Respuesta fisiológica al test de lanzadera en pacientes candidatos a cirugía bariátrica / Physiologic response to the incremental shuttle walk test in candidates to undergo bariatric surgery / Resposta fisiológica ao teste incremental de caminhada em candidatos a cirurgia bariátrica

Objetivos: la valoración de la tolerancia al ejercicio es clave para prescribir ejercicio en candidatos a cirugía bariátrica. El test de lanzadera (TL) se ha propuesto para este objetivo. Sin embargo, la evidencia que describe el rendimiento y respuesta fisiológica asociados a esta prueba en dicha población es escasa. El objetivo de este estudio fue describir la respuesta fisiológica a la realización del TL en candidatos a cirugía bariátrica. Métodos: este estudio transversal incluyó a 56 participantes. Se midieron factores antropométricos como la edad, peso, estatura y circunferencia de cintura, así como el nivel de actividad física espontáneo. Se valoró el rendimiento en el TL en metros, la respuesta fisiológica asociada en términos de frecuencia cardiaca de reserva (FCR) utilizada, presión arterial sistólica y diastólica, oximetría de pulso, sensación subjetiva al esfuerzo (SSE) y de fatiga de extremidades inferiores, antes y después del TL. Resultados: todos los participantes completaron la prueba sin complicaciones. Caminaron una mediana de 465 metros, equivalente al 61% de la distancia esperada. Utilizaron un 56% de la FCR, mientras que la SSE y fatiga de extremidades inferiores alcanzó valores 7/10 y 6/10 respectivamente. Fueron observadas asociaciones significativas entre el rendimiento en el TL vs factores antropométricos e indicadores de respuesta fisiológica. Conclusión: el TL es una prueba segura para valorar la tolerancia al esfuerzo en candidatos a cirugía bariátrica, la cual induce respuestas fisiológicas asociadas a intensidades moderadas. Se sugiere incluir esta prueba para la valoración de la condición física de estos sujetos.

Objective: Exercise tolerance measurement is key for exercise prescription in bariatric surgery candidates. Thus, the incremental shuttle walking test (ISWT) has been proposed as a useful tool for this purpose. However, reports describing the performance, and related physiological response, in candidates to bariatric surgery are scarce. Therefore, the aim of this study was to describe the physiological response of bariatric surgery candidates to the ISWT. Methods: This cross-sectional study included 56 participants. Anthropometric factors such as age, weight, height, and waist circumference were measured, as well as their spontaneous physical activity levels. Their ISWT performance was recorded, as well as the percentage of heart rate reserve used during the test, systolic and diastolic pressure, pulse oximetry, perceived exertion scale, and lower extremities fatigue, both before and after the ISWT. Results: All participants completed the test without complications. They walked a median of 465 meters, 61% of the expected distance. Heart rate reserve utilization reached 56%, while the perceived exertion rate and lower extremities fatigue reached 7/10 and 6/10, respectively. Moreover, significant associations between the ISWT performance vs anthropometric factors and physiological response outcomes were found. Conclusion: The ISWT is a safe and useful tool to assess exercise tolerance in bariatric surgery candidates, which induces physiological responses associated to moderate effort intensities. We suggest including the ISWT when assessing the physical performance of bariatric surgery candidates.

Objetivo: A medida da tolerância ao exercício é fundamental para a prescrição do exercício em candidatos à cirurgia bariátrica. Assim, o teste incremental de caminhada em vaivém (ISWT) tem sido proposto como uma ferramenta útil para este fim. No entanto, são escassos os relatos que descrevem o desempenho e a resposta fisiológica relacionada em candidatos à cirurgia bariátrica. Portanto, o objetivo deste estudo foi describir a resposta fisiológica do ISWT em candidatos à cirurgia bariátrica. Métodos: Este estudo transversal incluiu 56 participantes. Fatores antropométricos como idade, peso, altura, circunferência da cintura foram medidos, assim como os níveis de atividade física espontânea. O desempenho do ISWT foi registrado, assim como a porcentagem de reserva de frequência cardíaca utilizada durante o teste, pressão sistólica e diastólica, oximetria de pulso, escala de esforço percebido e fadiga de membros inferiores, tanto antes quanto após o ISWT. Resultados: Todos os participantes completaram o teste sem intercorrências. Eles caminharam uma mediana de 465 metros, o equivalente a 61% da distância esperada. A utilização de reserva de frequência cardíaca atingiu 56%, enquanto a taxa de esforço percebido e fadiga de membros inferiores atingiram 7/10 e 6/10, respectivamente. Além disso, foram encontradas associações significativas entre o desempenho do ISWT versus fatores antropométricos e os resultados da resposta fisiológica. Conclusão: O ISWT é uma ferramenta segura e útil para avaliar a tolerância ao exercício em candidatos à cirurgia bariátrica, que induz respostas fisiológicas associadas a intensidades moderadas de esforço. Sugerimos incluir o ISWT para avaliar o desempenho físico dos candidatos à cirurgia bariátrica.

Repercusiones pulmonares en pacientes con pectus excavatum: puesta al día / Pulmonary consequences on patients with pectus excavatum: update / Repercussões pulmonares em pacientes com pectus excavatum: atualização

El pectus excavatum (PEX) es una deformación de la pared torácica que obedece a una alteración de los cartílagos costales con el consiguiente hundimiento del esternón. Históricamente se clasificaba como un defecto únicamente estético o cosmético, sin embargo en los últimos años se han desarrollado nuevos métodos de estudio para la valoración de las repercusiones de esta patología, y existe cada vez más bibliografía que demuestra importantes repercusiones funcionales. Se realizó una puesta al día de las repercusiones pulmonares de la patología y análisis de los artículos más relevantes de los últimos años. Los síntomas respiratorios son frecuentes, estando presentes en más de la mitad de los pacientes. Se ha demostrado una disminución de la CVF, VEF1 y PEF25%-75%; así como la presencia de un patrón restrictivo y/o obstructivo, un aumento del VR y una alteración de la dinámica respiratoria. Se ha objetivado la afectación del PEX sobre la función pulmonar, determinando categóricamente que esta patología presenta una importante repercusión funcional.

Pectus excavatum (PEX) is a thoracic wall malformation due to an alteration of the costal cartilages with subsequent sinking of the sternum. Historically, it was considered a mere aesthetic or cosmetic defect, however, in recent years, new assessment methods have been developed to evaluate the repercussions of this pathology, and there is an increasing literature that demonstrates important functional consequences. We carried out an update of this pathology's pulmonary repercussions and analyzed the most relevant articles of the recent years. Respiratory symptoms are frequent, present in more than half of the patients. A decrease in FVC, FEV1 and PEF25%-75% has been shown; as well as the presence of a restrictive and/or obstructive pattern, an increase in RV and an alteration in respiratory dynamics. The affectation of PEX on pulmonary function has been objectified, and it has been determined categorically that this pathology has important functional consequences.

Pectus excavatum (PEX) é uma deformação da parede torácica devido a uma alteração das cartilagens costais com consequente afundamento do esterno. Historicamente, foi classificado como um defeito exclusivamente estético ou cosmético, porém, nos últimos anos, novos métodos de estudo foram desenvolvidos para avaliar as repercussões dessa patologia, e há uma literatura crescente que demonstra importantes repercussões funcionais. Foi realizada uma atualização das repercussões pulmonares da patologia e análise dos artigos mais relevantes dos últimos anos. Os sintomas respiratórios são frequentes, estando presentes em mais da metade dos pacientes. Foi demonstrada uma diminuição da CVF, VEF1 e PEF25-75%; bem como a presença de padrão restritivo e/ou obstrutivo, aumento do VD e alteração da dinâmica respiratória. A afetação do PEX na função pulmonar tem sido objetivada, determinando categoricamente que esta patologia apresenta importante repercussão funcional.

Effects of home-based inspiratory muscle training on sickle cell disease (SCD) patients

ABSTRACT Introduction: Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. Methods: This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. Results: Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSβ0 vs HbSC and HbSβ+), without differences between groups. Conclusion: Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. Trial registration:http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.

Cambios en la capacidad física y algunas variables fisiológicas en pacientes con insuficiencia cardiaca a las 6 y 12 semanas de un programa de rehabilitación cardiaca / Changes in physical capacity and some physiological variables in patients with cardiac insufficiency at 6 and 12 weeks of a cardiac rehabilitation program

Resumen Introducción: La insuficiencia cardiaca es un estado fisiopatológico y clínico en el cual el corazón es incapaz de aportar sangre de acuerdo con los requerimientos metabólicos periféricos, repercutiendo directamente sobre la capacidad aeróbica. La rehabilitación cardiaca durante 12 semanas tiene beneficios claros principalmente sobre la capacidad aeróbica, pero son pocos los estudios que detallan dichos cambios en el transcurso del proceso de intervención. Objetivo: Determinar los cambios en la capacidad aeróbica y algunas variables fisiológicas en pacientes con insuficiencia cardiaca, a las 6 y 12 semanas de su rehabilitación cardiaca. Método: Estudio de tipo descriptivo longitudinal. La muestra se constituyó por 23 pacientes vinculados a un programa de rehabilitación cardiaca, donde realizaron prueba de esfuerzo en tres momentos (inicio y semanas 6 y 12). Las variables cuantitativas se compararon en tres momentos utilizando la prueba de medidas repetidas hasta tres colas, teniendo en cuenta la homogeneidad y la igualdad de varianzas. La significación estadística fue de 0.05. Resultados: El consumo de oxígeno mostró un aumento de 3,6 ml/kg/min durante la rehabilitación, encontrando diferencias estadísticamente significativas en los tres momentos de medición, pero se evidenció un mayor incremento entre las semanas 1 y 6 (p = 0.00), cuando se registró un cambio de 2,2 ml/kg/min. La medición de la presión arterial sistólica/diastólica inicial y final mostró una disminución (p < 0.05). Conclusiones: En pacientes con insuficiencia cardiaca, el consumo de oxígeno obtuvo un incremento progresivo a lo largo de las 12 semanas de rehabilitación cardiaca, observándose su mayor incremento en las primeras 6 semanas de intervención.

Abstract Introduction: Heart failure is a pathological and clinical state in which the heart is unable to provide blood according to peripheral metabolic requirements having a direct impact on aerobic capacity. Cardiac rehabilitation for 12 weeks has clear benefits mainly on aerobic capacity, but few studies detail such changes over the course of the intervention process. Objective: To determine changes in aerobic capacity and some physiological variables in patients with cardiac insufficiency, at 6 and 12 weeks after cardiac rehabilitation. Method: Longitudinal descriptive type study. The sample was made up of 23 patients linked to a cardiac rehabilitation program, where they performed stress testing at three times (start, weeks 6 and 12). Quantitative variables were compared in 3 moments using the repeated measurement test up to 3 tails, taking into account the homogeneity and equality of variances. The statistical significance was 0.05. Results: Oxygen consumption showed an increase of 3.6 ml/kg/min during rehabilitation, finding statistically significant differences in the three measurement moments but there was a greater increase between week 1 and 6 (p = 0.00) where a change of 2.2 ml/kg/min was recorded. Measurement of initial and final systolic/diastolic blood pressure showed a decrease (p < 0.05). Conclusions: In patients with heart failure, oxygen consumption achieved a progressive increase over 12 weeks of cardiac rehabilitation, with its largest increase seen in the first 6 weeks of intervention.

Continuous Aerobic Training and High Intensity Interval Training Increase Exercise Tolerance in Heart Failure Patients: A Retrospective Study

Abstract Background: Conventional aerobic training is the first choice in cardiac rehabilitation for patients with chronic heart failure (CHF). However, high-intensity interval training (HIIT) may be an alternative, although it has little evidence. Objectives: To evaluate the effect of continuous aerobic training (CAT) or HIIT on exercise tolerance in CHF patients. Methods: Retrospective study with 30 patients, of both genders, members of a 10-week CAT or HIIT program. The control group (CON) consisted of patients who did not participate voluntarily in the program. Peak oxygen uptake (VO2peak), thresholds (LV1 and LV2), and ventilatory efficiency in the production of dioxide (VE/VCO2 slope), oxygen uptake efficiency (OUES), and VO2 recovery kinetics were analyzed. A two-way or repeated measures ANOVA was used, followed by Fisher's post-hoc test (p<0.05). Results: After 10 weeks of training, the CAT group increased the treadmill speed at LV1 (p=0.040), while the HIIT increased both the speed (p=0.030) and incline of the treadmill (p<0.001) for VO2peak and LV2, as well as the total time of the cardiopulmonary test. The VE/VCO2 slope was lower than that predicted for CAT (p=0.003) and HIIT (p=0.008). There was no change in VO2peak, recovery of heart rate (HR), and VO2, VE/VCO2, and OUES in both groups. Conclusions: After 10 weeks, both CAT and HIIT increased the tolerance to physical exercise. However, HIIT showed improvement in more parameters, differently from CAT.

Resistência muscular periférica e inspiratória reduzida em pacientes com cirrose hepática: um estudo transversal / Reduced peripheral and inspiratory muscle endurance in patients with liver cirrhosis: a cross-sectional study

ABSTRACT BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION: Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.

RESUMO CONTEXTO: A cirrose hepática (CH) causa várias alterações musculoesqueléticas. OBJETIVO: Testar a hipótese de que as resistências dos músculos periféricos e inspiratórios estão reduzidas em pacientes com CH. MÉTODOS: Vinte e um pacientes com CH (grupo CH; 61±14 anos) e 18 indivíduos pareados por idade (grupo controle; 56±17 anos) aceitaram participar deste estudo observacional transversal. Para avaliar a resistência muscular periférica, todos os voluntários realizaram um exercício de preensão manual rítmica a 45% de sua contração voluntária máxima. Um metrônomo foi usado para controlar os ciclos de contração-relaxamento a 60/min. A resistência muscular inspiratória foi avaliada com o PowerBreath®. Os participantes foram submetidos a exercícios musculares inspiratórios a 60% de sua força muscular inspiratória máxima. O tempo até a falha caracterizou a resistência muscular para os exercícios de preensão manual e de músculos inspiratórios. Além disso, foi avaliada a qualidade de vida dos participantes. RESULTADOS: A resistência muscular foi menor no grupo CH quando comparada ao grupo controle tanto para os exercícios de preensão manual (67 vs 130 s, P<0,001) quanto para os músculos inspiratórios (40 vs 114 s, P<0,001). A resistência muscular periférica foi diretamente correlacionada com o escore total de qualidade de vida (r=0,439, P=0,01) e com os seguintes domínios: fadiga (r=0,030, P=0,378), atividade (r=0,378 e P=0,030), sintomas sistêmicos (r=0,316, P=0,073) e preocupação (r=0,370, P=0,034). A resistência muscular inspiratória foi inversamente correlacionada com o escore total de qualidade de vida (r=0,573, P=0,001) e com os seguintes domínios: fadiga (r=0,503, P=0,002), atividade (r=0,464, P=0,004), sintomas sistêmicos (r=0,472, P=0,004), sintomas abdominais (r=0,461, P=0,005), função emocional (r=0,387, P=0,02) e preocupação (r=0,519, P=0,001). CONCLUSÃO: As resistências musculares periférica e inspiratória foram menores nos pacientes com CH quando comparados ao grupo controle.

Muscle oxygenation of the quadriceps and gastrocnemius during maximal aerobic effort / Oxigenación muscular de cuádriceps y gastrocnemio durante el esfuerzo aeróbico máximo / Oxigenação muscular de quadríceps e gastrocnêmio durante o esforço aeróbico máximo

ABSTRACT Introduction: Near infrared spectroscopy (NIRS) is a non-invasive technique that is used in the assessment of tissue oxygenation and the monitoring of physical activity. Objective: To determine the influence of sexual, anthropometric and ergospirometric factors on muscle oxygenation of the quadriceps and gastrocnemius, obtained by NIRS during a stress test. Methods: Twenty healthy subjects participated in this study (10 women). Two Humon Hex® devices were placed on the dominant side of the quadriceps and gastrocnemius muscles to measure muscle oxygen saturation (SmO2). The stress test was performed on a treadmill with electrocardiographic control and measurement of oxygen consumption. SmO2 was obtained at rest and after maximum effort during the stress test. In addition, the height, weight, skinfold and waist contour were measured. Bioimpedance was used to obtain the percentages of fat mass and muscle mass, which were used to calculate the relative fat mass (RFM). Results: The SmO2 of both muscles at rest is higher in males than in females. At maximum effort, the SmO2 of the quadriceps is similar in both groups. The SmO2 of both muscles is positively related to height, body mass, percentage of mass muscle and waist contour, and negatively with percentage of mass fat, RFM and skinfold thickness. The negative correlation between fat percentage and oxygen saturation is more evident in females. It was observed that the variables that quantify maximum effort are not related to the SmO2 values, except for the correlation between HR max and SmO2 of the gastrocnemius muscle in males. Conclusion: The SmO2 of recreational athletes is influenced by the location of the device and the fat mass of the subjects. The biggest differences between the sexes are in the gastrocnemius muscle. Level of Evidence II; Diagnostic Studies - Investigating a Diagnostic Test .

RESUMEN Introducción: La espectroscopia de infrarrojo cercano (NIRS) es una técnica no invasiva usada en la evaluación de la oxigenación tisular y en la monitorización de la actividad física. Objetivos: Determinar la influencia de factores sexuales, antropométricos y ergoespirométricos sobre la oxigenación muscular de cuádriceps y del gastrocnemio, obtenidos por NIRS durante un test de esfuerzo. Métodos: Participaron en este estudio 20 individuos saludables (10 mujeres). Se colocaron dos dispositivos Humon Hex® en el lado dominante de los músculos cuádriceps y gastrocnemio para medir la saturación de oxígeno muscular (SmO2). El test de esfuerzo fue realizado en una cinta ergométrica con control electrocardiográfico y medición del consumo de oxígeno. La SmO2 fue obtenida en reposo y después de esfuerzo máximo durante el test. Además, fueron medidos altura, peso, pliegues cutáneos y contorno de la cintura. Fue usada bioimpedancia para obtener los porcentuales de masa grasa y masa muscular, que fueron usados para calcular la masa grasa relativa (MGR). Resultados: La SmO2 de ambos músculos en reposo es mayor en hombres que en mujeres. En el esfuerzo máximo la SmO2 del cuádriceps es semejante en los dos grupos. La SmO2 de ambos músculos es positivamente relacionada con altura, masa corporal, porcentual de masa muscular y contorno de la cintura y negativamente relacionada con el porcentaje de masa grasa, MGR y espesor de los pliegues cutáneos. La correlación negativa entre el porcentual de grasa y la saturación de oxígeno es más evidente en las mujeres. Se observó que variables que cuantifican el esfuerzo máximo no está relacionadas con los valores SmO2, excepto por la correlación entre FCmáx y SmO2 del músculo gastrocnemio en sexo masculino. Conclusión: La SmO2 de los atletas recreativos es influenciada por la localización del dispositivo y por la masa grasa de los individuos. Las mayores diferencias entre los sexos están en el músculo gastrocnemio. Nivel de Evidencia II; Estudios diagnósticos - Investigación de un examen para diagnóstico .

RESUMO Introdução: A espectroscopia de infravermelho próximo (NIRS) é uma técnica não invasiva usada na avaliação da oxigenação tecidual e no monitoramento da atividade física. Objetivos: Determinar a influência de fatores sexuais, antropométricos e ergoespirométricos sobre a oxigenação muscular do quadríceps e do gastrocnêmio obtidos por NIRS durante um teste de esforço. Métodos: Participaram deste estudo 20 indivíduos saudáveis (10 mulheres). Dois dispositivos Humon Hex® foram colocados no lado dominante dos músculos quadríceps e gastrocnêmio para medir a saturação de oxigênio muscular (SmO2). O teste de esforço foi realizado em uma esteira com controle eletrocardiográfico e mensuração do consumo de oxigênio. A SmO2foi obtida em repouso e depois de esforço máximo durante o teste. Além disso, foram medidos estatura, peso, dobras cutâneas e contorno da cintura. A bioimpedância foi usada para obter os percentuais de massa gorda e massa muscular, que foram usados para calcular a massa gorda relativa (MGR). Resultados: A SmO2de ambos os músculos em repouso é maior em homens do que em mulheres. No esforço máximo, a SmO2do quadríceps é semelhante nos dois os grupos. A SmO2de ambos os músculos é positivamente relacionada com estatura, massa corporal, percentual de massa muscular e contorno da cintura e negativamente relacionada com a porcentagem de massa gorda, MGR e espessura das dobras cutâneas. A correlação negativa entre o percentual de gordura e a saturação de oxigênio é mais evidente nas mulheres. Observou-se que variáveis que quantificam o esforço máximo não estão relacionadas com os valores SmO2, exceto pela correlação entre FCmáx e SmO2do músculo gastrocnêmio no sexo masculino. Conclusão: A SmO2dos atletas recreativos é influenciada pela localização do dispositivo e pela massa gorda dos indivíduos. As maiores diferenças entre os sexos estão no músculo gastrocnêmio. Nível de Evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico .

Seguridad y mayor tolerancia al esfuerzo con entrenamiento interválico en comparación con el entrenamiento de intensidad moderada continua en cardiópatas de riesgo cardiovascular muy alto / Safety and improvement in exercise tolerance with interval training vs moderate-intensity continuous training in heart disease patient of very high cardiovascular risk

Resumen Objetivo: Evaluar la seguridad y el efecto del entrenamiento por intervalos de moderada y alta intensidad (EIMI, EIAI) y compararlo con el entrenamiento de intensidad moderada continua (EIMC) en pacientes de riesgo cardiovascular (RCV) muy alto. Método: Estudio cuasi experimental de 81 pacientes que ingresaron al programas de rehabilitación cardíaca y prevención secundaria (PRHCPS); en la estratificación de riesgo, todos los pacientes presentaron ≥ 2 factores de RCV alto. Entrenamiento concurrente: aeróbico supervisado: 2 semanas de entrenamiento de base de EIMC; luego el grupo EIMC con la misma prescripción, EIMI a 3 intervalos de 3' al 70 a 80% de FCR con pausas activas de 3' al 60 a 70% de FCR; EIAI, 3 intervalos de 3' a 80 a 90% de FCR con pausas activas de 3' al 70 a 80% de FCR, entrenamiento de fuerza con tres sesiones semanales de ejercicios isotónicos y una de calistenia e intervención multidisciplinaria. Resultados: 81 pacientes asignados en tres grupos: 61 a EIMC, 13 a EIMI y 7 a EIAI, sin diferencias significativas en las variables epidemiológicas. Hubo ganancias porcentuales en MET-carga de 45%, 60% y 86% (p = 0.17) y carga-vatios de 51, 44 y 48 en EIMC, EIMI, EIAI, respectivamente (p = 0.54). A pesar de no existir diferencias estocásticamente significativas intergrupales, sí se registró una ganancia mayor en MET-carga en el grupo de EIAI. No se observó desenlace adverso en ningún tipo de entrenamiento. Conclusiones: En cardiópatas de riesgo cardiovascular muy alto, el entrenamiento interválico EIMI/EIAI supervisado es seguro, con tendencia a mayor ganancia en tolerancia al esfuerzo (MET-carga) con el EIAI en comparación con el EIMC.

Abstract Objective: Evaluate safety and effects of training at moderate and high intensity intervals (MIIT, HIIT) compared to continuous moderate intensity training (MICT) in heart disease patient with very high cardiovascular risk (CVR). Method: Quasi-experimental study of 81 patients in a cardiac rehabilitation (CR) program, after risk stratification, all patients presented at least 2 factors with high CVR. All patients were provided supervised concurrent training: aerobic: initially 2 weeks MICT. subsequently MICT group with same prescription, MIIT 3 intervals of 3 ‘to 70-80% FCR with active pause exercise of 3' to 60 a 70% FCR, HIIT 3 intervals of 3'a 80-90% FCR with active pause exercise of 3 ‘70 a 80% FCR, resistance training 3 weekly sessions isotonic exercises and 1 calisthenics and multidisciplinary intervention. Results: 81 patients assigned to: 61 MICT group, 13 MIIT and 7 HIIT, no significant differences were observed. Percentage gains were obtained in METs-load 45%, 60% and 86% (p = 0.17) and watts 51, 44 and 48 in MICT, MIIT, HIIT respectively (p = 0.54). Although there are no statistical significant intergroup differences if there is a greater improvement in MET-load in the HIIT group. There was no adverse outcome in any training. Conclusions: In very high cardiovascular risk heart disease patient, supervised interval training (MIIT/HIIT) is safe, with a tendency to greater improvement in exercise tolerance (METs-load) with HIIT compared to MICT.

Cardiorespiratory function of patients with adolescent idiopathic scoliosis / Função cardiorrespiratória de pacientes com escoliose idiopática do adolescente / Función cardiorrespiratoria de pacientes con escoliosis idiopática del adolescente

ABSTRACT Objective: Adolescent idiopathic scoliosis (AIS) is a spinal deformity that can cause cardiorespiratory dysfunction, contributing to decreases in tolerance for aerobic exercise (TAE) and in functionality. The objective is to assess the TAE and lung capacity of patients who underwent corrective AIS surgery in the pre- (PRE) and postoperative (POST) periods. Methods: Sixty individuals, PRE (n=30, age: 18.5±2.4 years) and POST (n=30, age: 24.5±4.5 years), participated in the study. The forced vital capacity (FVC), the forced expiratory volume in the first second (FEV1) and the FEV1/FVC ratio, as well as the maximum inspiratory and expiratory pressure were verified. The TAE was assessed by the distance travelled in the 6-minute walk test (6MWT), together with blood pressure, heart rate, respiratory rate and peripheral oxygen saturation measured at the beginning and at the end of the test. Results: A mild restrictive pattern in lung function and reduced expiratory muscle strength were observed in both groups, but with no difference between the PRE and POST groups. No difference was found between the PRE (534±67.1 m) and POST (541± 69.5 m) groups for the distance travelled in the 6MWT, though both were below the predicted percentage (82.8±10.0% and 84.8±10.9%, respectively). Hemodynamic and respiratory changes caused by the 6MWT were observed, except for the peripheral oxygen saturation. Conclusion: The results suggest that even after surgical correction, patients with AIS continue to have low TAE. Level of evidence III; Therapeutics Study - Investigation of Treatment Results / Case-control study.

RESUMO Objetivo: A escoliose idiopática do adolescente (EIA) é uma deformidade da coluna que pode ocasionar disfunções cardiorrespiratórias, contribuindo para a diminuição da tolerância ao exercício aeróbio (TEA) e da funcionalidade. O objetivo é avaliar a TEA e a capacidade pulmonar em pacientes no pré (PRÉ) e pós-operatório (PÓS) de correção da EIA. Métodos: Participaram 60 indivíduos PRÉ (n = 30, idade: 18,5 ± 2,4 anos) e PÓS (n = 30, idade: 24,5 ± 4,5 anos). A capacidade vital forçada (CVF), o volume expiratório forçado no primeiro segundo (VEF1) e a razão VEF1/CVF, assim como as pressões inspiratória e expiratória máximas, foram verificados. A TEA foi avaliada pela distância percorrida no teste de caminhada de 6 minutos (TC6), acompanhado de medidas de pressão arterial, frequência cardíaca, frequência respiratória e saturação periférica de oxigênio no início e no final do teste. Resultados: Um padrão restritivo leve na função pulmonar e força da musculatura expiratória reduzida foram observados em ambos os grupos, mas sem diferença entre PRÉ e PÓS. Não foi encontrada diferença entre PRÉ (534 ± 67,1 m) e PÓS (541 ± 69,5 m) para a distância percorrida no TC6, abaixo do predito para ambos os grupos (82,8 ± 10,0% e 84,8 ± 10,9%, respectivamente). Foram observadas alterações hemodinâmicas e respiratórias provocadas pelo TC6, exceto para a saturação periférica de oxigênio. Conclusões: Os resultados sugerem que mesmo após a correção cirúrgica os pacientes com EIA continuam apresentando baixa TEA. Nível de evidência III; Estudos terapêuticos - Investigação dos Resultados do Tratamento / Estudo de caso-controle.

RESUMEN Objetivo: La escoliosis idiopática del adolescente (EIA) es una deformidad de la columna que puede causar disfunciones cardiorrespiratorias, contribuyendo para la disminución de la tolerancia al ejercicio aeróbico (TEA) y de la funcionalidad. El objetivo es evaluar la TEA y la capacidad pulmonar en pacientes en el pre (PRE) y postoperatorio (POS) de corrección de la EIA. Métodos: Participaron 60 individuos PRE (n=30, edad: 18,5±2,4 años) y POS (n=30, edad: 24,5±4,5 años). Fueron verificadas la capacidad vital forzada (CVF), el volumen espiratorio forzado en el primer segundo (VEF1) y la razón VEF1/CVF, así como las presiones inspiratoria y espiratoria máximas. La TEA fue evaluada por la distancia recorrida en el test de caminata de 6 minutos (TC6), acompañado de mediciones de presión arterial, frecuencia cardíaca, frecuencia respiratoria y saturación de oxígeno al inicio y al final del test. Resultados: Fueron observados un patrón restrictivo leve y fuerza muscular espiratoria reducida en ambos grupos, pero sin diferencia entre PRE y POS. No fue encontrada diferencia entre PRE (534 ± 67,1 m) y POS (541 ± 69,5 m) para la distancia recorrida en el TC6, por debajo de los predicho para ambos grupos (82,8 ± 10,0% y 84,8 ± 10,9%, respectivamente). Se observaron alteraciones hemodinámicas y respiratorias provocadas por el TC6, excepto para la saturación periférica de oxígeno. Conclusiones: Los resultados sugieren que incluso después de la corrección quirúrgica, los pacientes con EIA continúan presentando baja TEA. Nivel de evidencia III; Estudios Terapéuticos - Investigación de los Resultados del Tratamiento / Estudio de caso-control.

Reference Equation for the Six-Minute Walk Test in Brazilian Patients with Obesity

Abstract Background: Obesity has repercussions on functional capacity (FC). The six-minute walk test (6MWT) is a useful tool for assessing submaximal FC, and the distance reached at 6 minutes of walking (D6MW) is a relevant prognostic marker. Objective: This paper aims to establish a reference equation for the distance predicted in 6MWT in obese Brazilian subjects. Methods: This study included 460 patients (306 women), with a body mass index (BMI) > 30 kg/m2, 71% (328) of whom presented a grade III obesity (BMI ≥ 40 Kg/m²) and were evaluated with 6MWT. Heart rate, blood pressure, oxygen saturation and Borg scale perception of effort were recorded before and after the 6MWT. For statistical analysis, Kolmogorov-Smirnov tests, an unpaired T-Test, Pearson's correlation, and multiple linear regression were used, together with a significance level set at p<0.05. Results: Gender, age, and BMI were significantly correlated with D6MW and were identified by multiple linear regression as the best predictors of the D6MW. Together, they explain 48.7% of the D6MW variance for obese Brazilian subjects. Based on these findings, an equation was proposed - D6MW = 930.138 + (27.130 x Genderfemales = 0; males = 1) − (5.550 x BMI kg/m2) − (4.442 x Age years). When the average of the D6MW obtained with the above equation was compared to the average calculated with the equations described in medical literature for healthy and obese individuals, the latter tended to overestimate the D6MW. Conclusion: The proposed reference equation exhibited better assessment of FC in obese Brazilian patients, providing proper subsidies for the follow up ofinterventions in this population..

Oxigenación de músculos respiratorios y locomotores durante el test cardiopulmonar en pacientes con circulación de fontan: serie de casos / Patients with fontan: oxygen consumption in respiratory and Locomotor muscles during excersie testing

Resumen: Antecedentes: Los pacientes con circulación de Fontan (PCF) presentan limitación cardíaca durante el esfuerzo máximo lo que repercute en menor capacidad de ejercicio (VO2-peak). La rehabilitación cardiovascular (RC) revierte este desacondicionamiento, al aumentar el gasto cardíaco y diferencia arteriovenosa de oxígeno, aspectos evaluados con monitorización invasiva y gases exhalados. La valoración no invasiva de la saturación muscular de oxígeno (SmO2) es un método de reciente aplicación para evaluar la limitación muscular al ejercicio. En PCF esta limitación puede atribuirse a la mayor acción de músculos respiratorios (cambios ventilatorios) y/o locomotores (carga periférica). Objetivo: Evaluar el trabajo de músculos respiratorios y locomotores durante el ejercicio físico máximo e incremental mediante los cambios en la SmO2. Métodos: A seis PCF (5 hombres; 13.8±2.9 años; 158±9cm; 49.8±13.3 kg) se les valoró el VO2-peak (23.0±4.5mL·kg-1·min-1) mediante ciclo-ergoespirometría sincrónicamente con SmO2 en músculos respiratorios (SmO2-m.Intercostales) y locomotores (SmO2-m.Vastus-Laterallis) mediante espectroscopía cercana al rango infrarrojo durante el test cardiopulmonar. Resultados: SmO2-m.Intercostales disminuyó desde el 60% del VO2-peak (p<0.05), mientras que SmO2-m.Vastus-Laterallis no cambió. La ventilación pulmonar (VE) aumentó progresivamente, siendo significativo a partir del 60% VO2-peak (p<0.05). La mayor desoxigenación de SmO2-m.Intercostales (∆SmO2) se asoció con los máximos cambios en ventilación pulmonar (∆VE) en ejercicio (rho=0.80; p=0.05). Conclusiones: Durante un protocolo de esfuerzo, los pacientes con circulación de Fontan presentan mayor trabajo muscular respiratorio que locomotor. Los cambios en la ventilación pulmonar se asocian a mayor extracción de oxígeno en la musculatura respiratoria, reforzando la necesidad de incorporar el entrenamiento respiratorio en la rehabilitación cardiovascular.

Abstract: Background: During a maximum incremental exercise patients with Fontan circulation (PFC) show cardiac limitation reducing aerobic exercise capacity (VO2-peak). Cardiovascular rehabilitation (CR) reverses this deconditioning by increasing cardiac output and arteriovenous oxygen difference, aspects that can be evaluated by invasive methods and analyzing the exhaled gases. Non-invasive assessment of muscle oxygen saturation (SmO2) is a novel method for recording local oxygen levels. By this technology, it is possible to evaluate the muscle limitation to exercise. In PFC, that limitation could be attributed to higher contractions of respiratory (ventilatory changes) and/ or locomotor muscles (peripheral load). Objective: To evaluate in PFC the changes at SmO2 of respiratory and locomotor muscles during a maximum and incremental exercise protocol (cardiopulmonary test, VO2-peak). Methods: Six PFC (5 men; 13.8±2.9 years; 158±9 cm; 49.8±13.3 kg) were assessed during the VO2peak test (23.0±4.5mL·kg-1·min-1) by cyclo-ergospirometry synchronously with SmO2 at respiratory (SmO2-m.Intercostales) and locomotor (SmO2-m. Vastus-Laterallis) muscles by Near-Infrared Spectroscopy (NIRS). Results: SmO2-m.Intercostales decreased from 60% of VO2-peak (p<0.05), while SmO2-m.Vastus-Laterallis did not change. Minute ventilation (VE) increased progressively, showing changes to rest at 60% of VO2-peak (p<0.05). The higher deoxygenation of SmO2-m.Intercostales (∆SmO2) correlated to maximum changes of lung ventilation (∆VE) (rho=0.80; p=0.05). Conclusions: During an incremental and maximum exercise protocol, patients with Fontan circulation have more work at respiratory than locomotor muscles. Changes in VE are direct associated with greater extraction of oxygen at respiratory muscles, reinforcing the incorporation of respiratory muscle training in cardiovascular rehabilitation.

Effect of high-intensity interval training on aerobic capacity and heart rate control of heart transplant recipients: a systematic review with meta-analysis

Abstract Introduction: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. High-intensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderate-intensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. Methods: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Meta-analysis was performed using the random-effects, generic inverse variance method. Results: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. Conclusion: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

O Papel da Ecocardiografia sob Estresse na Detecção Precoce de Disfunção Diastólica em Pacientes com Doença Pulmonar Obstrutiva Crônica Não Grave / The Role of Stress Echocardiography in the Early Detection of Diastolic Dysfunction in Non-Severe Chronic Obstructive Pulmonary Disease Patients

Resumo Fundamento A dispneia por esforço é uma queixa comum de pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) e doença pulmonar obstrutiva crônica (DPOC). A ICFEP é comum na DPOC e é um fator de risco independente para a progressão e exacerbação da doença. A detecção precoce, portanto, tem grande relevância clínica. Objetivos O objetivo deste estudo foi detectar a frequência de ICFEP mascarada em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular manifesta, e analisar a correlação entre ICFEP mascarada e os parâmetros do teste cardiopulmonar de exercício (TCPE). Métodos Aplicamos o TCPE em 104 pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. A ecocardiografia foi realizada antes e no pico do TCPE. Os valores de corte para disfunção diastólica ventricular esquerda e direita induzida por estresse (DDVE/DDVD) foram E/e' >15; E/e' >6, respectivamente. A análise de correlação foi feita entre os parâmetros do TCPE e o estresse E/d'. Valor de p<0,05 foi considerado significativo. Resultados 64% dos pacientes tinham DDVE induzida por estresse; 78% tinham DDVD induzida por estresse. Ambos os grupos com estresse DDVE e DDVD obtiveram carga menor, V'O2 e pulso de O2 mais baixos, além de apresentarem redução na eficiência ventilatória (maiores inclinações de VE/VCO2). Nenhum dos parâmetros do TCPE foram correlacionados com E/e' DDVE/DDVD induzida por estresse. Conclusão Há uma alta prevalência de disfunção diastólica induzida por estresse em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. Nenhum dos parâmetros do TCPE se correlaciona com E/e' induzida por estresse. Isso demanda a realização de Ecocardiografia sob estresse por exercício (EES) e TCPE para detecção precoce e manejo adequado da ICFEP mascarada nesta população. (Arq Bras Cardiol. 2021; 116(2):259-265)

Abstract Background Exertional dyspnea is a common complaint of patients with heart failure with preserved ejection fraction (HFpEF) and chronic obstructive pulmonary disease (COPD). HFpEF is common in COPD and is an independent risk factor for disease progression and exacerbation. Early detection, therefore, has great clinical relevance. Objectives The aim of the study is to detect the frequency of masked HFpEF in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease, and to analyze the correlation between masked HFpEF and the cardiopulmonary exercise testing (CPET) parameters. Methods We applied the CPET in 104 non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. Echocardiography was performed before and at peak CPET. Cut-off values for stress-induced left and right ventricular diastolic dysfunction (LVDD/ RVDD) were E/e'>15; E/e'>6, respectively. Correlation analysis was done between CPET parameters and stress E/e'. A p-value <0.05 was considered significant. Results 64% of the patients had stress-induced LVDD; 78% had stress-induced RVDD. Both groups with stress LVDD and RVDD achieved lower load, lower V'O2 and O2-pulse, besides showing reduced ventilatory efficiency (higher VE/VCO2 slopes). None of the CPET parameters were correlated to stress-induced left or right E/e'. Conclusion There is a high prevalence of stress-induced diastolic dysfunction in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. None of the CPET parameters correlates to stress-induced E/e'. This demands the performance of Exercise stress echocardiography (ESE) and CPET for the early detection and proper management of masked HFpEF in this population. (Arq Bras Cardiol. 2021; 116(2):259-265)

Avaliação da capacidade funcional, força muscular respiratória e pico de fluxo expiratório em pacientes com apneia obstrutiva do sono / Evaluation of functional capacity, respiratory muscular strength and expiratory flow peak in patients with obstructive sleep apnea

Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é caracterizada pela obstrução das vias aéreas superiores durante o sono, o que causa efeitos sistêmicos durante a vigília. Objetivo: O objetivo deste estudo é avaliar a capacidade funcional, a força da musculatura respiratória e o pico de fluxo expiratório (PFE) de pacientes com SAOS. Métodos: Trata-se de um estudo transversal realizado na cidade de Patos de Minas/MG no ano de 2019, no qual foram incluídos 14 indivíduos que possuíam SAOS moderada e grave. Primeiramente os pacientes responderam a um questionário sociodemográfico elaborado pelos autores. Em seguida, foi realizada a manovacuometria, a mensuração do PFE e o teste de caminhada de seis minutos (TC6M). Resultados: A maioria dos pacientes eram homens (71,4%), obesos (78,6%) e hipertensos (57,1%). Como resultados dos testes obtivemos - PImáx obtida vs predita = 86,4 vs 102,8 (p = 0,004), PEmáx obtida vs predita = 98,5 vs 113,5 (p = 0,05), PFE obtido vs predito = 381,3 vs 495,8 (p < 0,001) e TC6M obtido vs predito = 485,3m vs 536,6m (p = 0,03). Conclusão: Nessa amostra de indivíduos com SAOS grave e moderada houve redução da força muscular respiratória, do PFE, e da capacidade funcional. (AU)

Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by upper airway obstruction during sleep, which causes systemic effects during wakefulness. Objective: The objective of this study is to assess functional capacity, respiratory muscle strength and peak expiratory flow (PEF) in patients with OSAS. Methods: This is a cross-sectional study held in the city of Patos de Minas/MG in the year of 2019, that included 14 individuals who had severe and moderate sleep apnea. First, the patients answered to a sociodemographic questionnaire prepared by the authors. Then, manovacuometry, PEF and six-minute walk test (6MWT) were performed. Results: Most patients were men (71.4%), obese (78.6%) and hypertensive (57.1%). As results of the tests we obtained - MIP obtained vs predicted = 86.4 vs 102.8 (p = 0.004), MPE obtained vs predicted = 98.5 vs 113.5 (p = 0.05), PEF obtained vs predicted = 381.3 vs 495.8 (p <0.001) and 6MWT obtained vs predicted = 485.3m vs 536.6m (p = 0.03). Conclusion: In this sample of individuals with severe and moderate OSAS, we observed a reduction in respiratory muscle strength, PEF, and functional capacity. (AU)

Time course of exercise capacity in patients recovering from COVID-19-associated pneumonia / Evolução temporal da capacidade de exercício em pacientes em recuperação de pneumonia associada à COVID-19

ABSTRACT Objective: High prevalences of muscle weakness and impaired physical performance in hospitalized patients recovering from COVID-19-associated pneumonia have been reported. Our objective was to determine whether the level of exercise capacity after discharge would affect long-term functional outcomes in these patients. Methods: From three to five weeks after discharge from acute care hospitals (T0), patients underwent a six-minute walk test (6MWT) and were divided into two groups according to the distance walked in percentage of predicted values: <75% group and ≥75% group. At T0 and three months later (T1), patients completed the Short Physical Performance Battery and the Euro Quality of Life Visual Analogue Scale, and pulmonary function and respiratory muscle function were assessed. In addition, a repeat 6MWT was also performed at T1. Results: At T0, 6MWD values and Short Physical Performance Battery scores were lower in the <75% group than in the ≥75% group. No differences were found in the Euro Quality of Life Visual Analogue Scale scores, pulmonary function variables, respiratory muscle function variables, length of hospital stay, or previous treatment. At T1, both groups improved their exercise capacity, but only the subjects in the <75% group showed significant improvements in dyspnea and lower extremity function. Exercise capacity and functional status values returned to predicted values in all of the patients in both groups. Conclusions: Four weeks after discharge, COVID-19 survivors with exercise limitation showed no significant differences in physiological or clinical characteristics or in perceived health status when compared with patients without exercise limitation. Three months later, those patients recovered their exercise capacity.

RESUMO Objetivo: Há relatos de altas prevalências de fraqueza muscular e de comprometimento do desempenho físico em pacientes hospitalizados em recuperação de pneumonia associada à COVID-19. Nosso objetivo foi determinar se o nível de capacidade de exercício após a alta altera os desfechos funcionais em longo prazo nesses pacientes. Métodos: Três a cinco semanas após a alta dos cuidados agudos (T0), os pacientes foram submetidos ao teste de caminhada de seis minutos (TC6) e divididos em dois grupos de acordo com a distância percorrida no TC6 (DTC6) em percentual do previsto: grupo <75% e grupo ≥75%. Em T0 e três meses depois (T1), os pacientes responderam à Short Physical Performance Battery e à Euro Quality of Life Visual Analogue Scale, e foram avaliadas a função pulmonar e a função muscular respiratória. Além disso, o TC6 foi repetido em T1. Resultados: Em T0, a DTC6 e as pontuações na Short Physical Performance Battery foram menores no grupo <75% do que no grupo ≥75%. Não foram encontradas diferenças nas pontuações na Euro Quality of Life Visual Analogue Scale, nas variáveis de função pulmonar e função muscular respiratória, no tempo de internação hospitalar ou no tratamento anterior. Em T1, ambos os grupos melhoraram a capacidade de exercício, mas apenas os indivíduos do grupo <75% apresentaram melhoras significativas na dispneia e na função dos membros inferiores. Os valores de capacidade de exercício e estado funcional retornaram aos valores previstos em todos os pacientes de ambos os grupos. Conclusões: Quatro semanas após a alta, os sobreviventes da COVID-19 com limitação ao exercício não apresentaram diferenças significativas nas características fisiológicas e clínicas ou na percepção do estado de saúde em comparação aos pacientes sem limitação ao exercício. Três meses depois, esses pacientes recuperaram sua capacidade de exercício.

Repercussão da doença arterial periférica na tolerância ao exercício e na qualidade de vida de idosos e o papel da fisioterapia cardiovascular: artigo de revisão / The impact of peripheral arterial disease on exercise tolerance and quality of life in the elderly and the role of cardiovascular physiotherapy: review article

Resumo A doença arterial periférica tem como principal sintoma a claudicação intermitente, fator que resulta em incapacidade funcional, comprometendo a qualidade de vida. Esta revisão objetivou fazer um levantamento sobre os impactos ocasionado pela doença nos idosos, investigando as possíveis contribuições da fisioterapia cardiovascular. Para isso, realizou-se uma busca nas bases de dados MEDLINE, LILACS, SciELO, Scopus, Science Direct e PEDro, a qual identificou 7.587 estudos. Desses, sete atenderam aos critérios de elegibilidade, sendo então agrupados e analisados conforme o nível de evidência, grau de recomendação e qualidade metodológica. Pôde-se observar um considerável impacto da doença sobre a tolerância ao exercício e a qualidade de vida. Quanto à abordagem terapêutica desses desfechos, os estudos relataram que houve melhora na deambulação e na qualidade de vida, aumento da capacidade funcional e redução da dor. No que se refere à modalidade de tratamento, a maioria das pesquisas incluíram exercícios aeróbicos.

Abstract The primary symptom of peripheral arterial its intermittent claudication; a condition that causes functional disabilities, compromising quality of life. This review aimed to survey the impacts of this disease on the elderly, investigating possible contributions that cardiovascular physiotherapy has to offer. Searches were run on the MEDLINE, LILACS, SciELO, Scopus, Science Direct, and PEDro databases, identifying 7,587 studies. Seven of these met the eligibility criteria and were grouped and analyzed according evidence level, recommendation grade, and methodological quality. It was observed that this disease is responsible for considerable impact on exercise tolerance and quality of life. Regarding the therapeutic approach to these outcomes, the studies reported that there were improvements in walking and quality of life, increased functional capacity, and reduced pain. With regard to the treatment modality, most research included aerobic exercises.

Reliability and validity of six-minute step test in patients with heart failure

Exercise intolerance is the hallmark consequence of advanced chronic heart failure (HF). The six-minute step test (6MST) has been considered an option for the six-minute walk test because it is safe, inexpensive, and can be applied in small places. However, its reliability and concurrent validity has still not been investigated in participants with HF with reduced ejection fraction (HFrEF). Clinically stable HFrEF participants were included. Reliability and error measurement were calculated by comparing the first with the second 6MST result. Forty-eight hours after participants underwent the 6MST, they were invited to perform a cardiopulmonary exercise test (CPET) on a cycle ergometer. Concurrent validity was assessed by correlation between number of steps and peak oxygen uptake (V̇O2 peak) at CPET. Twenty-seven participants with HFrEF (60±8 years old and left ventricle ejection fraction of 41±6%) undertook a mean of 94±30 steps in the 6MST. Intra-rater reliability was excellent for 6MST (ICC=0.9), with mean error of 4.85 steps and superior and inferior limits of agreement of 30.6 and -20.9 steps, respectively. In addition, strong correlations between number of steps and CPET workload (r=0.76, P<0.01) and peak V̇O2 (r=0.71, P<0.01) were observed. From simple linear regression the following predictive equations were obtained with 6MST results: V̇O2 peak (mL/min) = 350.22 + (7.333 × number of steps), with R2=0.51, and peak workload (W) = 4.044 + (0.772 × number of steps), with R2=0.58. The 6MST was a reliable and valid tool to assess functional capacity in HFrEF participants and may moderately predict peak workload and oxygen uptake of a CPET.