Inspiratory muscle training on quality of life and functional capacity after hospital discharge in patients submitted to coronary artery bypass grafting: A controlled clinical trial.

INTRODUCTION: There is a gap in knowledge about functional capacity and quality of life in patients undergoing coronary artery bypass grafting (CABG) after hospital discharge and the contribution of inspiratory muscle training (IMT). OBJECTIVE: To evaluate the influence of IMT on functional capacity and quality of life after hospital discharge of patients undergoing CABG. METHODOLOGY: Clinical trial. In the preoperative period, patients assessed maximum inspiratory pressure (MIP), quality of life using the SF-36 and functional capacity using the Six-Minute Walk Test (6MWT). On the first postoperative day, they were randomized into: control group (CG) receiving routine assistance from the hospital; intervention group(IG) in addition to conventional physical therapy and submitted to an IMT protocol based on the glycemic threshold. Being reevaluated on the day of hospital discharge and post-discharge month. RESULTS: 41 patients were included. In the preoperative period of the MIP assessment of the CG, it was 104 ± 14 cmH2O already in GI it was 103 ± 19cmH2O (p = 0.78) CG at discharge 80 ± 13 cmH2O already in GI it was 92 ± 15cmH2O(p < 0.01), revaluation CG 91 ± 11 cmH2O versus 98 ± 12 cmH2O (p < 0.01) of the IG. In the 6MWT the preoperative of the GC group was 420 ± 70 m already in GI it was 429 ± 71 m (p = 0,89), CG at discharge 326 ± 79 m versus 373 ± 55 m and revaluation of the CG 377 ± 75 m and IG 410 ± 57 m (p < 0.01). Functional capacity, general health status, emotional aspects and limitations due to physical aspects were significant when the three moments were compared. CONCLUSION: IMT increases functional capacity, inspiratory muscle strength and quality of life after discharge from patients undergoing CABG.

Efeitos da laserterapia em pacientes com pé diabético / Effects of laser therapy on patients with diabetic foot

Introdução: As úlceras de pé diabético representam uma importante causa de amputações não-traumáticas. A terapia com laser de baixa intensidade tem demonstrado bons resultados ao acelerar a cicatrização de feridas crônicas, sobretudo em condições de microcirculação reduzida. Portanto, o objetivo do estudo é avaliar os efeitos da laserterapia no tratamento dos pacientes com pé diabético.Metodologia: Tratou-se de uma revisão sistemática de estudos contidos nas bases de dados eletrônicos PubMed, LILACS e SciELO, sem restrição de ano, utilizando os descritores "Diabetes mellitus", "Hiperglicemia", "Lasers", "Pé diabético", "Lesão por pressão" nas línguas inglesa e portuguesa. Foram excluídos os estudos não-randomizados, relatos de caso, observações clínicas e revisões. A Cochrane Collaboration foi utilizada para analisar a qualidade metodológica dos estudos.Resultados: Foram encontrados 24 artigos, sendo excluídos 18 por não se adequarem ao objetivo do estudo. Os estudos trazem um resultado estatisticamente significativo da utilização do LLLT no processo de cicatrização das úlceras diabéticas. Apenas um estudo não teve relevância estatística quando comparado ao grupo controle. Ainda assim, todos os autores apresentam eficácia dessa conduta, mesmo de forma indireta.Conclusão: O uso da laserterapia é uma intervenção que promove efeitos importantes na melhora da cicatrização das feridas em pacientes com úlceras diabéticas. No entanto, não há congruência na literatura de quais são os parâmetros mais adequados para aplicação dessa técnica.

Introduction: Diabetic foot ulcers are a major cause of nontraumatic amputations. Low-level laser therapy (LLLT) has shown good results in accelerating chronic wound healing, especially in conditions of reduced microcirculation. Therefore, the objective this study was evaluate the effects of LLLT on the treatment of patients with diabetic foot.Methodology: We conducted a systematic review in the electronic databases PubMed, LILACS, and SciELO, with no restrictions on date of publication. The following terms were used: "Diabetes Mellitus", "Hyperglycemia", "Lasers", "Diabetic Foot", and "Pressure Ulcer", in English and Portuguese. We excluded nonrandomized studies, case reports, clinical observations, and reviews. The Cochrane Collaboration was used to evaluate the methodological quality of the studies.Results: The search yielded 24 articles, of which 18 were excluded because they did not fit the study objective. Study results on the use of LLLT for diabetic ulcer healing were statistically significant. Only one study had no statistical significance when compared to the control group. Still, all studies showed LLLT to be effective, even if indirectly.Conclusion: The use of LLLT promotes important effects on the improvement of wound healing in patients with diabetic ulcers. However, there is no consensus on the literature regarding the best parameters to apply this technique.

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial.

INTRODUCTION: Coronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss. OBJECTIVE: To evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG. METHOD: ology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques. RESULTS: 40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09). CONCLUSION: It is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.

Functional effects of aquatic exercise in pregnant women: a systematic review

Introduction: During pregnancy, there are changes in all systems of the human body, along with anatomical changes. It is common for women to decrease the intensity of physical activities, especially in the last trimester. Water activities during pregnancy have shown positive effects for this population. To review the effects of functional exercises in the aquatic environment for women during pregnancy. Methods: Systematic review using the PICO methodology, searched on the Pubmed, SciELO, LILACS, and Science Direct platforms, using the descriptors: Pregnancy, hydrotherapy, quality of life, pregnant women, and aquatic environment. Published randomized controlled trials that addressed the functional effects of aquatic exercise in pregnant women, published in English, Spanish, and Portuguese in the years 2010 to 2020 were included. In addition, the Boolean operators "and" and "or" were used. The research was conducted from May to July 2020. Results: The search initially resulted in 537 articles, of which 95 records remained after removing duplicates, 14 after reading abstracts and titles, and 5 articles were included in the end. The samples ranged from 46 to 140 participants. Of the five studies selected, all obtained positive results, including pain reduction during pregnancy, as well as improved weight control, blood pressure, and sleep quality. Conclusion: The practice of aquatic exercise for pregnant women acts positively in weight control, improves sleep quality, controls blood pressure, and decreases low back and joint pain. (AU)

Inspiratory muscle training based on anaerobic threshold on the functional capacity of patients after coronary artery bypass grafting: clinical trial

Abstract Introduction: Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG. Methods: This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT). Results: Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs. 11±10 cmH2O in the IMT-AT group (P<0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs. 57±30 meters in the IMT-AT group (P=0.04). Conclusion: IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.

Inspiratory Muscle Training Based on Anaerobic Threshold on the Functional Capacity of Patients After Coronary Artery Bypass Grafting: Clinical Trial.

INTRODUCTION: Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG. METHODS: This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT). RESULTS: Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs. 11±10 cmH2O in the IMT-AT group (P<0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs. 57±30 meters in the IMT-AT group (P=0.04). CONCLUSION: IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.

Equoterapia sobre o desempenho funcional em crianças com paralisia cerebral: uma revisão sistemática / Equotherapy on functional performance in children with cerebral paralysis: a systematic review

Introdução: A paralisia cerebral (PC) é uma condição permanente causada por uma lesão encefálica estática, multifatorial e não progressiva dos movimentos e postura. A equoterapia aparece como método terapêutico e educacional que utiliza o cavalo para melhoria do desenvolvimento de pessoas portadoras de necessidades especiais. Objetivos: Revisar sistematicamente os efeitos da equoterapia sobre o desempenho funcional em crianças com paralisia cerebral. Métodos: Trata-se de uma revisão sistemática revisada por dois revisores independentes, conforme recomendações PRISMA, nas bases de dados PubMed e Biblioteca Cochrane. Incluídos estudos originais que utilizaram a equoterapia em pacientes com paralisia cerebral publicados em português e na língua inglesa. A Escala PEDro foi utilizada para analisar a qualidade metodológica dos estudos e a Cochrane Collaboration para análise de risco de viés. Resultados: Foram incluídos cinco artigos, publicados entre os anos 2012 e 2019. Todos estudos evidenciaram resultados satisfatórios em pacientes com paralisia cerebral após o tratamento com a equoterapia, melhorando a marcha, o equilíbrio, o tônus, a simetria e a qualidade de vida independente se ela foi associada a outro método. Conclusão: A equoterapia é uma modalidade terapêutica eficaz no tratamento das crianças com paralisia cerebral, melhorando os déficits motores e neurológicos, além da espasticidade muscular. (AU)

Introduction: Cerebral palsy (CP) is a permanent condition caused by a static, multifactorial and non-progressive brain injury of the movements and posture. Equine therapy is a therapeutic and educational method that uses horse to improve the development of people with special needs. Methods: This is a systematic review reviewed by two independent reviewers, according to PRISMA recommendations, in the PubMed and Cochrane Library databases. Including original studies that used equine therapy in patients with cerebral palsy published in Portuguese and in the English language. The PEDro Scale was used to analyze the methodological quality of the studies and the Cochrane Collaboration for bias risk analysis. Results: Five articles published between the years 2012 and 2019 were included. All studies showed satisfactory results in patients with cerebral palsy after treatment with equine therapy, improving gait, balance, tone, symmetry and quality of life whether it was associated with another method. Conclusion: Equine therapy is an effective therapeutic modality in the treatment of children with cerebral palsy, improving motor and neurological deficits, as well as muscle spasticity, favors balance, postural control, reduction of joint deformities and gross motor function. (AU)

Efeitos da massagem terapêutica em recém-nascidos prematuros na unidade de terapia intensiva neonatal: uma revisão sistemática / Effects of therapeutic massage on premature newborn in the neonatal intensive therapy unit: a systematic review

INTRODUÇÃO: A Unidade de Terapia Intensiva Neonatal (UTIN) é o local para recém-nascidos de risco que necessitam de cuidados contínuos. A massagem terapêutica é um toque sistemático das mãos humanas que contribui para o ganho de peso, diminui as respostas à dor e diminui a permanência no hospital. OBJETIVO: Revisar os efeitos sistêmicos da massagem terapêutica em prematuros Na Unidade de Terapia Intensiva Neonatal. METODOLOGIA: Esta é uma revisão sistemática. Foi realizada uma busca nas bases de dados Pubmed, Scielo e Lilacs, sem restrições relacionadas ao ano de publicação. Apenas ensaios clínicos randomizados foram incluídos neste estudo, com uma amostra de indivíduos de ambos os sexos, com menos de 28 dias de idade e abordando massoterapia relacionada a respostas sistêmicas em prematuros na unidade de terapia intensiva neonatal. Foram excluídos os estudos relacionados ao exercício físico, uso de medicamentos, estimulação oral e efeitos gastrointestinais relacionados à massagem. Foram utilizados os seguintes descritores: "massagem" AND "recém-nascido prematuro" OR "prematuro" OR "prematuro" AND "unidades de terapia intensiva neonatal". RESULTADOS: Dos seis artigos incluídos nesta revisão, cinco apresentaram resultados satisfatórios sobre os efeitos sistêmicos da massagem terapêutica em recém-nascidos prematuros, como ganho de peso, diminuição da permanência na UTIN, melhora da função do sistema nervoso parassimpático e aumento da citotoxicidade celular de células assassinas naturais. Apenas um estudo relata que a massagem terapêutica não induz o sono. CONCLUSÃO: A massagem terapêutica produz efeitos benéficos sistêmicos em prematuros internados na Unidade de Terapia Intensiva Neonatal.

INTRODUCTION: The Neonatal Intensive Care Unit (NICU) is the place for at-risk newborns who need ongoing care. Massage therapy is a systematic touch by human hands that contributes to weight gain, decreases pain responses and decreases hospital stay. OBJECTIVE: To review the systemic effects of massage therapy on premature infants in the Neonatal Intensive Care Unit. METHODOLOGY: This is a systematic review. A search was performed in the PubMed, SciELO and LILACS database, with no restrictions related to the year of publication. Only randomized clinical trials were included in this study, with a sample of individuals of both sexes, under 28 days of age and addressing massage therapy related to systemic responses in premature infants in the neonatal intensive care unit. Studies that were related to physical exercise, medication use, oral stimulation and gastrointestinal effects related to massage were excluded. The following descriptors were used: "massage" AND "premature newborn" OR "premature" OR "preterm" AND "neonatal intensive care units". RESULTS: Of the six articles included in this literature review, five showed satisfactory results on the systemic effects of massage therapy on premature newborns, such as weight gain, decreased length of stay in the NICU, improvement in parasympathetic nervous system function and increased cell cytotoxicity of natural killer cells. Only one study reports that massage therapy does not induce sleep. CONCLUSION: Massage therapy produces systemic beneficial effects in preterm infants admitted to the Neonatal Intensive Care Unit.

Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery.

INTRODUCTION: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. OBJECTIVE: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. METHODS: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. RESULTS: 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). CONCLUSION: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery

Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results: 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.