Agalsidase alfa long-term effect on left ventricular hypertrophy in Fabry disease / Efecto a largo plazo de la agalsidasa alfa sobre la hi pertrofia ventricular izquierda en la enfermedad de Fabry

Abstract Introduction : Fabry disease (FD) is an X-linked ly sosomal storage disorder affecting glycosphingolipid metabolism. Most FD patients have cardiac involvement, mainly manifested as left ventricular hypertrophy (LVH), leading to early death due to complications (arrhyth mias, valvular disease, vascular involvement). Early initiation of enzyme replacement therapy (ERT) before fibrosis development has been associated with better cardiac outcomes in terms of left ventricular mass index (LVMI) and functional parameters. Methods : A retrospective observational study was conducted in patients with FD treated with agalsidase alfa for at least 2 years. The primary objectives were: [a] to assess the annual rate of change in LVMI; [b] to define the overall incidence of stability, regression or progression of LVMI. Results : Forty-nine patients were included in the final analysis, with a median follow-up of 7 years. The overall change in LVMI was 0.38 g/m2.73/year, without significant influence of baseline LVH, gender, age at ERT initiation, LV ejection fraction, body mass index, renal disease, and classical cardiovascular risk factors. Long-term ERT with agalsidase alfa was associated with stabilization of LVMI in 98% of patients with FD and was independent of the same covariables. Conclusion : Our results are in line with previous literature of comparable FD populations and probably represent the first study of its kind in Argentina. We here highlight the importance of cardiac morphomet ric stability as a positive outcome of ERT.

Resumen Introducción : La enfermedad de Fabry (EF) es una enfermedad de almacenamiento lisosomal ligada al cromosoma X que afecta el metabolismo de glicoes fingolípidos. La mayoría de pacientes EF tienen afec tación cardíaca, manifestada principalmente como hipertrofia ventricular izquierda (HVI), que conduce a muerte prematura secundaria a complicaciones (arritmias, valvulopatías, afectación vascular). El trata miento de reemplazo enzimático (TRE) precoz, iniciado antes del desarrollo de la fibrosis, se relaciona con mejores resultados cardíacos en términos del índice de masa ventricular izquierda (IMVI) y parámetros funcionales. Métodos : Se realizó un estudio retrospectivo obser vacional en que se incluyeron pacientes con EF tratados con agalsidasa alfa por al menos 2 años. Los objetivos primarios fueron: [a] evaluar el cambio anual del IMVI; [b] definir la incidencia global de estabilidad, regresión o progresión del IMVI. Resultados : Se incluyeron 49 pacientes, con segui miento (mediana) de 7 años. El cambio global en el IMVI fue 0.38 g/m2.73/año, sin influencia significativa de HVI basal, sexo, edad de inicio de TRE, fracción de eyección del VI, índice de masa corporal, insuficiencia renal y factores de riesgo cardiovascular clásicos. La TRE a largo plazo con agalsidasa alfa se relacionó con la estabilización del IMVI en el 98% de los pacientes con EF, independientemente de las mismas covariables. Conclusión : Nuestros resultados están en línea con la bibliografía previa de poblaciones comparables y, pro bablemente, representan el primer estudio de este tipo en Argentina. Se destaca la importancia de la estabilidad morfométrica cardíaca como resultado positivo de la TRE.

Consenso colombiano de expertos sobre recomendaciones basadas en evidencias para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal

Contexto: la enfermedad de Fabry se comporta como una enfermedad crónica con compromiso multisistémico y alto costo en salud. Objetivo: generar recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal mediante un consenso de expertos. Metodología: a partir de la búsqueda de evidencia en Pubmed, Embase y Google Scholar entre 2010 y agosto 2020, se formulan recomendaciones sobre la definición, el diagnóstico y el tratamiento de la enfermedad de Fabry en población adulta, las cuales se consultan a un panel de expertos a través de la metodología de consenso Delphi modificado. La calidad de los documentos se evaluó por equipo metodológico aplicando herramientas en función del tipo de documento incluido. Resultados: se formularon 53 recomendaciones sobre la definición, el diagnóstico y el tratamiento. Un panel de cinco expertos clínicos nacionales e internacionales externos al grupo desarrollador participaron en la consulta preconsenso y 50 recomendaciones fueron acordadas para su inclusión, para tres de ellas se requirió una sesión formal de consenso que se dio en una ronda, incorporando tres nuevas recomendaciones. Conclusiones: las recomendaciones basadas en evidencia y experticia clínica permitirán orientar de manera estandarizada a nivel nacional y regional, el diagnóstico y el tratamiento de pacientes con sospecha o enfermedad de Fabry con compromiso renal.

Background: Fabry disease behaves like a chronic condition, with multisystem involvement and high health care costs. Objective: To generate evidence-based recommendations for the diagnosis, treatment and follow-up of the Anderson-Fabry disease with renal commitment, through an expert consensus. Methodology: Based on the search of evidence in PubMed, Embase and Google Scholar between 2010 and August, 2020, recommendations on the definition, diagnosis and treatment of Fabry Disease in adult population were formulated after consulting with an expert panel through the modified Delphi consensus methodology. The quality of the documents was assessed by methodological team applying tools according to the type of document included. Results: 53 recommendations for the definition, diagnosis and treatment were formulated. A panel of five national and international clinical experts external to the developer group participated in the pre-consensus consultation and 50 recommendations were agreed upon for their inclusion. For 3 recommendations, a formal consensus session which took place in one round was required, and 3 new recommendations were incorporated. Conclusions: The recommendations based on evidence and clinical expertise will allow us to guide the diagnosis and treatment of patients with Fabry disease with renal involvement or suspicion thereof in a standardized manner at national and regional levels.

Major cardiovascular adverse events in Fabry disease patients receiving agalsidase alfa / Eventos cardiovasculares mayores en pacientes con enfermedad de Fabry tratados con agalsidasa alfa

Abstract Cardiovascular mortality (CVM) has become the major contributor to overall Fabry disease (FD) mortality in the enzyme replacement therapy (ERT) era. Our objectives were to describe causes and potential predictors of mortality in FD adult patients in Argentina, and to assess risk of major adverse cardio vascular events (MACE) in the ERT era. We retrospectively studied 93 consecutive patients treated with alpha-galactosidase A (median follow up: 9.5 years from start of ERT). Mean age at ERT starting was 35±16.3 years. Prevalence of cardiomyopathy and renal disease reached 47% and 41%, respectively. Eleven subjects (11.8%, 95%CI: 5-18%) died during follow up (1.24/100 patient-years). Mean overall survival was 71 years (95%CI: 66-75 years). Seven cases were considered as CVM; main causes were sudden death and stroke. Risk of MACE was 14% (95%CI: 6.9-21.1%; 1.47 events/100 patient-years from start of ERT). All but 2 subjects had at least one comorbid cardiovascular risk factor; however, 86% of patients remained free of MACE during follow-up. CVM remained low and our study was underpowered for detection of predictors of mortality, but it is worth noting that age at diagnosis and ERT starting, left ventricular mass index and renal disease trended to correlate with CVM. Prevalence of hypertension, diabetes and dyslipidemia were lower in FD patients when compared to population level data. As in the Argentinean general population, CVM was the leading cause of mortality among this cohort of consecutive FD patients treated with agalsidase alfa.

Resumen La mortalidad cardiovascular (MCV) se ha convertido en el principal contribuyente a la mortalidad general por enfermedad de Fabry (EF) en la era de la terapia de reemplazo enzimático (TRE). Nuestros objetivos fueron describir las causas y posibles predictores de mortalidad en pacientes adultos con EF en la Argentina, y evaluar el riesgo de eventos cardiovasculares mayores (MACE) en la actual era de TRE. Se estudiaron 93 pacientes consecutivos tratados con agalsidasa-alfa por una mediana de 9.5 años tras iniciar TRE. La edad al inicio de TRE fue 35 ± 16.3 años. La prevalencia de cardiomiopatía y enfermedad renal alcanzó 47% y 41%, respectivamente. Once sujetos (11.8%; IC95%: 5-18%) murieron durante el seguimiento (1.24/100 pacientes/año). La supervivencia global fue 71 años (IC95%: 66-75 años). Siete casos fueron considerados como MCV; las principales causas fueron muerte súbita e ictus. El riesgo de MACE fue 14% (IC95%: 6.9-21.1%; 1.47 eventos/100 pacientes/año desde la ERT). Todos menos 2 sujetos tenían al menos un factor de riesgo cardiovascular, pero el 86% permaneció libre de MACE. Los eventos de MCV fueron escasos. El estudio tuvo reducido poder estadístico para detectar predictores de mortalidad, pero la edad al diagnóstico y al iniciar la TRE, índice de masa ventricular izquierda y enfermedad renal tendieron a correlacionarse con MCV. La prevalencia de hipertensión, diabetes y dislipidemia fue menor en comparación con la población general. Como ocurre con la población general en Argentina, los eventos cardiovasculares fueron la principal causa de muerte en esta cohorte de pacientes consecutivos con EF tratados con agalsidasa-alfa.

Caracterização da variabilidade da frequência cardíaca em indivíduos com síndrome metabólica / Characterization of the heart rate variability in individuals with metabolic syndrome / Caracterización de la variabilidad de la frecuencia cardiaco en pacientes con síndrome metabólico

RESUMO Introdução: A variabilidade da frequência cardíaca (VFC) tem sido considerada um mecanismo de modulação do sistema nervoso autônomo. A diminuição da VFC pode estar associada à síndrome metabólica (SM). Objetivo: Comparar a VFC e variáveis de saúde em indivíduos com e sem SM. Métodos: Cento e dezenove participantes foram divididos em dois grupos: sem SM (SSM, n = 68) e com SM (CSM, n = 51). Foi avaliada a análise espectral da VFC em repouso, durante teste cardiopulmonar de exercício (TCPE) e na recuperação em bandas de baixa frequência (LF = 0,04-0,15 Hz), alta frequência (HF = 0,15-0,4 Hz) e razão LF/HF. Adicionalmente, a frequência cardíaca (FC) de repouso (FCrep), FC máxima (FCmáx), pressão arterial sistólica (PAS) e diastólica (PAD), glicemia, perfil lipídico, consumo de oxigênio pico (VO2pico) e composição corporal foram avaliados. Resultados: A FCrep e o VO2pico não apresentaram diferenças entre o CSM e o SSM (73,3 ± 9,1 vs. 70,1 ± 11,0 bpm) (26,8 ± 4,6 vs. 28,1 ± 6,6 ml.kg-1.min-1), respectivamente. A VFC foi similar entre os grupos nos diferentes momentos analisados. A glicemia (99,8 ± 22,5 vs. 87,6 ± 8,6 mg/dl) foi superior no CSM comparado ao SSM. Os valores de triglicérides (159,5 ± 68,8 vs. 89,2 ± 34,3 mg/dl) e VLDL-c (31,9 ± 13,8 vs. 17,8 ± 6,9 mg/dl) foram superiores no CSM comparado ao SSM. O HDL-c (40,7 ± 11,5 vs. 49,3 ± 9,8 mg/dl) foi menor no CSM comparado ao SSM. O IMC (33,1 ± 4,7 vs. 30,8 ± 3,8 Kg/m²) foi superior no CSM comparado ao SSM. A PAS (128,6 ± 12,9 vs. 119,5 ± 11,3 mmHg) e a PAD (77,2 ± 10,5 vs. 72,9 ± 8,1 mmHg) foram superiores no CSM comparado ao SSM, p < 0,05. Conclusão: Os resultados sugerem que a presença de SM não é suficiente para provocar alterações nos índices de VFC em repouso, durante teste cardiopulmonar de exercício (TCPE) e na recuperação quando os pacientes são comparados a indivíduos sem a doença.

ABSTRACT Introduction: Heart rate variability (HRV) has been considered a modulation mechanism of the autonomic nervous system. The reduction of HRV may be associated with metabolic syndrome (MS). Objective: To compare the HRV and health variables in individuals with and without MS. Methods: One hundred and nineteen participants were divided into two groups: without MS (WOMS, n=68) and with MS (WMS, n=51). We evaluated the spectral analysis of HRV at rest, during cardiopulmo-nary exercise testing (CPET) and recovery in low frequency bands (LF = 0.04-0.15 Hz), high frequency (HF = 0.15-0.4 Hz) and LF/HF ratio. Resting heart rate (HRres), maximum heart rate (HRmax), systolic blood pressure (SBP) and diastolic (DBP), blood glucose, lipid profile, peak oxygen consumption (VO2peak) and body composition were also evaluated. Results: There were no differences between HRres and VO2peak between the WMS and WOMS groups (73.3±9.1 vs. 70.1±11.0 bpm), (26.8±4.6 vs. 28.1±6.6 ml.kg-1.min-1), respectively. HRV was similar between the groups at the different moments analyzed. The blood glucose levels (99.8±22.5 vs. 87.6±8.6 mg/dl) were higher in WMS compared to WOMS. Triglyceride values (159.5±68.8 vs. 89.2±34.3 mg/dl) and VLDL-c (31.9±13.8 vs. 17.8±6.9 mg/dl) were higher in WMS compared to WOMS. HDL-c (40.7±11.5 vs. 49.3±9.8 mg/dl) was lower in WMS compared to WOMS. BMI (33.1±4.7 vs. 30.8±3.8 kg/m²) was higher in WMS compared to WOMS. The SBP (128.6±12.9 vs. 119.5±11.3 mmHg) and DBP (77.2±10.5 vs. 72.9± 8.1mmHg) were higher in WMS com-pared to WOMS, p<0.05. Conclusion: The results suggest that the presence of MS is not sufficient to induce changes in HRV at rest, during cardiopulmonary exercise test (CPET), and in recovery when patients are compared to healthy individuals.

RESUMEN Introducción: La variabilidad de la frecuencia cardiaca (VFC) ha sido considerada como un mecanismo de modulación del sistema nervioso autónomo. La disminución de VFC puede estar asociada con el síndrome metabólico (SM). Objetivo: Comparar la VFC y variables de salud en individuos con y sin SM. Métodos: Ciento diecinueve sujetos se dividieron en dos grupos: sin SM (SSM, n = 68) y con SM (CSM, n = 51). Se evaluó el análisis espectral de la VFC en reposo durante las pruebas de ejercicio cardiopulmonar (PECP) y la recuperación en banda de baja frecuencia (LF = 0,04-0,15 Hz), alta frecuencia (HF = 0,15-0,4 Hz) y la relación LF/HF. Además, se evaluaron la frecuencia cardiaca en reposo (FCrep), FC máxima (FCmáx), presión arterial sistólica (PAS) y diastólica (PAD), glicemia, perfil lipídico, consumo pico de oxígeno (VO2pico) y composición corporal. Resultados: FCrep y VO2pico no mostraron diferencias entre CSM y SSM (73,3 ± 9,1 vs. 70,1 ± 11,0 bpm) (26,8 ± 4,6 vs. 28,1 ± 6,6 ml.kg-1.min-1), respectivamente. La VFC fue similar entre los grupos en diferentes momentos analizados. La glicemia (99,8 ± 22,5 vs. 87,6 ± 8,6 mg/dl) fue mayor en CSM en comparación con SSM. Los valores de triglicéridos (159,5 ± 68,8 vs. 89,2 ± 34,3 mg/dl) y VLDL-C (31,9 ± 13,8 vs. 17,8 ± 6,9 mg/dl) fueron más altos en CSM en comparación con SSM. HDL-C (40,7 ± 11,5 vs. 49,3 ± 9,8 mg/dl) fue menor en CSM en comparación con el SSM. El IMC (33,1 ± 4,7 vs. 30,8 ± 3,8 kg/m²) fue mayor en CSM en comparación con SSM. La PAS (128,6 ± 12,9 vs. 119,5 ± 11,3 mmHg) y la PAD (77,2 ± 10,5 vs. 72,9 ± 8,1 mmHg) fueron más altas en CSM en comparación con SSM, p < 0,05. Conclusión: Los resultados sugieren que la presencia de SM no es suficiente para provocar cambios en los índices de VFC en reposo durante las pruebas de ejercicio cardiopulmonar (PECP) y en la recuperación cuando se comparan los pacientes y los individuos saludables.

A multidisciplinary weight-loss program: the importance of psychological group therapy

Abstract In addition to dietary factors and sedentary habits, there is a relationship between obesity and psychological variables, even without a clear distinction between cause, effect, and correlation. Despite this relationship, weight-loss programs are limited to a combination of nutrition and physical education, leaving psychological intervention out of the treatment plan. Self-esteem issues, depression, and anxiety are just some of the emotional conditions related to obesity. However, there is no information in the literature about the importance of psychological counseling in a multidisciplinary program for weight-loss in adults. In this context, the main objective of this study was to analyze the effect of cognitive-behavioral therapy in groups (CBTG) combined with nutrition and physical education within a multidisciplinary approach to treat obesity. 46 individuals (7 men and 39 women) were divided into two groups: control (GC) and psychology (GP). Baseline and intervention measures were obtained prior to intervention and before the final meeting, including physical capacity tests and the administering the International Physical Activities Questionnaire (IPAQ). Both groups attended weekly lectures given by a nutritionist and two physical education professionals for 12 weeks. In addition, the GP participated in weekly sessions of CBTG for the same period. After the program, there were significant changes in body mass index, waist circumference, body fat percentage, and strength of the lower limbs in both groups. In addition to these changes, the GP also showed improvements in diastolic blood pressure and IPAQ scores, being the only one that increased its time of weekly physical activity. Thus, it was concluded that the psychological treatment might play an important role in a multidisciplinary weight-loss program.(AU)

Association of genetic polymorphisms with physical capacities and body composition in older women / Associação de polimorfismos genéticos com capacidades físicas e composição corporal em idosas

Abstract The elderly population has grown substantially, and the decline in physical capacities and increase in the body fat percentage are important characteristics of aging. Genetic factors may explain these declines and studies related to this issue are justified because they predict what physical capacities present larger declines in different individuals and enable the adoption of strategies to slow them. Thus, the aim of this study was to evaluate the effect of ACE I / D and ACTN3 R / X genetic polymorphisms on body fat, muscle strength and power levels, aerobic capacity, flexibility and agility in older women. Sixty-six older women were genotyped with respect to ACTN3 and ACE polymorphisms for the division of groups and submitted to anthropometric measurements, physical tests in the AAHPERD and RIKLI and JONES test batteries and IPAQ to determine the level of physical activity and the Food Consumption Marker Form. Older women with XX genotype in relation to ACTN3 genotype had lower levels of flexibility of upper and lower limbs and lower cardiorespiratory fitness. Moreover, in relation to the ACE genotype, ID individuals exhibited higher cardiorespiratory fitness and lower body fat percentages. In relation to the other variables, there was no statistical difference among groups. It was concluded that the genetic variants under study play a role in some of the physical capacities and body composition in elderly women. In the future, data of this nature will enable each individual to have specific health interventions directed to the variables showing higher genetic potential for decline.

Resumo A população idosa tem crescido de forma substancial e o declínio nas capacidades físicas, além do aumento na porcentagem de gordura corpórea, são características importantes do envelhecimento. Fatores genéticos podem explicar estes declínios e pesquisas relacionadas a essa temática se justificam porque predizer quais capacidades físicas apresentarão maiores declínios em cada indivíduo possibilita a adoção de estratégias para retardá-los. Assim objetivamos avaliar o efeito dos polimorfismos genéticos ECA I/D e ACTN3 R/X nos níveis de gordura corporal, força e potência muscular, capacidade aeróbia, flexibilidade e agilidade em idosas. 66 idosas foram genotipadas em relação aos polimorfismos da ACTN3 e da ECA para divisão dos grupos e submetidas a medidas antropométricas, testes físicos da bateria de testes da AAHPERD e RIKLI E JONES, IPAQ para determinar o nível de atividade física e o Formulário de Marcadores de Consumo Alimentar. Mulheres idosas com o genótipo XX em relação ao gene da ACTN3 apresentaram menores níveis de flexibilidade dos membros superiores e menor capacidade cardiorrespiratória. Por outro lado, em relação ao gene da ECA, os indivíduos ID apresentaram maior capacidade cardiorrespiratória e menor porcentagem de gordura. Em relação às outras variáveis não houve diferença estatística entre os grupos. Concluímos que as variantes genéticas estudadas têm influência em algumas das capacidades físicas e na composição corporal em idosas. No futuro dados desta natureza possibilitarão cada indivíduo ter suas intervenções em saúde direcionadas às variáveis que ele apresenta maior potencial genético para declínio.

Propriedades mecânicas de aloenxertos meniscais de coelhos após preservação em glicerina e reidratação em NaCl 0,9% / Mechanical properties of rabbit meniscal allografts after glycerin preservation and rehydration in NaCl 0.9%

Foram avaliadas as propriedades mecânicas, força, deformação e tensão ao limite elástico, tensão ao ponto de ruptura e índice de rigidez, de meniscos frescos e meniscos transplantados por 70 dias em joelhos de coelhos, após preservação em glicerina. O primeiro grupo (tratado) foi formado por seis meniscos mediais do joelho esquerdo, coletados de animais oriundos de criação comercial. Esses meniscos foram armazenados em glicerina 98% por um período de 45-60 dias; em seguida, foram reidratados em solução salina a 0,5% de enrofloxacina, por 12 horas, e implantados em joelhos de outros seis coelhos, submetidos à meniscectomia. Após 70 dias da cirurgia, foi realizada a eutanásia dos animais e retirada dos aloenxertos para avaliação mecânica. O segundo grupo (controle) foi composto por seis meniscos mediais, retirados dos joelhos contralaterais (direito) dos mesmos animais. Para a amostra estudada, não houve diferença estatisticamente significante entre os grupos controle e tratado para nenhuma das variáveis analisadas, demonstrando que a reidratação de aloenxertos meniscais, após preservação em glicerina, mantém as características mecânicas desses, após 70 dias de implantação, semelhantes às de meniscos frescos.

We evaluated the mechanical properties, strength, strain and stress to the elastic limit, the rupture stress point and stiffness index of fresh menisci and menisci transplanted for 70 days in the knees of rabbits after preservation in glycerin. The first group (treated) was formed by six medial menisci of the left knee, collected from these animals for commercial breeding. These menisci were stored in 98% glycerin for a period of 30-60 days, and then rehydrated in a solution in 0.5% saline enrofloxacin for 12 hours, and implanted in the knees of another six rabbits underwent meniscectomy . After 70 days of surgery was performed the euthanasia of animals and removal of allografts for mechanical evaluation. The second group (control) consisted of six medial menisci, removed from the contralateral knees (right) of the same animals. For the sample studied, had no statistically significant difference between control and treated groups for any of the variables analyzed, showing that the rehydration of meniscal allografts after preservation in glycerin keeps the mechanical characteristics of these, after 70 days of implantation, similar to the meniscus fresh.

Guía para el diagnóstico, seguimiento y tratamiento de la enfermedad de Fabry / Guidelines for diagnosis, monitoring and treatment of Fabry disease

La enfermedad de Fabry es un trastorno de almacenamiento lisosomal hereditario ligado al cromosoma X, ocasionado por el déficit de la enzima alfa galactosidasa A. El conocimiento sobre esta patología, y en particular su manejo médico, ha progresado notablemente en la última década, incluyendo el desarrollo de su tratamiento específico. La presente guía fue desarrollada por profesionales médicos de diversas especialidades involucrados en la atención de pacientes con enfermedad de Fabry. La discusión y análisis de las evidencias científicas disponibles, sumado a la experiencia de cada uno de los participantes, ha permitido desarrollar los conceptos vertidos en esta guía con el objetivo de brindar una herramienta útil para todos los profesionales que asisten a pacientes con enfermedad de Fabry.

Fabry disease is an X-linked hereditary lysosomal storage disorder caused by deficiency of the enzyme alpha-galactosidase A. Knowledge about this disease, and its medical management, has made remarkable progress in the last decade, including the development of its specific treatment. This guide was developed by medical professionals from various specialties involved in the care of patients with Fabry disease. The discussion and analysis of the available scientific evidence, coupled with the experience of each of the participants, has allowed us to develop the concepts included in this guide in order to provide a useful tool for all professionals who care for patients with Fabry disease.

Efeito de treinamentos de flexibilidade sobre a força e o torque muscular: uma revisão crítica / Effect of flexibility trainings on strength and muscle torque: a critical review

A flexibilidade é uma capacidade física de vital importância tanto para atletas como para os demais indivíduos. O presente artigo analisou estudos que observaram as possíveis influências do treino de flexibilidade nos níveis de força e torque muscular. Para isso, foi realizada uma busca na base de dados Google Scholar, com as palavras chave “Flexibility training, range of motion, strength and torque”, no período entre 2004 e 2010. Dos 23 estudos incluídos na análise, 15 observaram o efeito agudo de uma sessão de alongamento, sendo que destes, 8 não mostraram efeito do treinamento de flexibilidade nos níveis de força e torque e 7 verificaram efeito negativo no ganho de força. Ainda, 8 dos estudos analisados eram longitudinais, apresentando rotinas de treinamento de no mínimo 4 semanas de alongamento. Entre os estudos longitudinais, 7 observaram uma melhora nos níveis de força e torque e apenas um relatou influência negativa. Os estudos analisados apresentavam diferentes metodologias e protocolos de treinamento, o que dificultou a obtenção de resultados conclusivos. Entretanto, parece que o músculo avaliado tem grande importância para o resultado, isso devido às diferenças estruturais e da capacidade elástica específica dos componentes musculares. Ainda, a frequência de treinamento se mostrou mais importante que o volume de cada sessão para causar mudanças nas variáveis analisadas. Aparentemente, o treinamento de flexibilidade tem efeito agudo deletério ou neutro nos níveis de força e torque, devendo ser evitado antes de uma sessão de treinamento de força. Por outro lado, seu efeito crônico parece ser benéfico, devendo ser mantida a recomendação para a inclusão de rotinas de exercícios de flexibilidade paralelamente ao treinamento de força, como forma de se obter melhores ganhos na força e no torque muscular.

Flexibility is a paramount physical capacity for athletes and others as well. This paper has analyzed studies which had observed possible influences in flexibility training of muscle strength and muscle torque levels. In order to accomplish that we searched the Google Scholar database the following key-words: “flexibility training, range of motion, strength and torque” looking up 2004 through 2010. Of the twenty-three studies we included in this analysis, fifteen observe acute effect from a stretching session; of those, eight did not sport any strength and torque flexibility training effect and seven show a negative strength gain. Moreover, a total of eight studies we have reviewed were longitudinal, exhibiting training routines of at least four weeks of stretching. Amongst those longitudinal studies, seven depict improvement of strength and torque levels and just one mentions negative results. All surveyed results use distinct methodologies and training protocols, which made our gathering of conclusive data rather difficult. Nevertheless, it appears that the evaluated muscle is of great importance for the result due to structural discrepancies and elastic capacity specific to each muscle component. Moreover, training frequency has been revealed to be more important than the volume of each session in causing changes in the investigated variables. Apparently flexibility training has harmful to neutral acute effect of strength and torque levels and should be avoided before strength training sessions. On the other hand, its chronic impact seems to be beneficial, henceforth we recommend it should be maintained in exercise routines parallel to strength training as a means of obtaining better muscle strength and torque gain.

Valor pronóstico del eco estrés con ejercicio en pacientes con enfermedad coronaria conocida o sospechada / Prognostic value of exercise stress echocardiography in patients with know or suspected coronary artery disease

Objetivo: Establecer el valor pronóstico del eco estrés con ejercicio en pacientes con enfermedad coronaria conocida o sospechada para predecir nuevos eventos coronarios adversos mayores en el seguimiento. Materiales y métodos: Se incluyeron en forma prospectiva y sucesiva 769 pacientes con enfermedad coronaria conocida o clínicamente sospechada a los cuales se les realizó un eco estrés con ejercicio sobre banda deslizante entre julio de 1996 y febrero de 2001. El desarrollo en el empeoramiento de anormalidades preexistentes se consideran criterios de anormalidad, indicativos de isquemia. Resultados: Durante un seguimiento medio de 18,5 ± 10,5 meses, el 11 por ciento de los pacientes incluídos presentó algún tipo de evento coronario adverso mayor: muerte de causa cardíaca 0,1 por ciento, infarto agudo de miocardio 0,7 por ciento, angina inestable 2,1 por ciento, cirugía de revascularización miocárdica 3,1 por ciento e intervencionismo percutáneo coronario 5,0 por ciento. Se obtuvo un resultado positivo para isquemia en el 24,7 por ciento y negativo en el 75,3 por ciento. El 30 por ciento de los pacientes con pruebas positivas y el 4,8 por ciento de los que tuvieron una prueba negativa presentaron nuevos eventos coronarios adversos mayores. El valor predictivo de una prueba positiva fue del 30,5 por ciento, mientras que el valor predictivo negativo fue del 95,2 por ciento. Conclusión: En una muestra de una población de pacientes con enfermedad arterial coronaria conocida o clínicamente sospechada, el eco estrés con ejercicio permite una estratificación efectiva del riesgo en el largo plazo, con un alto valor predictivo negativo para nuevos eventos coronarios adversos mayores. De esta manera, se puede transmitir tranquilidad al paciente y podrían evitarse estudios o procedimientos invasivos innecesarios. En contraposición, el valor predictivo positivo es bajo.