate form of CD. The PEDI-CHAGAS study (which stands for "Home-Based Exercise Program in the Indeterminate Form of Chagas Disease" in Portuguese) aims to evaluate the effects of a home-based exercise program on physical and mental health outcomes in individuals with indeterminate form of CD. Methods and design: The PEDI-CHAGAS is a two-arm (exercise and control) phase 3 superiority randomized clinical trial including patients with indeterminate form of CD. The exclusion criteria are <18 years old, evidence of non-Chagasic cardiomyopathy, musculoskeletal or cognitive limitations that preclude the realization of exercise protocol, clinical contraindication for regular exercise, and regular physical exercise (≥1 × per week). Participants will be assessed at baseline, and after three and 6 months of follow-up. The primary outcome will be QoL. Secondary outcomes will include blood pressure, physical fitness components, nutritional status, fatigability, autonomic modulation, cardiac morphology and function, low back pain, depression and anxiety, stress, sleep quality, medication use and adherence, and biochemical, inflammatory and cardiac biomarkers. Participants in the intervention group will undergo a home-based exercise program whilst those in the control group will receive only general information regarding the benefits of physical activity. Both groups will receive the same general nutritional counseling consisting of general orientations about healthy diets. Conclusion: The findings from the present study may support public health intervention strategies to improve physical and mental health parameters to be implemented more effectively in this population. Clinical trial registration: [https://ensaiosclinicos.gov.br/rg/RBR-10yxgcr9/], identifier [U1111-1263-0153].

Quality of life and associated factors in patients with chronic Chagas disease.

OBJECTIVES: To evaluate the quality of life (QoL) of patients with Chagas disease (CD) and the association between QoL domains and several clinical, socioeconomic and lifestyle characteristics of this population. METHODS: Cross-sectional observational study conducted from March 2014 to March 2017 including a total of 361 outpatients followed at Evandro Chagas National Institute of Infectious Disease, Brazil. QoL was assessed using the Portuguese shorter version of the original WHO Quality of Life questionnaire (WHOQOL-BREF). Information about clinical CD presentation, presence of comorbidities, functional class, previous benznidazole treatment, socioeconomic profile and lifestyle was also obtained. RESULTS: Environment and physical domains presented the worst QoL scores, while the social relationship domain presented the highest score. Multivariate regression analysis demonstrated that variables independently associated with QoL were functional class, sex, clinical presentation of CD, sleep duration, schooling, physical activity level, smoking, income per capita and residents by domicile. CONCLUSIONS: The low socioeconomic status and the physical limitations imposed by the disease presented an important impact on the QoL reduction among CD patients, especially on environment and physical domains. Strategies to improve QoL among CD patients should be tailored and consider many different variables to maximise improvements not only of patients' physical but also of their mental health.

Robotic cardiac surgery in Brazil.

BACKGROUND: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci® robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. METHODS: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy. RESULTS: The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term. CONCLUSIONS: Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.

Does being an Olympic city help improve recreational resources? Examining the quality of physical activity resources in a low-income neighborhood of Rio de Janeiro.

OBJECTIVES: To assess the quality of public physical activity resources (PARs) in a low socio-economic community in the Olympic city of Rio de Janeiro. METHODS: The Physical Activity Resource Assessment (PARA) instrument was used to assess all 29 public PARs located in this community. A quality indicator (QI) was developed based on PARA results. RESULTS: The average QI of the areas assessed was 1.3 ± 6.40 and the median 1 point, a considerably low score if compared to scores of public PARs across the city (13.6 ± 4.91 and 13 points). CONCLUSIONS: The urban regeneration necessary for hosting mega-sport events is frequently promoted as an opportunity to enhance PARs and therefore to improve health through physical activity (PA) participation. Findings indicate that the high number of elements that can discourage the use of these spaces may help explain the low level of PA during leisure time that has been previously reported of residents of the same neighborhood. Whether using the Olympic Games as catalyst or not, policies designed to encourage PA should focus also on the built environment.

Physical activity overcomes the effects of cumulative work time on hypertension prevalence among Brazilian taxi drivers.

BACKGROUND: The aim of this study was to assess the physical activity profile of taxi drivers and its relationship with hypertension prevalence in this group of workers. METHODS: Cross sectional exploratory study. Between November 2008 and April 2009, 491 taxi drivers from Rio de Janeiro, Brazil, answered a questionnaire focusing on previous hypertension diagnosis, occupational characteristics and physical activity habits. Two logistic models were developed to determine risk factors related to hypertension and to find variables associated with a higher probability of sedentarism. RESULTS: Hypertension prevalence was 22.6%. The workload of the group investigated was high. Results indicate that 'age', 'Body Mass Index', 'physical activity', and 'years as a taxi driver' are related to the probability of hypertension. Physical activity was shown to be a protection factor for hypertension, even considering the deleterious effect of time as a taxi driver. Our results also determined that the practice of physical activity is influenced by age, level of education and workload. CONCLUSIONS: It is recommended that programs to combat sedentary lifestyles as well as measures to reduce workloads be developed as strategies to prevent hypertension.

Adherence to physical activity in an unsupervised setting: Explanatory variables for high attrition rates among fitness center members.

OBJECTIVES: To evaluate the attrition rate of members of a fitness center in the city of Rio de Janeiro and the potential explanatory variables for the phenomenon. DESIGN: An exploratory, observational study using a retrospective longitudinal frame. METHODS: The records of 5240 individuals, members of the fitness center between January-2005 and June-2014, were monitored for 12 months or until cancellation of membership, whichever occurred first. A Cox proportional hazard regression model was adjusted to identify variables associated to higher risk of 'abandonment' of activities. This study was approved by Southern Cross University's Human Research Ethics Committee (approval number: ECN-15-176). RESULTS: The general survival curve shows that 63% of new members will abandon activities before the third month, and less than 4% will remain for more than 12 months of continuous activity. The regression model showed that age, previous level of physical activity, initial body mass index and motivations related to weight loss, hypertrophy, health, and aesthetics are related to risk of abandonment. Combined, those variables represent an important difference in the probability to abandon the gym between individuals with the best and worse combination of variables. Even individuals presenting the best combination of variables still present a high risk of abandonment before completion of 12 months of fitness center membership. CONCLUSIONS: Findings can assist in the identification of high risk individuals and therefore help in the development of strategies to prevent abandonment of physical activity practice.

Physical activity levels of economically disadvantaged women living in the Olympic city of Rio de Janeiro.

The objective of this study was to analyze the physical activity patterns of women living in a low-income community located in close proximity to the 2016 Rio de Janeiro Olympic Park. Data (N = 140) were collected in June and July 2012 using the International Physical Activity Questionnaire. Findings indicated that the majority (54.8%) of participants reported high levels of physical activity. The domains that contributed the most to this pattern were occupational and household physical activity. Significantly, 88.1% of participants reported low physical activity levels during their leisure-time. In the transport-related domain, participants were relatively more active, but more than half of them (57%) spent less than 600 MET-minutes/week in this domain. The results highlighted the discrepancies between different physical activity domains. In addition, the findings also suggested that low-income women in our study engaged little in physical activity during their leisure time. Therefore, the proposed commitments found in the Rio de Janeiro Candidature File to host the 2016 Olympic Games to increase sport/physical activity participation within low-income communities in Rio de Janeiro need to be implemented effectively if this physical activity behavior during self-directed time is to be changed.