Effectiveness of Cardiac Rehabilitation With mHealth Through Smartphone Functionalities: A Systematic Review Protocol.

Cardiovascular diseases are the leading cause of mortality worldwide, requiring support to manage symptoms and improve prognosis. Home-based cardiac rehabilitation is a realistic resource for this purpose, but it requires patients' self-management skills in order to change behaviours. Smartphones are considered mHealth technology (mobile technological resources in healthcare) and have the potential to provide modalities for delivery of cardiac rehabilitation. This systematic review aims to examine these modalities and identify those that are most effective for improving exercise capacity, quality of life, and patient compliance. Randomized controlled trials (1994 to 2022) performed with adults with coronary artery disease (post-myocardial infarction, angina, post-coronary artery bypass graft surgery) or heart failure eligible for home-based cardiac rehabilitation (mHealth) will be selected. Studies published in English, Spanish, or Portuguese that compare rehabilitation-specific mobile apps or smartphone-based features with conventional cardiac rehabilitation will be included. Searches will be conducted in MEDLINE, CENTRAL, EMBASE, LILACS, PEDro, grey literature, and ongoing or recently completed studies. Data and risk of bias will be assessed, and if appropriate, a meta-analysis will be carried out.

Les maladies cardiovasculaires constituent la principale cause de décès dans le monde et nécessitent des soins de soutien pour la prise en charge des symptômes et l'amélioration du pronostic. La réadaptation cardiaque à domicile est un moyen réaliste d'y arriver, mais pour ce faire, les patients doivent acquérir des compétences en autogestion qui leur permettront de modifier leurs comportements. Les téléphones intelligents sont considérés comme une technologie de santé mobile qui a le potentiel d'améliorer les méthodes d'administration de la réadaptation cardiaque. La présente revue systématique vise à examiner ces modalités et à cibler les plus efficaces dans l'amélioration de la capacité physique, de la qualité de vie et de l'adhésion des patients au programme. Des essais contrôlés randomisés (1994 à 2022) réalisés auprès d'adultes qui sont atteints d'une maladie coronarienne (angine ou trouble ayant mené à un infarctus du myocarde ou à un pontage aortocoronarien) ou d'insuffisance cardiaque et qui sont admissibles à la réadaptation cardiaque à domicile (technologie de santé mobile) seront sélectionnés. Nous inclurons les études publiées en anglais, en espagnol ou en portugais qui comparent des applications mobiles de réadaptation ou des fonctionnalités de téléphones intelligents à un programme traditionnel de réadaptation cardiaque. Les bases de données MEDLINE, CENTRAL, EMBASE, LILAC et PEDro, seront interrogées et la littérature grise ainsi que les études en cours seront examinées. Les données et le risque de biais seront évalués, et s'il y a lieu, une métanalyse sera effectuée.

Upper Limb Anaerobic Metabolism Capacity is Reduced in Mild and Moderate COPD Patients.

Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3' and 5' of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r2 = 0.604, adjusted r2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3' and 5' of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.

Complexity analysis of heart rate variability in chronic obstructive pulmonary disease: relationship with severity and symptoms.

PURPOSE: Chronic obstructive pulmonary disease (COPD) negatively impacts autonomic control of the heart rate, as assessed by time and frequency domains of heart rate variability (HRV) analysis. However, it is unknown whether symbolic dynamic analysis may identify cardiac autonomic impairment, and whether such nonlinear indices may be associated with disease severity, prognostic markers, perceived dyspnea and functional capacity in patients with COPD. The current study assessed cardiac autonomic modulation by symbolic analysis of HRV in patients with COPD compared with healthy controls. METHODS: We recruited 54 COPD patients and 20 healthy controls. The interval between two successive R-wave peaks was calculated in the resting supine position. HRV was analyzed using symbolic markers and Shannon entropy (SE). The six-minute walk test (6MWT) was applied in a 30-m corridor. RESULTS: We found a lower 6MWT distance in patients with COPD compared with healthy controls (p < 0.05). We found increased SE and decreased percentage of no variation patterns (0V%) in COPD patients compared with the control group (p = 0.001). Significant correlations were found between the percentage of one variation pattern (1V%) and the Medical Research Council dyspnea scale (r = 0.38, p = 0.01), BODE index (r = 0.38, p = 0.01), forced expiratory volume in the first second (FEV1) [L] (r = -0.44, p = 0.003) and FEV1 [%] (r = -0.35, p = 0.02). It was found that SE was inversely associated with 0V% (r = -0.87, p < 0.0001). CONCLUSION: COPD patients present with depressed sympathetic modulation of HR and higher SE compared with healthy controls. This increased irregularity was inversely associated with 0V%. These results suggested that COPD patients seem to have a cardiac control shifted towards a parasympathetic predominance compared with controls. Symbolic dynamic and complexity index of HRV are related to disease severity, symptoms and functional impairment in these patients.

Women with greater pelvic floor muscle strength have better sexual function.

OBJECTIVE: To investigate the relation between pelvic floor muscle strength and sexual function among women with higher and lower pelvic floor muscle strength. DESIGN: A cross-sectional study was performed among employees and students of the University. SETTING: Urogynecology department, Federal University of Pampa, Brazil, carried out between January and July of 2012. POPULATION: Forty women, aged 20-28 years. METHODS: Forty-nine women were screened and nine were excluded. Baseline information of the participants was obtained. The Female Sexual Function Index questionnaire was applied and pelvic floor muscle strength was randomly measured by transvaginal palpation according to the Ortiz scale, and by perineometry. Women were allocated into two groups according to muscle strength. MAIN OUTCOME MEASURES: Index of sexual function and pelvic floor muscle strength RESULTS: Women with stronger pelvic floor muscles scored higher in the following domains: desire, excitement, orgasm and general score of the questionnaire (4.9 ± 0.73 vs. 3.8 ± 0.58; 5.0 ± 0.35 vs. 4.3 ± 0.82; 5.8 ± 0.21 vs. 4.0 ± 1.00 and 32.4 ± 0.77 vs. 27.6 ± 3.29, p < 0.001). There was a moderate correlation between pelvic floor muscle pressure and both sexual satisfaction (r = 0.47, p = 0.03) and lubrication (r = -0.69, p = 0.001) as well as the manual evaluation of pelvic floor muscle strength, graded by the Ortiz and perineometry, which were interrelated (r = 0.65, p = 0.001). CONCLUSION: Our findings suggest that women with stronger pelvic floor muscles have better sexual function.

Oxygen and ventilatory output during several activities of daily living performed by COPD patients stratified according to disease severity.

OBJECTIVES: To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity. MATERIALS AND METHODS: Metabolic (VO2 and VCO2), ventilatory (f and VE), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts. RESULTS: The activities with the highest proportional metabolic and ventilatory output (VO2/VO2max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05). CONCLUSIONS: COPD patients present an increased proportion of energy expenditure while performing activities of daily living. The activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD's reduced ventilatory reserve.

Asynchrony and hyperinflation in patients with chronic obstructive pulmonary disease during two types of upper limbs exercise.

INTRODUCTION: Occurrence of dynamic hyperinflation during upper-limbs exercises in chronic obstructive pulmonary disease (COPD) patients it is not well established. We hypothesized that dynamic hyperinflation and thoracoabdominal asynchrony occurs in COPD patients accomplishing arms exercises. We assessed the occurrence and association of dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients during the accomplishment of two arm exercises. PATIENTS AND METHODS: This was a prospective study with 25 COPD patients. A maximal and a sub-maximal upper limbs exercise test with 50% load were performed with the diagonal technique and the arm cycle ergometer technique. Respiratory pattern, thoracoabdominal configuration and dynamic hyperinflation were assessed in the exercise tests. RESULTS: Thirty per cent and 60% of patients hyperinflated at the end of the sub-maximum exercise tests with the diagonal and cycle ergometer techniques, respectively. Thoracoabdominal asynchrony occurred in 80% and 100% of patients who hyperinflated with the diagonal and cycle ergometer techniques, respectively. For both exercises we found enhancement of pulmonary ventilation, dyspnea, central respiratory drive and shortening of expiratory time (P<.05). Upper-limbs exercises with the diagonal technique presented less number of patients with these alterations. CONCLUSIONS: Dynamic pulmonary hyperinflation and thoracoabdominal asynchrony association occurred in both upper-limbs exercises; however, the diagonal technique developed less dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients than the arm cycle ergometer.

Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients.

INTRODUCTION: Although physiotherapy is an integral part of the multiprofessional team in most ICUs there is only limited evidence concerning the effectiveness of its procedures. The objectives of this study were to verify if physiotherapy care provided within 24 h/day for hospitalized patients in the ICU reduce the length of stay, mechanical ventilation support, pulmonary infection and mortality compared to a physiotherapy care provided within 6 h/day. METHODS: A cohort study was designed to assess differences between one hospital where patients were given physiotherapy care for 24 h/day and another hospital with only 6 h/day. We considered the following as outcome measurements: clinical diagnosis, medication in use, presence of associated diseases, APACHE II and SOFA scores, ICU and mechanical ventilation length of stay, development of pulmonary infections and survival. RESULTS: One hundred and forty-six patients were enrolled. Patients admitted in the service A presented a lower length of stay in mechanical ventilation (p < 0.0001), ICU stay (p = 0.0003), respiratory infections (p = 0.0043) than patients admitted in service B. No difference was found for APACHE II score (p = 0.8) and SOFA scores (p = 0.2) between groups. The mortality risk was OR 1.3 (1.01-2.33) (p = 0.04) for patients in the service B. CONCLUSION: The presence of a physiotherapist in the intensive care unit contributes decisively to the early recovery of the patient, reducing mechanical ventilation support need, number of hospitalization days, incidence of respiratory infection and risk of mortality.

Respiratory muscle assessment in predicting extubation outcome in patients with stroke.

BACKGROUND: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured. RESULTS: The group who presented success to the extubation process presented 12.5±2.2=days in mechanical ventilation and the group who failed presented 13.1±2=days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4±0.08 (0.36-0.44) and 0.5±0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37±0.05 (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25±0.05 for the success group (0.21-0.28; p<0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r=0.55; p=0.009) and PaO(2)/FiO(2) (r=-0.59; p=0.005). Patients who presented a high RSRI (OR, 3.66; p=0.004) and Pdi (OR, 7.3; p=0.002), and low PaO(2)/FIO(2) (OR, 4.09; p=0.007), Pdi/Pdimax (OR, 4.12; p=0.002) and RAW (OR, 3.0; p=0.02) developed mechanical ventilation extubation failure. CONCLUSION: Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients.

WITHDRAWN: Respiratory Muscle Assessment in Predicting Extubation Outcome in Patients With Stroke.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, doi:10.1016/j.arbr.2012.06.007. The duplicate article has therefore been withdrawn.

Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients.

OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.

Respiratory biofeedback accuracy in chronic renal failure patients: a method comparison.

OBJECTIVE: To analyse respiratory biofeedback effects on respiratory muscle strengthening in chronic renal failure patients. DESIGN: Randomized controlled study. SETTING: Nephrology and dialysis centre. SUBJECTS AND INTERVENTION: Forty-one end-stage renal patients on haemodialysis treatment were allocated into three groups: control (n = 10), G-1 (inspiratory muscle training using Threshold IMT device; n = 16) and G-2 (biofeedback; n = 15) and given respiratory muscle training (three sessions/week for six weeks). MAIN MEASURES: Forced vital capacity (FVC), expiratory volume in the first second (FEV(1)), FEV(1)/FVC ratio, maximal voluntary ventilation (MVV) and maximal inspiratory (MIP) and expiratory (MEP) pressures were measured before and after the respiratory muscle training programme. RESULTS: Both training methods were efficient since we found an increase after training in the FVC in the G-1 group (from 2.45 ± 0.17 to 2.85 ± 0.16; P = 0.001) and in the G-2 group (from 2.35 ± 0.19 to 2.55 ± 0.19; P = 0.007), in the FEV(1) in G-1 (from 2.18 ± 0.16 to 2.46 ± 0.14; P = 0.01) and in G-2 (from 1.97 ± 0.17 to 2.20 ± 0.15; P < 0.0001), MIP in G-1 (from 70.63 ± 4.03 to 108.75 ± 7.41; P < 0.0001) and in G-2 (from 67.67 ± 5.02 to 96.33 ± 8.30; P < 0.001) and MEP in G-1 (from 73.13 ± 5.10 to 82.50 ± 6.74; P = 0.007) and in G-2 (from 67.67 ± 5.41 to 76.00 ± 4.29; P = 0.002). CONCLUSIONS: Respiratory biofeedback is efficient as a respiratory muscle training modality for patients with chronic renal failure.

Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients

OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.

Lactic acid levels in patients with chronic obstructive pulmonary disease accomplishing unsupported arm exercises.

Patients with chronic obstructive pulmonary disease (COPD) may suffer dyspnea when performing unsupported arm exercises (UAE). However, some factors related to the tolerance of the upper limbs during these exercises are not well understood. Our investigation was to determine if an unsupported arm exercise test in patients with COPD accomplishing diagonal movements increases lactic acid levels; also, we assessed the metabolic, ventilatory and cardiovascular responses obtained from the unsupported arm exercise test. The study used results of maximal symptom limited tests with unsupported arms and legs performed on 16 patients with COPD. In order to do the test, some metabolic, respiratory and cardiovascular parameters such as oxygen uptake (VO(2)), carbon dioxide production (VCO(2)), respiratory rate (RR), pulmonary ventilation (VE), heart rate (HR) and blood pressure (BP) were measured during the exercise tests. Furthermore, blood lactate concentration was measured during the arm test. We detected a significant increase in the mean blood lactate concentration, VO(2), VCO(2), VE and RR from the resting to the peak phase of the UAE test. The mean values of VO(2), VCO(2) and VE obtained at the peak of the UAE test corresponded to 52.5%, 50.0% and 61.2%, respectively, of the maximal values obtained at the peak of the leg exercise test. In comparison, the mean heart rate and systolic arterial blood pressure were significantly lower at the peak of the UAE test than at the peak leg exercise test and corresponded to 76.2% and 83.0%, respectively. Unsupported incremental arm exercises in patients with COPD increases blood lactic acid levels.

Modulation of operational lung volumes with the use of salbutamol in COPD patients accomplishing upper limbs exercise tests.

INTRODUCTION: Pulmonary dynamic hyperinflation (DH) is an important factor limiting the physical capacity of patients with COPD. Inhaled bronchodilator should be able to reduce DH. OBJECTIVE: To measure DH in COPD patients during upper limbs exercise tests with previous use of bronchodilator or placebo, and to evaluate the respiratory pattern to justify the dynamics of hyperinflation. METHODS: Inspiratory capacity (IC) of 16 patients with COPD (age: 63+/- 13 years; FEV(1) of 1.5+/-0.7 L-41+/-11% predicted) was measured before and after an incremental arm exercise test (diagonal technique) with randomly and double-blinded inhaled placebo or salbutamol. RESULTS: Rest IC increased from 2.32+/-0.44 L to 2.54+/-0.39 L after inhalation of 400 mcg of salbutamol (p=0.0012). There was a decrease in the IC after a maximal incremental arm exercise test, 222+/-158 ml (p=0.001) with placebo use, but no change was seen after the salbutamol use: 104+/-205 ml (p=0.41); 62% of the patients presented a 10% or more reduction in the IC after the exercise with placebo. There was a correlation between DH and lower FEV(1)/FVC (p=0.0067), FEV(1) predicted (p=0.0091) and IC% predicted (p=0.043) and higher VO(2)ml/Kg/min % predicted (p=0.05). Minute ventilation and respiratory rate were higher during the exercise with placebo (p=0.002) whereas VE/MVV ratio was lower in the exercise after salbutamol (p>0.05). CONCLUSION: We conclude that the use of bronchodilator increases the IC of patient with COPD and may help not to increase the DH during a maximal exercise with the arms.