Predictors of Post-COVID-19 Functional Status Scale in Hospitalized Patients Recovering From SARS-CoV-2 Infection.

OBJECTIVE: The study aimed to investigate whether peripheral and inspiratory muscle strength and architecture, functional capacity, functional mobility, fatigue, and health-related quality of life are predictors of the Post-COVID-19 Functional Status Scale score in patients with post-COVID-19 syndrome who were hospitalized. DESIGN: A cross-sectional study included 69 patients (53.3 ± 13.2 yrs, 36 men) with post-COVID-19 syndrome. The following outcomes were assessed: peripheral (dynamometry) and inspiratory (manovacuometry) muscle strength, muscle architecture (ultrasound), functional capacity (six-minute walk test), functional mobility (Timed Up and Go), fatigue (Functional Assessment of Chronic Illness Therapy), health-related quality of life (36-item Short-Form Health Survey), and functional status (Post-COVID-19 Functional Status scale). RESULTS: Functional mobility (ß = 0.573, P < 0.001), vastus intermedius echogenicity (ß = -0.491, P = 0.001), length of stay (ß = 0.349, P = 0.007), and female sex (ß = 0.415, P = 0.003) influenced the Post-COVID-19 Functional Status Scale. CONCLUSIONS: Functional mobility, muscle quality of the vastus intermedius, length of stay, and female sex influence the Post-COVID-19 Functional Status Scale score in this population. It is noteworthy that functional mobility is an independent predictor of Post-COVID-19 Functional Status Scale.

Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial.

BACKGROUND: Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation. METHODS: This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers. DISCUSSION: This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated. TRIAL REGISTRATION: ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.

Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis.

Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the effects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the effect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of effort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (- 2.33 bpm; 95% CI: - 4.56 to - 0.10) (very low evidence) when using a pressure level of 5 cmH2O. The other outcomes analyzed were not significantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential benefit of EPAP in this population.

Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND: The effects of adding moderate-to-high intensity inspiratory muscle training (IMT) to short-term aerobic and resistance exercise (combined training [CT]), after coronary artery bypass grafting (CABG) are not established. This study aimed to determine the effects of moderate-to-high intensity IMT + CT on exercise capacity, respiratory muscle strength, inspiratory muscle endurance, quality of life (QoL), and laboratory biomarkers in patients after CABG who were participants of a phase II cardiac rehabilitation program. METHODS: Twenty-four patients were randomly assigned to either the IMT + CT group (n = 12), who performed moderate-to-high intensity IMT with CT or the sham-IMT + CT group (n = 12). Patients completed two sessions per week for 12 weeks. Each patient underwent a cardiopulmonary exercise test, six-minute walk test (6MWT), respiratory muscle strength and endurance evaluation, QoL questionnaire, and serum advanced oxidation protein products, ferric reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity C-reactive protein, before and after the 12-week intervention. RESULTS: The IMT + CT group showed significantly greater improvements in peak oxygen uptake (1.3 mL∙kg-1∙min-1; 95% confidence interval [95% CI], 0.5 to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5), maximal inspiratory pressure (23.0 cmH2O; 95% CI, 9.3 to 36.7), QoL (-15.1 points; 95% CI, -26.9 to -3.3), and FRAP (83.7 µmol/L; 95% CI, 20.2 to 147.1) compared to the sham-IMT + CT group as a result of the intervention. CONCLUSIONS: Short-term moderate-to-high intensity IMT with CT provided additional benefits in exercise capacity, inspiratory muscle strength, QoL, and antioxidant profile in patients after CABG. Trial Registration clinicaltrials.gov Identifier: NCT02885077.

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial.

Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/]).

Does peripheral arterial occlusive disease influence muscle strength and exercise capacity in COPD patients?

BACKGROUND: The pathophysiology of chronic obstructive pulmonary disease (COPD) is complex and understanding of it has been changing in recent years, with regard to its multisystemic manifestations, especially peripheral dysfunction and its influence on intolerance to exercise. OBJECTIVES: To evaluate the relationship between peripheral arterial occlusive disease (PAOD) and peripheral muscle strength and exercise capacity in COPD patients. METHODS: We conducted a cross-sectional study of 35 patients with COPD who were evaluated with the Ankle-Brachial Index, handgrip strength test, 1 repetition maximum (1RM) of knee extensors and flexors, and distance covered in the incremental shuttle walking test (dISWT). RESULTS: COPD patients with coexisting PAOD had lower dominant handgrip strength test results (33.00 vs. 26.66 kgf, p = 0.02) and worse performance in the dISWT (297.32 vs. 219.41 m, p = 0.02) when compared to the COPD patients without PAOD. Strong correlations were found between the result of the handgrip strength test and both the dISWT (r = 0.78; p < 0.001) and the 1RM/knee extension (r = 0.71; p = 0.03); and also between the dISWT and both the 1RM/knee extension (r = 0.72; p = 0.02) and the 1RM/knee flexion (r = 0.92; p < 0.001). The linear regression model showed that the dISWT variable alone explains 15.3% of the Ankle-Brachial Index result (p = 0.01). CONCLUSION: COPD patients with PAOD exhibit reduced muscle strength and lower exercise capacity than COPD patients without PAOD.

CONTEXTO: A doença pulmonar obstrutiva crônica (DPOC) apresenta uma complexa fisiopatologia e sua compreensão vem se modificando nos últimos anos, com atenção para as manifestações multissistêmicas, em especial a disfunção periférica e sua influência na intolerância ao exercício físico. OBJETIVO: Avaliar o impacto da doença arterial periférica obstrutiva (DAOP) na força muscular periférica e na capacidade de exercício dos portadores de DPOC. MÉTODOS: Estudo transversal realizado com 35 portadores de DPOC, que foram avaliados pelo índice tornozelo-braquial, teste de força de preensão palmar (FPP), uma repetição máxima (1RM) de extensores e flexores de joelho, e a distância no incremental shuttle walking test (dISWT). RESULTADOS: Portadores de DPOC com DAP coexistente apresentaram menor FPP da mão dominante (33,00 versus 26,66 kgf, p = 0,02) e pior desempenho no dISWT (297,32 versus 219,41 m, p = 0,02) quando comparados aos portadores de DPOC sem DAP. Fortes correlações foram encontradas entre a medida da FPP e a dISWT (r = 0,78; p < 0,001) e a 1RM/extensão de joelho (r = 0,71; p = 0,03); entre a dISWT e a 1RM/extensão de joelho (r = 0,72; p = 0,02) e a 1RM/flexão de joelho (r = 0,92; p < 0,001). O modelo de regressão linear identificou que a variável dISWT explica isoladamente 15,3% do resultado do índice tornozelo braquial (p = 0,01). CONCLUSÃO: Portadores de DPOC com DAOP coexistente apresentam maior perda da força muscular periférica e pior desempenho da capacidade de exercício quando comparados aos portadores de DPOC sem DAOP.

Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals.

OBJECTIVE:: To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. METHODS:: We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. RESULTS:: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. CONCLUSIONS:: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects. OBJETIVO:: Avaliar os efeitos da pressão expiratória positiva (PEP) na permeabilidade da membrana epitelial pulmonar em indivíduos saudáveis. MÉTODOS:: Foi avaliada uma coorte de 30 indivíduos saudáveis (15 homens e 15 mulheres), com média de idade de 28,3 ± 5,4 anos, média da relação VEF1/CVF de 0,89 ± 0,14 e média de VEF1 de 98,5 ± 13,1% do previsto. Os indivíduos foram submetidos a cintilografia pulmonar por inalação de radioaerossol de ácido dietilenotriaminopentacético marcado com tecnécio-99m (99mTc-DTPA em inglês) em dois estágios: durante respiração espontânea e durante respiração com uma máscara de PEP de 10 cmH2O (n = 10), 15 cmH2O (n = 10) ou 20 cmH2O (n = 10). O 99mTc-DTPA foi nebulizado por 3 min, e sua depuração foi registrada por cintilografia por um período de 30 min durante respiração espontânea e por um período de 30 min durante a respiração com uma máscara de PEP. RESULTADOS:: A depuração pulmonar do 99mTc-DTPA foi significativamente menor quando PEP foi aplicada a 10 cmH2O (p = 0,044), 15 cmH2O (p = 0,044) e 20 cmH2O (p = 0,004), em comparação com a observada durante a respiração espontânea. CONCLUSÕES:: Nossos achados indicam que o uso de PEP nos níveis testados pode induzir um aumento na permeabilidade da membrana epitelial pulmonar e no volume pulmonar em indivíduos saudáveis.

Estimulação elétrica funcional associada ao treinamento combinado pós-CRM: ensaio clínico randomizado / Estimulación eléctrica funcional asociada con el entrenamiento combinado post-CABG: ensayo clínico aleatorizado / Functional electrical stimulation associated with combined post-CABG training: a randomized clinical trial

RESUMO Os efeitos da adição da estimulação elétrica funcional (EEF) ao treinamento aeróbico e resistido (treino combinado) de curto prazo em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) ainda não foram estabelecidos. O objetivo do presente estudo é avaliar o impacto da adição da EEF ao treino combinado no fluxo arterial periférico, na capacidade funcional e na qualidade de vida de pacientes pós-CRM participantes de um programa de reabilitação cardíaca - Fase II. Trata-se de um ensaio clínico randomizado, duplo cego, composto por 17 pacientes (54,8±10,5 anos, 12 homens) randomizados ou em grupo intervenção (GI, n=8,) submetido à EEF no músculo quadríceps associada ao treino combinado, ou em grupo sham (GS, n=9), que realizou a EEF sham em associação ao treino combinado. Os desfechos avaliados foram: fluxo arterial periférico (índice tornozelo-braquial), capacidade funcional (distância percorrida no teste de caminhada de seis minutos - DTC6M) e qualidade de vida (questionário MacNew). Na comparação entre os grupos, o aumento do índice tornozelo-braquial (GI: 0,14±0,08 mmHg vs. GC: 0,05±0,04 mmHg; p=0,020) e do escore do domínio global do questionário MacNew (GI: 1,1±0,3 pontos vs. GC: 0,6±0,4 pontos; p=0,020) foi maior no GI. Entretanto, não foi observada diferença entre os grupos para a DTC6M (GI: 130,9±73,7 m vs. GS: 73,7±32,6 m; p=0,072). A adição da EEF, durante curto período, potencializou os efeitos do exercício aeróbico e resistido sobre o fluxo arterial periférico e a qualidade de vida em pacientes pós CRM em Fase II da reabilitação cardíaca.

RESUMEN Aún no se han establecido los efectos de agregar estimulación eléctrica funcional (EPS) cortoplacista al entrenamiento aeróbico y de resistencia (entrenamiento combinado) en pacientes sometidos a cirugía de injerto de derivación de las arterias coronarias (CABG). El objetivo del presente estudio fue evaluar el impacto de la adición de EPS al entrenamiento combinado sobre el flujo arterial periférico, la capacidad funcional y la calidad de vida de los pacientes post-CABG que participan en un programa de rehabilitación cardíaca de Fase II. Este es un ensayo clínico aleatorizado, doble ciego, compuesto por 17 pacientes (54,8±10,5 años, 12 hombres) aleatorizados en un grupo de intervención (GI, n=8) sometidos a EEF en el músculo cuádriceps asociado a entrenamiento combinado o en grupo simulado (GS, n=9), que realizó el simulacro de EEF en asociación con el entrenamiento combinado. Los resultados evaluados fueron: flujo arterial periférico (índice tobillo braquial), capacidad funcional (distancia recorrida en la prueba de caminata de seis minutos - 6MWT) y calidad de vida (cuestionario MacNew). Al comparar los grupos, el aumento del índice tobillo braquial (GI: 0,14±0,08 mmHg vs. GC: 0,05±0,04 mmHg; p=0,020) y la puntuación para el dominio global del cuestionario MacNew (GI: 1,1±0,3 puntos vs. GC: 0,6±0,4 puntos; p=0,020) fueron mayores en el GI. Sin embargo, no hubo diferencias entre los grupos en la 6MWT (GI: 130,9±73,7 m vs. GS: 73,7±32,6 m; p=0,072). La adición de EEF, durante un período corto, potenció los efectos del ejercicio aeróbico y de resistencia sobre el flujo arterial periférico y la calidad de vida en pacientes post-CABG en la Fase II de rehabilitación cardíaca.

ABSTRACT The effects of adding functional electrical stimulation (FES) to short-term aerobic and resistance exercise (combined training) in patients undergoing coronary artery bypass graft (CABG) surgery have not yet been established. This study aims to evaluate the effect of adding FES to combined training on peripheral arterial flow, functional capacity and quality of life of post-CABG patients participating in a cardiac rehabilitation program - Phase II. This is a randomized, double-blind, clinical trial, composed of 17 patients (54.8±10.5 years old, 12 men) randomized or in an intervention group (IG, n=8,) submitted to FES in the quadriceps muscle associated with combined training, or in a sham group (SG, n=9), which performed the FES sham in association with the combined training. The evaluated outcomes were: peripheral arterial flow (ankle-brachial index), functional capacity (distance covered in the six-minute walk test - 6MWT) and quality of life (MacNew questionnaire). In the comparison between the groups, the increase in the ankle-brachial index (IG: 0.14±0.08mmHg vs. CG: 0.05±0.04mmHg; p=0.020) and the score of the global MacNew questionnaire (IG: 1.1±0.3 points vs. CG: 0.6±0.4 points; p=0.020) was higher in the IG. However, no difference was observed between the groups for the 6MWT (IG: 130.9±73.7m vs SG: 73.7±32.6m; p=0.072). The addition of FES, during a short period, potentiated the effects of aerobic and resistance exercise on peripheral arterial flow and quality of life in patients after CABG in Phase II of cardiac rehabilitation.

DNA damage and repair capacity in lymphocyte of chronic obstructive pulmonary diseases patients during physical exercise with oxygen supplementation.

BACKGROUND: We hypothesized that the use of oxygen supplementation during aerobic exercise induces less DNA damage than exercise alone. The aim of this study is to assess the level of DNA damage induced by physical exercise with and without oxygen supplementation in chronic obstructive pulmonary diseases (COPD) patients. METHODS: Peripheral blood was collected before and after aerobic exercise in two conditions: (I) aerobic exercise without oxygen supplementation (AE group) and (II) with oxygen supplementation (AE-O2 group). Lymphocytes were collected to perform the alkaline version of the Comet Assay. To assess the susceptibility to exogenous DNA damage, the lymphocytes were treated with methyl methanesulphonate (MMS) for 1-h or 3-h. After 3-h treatment, the percentage of residual damage was calculated assuming the value of 1-h MMS treatment as 100%. RESULTS: AE group showed lower induced damage (1 h of MMS treatment) and consequently less DNA repair compared to AE-O2 group. AE-O2 group showed an increase in the induced DNA damage (1 h of MMS treatment) and an increased DNA repair capacity. Within the AE-O2 group, in the post-exercise situation the induced DNA damage after 1 h of MMS treatment was higher (p = 0.01) than in the pre-exercise. CONCLUSION: COPD patients who performed physical exercise associated with oxygen supplementation had a better response to DNA damage induced by MMS and a better DNA repair when compared to the condition of physical exercise without oxygen supplementation. TRIAL REGISTRATION: UNISC N374.298. Registered 04 JUN 2013 (retrospectively registered).

Association between the ankle-brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

BACKGROUND: Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC), abnormal ankle-brachial index (ABI), and physical activity level on functional capacity of these patients has not been fully studied. OBJECTIVE: The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD) in this sample of patients. PATIENTS AND METHODS: This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40); borderline PAD (n=23, values between 0.91 and 1.00); and patients with PAD (n=35, ≤0.90). The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ) and functional capacity was assessed by the 6-minute walk distance (6MWD). RESULTS: The prevalence of PAD was 21.6% in the total sample. The 6MWD showed strong correlation with the absence of IC (r=0.785; P<0.001), moderate correlation with age (r=-0.347; P<0.001), and weak correlations with IPAQ scores (r=0.164; P=0.038) and ABI (r=0.216; P=0.006). Age, ABI, and absence of IC were independently associated with the outcome (P=0.001, P=0.001, and P=0.028, respectively). CONCLUSION: The current study demonstrates that 6MWD is associated with IPAQ scores, ABI, and absence of IC. Age, ABI and absence of IC were independently associated with functional capacity in patients with or at high risk of cardiovascular disease.

Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective?

Inspiratory muscular training (IMT) increases the respiratory muscle strength, however, there is no data demonstrating its superiority over the incentive spirometry (IS) in doing so. Values of muscle strength after IMT (Threshold IMT(®)) and by the IS (Voldyne(®)) in healthy females was compared. Subjects (n=40) were randomly divided into control group (CG, n=14), IS group (ISG, n=13) and threshold group (TG, n=13). PImax was measured before (pre-IMT), at 15 and 30 days of IMT. There was an increase in PImax of the TG at 15 days (p<0.001) and 30 days of IMT (p<0.001). The same occurred with the ISG, which increased the PImax at 15 days (p<0.001) and 30 days of training (p<0.001). After 30 days of IMT, the TG presented a PImax which was significantly higher than ISG and the CG (p=0.045 and p<0.001, respectively). It can be concluded that IMT by threshold was more effective in increasing muscle strength than the Voldyne.

Influence of stress factors on the vital signs of neonates under intensive care / Influência de fatores estressores sobre os sinais vitais de neonatos em terapia intensiva / Influencia de factores estresores sobre los signos vitales de neonatos en la terapia intensiva

Justificativa e Objetivos: A manutenção do desenvolvimento normal e a maturação do Sistema Nervoso Central do recém-nascido, no primeiro ano de vida, associado às condições ambientais nas quais está inserido, justificam a relevância científica desta pesquisa. Nosso objetivo foi descrever a influência de fatores estressores sobre os sinais vitais de recém-nascidos hospitalizados na Unidade de Tratamento Intensivo Neonatal de um hospital de ensino. Método: Estudo transversal com amostragem de conveniência. Os participantes foram observados nos momentos identificados como sendo de maior e de menor exposição a fatores estressores, sendo registrados níveis de pressão sonora, iluminância, quantidade de procedimentos, presença de dor, além dos indicadores de sinais vitais expressos pelo monitor do paciente. Resultados: Treze neonatos predominantemente prematuros moderados, de baixo peso, nascidos de parto cesárea, com média de idade de 8,0 ± 5,9 dias, preponderância feminina e respirando sob ar ambiente foram avaliados. Notou-se que ambos os fatores estressores provocaram aumento significativo da frequência cardíaca (pressão sonora: p=0,001, Iluminância: p<0,001, procedimentos: p=0,002), ocorrendo o mesmo com a frequência respiratória (pressão sonora: p<0,001, Iluminância: p=0,022, procedimentos: p<0,001) e escore obtido na Escala de Avaliação da Dor Neonatal (pressão sonora: p=0,001, Iluminância: p=0,016, procedimentos: p<0,003), além de redução da saturação periférica de oxigênio (pressão sonora: p=0,011, Iluminância: p=0,024, procedimentos: p<0,016), quando comparados os períodos de maior e de menor exposição. Conclusão: Nossos achados demonstraram o impacto negativo de fatores ambientais e sua influência sobre os sinais vitais de recém-nascidos hospitalizados.(AU)

Background and Objectives: The maintenance of regular development and maturation of the Central Neural System of the neonate in the first year, associated to the environmental conditions in which he is inserted, justify the scientific relevance of this research. Our objective was to describe the influence of stressful factors on hospitalized neonates in the Neonatal Intensive Care Unit of a teaching hospital. Methods: Cross-sectional study with convenience sampling. The participants were observed in moments that were identified as being of more and less exposition to stress factors, in which the sound pressure, illuminance, quantity of procedures, presence of pain, besides the indicators of vital signs expressed by the patient's monitor were registered. Results: Thirteen neonates, predominantly moderate premature babies of low weight, of c-section birth, average age of 8.0 ± 5.9 days, mostly female and breathing room air were evaluated. We noted that stress factors produced significant increase of the heart rate (sound pressure: p=0.001, illuminance: p<0.001, procedures: p=0.022), occurring the same with the respiratory rate (sound pressure: p<0.001, illuminance: p=0.022, procedures: p<0.001) and score obtained in the Neonatal Pain Evaluation Scale (sound pressure: p=0.001, illuminance: p=0.016, procedures: p<0.003), besides the reduction of peripheral oxygen saturation (sound pressure: p=0.011, illuminance: p=0.024, procedures: p<0.016), when compared to the periods of higher and lower exposition. Conclusion: Our findings demonstrated the negative impact of the environmental factors and its influence on the vital signs of hospitalized neonates.(AU)

Justificación y objetivos: El mantenimiento del desarrollo normal y la maduración del Sistema Nervioso Central del recién nacido, en el primer año de vida, asociado a las condiciones ambientales en las que está inserto, justifican la relevancia científica de esta investigación. Nuestro objetivo fue describir la influencia de factores estresores sobre los signos vitales de recién nacidos hospitalizados en la Unidad de Tratamiento Intensivo de un hospital de enseñanza. Métodos: Estudio transversal con muestreos de conveniencia. Los participantes fueron observados en los momentos identificados como de mayor y de menor exposición a los factores estresores, siendo registrados niveles de presión sonora, iluminancia, cantidad de procedimientos, presencia de dolor, además de los indicadores de los signos vitales expresados en el monitor del paciente. Resultad: Trece neonatos predominantemente prematuros moderados, de bajo peso, nacidos de cesárea con media de edad de 8,0 ± 5,9 días, preponderancia femenina y respirando en aire ambiente fueron evaluados. Se notó que ambos factores estresores provocaron aumento significativo de la frecuencia cardíaca (presión sonora: p=0,001, Iluminancia: p<0,001, procedimientos: p=0,002), ocurriendo lo mismo con la frecuencia respiratoria (presión sonora: p<0,001, Iluminancia: p=0,022, procedimientos: p<0,001) y puntación obtenida en la Escala de Evaluación de Dolor Neonatal (presión sonora: p=0,001, Iluminancia: p=0,016, procedimientos: p<0,003), además de reducción de la saturación periférica de oxigeno (presión sonora: p=0,011, Iluminancia: p=0,024, procedimientos: p<0,016), cuando comparados los periodos de mayor y de menor exposición. Conclusiones: Nuestros hallazgos demostraron el impacto negativo de factores ambientales y su influencia sobre los signos vitales del recién nacidos hospitalizados.(AU)

Sternocleidomastoid muscle activation following inspiratory muscle training in patients with chronic obstructive pulmonary disease: a randomized clinical trial / Ativação do músculo esternocleidomastoideo após treinamento muscular inspiratório em pacientes com doença pulmonar obstrutiva crônica: ensaio clínico randomizado / Activación del músculo esternocleidomastoideo tras el entrenamiento muscular inspiratorio de pacientes con enfermedad pulmonar obstructiva crónica: un ensayo clínico aleatorizado

ABSTRACT This study aims to assess the effect of short-time low frequency inspiratory muscle trainer (Threshold IMT) on inspiratory muscle strength and electromyographic activity of the sternocleidomastoid (SCM) muscle in people with chronic obstructive pulmonary disease (COPD). People with COPD participating in a lung rehabilitation program were allocated to a control or inspiratory muscle training (IMT) group. The control group participated in the usual rehabilitation, whereas the other group received IMT (performed with a load of 50% maximal inspiratory pressure (MIP) adjusted weekly). Both interventions lasted for 2 months. Outcomes included electromyographic analysis of the SCM and MIP. In total, ten participants were allocated to each group. The IMT group presented an increase in absolute (p<0.001) and predicted (p<0.001) values of MIP and also in pre- and post-intervention variation between groups (p=0.003 and p=0.008, respectively). Such differences were not found in the control group. The SCM muscle activity decreased in the IMT post intragroup evaluation (p=0.008). IMT provided a reduction of the electromyographic activity of SCM in COPD patients, also increasing inspiratory muscle strength in the study participants.

RESUMO O objetivo deste estudo foi avaliar o efeito do treinamento muscular inspiratório de baixa frequência de curta duração (Threshold TMI) na força muscular inspiratória e na atividade eletromiográfica do músculo esternocleidomastoideo (ME) em pessoas com doença pulmonar obstrutiva crônica (DPOC). Pessoas com DPOC que participam de um programa de reabilitação pulmonar foram alocadas em um grupo controle ou de treinamento muscular inspiratório (TMI). O grupo controle participou da reabilitação habitual, enquanto o grupo TMI também recebeu TMI, com carga de 50% da pressão inspiratória máxima (PImáx) ajustada semanalmente. Ambas as intervenções duraram 2 meses. Os resultados incluíram análise eletromiográfica do SCM e PImáx. Dez participantes foram alocados para o grupo controle e 10 para o grupo TMI. O grupo com TMI apresentou um aumento na PImáx nos valores absoluto (p<0,001) e previsto (p<0,001) e na variação pré e pós-intervenção entre os grupos (p=0,003 e p=0,008, respectivamente). Tais diferenças não foram encontradas no grupo controle. A atividade muscular do ME diminuiu no TMI após avaliação intragrupo (p=0,008). O TMI proporcionou redução da atividade eletromiográfica do ME em pacientes com DPOC, além de aumentar a força muscular inspiratória nos participantes do estudo.

RESUMEN El presente estudio tuvo como objetivo evaluar el efecto del entrenamiento muscular inspiratorio de baja frecuencia a corto plazo (Threshold TMI) sobre la fuerza muscular inspiratoria y la actividad electromiográfica del músculo esternocleidomastoideo (ME) en personas con enfermedad pulmonar obstructiva crónica (EPOC). Las personas con EPOC que participan en un programa de rehabilitación pulmonar se asignaron a un grupo control o de entrenamiento muscular inspiratorio (EMI). El grupo control participó en la rehabilitación habitual, mientras que el grupo de EMI también recibió EMI, con una carga del 50% de la presión inspiratoria máxima (PImáx) ajustada semanalmente. Ambas intervenciones tuvieron 2 meses de duración. Los resultados incluyeron el análisis electromiográfico de SCM y PImáx. Se asignaron 10 participantes al grupo control y 10 al grupo de EMI. El grupo de EMI tuvo un aumento de la PImáx en los valores absoluto (p<0,001) y predicho (p<0,001) y en la variación pre y posintervención entre grupos (p=0,003 y p=0,008, respectivamente). No se encontraron estas diferencias en el grupo control. La actividad muscular del ME disminuyó en el EMI después de la evaluación intragrupal (p=0,008). El EMI redujo la actividad electromiográfica del ME de pacientes con EPOC, además aumentó la fuerza muscular inspiratoria en los participantes del estudio.

Short-term inspiratory muscle training potentiates the benefits of aerobic and resistance training in patients undergoing CABG in phase II cardiac rehabilitation program.

OBJECTIVE: To investigate the efficiency of short-term inspiratory muscle training program associated with combined aerobic and resistance exercise on respiratory muscle strength, functional capacity and quality of life in patients who underwent coronary artery bypass and are in the phase II cardiac rehabilitation program. METHODS: A prospective, quasi-experimental study with 24 patients who underwent coronary artery bypass and were randomly assigned to two groups in the Phase II cardiac rehabilitation program: inspiratory muscle training program associated with combined training (aerobic and resistance) group (GCR + IMT, n=12) and combined training with respiratory exercises group (GCR, n=12), over a period of 12 weeks, with two sessions per week. Before and after intervention, the following measurements were obtained: maximal inspiratory and expiratory pressures (PImax and PEmax), peak oxygen consumption (peak VO2) and quality of life scores. Data were compared between pre- and post-intervention at baseline and the variation between the pre- and post-phase II cardiac rehabilitation program using the Student's t-test, except the categorical variables, which were compared using the Chi-square test. Values of P<0.05 were considered statistically significant. RESULTS: Compared to GCR, the GCR + IMT group showed larger increments in PImax (P<0.001), PEmax (P<0.001), peak VO2 (P<0.001) and quality of life scores (P<0.001). CONCLUSION: The present study demonstrated that the addition of inspiratory muscle training, even when applied for a short period, may potentiate the effects of combined aerobic and resistance training, becoming a simple and inexpensive strategy for patients who underwent coronary artery bypass and are in phase II cardiac rehabilitation.

Características de neonatos com síndrome do desconforto respiratório considerando a via de parto em uma unidade de terapia intensiva da região central do RS / Characteristics of neonates with respiratory distress syndrome admitted to an intensive care unit of the central region of RS

Objetivo: Analisar as características dos neonatos com Síndro-me do Desconforto Respiratório (SDR), considerando a via de parto, admitidos em uma Unidade de Terapia Intensiva de um hospital universitário da região central do Rio Grande do Sul. Materiais e métodos: Estudo retrospectivo, realizado no período de abril a maio de 2017, através da análise de prontuários de neonatos com idade gestacional acima de 37 semanas, ambos os sexos, internados no ano de 2016 na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Universitário de Santa Maria com CID 10 P22 ­ Desconforto (angústia) respiratório(a) do recém-nascido. Resultados: A amostra foi constituída por 40 registros de nascimentos (25 do sexo masculino), divididos em parto vaginal (n=11) e cesárea (n=29), representando 27,5% e 72,5%, respectivamente, das internações totais. A média de idade materna foi de 27±7 anos, com uma média de 7±5 con-sultas pré-natais. Durante o período de internação 65%(n=26) dos 40 neonatos necessitaram de oxigenoterapia. Conclusão:A partir dos resultados obtidos no presente estudo, observamos que a SDR representa 11% das internações ocorridas na UTIN, no ano de 2016. A prevalência, quanto ao tipo de parto, foi de neonatos nascidos de cesariana, sem a presença do trabalho de parto e com idade gestacional de 38 semanas. (AU)

Objective: To analyze the characteristics of newborns with Respiratory Distress Syndrome (RDS), considering the route of delivery, admitted to an Intensive Care Unit of a university hospital in the central region of Rio Grande do Sul, Brazil. Materials and methods: A retrospective study, conducted from April to May 2017, through the analysis of records of neonates with gestational age above 37 weeks, both sexes, hospitalized in 2016 at the Neonatal Intensive Care Unit (NICU) of the Uni-versity Hospital of Santa Maria, with ICD 10 P22 - Respiratory distress syndrome of newborn. Results: The sample consisted of 40 birth records (25 males), divided into vaginal (n = 11) and caesarean (n = 29), representing 27.5% and 72.5%, respective-ly, of total hospitalization. The mean maternal age was 27 ± 7 years, with a mean of 7 ± 5 prenatal consultations. During the hospitalization period, 65% (n = 26) of the 40 neonates required oxygen therapy. Conclusion: Based on the results obtained in the present study, we observed that the RDS represents 11% of the hospitalizations that occurred in the NICU in 2016. The prevalence, in terms of route delivery, was of neonates born caesarean, without the presence of labor and gestational age of 38 weeks. (AU)

WITHDRAWN: Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective?

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.05.005. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Efeitos do exercício passivo precoce em cicloergômetro na espessura muscular do quadríceps femoral de pacientes críticos: estudo-piloto randomizado controlado / Efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular del cuádriceps femoral de pacientes críticos: un estudio piloto aleatorizado controlado / Effects of early passive cycling exercise on quadriceps femoris thickness in critically ill patients: a controlled randomized pilot study

RESUMO O objetivo deste estudo foi avaliar os efeitos do exercício passivo precoce em cicloergômetro na espessura muscular (EM) do quadríceps femoral (EMQ) de pacientes críticos admitidos em uma Unidade de Terapia Intensiva (UTI) de um hospital universitário terciário. O método utilizado foi um estudo-piloto randomizado controlado conduzido em uma amostra de 24 pacientes (51±18,11 anos, 16 do sexo masculino), com 24 a 48 horas de ventilação mecânica (VM), aleatoriamente divididos em dois grupos: grupo-controle (n=12), que recebeu a fisioterapia convencional; e grupo-intervenção (n=12), que recebeu o exercício passivo em cicloergômetro, uma vez ao dia, durante o período de sete dias do protocolo, em adição à fisioterapia convencional. A EMQ foi mensurada através da ultrassonografia. A primeira medida ultrassonográfica foi realizada entre as primeiras 48 horas de VM e a segunda ao término do protocolo. Não houve diferenças significativas na EMQ esquerda (27,29±5,86mm vs. 25,95±10,89mm; p=0,558) e direita (24,96±5,59mm vs 25,9±9,21mm; p=0,682) do grupo-controle e na EMQ esquerda (27,2±7,38mm vs 29,57±7,89mm; p=0,299) e direita (26,67±8,16mm vs 28,65±8,04mm; p=0,381) do grupo-intervenção. Na comparação entre os grupos, não houve alterações significativas em relação à EMQ esquerda (3,61±1,07mm; p=0,248) e a EMQ direita (2,75±0,85mm; p=0,738). Os resultados deste estudo-piloto demonstraram que a aplicação precoce do exercício passivo em cicloergômetro não promoveu mudanças significativas na espessura da camada muscular avaliada. No entanto, nossos achados sinalizam que a fisioterapia convencional foi capaz de preservar a EMQ de pacientes críticos admitidos em UTI.

RESUMEN El presente estudio tuvo como objetivo evaluar los efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular (EM) del cuádriceps femoral (EMC) de pacientes críticos ingresados en una Unidad de Cuidados Intensivos (UCI) de un hospital universitario terciario. Se utilizó como método un estudio piloto aleatorizado controlado con una muestra de 24 pacientes (51±18,11 años, 16 varones), con 24 a 48 horas de ventilación mecánica (VM), quienes fueron divididos aleatoriamente en dos grupos: grupo de control (n=12), que recibió fisioterapia convencional; y grupo intervención (n=12), que recibió el ejercicio pasivo en cicloergómetro una vez al día durante el período de protocolo de siete días, además de la fisioterapia convencional. El EMC se midió por ecografía. La primera medición ecográfica se realizó entre las primeras 48 horas de VM, y la segunda al final del protocolo. No hubo diferencias significativas en el EMC izquierdo (27,29±5,86 mm vs. 25,95±10,89mm; p=0,558) y derecho (24,96±5,59mm vs 25,9±9,21mm; p=0,682) del grupo de control; y en el EMC izquierdo (27,2±7,38mm vs 29,57±7,89mm; p=0,299) y derecho (26,67±8,16mm vs 28,65±8,04mm; p=0,381) del grupo intervención. En la comparación entre grupos, no hubo cambios significativos en el EMC izquierdo (3,61±1,07 mm; p=0,248) y en el EMC derecho (2,75±0,85 mm, p=0,738). Los resultados de este estudio piloto demostraron que la aplicación precoz del ejercicio pasivo en cicloergómetro no promovió cambios significativos en el espesor de la capa muscular evaluada. Sin embargo, nuestros hallazgos indican que la fisioterapia convencional pudo preservar el EMC de pacientes críticos ingresados en la UCI.

ABSTRACT The objective of this study was to evaluate the effects of early passive cycling exercise on quadriceps femoris thickness (QFT) in critically ill patients admitted in the intensive care unit (ICU) of a tertiary care university hospital. A controlled randomized pilot study was conducted with a sample of 24 patients (51±18.11 years, 16 male), on mechanical ventilation (MV) from 24 to 48 hours, who were randomly divided into two groups: control group (n=12), receiving conventional physical therapy; and an intervention one (n=12), receiving passive cycle ergometer, once a day, throughout seven days of protocol, in addition to conventional physical therapy. The QFT was measured by ultrasonography. The first ultrasonographic measurement was performed within 48 hours after the start of MV, and the second at the end of the protocol. There were no significant differences in QFT of the left (27,29±5,86mm vs 25,95±10,89mm; p=0,558) and right (24,96±5,59mm vs 25,9±9,21mm; p=0,682) in the control group, and in QFT of the left (27,2±7,38mm vs 29,57±7,89mm; p=0,299) and right (26,67±8,16mm vs 28,65±8,04mm; p=0,381) in the intervention group. There were no significant between-groups differences for left QFT (3,61±1,07mm; p=0,248) and right QFT (2,75±0,85mm; p=0,738). The results of this pilot study demonstrate that application of early passive cycle ergometer exercises has not significantly change the muscle layer thickness. However, our findings indicate that conventional physical therapy is able to preserve the quadriceps femoris thickness in critically ill patients admitted in ICU.

The influence of active and passive smoking on the cardiorespiratory fitness of adults.

BACKGROUND: The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test. METHODS: The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol. RESULTS: VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = - 0.401, p = 0.044), percentage of body fat (r = - 0.429, p = 0.011), and waist circumference (WC) (r = - 0.382, p = 0.025). CONCLUSION: VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.

Association between respiratory variables and exercise capacity in COPD patients / Associação entre variáveis respiratórias e capacidade de exercício em portadores de DPOC / Asociación entre variables respiratorias y capacidad de ejercicio en portadores de EPOC

Justificativa e Objetivos: A DPOC é caracterizada pela limitação progressiva do fluxo aéreo associada a uma resposta inflamatória. O objetivo do estudo foi avaliar a influência e a associação das variáveis respiratórias sobre a capacidade de exercício em portadores de DPOC. Métodos: Estudo transversal avaliou 39 portadores de DPOC para obtenção do volume expiratório forçado no primeiro segundo (VEF1) e a capacidade vital forçada (CVF). A força muscular respiratória (FMR) avaliada em seus componentes de pressão inspiratória máxima (PImax) e pressão expiratória máxima (PEmax). Capacidade de exercício avaliada pelo Teste de Caminhada de Seis Minutos (TC6m) e Incremental Shuttle Walking Test (ISWT). Resultados: O VEF1 (% 39,8±15,3) e CVF (% 60,2±17,1) se encontram reduzidos em relação ao predito classificando-os em estadiamento grau II (21%), III (51%) e IV (28%). A PImax (92,7±14,6 % predito) e PEmax (97,6±19,0 % predito) se encontram dentro dos valores previsto para os sujeitos. Evidenciada correlação moderada entre a distância percorrida no ISWT vs VEF1 (r=0,35; p=0,02) e ISWT vs CVF (r=0,42; p<0,001), TC6m vs VEF1 (r=0,38; p=0,01) e TC6m vs CVF (r=0,52; p<0,001). A FMR se correlacionou diretamente com a distância percorrida no ISWT [PImax (r=0,44; p=0,005); PEmax (r=0,57; p<0,001)] e com TC6m [PImax (r=0,43; p=0,006); PEmax (r=0,59; p<0,001)]. A PEmax e o VEF1 influenciaram 37% do desempenho no TC6m e a PEmax influenciou isoladamente 58% da distância percorrida no ISWT. Conclusão: A força muscular respiratória e os volumes pulmonares reduzidos se associaram e influenciaram diretamente na capacidade de exercício máximo e submáximo de portadores de DPOC.(AU)

Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive airflow limitation associated with an inflammatory response. The aim of the study was to evaluate the influence and the association of respiratory variables on exercise capacity in COPD patients. Methods: A cross-sectional study evaluated 39 COPD patients to obtain forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Respiratory muscle strength (RMS) was evaluated at its maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) components. Exercise capacity was assessed by Six-Minute Walk Test (6MWT) and Incremental Shuttle Walking Test (ISWT). Results: FEV1 (39.8±15.3%predicted) and FVC (60.2±17.1% predicted) were reduced, which classified them in stages II (21%), III (51%) and IV (28%). MIP (92.7±14.6% predicted) and MEP (97.6±19.0% predicted) were within the expected values. A moderate correlation was observed between the ISWT vs FEV1 (r=0.35;p=0.02) and ISWT vs FVC (r=0.42;p<0.001), 6MWT vs FEV1 (r=0.38;p=0.01) and 6MWT vs FVC (r=0.52;p<0.001). RMS showed a moderate correlation with the ISWT [MIP (r=0.44;p=0.005); MEP (r=0.57;p<0.001)] and 6MWT [MIP (r=0.43;p=0.006); MEP (r=0.59;p<0.001)]. MEP and FEV1 influenced 37% of performance at the 6MWT and MEP alone influenced 58% of distance walked at the ISWT. Conclusion: Reducing both respiratory muscle strength and lung volumes were associated with changes in exercise and they adversely affected the maximum and submaximal exercise capacity in COPD patients.(AU)

Justificación y objetivos: La EPOC se caracteriza por la limitación progresiva del flujo aéreo asociada a una respuesta inflamatoria. El objetivo del estudio fue evaluar la influencia y la asociación de las variables respiratorias sobre la capacidad de ejercicio portadores de EPOC. Métodos: Estudio transversal evaluó 39 portadores de EPOC para obtener el volumen espiratorio forzado en el primer segundo (VEF1) y la capacidad vital forzada (CVF). La fuerza muscular respiratoria (FMR) evaluada en sus componentes de presión inspiratoria máxima (PImax) y presión espiratoria máxima (PEmax). Capacidad de ejercicio evaluada por la Prueba de Caminata de seis minutos (TC6m) e Incremental Shuttle Walking Test (ISWT). Resultados: El VEF1 (% 39,8 ± 15,3) y CVF (% 60,2 ± 17,1) se encuentran reducidos en relación al predicado clasificándolos en estadificación grado II (21%), III (51%) y IV (28%). La PImax (92,7 ± 14,6% predito) y PEmax (97,6 ± 19,0% predito) se encuentran dentro de los valores previstos para los sujetos. Se observó una correlación moderada entre la distancia recorrida en el ISWT vs VEF1 (r = 0,35; p = 0,02) e ISWT vs CVF (r = 0,42; p <0,001), TC6m vs VEF1 (r = 0,38; p = 0,01) y TC6m vs CVF (r = 0,52; p <0,001). La FMR se correlacionó directamente con la distancia recorrida en el ISWT [PImax (r = 0,44; p = 0,005); (P = 0,001) y con TC6m [PImax (r = 0,43; p = 0,006); PEmax (r = 0,59; p <0,001)]. La PEmax y el VEF1 influenciaron el 37% del rendimiento en el TC6m y la PEmax influenció aisladamente el 58% de la distancia recorrida en el ISWT. Conclusión: La fuerza muscular respiratoria y los volúmenes pulmonares reducidos se asociaron e influenciaron directamente en la capacidad de ejercicio máximo y submáximo de portadores de EPOC.(AU)

Functional capacity and mental state of patients undergoing cardiac surgery / Capacidade funcional e estado mental de pacientes submetidos à cirurgia cardíaca

Abstract Introduction: Cardiovascular diseases are a serious public health problem in Brazil. Myocardial revascularization surgery (MRS) as well as cardiac valve replacement and repair are procedures indicated to treat them. Thus, extracorporeal circulation (ECC) is still widely used in these surgeries, in which patients with long ECC times may have greater neurological deficits. Neurological damage resulting from MRS can have devastating consequences such as loss of independence and worsening of quality of life. Objective: To assess the effect of cardiac surgery on a patient's mental state and functional capacity in both the pre- and postoperative periods. Methods: We conducted a cross-sectional study with convenience sampling of subjects undergoing MRS and valve replacement. Participants were administered the Mini-Mental State Exam (MMSE) and the Duke Activity Status Index (DASI) in the pre- and postoperative periods, as well as before their hospital discharge. Results: This study assessed nine patients (eight males) aged 62.4 ± 6.3 years with a BMI of 29.5 ± 2.3 kg/m2. There was a significant decrease in DASI scores and VO2 from preoperative to postoperative status (p = 0.003 and p = 0.003, respectively). Conclusion: This study revealed a loss of cognitive and exercise capacity after cardiac surgery. A larger sample however is needed to consolidate these findings.

Resumo Introdução: As doenças cardiovasculares são um grave problema de saúde pública no Brasil, sendo as cirurgias de revascularização do miocárdio (CRM) e reparações ou trocas valvares, indicadas para tratamento destas doenças. Assim, a circulação extracorpórea (CEC) ainda é muito utilizada nestas cirurgias, onde pacientes com tempo elevado de CEC podem apresentaram maiores déficits neurológicos. Os danos neurológicos decorrentes da CRM podem ter consequências devastadoras como perda de independência e piora na qualidade de vida. Objetivo: Avaliar o efeito da cirurgia cardíaca sobre o estado mental e capacidade funcional de pacientes cardiopatas nos períodos pré e pós-operatório. Métodos: Estudo transversal, com amostra de conveniência, onde os sujeitos foram submetidos à CRM e troca valvar. Foram aplicados os questionários Mini-Mental State Exam (MMSE) e o Duke Activity Status Index (DASI), no período pré-operatório e antes da alta hospitalar. Resultados: Foram avaliados nove pacientes (oito homens) com idade 62,4 ± 6,3 anos e IMC 29,5 ± 2,3 Kg/m2. Observou-se uma queda significativa no DASI e no VO2 no período pós em relação ao pré-operatório (p = 0,003 e p = 0,003, respectivamente). Conclusão: No presente estudo constatou-se uma perda da capacidade cognitiva e de exercício após a cirurgia cardíaca. No entanto, um aumento do tamanho amostral faz-se necessário para consolidação dos resultados.