The Effect of Yiqi Huoxue Formula （益气活血方） in the Treatment of Chronic Pulmonary Heart Disease and Heart Failure with Qi Deficiency and Blood Stasis Pattern of 58 Cases： A Randomized Controlled Trial / 中医杂志

ObjectiveTo explore the effectiveness and safety of Yiqi Huoxue Formula （益气活血方， YHF） in the adjuvant treatment of chronic pulmonary heart disease （CPHD） and heart failure （HF）with qi deficiency and blood stasis pattern. MethodsOne hundred and twenty patients with CPHD and HF with qi deficiency and blood stasis pattern were allocated randomly into treatment group and control group， with 60 case in each group. The control group was given conventional basic western medicine， while the treatment group was given oral administration of YHF granules in addition， one dose per day. The treatment course for both groups was 8 weeks. The TCM symptom scores， Minnesota Life Quality Scale （MLHF-Q） scores， echocardiographic indicators including right ventricular end-diastolic diameter （RVEDD）， left ventricular end-diastolic diameter （LVEDD）， left atrial end-diastolic diameter （LAEDD） and pulmonary artery mean pressure （PAMP）， six-minute walking distance （6MWD）， and plasma N-terminal pro-B-type natriuretic peptide （NT-ProBNP） level were compared between the groups. The effectiveness regarding cardiac function and TCM syndromes were compared between the two groups after treatment， and the occurrence of adverse events was observed. ResultsWith two drop-outs both in the treatment group and control group， and 58 cases in each group were included in the outcome analysis. The total effective rate regarding cardiac function and TCM syndromes in the treatment group were 91.38% （53/58） and 96.55% （56/58）， respectively， significantly higher than the corresponding 70.69% （41/58） and 48.27% （28/58） in the control group （P＜0.05）. After treatment， the TCM symptom scores and RVEDD level were significantly reduced in the treatment group， and MLHF-Q score， plasma NT-ProBNP level and PAMP level decreased significantly， while 6MWD increased in both groups （P＜0.01）. Compared to those in the control group， the TCM symptom scores， MLHF-Q score， plasma NT-ProBNP level and PAMP level significantly decreased， while 6MWD increased in the treatment group （P＜0.01）. There were no obvious abnormalities in the blood， urine， stool routine and liver and kidney function indicators in both groups. One adverse reaction each occurred in both groups， and there was no statistically significant difference in the incidence rates（P＞0.05）. ConclusionYHF combined with conventional western medicine can significantly improve the clinical efficacy， improve the clinical symptoms and cardiac function， increase the quality of life and exercise tolerance， and is relatively safe.

Validity of the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) in individuals with Chronic Obstructive Pulmonary Disease in Brazil / Validación de la Escala de Fatiga, Functional Assessment Of Chronic Illness Therapy Fatigue Scale (FACIT-F) en individuos con enfermedad pulmonar obstructiva crónica en Brasil / Validade da Escala de Fadiga, Functional Assessment Of Chronic Illness Therapy Fatigue Scale (FACIT-F) em indivíduos com Doença Pulmonar Obstrutiva Crônica no Brasil

ABSTRACT Fatigue is one of the most prevalent symptoms in individuals with Chronic Obstructive Pulmonary Disease (COPD), but it is poorly evaluated. The Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) is one of the main instruments used to measure fatigue. However, this instrument has not yet been validated for the Brazilian population with COPD. This study aimed to investigate the validity of the FACIT-F fatigue scale in individuals with COPD. In a cross-sectional study, the impact of symptoms (COPD Assessment Test - CAT), dyspnea (modified Medical Research Council - MRC scale), functional capacity (six-minute step test - 6MST), exertional fatigue (Borg modified scale at the end of 6MST), and the FACIT-F scale to assess multidimensional fatigue were evaluated. Concurrent validity was assessed by associating the FACIT-F with the CAT, and convergent validity by associating it with the number of steps, perceived exertional fatigue, and dyspnea. Discriminant validity was assessed by comparing fatigue with the dyspnea severity strata. In total, 92 participants were studied (69.9±8.8 years, FEV1: 48.4% of predicted). The FACIT-F presented an average of 30.1±10.9 points, strong concurrent validity with the CAT (r=-0.80), strong convergent validity with dyspnea (r=−0.66), and low with exercise capacity (r=0.40) and fatigue on exertion (r=-0.44). FACIT-F was effective in discriminating groups with different intensities of dyspnea. Conclusion: The FACIT-F is a valid tool for assessing fatigue in the Brazilian population with COPD.

RESUMEN La fatiga es uno de los síntomas más frecuentes en los individuos con enfermedad pulmonar obstructiva crónica (EPOC), pero su evaluación sigue siendo deficiente. Uno de los principales instrumentos utilizados para medir la fatiga es la Functional assessment of chronic illness therapy fatigue scale (FACIT-F). Sin embargo, este instrumento aún no ha sido validado para la población con EPOC en Brasil. En este contexto, el objetivo de este estudio fue investigar la validez de la escala de fatiga FACIT-F en individuos con EPOC. El estudio transversal evaluó el impacto de los síntomas (COPD Assessment Test -CAT), de la disnea (escala modificada del Consejo de Investigación Médica -MRC), de la capacidad funcional (prueba de pasos de seis minutos -6MST), de la fatiga de esfuerzo (escala modificada de Borg al final de la 6MST) y de la escala FACIT-F para evaluar la fatiga multidimensional. La validez concurrente se evaluó asociando la escala con el CAT, y la validez convergente la asoció con el número de pasos, la fatiga al esfuerzo percibida y la disnea. La validez discriminante se evaluó comparando la fatiga con los estratos de gravedad de la disnea. Se estudió a 92 participantes (69,9±8,8 años, VEF1: 48,4% del predicho). La FACIT-F tuvo una puntuación media de 30,1±10,9, fuerte validez concurrente con el CAT (r=-0,80), fuerte validez convergente con la disnea (r=-0,66) y baja con la capacidad de ejercicio (r=0,40) y con la fatiga de esfuerzo (r=-0,44). La FACIT-F fue eficaz para distinguir grupos con diferentes intensidades de disnea, por lo que muestra ser un instrumento válido para evaluar la fatiga en la población brasileña con EPOC.

RESUMO A fadiga é um dos sintomas mais prevalentes nos indivíduos com Doença Pulmonar Obstrutiva Crônica (DPOC), porém, ainda é pouco avaliada. Um dos principais instrumentos utilizados para mensurar a fadiga é a functional assessment of chronic illness therapy fatigue scale (Facit-F). Entretanto, este instrumento ainda não foi validado para a população com DPOC no Brasil. Dessa forma, o objetivo deste estudo foi investigar a validade da escala de fadiga Facit-F em indivíduos com DPOC. Em um estudo transversal, foram avaliados o impacto dos sintomas (COPD Assessment Test - CAT), a dispneia (escala do Medical Research Council - MRC modificada), a capacidade funcional (teste do degrau de seis Minutos - TD6), a fadiga no esforço (escala de Borg modificada ao final do TD6) e a escala Facit-F para avaliar a fadiga multidimensional. A validade concorrente foi avaliada pela associação da escala com o CAT, e a validade convergente pela associação desta com o número de degraus, percepção de fadiga no esforço e a dispneia. A validade discriminante foi avaliada comparando a fadiga com os estratos da gravidade da dispneia. Foram estudados 92 participantes (69,9±8,8 anos, VEF1: 48,4% do previsto). A Facit-F apresentou uma média de 30,1±10,9 pontos, validade concorrente forte com o CAT (r=-0,80), validade convergente forte com a dispneia (r=-0,66) e baixa com a capacidade de exercício (r=0,40) e com a fadiga ao esforço (r=-0,44). A Facit-F foi eficaz em discriminar grupos com diferentes intensidades de dispneia, portanto é um instrumento válido para a avaliação da fadiga na população brasileira com DPOC.

Recuperación de la frecuencia cardíaca en pacientes con enfermedad pulmonar intersticial difusa

Introducción: La enfermedad pulmonar intersticial difusa no soporta el ejercicio, debido a la sensación de disnea y fatiga durante el esfuerzo de baja intensidad. La recuperación de la frecuencia cardíaca se relaciona con el desempeño en el test de caminata de los seis minutos. Objetivo: Determinar las diferencias sociodemográficas de la función y la capacidad pulmonar en pacientes con enfermedad intersticial difusa, a partir de la recuperación de la frecuencia cardíaca durante el test de caminata de los seis minutos. Métodos: Se realizó un estudio descriptivo de corte transversal. Se calculó la recuperación de la frecuencia cardíaca a partir de la diferencia entre el final del test y los cinco minutos de la prueba. Se conformaron dos grupos de comparación, anormal versus normal, en variables sociodemográficas de la función pulmonar y la capacidad funcional. Resultados: Se vincularon 38 pacientes en el grupo normal y en el anormal 26. En el primero predominaron la edad de 62,26 ± 15,82 y los hombres (52,6 %); mientras que en el grupo anormal los años promediaron entre 58,77 ± 13,23 y sobresalieron las mujeres (61,5 %). Se presentó un valor p < 0,05 del grupo recuperación de la frecuencia anormal en la distancia recorrida, disnea y fatiga al final, un minuto y a los cinco minutos de culminar el test. Conclusiones: Los pacientes con enfermedad pulmonar intersticial difusa con una recuperación de la frecuencia cardíaca anormal presentaron peores resultados en la distancia recorrida, volumen de oxígeno, los equivalentes metabólicos, disnea y fatiga de los miembros inferiores.

Introduction: Diffuse interstitial lung disease does not tolerate exercise, due to the sensation of dyspnea and fatigue during low-intensity exertion. Heart rate recovery is related to performance in the six-minute walk test. Objective: To determine sociodemographic differences in lung function and capacity in patients with diffuse interstitial lung disease, based on heart rate recovery during the 6-minute walk test. Methods: A descriptive cross-sectional study was performed. Heart rate recovery was calculated from the difference between the end of the test and the five minutes of the test. Two comparison groups were formed, abnormal versus normal, in sociodemographic variables of pulmonary function and functional capacity. Results: 38 patients were included in the normal group and 26 in the abnormal group. In the normal group, age was 62.26 ± 15.82 and men were predominant (52.6 %); while in the abnormal group, age averaged 58.77 ± 13.23 and women were predominant (61.5 %). A p-value < 0.05 of the abnormal frequency recovery group was presented in the distance run, dyspnea at the end, fatigue at the end, 1 minute and at 5 minutes after the culmination of the test. Conclusions: Patients with diffuse interstitial lung disease with abnormal heart rate recovery had worse results in distance run, oxygen volume, metabolic equivalents, dyspnea and lower limb fatigue.

Avaliação Cardiodinâmica Não Invasiva por Cardiografia de Impedância durante o Teste de Caminhada de Seis Minutos em Pacientes com Insuficiência Cardíaca / Non-Invasive Assessment of Cardiodynamics by Impedance Cardiography during the Six-Minute Walk Test in Patients with Heart Failure

Resumo Fundamento O Teste de Caminhada de seis Minutos (TC6M) é comumente usado para avaliar pacientes com insuficiência cardíaca. No entanto, vários fatores clínicos podem influenciar a distância percorrida pelos pacientes no teste. A cardiografia de impedância (CI) na avaliação morfológica é uma ferramenta útil para avaliar a hemodinâmica cardíaca de maneira não invasiva. Objetivo Este estudo teve como objetivo comparar as respostas de aceleração e desaceleração do Débito Cardíaco (DC), da Frequência Cardíaca (FC), e do Volume Sistólico (VS) ao TC6M de indivíduos com insuficiência cardíaca e fração de ejeção reduzida (ICFEr) com as de controles sadios. Métodos Este é um estudo transversal observacional. O DC, a FC, o VS e o Índice Cardíaco (IC) foram avaliados antes, durante e após o TC6M por CI. O nível de significância adotado na análise estatística foi 5%. Resultados Foram incluídos 27 participantes (13 com ICFEr e 14 controles sadios). A aceleração do DC e da FC foi significativamente diferente entre os grupos (p<0,01 e p=0,039, respectivamente). Encontramos diferenças significativas no VS, no DC e no IC entre os grupos (p<0,01). A regressão linear mostrou uma contribuição deficiente do VS à mudança no DC no grupo com ICFEr (22,9% versus 57,4%). Conclusão O principal resultado deste estudo foi o fato de que indivíduos com ICFEr apresentaram valores mais baixos de aceleração do DC e da FC durante o teste de exercício submáximo em comparação a controles sadios. Isso pode indicar um desequilíbrio na resposta autonômica ao exercício nessa condição.

Abstract Background The six-minute walk test (6MWT) is commonly used to evaluate heart failure (HF) patients. However, several clinical factors can influence the distance walked in the test. Signal-morphology impedance cardiography (SM-ICG) is a useful tool to noninvasively assess hemodynamics. Objective This study aimed to compare cardiac output (CO), heart rate (HR), and stroke volume (SV) acceleration and deceleration responses to 6MWT in individuals with HF and reduced ejection fraction (HFrEF) and healthy controls. Methods This is a cross-sectional observational study. CO, HR, SV and cardiac index (CI) were evaluated before, during, and after the 6MWT assessed by SM-ICG. The level of significance adopted in the statistical analysis was 5%. Results Twenty-seven participants were included (13 HFrEF and 14 healthy controls). CO and HR acceleration significantly differed between groups (p<0.01; p=0.039, respectively). We found significant differences in SV, CO and CI between groups (p<0.01). Linear regression showed an impaired SV contribution to CO change in HFrEF group (22.9% versus 57.4%). Conclusion The main finding of the study was that individuals with HFrEF showed lower CO and HR acceleration values during the submaximal exercise test compared to healthy controls. This may indicate an imbalance in the autonomic response to exercise in this condition.

Fatores correlacionados a intolerância ao exercício na alta de pacientes hospitalizados por COVID-19 / Factors correlated to exercise intolerance upon discharge in patients hospitalized for COVID-19

Objetivo: Verificar a prevalência da intolerância ao exercício e a correlação com o perfil sociodemográfico, clínico, de hospitalização e função física na alta de pacientes hospitalizados pela COVID-19. Métodos: Estudo transversal com 52 pacientes internados por COVID-19 no Hospital Santa Casa de Misericórdia de Vitória, Espírito Santo. Coletou-se informações no momento da alta quanto ao perfil sociodemográfico, clínico, de hospitalização e função física, através de questionário semiestruturado, prontuário eletrônico, escalas e testes. Utilizou-se o Medical Research Council Modificado (mMRC) para graduar a dispneia, o Medical Research Council (MRC) para avaliar força muscular periférica, a manovacuometria, através das pressões inspiratória e expiratória máximas, para mensurar força muscular respiratória e a Medida de Independência Funcional (MIF) para funcionalidade. A variável desfecho, tolerância ao exercício, foi medida pelo Teste de Sentar e Levantar de 1 minuto. Resultados: Todos participantes apresentaram intolerância ao exercício no momento da alta hospitalar. O desempenho no teste de sentar e levantar foi inversamente correlacionado com o grau de dispneia e diretamente com a força muscular inspiratória, pontuação total da Medida de Independência Funcional, domínios de autocuidado, locomoção, mobilidade (p 0,019), e controle de esfíncter Conclusão: A prevalência da intolerância ao exercício na alta por COVID-19 foi de 100%, e estava correlacionada com o grau de dispneia, força muscular inspiratória e funcionalidade para autocuidado, locomoção, mobilidade e controle de esfíncter. Destaca-se a avaliação da tolerância ao exercício como importante preditor de sequelas pós-COVID-19, capaz de avaliar a interação entre diversos sistemas orgânicos.

Objective: To verify the prevalence of exercise intolerance and the correlation with the sociodemographic, clinical, hospitalization and physical function profile at discharge of patients hospitalized for COVID-19. Methods: Cross-sectional study with 52 patients hospitalized for COVID-19 at Hospital Santa Casa de Misericórdia in Vitória, Espírito Santo. Information was collected at discharge regarding the sociodemographic, clinical, hospitalization and physical function profile, through a semi-structured questionnaire, electronic medical record, scales and tests. The Modified Medical Research Council (mMRC) was used to grade dyspnea, the Medical Research Council (MRC) was used to assess peripheral muscle strength, manovacuometry, through maximal inspiratory and expiratory pressures, to measure respiratory muscle strength and the Independence Measure Functional (MIF) for functionality. The outcome variable, exercise tolerance, was measured by the 1-minute Sit and Stand Test. Results: All participants presented exercise intolerance at discharge. Performance in the 1-minute Sit and Stand Test was inversely correlated with the degree of dyspnea and directly with inspiratory muscle strength, total score on the Independence Measure Functional, self-care domains, locomotion, mobility and sphincter control. Conclusion: The prevalence of exercise intolerance at discharge due to COVID-19 was 100%, and was correlated with the degree of dyspnea, inspiratory muscle strength and functionality for self-care, locomotion, mobility and sphincter control. The assessment of exercise tolerance stands out as an important predictor of sequelae after COVID-19, capable of assessing the interaction between different

La prueba cardiopulmonar de ejercicio contribuye a determinar con precisión el riesgo en pacientes con hipertensión pulmonar de bajo riesgo / Cardiopulmonary Exercise Testing Contributes to Accurate Risk Assessment in Patients with Low-risk Pulmonary Hypertension

RESUMEN Introducción : Las guías europeas de hipertensión arterial pulmonar (HAP) estratifican el riesgo valiéndose de características clínicas y estudios complementarios entre los cuales está la prueba cardiopulmonar de ejercicio (PCPE), de la cual toma en cuenta 3 parámetros: el consumo de O2 (VO2) pico, su porcentaje respecto del predicho y la pendiente ventilación minuto/ producción de dióxido de carbono (VE/VCO2). Sin embargo, ninguno de los modelos que validaron esta forma de estratificar el riesgo incluyeron la PCPE entre sus variables. Objetivos : Determinar qué proporción de pacientes con HAP del grupo I considerados de bajo riesgo y que caminan >440 metros en la prueba de caminata de 6 minutos (PC6M) tienen en la PCPE parámetros considerados de riesgo moderado o alto. Material y métodos : Se incluyeron pacientes >18 años con diagnóstico de HAP del grupo I considerados de bajo riesgo con una PC6M >400 metros a los que se les realizó una PCPE en la que se registró el VO2 pico, su porcentaje respecto del VO2 predicho y la pendiente VE/VCO2. Se determinó qué proporción de pacientes presentaban estos parámetros en un estrato de riesgo mayor a bajo riesgo (VO2 pico <15 ml/kg/min, su porcentaje respecto del predicho <65% y la pendiente VE/VCO2 >36). Resultados : Se incluyeron 18 pacientes. A pesar de ser pacientes de bajo riesgo y con buena clase funcional todos presentaron un VO2 pico menor al 85% del predicho, lo cual determina un deterioro al menos leve de la capacidad funcional. Un único paciente (6%) presentó los tres parámetros evaluados en bajo riesgo, 8 pacientes (44%) tuvieron al menos un parámetro alterado, 7 pacientes (39%) presentaron 2 parámetros alterados y en 2 pacientes (11%) todos los parámetros estuvieron alterados. Los parámetros que más frecuentemente se vieron alterados fueron el porcentaje respecto del VO2 predicho y la pendiente VE/VCO2, en el 67% de los casos. Solo 4 pacientes presentaron un VO2 pico <15 ml/k/m. Ningún paciente presentó valores de VO2 pico o porcentaje respecto del predicho en la categoría de alto riesgo. Sin embargo, 6 pacientes (33%) presentaron una pendiente VE/VCO2 considerada de alto riesgo. Conclusión : El 94% de los pacientes considerados de bajo riesgo presentaron al menos una variable en la PCPE que no corresponde a un perfil de riesgo bajo. La pendiente VE/VCO2 y el porcentaje de VO2 pico respecto del predicho fueron las variables más frecuentemente alteradas. La pendiente VE/VCO2 fue la única que mostró valores considerados de alto riesgo. La PCPE podría tener un lugar en la estratificación de precisión de pacientes de bajo riesgo. El valor de este hallazgo deberá ser evaluado en estudios prospectivos, al tiempo que genera las bases para el planteo de hipótesis respecto de la estratificación de riesgo y la intensidad del tratamiento en pacientes que aparentan estar en bajo riesgo.

ABSTRACT Background : European guidelines for pulmonary arterial hypertension (PAH) stratify the risk using clinical characteristics and complementary studies, including the cardiopulmonary exercise test (CPET). This takes into account 3 parameters: peak O2 consumption (peak VO2), its percentage with respect to the predicted VO2, and the minute ventilation/carbon dioxide production (VE/VCO2) slope. However, none of the models that validated this way of stratifying risk included PCPE among their variables. Objectives : To determine what proportion of patients with group I PAH considered to be at low risk and who walk >440 meters in the 6-minute walk test (6MWT) have parameters considered to be of moderate or high risk in the PCPE. Methods : Patients >18 years of age, diagnosed with group I PAH at low risk of events, who walked >440 meters in the 6MWT and had NT-proBNP value <300 pg/dL were included. A CPET was performed in which the peak VO2, its percentage with respect to the predicted VO2, and the VE/VCO2 slope were recorded. It was determined what proportion of patients presented these parameters in a higher than low risk stratum (peak VO2 consumption ≤15 ml/min/Kg, its percentage with respect to the predicted VO2 ≤65% and the VE/VCO2 slope ≥36). Results : Eighteen patients were included. Despite being low-risk patients with a good functional class, all patients presented a peak VO2 less than 85% of predicted, which determines a deterioration of functional capacity. A single patient (6%) presented the three parameters evaluated at low risk, 8 patients (44%) had at least one altered parameter, 7 patients (39%) presented 2 altered parameters and in 2 patients (11%) all parameters were altered. The parameters that were most frequently altered were the percentage of predicted peak VO2 and the VE/VCO2 slope in 67% of the cases. Only 4 patients presented a peak VO2 <15 ml/kg/m. No patient presented peak VO2 values or percentage of predicted VO2 in the high-risk category. However, 6 patients (33%) presented a high-risk VE/VCO2 slope. Conclusion : Majority (92%) of the patients considered low risk and who walk more than 440 meters in 6 minutes presented at least one altered variable in the CPET. The VE/VCO2 slope and the percentage of predicted peak VO2 consumption were the most frequently altered variables. The VE/VCO2 slope was the only one that showed values considered high risk. CPET could have a place in the precision stratification of low-risk patients. The value of this finding should be evaluated in prospective studies.

Effect of smoking habit on cardiopulmonary function in patients with myocardial infarction -A study based on cardiopulmonary exercise testing- / 体力科学

The purpose of this study was to examine the relationship between smoking and cardiopulmonary function, and the effect of smoking habit on exercise tolerance after discharge from the hospital, focusing on CPX test data of patients hospitalized for acute myocardial infarction, and on CPX test data at 6 months after discharge. A total of 123 male patients hospitalized for acute myocardial infarction between April 2014 and December 2020 were included. Laboratory and CPX data were compared between smokers and non-smokers. CPX data of smokers, ex-smokers and non-smokers were also compared in 24 patients who underwent CPX examination 6 months after discharge. HDL-C was significantly decreased (p < 0.05) and τON was significantly prolonged (p < 0.05) during hospitalization in smokers. τON was significantly shorter only in ex-smokers (p < 0.05) 6 months after discharge compared to during hospitalization. These results suggest that τON, which reflects the oxygen uptake kinetics of peripheral tissues, is shortened by smoking cessation.

Research progress on the influence of a ketogenic diet on athletic performance and fatigue recovery / 中国实验动物学报

Ketogenic diet can supplement blood ketone,provide energy for skeletal muscle,and affect the athletic performance and recovery of animals and humans after fatigue.In this paper,it was found that ketogenic diet transformed muscle fibers from Ⅱb to Ⅱa through axonal germination and nerve reinnervation,improved the quality and function of mitochondria of fast muscle and increased histone acetyltransferase to enhance skeletal muscle strength.Using ketone body to provide energy,it can reduce glycolysis and improve the ability of fatty acid oxidation in slow muscle to improve exercise endurance;It can reduce endoplasmic reticulum stress,oxidative stress and inflammatory reaction of skeletal muscle,protect the body from injury,reduce the consumption of muscle glycogen and the accumulation of lactic acid,reduce fatigue after exercise and promote recovery.It is considered that ketogenic diet has low negative effects on the body,can improve sports performance and accelerate fatigue recovery,and can be used as a diet scheme in competitive sports and rehabilitation training.

Effects of resistance training on exercise tolerance in marathon runners / Efeitos do treinamento de resistência sobre a tolerância ao exercício em corredores de maratona / Efectos del entrenamiento de resistencia sobre la tolerancia al ejercicio en corredores de maratón

ABSTRACT Introduction: A high index of exercise tolerance is fundamental for marathon runners, indicating a good capacity to perform the exercises considering their maximum duration and workload. Objective: Evaluate the effects of resistance training with different loads on exercise tolerance of marathon runners. Methods: 120 professional long-distance runners were selected as volunteers for the experiment. Divided into experimental groups A, B and Control, the intervention had a 9-week period. The experimental groups A and B received resistance training with different loads, while the Control group did not undergo training intervention. Results: Upper limb muscle mass increased from 3.38 ± 0.18 to 3.75 ± 0.37 in group A; from 3.40 ± 0.15 to 3.66 ± 0.31 in group B; peak biceps brachii moment increased from 53.60 ± 6.27 to 62.97 ± 8.87 in group A; from 53.67 ± 5.68 to 58.48 ± 6.16 in group B; from 5. 37 ± 2.16 to 5.73 ± 2.67 in group A; from 7.21 ± 2.62 to 6.76 ± 4.36 in group B; and from 154.86 ± 19.69 to 108.30 ± 31.75 in group A; group B presented a reduction from 156.97 ± 46.13 to 116.45 ± 39.09, and the data from the control group did not change significantly. Conclusion: Resistance training with different loads in daily training can effectively improve the endurance of long-distance runners. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Um índice elevado de tolerância ao exercício é fundamental para corredores de maratona, sinalizando uma boa capacidade para a realização dos exercícios considerando sua duração máxima e carga de trabalho. Objetivo: Avaliar os efeitos do treinamento de resistência com distintas cargas sobre a tolerância ao exercício dos corredores de maratona. Métodos: Foram selecionados 120 corredores profissionais de longa distância como voluntários para o experimento. Divididos em grupo experimental A, B e Controle, a intervenção teve um período de 9 semanas. Os grupos experimentais A e B receberam treinamento de resistência com cargas diferentes, enquanto o grupo Controle não sofreu intervenção de treinamento. Resultados: A massa muscular dos membros superiores elevou-se de 3,38 ± 0,18 para 3,75 ± 0,37 no grupo A; de 3,40 ± 0,15 para 3,66 ± 0,31 no grupo B; o momento de pico do bíceps braquial aumentou de 53,60 ± 6,27 para 62,97 ± 8,87 no grupo A; de 53,67 ± 5,68 para 58,48 ± 6,16 no grupo B; de 5. 37 ± 2,16 para 5,73 ± 2,67 no grupo A; de 7,21 ± 2,62 para 6,76 ± 4,36 no grupo B; e de 154,86 ± 19,69 para 108,30 ± 31,75 no grupo A; o grupo B apresentou redução de 156,97 ± 46,13 para 116,45 ± 39,09, e os dados do grupo de controle não sofreram alterações significativas. Conclusão: O treinamento de resistência com diferentes cargas no treinamento diário pode efetivamente melhorar a resistência dos corredores de longa distância. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Un alto índice de tolerancia al ejercicio es fundamental para los corredores de maratón, indicando una buena capacidad para realizar los ejercicios, considerando su máxima duración y carga de trabajo. Objetivo: Evaluar los efectos del entrenamiento de resistencia con diferentes cargas sobre la tolerancia al ejercicio de corredores de maratón. Métodos: 120 corredores profesionales de larga distancia fueron seleccionados como voluntarios para el experimento. Divididos en los grupos experimentales A, B y Control, la intervención tuvo una duración de 9 semanas. Los grupos experimentales A y B recibieron entrenamiento de resistencia con diferentes cargas, mientras que el grupo Control no se sometió a intervención de entrenamiento. Resultados: La masa muscular del miembro superior aumentó de 3,38 ± 0,18 a 3,75 ± 0,37 en el grupo A; de 3,40 ± 0,15 a 3,66 ± 0,31 en el grupo B; el momento máximo del bíceps braquial aumentó de 53,60 ± 6,27 a 62,97 ± 8,87 en el grupo A; de 53,67 ± 5,68 a 58,48 ± 6,16 en el grupo B; de 5. 37 ± 2,16 a 5,73 ± 2,67 en el grupo A; de 7,21 ± 2,62 a 6,76 ± 4,36 en el grupo B; y de 154,86 ± 19,69 a 108,30 ± 31,75 en el grupo A; el grupo B presentó una reducción de 156,97 ± 46,13 a 116,45 ± 39,09, y los datos del grupo control no sufrieron cambios significativos. Conclusión: El entrenamiento de resistencia con diferentes cargas en el entrenamiento diario puede mejorar eficazmente la resistencia de los corredores de fondo. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Inspiratory muscle training in people with chronic obstructive pulmonary disease (COPD): a systematic review / Entrenamiento de los músculos inspiratorios en personas con enfermedad pulmonar obstructiva crónica (EPOC): una revisión sistemática / Treinamento muscular inspiratório em pessoas com doença pulmonar obstrutiva crônica (DPOC): uma revisão sistemática

ABSTRACT This systematic review aimed to demonstrate the effectiveness of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD), analyzing the effects of IMT on inspiratory muscle strength and endurance, exercise tolerance and reduction of dyspnea. A systematic search was carried out in the PubMed, Cochrane and Lilacs databases, from August 2021 to February 2023, searching for studies published from 2016. The descriptors used for the search followed the description of the MeSH/DeCS terms, namely: "Pulmonary Disease, Chronic Obstructive," "Breathing Exercises," "Exercise Tolerance," "Dyspnea," and "Muscle strength," with the languages: English and Portuguese, using the Boolean operators "AND" and "OR." Ten studies met the inclusion criteria, including 733 patients. In all examined studies, there was a significant increase in inspiratory muscle strength and endurance compared to the control group; of the ten studies analyzed, four showed advances in reducing dyspnea and exercise tolerance. Notably, inspiratory muscle training is effective in improving dyspnea, exercise tolerance, and in increasing inspiratory muscle strength and endurance in people with moderate to severe COPD.

RESUMEN El objetivo de esta revisión sistemática fue evaluar la efectividad del entrenamiento muscular inspiratorio (EMI) en personas con enfermedad pulmonar obstructiva crónica (EPOC), analizando los efectos del EMI en la fuerza y resistencia muscular inspiratoria, en la tolerancia al ejercicio y en la reducción de la disnea. Se realizó una búsqueda sistemática en las bases de datos PubMed, Cochrane y LILACS, en el período de agosto de 2021 a febrero de 2023, en los estudios publicados desde 2016. Los descriptores utilizados en la búsqueda siguieron la descripción de los Medical Subject Headings (MeSH)/Descriptores en Ciencias de la Salud (DeCS), a saber: "pulmonary disease, chronic obstructive", "breathing exercises", "exercise tolerance", "dyspnea" y "muscle strength", en los idiomas inglés y portugués, y con los operadores booleanos "AND" y "OR". Diez estudios cumplieron los criterios de inclusión, en los cuales participaron 733 pacientes. En todos los estudios en análisis, se observó un significativo incremento de la fuerza muscular inspiratoria y de la resistencia en comparación con el grupo control. De los 10 estudios analizados, cuatro mostraron progreso en la reducción de la disnea y en la tolerancia al ejercicio. Cabe destacar que el entrenamiento muscular inspiratorio mostró ser eficaz en la mejora de la disnea, en la tolerancia al ejercicio y en el aumento de la fuerza y la resistencia muscular inspiratoria en personas con EPOC de moderada a grave.

RESUMO O objetivo desta revisão sistemática foi evidenciar a eficácia do treinamento muscular inspiratório (TMI) em pessoas com doença pulmonar obstrutiva crônica (DPOC), analisando os efeitos do TMI na força e resistência muscular inspiratória; na tolerância ao exercício; e na redução da dispneia. Realizou-se uma busca de forma sistemática nas bases de dados PubMed, Cochrane e LILACS, no período de agosto de 2021 a fevereiro 2023, por estudos publicados a partir de 2016. Os descritores utilizados para a busca seguiram a descrição dos Medical Subject Headings (MeSH)/Descritores em Ciências da Saúde (DeCS), sendo eles: "pulmonary disease, chronic obstructive", "breathing exercises", "exercise tolerance", "dyspnea" e "muscle strength", com o filtro dos idiomas inglês e português e os operadores booleanos "AND" e "OR". Dez estudos cumpriram os critérios de inclusão, envolvendo 733 pacientes. Em todos os estudos examinados, houve um aumento expressivo da força e da resistência muscular inspiratória em comparação ao grupo-controle. Ainda, dos 10 estudos analisados, quatro apresentaram progressos na diminuição da dispneia e na tolerância ao exercício. Ressalta-se que o treinamento muscular inspiratório é eficaz na melhora da dispneia, da tolerância ao exercício e do aumento da força e da resistência muscular inspiratória em pessoas com DPOC em estágios moderado a grave.

Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

ABSTRACT Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2max (−5.84 mL.kg−1.min−1, 95% CI −6.93, −4.76 mL.kg−1.min−1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (−93.30 meters, 95% CI −141.2, −45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

A simulation study to compare physiological responses to hypoxia and exercise between anaemic subjects and healthy controls

Objectives: Military flying is a complex task and requires high level of physical fitness of aviators. Various aviation stressors such as acceleratory force, hypoxia, cold weather conditions and decompression sickness place enormous stress on human physiological systems of the aviators. Individuals with Hb <13 g/dL (males) are being placed in the lower medical category which makes them unfit to fly. The present study was undertaken to assess the implication of low haemoglobin (Hb) on exercise capacity and hypoxia tolerance. Materials and Methods: Twenty-five individuals with anaemia and 15 healthy controls participated in the study. The participants were subjected to normobaric hypoxia (NH) equivalent to an altitude of 15,000 feet. Different physiological parameters such as heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), respiratory rate (fR) and arterial oxygen saturation (SpO2) were measured during NH. Participants also performed maximal aerobic capacity (V?O2 max) and maximal anaerobic capacity test in bicycle ergometer. Results: HR, SBP, DBP and fR in anaemic subjects were higher than healthy controls during NH, whereas SpO2 in anaemic subjects was lower as compared to healthy controls. Anaemic individuals had a lower VO2 max than their healthy counterparts. Critical power and anaerobic work capacity were lower in anaemic subjects than healthy controls. Conclusion: There is a deterioration in exercise capacity and hypoxia tolerance in individuals with low Hb levels. Adequate precaution should be exercised for permitting military aviators to fly with low Hb level.

Relação da Função Pulmonar e da Força Inspiratória com Capacidade Aeróbica e com Prognóstico na Insuficiência Cardíaca / Relationship of Lung Function and Inspiratory Strength with Exercise Capacity and Prognosis in Heart Failure

Resumo Fundamento A espirometria é subutilizada na insuficiência cardíaca (IC) e não está claro o grau de associação de cada defeito com a capacidade de exercício e com o prognóstico desses pacientes. Objetivo Determinar a relação da %CVF prevista (ppCVF) e do VEF1/CVF contínuos com: 1) pressão inspiratória máxima (PImáx), fração de ejeção do ventrículo esquerdo (FEVE) e desempenho ao exercício; e 2) prognóstico, para o desfecho composto de morte cardiovascular, transplante cardíaco ou implante de dispositivo de assistência ventricular. Métodos Coorte de 111 participantes com IC (estágios AHA C/D) sem pneumopatia; foram submetidos a espirometria, manovacuometria e teste cardiopulmonar máximo. As magnitudes de associação foram verificadas por regressões lineares e de Cox (HR; IC 95%), ajustadas para idade/sexo, e p <0,05 foi considerado significativo. Resultados Com idade média 57±12 anos, 60% eram homens, 64% em NYHAIII. A cada aumento de 10% no VEF1/CVF [β 7% (IC 95%: 3-10)] e no ppCVF [4% (2-6)], foi associado à reserva ventilatória (VRes); no entanto, apenas o ppCVF associado à PImáx [3,8cmH2O (0,3-7,3)], à fração de ejeção do ventrículo esquerdo (FEVE) [2,1% (0,5-3,8)] e ao VO2 pico [0,5mL/kg/min (0,1-1,0)], considerando idade/sexo. Em 2,2 anos (média), ocorreram 22 eventos; tanto FEV1/FVC (HR 1,44; IC 95%: 0,97-2,13) quanto ppCVF (HR 1,13; 0,89-1,43) não foram associados ao desfecho. Apenas no subgrupo FEVE ≤50% (n=87, 20 eventos), VEF1/CVF (HR 1,50; 1,01-2,23), mas não ppCVF, foi associado a risco. Conclusão Na IC crônica, ppCVF reduzido associou-se a menor PImáx, FEVE, VRes e VO2 pico, mas não distinguiu pior prognóstico em 2,2 anos de acompanhamento. Entretanto, VEF1/CVF associou-se apenas com VRes, e, em participantes com FEVE ≤50%, o VEF1/CVF reduzido mostrou pior prognóstico proporcional. Portanto, VEF1/CVF e ppFVC contribuem para melhor fenotipagem de pacientes com IC.

Abstract Background Spirometry is underused in heart failure (HF) and the extent to which each defect associates with exercise capacity and prognosis is unclear. Objective To determine the distinct relationship of continuous %predicted FVC (ppFVC) and FEV1/FVC with: 1) maximal inspiratory pressure (MIP), left ventricular ejection fraction (LVEF), exercise performance; and 2) prognosis for the composite of cardiovascular death, heart transplantation or left ventricular assist device implant. Methods A cohort of 111 HF participants (AHA stages C/D) without diagnosed pneumopathy, spirometry, manovacuometry and maximum cardiopulmonary test. The association magnitudes were verified by linear and Cox (HR; 95% CI) regressions, age/sex adjusted. A p<0.05 was considered significant. Results Age was 57±12 years, 60% men, 64% in NYHA III. Every 10%-point increase in FEV1/FVC [β 7% (95% CI: 3-10)] and ppFVC [4% (2-6)] associated with ventilatory reserve (VRes), however only ppFVC associated with MIP [3.8 cmH2O (0.3-7.3)], LVEF [2.1% (0.5-3.8)] and VO2peak [0.5 mL/kg/min (0.1-1.0)], accounting for age/sex. In 2.2 years (mean), 22 events occurred, and neither FEV1/FVC (HR 1.44; 95% CI: 0.97-2.13) nor ppFVC (HR 1.13; 0.89-1.43) was significantly associated with the outcome. Only in the LVEF ≤50% subgroup (n=87, 20 events), FEV1/FVC (HR 1.50; 1.01-2.23), but not ppFVC, was associated with greater risk. Conclusions In chronic HF, reduced ppFVC associated with lower MIP, LVEF, VRes and VO2peak, but no distinct poorer prognosis over 2.2 years of follow-up. Distinctively, FEV1/FVC was associated only with VRes, and, in participants with LVEF ≤50%, FEV1/FVC reduction proportionally worsened prognosis. Therefore, FEV1/FVC and ppFVC add supplementary information regarding HF phenotyping.

The exercise tolerance and ventilatory efficiency of lung cancer patients with type 2 diabetes / 中华物理医学与康复杂志

Objective:To explore the aerobic exercise tolerance and ventilatory efficiency during cardiopulmonary exercise testing (CPET) of persons with non-small cell lung cancer (NSCLC) complicated by type 2 diabetes mellitus (T2DM).Methods:Forty-eight persons with NSCLC and T2DM formed an NSCLC-T2DM group while another 48 persons with NSCLC but not T2DM formed an NSCLC-non T2DM group. Another 24 healthy counterparts were enrolled into the control group. All completed CPET before pneumonectomies were performed on those with NSCLC. Indexes of static pulmonary function, exercise tolerance, heart rate recovery, ventilation efficiency and gas exchange were computed.Results:Compared with the control group, both NSCLC groups had, on average, lower peak oxygen uptake (VO 2peak), lower anaerobic thresholds (ATs) and lower peak O 2 pulse rates. They also had higher average VE/VCO 2 slopes and VE/VCO 2 nadirs. Compared with the NSCLC-non T2DM group, those with T2DM had a significantly lower average VO 2peak and WRpeak, as well as significantly higher average VE/VCO 2 slope and VE/VCO 2 nadir. Compared with the control group, the average VO 2 and VCO 2 of both NSCLC groups was lower at the AT and during peak exercise, with the NSCLC-T2DM group′s averages significantly lower than those of the NSCLC-non T2DM group during peak exercise. During warm-up and at the AT, the NSCLC groups had a significantly higher average heart rate than the control group. Then, compared with the control group and the NSCLC-non T2DM group, the average heart rate in the NSCLC-T2DM group decreased significantly more slowly during the first three minutes of the recovery period. Compared with the control group, the VE/VCO 2 values of the NSCLC groups were significantly higher at the AT and during peak exercise. During the warm-up and at the AT, the average partial pressures of end-tidal carbon dioxide in the NSCLC groups were significantly lower than among control group, and during peak exercise the NSCLC-T2DM group′s average value was significantly lower than the control group′s. Compared with the control group and the NSCLC-non T2DM group, the NSCLC-T2DM group′s average forced expiratory volume in one second, forced vital capacity, peak expiratory flow rate and maximum voluntary ventilation were all significantly lower. Conclusions:Diabetes impairs the exercise tolerance and ventilation efficiency of persons with NSCLC. Without diabetes their exercise tolerance and ventilation efficiency would be impaired only slightly. CPET can provide a basis for risk assessment before pneumonectomy.

Oxigenoterapia domiciliaria y capacidad aeróbica en pacientes con enfermedad pulmonar intersticial difusa. Estudio transversal / Home Oxygen Therapy And Aerobic Capacity In Patients With Diffuse Interstitial Lung Disease. Cross-Sectional Study

Introducción: La enfermedad pulmonar intersticial difusa es un grupo de enfermedades que causan un trastorno de la capacidad aeróbica y calidad de vida, además, ocasionan una gran tasa de morbimortalidad para esta población. El uso de oxigenoterapia domiciliaria mayor a 15 horas diarias tiene beneficios en pacientes hipoxémicos crónicos, sin embargo, poco se ha comparado su uso con pacientes que no lo reciben. Objetivo: Describir las características clínicas, capacidad aeróbica funcional y calidad de vida relacionada con la salud de dos grupos de pacientes con enfermedad pulmonar intersticial difusa, uno con indicación de oxigenoterapia domiciliaria y otro grupo sin indicación. Métodos: Estudio descriptivo transversal, que incluyó 41 pacientes con enfermedad pulmonar intersticial difusa que firmaron consentimiento informado. En ambos grupos, características demográficas y clínicas, ansiedad/depresión, calidad de vida relacionada con la salud con el cuestionario Saint George y la capacidad aeróbica funcional con la prueba de marcha de seis minutos fueron medidas. Se compararon los grupos con la prueba t de student para muestras independientes. Resultados: El grupo enfermedad pulmonar intersticial difusa con oxigenoterapia domiciliaria presentó mayor porcentaje de antecedente de tabaquismo (p = 0,041), menor distancia caminada en la prueba de marcha de seis minutos (304,1 ± 108,7 vs. 390,3 ± 95,6 p = 0,01), y menor porcentaje de la distancia predicha (58,37 ± 20,45 vs. 73,34 ± 22,90, p = 0,034) frente al grupo enfermedad pulmonar intersticial difusa sin oxigenoterapia domiciliaria. Conclusiones: Los pacientes con enfermedad pulmonar intersticial difusa con indicación de oxigenoterapia domiciliaria presentan menor capacidad aeróbica funcional comparada con pacientes sin indicación(AU)

Introduction: Diffuse interstitial lung disease is a group of diseases that cause a disorder of aerobic capacity and quality of life; in addition, they cause a high rate of morbidity and mortality for this population. The use of home oxygen therapy greater than 15 hours a day has benefits in chronic hypoxemic patients, however, little has been compared to patients who do not receive it. Objective: Describe the clinical characteristics, functional aerobic capacity and health-related quality of life of two groups of patients with diffuse interstitial lung disease, one with indication for home oxygen therapy and another group without indication. Methods: A cross-sectional descriptive study included 41 patients with diffuse interstitial lung disease who signed informed consent. In both groups, demographic and clinical characteristics, anxiety/depression, health quality of life related with the Saint George questionnaire, and functional aerobic capacity with the six-minute gait test were measured. The groups were compared with the student's t-test for independent samples. Results: The diffuse interstitial lung disease group with home oxygen therapy presented a higher percentage of smoking history (p = 0.041), a shorter distance walked in the six-minute gait test (304.1 ± 108.7 vs. 390.3 ± 95.6 p = 0.01), and a lower percentage of the predicted distance (58.37 ± 20.45 vs. 73.34 ± 22.90, p = 0.034) compared to the diffuse interstitial lung disease group without home oxygen therapy. Conclusions: Patients with diffuse interstitial lung disease with indication of home oxygen therapy have lower functional aerobic capacity compared to patients without indication(AU)

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.

Avaliação da função cardiovascular e qualidade de vida em pacientes com insuficiência cardíaca com e sem comportamento sedentário / Evaluation of cardiovascular function and quality of life in patients with heart failure with and without sedentary behavior

RESUMO: Fundamentos e objetivos: Apesar dos reconhecidos benefícios da prática de atividade física em pacientes com doença cardiovascular, acredita-se que pacientes com insuficiência cardíaca e fração de ejeção reduzida com comportamento não sedentário, mesmo que não pratiquem exercício físico regular, apresentem melhora da função cardiovascular e qualidade de vida em comparação a pacientes sedentários. Objetivo: comparar a capacidade funcional, função ventricular e quali-dade de vida de pacientes com insuficiência cardíaca sedentários e não sedentários. Métodos: Foram avaliados pacientes com Insuficiência Cardíaca e Fração de ejeção <50%, sendo compostos dois grupos, sedentários (n=45) e não sedentários (n=36), de acordo com o Questionário Internacional de Atividade Física. Os grupos foram submetidos à avaliação clínica e de qualidade de vida, teste de caminhada de Cooper, ecocardiograma e comparação pelo teste Qui-Quadrado para variáveis categóricas ou teste T de Student ou Mann-Whitney para variáveis contínuas. Nível de significância de 5%. Resultados: Os grupos foram homogêneos em relação às características basais e etiologia. Os pacientes do Grupo Não Sedentário apre-sentaram menos sintomas limitantes (p<0,01), menor necessidade de digitálicos (p=0,02), melhor fração de encurtamento ventricular (p=0,03) e menor aumento do volume indexado do átrio esquerdo (p=0,004). Não foram encontradas diferen-ças no teste de caminhada entre os grupos. Houve maior prejuízo do quesito capacidade funcional da qualidade de vida do grupo Sedentário. Conclusão: Considerando a limitação da amostra, pacientes com insuficiência cardíaca e comporta-mento não sedentário apresentam maior tolerabilidade ao exercício por apresentarem sintomas menos limitantes, melhor função ventricular e melhor qualidade de vida no quesito capacidade funcional quando comparados a pacientes sedentáriosRESUMOFundamentos e objetivos: Apesar dos reconhecidos benefícios da prática de atividade física em pacientes com doença cardiovascular, acredita-se que pacientes com insuficiência cardíaca e fração de ejeção reduzida com comportamento não sedentário, mesmo que não pratiquem exercício físico regular, apresentem melhora da função cardiovascular e qualidade de vida em comparação a pacientes sedentários. Objetivo: comparar a capacidade funcional, função ventricular e quali-dade de vida de pacientes com insuficiência cardíaca sedentários e não sedentários. Métodos: Foram avaliados pacientes com Insuficiência Cardíaca e Fração de ejeção <50%, sendo compostos dois grupos, sedentários (n=45) e não sedentários (n=36), de acordo com o Questionário Internacional de Atividade Física. Os grupos foram submetidos à avaliação clínica e de qualidade de vida, teste de caminhada de Cooper, ecocardiograma e comparação pelo teste Qui-Quadrado para variáveis categóricas ou teste T de Student ou Mann-Whitney para variáveis contínuas. Nível de significância de 5%. Resultados: Os grupos foram homogêneos em relação às características basais e etiologia. Os pacientes do Grupo Não Sedentário apre-sentaram menos sintomas limitantes (p<0,01), menor necessidade de digitálicos (p=0,02), melhor fração de encurtamento ventricular (p=0,03) e menor aumento do volume indexado do átrio esquerdo (p=0,004). Não foram encontradas diferen-ças no teste de caminhada entre os grupos. Houve maior prejuízo do quesito capacidade funcional da qualidade de vida do grupo Sedentário. Conclusão: Considerando a limitação da amostra, pacientes com insuficiência cardíaca e comporta-mento não sedentário apresentam maior tolerabilidade ao exercício por apresentarem sintomas menos limitantes, melhor função ventricular e melhor qualidade de vida no quesito capacidade funcional quando comparados a pacientes sedentários. (AU)

ABSTRACT: Purpose: Despite the recognized benefits of practicing physical activity in patients with cardiovascular disease, it is believed that patients with heart failure and reduced ejection fraction with non-sedentary behavior may present an improvement in cardiovascular function and quality of life compared to sedentary patients, even if they do not practice regular physical ex-ercise. The aim of the present study was to compare functional capacity, systolic and diastolic cardiac function and quality of life of sedentary and non-sedentary patients with heart failure and reduced ejection fraction. Methods: Patients with heart failure and ejection fraction below 50% were divided into two groups, Sedentary (n = 45) and Non-Sedentary (n = 36), using the IPAQ questionnaire. These two groups were evaluated with clinical evaluation, quality of life SF-36 questionnaire, Cooper walking test and transthoracic echocardiography. They were compared by Chi-Square test for categorical variables or Test T or Man-Whitney for continuous variables; the level of significance adopted in the statistical analysis was 5%. Results: The groups were homogeneous in relation to the baseline characteristics and etiology. The Non-Sedentary Group had fewer patients with severe symptoms (p <0.01), less necessity of digitalis (p = 0.02) and better left ventricle fractional shorten-ing (p = 0.03). There was no apparent difference in the walk-test data between groups. Additionally, there was a greater impairment in the functional capacity of the SF-36 Questionnaire in the Sedentary Group. Conclusion: Considering the sample limitation, patients with heart failure and non-sedentary behavior have greater tolerability to exercise because they have fewer limiting symptoms and better quality of life in the functional capacity domain than sedentary patients.