Cardiovascular disease prevention and implications for worksite health promotion programs in Brazil.

Economic growth, an aging population, and changes in lifestyle patterns have contributed to the rise in cardiovascular disease (CVD) in Brazil. Worksite health and wellness programs are viewed as a potentially viable means to address the increase in disease burden in Brazil. The purpose of the present review is to investigate actions proposed by the Brazilian Government for CVD prevention and the current state of worksite health promotion. Our review of literature found that the Brazilian Government has been showing a growing interest in developing and promoting CVD preventive strategies, primarily through better control of known risk factors (i.e. smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose). Current initiatives are considered positive steps toward better CVD prevention in Brazil. With respect to worksite health and wellness, additional work is needed to determine optimal program delivery models, financial implications and individual/population compliance with healthier lifestyle choices.

Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs.

Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even so, there is wide consensus that primary prevention of CVD is an effective and worthwhile pursuit. Moreover, continual engagement with individuals who have already been diagnosed as having CVD would be beneficial. Implementing health and wellness programs in the workplace allows for the opportunity to continually engage a group of individuals with the intent of effecting a positive and sustainable change in lifestyle choices. Current evidence indicates that health and wellness programs in the workplace provide numerous benefits with respect to altering CV risk factor profiles in apparently healthy individuals and in those at high risk for or already diagnosed as having CVD. This review presents the current body of evidence demonstrating the efficacy of worksite health and wellness programs and discusses key considerations for the development and implementation of such programs, whose primary intent is to reduce the incidence and prevalence of CVD and to prevent subsequent CV events. Supporting evidence for this review was obtained from PubMed, with no date limitations, using the following search terms: worksite health and wellness, employee health and wellness, employee health risk assessments, and return on investment. The choice of references to include in this review was based on study quality and relevance.

Anthropometric and musculoskeletal assessment of patients with Marfan syndrome.

BACKGROUND: Marfan syndrome (MS) is an autosomic dominant condition of the connective tissue that involves the ocular, cardiovascular and musculoskeletal systems. MS is caused by mutations in the fibrillin-1 gene, leading to joint ligaments flaccidity, joint hypermobility and an overgrowth of the long bones. OBJECTIVES: The aim of the present study was to assess anthropometry, musculoskeletal alterations and the prevalence of physical therapy treatments among patients with MS. METHODS: Twenty-six patients were included in this study [17 females (age: 13.23±2.77 years; body mass 51.5±24-68 Kg; height 1.70±1.40-1.81 m; arm span: 1.73±0.12 m) and 9 males (age: 14.44±2.18; body mass: 61.0±42-72 Kg; height: 1.83±1.66-1.97 m; arm span: 1.93±0.13 m)]. Anthropometric measurements and musculoskeletal abnormalities were determined in a standardized fashion: pectus and scoliosis were assessed through radiography and angulation (â) of the scoliosis curve using the Cobb method; arachnodactyly was assessed through the thumb sign and Walker-Murdoch test and dolichostenomelia was assessed by arm span in relation to height. Patients also responded to a questionnaire addressing participation in physical therapy. RESULTS: In comparison to values estimated for the Brazilian population, mass and height were greater among the patients with MS (females: p=0.001 e p<0.0005 e males p=0.019 e p=0.0001, respectively). The following musculoskeletal abnormalities were found: pectus in 3 patients (11%), pectus and scoliosis in 19 (73%), dolichostenomelia in 11 (42%) and arachnodactyly in 21 (80%). Eleven patients (42%) with MS had previously undergone physical therapy. CONCLUSIONS: Patients with MS exhibit altered musculoskeleto and anthropometry and have infrequent physical therapy treatment.

Assessment and medium-term follow up of heart transplant candidates undergoing low-intensity exercise.

OBJECTIVE: To study cardiovascular behavior and safety regarding a low-intensity exercise program for heart transplant candidates with severe heart failure. METHODS: Twenty-one patients with severe heart failure on the transplant list of the UNIFESP university hospital (Brazil) were studied. Following evaluation, the patients were monitored during an exercise program with six progressive phases (1--upper limbs; 2--lower limbs; 3--walking; 4--½ flight of stairs; 5--walking 200 m; and 6--whole flight of stairs), with the intensity estimated at two to six metabolic equivalents (1 MET = 3.5 ml of O2/kg/min.). The patients were prospectively followed up for approximately 17 months for the occurrence of clinical complications and death. RESULTS: Three patients were unable to perform the complete program; BMI, maximal respiratory pressure (Pimax and Pemax, cmH2O) and number of previous hospitalizations were considered predictors for this subgroup. Heart rate (HR, bpm), double product (DP, bpm x mmHg) and Borg perceived exertion scale (PE) underwent the greatest oscillation during exercise, especially in phase 5 (H"METS), and are considered the best markers related to exertion. Blood pressure (BP, mmHg) oscillated little. There was no increase in the incidence of arrhythmia (Kappa = 0.552) during exercise. There was a moderate positive correlation between PE and BP (r = 0.4; P = 0.02) in phase 5 (walking 200 m). The patients who died had low Pimax values upon the initial evaluation. During the exercise program, there was a reduction in BP response and an increase in HR response. CONCLUSION: Regarding cardiovascular behavior, the exercise program proved safe and well tolerated, but there is a need for monitoring. Information obtained upon the initial evaluation and during exercise program is associated to decompensation and death. Such information could assist in determining the stage of the disease.