Should We Use the Functional Electrical Stimulation-Cycling Exercise in Clinical Practice? Physiological and Clinical Effects Systematic Review With Meta-analysis.

OBJECTIVE: To examine the evidence regarding functional electrical stimulation cycling's (FES-cycling's) physiological and clinical effects. DATA SOURCES: The study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses protocol. PubMed, Embase, Cochrane Review, CINAHL, Scopus, Sport Discus, and Web of Science databases were used. STUDY SELECTION: Randomized controlled trials involving FES-cycling were included. Studies that did not involve FES-cycling in the intervention group or without the control group were excluded. Two reviewers screened titles and abstracts and then conducted a blinded full-text evaluation. A third reviewer resolved the discrepancies. DATA EXTRACTION: Meta-analysis was performed using inverse variance for continuous data, with effects measured using the mean difference and random effects analysis models. A 95% confidence interval was adopted. The significance level was set at P<.05, and trends were declared at P=.05 to ≤.10. The I2 method was used for heterogeneity analysis. The minimal clinically important difference was calculated. Methodological quality was assessed using the risk of bias tool for randomized trials. The Grading of Recommendations Assessment, Development, and Evaluation method was used for the quality of the evidence analysis. DATA SYNTHESIS: A total of 52 studies were included. Metabolic, cardiocirculatory, ventilatory, and peripheral muscle oxygen extraction variables presented statistical (P<.05) and clinically important differences favoring FES-cycling, with moderate-to-high certainty of evidence. It also presented statistical (P<.05) and clinically important improvements in cardiorespiratory fitness, leg and total body lean mass, power, physical fitness in intensive care (moderate-to-high certainty of evidence), and torque (low certainty of evidence). It presented a trend (P=.05 to ≤.10) of improvement in muscle volume, spasticity, and mobility (low-to-moderate certainty of evidence). It showed no difference (P>.10) in 6-minute walking distance, muscle cross-sectional area, bone density, and length of intensive care unit stay (low-to-moderate certainty of evidence). CONCLUSIONS: FES-cycling exercise is a more intense stimulus modality than other comparative therapeutic modalities and presented clinically important improvement in several clinical outcomes.

Association between performance on the Glittre ADL-test and the functional capacity of patients with HF: A cross-sectional study.

Background: The Weber classification based on peak VO2 is a well-established method for categorizing patients with heart failure (HF) regarding severity. However, other submaximal tests such as the Glittre ADL-Test have been gaining prominence in practice due to a coherent and more comprehensive correlation with limitations for performing activities of daily living in patients with heart failure.Objective: To investigate the correlation between the time required to perform the Glittre ADL-Test and the peak VO2 in patients with HF.Methods: A cross-sectional study conducted with 40 adult individuals (21 to 65 years) diagnosed with HF of all etiologies, with LVEF<50% and NYHA II and III.Results: The average time for performing the Glittre ADL-Test was 284.9 seconds, and a significant difference was found between Weber classification classes A and C (p = .01). Significant correlations with peak VO2 were also found (r = -0.424 - p < .01). Thirty (30) patients performed a second test, and the ICC found in the reproducibility analysis was 0.75 (95% CI 0.14-0.91) and p < .01.Conclusion: The Glittre ADL-Test was able to reflect the functional performance of individuals with HF, suggesting that it represents an evaluation tool which can be safely used in clinical practice.

Effects of physical exercise on the autonomic nervous system in patients with coronary artery disease: a systematic review.

BACKGROUND: Imbalance in autonomic modulation can occur after a cardiac event, which can lead to deleterious consequences. Exercise has proven to be a therapy which affects this modulation and can be assessed through heart rate variability (HRV). AREAS COVERED: The objective of this systematic review was to investigate the effects of physical exercise on heart rate variability in individuals with coronary artery disease (CAD). The PubMed, PEDro, Scielo, Lilacs and Cochrane databases were systematically searched, for articles which performed supervised exercises in phase II of cardiac rehabilitation in patients with CAD. EXPERT OPINION: Given the differences between studies on interventions and population characteristics, it is difficult to justify similarities or divergences in terms of results. In addition to the variation in sample size, intervention duration, carrying out an additional program at home, and patients with different clinical presentations, it can be inferred that responses to exercise may vary for certain types/clinical profile of individuals with CAD. Thus, it is necessary to carry out more studies with greater methodological rigor, greater standardization of the variables studied and the evaluation forms, in order to increase the veracity of the results and the consequent clinical relevance and therapeutic application.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients.

OBJECTIVE:: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS:: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS:: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION:: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.