Impact of asthma on heart rate variability in children and adolescents: Systematic review and meta-analysis.

PURPOSE: Asthma is associated with abnormal autonomic function, and heart rate variability is considered a simple, accurate, and noninvasive tool for monitoring the autonomic system. Thus, the aim of this study was to investigate the impact of asthma on heart rate variability in children and adolescents. METHODS: This systematic review of observational studies and clinical trials evaluated heart rate variability in children and adolescents with asthma compared to healthy controls. The data were extracted independently by two reviewers. The quality of the selected articles was assessed using Agency for Health Care Research and Quality indicators. Random effects meta-analysis was performed for each outcome, with the effect size reported as standardized mean difference. RESULTS: Fifteen studies were included, of which five were classified as having high methodological quality. In the meta-analysis, long-term recording of the standard deviation of all normal-to-normal sinus R-R intervals differed significantly between groups (standardized mean difference [SMD] = -0.46 [95% confidence interval {CI}: -0.79 to -0.14], p < 0.005, I2 = 0%). Moreover, R-R intervals (long-term) were significantly shorter in asthmatic children than controls (SMD = -0.47 [95% CI: -0.68 to -0.25], p < 0.0001, I2 = 0). There were no significant differences between adjacent normal R-R intervals that exceed 50 ms (long-term) and the root mean square of successive differences between normal sinus R-R intervals (short-term). Regarding frequency-domain variables, long-term low frequency measurements differed significantly between groups (SMD = -0.34 [95% CI: -0.58 to -0.10], p < 0.005, I2 = 15%). There were no differences in high frequency measurements or in the ratio between low/high frequency powers (short- or long-term) between groups. CONCLUSION: The results confirm the impact of asthma on heart rate variability in children and adolescents, indicating lower heart rate variability and sympathetic modulation.

Determinants of exercise capacity in children and adolescents with severe therapy-resistant asthma.

OBJECTIVE: To evaluate the exercise capacity of children and adolescents with severe therapy resistant asthma (STRA) aiming to identify its main determinants. METHODS: Cross-sectional study including individuals aged 6-18 years with a diagnosis of STRA. Clinical (age and gender), anthropometric (weight, height and body mass index) and disease control data were collected. Lung function (spirometry), cardiopulmonary exercise testing (CPET) and exercise-induced bronchoconstriction (EIB) test were performed. RESULTS: Twenty-four patients aged 11.5 ± 2.6 years were included. The mean forced expiratory volume in one second (FEV1) was 91.3 ± 9.2%. EIB occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO2peak) was 34.1 ± 7.8 mL kg-1 min-1. A significant correlation between ventilatory reserve and FEV1 (r = 0.57; p = 0.003) was found. Similarly, there was a significant correlation between CPET and percent of FEV1 fall in the EIB test for both VE/VO2 (r = 0.47; p = 0.02) and VE/VCO2 (r = 0.46; p = 0.02). Patients with FEV1<80% had lower ventilatory reserve (p = 0.009). In addition, resting heart rate correlated with VO2peak (r=-0.40; p = 0.04), VE/VO2 (r = 0.46; p = 0.02) and VE/VCO2 (r = 0.48; p = 0.01). CONCLUSIONS: Exercise capacity is impaired in approximately 30% of children and adolescents with STRA. The results indicate that different aspects of aerobic fitness are influenced by distinct determinants, including lung function and EIB.

Diagnostic performance of the physical activity-related question of the GINA questionnaire to detect exercise-induced bronchoconstriction in asthma.

INTRODUCTION: The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents. MATERIAL AND METHODS: We divided participants (aged 6-18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument. RESULTS: We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV1z-score of -0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV1 after the EIB test. We found a higher frequency of EIB in participants with FEV1 z-score values of less than -1.0 compared to those with a z-score of -1.0 or greater (P = .05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (P = .41), with sensitivity of 42.1% and specificity of 57.1%. CONCLUSIONS: The item concerning physical activity in the GINA questionnaire has insufficient diagnostic power to detect EIB in children and adolescents with asthma.

Continuous positive airway pressure acutely increases exercise duration in children with severe therapy-resistant asthma: a randomized crossover trial.

BACKGROUND: Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ventilation on exercise capacity in individuals with severe therapy-resistant asthma (STRA) are unknown. This study aimed to evaluate the immediate effect of continuous positive airway pressure (CPAP) on exercise tolerance in children with STRA. METHODS: We performed a controlled, randomized, crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA. Clinical, anthropometric and lung function data were collected. The participants in the intervention group (IG) used CPAP (PEEP 10cmH2O and FiO2 0.21) for a period of 40 min. Subjects in the control group (CG) used CPAP with minimum PEEP at 1 cmH20 also for 40 min. Afterwards, subjects from both groups underwent cardiopulmonary exercise testing (CPET). After a 15-day washout period, on a subsequent visit, subjects participated in the opposite group to the initial one. RESULTS: Thirteen subjects with a mean age of 12.30 ± 1.7 years were included. The variables of peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) before using CPAP and after performing CPET did not show significant differences. Regarding CPET results, there was no significant difference (P = 0.59) between groups at peak exercise for oxygen consumption-VO2 (CG: 33.4 ± 6.3 and IG: 34.5 ± 5.9, mL kg-1 min-1). However, the IG (12.4 ± 2.1) presented a total test time (min) significantly (P = 0.01) longer than the CG (11.5 ± 1.3). CONCLUSION: The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.

Peripheral muscle strength is associated with aerobic fitness and use of antibiotics in patients with cystic fibrosis.

AIMS: Individuals with cystic fibrosis (CF) may develop muscle abnormalities, although little is known on its clinical and functional impact. This study aimed to evaluate the association of peripheral muscle strength with aerobic fitness, habitual physical activity, lung function and the use of antibiotics (ATB) in patients with CF. METHODS: A cross-sectional study where individuals aged ≥6 years underwent peripheral muscle strength evaluation (biceps, quadriceps and hamstrings) and performed a cardiopulmonary exercise test. Demographic, anthropometric, genetic, lung function and total days of ATB use within 1 year of tests were also collected. RESULTS: Correlation was found for biceps (r = .45; P = .002) strength with the peak oxygen consumption (VO2 peak). Muscle strength (biceps and quadriceps) also correlated with the ventilatory equivalent for oxygen consumption (VE /VO2 ) at anaerobic threshold (AT) and with the ventilatory equivalent for carbon dioxide production (VE /VCO2 ) both at AT and peak exercise. Negative correlations were found for quadriceps (r = -.39) and hamstrings (r = -.42) with the total days of ATB use in the following year. Patients needing to use ATB presented lower biceps strength (P = .05) and individuals with VO2 peak lower than 37 mL·kg-1 ·min-1 presented lower muscle strength for both biceps (P = .01) and quadriceps (P = .02). CONCLUSIONS: The results have shown that peripheral muscle strength is associated with aerobic fitness and the use of antibiotics in patients with CF.

Effects of hammock positioning on clinical parameters in preterm infants admitted to a neonatal intensive care unit: a systematic review / Efeitos da rede de posicionamento nos parâmetros clínicos de prematuros admitidos em unidade de terapia intensiva neonatal: uma revisão sistemática

ABSTRACT Objective: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU). Data sources: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale. Data synthesis: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low. Conclusions: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.

RESUMO Objetivo: Revisar os efeitos da rede de posicionamento nos parâmetros clínicos de recém-nascidos pré-termo (RNPT) admitidos em Unidade de Terapia Intensiva Neonatal (UTIN). Fontes de dados: Trata-se de uma revisão sistemática realizada na PubMed, na Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), na Biblioteca Eletrônica Científica Online (SciELO) e na Base de Dados em Evidências em Fisioterapia (PEDro). Selecionaram-se estudos de intervenção, nos idiomas inglês, português e espanhol, que avaliaram os efeitos da rede de posicionamento sobre parâmetros clínicos de RNPT admitidos em UTIN. Foram utilizadas três estratégias de busca: hammock positioning OR patient positioning AND intensive care units AND infant, newborn; hammock positioning OR patient positioning AND intensive care units; e hammock positioning OR patient positioning AND intensive care units, neonatal. Não houve restrição quanto ao ano de publicação dos artigos. A qualidade metodológica foi avaliada pela escala PEDro. Síntese dos dados: De um total de 597 artigos, apenas seis foram incluídos. As amostras totalizaram 139 neonatos, com idade gestacional entre 26 e 37 semanas e média de peso gestacional <2.240 g. Quatro estudos incluíram pacientes sem nenhuma patologia associada, e a maior parte deles dispôs os RNPT em supino na rede de posicionamento. A duração da intervenção variou de 15 até 180 minutos, e a maioria aplicou essa intervenção em apenas um momento. Foi observada melhora na frequência cardíaca (FC), na frequência respiratória (FR) e na dor (3/4 estudos), além de ganhos na saturação periférica de oxigênio (SpO2) (2/4 estudos). Apenas um artigo relatou piora da SpO2 com a intervenção. A qualidade metodológica foi classificada como baixa. Conclusões: Embora a rede de posicionamento pareça causar melhora na FC, na FR e na dor em RNPT, a baixa qualidade metodológica torna inconsistentes os resultados.

EFFECTS OF HAMMOCK POSITIONING ON CLINICAL PARAMETERS IN PRETERM INFANTS ADMITTED TO A NEONATAL INTENSIVE CARE UNIT: A SYSTEMATIC REVIEW.

OBJECTIVE: To review the effects of the hammock positioning on clinical parameters of preterm newborn infants (PTNB) admitted to the Neonatal Intensive Care Unit (NICU). DATA SOURCES: This was a systematic review performed by searching the Pubmed, Lilacs, SciELO and PEDro databases. Intervention studies in English, Portuguese and Spanish that evaluated the effects of hammock positioning on clinical parameters of PTNB admitted to the NICU were selected. Three search strategies were used: 1) hammock positioning OR patient positioning AND intensive care units AND infant, newborn; 2) hammock positioning OR patient positioning AND intensive care units; 3) hammock positioning OR patient positioning AND intensive care units, neonatal. There was no restriction on the year of publication of the articles. Methodological quality was assessed by the PEDro scale. DATA SYNTHESIS: Among 597 articles, only six were included and 139 neonates with gestational ages between 26 and 37 weeks and an average gestational weight <2240g were analyzed. Four studies included patients without any associated pathology and most of them placed the PTNB supine in hammock positioning. The duration of the intervention ranged from 15 to 180 minutes and most applied it at just one moment. There was an improvement in heart rate (HR), respiratory rate (RR) and pain (3/4 studies), as well as gains in peripheral oxygen saturation (SpO2) (2/4 studies). Only one study reported worsening of SpO2 with the intervention. The methodological quality of the studies was classified as low. CONCLUSIONS: Although this review suggests improvement with hammock positioning in HR, RR and pain in PTNB, the low methodological quality makes the results inconsistent.

Evaluation of the exercise intensity generated by active video gaming in patients with cystic fibrosis and healthy individuals.

BACKGROUND: Adherence of patients with cystic fibrosis (CF) to exercise is challenging. Here we compared the physiological responses during the use of interactive video games (VG) with the cardiopulmonary exercise test (CPET) in healthy and CF subjects. METHODS: Cross-sectional study including CF and healthy (CON) subjects older than 6 years. Individuals were evaluated in two visits. At visit one, anthropometric measures, spirometry and CPET were performed. In the second visit, a physical activity questionnaire was applied and gas analyses performed during the use (10 min) of both Nintendo Wii (Wii Fit Plus: (1) Obstacle Course, (2) Rhythm Boxing and (3) Free Run) and Xbox One (Just Dance 2015: (1) Love Me Again, (2) Summer and (3) Happy). RESULTS: Twenty-five CON and 30 CF patients were included. The mean FEV1 (%) was significantly lower in the CF group compared to CON. There were no differences between groups at peak exercise (CPET) for heart rate (HR), oxygen consumption (VO2) and minute ventilation (VE). In the CON group, games 2 and 3 (Xbox) and game 3 (Nintendo) increased HR to values similar to the anaerobic threshold (AT), while for the CF group this occurred for games 2 (Xbox) and 3 (Nintendo). As for VO2 and VE, both groups obtained similar responses as compared to AT values in games 2 (Xbox) and 3 (Nintendo). CONCLUSION: The use of VG generated a cardiorespiratory response similar to AT levels found during CPET, indicating that it may be an alternative for exercise training of CF individuals.

Los efectos del entrenamiento físico en niños asmáticos / Effects of exercise training in children with asthma

Asthma is a chronic obstructive respiratory disease with high prevalence in children. Several factors may trigger asthma symptoms, including exercise, which can lead to exercise-induced bronchoconstriction (EIB). Although physical exercise may represent a risk factor for triggering bronchial obstruction in asthmatics, studies have also indicated several positive effects. Thus, this article aimed to summarize current evidence on the effects of exercise training in children with asthma. There is substantial available evidence on the topic. Most of the findings show that exercise induce positive effects, including the increase of aerobic fitness, decrease of EIB levels, as well as an increase in both disease control and quality of life levels in asthmatic children. As for possible influencing factors in order to obtain exercise-induced positive effects, an adequate prescription of exercise intensity highlights and should be personalized, as well as established close to the anaerobic threshold. Thus, considering the evidence showing beneficial effects and the fact that the practice of physical exercise consists of a low cost and safe non-pharmacological therapy, supervised, personalized and individual recommendation of exercise training by health professionals are indicated to asthmatic children.

El asma es una enfermedad respiratoria obstructiva crónica con alta prevalencia en niños. Varios factores pueden desencadenar síntomas de asma, incluido el ejercicio, que puede conducir a la broncoconstricción inducida por el ejercicio (BIE). Aunque el ejercicio físico puede representar un factor de riesgo para desencadenar la obstrucción bronquial en los asmáticos, estudios también han indicado varios efectos positivos. Este artículo tiene como objetivo resumir la evidencia actual sobre los efectos del entrenamiento físico en niños con asma. Hay evidencia sustancial disponible sobre el tema. La mayoría de los hallazgos muestran que el ejercicio induce efectos positivos, incluido el aumento de la aptitud aeróbica, la disminución de los niveles de la BEI, así como un aumento tanto en el control de la enfermedad como en los niveles de calidad de vida en niños asmáticos. Se destaca la importancia de una prescripción de la intensidad del ejercicio adecuada y personalizada, cerca del umbral anaeróbico, para obtener los efectos positivos inducidos por el ejercicio. Por lo tanto, considerando la evidencia que muestra efectos beneficiosos y el hecho de que la práctica del ejercicio físico consiste en una terapia no farmacológica, segura y de bajo costo, el entrenamiento físico supervisado, personalizado e individualizado por parte de profesionales de la salud es recomendado para niños asmáticos.

Modified Shuttle Test Distance Correlates With Peak Oxygen Uptake in Children and Adolescents With Severe Therapy-Resistant Asthma.

INTRODUCTION: Several tests may be used to assess exercise intolerance in severe therapy-resistant asthma (STRA), including the gold standard cardiopulmonary exercise test (CPET) and the modified shuttle test (MST). OBJECTIVE: To correlate the distance achieved in the MST with peak oxygen uptake (VO2peak) and to compare the maximal heart rate (HRmax) obtained in both tests in children and adolescents with STRA. METHODS: This is a cross-sectional study, with 19 children and adolescents with STRA. Demographic, anthropometric, clinical data, and spirometric values were collected. CPET and the MST were performed in two consecutive visits. HRmax, pulse oxygen saturation, and dyspnea were compared between tests. The distance achieved in the MST was correlated with VO2peak. RESULTS: Nineteen patients with a mean age of 11.5 ± 2.5 years were included. The mean HRmax (bpm) achieved was 180.8 ± 12.10 for the MST and 187.6 ± 9.35 for CPET, whereas the mean HRmax as a percentage of predicted (HRmax%) was 90.7 ± 6.5 for the MST and 93.8 ± 4.5 for CPET. A difference of only 6 bpm was found for HRmax (p = 0.10) and of 3% for HRmax% (p = 0.06) between tests. A strong correlation was found between the MST (r = 0.79; p = 0.001) and VO2peak measured through CPET. However, there were no correlations between the MST and both body mass index (r = -0.14; p = 0.564) and forced expiratory volume in the first second - FEV1 (r = -0.02; p = 0.917). CONCLUSION: The results demonstrate that the MST distance strongly correlates with VO2peak, measured through CPET, and the main physiological variable responses were similar between both tests. Our results provide additional data for the use of the MST to assess exercise capacity in children and adolescents with STRA.

Exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans: a systematic review / Capacidade de exercício em crianças e adolescentes com bronquiolite obliterante pós-infecciosa: uma revisão sistemática

ABSTRACT Objective: To evaluate exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans. Data source: This is a systematic review based on data from PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), and Physiotherapy Evidence Database (PEDro). We used the following search strategy: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six-minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans." We selected studies that evaluated exercise capacity through maximal/submaximal testing in children and adolescents with post-infectious bronchiolitis obliterans, and no other associated disease. We searched articles in English, Portuguese, and Spanish, without restrictions regarding the period of publication. The methodological quality was assessed by the Agency for Healthcare Research and Quality (AHRQ) protocol. Data synthesis: Out of the 81 articles found, only 4 were included in this review. The studies totaled 135 participants (121 with post-infectious bronchiolitis obliterans and 14 healthy), with sample sizes between 14 and 58 subjects. All patients underwent spirometry to evaluate pulmonary function, indicating an obstructive ventilatory pattern. Among them, 3/4 had their physical performance assessed by the six-minute walk test and 2/4 by the cardiopulmonary exercise testing. These test results were compared to those of a control group (1/4) and presented as percentage of predicted and/or in meters (3/4). Lastly, 3/4 of the studies showed reduced exercise capacity in this population. The studies included were classified as having high methodological quality. Conclusions: Findings of the study demonstrate that children and adolescents with post-infectious bronchiolitis obliterans have reduced exercise capacity.

RESUMO Objetivo: Avaliar a capacidade de exercício em crianças e adolescentes com bronquiolite obliterante pós-infeciosa. Fonte de dados: Trata-se de uma revisão sistemática por meio das bases de dados PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e Physiotherapy Evidence Database (PEDro). Utilizou-se a seguinte estratégia de busca: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans". Foram selecionados estudos que avaliaram a capacidade de exercício por meio de testes máximos/submáximos em crianças e adolescentes com bronquiolite obliterante pós-infeciosa, sem qualquer outra doença associada. Buscaram-se artigos nos idiomas inglês, português e espanhol e sem restrições quanto ao período de publicação. A qualidade metodológica foi avaliada pelo protocolo da Agency for Health Care Research and Quality (AHRQ). Síntese dos dados: De um total de 81 artigos, apenas 4 foram incluídos nesta revisão. Os estudos totalizaram 135 participantes (121 com bronquiolite obliterante pós-infeciosa e 14 saudáveis), com tamanho amostral entre 14 e 58 sujeitos. Todos avaliaram a função pulmonar por meio da espirometria, observando um padrão ventilatório obstrutivo. Desses, 3/4 avaliaram o desempenho físico pelo teste de caminhada de seis minutos e 2/4 pelo teste de exercício cardiopulmonar. Os resultados desses testes foram comparados a um grupo controle (1/4), bem como apresentados em percentual do previsto e/ou em metros (3/4). Por fim, 3/4 dos estudos demostraram que a capacidade de exercício se encontra reduzida nessa população. Os estudos incluídos foram classificados com alta qualidade metodológica. Conclusões: Os achados do estudo demonstram que crianças e adolescentes com bronquiolite obliterante pós-infeciosa apresentam redução da capacidade de exercício.

EXERCISE CAPACITY IN CHILDREN AND ADOLESCENTS WITH POST-INFECTIOUS BRONCHIOLITIS OBLITERANS: A SYSTEMATIC REVIEW.

OBJECTIVE: To evaluate exercise capacity in children and adolescents with post-infectious bronchiolitis obliterans. DATA SOURCE: This is a systematic review based on data from PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), and Physiotherapy Evidence Database (PEDro). We used the following search strategy: "Exercise capacity OR Exercise Test OR Physical fitness OR Functional capacity OR Six-minute walk test OR Shuttle walk test OR Cardiopulmonary exercise test AND Bronchiolitis obliterans." We selected studies that evaluated exercise capacity through maximal/submaximal testing in children and adolescents with post-infectious bronchiolitis obliterans, and no other associated disease. We searched articles in English, Portuguese, and Spanish, without restrictions regarding the period of publication. The methodological quality was assessed by the Agency for Healthcare Research and Quality (AHRQ) protocol. DATA SYNTHESIS: Out of the 81 articles found, only 4 were included in this review. The studies totaled 135 participants (121 with post-infectious bronchiolitis obliterans and 14 healthy), with sample sizes between 14 and 58 subjects. All patients underwent spirometry to evaluate pulmonary function, indicating an obstructive ventilatory pattern. Among them, 3/4 had their physical performance assessed by the six-minute walk test and 2/4 by the cardiopulmonary exercise testing. These test results were compared to those of a control group (1/4) and presented as percentage of predicted and/or in meters (3/4). Lastly, 3/4 of the studies showed reduced exercise capacity in this population. The studies included were classified as having high methodological quality. CONCLUSIONS: Findings of the study demonstrate that children and adolescents with post-infectious bronchiolitis obliterans have reduced exercise capacity.

Equações utilizadas para a predição de frequência cardíaca máxima na população pediátrica não atlética: uma revisão sistemática / Equations used to predict maximum heart rate in the non-athletic pediatric population: a systematic review

OBJETIVOS: Revisar a aplicabilidade das equações preditivas de frequência cardíaca máxima durante os testes de exercício em crianças e adolescentes não atletas. MÉTODOS: Trata-se de uma revisão sistemática, realizada no Pubmed, Lilacs, Scielo e PEDro. Foram incluídos estudos que compararam a frequência cardíaca máxima medida e a estimada por equações preditivas durante testes de esforço em crianças e adolescentes não atletas. Utilizou-se a seguinte estratégia de pesquisa: Exercise test OR Exercise testing OR Cardiopulmonary exercise test OR Cardiopulmonary exercise testing OR Peak oxygen uptake OR Maximal oxygen consumption OR Exercise tolerance OR Exercise capacity AND Heart rate OR Heart rates OR Pulse rate OR Pulse rates OR Heart rate control OR Cardiac chronotropic OR Predictive value test AND Predictive equations. A qualidade metodológica foi avaliada pela escala da Agency for Health Care Research and Quality. RESULTADOS: De um total de 858 artigos localizados, apenas quatro foram incluídos. Os artigos totalizaram 325 participantes (sete a 18 anos). Todos os estudos mensuraram a frequência cardíaca máxima por meio do teste de esforço cardiopulmonar. Enquanto nenhum estudo (04/04=100%; 01/01=100%) recomendou as fórmulas "220 - idade" e a "207 ­ 0,7 x idade", as equações "208 ­ (0,7 x idade)" e a "200 ­ 0,48 x idade" foram adequadas em 02/03 (66,6%) artigos e 01/01 (100%) documentos, respectivamente. A qualidade metodológica foi considerada alta em todos os artigos avaliados, oscilando entre 76 e 97 pontos. CONCLUSÕES: Os achados parecem sugerir que a fórmula "208 ­ (0,7 x idade)" foi a equação mais testada e adequada em grande parte para estimar os valores de frequência cardíaca máxima em crianças e adolescentes não atletas. No entanto, ainda são necessários mais estudos para confirmar esses resultados.

AIMS: To evaluate the applicability of the predictive equations of maximum heart rate during exercise tests in non-athlete children and adolescents. METHODS: It is a systematic review, carried out through Pubmed, Lilacs, Scielo and PEDro. We included studies comparing the maximum heart rate measured and estimated by predictive equations during stress tests in non-athlete children and adolescents. The following search strategy was used: Exercise test OR Exercise testing OR Cardiopulmonary exercise test OR Cardiopulmonary exercise testing OR Peak oxygen uptake OR Maximal oxygen consumption OR Exercise tolerance OR Exercise capacity AND Heart rate OR Heart rates OR Pulse rate OR Pulse rates OR Heart rate control OR Cardiac chronotropic OR Predictive value test AND Predictive equations. The methodological quality was assessed by the Agency for Health Care Research and Quality scale. RESULTS: Of a total of 858 articles located, only four were included. The articles totaled 325 participants (seven to 18 years). All studies measured the maximum heart rate by cardiopulmonary stress test. While no study recommended (04/04=100%; 01/01=100%) the formulas "220 - age" and "207 - 0.7 x age", the equations "208 - (0.7 x age)" and "200 - 0.48 x age" were adequate in 02/03 (66.6%) articles and 01/01 (100%) document, respectively. The methodological quality was considered high in all articles evaluated, ranging from 76 to 97 points. CONCLUSIONS: The findings seem to suggest that the formula "208 - (0.7 x age)" was the most tested and adequate equation to a large extent for estimating maximum heart rate in non-athlete children and adolescents. However, further studies are still needed to confirm these results.