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BACKGROUND: Cardiorespiratory fitness (CRF) is an important prognostic marker in chronic obstructive pulmonary disease (COPD). Obstructive sleep apnea (OSA) also negatively affects exercise tolerance. However, the impact of their association on CRF has not been evaluated. We hypothesized that patients with overlap syndrome would demonstrate a greater impairment in CRF, particularly those with severe COPD. METHODS: Individuals with COPD were recruited. First, subjects underwent clinical and spirometry evaluation. Next, home-based sleep evaluation was performed. Subjects with an apnea-hypopnea index (AHI) < 15 episodes/h were allocated to the COPD group and those with an AHI ≥ 15 episodes/h to the overlap group. On the second visit, subjects underwent a cardiopulmonary exercise test. Subsequently, they were divided into four groups according to the severity of COPD and coexistence of OSA: COPDI/II; overlap I/II; COPDIII/IV; and overlap III/IV. RESULTS: Of the 268 subjects screened, 31 were included. The overlap group exhibited higher values for peak carbon dioxide (COPD: 830 [678-1157]; overlap: 1127 [938-1305] mm Hg; p < 0.05), minute ventilation (COPD: 31 [27-45]; overlap: 48 [37-55] L; p < 0.05), and peak systolic blood pressure (COPD: 180 [169-191]; overlap: 220 [203-227] mm Hg; p <; 0.001) and peak diastolic blood pressure COPD: 100 [93-103]; overlap: 110 [96-106] mm Hg; p < 0.001). COPD severity associated with OSA produced a negative impact on exercise time (COPDIII/IV: 487 ± 102; overlap III/IV: 421 ± 94 s), peak oxygen uptake (COPDIII/IV: 12 ± 2; overlap III/IV: 9 ± 1 ml.Kg.min-1 ; p < 0.05) and circulatory power (COPDIII/IV: 2306 ± 439; overlap III/IV: 2162 ± 340 ml/kg/min.mmHg; p < 0.05). CONCLUSION: Overlap syndrome causes greater hemodynamic and ventilatory demand at the peak of dynamic exercise. In addition, OSA overlap in individuals with more severe COPD impairs CRF.
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Aptidão Cardiorrespiratória , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Testes de Função Respiratória , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
AIM: to evaluate the acute effects of expiratory positive airway pressure on cardiac autonomic modulation in chronic obstructive pulmonary disease patients during spontaneous breathing and slow deep breathing. METHODS: 17 patients were evaluated. The R-R intervals were collected (Polar® S810i) during spontaneous breathing (10 minutes) and slow deep breathing (4 minutes), with and without 5 cmH2O expiratory positive airway pressure. Stable signals were analyzed by Kubios®. Heart rate variability indices were computed in time domain and in frequency domain. RESULTS: Expiratory positive airway pressure application affected low frequency (spontaneous breathing: 62.5±4.1 vs slow deep breathing: 28.2±4.2, p<0.001) and high frequency (spontaneous breathing: 37.4±17.3 vs slow deep breathing: 58.9±18.1, p<0.001). Interactions were observed between expiratory positive airway pressure effect and slow deep breathing effect for low frequency (p<0.001), high frequency (p<0.001) and low frequency/high frequency ratio (p<0.001). When patients were stratified by disease's severity, we identified a significant low frequency reduction (p<0.001) and high frequency increase (p<0.001) for all stages when slow deep breathing was associated with expiratory positive airway pressure. CONCLUSION: A 5 cmH2O expiratory positive airway pressure during spontaneous and slow deep breathing can elicit an acute response, resulting in a cardiac autonomic control improvement in moderate-to-very severe patients.
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Sistema Nervoso Autônomo , Doença Pulmonar Obstrutiva Crônica , Coração , Frequência Cardíaca , HumanosRESUMO
Aim was to identify critical load (CL) in young and elderly apparently healthy male cohorts. To contrast the metabolic, cardiovascular and perceptual responses on CL according to age. We evaluated 12 young (23 ± 3 years) and 10 elderly (70 ± 2 years) apparently healthy active males, who underwent: (1) 1 repetition maximum (1RM) test on a 45° Leg Press; (2) on different days, three high-intensity resistance exercise constant load tests (60%, 75% and 90% 1RM) until fatigue (Tlim). Absolute values of both the CL asymptote and curvature constant (kg) were significantly lower in elderly subjects (P < 0.05). In contrast, elderly subjects demonstrated a significantly higher number of repetitions at CL when compared with young subjects (P < 0.05). As expected, oxygen uptake (VO2) and heart rate (HR) during maximal aerobic exercise testing were significantly reduced in older subjects. However, percent-predicted aerobic capacity were higher in older subjects (P < 0.05). In addition, blood lactate ([La-]) corrected to Tlim and rating of perceived exertion values were greater in younger subjects at all intensities (P < 0.05). These findings, despite reduced force production in older subjects, endurance-related parameters are well preserved according to age-adjusted percent-predicted values in apparently healthy males.
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Envelhecimento , Exercício Físico/fisiologia , Treinamento Resistido , Adulto , Idoso , Teste de Esforço , Frequência Cardíaca , Humanos , Ácido Láctico/sangue , Masculino , Fadiga Muscular , Consumo de Oxigênio , Esforço Físico , Adulto JovemRESUMO
OBJECTIVE: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. DESIGN: A randomized controlled study. SUBJECTS: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. INTERVENTION: Patients were randomized into two groups: control group subject to the usual care ( n = 35); neuromuscular electrical stimulation group ( n = 35) received daily training sessions to both lower extremities for around two weeks. MAIN MEASURES: The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. RESULTS: After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P < 0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively). CONCLUSION: A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.
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Cardiotônicos/administração & dosagem , Terapia por Estimulação Elétrica , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Adulto , Idoso , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Teste de CaminhadaRESUMO
OBJECTIVE: To compare pulmonary function, functional capacity, and clinical outcomes among conventional mechanical ventilation (CMV), early open-lung (EOL), and late open-lung (LOL) strategies after off-pump coronary artery bypass surgery (OPCAB). DESIGN: Prospective, randomized, and double-blinded study. SETTING: Two hospitals of the Federal University of Sao Paulo, Brazil. PARTICIPANTS: Ninety-three patients undergoing elective first-time OPCAB. INTERVENTIONS: Patients were randomized into 3 groups: CMV (n=31); LOL (n=32) initiated upon intensive care unit (ICU) arrival; EOL (n = 30) initiated after intubation. MEASURAMENTS AND MAIN RESULTS: Spirometry was performed at bedside preoperatively and on postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated presurgically and on POD 1; 6-minute walk test (6MWT) was performed presurgically and on POD 5. Both open-lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 compared to the CMV group (p<0.05). Similar results were found in relation to the 6MWT distance. Shunt fraction was lower and PaO2 was higher in both open-lung groups (p<0.05). Open-lung groups had shorter intubation time and hospital stay as well as fewer respiratory events (p<0.05). No statistical difference was found relative to the aforementioned results when the EOL and LOL groups were compared. CONCLUSIONS: Both open-lung strategies were able to promote higher pulmonary function preservation and greater recovery of functional capacity with better clinical outcomes after OPCAB. No difference in outcome was found when comparing initiation of OLS intraoperatively or after ICU arrival.
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Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Respiração Artificial , Adulto , Idoso , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Respiração com Pressão Positiva , Estudos Prospectivos , Capacidade VitalRESUMO
The objective of the present study is to evaluate the acute effects of low-level laser therapy (LLLT) on functional capacity, perceived exertion, and blood lactate in hospitalized patients with heart failure (HF). Patients diagnosed with systolic HF (left ventricular ejection fraction <45 %) were randomized and allocated prospectively into two groups: placebo LLLT group (n = 10)-subjects who were submitted to placebo laser and active LLLT group (n = 10)-subjects who were submitted to active laser. The 6-min walk test (6MWT) was performed, and blood lactate was determined at rest (before LLLT application and 6MWT), immediately after the exercise test (time 0) and recovery (3, 6, and 30 min). A multi-diode LLLT cluster probe (DMC, São Carlos, Brazil) was used. Both groups increased 6MWT distance after active or placebo LLLT application compared to baseline values (p = 0.03 and p = 0.01, respectively); however, no difference was observed during intergroup comparison. The active LLLT group showed a significant reduction in the perceived exertion Borg (PEB) scale compared to the placebo LLLT group (p = 0.006). In addition, the group that received active LLLT showed no statistically significant difference for the blood lactate level through the times analyzed. The placebo LLLT group demonstrated a significant increase in blood lactate between the rest and recovery phase (p < 0.05). Acute effects of LLLT irradiation on skeletal musculature were not able to improve the functional capacity of hospitalized patients with HF, although it may favorably modulate blood lactate metabolism and reduce perceived muscle fatigue.
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Lactatos/sangue , Terapia com Luz de Baixa Intensidade/métodos , Fadiga Muscular/efeitos da radiação , Músculo Esquelético/efeitos da radiação , Adulto , Idoso , Método Duplo-Cego , Teste de Esforço , Feminino , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
Heart failure (HF) is an important public health issue in South America. Economic impacts are substantial. Chagas heart disease is a prevalent HF etiology; it is caused by the protozoan Trypanosoma cruzi. Cardiac rehabilitation (CR) is an integral component of HF care. The benefits of CR in HF patients need to be assessed. The effectiveness and safety of CR delivery, such as home-based interventions, should be explored. Strategies to improve adherence in CR are imperative. We describe past and current CR trends for HF patients and discuss the future of this important intervention.
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Terapia por Exercício/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/reabilitação , Humanos , Morbidade/tendências , América do Sul/epidemiologiaRESUMO
OBJECTIVE: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. METHODS: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. RESULTS: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. CONCLUSION: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.
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Doença da Artéria Coronariana , Feminino , Humanos , Assistência ao Convalescente , Índice de Massa Corporal , Brasil/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Seguimentos , Obesidade/complicações , Sobrepeso/complicações , Alta do Paciente , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , MasculinoRESUMO
While the majority of individuals with coronavirus disease 2019 (COVID-19) recover completely, a significant percentage experience persistent symptom, which has been characterized as Long COVID and may be associated with cardiac and autonomic dysfunction. We evaluated heart rate variability (HRV) at rest and during deep-breathing (M-RSA) in patients with Long COVID. Case-control design involved 21 patients with Long COVID and 20 controls; the HRV was evaluated (POLAR system) at rest in the supine position and during M-RSA and expressed in time domain and non-linear analysis. In the supine position we found a reduction HRV measures in Long COVID' patients compared to controls for: Mean_iRR (p < 0.001), STD_iRR (p < 0.001); STD_HR (p < 0.001); SD1 (p < 0.001); SD2 (p < 0.001); alpha2 (p < 0.001). In the M-RSA we found reduction Mean_iRR (p < 0.001), STD_iRR (p < 0.001), STD_HR (p < 0.001), rMSSD (p < 0.001), RR_tri-index (p < 0.001) in Long COVID' patients except for highest Mean_HR p < 0.001. In conclusion, Long COVID reduced HRV at rest and during deep breathing. These findings may imply impairment of cardiac autonomic control when symptoms of COVID-19 persist following initial recovery.
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COVID-19 , Síndrome de COVID-19 Pós-Aguda , Humanos , Frequência Cardíaca/fisiologia , Sistema Nervoso Autônomo , CoraçãoRESUMO
Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients.
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BACKGROUND: Endothelial function assessment may provide important insights into the cardiovascular function and long-term effects of exercise training. Many studies have investigated the possible negative effects on cardiovascular function due to extreme athletic performance, leading to undesirable effects. The purposes of this study were to investigate the acute effects of maximal intensity exercise on endothelium-dependent vasodilation, and to understand the patterns of flow-mediated dilation (FMD) change following maximal exercise in elite female athletes with a high-volume training history. METHODS: Twenty-six elite female soccer players (mean age, 22±4 years; BMI, 21±2 kg/m2; VO
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Endotélio Vascular/fisiologia , Exercício Físico/fisiologia , Condicionamento Físico Humano/fisiologia , Futebol/fisiologia , Vasodilatação/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiologia , Teste de Esforço , Feminino , Humanos , Fluxo Sanguíneo Regional/fisiologia , Adulto JovemRESUMO
OBJECTIVE: This study investigated the concurrent validity, inter and intra-reliability of manual evaluation in Asthma patients. METHODS: Twenty six asthma patients were assessed. Maximal respiratory muscle strength (Mrms) was tested by inspiratory and expiratory pressure (MIP and MEP, respectively) trough manovacuometer. In addition, Mrms of diaphragm (anterior and posterior), Intercostals (lower and upper portion) and Rectus abdominal were obtained manually, according to Medical Research Council (MRC) scale. Two independents evaluators, previously trained, made both measurements. RESULTS: Reproducibility of Mrms intra-evaluators: anterior diaphragm (ICCs, 0.79 and 0.67); Posterior portion of the diaphragm (ICCs, 0.43 and 0.51); Upper intercostals (ICCs, 0.47 and 0.40); Lower intercostals (ICCs, 0.81 and 0.51) and rectus abdominal (ICCs, 1.0). Inter-reproducibility of anterior diaphragm was low to moderate, while intercostals (upper and lower portion) was relatively low. However, rectus abdominal presented high reproducibility reflecting in almost perfect agreement. In addition, we found positive correlations between MIP versus Lower Intercostals (r = .60, p = .007) and MEP versus rectus abdominal (r = .41, p = .04). CONCLUSION: In asthmatic patients, manual evaluation of the respiratory muscles is reliable. In addition, maximal respiratory pressures using manometer assessment were related to manual evaluation, in special to diaphragm and rectus abdominal muscles.
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Asma/fisiopatologia , Diafragma/fisiopatologia , Músculos Respiratórios/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Reprodutibilidade dos Testes , Mecânica Respiratória , Músculos Respiratórios/fisiologiaRESUMO
Respiratory limitation can be a primary mechanism for exercise cessation in female athletes. This study aimed to assess the effects of inspiratory loading (IL) on intercostal muscles (IM), vastus lateralis (VL) and cerebral (Cox) muscles oxygenation in women soccer players during high-intensity dynamic exercise. Ten female soccer players were randomized to perform in order two constant-load tests on a treadmill until the exhaustion time (Tlim) (100 % of maximal oxygen uptake- VËO2). They breathed freely or against a fixed inspiratory loading (IL) of 41 cm H2O (â¼30 % of maximal inspiratory pressure). Oxygenated (Δ[OxyHb]), deoxygenated (Δ[DeoxyHb]), total hemoglobin (Δ[tHb]) and tissue saturation index (ΔTSI) were obtained by NIRs. Also, blood lactate [La-] was obtained. IL significantly reduced Tlim (224 ± 54 vs 78 ± 20; P < 0.05) and increased [La-], VËO2, respiratory cycles and dyspnea when corrected to Tlim (P < 0.05). IL also resulted in decrease of Δ[OxyHb] of Cox and IM during exercise compared with rest condition. In addition, decrease of Δ[OxyHb] was observed on IM during exercise when contrasted with Sham (P < 0.05). Furthermore, significant higher Δ[DeoxyHb] of IM and significant lower Δ[DeoxyHb] of Cox were observed when IL was applied during exercise in contrast with Sham (P < 0.05). These results were accompanied with significant reduction of Δ[tHb] and ΔTSI of IM and VL when IL was applied (P < 0.05). High-intensity exercise with IL decreased respiratory and peripheral muscle oxygenation with negative impact on exercise performance. However, the increase in ventilatory work did not impact cerebral oxygenation in soccer players.
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Desempenho Atlético/fisiologia , Encéfalo/metabolismo , Exercício Físico/fisiologia , Inalação/fisiologia , Músculos Intercostais/fisiologia , Consumo de Oxigênio/fisiologia , Oxigênio/metabolismo , Músculo Quadríceps/fisiologia , Músculos Respiratórios/fisiologia , Adulto , Atletas , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Músculos Intercostais/metabolismo , Músculo Quadríceps/metabolismo , Músculos Respiratórios/metabolismo , Futebol , Espectroscopia de Luz Próxima ao Infravermelho , Adulto JovemRESUMO
BACKGROUND: The evaluation of thoracoabdominal mobility is a tool extensively used in the physiotherapy practice in different populations. Photogrammetry may be a simple tool to analyse thoracoabdominal mobility; however, it is unclear whether this assessment can be a reliable method. AIM: To test the reliability intra-examinator by photogrammetry in asthmatic patients and in health controls. METHODS: Twenty-six asthmatic patients (29 ± 9 years) and 14 healthy matched controls (27 ± 8 years) were assessed by thoracoabdominal mobility. Photographs during rest, during inspiration and expiration maximum were used to calculate latero-lateral and antero-posterior diameters of the thorax (at axillary and xiphoid levels) and umbilical by markers positioned in osseous structures. An evaluator obtained the same measurements in an 8-day interval. RESULTS: We found a moderate reliability for axillary, xiphoid and umbilical mobility (average intraclass correlation coefficient [ICC] respectively [0.68, 0.55 and 0.73]) for asthmatic group. In addition, for control group, we found a moderate reliability for axillary mobility (average ICC respectively [0.68] and a good reliability for xiphoid and umbilical mobility) (average ICC 0.81 and 0.70). Bland-Altman plots showed goods limit of agreement in photos 1 and 2 in both groups. CONCLUSION: The photogrammetric analysis of thoracoabdominal mobility presented itself as a reliable method and may be used in clinical practice in asthmatic patients and in controls.
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Asma/fisiopatologia , Medidas de Volume Pulmonar/métodos , Fotogrametria/normas , Modalidades de Fisioterapia/normas , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Testes de Função Respiratória , Parede Torácica/fisiologia , Adulto JovemRESUMO
OBJECTIVE: To establish a cut-off point for clinical and functional variables to determinate sarcopenia and dynapenia in COPD patients, and to analyze the impact of skeletal muscle dysfunction (SMD) on these variables. METHODS: Cross-sectional study, screened COPD patients for sarcopenia or dynapenia through low muscle mass and hand grip strength (HGS). Clinical variables: pulmonary function, respiratory muscle strength and functional capacity (FC). The precision of the variables in determining points of predictive cut-off for sarcopenia or dynapenia were performed using the Receiver Operating Characteristic curve and two-way analysis of variance. RESULTS: 20 COPD patients stratified for sarcopenia (n = 11) and dynapenia (n = 07). Sarcopenia group presented lower lean mass and lower maximal inspiratory pressure (MIP), decreased HGS, reduced FC (p<0.050). Dynapenia group presented reduced MIP, lower HGS and walked a shorter distance at Incremental shuttle walk test (ISWT) (p<0.050). We found cut-off points of forced expiratory volume in one second (FEV1), MIP and maximal expiratory pressure (MEP) and ISWT. It is possible to identify sarcopenia or dynapenia in these patients. We found the coexistence of the conditions (SMD effect) in COPD - reduction in the distance in the ISWT (p = 0.002) and %ISWT (p = 0.017). CONCLUSION: In moderate to very severe COPD patients the sarcopenia could be predicted by FEV1 (%predicted) < 52, MIP < 73 cmH2O, MEP < 126 cmH2O and distance traveled of < 295 m in ISWT. Whereas dynapenia could be predicted by FEV1 < 40%, MIP < 71 cmH2O, MEP < 110 cmH2O and distance of < 230 m traveled in ISWT.
OBJETIVO: Estabelecer ponto de corte entre as variáveis clínicas e funcionais para avaliar a prevalência de sarcopenia e dinapenia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC), além de analisar o impacto da Disfunção Muscular Esquelética (DME) nestas variáveis. MÉTODOS: Realizado estudo transversal com pacientes diagnosticados com DPOC para determinar sarcopenia ou dinapenia por meio do índice de baixa massa muscular e Força de Preensão Palmar (FPP). Avaliadas a função pulmonar, força muscular respiratória e capacidade funcional (CF). A precisão das variáveis na determinação dos pontos de corte previstos para as doenças em questão foi obtida a partir da curva Receiver Operating Characteristic (ROC) e de uma análise bidirecional da variância. RESULTADOS: Ao final da análise, obtiveram-se 20 pacientes com DPOC estratificados por sarcopenia (n = 11) e dinapenia (n = 07). O grupo com sarcopenia apresentou menor massa magra e menor pressão inspiratória máxima (PImáx), diminuição da Força de Preensão Palmar (FPP) e redução da CF (p<0,050). O grupo com dinapenia apresentou redução da PImáx, menor FPP e menor distância percorrida no teste Incremental Shuttle Walk (ISWT) (p<0,050). Foram encontrados pontos de corte no Volume Expiratório Forçado (VEF1) durante o primeiro segundo na PImáx, na Pressão Expiratória Máxima (PEmáx) e no ISWT, o que possibilitou identificar sarcopenia ou dinapenia nestes pacientes. A partir destes resultados, foi possível encontrar coexistência das condições (efeito DME) na DPOC: redução da distância no ISWT (p = 0,002) e % ISWT (p = 0,017). CONCLUSÕES: Em pacientes com DPOC moderada a muito grave, a sarcopenia pode ser prevista pelo VEF1 (% previsto) <52, PImáx <73 cm H2O, PEmáx <126 cm H2O e distância percorrida de <295 metros no ISWT. Já a dinapenia pode ser prevista pelo VEF1 <40%, PImáx <71 cm H2O, PEmáx <110 cm H2O e distância de <230 metros percorrida no ISWT.
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Pulmão/fisiopatologia , Debilidade Muscular/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Sarcopenia/fisiopatologia , Idoso , Análise de Variância , Estudos Transversais , Feminino , Volume Expiratório Forçado/fisiologia , Força da Mão/fisiologia , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Força Muscular/fisiologia , Curva ROC , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Capacidade Vital/fisiologia , Teste de CaminhadaRESUMO
ABSTRACT Objective: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. Methods: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. Results: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ2=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. Conclusion: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.
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BACKGROUND: The use of information and communication technologies improves the versatility of learning environments by broadening the scope of educational practices, allowing students to communicate with other institutions and providing access to information in real time. However, these tools, in addition to environmental characteristics, can increase the internal thermal load, which is directly influenced by the external environment, with a consequent impact on body physiology. OBJECTIVE: The present study investigated the relationship between air temperature and blood pressure and heart rate among students performing cognitive tasks at computer laboratories in four public universities (three in Northeastern Brazil and one in Northern Brazilian). METHODS: Thermal conditions and physiological parameters were analysed over three consecutive days, and the participants were subjected to changes in air temperature from 20°C to 33°C. Blood pressure and heart rate were measured before and after testing. RESULTS: Analyses of the experimental data showed changes in heart rate at high temperatures, with a greater risk of students from Teresina and Manaus institutions presenting heart rates above 100 bpm during cognitive tasks. CONCLUSIONS: Within the temperature range applied, on the day of the highest temperature, we observed the highest percentage of participants who reported thermal discomfort (63%, 33°C; 58%, 29°C; 38%, 28°C) and a reduction of cognitive performance (15 to 10 points when the air temperature increases from 20 to 33°C).
Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Análise e Desempenho de Tarefas , Temperatura , Adolescente , Adulto , Brasil , Feminino , Temperatura Alta , Humanos , Masculino , Estudantes/estatística & dados numéricos , Universidades/organização & administraçãoRESUMO
BACKGROUND: Chronic obstructive pulmonary disease (COPD) manifests itself in complex ways, with local and systemic effects; because of this, a multifactorial approach is needed for disease evaluation, in order to understand its severity and impact on each individual. Thus, our objective was to study the correlation between easily accessible variables, usually available in clinical practice, and maximum aerobic capacity, and to determine models for peak oxygen uptake (VO2peak) estimation in COPD patients. SUBJECTS AND METHODS: Individuals with COPD were selected for the study. At the first visit, clinical evaluation was performed. During the second visit, the volunteers were subjected to the cardiopulmonary exercise test. To determine the correlation coefficient of VO2peak with forced expiratory volume in 1 second (FEV1) (% pred.) and the COPD Assessment Test score (CATs), Pearson or Spearman tests were performed. VO2 at the peak of the exercise was estimated from the clinical variables by simple and multiple linear regression analyses. RESULTS: A total of 249 subjects were selected, 27 of whom were included after screening (gender: 21M/5F; age: 65.0±7.3 years; body mass index: 26.6±5.0 kg/m2; FEV1 (% pred.): 56.4±15.7, CAT: 12.4±7.4). Mean VO2 peak was 12.8±3.0 mLâ kg-1â min-1 and VO2peak (% pred.) was 62.1%±14.9%. VO2peak presented a strong positive correlation with FEV1 (% pred.), r: 0.70, and a moderate negative correlation with the CATs, r: -0.54. In the VO2peak estimation model based on the CAT (estimated VO2peak =15.148- [0.185× CATs]), the index explained 20% of the variance, with estimated error of 2.826 mLâ kg-1â min-1. In the VO2peak estimation model based on FEV1 (estimated VO2peak =6.490+ [0.113× FEV1]), the variable explained 50% of the variance, with an estimated error of 2.231 mLâ kg-1â min-1. In the VO2peak estimation model based on CATs and FEV1 (estimated VO2peak =8.441- [0.0999× CAT] + [0.1000× FEV1]), the variables explained 55% of the variance, with an estimated error of 2.156 mLâ kg-1â min-1. CONCLUSION: COPD patients' maximum aerobic capacity has a significant correlation with easily accessible and widely used clinical variables, such as the CATs and FEV1, which can be used to estimate peak VO2.
Assuntos
Tolerância ao Exercício , Volume Expiratório Forçado , Consumo de Oxigênio , Doença Pulmonar Obstrutiva Crônica , Idoso , Limiar Anaeróbio , Brasil , Correlação de Dados , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória/métodos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The study was conducted to determine the impact of chronic obstructive pulmonary disease (COPD) in association with obstructive sleep apnea syndrome (OSAS) on cardiac autonomic control and functional capacity. SUBJECTS AND METHODS: The study was a cross-sectional prospective controlled clinical study. Heart rate variability indices of 24 COPD (n = 12) and COPD+OSAS (n = 12) patients were evaluated and compared by electrocardiographic recordings acquired during rest, active postural maneuver (APM), respiratory sinus arrhythmia maneuver (RSA-m), and the 6-minute walk test (6MWT). RESULTS: The COPD group presented higher parasympathetic modulation during APM when compared to the COPD+OSAS group (P = 0.02). The COPD+OSAS group presented higher sympathetic modulation during RSA-m when compared to the COPD group (P = 0.00). The performance during 6MWT was similarly impaired in both groups, despite the greater severity of the COPD group. CONCLUSION: Subjects with COPD+OSAS present marked sympathetic modulation, and the presence of OSAS in COPD subjects has a negative impact on functional capacity regardless of the severity of lung disease.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Coração/inervação , Hemodinâmica , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Idoso , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Feminino , Nível de Saúde , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Teste de CaminhadaRESUMO
PURPOSE: To evaluate the heart rate variability (HRV) indices and heart rate (HR) responses during isometric contraction (IC) and Valsalva maneuver (VM) in COPD patients. METHODS: Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar® S810i) during dominant upper limb IC (2 minutes). Stable signals were analyzed by Kubios HRV® software. Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index]) and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio). The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds). The Valsalva index was also calculated. RESULTS: During IC: time domain indices (mean HR increased [P=0.001], RMSSD, and RR tri index decreased [P=0.005 and P=0.005, respectively]); frequency domain indices (LF increased [P=0.033] and HF decreased [P=0.002]); associations were found between forced expiratory volume in 1 second (FEV1) vs RMSSD (P=0.04; r=-0.55), FEV1 vs HR (P=0.04; r=-0.48), forced vital capacity (FVC) vs RMSSD (P=0.05; r=-0.62), maximum inspiratory pressure (MIP) vs HF (P=0.02; r=0.68). FEV1 and FVC justified 30% of mean HR. During VM: HR increased (P=0.01); the nadir showed normal bradycardic response; the Valsalva index was =0.7. CONCLUSION: COPD patients responded properly to the upper limb IC and to the VM; however, HR recovery during VM was impaired in these patients. The severity of the disease and MIP were associated with increased parasympathetic modulation and higher chronotropic response.