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INTRODUCTION: Exercise capacity has been established as a protective factor against joint impairment in people with haemophilia (PWH). However, little is known about how exercise capacity is affected in PWH. AIM: To analyse exercise capacity, as assessed by standardised laboratory or field tests in PWH. METHODS: A systematic review was conducted to identify manuscripts investigating physical capacity in PWH. An electronic search of PubMed/MEDLINE, Embase, Web of Science, CENTRAL and CINAHL was conducted from inception to 13 April, 2022. Two independent reviewers performed data extraction and assessed study quality using the critical appraisal tools of the Joanna Briggs Institute. RESULTS: Nineteen studies with 825 patients were included. Most studies used the six-min walk test (6MWT) or peak/maximal oxygen consumption (VO2 max). In children, the distance walked ranged from 274 ± 36.02 to 680 ± 100 m. In adults, the distance walked ranged from 457.5 ± 96.9 to 650.9 ± 180.3 m. VO2 max ranged from 37 ± 8 to 47.42 ± 8.29 ml kg-1 min-1 . Most studies reported lower values of exercise capacity compared to standardised values. Overall, the quality of the studies was moderate. CONCLUSION: Most of the studies showed that PWH have lower exercise capacity compared to reference values of 6MWT or VO2 max. Based on these results, it is necessary to emphasise in both the promotion and the prescription of physical exercise in PWH.
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Tolerância ao Exercício , Hemofilia A , Adulto , Criança , Humanos , Exercício Físico , Terapia por Exercício/métodos , CaminhadaRESUMO
Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.
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Women treated for breast cancer are facing a lifetime risk of developing lymphedema, which occurs in up to 40% of this population. There is a lack of evidence and limited knowledge regarding the treatment of breast cancer-related lymphedema (BCRL). The aim of this study was to identify, describe, and organize the currently available evidence in the treatment of BCRL. METHODS: We conducted an evidence mapping review study according to the methodology proposed by Global Evidence Mapping. We performed a systematic search in Medline, Embase, Central (Cochrane), and Epistemonikos, from 2000-2020. We included studies about all treatment types for BCRL, including surgical and nonsurgical treatment. Results were summarized in narrative and tabular forms. RESULTS: A total of 240 studies were included in this mapping review, distributed as follows: 147 experimental studies [102 randomized clinical trials (RCTs) and 45 quasi-experimental clinical trials], 48 observational studies (34 prospective and 14 retrospective studies), and 45 systematic reviews (17 of them with metanalysis). Most of the RCTs were on nonsurgical interventions. Only two RCTs addressed surgical intervention. CONCLUSIONS: In the last 20 years, there were an average of 12 publications per year on the treatment of BCRL. Recently this lack of attention has been partially corrected, as the majority were published in the past 5 years. However, most of them were on nonsurgical interventions. Well-designed RCTs on surgery are needed to measure the effectiveness of the applied interventions.
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La evaluación de la capacidad respiratoria y funcional en pacientes con COVID-19 después de la fase aguda es esencial para estimar el impacto de los deterioros causados por la enfermedad en el nivel de funcionamiento relacionados con las actividades y tareas y su impacto en la participación. Esta información provee evidencia invaluable del impacto de la enfermedad para implementar las estrategias de rehabilitación más adecuadas. El objetivo de esta revisión es determinar cuáles son las mejores herramientas para evaluar la capacidad respiratoria y funcional en personas post-infección por COVID-19, para ello, se realizó una revisión narrativa de la literatura incluyendo estudios que aplicaron evaluaciones respiratorias y funcionales en pacientes post-infección por COVID-19. Se encontró que las herramientas más utilizadas para evaluar la función respiratoria fueron la capacidad de difusión y la espirometría. Para evaluar la capacidad funcional, las pruebas más utilizadas fueron el test de marcha de 6 minutos, el Sit-to-Stand test, Short Performance Physical Battery y el índice de Barthel. Finalmente, dada la heterogeneidad de la presentación clínica de la COVID-19, es fundamental contar con herramientas sencillas para evaluar y monitorizar las consecuencias de la enfermedad en la función respiratoria y el estado funcional de los pacientes.
The assessment of respiratory and functional capacity in patients with COVID-19 after the acute phase is essential to estimate the impact of the disease's impairments on functioning related to the activities and tasks and their impact on participation. This information provides invaluable evidence of the impact of the disease to implement the most appropriate rehabilitation strategies. This review aims to determine the best tests to assess people's respiratory and functional capacity after COVID-19 infection. A narrative review of the literature was carried out that includes studies that applied respiratory and functional assessment in post-COVID-19 infection patients. It was found that the most used tests to assess respiratory function were diffusion capacity and spirometry. The most widely used tests to assess functional capacity were the 6-minutes walk test, the Sit-to-Stand test, the Short Performance Physical Battery, and the Barthel index. Finally, due to the heterogeneity of the clinical presentation of COVID-19, it is essential to have simple tests to assess and monitor the consequences of the disease on patients' respiratory function and functional status.
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BACKGROUND: Exercise and physical activity (PA) are essential components of the care of cystic fibrosis (CF) patients. Lower PA levels have been associated with worse pulmonary function, aerobic fitness, glycemic control, and bone mineral density. Most people with CF do not engage in the recommended amounts of PA. OBJECTIVE: To determine the level of PA in children and adolescents with CF. METHODS: A systematic review with meta-analysis was conducted without language restrictions in five databases. Were included studies that analyzed PA measured by objective and subjective instruments in children and adolescents with CF. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. The risk of bias of the included studies was assessed with the National Heart, Lung, and Blood Institute's risk-of-bias tool. RESULTS: Of the 1535 reports returned by the initial search, 20 articles reporting on 785 patients were included in the data synthesis. The forest plot showed that the CF group had a similar moderate-to-vigorous PA (MVPA) (mean difference, -7.79; 95% CI -15.65 to 0.08 min/d; P = .05) and sedentary time (mean difference, -50.81; 95%CI, -109.96 to 8.35 min/d; P = .09) to the control group. CONCLUSION: Children and adolescents with CF have a similar MVPA and sedentary time compared to controls. There are many options, subjective and objective, for assessing PA in this population. Optimal tool selection should guarantee more valid results.
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Fibrose Cística , Exercício Físico , Adolescente , Criança , Fibrose Cística/fisiopatologia , Humanos , Pulmão/fisiopatologia , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
La Organización Mundial de la Salud (OMS) ha definido la infección por coronavirus (SARS-CoV-2) como una pandemia. Su infección puede causar potencialmente una enfermedad respiratoria muy severa1,2. Por otro lado, la tasa de transmisión ha sido muy alta, especialmente entre profesionales de la salud. Los kinesiólogos están en un alto riesgo de contraer la infección, particularmente cuando aplican técnicas respiratorias, el uso de oxígeno o la ventilación no invasiva. El objetivo de estas recomendaciones es proveer información práctica para que los profesionales tomen las precauciones necesarias para evitar contraer la infección. Además describir los riesgos de transmisión, dispersión de partícula según intervención y las recomendaciones basadas en la literatura actual revisada.
Recently the World Health Organization (WHO) has defined coronavirus infection (SARS-CoV-2) as a pandemic. Its infection can potentially cause a very severe respiratory illness1,2. Furthermore, the transmission rate has been very high, especially among health professionals. Physiotherapists are at high risk of contracting the infection, particularly when applying respiratory techniques, the use of oxygen, or non-invasive ventilation1. The objective of these recommendations is to provide practical information for professionals to take the necessary precautions to avoid contracting the infection. Also, to describe the risks of transmission, particle dispersion according to intervention and the recommendations based on the current literature reviewed.