Effects of a cardiopulmonary rehabilitation protocol on functional capacity, dyspnea, fatigue, and body composition in individuals with post-COVID-19 syndrome: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Reduced functional capacity, dyspnea, fatigue, and changes in body composition are common in patients with post-COVID-19 syndrome (PCS), and cardiopulmonary rehabilitation may improve these parameters. Thus, the present study verified the effects of cardiopulmonary rehabilitation (respiratory, aerobic, and resistance muscle training) on submaximal exercise tolerance, dyspnea, fatigue, and body composition. METHODS: This controlled and randomized clinical trial applied a six-week outpatient intervention protocol in individuals over 18 years old (n = 33) with a diagnosis of COVID-19 confirmed by polymerase chain reaction. These individuals were allocated to cardiopulmonary rehabilitation (n = 17) or control groups (i.e., educational lectures; n = 16). The cardiopulmonary rehabilitation group performed respiratory, aerobic, and resistance muscle training. Submaximal exercise tolerance, dyspnea, fatigue, and body composition were assessed before and after the protocol. RESULTS: After 6 weeks, the cardiopulmonary rehabilitation group increased the tolerance to submaximal exercise, with a difference of 100.46 m (95% confidence interval [CI]: 7.40-193 m) in the distance walked on the six-minute walk test, reduced dyspnea (-1.45, 95% CI: -1.98--0.92) in the modified Medical Research Council, and increased 0.63 kg (95% CI: 0.09-1.18 kg) of muscle mass in the upper limbs compared with the control group. CONCLUSION: The six-week cardiopulmonary rehabilitation protocol improved functional capacity, reduced dyspnea, and increased muscle mass in the upper limbs in individuals with PCS. Thus, these results supported the protocol use in this population and encourage further studies to assess its effectiveness in a large sample.

A pilot randomized controlled trial of transcranial direct current stimulation adjunct to moderate-intensity aerobic exercise in hypertensive individuals.

Background: Hypertension is a global issue that is projected to worsen with increasingly obese populations. The central nervous system including the parts of the cortex plays a key role in hemodynamic stability and homeostatic control of blood pressure (BP), making them critical components in understanding and investigating the neural control of BP. This study investigated the effects of anodal transcranial direct current stimulation (tDCS) associated with aerobic physical exercise on BP and heart rate variability in hypertensive patients. Methods: Twenty hypertensive patients were randomized into two groups: active tDCS associated with aerobic exercise or sham tDCS associated with aerobic exercise. BP and heart rate variability were analyzed before (baseline) and after twelve non-consecutive sessions. After each tDCS session (2 mA for 20 min), moderate-intensity aerobic exercise was carried out on a treadmill for 40 min. Results: A total of 20 patients were enrolled (53.9 ± 10.6 years, 30.1 ± 3.7 Kg/m2). There were no significant interactions between time and groups on diastolic BP during wake, sleep, over 24 and 3 h after the last intervention. Heart rate variability variables showed no significant difference for time, groups and interaction analysis, except for HF (ms2) between groups (p < 0.05). Conclusion: Anodal tDCS over the temporal cortex associated with aerobic exercise did not induce improvements in BP and heart rate variability. Clinical trial registration: https://ensaiosclinicos.gov.br/rg/RBR-56jg3n/1, identifier: RBR-56jg3n.

The Effect of Telerehabilitation on Physical Fitness and Depression/Anxiety in Post-COVID-19 Patients: A Randomized Controlled Trial.

Aim: The aim of this research was to evaluate the impact of a telerehabilitation program on physical fitness, muscle strength, and levels of depression and anxiety in post-COVID-19 patients. Methods: Thirty-two individuals recovered from COVID-19 (48.20±12.82 years) were allocated into either a telerehabilitation (TG n=16) or control (CG n=16) group. Physical fitness, handgrip strength, depression and anxiety levels were assessed before and after an 8-week intervention. Results: There was a significant improvement in muscle strength in both groups. Physical fitness significantly increased compared to the CG at the end of the intervention. Levels of anxiety and depression significantly decreased after the intervention when compared to the CG. Conclusion: Eight weeks of functional telerehabilitation training is a viable and efficient way to rehabilitate patients affected by COVID-19, as it improved physical conditioning and mental health.

Impaired Neuromuscular Efficiency and Symptom-Limited Aerobic Exercise Capacity 4 Weeks After Recovery From COVID-19 Appear to Be Associated With Disease Severity at Onset.

OBJECTIVE: The objectives of this study were to evaluate neuromuscular recruitment and efficiency in participants who recovered from COVID-19 and assess the association between neuromuscular efficiency and symptom-limited aerobic exercise capacity. METHODS: Participants who recovered from mild (n = 31) and severe (n = 17) COVID-19 were evaluated and compared with a reference group (n = 15). Participants underwent symptom-limited ergometer exercise testing with simultaneous electromyography evaluation after a 4-week recovery period. Activation of muscle fiber types IIa and IIb and neuromuscular efficiency (watts/percentage of root-mean-square obtained at the maximum effort) were determined from electromyography of the right vastus lateralis. RESULTS: Participants who had recovered from severe COVID-19 had lower power output and higher neuromuscular activity than the reference group and those who had recovered from mild COVID-19. Type IIa and IIb fibers were activated at a lower power output in participants who had recovered from severe COVID-19 than in the reference group and those who had recovered from mild COVID-19, with large effect sizes (0.40 for type IIa and 0.48 for type IIb). Neuromuscular efficiency was lower in participants who had recovered from severe COVID-19 than in the reference group and those who had recovered from mild COVID-19, with a large effect size (0.45). Neuromuscular efficiency showed a correlation with symptom-limited aerobic exercise capacity (r = 0.83). No differences were observed between participants who had recovered from mild COVID-19 and the reference group for any variables. CONCLUSION: This physiological observational study supports the notion that more severe COVID-19 symptoms at disease onset appear to correspondingly impair neuromuscular efficiency in survivors over a short time frame of 4 weeks after recovery, potentially contributing to reduced cardiorespiratory capacity. Further studies are needed to replicate and extend these findings with respect to their clinical implications for assessment/evaluation and interventions. IMPACT: After 4 weeks of recovery, neuromuscular impairment is particularly evident in severe cases; this problem may contribute to reduced cardiopulmonary exercise capacity.

Effects of transcranial direct current stimulation associated with an aerobic exercise bout on blood pressure and autonomic modulation of hypertensive patients: A pilot randomized clinical trial.

The objective of this article was to evaluate the effects of an aerobic exercise bout associated with a single session of anodal transcranial direct current stimulation (tDCS) over the left temporal lobe on blood pressure (BP) and heart rate variability (HRV) in hypertensive people. After met the inclusion criteria, twenty hypertensive people were randomized to active-tDCS or sham-tDCS group. Initially, they provided their sociodemographic data, a blood sample, and went through an evaluation of the cardiorespiratory performance. Then, a single session of tDCS with an intensity of 2 mA over the left lobe during 20 min was carried out. After tDCS, it was performed a session of moderate-intensity aerobic exercise during 40 min. BP during 24 h and HRV measurements were performed before (baseline) and after the intervention. Systolic BP during sleep time decreased in the active-tDCS group (p = 0.008). Diastolic BP showed a significant decrease 3 h after the intervention in the active-tDCS group (p = 0.01). An intragroup comparison showed a significant decrease in systolic BP 3 h after intervention only for the active-tDCS group (p = 0.04). Besides, there was a trend toward a difference in wake for diastolic BP for active-tDCS (p = 0.07). Lastly, there were no changes in the HRV for both groups. It is suggested that anodal tDCS associated with moderate-intensity aerobic exercise can decrease systolic and diastolic BP of hypertensive people during sleep time and 3 h after the intervention.

Postexercise Hypotension Is Volume-Dependent in Hypertensives: Autonomic and Forearm Blood Responses.

de Freitas Brito, A, Brasileiro Santos, MdS, Coutinho de Oliveira, CV, and da Cruz Santos, A. Postexercise hypotension is volume-dependent in hypertensives: autonomic and forearm blood responses. J Strength Cond Res 33(1): 234-241, 2019-The purpose of this study was to evaluate the effect of 2 sessions of resistance exercise (RE) with different volumes on postexercise hypotension (PEH), forearm blood flow (FBF), and cardiac autonomic balance (LF/HF) in hypertensive elderly woman. The study was conducted with 16 hypertensive elderly (25.7 ± 3 kg·m², 55.5 ± 3 years) subjected to 3 experimental sessions, i.e., a control session, exercise with a set (S1), and exercise with 3 sets (S3). For each session, the subjects were evaluated before and after intervention. In the preintervention period, blood pressure (BP), FBF, and LF/HF were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same period. Both S1 and S3 comprised a set of ten repetitions of 10 exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (postintervention) in the supine position. Postexercise hypotension (systolic/diastolic) was greater in S3 than in S1 (-26 ± 4/-14 ± 5 mm Hg vs. -18 ± 5/-8 ± 5 mm Hg, p ≤ 0.05). Similarly, FBF and cardiac LF/HF increased in both sessions, being more evident in S3 than in S1 (4.98 ± 0.32 vs. 4.36 ± 0.27 ml·min·100 ml, p ≤ 0.05; and LF/HF = 1.69 ± 0.225 vs. 1.37 ± 0.13 p ≤ 0.05, respectively). We conclude that a single RE session with 3 series were able to promote higher PEH in hypertensive women, and this phenomenon was accompanied by increased FBF and increased cardiac autonomic activity.

Correction to: Obstructive sleep apnea does not impair cardiorespiratory responses to progressive exercise performed until exhaustion in hypertensive elderly.

The original version of this article was published online containing two items that require correction, namely the abstract (Results section) and Table 3.

Obstructive sleep apnea does not impair cardiorespiratory responses to progressive exercise performed until exhaustion in hypertensive elderly.

BACKGROUND: Elderly people have a high prevalence to systemic arterial hypertension (SAH) and obstructive sleep apnea (OSA). Both comorbidities are closely associated and inflict damage on cardiorespiratory capacity. METHODS: In order to assess cardiorespiratory responses to the cardiopulmonary exercise test (CPET) among hypertensive elderly with OSA, we enrolled 28 subjects into two different groups: without OSA (No-OSA: apnea/hypopnea index (AHI) < 5 events/h; n = 15) and with OSA (OSA: AHI ≥ 15 events/h; n = 13). All subjects underwent CPET and polysomnographic assessments. After normality and homogeneity evaluations, independent t test and Pearson's correlation were performed. The significance level employed was p ≤ 0.05. RESULTS: Hypertensive elderly with OSA presented lower heart rate recovery (HRR) in the second minute (HRR2) in relation to the No-OSA group. A negative correlation between AHI and ventilation (VE) (r = -0.63, p = 0.02) was found in polysomnography and CPET data comparisons, and oxygen saturation (O2S) levels significantly correlated with VE/VCO2slope (r = 0.66, p = 0.01); in addition, OSA group presented a positive correlation between oxygen consumption and O2S (r = 0.60, p = 0.02), unlike the no-OSA group. CONCLUSIONS: OSA does not affect the CPET variables in hypertensive elderly, but it attenuates the HRR2. The association between O2S during sleep with ventilatory responses probably occurs due to the adaptations in the oxygen transport system unleashed via mechanical respiratory feedback; thus, it has been identified that OSA compromises the oxygen supply in hypertensive elderly.

Effect of short-term positive airway pressure on blood pressure in controlled hypertensive patients with obstructive sleep apnoea syndrome: a prospective cohort study.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is associated with cardiovascular disease, especially in patients with high blood pressure. Continuous positive airway pressure (CPAP) seems to contribute to blood pressure control in patients with OSAS, mainly those with uncontrolled hypertension. However, the effect of CPAP on controlled hypertensive patients with OSAS is not known. OBJECTIVE: To evaluate the effects of CPAP on blood pressure of controlled hypertensive patients with OSAS. DESIGN: Prospective cohort study. PATIENTS: 36 recently diagnosed patients with OSAS and hypertension controlled with oral antihypertensive medication. METHODS: CPAP was performed for 5 days. Systolic and diastolic blood pressure were recorded at baseline and 5 days later using 24 h ambulatory blood pressure measurement. RESULTS: Mean (SD) 24 h systolic blood pressure was reduced from 128.9 (3.4) to 126.5 (3.5), p<0.001 and mean (SD) 24 h diastolic blood pressure was reduced from 86.9 (3.3) to 84.8 (3.3), p<0.001. A reduction in the proportion of 'non-dippers' in the participants was registered (from 40.6% at baseline to 18.2%). CONCLUSIONS: A short course of CPAP may reduce systolic and diastolic blood pressure in patients with OSAS and controlled hypertension. TRIAL REGISTRATION NUMBER: RBR - 386qsg; Brazilian Clinical Trials Registry (REBEC).

High-Intensity Resistance Exercise Promotes Postexercise Hypotension Greater than Moderate Intensity and Affects Cardiac Autonomic Responses in Women Who Are Hypertensive.

The purpose of this study was to evaluate the effect of high-intensity resistance exercise (RE) sessions on blood pressure (BP), heart rate (HR), cardiac autonomic modulation, and forearm blood flow (FBF). Sixteen trained hypertensive women (n = 16, 56 ± 3 years) completed the following 3 experimental sessions: control (CS), RE at 50% (EX50%), and RE at 80% (EX80%) of 1 repetition maximum (1RM). Both EX50% and EX80% comprised a set of 10 repetitions of 10 exercises, with an interval of 90 seconds between exercises. Measurements were taken preintervention and postintervention (at 10, 30, 50, 70, and 90 minutes of recovery). Reductions in systolic/diastolic BP after exercise were greater in EX80% (largest declines, -29 ± 4/-14 ± 5 mm Hg) than EX50% (largest declines, -18 ± 6/-8 ± 5 mm Hg, p ≤ 0.05). Heart rate and cardiac sympathovagal balance (LF/HF) increased more in relation to pre-exercise values in EX80% than EX50% (largest increases 96 ± 3 vs. 90 ± 4 b·min, LF/HF = 1.77 ± 0.25 vs. 1.40 ± 0.20, respectively, p ≤ 0.05). Increases in FBF and hyperemia was also higher in EX80% than EX50% compared with pre-exercise (4.97 ± 0.28 vs. 4.36 ± 0.27 ml·min·100 ml and 5.90 ± 0.20 vs. 5.38 ± 0.25 ml·min·100 ml; p ≤ 0.05, respectively). These results suggest that RE of higher intensity promoted greater postexercise hypotension accompanied by greater increases in FBF, vasodilator response, HR, and cardiac sympathovagal balance.