Predição do Consumo de Oxigênio de Pico em Pacientes Cardiopatas com Base no Desempenho no Teste Timed Up and Go / Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test

Resumo Fundamento A utilização do teste timed up and go (TUG) na avaliação da aptidão cardiorrespiratória em cardiopatas não está bem definida na literatura. Objetivos Testar a associação entre o TUG e o consumo de oxigênio de pico (VO2pico), construir uma equação com base no TUG para prever o VO2pico e determinar um ponto de corte para estimar um VO2pico ≥ 20 mL.kg−1.min−1. Métodos Estudo transversal com 201 indivíduos portadores de doença arterial coronariana ou insuficiência cardíaca, com idade entre 36 e 92 anos, submetidos ao TUG e ao teste cardiopulmonar de exercício. Foram realizadas análises de correlação, curva ROC, regressão linear múltipla e Bland-Altman. Um p < 0,05 foi adotado como significante. Resultados A média de idade da amostra total foi 67 ± 13 anos, e 70% dos participantes eram do sexo masculino. A média de VO2pico foi de 17 ± 6 mL.kg−1.min−1 e a média de desempenho no TUG foi de 7 ± 2,5 segundos. A correlação entre o VO2pico e o TUG foi r = −0,54 (p < 0,001) e R2 de 0,30. Foi desenvolvida a equação com base no TUG: V O 2 pico = 33 , 553 + ( − 0 , 149 ∗ idade ) + ( − 0 , 738 ∗ T U G ) + ( − 2 , 870 ∗ sexo ); sendo atribuído o valor 0 ao sexo masculino e 1 ao sexo feminino (R ajustado: 0,41; R2 ajustado: 0,40). O VO2pico estimado pela equação foi 18,81 ± 3,2 mL.kg−1.min−1 e o determinado pelo teste cardiopulmonar de exercício foi 18,18 ± 5,9 mL.kg−1.min−1 (p > 0,05). O melhor ponto de corte para o VO2pico ≥ 20 mL.kg−1.min−1 foi de ≤ 5,47 segundos (área sob a curva: 0,80; intervalo de confiança de 95%: 0,74 a 0,86). Conclusões O TUG e o VO2pico apresentaram associação significativa. A equação preditiva do VO2pico foi desenvolvida e validada internamente com bom desempenho. O ponto de corte no TUG para prever um VO2pico ≥ 20 mL.kg−1.min−1 foi ≤ 5,47 segundos.

Abstract Background The use of the timed up and go (TUG) test to assess cardiorespiratory fitness in patients with heart disease has not been well defined in the literature. Objectives Test the association between TUG and peak oxygen consumption (VO2peak), construct an equation based on TUG to predict VO2peak, and determine a cutoff point to estimate VO2peak ≥ 20 mL/kg/min. Methods This cross-sectional study included 201 patients with coronary artery disease or heart failure, between 36 and 92 years of age, who underwent TUG and cardiopulmonary exercise test. Correlation, ROC curve, multiple linear regression, and Bland-Altman analyses were performed. The significance level was set at p < 0.05. Results The mean age of the total sample was 67 ± 13 years, and 70% of participants were male. The mean VO2peak was 17 ± 6 mL/kg/min, and the mean TUG time was 7 ± 2.5 seconds. The correlation between VO2peak and TUG was r = −0.54 (p < 0.001), and R2 was 0.30. The following equation was developed based on TUG: V O 2 peak = 33.553 + ( − 0.149 × age ) + ( − 0.738 × TUG ) + ( − 2.870 × sex ); a value of 0 was assigned to the male sex and 1 to the female sex (adjusted R: 0.41; adjusted R2: 0.40). The VO2peak estimated by the equation was 18.81 ± 3.2 mL/kg/min, and the VO2peak determined by cardiopulmonary exercise test was 18.18 ± 5.9 mL/kg/min (p > 0.05). The best cutoff point in the TUG for VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds (area under the curve: 0.80; 95% confidence interval: 0.74 to 0.86). Conclusions TUG and VO2peak showed a significant association. A prediction equation for VO2peak was developed and validated internally with good performance. The cutoff point in the TUG to predict VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds.

Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test. / Predição do Consumo de Oxigênio de Pico em Pacientes Cardiopatas com Base no Desempenho no Teste Timed Up and Go.

BACKGROUND: Central Illustration : Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test CPET: cardiopulmonary exercise test; TUG: timed up and go test; VO2peak: peak oxygen consumption. BACKGROUND: The use of the timed up and go (TUG) test to assess cardiorespiratory fitness in patients with heart disease has not been well defined in the literature. OBJECTIVES: Test the association between TUG and peak oxygen consumption (VO2peak), construct an equation based on TUG to predict VO2peak, and determine a cutoff point to estimate VO2peak ≥ 20 mL/kg/min. METHODS: This cross-sectional study included 201 patients with coronary artery disease or heart failure, between 36 and 92 years of age, who underwent TUG and cardiopulmonary exercise test. Correlation, ROC curve, multiple linear regression, and Bland-Altman analyses were performed. The significance level was set at p < 0.05. RESULTS: The mean age of the total sample was 67 ± 13 years, and 70% of participants were male. The mean VO2peak was 17 ± 6 mL/kg/min, and the mean TUG time was 7 ± 2.5 seconds. The correlation between VO2peak and TUG was r = -0.54 (p < 0.001), and R2 was 0.30. The following equation was developed based on TUG: V O 2 peak = 33.553 + ( - 0.149 × age ) + ( - 0.738 × TUG ) + ( - 2.870 × sex ) ; a value of 0 was assigned to the male sex and 1 to the female sex (adjusted R: 0.41; adjusted R2: 0.40). The VO2peak estimated by the equation was 18.81 ± 3.2 mL/kg/min, and the VO2peak determined by cardiopulmonary exercise test was 18.18 ± 5.9 mL/kg/min (p > 0.05). The best cutoff point in the TUG for VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds (area under the curve: 0.80; 95% confidence interval: 0.74 to 0.86). CONCLUSIONS: TUG and VO2peak showed a significant association. A prediction equation for VO2peak was developed and validated internally with good performance. The cutoff point in the TUG to predict VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds.

Impaired flexibility in patients with tropical spastic paraparesis/HTLV-associated myelopathy: evaluation via pendulum fleximeter.

BACKGROUND: Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility. OBJECTIVE: To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals. METHODS: The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter. RESULTS: No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion. CONCLUSIONS: Individuals with TSP/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.

ANTECEDENTES: A flexibilidade é fundamental para a execução harmoniosa dos movimentos articulares. Embora a disfunção do músculo esquelético em pacientes com HTLV-1 possa interferir na mobilidade, não está claro se esses pacientes apresentam flexibilidade reduzida. OBJETIVO: Avaliar as diferenças de flexibilidade entre os indivíduos infectados com e sem mielopatia e o grupo controle sem infecção HTLV-1. Também investigamos se idade, sexo, índice de massa corporal (IMC), nível de atividade física ou dor lombar influenciam a flexibilidade em indivíduos infectados pelo HTLV-1. MéTODOS: A amostra foi composta por 56 adultos, dos quais 15 não possuíam HTLV-1, 15 possuíam HTLV-1 sem mielopatia e 26 possuíam TSP/HAM. A flexibilidade foi avaliada por meio do teste de sentar e alcançar e do flexímetro de pêndulo. RESULTADOS: Não foram observadas diferenças na flexibilidade entre os grupos com e sem mielopatia no teste de sentar e alcançar. Os resultados do flexímetro pendular dos indivíduos com TSP/HAM apresentaram a menor flexibilidade entre os grupos em relação à flexão do tronco, flexão e extensão do quadril, flexão do joelho e dorsiflexão do tornozelo, mesmo após ajuste para idade, sexo, IMC, nível de atividade física e dor lombar usando modelos de regressão múltipla linear. Além disso, os indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade nos movimentos de flexão do joelho, dorsiflexão e flexão plantar do tornozelo. CONCLUSãO: Indivíduos com TSP/HAM demonstraram redução da flexibilidade na maioria dos movimentos avaliados pelo flexímetro pendular. Além disso, indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade do joelho e tornozelo, representando potencialmente um marcador de desenvolvimento mielopático.

Impaired flexibility in patients with tropical spastic paraparesis/HTLV-associated myelopathy: evaluation via pendulum fleximeter / Flexibilidade prejudicada em pacientes com paraparesia espástica tropical/mielopatia associada ao HTLV: avaliação via flexímetro pendular

Abstract Background Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility. Objective To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals. Methods The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter. Results No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion. Conclusions Individuals with TSP/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.

Resumo Antecedentes A flexibilidade é fundamental para a execução harmoniosa dos movimentos articulares. Embora a disfunção do músculo esquelético em pacientes com HTLV-1 possa interferir na mobilidade, não está claro se esses pacientes apresentam flexibilidade reduzida. Objetivo Avaliar as diferenças de flexibilidade entre os indivíduos infectados com e sem mielopatia e o grupo controle sem infecção HTLV-1. Também investigamos se idade, sexo, índice de massa corporal (IMC), nível de atividade física ou dor lombar influenciam a flexibilidade em indivíduos infectados pelo HTLV-1. Métodos A amostra foi composta por 56 adultos, dos quais 15 não possuíam HTLV-1, 15 possuíam HTLV-1 sem mielopatia e 26 possuíam TSP/HAM. A flexibilidade foi avaliada por meio do teste de sentar e alcançar e do flexímetro de pêndulo. Resultados Não foram observadas diferenças na flexibilidade entre os grupos com e sem mielopatia no teste de sentar e alcançar. Os resultados do flexímetro pendular dos indivíduos com TSP/HAM apresentaram a menor flexibilidade entre os grupos em relação à flexão do tronco, flexão e extensão do quadril, flexão do joelho e dorsiflexão do tornozelo, mesmo após ajuste para idade, sexo, IMC, nível de atividade física e dor lombar usando modelos de regressão múltipla linear. Além disso, os indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade nos movimentos de flexão do joelho, dorsiflexão e flexão plantar do tornozelo. Conclusão Indivíduos com TSP/HAM demonstraram redução da flexibilidade na maioria dos movimentos avaliados pelo flexímetro pendular. Além disso, indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade do joelho e tornozelo, representando potencialmente um marcador de desenvolvimento mielopático.

Human T Cell Lymphotropic Virus Type 1 Global Prevalence Associated with the Human Development Index: Systematic Review with Meta-Analysis.

In 2012, the number of people infected with human T cell lymphotropic virus type 1 (HTLV-1) was estimated to be 10 million worldwide. Prevalence varies according to geographic location, ethnic factors, sex, age, populations exposed to risk factors, income, and education, reaching countries with the worst socioeconomic scenarios. There is a need to determine the current global prevalence of HTLV-1 and examine its association with countries' human development index (HDI) to provide data for global health policy. Systematic review with meta-analysis is according to PRISMA 2020 recommendations. It was registered at PROSPERO, CRD42021223146. Prevalence or cross-sectional studies of HTLV-1 infection with at least 100 participants, screening, and confirmatory serologic testing were included. Studies with incomplete or unavailable results or with duplicate information were excluded. Data were selected by two independent investigators and analyzed using R software, a metapackage that generated the forest plots [95% confidence interval (CI)]. Heterogeneity was assessed using the I2 statistic, and funnel plot asymmetry was assessed using Egger's test. Countries were compared using an HDI cutoff ≥0.8. Methodological quality was assessed using Joanna Briggs Institute (JBI) criteria. The overall prevalence of HTLV-1 infection was 0.91% (95% CI: 0.80-1.02, p < .0001) and was higher in low HDI countries [1.18% (95% CI: 1.03-1.34)] than in high HDI countries [0.41% (95% CI: 0.27-0.57)]. Prevalence varied according to the populations studied: it was higher in the general population [1.65% (95% CI: 1.08-2.34)] compared to pregnant women [0.34% (95% CI: 0.17-0.57)] and blood donors [0.04% (95% CI: 0.01-0.08)]. Consistently, prevalence for each population group was higher in low HDI countries than in high HDI countries. The worldwide prevalence of HTLV-1 infection is highly heterogeneous, with a global prevalence of 0.91%. In high HDI countries, the observed prevalence is approximately three times lower than in low HDI countries. In the general population, the observed prevalence is about 5 times higher than in pregnant women and 41 times higher than in blood donors.

Integrative and Multidisciplinary Care for People Living With Human T-Cell Lymphotropic Virus in Bahia, Brazil: 20 Years of Experience.

Brazil is home to the highest absolute number of human T-cell lymphotropic virus type-1 (HTLV-1)-infected individuals worldwide; the city of Salvador, Bahia, has the highest prevalence of HTLV-1 infection in Brazil. Due to the complex nature of several diseases associated with this retrovirus, a multidisciplinary health care approach is necessary to care for people living with HTLV-1. The Bahia School of Medicine and Public Health's Integrative Multidisciplinary HTLV Center (CHTLV) has been providing support to people living with HTLV and their families since 2002, striving to ensure physical and mental well-being by addressing biopsychosocial aspects, providing clinical care and follow-up, including to pregnant/postpartum women, as well as comprehensive laboratory diagnostics, psychological therapy, and counseling to family members. To date, CHTLV has served a total of 2,169 HTLV-infected patients. The average patient age is 49.8 (SD 15.9) years, 70.3% are female, most are considered low-income and have low levels of education. The majority (98.9%) are HTLV-1 cases, and approximately 10% have been diagnosed with tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM), while 2.2% have infective dermatitis and 1.1% have adult T-cell lymphoma. In all, 178 pregnant/postpartum women [mean age: 32.7 (±6.5) years] have received care at CHTLV. Regarding vertical transmission, 53% of breastfed infants screened for HTLV tested positive in their second year of life, nearly 18 times the rate found in non-breastfed infants. This article documents 20 years of experience in implementing an integrative and multidisciplinary care center for people living with HTLV in Bahia, Brazil. Still, significant challenges remain regarding infection control, and HTLV-infected individuals continue to struggle with the obtainment of equitable and efficient healthcare.

Efeito do pré-condicionamento isquêmico remoto no consumo máximo de oxigênio e potência máxima em corredores e ciclistas: revisão sistemática e metanálise / Effect of remote ischemic pre-conditioning on maximum oxygen consumption and maximum power in runners and cyclists: systematic review and metanalysis

INTRODUÇÃO: O pré-condicionamento isquêmico remoto (PCIR) é uma intervenção cardioprotetora não invasiva que atenua a lesão celular sofrida por uma isquemia prolongada. Seus efeitos de proteção sobre o coração, quando aplicado ao esporte, pode melhorar o desempenho do exercício. OBJETIVO: Investigar o efeito do pré-condicionamento isquêmico remoto no consumo máximo de oxigênio (VO2máx) e potência máxima (Wmáx) em corredores e ciclistas. METODOLOGIA: Revisão sistemática e metanálise, com ensaios clínicos randomizados. Baseado no PRISMA e avaliado pelo repositório de projetos de revisões sistemática PROSPERO; entretanto, não obteve o registro por se tratar de um desfecho de performance esportiva. As buscas foram realizadas nas bases de dados Medline/PubMed, SciELO, Periódicos CAPES. A seleção dos estudos foi realizada em duas etapas: leitura do título e resumo, e leitura completa dos artigos. A extração dos dados foi realizada pela transcrição das informações. A qualidade metodológica foi avaliada pela escala risco de viés através da ferramenta Cochrane. Excluíram-se estudos que investigaram variáveis diferentes dos desfechos selecionados para esta revisão. RESULTADOS: Foram incluídos oito ensaios clínicos. Verificou-se que nos itens geração de sequência aleatória, ocultação de alocação e cegamento de avaliadores de desfecho em quase todos os estudos tiveram alto risco de viés. Os resultados da metanálise não mostraram diferenças significativas no VO2máx e Wmáx. CONCLUSÃO: O pré-condicionamento isquêmico remoto não se mostrou eficaz para aumentar o VO2máx e a Wmáx em corredores e ciclistas.

INTRODUCTION: Remote ischemic preconditioning (PIRC) is a non-invasive cardioprotective intervention that attenuates cell damage suffered by prolonged ischemia. Its protective effects on the heart, when applied to sport, can improve exercise performance. OBJECTIVE: To investigate the effect of remote ischemic preconditioning on maximum oxygen consumption (VO2max) and maximum power (Wmax) in runners and cyclists. METHODOLOGY: Systematic review and metaanalysis, with randomized clinical trials. Based on PRISMA and evaluated by the PROSPERO systematic review project repository; however, it did not obtain registration because it is an outcome of sports performance. The searches were carried out in the Medline / PubMed, SciELO, Capes Periodicals databases. The selection of studies was carried out in two stages: reading the title and summary and reading the articles in full. Data extraction was performed by transcribing the information. Methodological quality was assessed by the risk of bias scale using the Cochrane tool. Studies that investigated variables other than the outcomes selected for this review were excluded. RESULTS: Eight clinical trials were included. In the generation of the item of random sequence, concealment of allocation and blinding of outcome evaluators in almost all studies had a high risk of bias. The analysis of the risk of bias was high risk. The results of the meta-analysis did not show significant differences in VO2max and Wmax. CONCLUSION: Remote ischemic preconditioning was not effective in increasing VO2max and Wmax in runners and cyclists.

Efeito do pré-condicionamento isquêmico remoto no consumo máximo de oxigênio e potência máxima em corredores e ciclistas: revisão sistemática e metanálise / Effect of remote ischemic pre-conditioning on maximum oxygen consumption and maximum power in runners and cyclists: systematic review and metanalysis

INTRODUÇÃO: O pré-condicionamento isquêmico remoto (PCIR) é uma intervenção cardioprotetora não invasiva que atenua a lesão celular sofrida por uma isquemia prolongada. Seus efeitos de proteção sobre o coração, quando aplicado ao esporte, pode melhorar o desempenho do exercício. OBJETIVO: Investigar o efeito do pré-condicionamento isquêmico remoto no consumo máximo de oxigênio (VO2máx) e potência máxima (Wmáx) em corredores e ciclistas. METODOLOGIA: Revisão sistemática e metanálise, com ensaios clínicos randomizados. Baseado no PRISMA e avaliado pelo repositório de projetos de revisões sistemática PROSPERO; entretanto, não obteve o registro por se tratar de um desfecho de performance esportiva. As buscas foram realizadas nas bases de dados Medline/PubMed, SciELO, Periódicos CAPES. A seleção dos estudos foi realizada em duas etapas: leitura do título e resumo, e leitura completa dos artigos. A extração dos dados foi realizada pela transcrição das informações. A qualidade metodológica foi avaliada pela escala risco de viés através da ferramenta Cochrane. Excluíram-se estudos que investigaram variáveis diferentes dos desfechos selecionados para esta revisão. RESULTADOS: Foram incluídos oito ensaios clínicos. Verificou-se que nos itens geração de sequência aleatória, ocultação de alocação e cegamento de avaliadores de desfecho em quase todos os estudos tiveram alto risco de viés. Os resultados da metanálise revelou VO2máx (p < 0,01), o PCIR mostrou ser eficaz; Wmáx não houve diferença significativa. CONCLUSÃO: O pré-condicionamento isquêmico remoto pode ser capaz de aumentar o VO2máx em corredores e ciclistas. A Wmáx demonstra não ser influenciada pelo PCIR.

INTRODUCTION: Remote ischemic preconditioning (PIRC) is a non-invasive cardioprotective intervention that attenuates cell damage suffered by prolonged ischemia. Its protective effects on the heart, when applied to sport, can improve exercise performance. OBJECTIVE: To investigate the effect of remote ischemic preconditioning on maximum oxygen consumption (VO2max) and maximum power (Wmax) in runners and cyclists. METHODOLOGY: Systematic review and metaanalysis, with randomized clinical trials. Based on PRISMA and evaluated by the PROSPERO systematic review project repository; however, it did not obtain registration because it is an outcome of sports performance. The searches were carried out in the Medline / PubMed, SciELO, Capes Periodicals databases. The selection of studies was carried out in two stages: reading the title and summary and reading the articles in full. Data extraction was performed by transcribing the information. Methodological quality was assessed by the risk of bias scale using the Cochrane tool. Studies that investigated variables other than the outcomes selected for this review were excluded. RESULTS: Eight clinical trials were included. In the generation of the item of random sequence, concealment of allocation and blinding of outcome evaluators in almost all studies had a high risk of bias. The analysis of the risk of bias was high risk. The meta-analysis results revealed VO2max (p <0.01), the PCIR proved to be effective; Wmax there was no significant difference. CONCLUSION: Remote ischemic preconditioning may be able to increase VO2max in runners and cyclists. Wmax demonstrates that the PCIR does not influence it.

Correlação da ventilação voluntária máxima com a força e resistência dos músculos respiratórios em jovens / Correlation of maximum voluntary ventilation to the strength and resistance of young respiratory muscles

A ventilação voluntária máxima é um dos testes difundidos para avaliação da resistência da musculatura respiratória, mesmo sem ser validado para este fim. Na literatura ainda são encontradas controvérsias quanto a interpretação e aplicabilidade do uso da VVM na prática clínica. OBJETIVO: Verificar a correlação entre a ventilação voluntária máxima e a força e resistência dos músculos respiratórios em jovens hígidos. MATERIAIS E MÉTODOS: Estudo observacional de corte transversal realizado na Clínica. Foram incluídos indivíduos > 18 anos, de ambos os sexos e hígidos. Os participantes tiveram sua avaliação da força muscular respiratória através do manovacuômetro, no qual se obteve a Pimáx e Pemáx. A resistência foi avaliada através do teste de carga constante pelo Power Breathe, utilizando 60% da Pimáx. A ventilação voluntária máxima foi realizada pelo espirômetro. Para a correlação das variáveis Pimáx, Pemáx e VVM foi aplicado o teste de correlação de Pearson. O estudo foi aprovado pelo comitê de ética, CAAE 10849519.9.0000.5544. RESULTADOS: Foram avaliados 27 participantes, em que 59,3% eram do sexo masculino e 55,6% ativos. A ventilação voluntária máxima com a Pimáx e Pemáx, apresentaram respectivamente p = 0,04 e 0,02 e r = 0,53 e 0,57. CONCLUSÃO: O teste de ventilação voluntária máxima possui uma correlação moderada com a força muscular respiratória, e não obtém correlação com o teste de carga constante.

Maximum voluntary ventilation is one of the widespread tests for assessing respiratory muscle strength, even without being validated for this purpose. Controversies are still found in the literature regarding the interpretation and applicability of the use of MVV in clinical practice. OBJECTIVE: To verify the correlation between maximum voluntary ventilation and respiratory muscle strength and endurance in healthy youngsters. MATERIALS AND METHODS: Observational cross-sectional study conducted at the Clinic. Individuals> 18 years of age, of both sexes and healthy were included. Participants had their respiratory muscle strength assessment using a manovacuometer, in which Pimax and Pmax were obtained. The resistance was evaluated through the constant load test by Power Breathe, using 60% of the Pimáx. Maximum voluntary ventilation was performed by a spirometer. Pearson's correlation test was applied to correlate the variables Pimax, Pmax and VVM. The study was approved by the ethics committee, CAAE 10849519.9.0000.5544. RESULTS: 27 participants were evaluated, of which 59.3% were male and 55.6% were active. The maximum voluntary ventilation with Pimax and Pmax, presented respectively p = 0.04 and 0.02 and r = 0.53 and 0.57. CONCLUSION: The maximum voluntary ventilation test has a moderate correlation with respiratory muscle strength and has no correlation with the constant load test.

Modulação da variabilidade da frequência cardíaca em praticantes de CrossFit® / Modulation of heart rate variability in CrossFit® practitioners

INTRODUÇÃO: O CrossFit® é um tipo de exercício físico que afeta a homeostase do corpo exigindo ajustes pela via autonômica. Devido sua intensidade de treino ocorre uma modificação no tônus vagal e adaptações fisiológicas cardiovasculares. OBJETIVO: Verificar a variabilidade da frequência cardíaca em praticantes de CrossFit®. MATERIAIS E MÉTODOS: Corte transversal em praticantes de CrossFit® no período de março a junho de 2017, com idade ≥18 anos, tempo de prática ≥3 meses e uma frequência ≥2 vezes na semana. Excluídos: fumantes, gestantes, comorbidades auto referidas (Diabetes Mellitus, hipertensão, doenças cardiorrespiratórias e disfunção na tireoide), mulheres no período menstrual, menopausa, ou aqueles que tiveram dificuldade na compreensão do teste proposto. Para a mensuração da variabilidade da frequência cardíaca (VFC) foi utilizado o cardiofrequencimetro da marca Polar® modelo V800 heart rate monitor, para a sua análise foi utilizado KUBIOS HRV versão 2.0. Aprovação do CEP-BAHIANA (CAAE 46685415.0.0000.5544). RESULTADOS: Foram pesquisados 16 participantes, com idade média de 32,11 ± 6,44 anos, 10 (62, 5%) homens. O IMC encontrado foi de 26,39±3,80 kg/m², classificando 9 (56,3%) indivíduos como sobrepeso e 6 (37,5%)com peso normal. Os valores obtidos da VFC no domínio do tempo:VLFms2: 1544(859-3640); LFms2:827(550-2115); HFms2:661(335-1577);LF/ HF:1,18(0,86-1,8). CONCLUSÃO: Na amostra estudada, observou-se que praticantes de CrossFit® possuem leve predomínio da atividade simpática, especialmente o sexo masculino e naqueles que praticam atividade física cinco ou mais vezes por semana.

INTRODUCTION: CrossFit® is a type of physical exercise that affects the homeostasis of the body requiring adjustments through the autonomic pathway. Due to its intensity of training there is a modification in vagal tone and cardiovascular physiological adaptations. OBJECTIVE: To verify heart rate variability in CrossFit® practitioners. MATERIALS AND METHODS: Cross-section in CrossFit® practitioners from March to June 2017, aged ≥18 years, practice time ≥3 months and a frequency ≥2 times in the week. Excluded: smokers, pregnant women, self-referenced comorbidities (Diabetes Mellitus, hypertension, cardiorespiratory diseases and thyroid dysfunction), women in the menstrual period, menopause, or those who had difficulty understanding the proposed test. For the measurement of heart rate variability (HRV), the heart rate monitor model V800 heart rate monitor was used for its analysis was KUBIOS HRV version 2.0. Approval of CEP-BAHIANA (CAAE 46685415.0.0000.5544). 5544. RESULTS: 16 participants were studied, with a mean age of 32.11 ± 6.44 years, 10 men (62.5%). The mean BMI found was 26.39 ± 3.80 kg/ m², classifying 9 (56.3%) individuals as overweight and 6 (37.5%) with normal weight. The values obtained from HRV in the time domain: VLF:1544 (859-3640), LF: 827 (550-2115), HF: 661 (335-1577), LF / HF: 1.18 (0.86-1,8). CONCLUSION: In the studied sample, it was observed that CrossFit® practitioners have a slight predominance of sympathetic activity, especially males and those who practice physical activity five or more times per week.

Estilo de vida após sete anos do evento coronariano isquêmico: estudo transversal / Lifestyle after seven years of post ischemic coronary event: cross-sectional study

FUNDAMENTOS: O envelhecimento acelerado da população e a não aderência de hábitos de vida saudável implica no aparecimento de comorbidades, levando assim à perda da capacidade funcional, limitando o indivíduo nas atividades laborais e sociais. A magnitude do problema leva a refletir sobre a importância dos programas multidisciplinares, despertando para a mudança de hábitos de vida, principalmente em indivíduos que sofreram um evento isquêmico a longo prazo. OBJETIVO: Comparar o estilo de vida de indivíduos após sete anos do evento coronariano isquêmico. MÉTODO: Trata-se de um estudo de coorte retrospectivo, composto por indivíduos portadores de Síndrome Coronariana Isquêmica. Critérios de inclusão: participantes de um estudo prévio, no período compreendido entre abril de 2006 a janeiro de 2007. Após o consentimento, foi realizada uma breve entrevista por contato telefônico, com as seguintes questões: dados sociodemográficos; comorbidades; estilo de vida; número de internações por problemas cardíacos; presença de dor torácica. As variáveis categóricas apresentadas em termos de frequência absoluta, enquanto os dados numéricos, em termos de média e desvio-padrão (XD ± DP). O teste de McNemar para comparação das variáveis categóricas pareadas e teste qui-quadrado para comparação das variáveis categóricas, p≤ 0,0 5. CAAE: 05874112.9.0000.5544. RESULTADOS: Destacam-se as comorbidades mais prevalentes a Hipertensão Arterial Sistêmica 24 (80%), Dislipidemia 21 (70%), Diabete Mellitus 14 (46,6%). Após sete anos do evento, houve um aumento de hipertensos (p=0,01) em contrapartida redução de tabagistas (p=0,02). CONCLUSÃO: Apesar dos indivíduos terem modificado dois estilos de vida relevantes e significantes como a hipertensão e o tabagismo, a população estudada mantém elevadas taxas de fatores de risco cardiovasculares, necessitando de uma intervenção da equipe multidisciplinar.

BACKGROUND: The population's accelerated aging process and unhealthy lifestyle imply in the appearance of comorbidities, thus leading to the loss of functional capacity, limiting the individual in labor, recreational and social activities. The magnitude of the problem reflects on the importance of multidisciplinary programs, awakening the need to change lifestyle, especially in individuals who have suffered a long-term ischemic event. OBJECTIVE: To compare the lifestyle of individuals after seven years of ischemic coronary event. METHOD: This is a retrospective cohort composed of individuals with Ischemic Coronary Syndrome (ICS). Inclusion criteria: participants from a previous study, in the period from April 2006 to January 2007. After the consent, a brief interview was performed by telephone contact, with the following questions: sociodemographic data; comorbidities; Lifestyle; number of hospitalizations due to cardiac problems; presence of chest pain. The categorical variables presented in terms of absolute frequency, while the numerical data, in terms of mean and standard deviation (XD ± SD). The McNemar test for comparison of the categorical variables paired and chi-square test for comparison of the categorical variables, p≤ 0.05. CAAE: 05874112.9.0000.5544. RESULTS: We highlight the most prevalent comorbidities, Hypertension 24 (80%), Dyslipidemia 21 (70%), Diabetes 14 (46.6%). After seven years event, there was an increase in hypertensive patients (p = 0.01) in contrast smokers reduction (p = 0.02). CONCLUSION: Although the individuals have modified two significant lifestyles such as the relevant, hypertension and smoking, the studied population maintains high rates of cardiovascular risk factors, necessitating an intervention by the multidisciplinary team.

Comparação da força e resistência dos músculos inspiratórios entre ativos e sedentários / Comparison of the strength and resistance of inspirational muscles between assets and sedentary

Introdução: A prática regular de atividade física está associada com melhora do estado de saúde, aumento da capacidade funcional, aumento da força muscular e redução da mortalidade por doenças cardíacas. Apesar dos benefícios de a prática regular de exercício físico estarem consolidados na literatura, as adaptações na força e resistência dos músculos inspiratórios são controversas. Objetivo: Testar a hipótese que não há diferença da força e resistência dos músculos inspiratórios entre indivíduos ativos e sedentários. Métodos:Estudo observacional de corte transversal. Avaliou-se indivíduos entre 18 e 30 anos, ambos os sexos e saudáveis. Os voluntários foram divididos em ativos e sedentários de acordo a classificação da American College of Sports Medicine (ACMS). Os indivíduos tiveram a força máxima dos músculos inspiratórios (FMI) determinada através do dispositivo POWERbreathe® K5 inspiratory muscle trainer, que intula esta variável como Sindex. A resistência dos músculos inspiratórios foi avaliada través de um teste incremental. Para comparação das médias foi aplicada o teste t de student para distribuição simétrica, p< 0,05. O estudo foi aprovado pelo comitê de ética em pesquisa com CAAE : 37781014.4.0000.5544. Resultados: Foram avaliados 92 indivíduos, destes 55 (60%) foram classificados como ativos e 57 (62%) do sexo masculino. Ao realizar a comparação do Sindex entre ativos e sedentários (128±26; 119±24 cmH2O; p=0,85) e da exaustão no teste incremental (6516% e 6016%;p=0,095), respctivamente. Conclusão: Os indivíduos ativos não apresentam músculos inspiratórios mais fortes e resistentes quando comparados com sedentários. [AU]

Introduction: The regular practice of physical activity is associated with improved health status, increased functional capacity, increased muscle strength and reduced mortality from heart disease. Although the benefits of regular exercise are well established in the literature, adaptations in inspiratory muscle strength and endurance are controversial. Objective: To test the hypothesis that there is no difference in the strength and resistance of the inspiratory muscles between active and sedentary individuals. Methods: Cross-sectional observational study. It was evaluated individuals between 18 and 30 years old, both sexes and healthy. The volunteers were divided into active and sedentary according to the classification of the American College of Sports Medicine (ACMS). Individuals had maximal inspiratory muscle strength (IMS) determined through the POWERbreathe® K5 inspiratory muscle trainer, which injects this variable as Sindex. The inspiratory muscle strength was evaluated through an incremental test. For the comparison of the means the student's t-test was applied for symmetrical distribution, p <0.05. The study was approved by the research ethics committee with CAAE: 37781014.4.0000.5544. Results: A total of 92 individuals were evaluated. Of these, 55 (60%) were classified as active and 57 (62%) were male. When comparing Sindex between active and sedentary (128 ± 26/119 ± 24 cmH2O, p = 0.85) and exhaustion in the incremental test (63.2 ± 16.1%. p = 0.095), respectively. Conclusion: Active individuals do not present stronger and stronger inspiratory muscles when compared to sedentary ones. [AU]

Como periódicos científicos em fisioterapia podem auxiliar a tratar as assimetrias regionais / How scientific journals in physiotherapy can fix regional asymmetries

Apresenta contextualização da fisioterapia enquanto ciência e profissão e argumenta pela necessidade de periódicos cientificamente rigorosos e relevantes para ajudar a tratar assimetrias regionais no desenvolvimento do campo.

It presents contextualization of physiotherapy both as a science and a profession and argues for the need of scientifically rigorous and relevant journals to help fix regional asymmetries in the development of the field.

Quality of life and pain multidimensional aspects in individuals with HTLV-1.

HTLV-1 creates a chronic health condition that involves moderate to severe pain with a negative impact on quality of life (QoL). There is no consensus on which attitudes to pain are more related to the worsening of QoL in HTLV-1 infected patients. The aim of this study was to investigate the correlation between QoL and multidimensional aspects of pain in patients with HTLV-1. A cross-sectional study was conducted in Salvador, Bahia, Brazil. The study included individuals diagnosed with HTLV-1. The Short Form 36 Questionnaire was used to analyze QoL, and the Brief Pain Inventory was used to assess multidimensional aspects of pain. The mean pain intensity was 4.88±3.06 on the visual pain scale, and the average impact on QoL corresponded to a loss of approximately 40%. Moderate to high correlations between pain intensity and all domains of QoL were observed and compared reaction attitudes for general activity, mood, ability to walk, ability to work, relationships, sleep, and ability to enjoy life (r>0.40; p<0.05). Moderate correlations were found between all domains of QoL, pain intensity, and reactive attitudes to pain. The greatest pain intensity impacts involved difficulty to walk and to work, and interpersonal relationships in the emotional aspect of QoL.

Quality of life of patients after an acute coronary event: hospital discharge.

BACKGROUND: The acute coronary syndrome (ACS) has a high morbi-mortality rate, including physical deficiencies and functional limitations with impact on quality of life. Cardiovascular rehabilitation 1 (CVR1) should begin as early as possible, to enable improvement in functional capacity and quality of life. Previous studies have shown association of cardiovascular diseases with quality of life, in which depression and anxiety are the domains most altered. The aim of the study is to verify the impact of an acute coronary event on quality of life at the moment of hospital discharge. METHODOLOGY: This was a cross-sectional study, with ACS patients hospitalized in ICU of a private hospital in the city of Salvador, Brazil, submitted to CVR1. The quality of life questionnaire Euroqol-5D was applied on discharge from hospital. Patients included in the study were those with ACV, who had medical permission to walk, had not been submitted to acute surgical treatment, were time and space oriented, and over the age of 18 years. Patients excluded from the study were those with cognitive, orthopedic and neurological problems, who used orthesis on a lower limb, and were in any condition of risk at the time of beginning with CVR1. Data were collected by a previously trained ICU team. RESULTS: Data were collected of 63 patients who revealed compromise in the domains of pain/feeling ill (20.63%) and anxiety/depression (38.09%). Statistical significance was observed in the association between sex and pain/feeling ill (P < 0.01), sex and anxiety/depression (P < 0.01), diabetes and mobility (P < 0.01), hereditary factors and anxiety/depression (p < 0.01), BMI and pain/feeling ill (P < 0.01). CONCLUSION: In this sample of patients, on discharge from hospital after ACS, the pain/feeling ill and anxiety/depression domains were shown to be compromised.

Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome.

BACKGROUND: Lack of a standardized and monitored technique to start rehabilitation of patients with acute coronary syndrome (ACS) in the coronary care unit. OBJECTIVE: To describe the technique of and circulatory response to a 50-m walk (W50m). METHODS: Experimental cross-sectional study of 65 patients with ACS; of these, 36 (54%) with acute myocardial infarction (AMI), Killip I, 29 (45.2%) with unstable angina (UA), 61.5% males with age of 62.8 +/- 12.7 years. Walk was started 45+/-23 h after hospitalization. Parameters measured: systolic blood pressure (SBP mmHg), diastolic blood pressure (DBP mmHg), heart rate (HR bpm), double product (SBP mmHg X HR bpm), peripheral oxygen saturation (SpO2%), walking time, and exercise tolerance by Borg scale (BS). Measurements were taken while supine, sitting, in orthostasis (phase 1 [gravitational stress]), end of the walk, and after a 5-minute rest (phase 2 [exercise stress]). RESULTS: Increased HR in response to the sitting gravitational stress (Delta=4.18) and with orthostasis (Delta=2.69) (p<0.001) was observed. At the end of walk, there was an elevation in SBP (Delta=4.84), (p<0.001), HR (Delta=4.68), (p<0.001) and DP (Delta=344.97), (p=0.004), and a reduction in SpO2 (Delta=-1.42), (p<0.001), with return to baseline values after 5 minutes. Walking time was 2'36''+/-1'17'', and exercise tolerance by BS was good. SBP response >or= 142 mmHg when sitting was associated with a significant increase (p=0.031) of 11 mmHg at exercise in 13 patients with overweight/obesity and 85% with hypertension. Adverse effects occurred in 19 (29.2%) patients and dizziness in 23.1%, which impaired the walk in three of them. CONCLUSION: In this sample, patients did not present severe collateral effects to W50m. 24 hours after a coronary event.

Resposta circulatória à caminhada de 50 m na unidade coronariana, na síndrome coronariana aguda / Respuesta circulatoria a la caminata de 50m en la unidad coronaria, en la síndrome coronaria aguda / Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome

FUNDAMENTO: Ausência de técnica padronizada e monitorada para iniciar a reabilitação de pacientes com síndrome coronariana aguda (SCA), na unidade coronariana. OBJETIVO: Descrever a técnica e a resposta circulatória à caminhada de 50 m (C50m). MÉTODOS: Estudo experimental, transversal, com 65 pacientes com SCA; destes 36 (54 por cento) com infarto agudo do miocárdio (IAM), Killip I; 29 (45,2 por cento) com angina instável (AI); 61,5 por cento do sexo masculino, idade 62,8 ± 12,7 anos. Caminhada com início 45 ± 23 horas pós-internamento. Mensuraram-se pressão arterial sistólica (PAS mmHg) e diastólica (PAD mmHg), freqüência cardíaca (FC bpm), duplo produto (PAS mmHg X FC bpm), saturação periférica de oxigênio (SpO2 por cento), tempo de caminhada e percepção do esforço pela escala de Borg (EB). Obtiveram-se medições nas posições supina, sentada e ortostase (fase 1 - estresse gravitacional), no final da caminhada e pós-repouso de 5 minutos (fase 2 - estresse físico). RESULTADOS: Observou-se aumento da FC ao estresse gravitacional sentado (Δ = 4,18) e em ortostase (Δ = 2,69), (p < 0,001). Houve elevação pós-caminhada da PAS (Δ = 4,84), (p < 0,001); FC (Δ = 4,68), (p < 0,001); DP (Δ = 344,97), (p = 0,004); e decréscimo da SpO2 (Δ = -1,42), (p < 0,001), com retorno dos valores basais após 5 minutos. O tempo de caminhada foi de 2'36" ± 1'17". Observou-se boa tolerância ao exercício pela EB. Resposta da PAS > 142 mmHg ao sentar associou-se com aumento significativo (p = 0,031) de 11 mmHg ao exercício em 13 pacientes com sobrepeso/obesidade e 85 por cento com hipertensão. Verificaram-se efeitos adversos em 19 (29,2 por cento) pacientes, tonturas em 23,1 por cento, com impedimento da caminhada em três deles. CONCLUSÃO: Nesta amostra, após 24 horas do evento coronariano, não se verificaram efeitos colaterais graves à C50m.

BACKGROUND: Lack of a standardized and monitored technique to start rehabilitation of patients with acute coronary syndrome (ACS) in the coronary care unit. OBJECTIVE: To describe the technique of and circulatory response to a 50-m walk (W50m). METHODS: Experimental cross-sectional study of 65 patients with ACS; of these, 36 (54 percent) with acute myocardial infarction (AMI), Killip I, 29 (45.2 percent) with unstable angina (UA), 61.5 percent males with age of 62.8 ± 12.7 years. Walk was started 45±23h after hospitalization. Parameters measured: systolic blood pressure (SBP mmHg), diastolic blood pressure (DBP mmHg), heart rate (HR bpm), double product (SBP mmHg X HR bpm), peripheral oxygen saturation (SpO2 percent), walking time, and exercise tolerance by Borg scale (BS). Measurements were taken while supine, sitting, in orthostasis (phase 1 [gravitational stress]), end of the walk, and after a 5-minute rest (phase 2 [exercise stress]). RESULTS: Increased HR in response to the sitting gravitational stress (Δ=4.18) and with orthostasis (Δ=2.69) (p<0.001) was observed. At the end of walk, there was an elevation in SBP (Δ=4.84), (p<0.001), HR (Δ=4.68), (p<0.001) and DP (Δ=344.97), (p=0.004), and a reduction in SpO2 (Δ=-1.42), (p<0.001), with return to baseline values after 5 minutes. Walking time was 2'36"±1'17", and exercise tolerance by BS was good. SBP response > 142 mmHg when sitting was associated with a significant increase (p=0.031) of 11 mmHg at exercise in 13 patients with overweight/obesity and 85 percent with hypertension. Adverse effects occurred in 19 (29.2 percent) patients and dizziness in 23.1 percent, which impaired the walk in three of them. CONCLUSION: In this sample, patients did not present severe collateral effects to W50m. 24 hours after a coronary event.

FUNDAMENTO: Ausencia de técnica estandarizada y de monitoreo para iniciarse la rehabilitación de pacientes con síndrome coronaria aguda (SCA), en la unidad coronaria. OBJETIVO: Describir la técnica y la respuesta circulatoria a la caminata de 50m (C50m)./ MÉTODOS: Estudio experimental, transversal, con 65 pacientes con SCA; el número de 36 (54 por ciento) de ellos con infarto agudo de miocardio (IAM), Killip I; un total de 29 (45,2 por ciento) con angina instable (AI); el 61,5 por ciento del sexo masculino, edad 62,8 ± 12,7 años. Caminata con inicio 45 ± 23 horas post internación. Se calcularon la presión arterial sistólica (PAS mmHg) y diastólica (PAD mmHg), la frecuencia cardiaca (FC bpm), el doble producto (PAS mmHg X FC bpm), la saturación periférica de oxígeno (SpO2 por ciento), el tiempo de caminata y la percepción del esfuerzo a través de la escala de Borg (EB). Se obtuvieron mediciones en las posiciones supina, sentada y ortostasis (fase 1 - estrés gravitacional), al final de la caminata y del post reposo de 5 minutos (fase 2 - estrés físico). RESULTADOS: Se observó un aumento de la frecuencia cardiaca (FC) al estrés gravitacional en la posición sentada (Δ = 4,18) y en ortostasis (Δ = 2,69), (p < 0,001). Hubo elevación post caminata de la PAS (Δ = 4,84), (p < 0,001); FC (Δ = 4,68), (p < 0,001); (DP) (Δ = 344,97), (p = 0,004); y descenso de la SpO2 (Δ = -1,42), (p < 0,001), con retorno de los valores basales tras 5 minutos. El tiempo de caminata fue de 2'36" ± 1'17". Se observó una buena tolerancia al ejercicio mediante la EB. Respuesta de la PAS > 142 mmHg al sentarse se asoció al aumento significativo (p = 0,031) de 11 mmHg al ejercicio en 13 pacientes con sobrepeso/obesidad y el 85 por ciento con hipertensión. Se verificaron efectos adversos en 19 (29,2 por ciento) pacientes, vértigos en el 23,1 por ciento, con interrupción de la caminata en tres de ellos. CONCLUSIÓN: En esta muestra, tras 24 horas ...