PEEP-ZEEP Compared with Bag Squeezing and Chest Compression in Mechanically Ventilated Cardiac Patients: Randomized Crossover Clinical Trial.

Background and Objectives: Perform the bag squeezing and PEEP-ZEEP techniques associated with manual chest compression in mechanically ventilated cardiac patients in order to observe their effectiveness in the removal of pulmonary secretions and safety from a hemodynamic and ventilatory point of view. Methods: This is a randomized crossover clinical trial developed in a hospital in southern Brazil. We included hemodynamically stable male and female patients aged over 18 years who used invasive mechanical ventilation for at least 48 h. The control group was established for the bag-squeezing technique and the intervention group for the PEEP-ZEEP maneuver, both associated with manual chest compression. Tracheal aspiration was performed 2 h before in order to match the groups in relation to the volume of secretion, and also immediately at the end of the techniques in order to measure the amount of secretion collected. Results: The sample had 36 individuals with a mean age of 70.3 years, 21% of the patients were male, and the majority (10.4%) were hospitalized for ischemic heart disease. DBP (p = 0.024), MAP (p = 0.004) and RR (p = 0.041) showed a significant difference in the post-moment in both groups. There was a significant difference in the reduction of peak pressure values (p = 0.011), in the moment after performing the techniques, and also in the Cdyn (p = 0.004) in the control group versus moment. Conclusions: Both maneuvers are safe in terms of hemodynamics and ventilatory mechanics, in addition to being capable of favoring airway clearance through secretion removal, and they can be used in routine physiotherapeutic care.

Dietary intake of anthocyanins improves arterial stiffness, but not endothelial function, in volunteers with excess weight: A randomized clinical trial.

Excess body weight has been associated with endothelial dysfunction and increased arterial stiffness. Foods rich in polyphenols and anthocyanins such as açaí-juçara (Euterpe edulis Martius) fruit may have protective vascular effects. Thus, we examined the effect of dietary intake of anthocyanins (açaí-juçara fruit) on endothelial function (flow-mediated dilation [FMD]) and arterial stiffness (pulse wave velocity [PWV]) in individuals with excess body weight. Fifty-five individuals with BMI ≥25 kg/m2 were randomized into non-anthocyanin (N-ATH, n = 25) or anthocyanin (ATH, n = 30) intake groups. A 12-week individualized diet plan (20% reduction in total energy intake) was prescribed and included daily intake of açaí-juçara 200 g (anthocyanins 293.6 mg) in the ATH diet plan. We evaluated anthropometric and biochemical parameters, FMD, PWV, and peripheral vascular resistance (PVR). A GEE (Bonferroni post-hoc) was used (p ≤ 0.05). No change in FMD was observed. However, PWV showed a reduction from baseline in the ATH (p = 0.002) and vs. N-ATH (p = 0.036). Both groups showed reduced peripheral vascular resistance (N-ATH, p = 0.005; ATH, p = 0.040) with no significant differences between them. In conclusion, dietary intake of anthocyanins proved effective in protecting against arterial stiffness (by PWV) in individuals with excess weight. PVR was reduced in both diet groups regardless of dietary intake of anthocyanins.

Pulmonary and Functional Rehabilitation Improves Functional Capacity, Pulmonary Function and Respiratory Muscle Strength in Post COVID-19 Patients: Pilot Clinical Trial.

BACKGROUND: Patients affected by COVID-19 may develop an impaired lung function, with reduced lung capacities and volumes, respiratory muscle weakness, changes in radiographic and tomographic findings, limitations in exercising, decreased functional capacity, depression, anxiety and reduced quality of life. Thus, we aimed to analyze the effects of a pulmonary and functional rehabilitation program on the functional capacity, lung function and respiratory muscle strength in patients who were affected by COVID-19 syndrome. METHODS: This is a pilot clinical trial, composed of post-COVID-19 patients with mild, moderate or severe involvement, in which, they underwent a pulmonary and functional rehabilitation program. Patients were evaluated for functional capacity by the 6 min walk test, pulmonary function by spirometry, respiratory muscle strength by manovacuometry, handgrip strength by dynamometry, quality of life by the COPD Assessment Test and functional status by the PCFS. After the initial assessments, the patients performed the rehabilitation protocol in 16 sessions (inspiratory muscle training, aerobic exercise and peripheral muscle strength) and, at the end, they were evaluated again. RESULTS: A total of 29 patients completed the program (12.7 ± 2.7 sessions). The functional capacity increased in meters walked from 326.3 ± 140.6 to 445.4 ± 151.1 (p < 0.001), with an increase in the predicted value from 59.7% to 82.6% (p < 0.001). The lung function increased in liters from 2.9 ± 0.8 to 3.2 ± 0.8 (p = 0.004) for forced vital capacity and from 2.5 ± 0.7 to 2.7 ± 0.7 (p = 0.001) for forced expiratory volume in the first second. The respiratory muscle strength increased in cmH2O from 101.4 ± 46.3 to 115.8 ± 38.3 (p = 0.117) for inspiratory pressure and from 85.8 ± 32.8 to 106.7 ± 36.8 (p < 0.001) for expiratory pressure. CONCLUSIONS: The pulmonary and functional rehabilitation program provided an improvement in the functional capacity, pulmonary function and respiratory muscle strength in post-COVID-19 patients, restoring their quality of life.

Acceptance of Low-Sodium Hospital Diet by Cardiac Patients: A Randomized Controlled Crossover Trial

Abstract Background Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition. Objective To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients. Methods A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet (cooked without salt; salt [2g per meal] added by the patient at the time of consumption) on one day and on the next day patients were given the intervention diet - a low sodium diet cooked with salt (2 grams of salt, divided between preparations). Dietary acceptance was evaluated by weighing leftover food and calculating intake. A questionnaire was used to verify reasons that influenced acceptance. For data analysis, parametric data are presented as mean and standard deviation, Student's t test was used to compare means, with significance defined as p<0.05. Results Sixty-four patients were evaluated, with a mean age of 66 ± 11.3 years; 64% were male. There were no differences in percentage acceptance between the standard low-sodium diet and the low-sodium diet cooked with salt at lunch (p= 0.876) or at dinner (p= 0.255). Around 80% of what was offered at each meal was consumed by the patients, with no significant difference between groups. Conclusions The low-sodium diet cooked with salt was well accepted, but there was no difference when compared with the standard low-sodium diet, which also had adequate acceptance.

Ventilatory Muscle Training for Early Cardiac Rehabilitation Improved Functional Capacity and Modulated Vascular Function of Individuals Undergoing Coronary Artery Bypass Grafting: Pilot Randomized Clinical Trial.

Background: Cardiac rehabilitation with aerobic exercises is the first strategy for nonpharmacological treatment in the postoperative period of individuals undergoing coronary artery bypass grafting (CABG) to improve functional capacity and vascular health. However, other exercise modalities remain uncertain regarding the same benefits. Objectives: Evaluation of the effect of different modalities of exercise, such as early cardiac rehabilitation on subjects submitted to CABG in the six-minute walk test (6-MWT) and on the percentage of flow-mediated dilatation (FMD) of the brachial artery. Methods: A randomized clinical trial in which 15 patients (62.7 ± 6.7 years) who underwent CABG were randomly assigned to the following groups: isometric (IG, Handgrip Jamar®), ventilatory muscle training (VG, PowerBreathe®) and control (CG, conventional respiratory and motor physiotherapy). All patients were attended to physically twice a day (20 min/session) for a consecutive week after the CABG (hospital admission). Functional capacity was assessed by 6-MWT and endothelial function was assessed through the technique of FMD, before and after (~7 days) admission to CABG. The doppler ultrasound videos were analyzed by Cardiovascular Suite® software (Quipu, Pisa, Italy) to measure %FMD. Statistics: Generalized estimation equation, followed by Bonferroni post hoc (p < 0.05). Results: Systolic, diastolic and mean arterial pressure (SBP/DBP/MAP, respectively) were 133, 76 and 95 mmHg. The groups presented walking meters (m) distance before and after intervention of: IGbasal 357.80 ± 47.15 m vs. IGpost 306.20 ± 61.63 m, p = 0.401 (+51 m); VGbasal 261.50 ± 19.91 m vs. VGpost 300.75 ± 26.29 m, p = 0.052 (+39 m); CG basal 487.83 ± 83.23 m vs. CGpost 318.00 ± 31.08, p = 0.006 (−169 m). %FMD before and after intervention was IGbasal 10.4 ± 4.8% vs. IGpost 2.8 ± 2.5%, p = 0.152; VGbasal 9.8 ± 5.1% vs. VGpost 11.0 ± 6.1%, p = 0.825; CGbasal 9.2 ± 15.8% vs. CGpost 2.7 ± 2.6%, p = 0.710 and resting mean basal blood flow was IGbasal 162.0 ± 55.0 mL/min vs. IGpost 129.9 ± 63.7 mL/min, p = 0.662; VGbasal 83.74 ± 12.4 mL/min vs. VGpost 58.7 ± 17.1 mL/min, p = 0.041; CGbasal 375.6 ± 183.7 mL/min vs. CGpost 192.8 ± 115.0 mL/min, p = 0.459. Conclusions: Ventilatory muscle training for early cardiac rehabilitation improved acute functional capacity and modulated mean flow of individuals undergoing CABG.

Physical Activity and Cardiovascular Risk Factors in Children: a Meta-Analysis Update

Abstract Background Obesity and overweight in childhood can increase the risk of developing cardiovascular disease throughout live. Objectives This study provides an update of a meta-analysis of randomized clinical trials (RCT) published in 2014, to assess the effects of physical activity interventions on preventing cardiovascular risk factors in childhood. Methods This update combines data from the previous search with new data obtained from June 2013 to June 2020. Searches were performed on PubMed, EMBASE and Cochrane CENTRAL. The RCTs enrolled used interventions with physical activity longer than six months in school children aged 6-12 years, and evaluated body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels. Data analysis was performed using a random-effects model and a P value <0.05 was considered statistically significant. Results A total of 28,603 articles were retrieved, and 17 RCTs (11,952 subjects) were included. Physical activity interventions were associated with reduction in SBP [−2.11mmHg (95%CI −3.67, −0.54), I243%], DBP [−2.08mmHg (95%CI −3.68, −0,49), I265%] and TG [-0.08mmol/L (95% CI -0.13, -0.03), I20%], and increase in TC [0.17mmol/L (95%CI 0.04, 0.30), I20%]. However, the interventions were not associated with reductions in BMI [−0.03 kg/m2 (95%CI −0.17, 0.10), I20%]. Conclusion This update confirms and reinforces the beneficial effects of physical activity intervention in reducing systolic and diastolic blood pressure and TG levels.

Implementation of a Telecardiology Service in a Health Unit in the City of Porto Alegre, Brazil: A Pilot Study

Abstract Background: The implementation of Telecardiology in primary care in the city of Porto Alegre, Brazil, is a viable and promising strategy. It would decrease the distance between patient and specialized professional services by reducing unnecessary referrals and improving the quality of primary care and satisfaction of patients and health professionals. Objective: To implement a Telecardiology service and assess user satisfaction using the CARDIOSATIS scale. Methods: This was a pilot study developed by a partnership between the Institute of Cardiology and the Telehealth Center of Rio Grande do Sul. The study was carried out at Eri Flores-Vila Vargas health center in the city of Porto Alegre, from May to October 2019, and included 21 patients attending the health center. The descriptive analysis of data was performed using the SPSS program (Statistical Package for the Sciences) version 23. Data normality was checked using the Kolmogorov-Smirnov test. Statistical significance was set at 10%. Results: Mean age of participants was 43.8 ± 16.1 years. The most common risk factors in the sample were physical inactivity (81%) and smoking (43%). Most patients had normal electrocardiogram (ECG) readings. The time elapsed from the performance of the ECG test, transmission of the ECG traces to Telehealth, and return of the final ECG report to the health center was 0-7 days. The CARDIOSATIS scale revealed a high prevalence of "very satisfied" users for the general satisfaction domain, and only 14.3% of patients were dissatisfied with their health. Conclusions: Telecardiology reduced the distance between patient and the specialized professional, with a high level of patient and health professional satisfaction. Our study can serve as a basis for the implementation of a telecardiology network in the city of Porto Alegre in the future.

Ventilator versus manual hyperinflation in adults receiving mechanical ventilation: A systematic review.

INTRODUCTION: Manual hyperinflation (MHI) or with a mechanical ventilator (VHI) are alternatives in bronchial hygiene therapy, in recent years several studies have emerged with the objective of verifying the effectiveness and safety of the techniques. OBJECTIVE: Systematically review and analyze the most recent studies in the literature on MHI and VHI, compare both techniques and demonstrate their effectiveness in bronchial hygiene therapy in mechanically ventilated patients. METHODS: We conducted this systematic review based on the PICO strategy and used the databases Ovid, LILACS, CINAHL, Pubmed and CENTRAL. Search, selection and analysis of randomized controlled trials on MHI, VHI or comparing both techniques. We performed a comparison on secretion elimination, static and dynamic compliance, oxygenation and clinical outcomes. The studies were analyzed by two independent evaluators. RESULTS: Nine articles were selected comparing MHI with usual care, demonstrating improved compliance in the MHI group, but with no impact on secretion removal. Four studies compared VHI with usual care, with three showing increased secretion elimination and compliance in the HVM group. Another four articles compared MHI with VHI but none of the studies showed superiority in terms of elimination of secretion and three studies found improvement in static compliance. CONCLUSION: Both techniques have proven to be effective alternatives to bronchial hygiene therapy.

The Influence of Cognitive Behavioral Intervention for Anger Management on Endothelial Function in Patients With Recent Myocardial Infarction: A Randomized Clinical Trial.

OBJECTIVE: Anger may cause adverse cardiovascular responses, but the effects of anger management on clinical cardiovascular outcomes are insufficiently understood. We sought to assess the influence of anger management through a cognitive behavioral intervention on endothelial function in patients with a recent myocardial infarction (MI). METHODS: Patients with ST-elevation MI and a low anger control score were enrolled during hospitalization in a randomized, parallel, controlled clinical trial. Intervention was anger management with cognitive behavioral techniques implemented by a psychologist in two individual monthly sessions. The primary end point was the between-group difference in the variation of flow-mediated dilation (FMD) in the brachial artery from baseline to the 3-month follow-up. The second end point comprised major cardiovascular events at 24-month follow-up. RESULTS: A total of 43 patients (age = 56 [9] years; 23.3% women) were randomized to the intervention group and 47 patients (age = 58 [10] years; 19.1% women) to the control group. Baseline clinical characteristics were not statistically different between groups. Both groups showed a significant improvement in anger control from baseline to end point; however, the difference in intergroup variation was not statistically significant. The difference in FMD variation from baseline to the 3-month follow-up was significantly higher in the intervention group. The partial η2 was 0.057 (p = .024), indicating a medium effect size. There was no difference between groups regarding major cardiovascular events. CONCLUSIONS: Anger management by cognitive behavioral techniques may improve endothelial function in post-MI patients with low anger control, but it remains unclear via which mechanism these effects occurred. Further studies with larger numbers of patients, assessments of changes in anger, improved comparability of preintervention FMD, and longer follow-up are warranted.Trial Registration:ClinicalTrials.gov identifier: NCT02868216.

Increased Maximal Expiratory Pressure, Abdominal and Thoracic Respiratory Expansibility in Healthy Yoga Practitioners Compared to Healthy Sedentary Individuals

Abstract Background Increasing thoracic expansion is effective at reducing blood pressure in hypertensive subjects. Yoga prescribes many respiratory techniques with a growing number of practitioners. However, very little is known whether sedentary or yoga practitioners show measurable differences in their respiratory patterns. Objective This study aims to demonstrate differences between healthy sedentary individuals and healthy yoga practitioners regarding maximal respiratory pressures and thoracic and abdominal respiratory expansibility. Methods Maximal inspiratory and expiratory pressures (MIP and MEP, respectively) were evaluated by manovacuometry, while respiratory expansion was assessed by the cirtometry of abdominal (CA), thoracic xiphoidal (CTX), and thoracic axillary (CTA) circumferences at rest (end expiratory moment) and at full inspiration in healthy sedentary individuals (SED) and yoga practitioners (YOGA). A delta derived from rest and full inspiration measures (ΔCA, ΔCTX, and ΔCTA, respectively), followed by a percentage of each item (ΔCA/CA, ΔCTX/CTX, and ΔCTA/CTA) was then calculated. Groups were compared by means of an unpaired Student's t-test, with a significance level p < 0.05. Results All respiratory expansion measures were significantly higher in in the YOGA group. A significantly higher MEP (cmH2O) was also detected in yoga practitioners: SED 89.3 ± 19.3 and YOGA 114.7 ± 24.8 ( p = 0.007), along with decreased heart rate at rest (bpm): SED 84±6 and YOGA 74±15 ( p = 0.001). Conclusions Yoga practitioners have shown greater thoracic and abdominal expansion and increased MEP, when compared to healthy sedentary individuals, as well as significantly lower heart rates at rest and body mass index (BMI). However, whether or not these findings are related to respiratory patterns is uncertain.

Efeitos de Diferentes Tipos de Treinamento Físico na Função Endotelial em Pré-Hipertensos e Hipertensos: Uma Revisão Sistemática / Effects of Different Types of Exercise Training on Endothelial Function in Prehypertensive and Hypertensive Individuals: A Systematic Review

Resumo Fundamento: A hipertensão sustentada pode levar ao remodelamento vascular e lesão das células endoteliais, o que pode explicar a disfunção endotelial encontrada em hipertensos. O treinamento físico pode melhorar a saúde vascular em indivíduos com risco cardiovascular, mas pouco se sabe sobre seus efeitos em pré-hipertensos e hipertensos. Objetivo: Revisar a literatura mostrando evidências de alterações da função endotelial em resposta a diferentes modalidades de treinamento físico em pré-hipertensos e hipertensos. Métodos: Realizamos uma revisão sistemática de estudos nas bases de dados MEDLINE, Cochrane, LILACS, EMBASE e SciELO seguindo tanto as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) quanto a estratégia PICO (paciente/população, intervenção, comparação e resultados). Os ensaios clínicos randomizados (ECRs) publicados até abril de 2019 foram selecionados e avaliados por quatro revisores independentes. A qualidade metodológica foi avaliada por meio da escala PEDro (Physiotherapy Evidence Database). Resultados: Nossa busca rendeu 598 resumos, e 10 estudos foram elegíveis para revisão. Todos eles apresentaram qualidade metodológica aceitável pela escala PEDro. Dos 10 estudos, 7 envolveram treinamento aeróbico, 1 treinamento resistido isométrico e 2 treinamento aeróbico e treinamento resistido dinâmico separadamente. Sete estudos usaram dilatação fluxo-mediada (DFM) para avaliar a saúde vascular, e três usaram pletismografia. A maioria dos protocolos de treinamento envolveu indivíduos hipertensos e consistiu em exercícios de baixa e moderada intensidade. Conclusão: Nossa revisão sistemática mostrou que o treinamento aeróbico contínuo moderado é eficaz para melhorar a saúde vascular em indivíduos hipertensos. Em pré-hipertensos, o treinamento aeróbico intervalado vigoroso parece ser uma alternativa para benefícios à saúde vascular. O treinamento físico resistido isométrico ou dinâmico pode ser usado como alternativa secundária, mas ainda requer mais investigação.

Abstract Background: Sustained high blood pressure can lead to vascular remodeling and endothelial cell injury, which may explain the endothelial dysfunction found in hypertensive individuals. Exercise training can improve vascular health in individuals with cardiovascular risk, but little is known about its effects in prehypertensive and hypertensive individuals. Objective: To review the literature showing evidence of changes in endothelial function in response to different modalities of exercise training in prehypertensive and hypertensive individuals. Methods: We conducted a systematic review of studies in the MEDLINE, Cochrane, LILACS, EMBASE, and SciELO databases following both the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the PICO framework (patient/population, intervention, comparison and outcomes). Randomized clinical trials (RCTs) published up to April 2019 were selected and assessed by four independent reviewers. The methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. Results: Our search yielded 598 abstracts, and 10 studies were eligible for review. All of them had acceptable methodological quality by PEDro scale. Of the 10 studies, 7 involved aerobic training, 1 isometric resistance training, and 2 aerobic training and dynamic resistance training separately. Seven studies used flow-mediated dilation (FMD) to assess the vascular health, and three used plethysmography. Most training protocols involved hypertensive individuals and consisted of low and moderate-intensity exercise. Conclusion: Our systematic review showed that moderate continuous aerobic training is effective to improve vascular health in hypertensive individuals. In prehypertensive individuals, vigorous interval aerobic training seems to be an alternative to determine vascular health benefits. Resistance exercise training, either isometric or dynamic, can be used as a secondary alternative, but still requires further investigation.

Effects of Hydroxychloroquine on endOthelial function in eLDerly with sleep apnea (HOLD): study protocol for a randomized clinical trial.

BACKGROUND: Sleep apnea and coronary artery disease are prevalent and relevant diseases. The mechanism by which sleep apnea leads to coronary artery disease remains unclear. Intermittent hypoxia, caused by sleep apnea, leads to inflammation and consequent endothelial dysfunction. Endothelial dysfunction precedes the development of atherosclerotic disease and the occurrence of cardiovascular events. Agents that potentially act to improve endothelial function can help prevent cardiovascular events. Patients using immunomodulators due to rheumatic diseases have a lower prevalence of cardiovascular diseases. However, the potential cardioprotective effect of these drugs in patients without autoimmune diseases is not clear. Hydroxychloroquine (HCQ) is an immunomodulator used to treat rheumatoid arthritis and systemic lupus erythematosus. In addition to its anti-inflammatory properties, HCQ reduces cholesterol and blood glucose levels and has antithrombotic effects. The drug is inexpensive and widely available. Adverse effects of HCQ are rare and occur more frequently with high doses. OBJECTIVE: In this randomized clinical trial, the effect of HCQ treatment on endothelial function will be tested in seniors with sleep apnea. METHODS: We will recruit participants over the age of 65 and with moderate-severe sleep apnea from an ongoing cohort. We chose to use this sample already evaluated for sleep apnea for reasons of convenience, but also because the elderly with sleep apnea are vulnerable to heart disease. Endothelial function will be assessed by examining flow-mediated dilation of the brachial artery, the gold standard method, considered an independent predictor of cardiovascular events in the general population and by peripheral arterial tonometry, the most recent and most easily obtained method. Hydroxychloroquine will be used at a dose of 400 mg/daily for 8 weeks. DISCUSSION: Our study aims to obtain evidence, albeit preliminary, of the efficacy of hydroxychloroquine in improving endothelial function and reducing cardiovascular risk markers. If the improvement occurs, we plan to design a randomized multicenter clinical trial to confirm the findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04161339 . Registered on November 2019.

May Measurement Month 2019: an analysis of blood pressure screening results from Brazil.

The aim of this study is to describe the results of the May Month Measurement (MMM) campaign implemented in Brazil, in 2019. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 13 476 individuals, 58.2% were white, 60.8% were women. The average age was 46.3 (18.6) years. Of all 13 476 participants, 6858 (50.9%) had hypertension defined as a systolic BP ≥140 mmHg or a diastolic BP ≥90 mmHg or being on anti-hypertensive medication. Of those with hypertension, 68.8% were aware of their diagnosis, 65.3% were on antihypertensive medication, and 36.1% had controlled BP (<140/90 mmHg). In addition, of 4479 participants on anti-hypertensive medication, 55.2% had controlled BP. The use of anti-hypertensive medication was associated with higher systolic (P < 0.001) and diastolic BP (P < 0.001) and having diabetes with higher systolic BP (P < 0.001). Previous hypertension in pregnancy was associated with higher systolic (P = 0.038) and diastolic BP (P = 0.003), and smoking was associated with higher systolic BP (P < 0.001). Lastly, obese and overweight individuals showed significantly higher systolic (P < 0.001) and diastolic (P < 0.001) BP. The Brazilian MMM19 data demonstrate that strategies to increase awareness of hypertension and a better control of the risk factors are still needed.

Effects of Different Types of Exercise Training on Endothelial Function in Prehypertensive and Hypertensive Individuals: A Systematic Review. / Efeitos de Diferentes Tipos de Treinamento Físico na Função Endotelial em Pré-Hipertensos e Hipertensos: Uma Revisão Sistemática.

BACKGROUND: Sustained high blood pressure can lead to vascular remodeling and endothelial cell injury, which may explain the endothelial dysfunction found in hypertensive individuals. Exercise training can improve vascular health in individuals with cardiovascular risk, but little is known about its effects in prehypertensive and hypertensive individuals. OBJECTIVE: To review the literature showing evidence of changes in endothelial function in response to different modalities of exercise training in prehypertensive and hypertensive individuals. METHODS: We conducted a systematic review of studies in the MEDLINE, Cochrane, LILACS, EMBASE, and SciELO databases following both the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the PICO framework (patient/population, intervention, comparison and outcomes). Randomized clinical trials (RCTs) published up to April 2019 were selected and assessed by four independent reviewers. The methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. RESULTS: Our search yielded 598 abstracts, and 10 studies were eligible for review. All of them had acceptable methodological quality by PEDro scale. Of the 10 studies, 7 involved aerobic training, 1 isometric resistance training, and 2 aerobic training and dynamic resistance training separately. Seven studies used flow-mediated dilation (FMD) to assess the vascular health, and three used plethysmography. Most training protocols involved hypertensive individuals and consisted of low and moderate-intensity exercise. CONCLUSION: Our systematic review showed that moderate continuous aerobic training is effective to improve vascular health in hypertensive individuals. In prehypertensive individuals, vigorous interval aerobic training seems to be an alternative to determine vascular health benefits. Resistance exercise training, either isometric or dynamic, can be used as a secondary alternative, but still requires further investigation.

FUNDAMENTO: A hipertensão sustentada pode levar ao remodelamento vascular e lesão das células endoteliais, o que pode explicar a disfunção endotelial encontrada em hipertensos. O treinamento físico pode melhorar a saúde vascular em indivíduos com risco cardiovascular, mas pouco se sabe sobre seus efeitos em pré-hipertensos e hipertensos. OBJETIVO: Revisar a literatura mostrando evidências de alterações da função endotelial em resposta a diferentes modalidades de treinamento físico em pré-hipertensos e hipertensos. MÉTODOS: Realizamos uma revisão sistemática de estudos nas bases de dados MEDLINE, Cochrane, LILACS, EMBASE e SciELO seguindo tanto as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) quanto a estratégia PICO (paciente/população, intervenção, comparação e resultados). Os ensaios clínicos randomizados (ECRs) publicados até abril de 2019 foram selecionados e avaliados por quatro revisores independentes. A qualidade metodológica foi avaliada por meio da escala PEDro (Physiotherapy Evidence Database). RESULTADOS: Nossa busca rendeu 598 resumos, e 10 estudos foram elegíveis para revisão. Todos eles apresentaram qualidade metodológica aceitável pela escala PEDro. Dos 10 estudos, 7 envolveram treinamento aeróbico, 1 treinamento resistido isométrico e 2 treinamento aeróbico e treinamento resistido dinâmico separadamente. Sete estudos usaram dilatação fluxo-mediada (DFM) para avaliar a saúde vascular, e três usaram pletismografia. A maioria dos protocolos de treinamento envolveu indivíduos hipertensos e consistiu em exercícios de baixa e moderada intensidade. CONCLUSÃO: Nossa revisão sistemática mostrou que o treinamento aeróbico contínuo moderado é eficaz para melhorar a saúde vascular em indivíduos hipertensos. Em pré-hipertensos, o treinamento aeróbico intervalado vigoroso parece ser uma alternativa para benefícios à saúde vascular. O treinamento físico resistido isométrico ou dinâmico pode ser usado como alternativa secundária, mas ainda requer mais investigação.

Individuals with controlled hypertension show endothelial integrity following a bout of moderate-intensity exercise: randomized clinical trial.

To examine the acute effects of aerobic exercise (AE), resistance exercise (RE) or combined exercise (CE) on flow-mediated dilation (FMD), progenitor cells (PCs), endothelial progenitor cells (EPCs), oxidative stress markers and endothelial-cell derived microvesicles (EMVs) in patients with hypertension. This is a randomized, parallel-group clinical trial involving an intervention of one session of three different modalities of exercise. Thirty-three males (43 ± 2y) were randomly divided into three groups: a session of AE (n = 11, 40 min, cycle ergometer, 60% HRR); a session of RE (n = 11, 40 min, 4 × 12 lower limb repetitions, 60% 1-RM); or a session of CE (n = 11, 20-min RE + 20-min AE). FMD was assessed 10 min before and 10, 40 and 70 min post-intervention. Blood samples were collected at the same time points (except 40 min). FMD were similar in all groups and from baseline (within each group) after a single exercise bout (AE, RE or CE). At 70 min, RE group showed higher levels of PCs compared to the AE (81%) and CE group (60%). PC levels were reduced from baseline in all groups (AE: 32%, p = 0.037; RE: 15%, p = 0.003; CE: 17%, p = 0.048). The levels of EPCs, EMVs and oxidative stress were unchanged. There were no acute effects of moderate-intensity exercise on FMD, EPCs, EMVs and oxidative stress, but PCs decreased regardless of the exercise modality. Individuals with controlled hypertension do not seem to have impaired vascular function in response to a single exercise bout.

Aerobic exercise, but not isometric handgrip exercise, improves endothelial function and arterial stiffness in patients with myocardial infarction undergoing coronary intervention: a randomized pilot study.

BACKGROUND: Aerobic exercise improves endothelial function and arterial stiffness after myocardial infarction (MI), but the effects of isometric exercise on cardiovascular parameters are still uncertain. We aimed to assess the effects of one session of aerobic or isometric exercise on flow-mediated dilation (FMD) and pulse wave velocity (PWV) in post-MI volunteers undergoing percutaneous coronary intervention (PCI). METHODS: Twenty post-MI patients undergoing PCI were randomized to aerobic (AE, n = 10) or isometric (IE, n = 10) exercise groups. We evaluated cardiac structure and function (echocardiographic); carotid plaque presence (ultrasound). FMD and PWV were measured 10 min before and 10 min after the intervention: a single session of moderate-intensity AE (30 min; ratings 12-14 on Borg's scale or 50-60% HRreserve) or handgrip IE (four two-minute bilateral contractions; 30% maximal voluntary contraction; 1-min rest). Generalized estimating equations (Bonferroni post-hoc) was used to assess differences (p ≤ 0.050). RESULTS: FMD improved only in the AE group (Δ = 4.9%; p = 0.034), with no difference between groups after exercise. Even after adjustment (for baseline brachial artery diameter) the effectiveness of AE remained (p = 0.025) with no change in the IE group. PWV was slightly reduced from baseline in the AE group (Δ = 0.61 m/s; p = 0.044), and no difference when compared to the IE group. Peripheral vascular resistance decreased in AE versus IE (p = 0.050) and from baseline (p = 0.014). CONCLUSIONS: Vascular measurements (FMD and PWV) improved after a single session of AE. There are apparently no benefits following a session of IE. TRIAL REGISTRATION: http://www.clinicaltrials.gov and ID number NCT04000893.

Benefícios do exercício físico na hipertensão arterial pulmonar associada à cardiopatia congênita não corrigida / Benefits of Physical exercise in pulmonary arterial hypertension associated with uncorrected congenital heart disease

Introdução: as cardiopatias congênitas são classificadas como um dos principais grupos para desenvolver hipertensão arterial pulmonar. O programa de exercício físico pode auxiliar no aumento da capacidade de vida diária, melhora clínica e funcional, minimizando as consequências deletérias da patologia. Relato do caso: reportamos um caso de um paciente do gênero masculino, 31 anos, com diagnóstico clínico de hipertensão arterial pulmonar grave em decorrência da dupla via de saída do ventrículo direito com comunicação interventricular, sem intervenção cirúrgica. Após ser encaminhado ao programa de Reabilitação Cardiopulmonar e Metabólica em um centro de referência em cardiologia do Rio Grande do Sul, foram realizadas avaliações clínicas e, também, da capacidade funcional pelo teste de caminhada de 6 minutos, da força muscular e resistência periférica, pelo teste Sentar-Levantar, e da força muscular respiratória, pelo exame de manovacuometria. Os valores apresentavam-se abaixo do valor previsto. O programa de exercício proposto foi realizado durante 30 sessões constando de exercícios aeróbicos com duração de 33 minutos, combinados ao treino de fortalecimento dos grandes grupos musculares. Conclusão: após o término do programa observou-se um acréscimo de 83 metros no teste de caminhada de 6 minutos e um aumento da força muscular respiratória, assim como, redução redução nos parâmetros da escala de Borg.

Introduction: congenital heart disease is classified as one of the main groups to develop pulmonary arterial hypertension. The exercise program can help to improve daily living, capacity, clinical and functional improvement, minimizing the deleterious consequences of the disease. Case report: we report a case of a 31-year-old male patient with a clinical diagnosis of severe pulmonary arterial hypertension due to the right ventricular double outflow tract with interventricular communication without surgical intervention. After being referred to the Cardiopulmonary and Metabolic Rehabilitation program at a cardiology reference center in Rio Grande do Sul, clinical evaluation was performed, as well as functional capacity by the 6-minute walk test, muscle strength and peripheral resistance by the sitting-rising test, and respiratory muscle strength by the manovacuometry exam. The values were below the predicted value. The proposed exercise program was performed during 30 sessions consisting of aerobic exercises lasting 33 minutes, added strength training of largemuscle groups. Conclusion: after the program there was an increase of 83 meters in the 6-minute walk test and an increase in respiratory muscle strength, as well as a reduction in Borg scale parameters.