Cardiovascular, Respiratory, and Functional Effects of Home-Based Exercise Training after COVID-19 Hospitalization.

INTRODUCTION: The present randomized, single-center, and single-blinded clinical trial tested the hypothesis that tele-supervised home-based exercise training (exercise) is an effective strategy for improving cardiovascular, respiratory, and functional capacity parameters in individuals who were hospitalized due to coronavirus disease 2019 (COVID-19). METHODS: Thirty-two individuals (52 ± 10 yr; 17 were female) randomly assigned to exercise ( n = 12) or control groups ( n = 20) had their anthropometric (weight, body mass index), hemodynamic (brachial and central blood pressure), vascular (arterial stiffness), ventilatory (pulmonary function and respiratory muscle strength), and functional parameters (handgrip strength, five-time sit to stand, timed up and go test, and 6-min walking test) assessed at baseline (30-45 d of hospital discharged) and after 12 wk of follow-up. RESULTS: Both groups similarly increased ( P < 0.001) forced vital capacity (absolute and percent of predicted), forced expiratory volume in the first second (absolute and percent of predicted), and handgrip strength during follow-up. However, only the exercise group reduced carotid-femoral pulse wave velocity (-2.0 ± 0.6 m·s -1 , P = 0.048) and increased ( P < 0.05) resting oxygen saturation (1.9% ± 0.6%), mean inspiratory pressure (24.7 ± 7.1 cm H 2 O), mean expiratory pressure (20.3 ± 5.8 cm H 2 O), and percent of predicted mean expiratory pressure (14% ± 22%) during follow-up. No significant changes were found in any other variable during follow-up. CONCLUSIONS: Present findings suggest that tele-supervised home-based exercise training can be a potential adjunct therapeutic to rehabilitate individuals who were hospitalized due to COVID-19.

Can Previous Levels of Physical Activity Affect Risk Factors for Cardiorespiratory Diseases and Functional Capacity after COVID-19 Hospitalization? A Prospective Cohort Study.

Purpose: To evaluate the influence of previous levels of physical activity on hemodynamic, vascular, ventilatory, and functional outcomes after coronavirus disease 2019 (COVID-19) hospitalization. Methods: Sixty-three individuals with COVID-19 had their clinical status and previous levels (12 month) of physical activity (Baecke Questionnaire of Habitual Physical Activity) assessed at hospital admission. Individuals were then allocated to lower levels of physical activity (ACTLOWER; N = 22), intermediate levels of physical activity (ACTINTERMEDIATE; N = 22), or higher levels of physical activity (ACTHIGHER; N = 19) groups, according to tertiles of physical activity. Resting hemodynamic (heart rate and brachial/central blood pressures) and vascular (carotid-femoral pulse wave velocity, augmentation index, and brachial artery flow-mediated dilation) variables, pulmonary function (spirometry), respiratory muscle strength (maximal respiratory pressures), and functional capacity (handgrip strength, five-time sit-to-stand, timed-up and go, and six-minute walking tests) were measured at 30 to 45 days after hospital discharge. Results: ACTLOWER showed lower levels (P < 0.05) of forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation, and maximal expiratory pressure than ACTHIGHER. ACTLOWER also had lower (P = 0.023) walking distance (~21%,) and lower percentage of predicted walking distance (~20%) at six-minute walking test during follow-up than ACTINTERMEDIATE. However, hemodynamic and vascular variables, handgrip strength, five-time sit-to-stand, and timed-up and go were not different among groups. Conclusion: ACTLOWER showed impaired ventilatory parameters and walking performance when compared with ACTHIGHER and ACTINTERMEDIATE, respectively. These results suggest that previous levels of physical activity may impact ventilatory and exercise capacity outcomes 30 to 45 days after COVID-19 hospitalization discharge.

Determinants of endothelial dysfunction in noncritically ill hospitalized COVID-19 patients: A cross-sectional study.

OBJECTIVE: The aim of this study was to identify determinants of endothelial dysfunction in patients hospitalized with acute COVID-19. METHODS: A total of 109 hospitalized COVID-19 patients in noncritical status were cross-sectionally studied. Clinical data (age, sex, comorbidities, and medications) and BMI were assessed. Laboratory tests included serum hemoglobin, leukocytes, lymphocytes, platelets, C-reactive protein, ferritin, D-dimer, and creatinine. Physical status was evaluated using a handgrip dynamometer. Endothelial function was assessed noninvasively using the flow-mediated dilation (FMD) method. RESULTS: The sample average age was 51 years, 51% of patients were male, and the most frequent comorbidity was obesity (62%). Univariate analysis showed association of lower FMD with higher BMI, hypertension, use of oral antihypertensive, higher blood levels of creatinine, and larger baseline artery diameter. After adjusting for confounders, the multivariate analysis showed BMI (95% CI: -0.26 to -0.11; p < 0.001) as the major factor associated with FMD. Other factors associated with FMD were baseline artery diameter (95% CI: -1.77 to -0.29; p = 0.007) and blood levels of creatinine (95% CI: -1.99 to -0.16; p = 0.022). CONCLUSIONS: Increased BMI was the major factor associated with endothelial dysfunction in noncritically hospitalized COVID-19 patients. This may explain one of the pathways in which obesity may increase the risk for severe COVID-19.

The Urgent Need for Recommending Physical Activity for the Management of Diabetes During and Beyond COVID-19 Outbreak.

Diabetes is the second most prevalent non-communicable chronic diseases (NCDs) in patients with coronavirus disease 2019 (COVID-19) and is highly associated with increased incidence of disease severity and mortality. Individuals with diabetes and poor glycemic control have an even worse prognosis. Despite of the need/effectiveness of social distancing measures (i.e.: home confinement, quarantine and/or lockdown) during COVID-19 outbreak, preliminary findings showed an increase in negative behaviors during COVID-19 home confinement (i.e.: ~33.5% reduction in physical activity, ~28.6% (~3.10h) increase in sedentary behavior (i.e.: daily sitting, reclining and lying down time), and more unhealthy food consumption and meal pattern), which may have important clinical implications. For example, we estimated that this reduction in physical activity can increase the cases of type 2 diabetes (from ~7.2% to ~9.6%; ~11.1 million cases per year) and all-cause mortality (from ~9.4% to ~12.5%; ~1.7 million deaths per year) worldwide. Few weeks of reduction in physical activity levels result in deleterious effects on several cardiometabolic (i.e.: glycemic control, body composition, inflammatory cytokines, blood pressure, vascular function…) and functional parameters (i.e.: cardiorespiratory/muscle fitness, balance, agility…). In contrast, physical activity and exercise are important tools for preventing and treating diabetes and others NCDs. Home-based exercise programs are useful, safe and effective for the management of diabetes, and could be widely used during COVID-19 outbreak. In this context, there is an urgent need for recommending physical activity/exercise, during and beyond COVID-19 outbreak, for improving the management of diabetes, as well as to prevent the increase in global burden of COVID-19, diabetes and others NCDs.

Prescribing high-intensity interval exercise by RPE in individuals with type 2 diabetes: metabolic and hemodynamic responses.

We tested the hypothesis that rating of perceived exertion (RPE) is a tool as efficient as the heart rate (HR) response to the cardiopulmonary exercise test (CPX) for prescribing and self-regulating high-intensity interval exercise (HIIE), and that metabolic and hemodynamic response to HIIE is superior than to continuous moderate-intensity exercise (MICE) in individuals with type 2 diabetes mellitus (T2DM). Eleven participants (age = 52.3 ± 3 years) underwent HIIE prescribed and self-regulated by RPE (HIIERPE; 25 min), HIIE prescribed and regulated by an individual's HR response to CPX (HIIEHR; 25 min), MICE prescribed and self-regulated by RPE (30 min) and control (30 min of seated resting) intervention in random order. HR, blood pressure (BP), capillary glucose, endothelial reactivity, and carotid-femoral pulse wave velocity were assessed before, immediately after, and 45 min after each intervention. Exercise HR, speed, and distance were measured during exercise sessions. Twenty-four-hour ambulatory BP was measured after each intervention. Exercise HR, speed, and distance were similar between HIIERPE and HIIEHR. BP response was not different among HIIERPE, HIIEHR, and MICE. Capillary glycaemia reduction was greater (P < 0.05) after HIIERPE (48.6 ± 9.6 mg/dL) and HIIEHR (47.2 ± 9.5 mg/dL) than MICE (29.5 ± 11.5 mg/dL). Reduction (P < 0.05) in 24-h (6.7 ± 2.2 mm Hg) and tendency toward reduction (P = 0.06) in daytime systolic (7.0 ± 2.5 mm Hg) ambulatory BP were found only after HIIERPE. These results suggest that HIIE is superior to MICE for reducing glycaemia and ambulatory BP, and that the 6-20 RPE scale is a useful tool for prescribing and self-regulating HIIE in individuals with T2DM.

Clinical outcomes related to the incidence of ventilator-associated pneumonia in adults - a cohort study / Desfechos clínicos ligados à incidência de pneumonia associada à ventilação mecânica no adulto - estudo de coorte

Abstract Introduction: Ventilator-Associated Pneumonia (VAP) is a common complication found in the Intensive Care Unit (ICU) and is associated with increased mortality, length of hospital stay and mechanical ventilation (MV) time. Objective: To determine the incidence of VAP and its impact on the clinical course of the subject undergoing invasive MV in the ICU. Methods: This is a cohort study of hospitalized subjects in the general adult ICU of the State Hospital of Bauru / SP. The clinical information for the period of 19 months were collected. Stratification for the groups was based on the presence or absence of VAP, free_VAP and VAP, respectively. The Hotelling T² with 95% confidence, chi-square and the Mann-Whitney tests were executed using the "R" software and the results showed as mean ± standard deviation and absolute and relative distribution (p < 0.05). Results: The sample was of 322 subjects; the VAP group consisted of 73 (22.67%), 54.79% male, age: 62.31±16.96 years and the APACHE II: 29.98 ± 8.64. The VAP group had longer time of the MV and of the ICU compared to free VAP group; even in this group, the highest incidence of death in the ICU occurred between the 16th and 20th day of hospitalization. The free VAP group was older and 50% of the patients discharged from hospital. Conclusion: VAP and their interfaces still impact on the clinical evolution of the subjects mainly on the time factor of MV and ICU stay. The highest incidence of death in the ICU occurs in the first weeks.

Resumo Introdução: A Pneumonia Associada à Ventilação Mecânica (PAV) é uma complicação comumente encontrada na Unidade de Terapia Intensiva (UTI) e está associada à maior mortalidade, tempo de internação e ventilação mecânica (VM). Objetivo: Verificar a incidência da PAV e seu impacto sobre a evolução clínica dos sujeitos submetidos à ventilação mecânica invasiva na UTI. Métodos: Trata-se de um estudo de coorte com sujeitos internados na UTI geral adulto do Hospital Estadual de Bauru/SP. Foram coletadas as informações clínicas referentes ao período de 19 meses. A estratificação para os grupos foi realizada com base na ocorrência ou não da PAV, sem_PAV e PAV, respectivamente. Foi aplicado o teste T2 de Hotelling com 95% de confiança e Qui-Quadrado utilizando o Software "R" e os resultados apresentados em média ± desvio padrão e distribuição absoluta e relativa (p < 0,05). Resultados: A casuística foi de 322 sujeitos; o grupo PAV constou de 73 (22,67%), sendo 54,79% do sexo masculino, idade: 62,31 ± 16,96 anos e APACHE II: 29,98 ± 8,64. O grupo NAV teve maior tempo de VM e na UTI se comparado ao grupo sem_NAV; ainda neste grupo, a maior incidência de óbito na UTI ocorreu entre o 16° ao 20° dia de internação. O grupo sem_PAV era mais velho e 50% deste tiveram alta hospitalar. Conclusão: A PAV e suas interfaces ainda causam impacto sobre a evolução clínica dos sujeitos principalmente quanto ao fator tempo de ventilação mecânica e de internação na UTI. A maior incidência de óbito na UTI ocorre nas primeiras semanas.

Brazilian Portuguese translation and cross-cultural adaptation of the "Caregiver Priorities and Child Health Index of Life with Disabilities" (CPCHILD) questionnaire.

BACKGROUND: Consideration of the quality of life in relation to individual health status is crucial for planning and maintaining a system of patient-centered care. Until recently, there have been no suitable instruments to assess health-related quality of life (HRQoL,) of children and adolescents with severe, non-ambulant cerebral palsy (GMFCS functional levels IV and V). The "Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire" (CPCHILD) was developed in English specifically for this population, and has been validated in Canada. The aim of this study was to translate and adapt the CPCHILD Questionnaire into Brazilian Portuguese, thus permitting researchers in Brazil to access this important tool for measuring HRQoL in this population, as well as the possibility of making comparisons with other studies that use the same questionnaire in other languages. METHOD: The cross-cultural adaptation included two forward translations by independent translators, their synthesis, two back-translations by independent translators, an assessment of the versions by an expert committee and the development of a pre-final version, which was tested on 30 caregivers of children (5 -18) with severe cerebral palsy (GMFCS IV & V). RESULTS: Despite the relative equivalence between the two translations, some items required adaptations for the synthesized version. Certain modifications were necessary in the pre-final version to achieve idiomatic equivalence. The modifications were required to account for the socioeconomic and cultural levels of the target population. CONCLUSION: The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a Brazilian Portuguese equivalent to measure the HRQoL of children with severe developmental disabilities, with the potential to measure the benefits of various procedures that are indicated for these patients. This adaptation exhibited a satisfactory level of semantic equivalence between the Portuguese target and the original English source versions. The validity of the Brazilian version of the instrument must be established in the future by assessing its psychometric properties on Brazilian epidemiological samples.

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2 / Sensitive-motor alteration of the lower limbs in diabetics type 2

INTRODUÇÃO: A alta incidência do Diabetes mellitus (DM) na população torna essa patologia alvo de muitas pesquisas. Uma das complicações do DM é a neuropatia periférica crônica caracterizada por atrofia e degeneração axonal e/ou alteração da célula de Schwann. A fisioterapia atua na estimulação da regeneração da fibra nervosa, o que reduz o risco de desenvolvimento do pé diabético. OBJETIVO: Identificar o comprometimento da sensibilidade nos membros inferiores (MMII) de diabéticos e verificar fatores que contribuíram para o desenvolvimento do pé diabético, como glicemia, hemoglobina glicada (HbA1c), tempo de diagnóstico, pressão arterial e antropometria. MATERIAIS E MÉTODOS: Os diabéticos foram avaliados na Associação dos Diabéticos de Bauru, participaram de entrevista e foram submetidos a antropometria, triagem pressórica e teste neurossensorial no Sistema Pontuação Clínica Toronto (SPCT). RESULTADOS: Os 68 pacientes (61,76% mulheres e 38,23% homens) tinham 62,93 ± 9,64 anos, apresentaram pressão sistólica de 132,54 ± 17,95 mmHg e diastólica 80,39 ± 11,35 mmHg, índice de massa corpórea 30,34 ± 5,80 kg/m², glicemia 149,20 ± 60,37mg/dL, HbA1c 7,72 ± 1,4%; tempo de diagnóstico de um a 34 anos. Dentre eles, 80,88% apresentavam sobrepeso; 72,06%, hipertensão arterial; 42,64%, dislipidemia; 14,7%, problemas renais; e 17,64%, vasculares. Pelo SPCT, 97,05% apresentavam neuropatia, 95,59% com simetria. Na avaliação, 57,35% apresentavam alteração sensitiva protetora; 60,29%, sensibilidade térmica; 26,47%, tátil; 17,64%, vibratória; 7,35%, dolorosa; e 1,47%, alteração cinestésica. Nos pés, 72,05% apresentavam pele ressecada; 64,70%, fissuras; 54,41%, calosidade; e 44,11%, micose; 50% referiram dor; 39,7%, dormência; 41,17%, parestesia; 27,94%, ataxia. Reflexos estavam ausentes ou diminuídos em 14,71% dos indivíduos; desses, 38,23% no Aquileu. Observou-se correlação positiva entre o SPCT com a glicemia e a circunferência abdominal e a hemoglobina glicada com a glicemia. CONCLUSÃO: Houve grande incidência de neuropatia simétrica; alteração de sensibilidade com presença de sinais clínicos, sintomas, arreflexia e hiporeflexia; e incidência de obesidade e hipertensão associadas. Faz-se necessário o acompanhamento da fisioterapia na avaliação da sensibilidade para prevenir, reduzir sintomas e melhorar a circulação sanguínea em MMII.

INTRODUCTION: The high incidence of diabetes mellitus (DM) in the population becomes this pathology subject of much research. One complication of diabetes is peripheral neuropathy characterized by chronic atrophy and axonal degeneration and/or alteration of the Schwann cell. The physiotherapy works in the stimulation of regeneration of the nerve fiber, which reduces the risk of developing diabetic foot. OBJECTIVE: To identify the sensitivity disorders in the lower limbs (LL) in diabetics patients and verify factors that contribute to the development the diabetic foot as glicemic level, glycosylated hemoglobin (GH), time of the diagnostic, blood pressure, anthropometry and life habits. MATERIALS AND METHODS: The diabetics patients were valued in Bauru Diabect Association and submitted the interview, anthropometry, blood pressure, by the Toronto Clinical Scoring System avaliation (TCSS - sensorial test, reflexes e symptoms). RESULTS: The 68 enrolled patients, 61.76% female and 38.23% male, with 62.93 ± 9.64 years-old, showed systolic blood pressure of 132.54 ± 17.95 mmHg and diastolic blood pressure of 80.39 ± 11,35 mmHg; body mass index, 30,34 ± 5,80 kg/m2; glicemic level, 149,20 ± 60,37mg/dL; GH, 7,72 ± 1,4%; time of the diagnostic, one to 34 years; 80,88% had overweight, 72,06%, hypertension; 42,64%, dyslipidemia; 14,7%, kidney; and 17,64%, vascular disorders. According to TCSS, 97.05% showed neuropathy, 95.59% were symmetrical. Regarding the sensitivity altered, 57.35% showed in protect; 60.29%, thermal; 26.47%, tactile; 17.64%, vibratory; 7.35%, painful; and 1.47%, kinectic-postural. In the feet, 72.05% had dry foot skin; 64.70%, fissures; 54.41%, callosity; 44.11%, mycosis; 50% reported pain; 39,7%, numbness; 41,17%, tingling; 27,94%, sensory ataxia. The reflexes were abolished or decreased in 14.71%; 38.23% are localized in Achilles tendon. There was positive correlation between the TCSS with abdominal circumference and blood glucose and glycated hemoglobin with glucose. CONCLUSION: There was great incidence of the symmetrical neuropathy; sensibility alteration with clinical manifestations, symptons, areflexia and hyporeflexia; obesity and hypertension incidences were associated. It is very necessary the physiotherapy accompaniment on the sensitivity valuation to prevent, reduce the symptons and improve the blood circulation in LL.