Frailty influences the vascular responsiveness of elderly individuals with chronic heart failure.

INTRODUCTION: Frailty is highly prevalent in heart failure (HF) patients. HF is associated with oxidative stress and chronic inflammation, which impair oxygen use by skeletal muscles. Little is known about the influence of frailty on vascular responsiveness and tissue oxygenation. OBJECTIVE: Analyze the influence of frailty on vascular responsiveness and muscle oxygenation in elderly individuals with and without HF. METHODS: Individuals aged ≥60 years, with or without HF, were evaluated for frailty (phenotype). Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation at rest (oxygen saturation - StO2 and deoxyhemoglobin) and during handgrip exercise (minimum StO2 and maximum deoxyhemoglobin), and oxygenation variables. STATISTICAL ANALYSIS: Results were grouped according to the frailty phenotype: non-frail, pre-frail, and frail. Shapiro-Wilk test was used to assess normality. Data were compared using a two-way analysis of variance (ANOVA). Bonferroni post hoc test was applied to determine the influence of frailty or HF on NIRS variables. SPSS software was used in the analyses; p < 0.05 was considered significant. RESULTS: 55 elderly participants (61.8% female; 70.4 ± 7.2 years old; 28 HF patients) participated in the study. 32.7% (n = 18) were classified as non-frail, 43.3% (n = 24) as pre-frail, and 23.6% (n = 13) as frail. The analysis of vascular responsiveness (n = 52) identified an influence (p < 0.05) of frailty on the reperfusion rate (slope 2 and ∆StO2 of nadir-peak) and desaturation during occlusion (area under the curve of StO2) in HF patients. There was no influence of frailty or HF on muscle oxygenation at rest and during exercise (n = 54; p > 0.05). CONCLUSION: The coexistence of frailty and HF seems to impair vascular responsiveness, as frail elderly participants with HF presented lower reperfusion rates and higher desaturation levels during the arterial occlusion test. However, the presence of frailty or HF alone had no influence on muscle oxygenation at rest or during exercise.

O desempenho e as respostas fisiológicas ao teste de elevação do calcanhar bipodal são influenciados pela cadência e posição dos tornozelos / Bilateral heel-rise test performance and physiological response are influenced by cadence and ankle position

INTRODUÇÃO: Diferentes protocolos do teste de elevação do calcanhar (TEC) têm sido utilizados, sendo necessário analisar o impacto das variações nas respostas do teste. OBJETIVO: Comparar o desempenho e respostas de oxigenação muscular (OM) e frequência cardíaca (FC) de adultos em diferentes protocolos do TEC bipodal. MATERIAIS E MÉTODOS: Este foi um estudo transversal do tipo cruzado. Trinta participantes (23,1±2,9 anos; 16 homens) realizaram quatro protocolos do TEC bipodal, variando cadenciamento (autocadenciado e cadenciado externamente) e posição dos tornozelos (neutra e dorsiflexão). Para a OM, analisamos a saturação tecidual de oxigênio (StO2 ) e variação da concentração de oxihemoglobina (∆[O2 Hb]) e calculamos a variação entre os menores valores e os valores finais (∆Nadir-Final) e área sob a curva (AUC). Para a FC, calculamos a variação dos valores iniciais e finais (∆FC) e constante de tempo (τ). O teste de Friedman foi utilizado para comparar as variáveis entre os protocolos. A ANOVA de dois fatores foi utilizada para identificar o impacto da cadência e/ou posição dos tornozelos. RESULTADOS: O número de repetições e o tempo de execução foram maiores nos protocolos em posição neutra e cadenciado externamente (p<0,001 para ambos). ∆Nadir-Final (StO2: p<0,001; ∆[O2Hb]: p=0,005) e AUC (StO2: p<0,001; ∆[O2Hb]: p<0,001) dea mbas as variáveis de OM foram maiores nos protocolos em posição neutra. Protocolos autocadenciados apresentaram maior aumento da FC e τ mais rápida (p=0,006 e p=0,046). CONCLUSÃO: O TEC realizado em posição neutra e cadenciamento externo gera maiores repetições e tempo de execução. A dorsiflexão promoveu menor reperfusão muscular e o autocadenciamento, maior e mais rápido aumento da FC.

INTRODUCTION: Different heel-rise test (HRT) protocols have been used, possibly leading to varied responses. It is necessary to analyse the impact of protocol variation on test responses. PURPOSE: To compare the performance, muscle oxygenation (MO), and heart rate (HR) responses of adults in bilateral HRT protocols. METHODS: This was a cross-sectional crossover study. Thirty participants (23.1±2.9 years; 16 men) performed four bilateral HRT protocols with varying cadence (self-cadenced; externally cadenced) and ankle position (neutral; dorsiflexion). For MO responses, we analysed tissue oxygen saturation (StO2) and oxyhemoglobin concentration variation (∆[O2Hb]) and calculated the variation between the smallest and final values (∆Nadir-Final) and the area under the curve (AUC). The variation between the initial and final HR values (∆HR) and the time constant (τ) were calculated. Friedman's test was used to compare the variables among the protocols. Two-way ANOVA was used to identify the impact of cadence and/or ankle position. RESULTS: The number of repetitions and execution time were higher in the neutral position and externally cadenced protocols (p<0.001 for both). ∆Nadir-Final (StO2: p<0.001;∆[O2Hb]: p=0.005) and AUC (StO2: p<0.001; ∆[O2Hb]: p<0.001) of both MO variables were higher in the neutral position protocols. Selfcadenced protocols presented higher HR increase and faster τ (p=0.006 and p=0.046). CONCLUSION: Bilateral HRT performed in a neutral position, and external cadence promotes more repetitions and a longer execution time. Dorsiflexion promotes lower muscle reperfusion, and self-cadence higher and faster HR increase.

Application and Measurement Properties of the Talk Test in Cardiopulmonary Patients: A Systematic Review.

Background: The talk test (TT) evaluates the exercise intensity by measuring speech comfort level during aerobic exercise. There are several application protocols available to assess individuals with cardiopulmonary diseases. However, the measurement properties of the TT were not systematically reviewed yet. Methods: A systematic review was developed, registered (CRD420181068930), and reported according to PRISMA Statement. Randomized clinical trials, cross-sectional studies, or series cases were identified through multiple databases and were selected if they presented concomitant speech provocation and an exercise test. Included studies were evaluated based on methodological quality (adapted New Castle-Ottawa Scale), descriptive quality (STROBE Statement), and risk of bias (COSMIN bias risk scale). Results: Ten studies were included. Seven studies presented moderate to high quality and the majority presented good scores according to the STROBE statement. Four hundred and fourteen subjects performed the TT, the majority being patients with coronary artery disease. The test validity was supported by the included studies. Talk Test reliability was considered satisfactory, although only one study presented an adequate reliability analysis. The studies found a correlation between the last positive stage of the TT with the first ventilatory threshold. Workload, oxygen uptake, and heart rate in the last positive stage of the TT were not different from the same parameters related to the first ventilatory threshold. Conclusions: The evidence indicates that the TT is suitable as an alternative tool for the assessment and prescription of exercise in individuals with cardiovascular diseases. The stage when the individual is still able to speak comfortably is suggested as the intensity for aerobic exercise prescription. As there is still no well-defined and fully explored TT protocol, caution is required when interpreting the TT results.