Efectos de la rehabilitación cardíaca de fase I. Revisión sistemática / Effects of phase I of cardiac rehabilitation. Systematic review

Resumen Introducción: La rehabilitación cardíaca de fase I es un programa hospitalario que tiene como objetivo reducir los efectos que se pueden derivar del reposo prolongado en cama e instruir al paciente para el ingreso a la fase ambulatoria de rehabilitación. Objetivo: Analizar los efectos de la rehabilitación cardíaca de fase I en pacientes sometidos a revascularización miocárdica y cambios valvulares, mediante una revisión sistemática de la literatura. Método: La revisión incluyó ensayos clínicos controlados aleatorizados que analizaran los efectos de la rehabilitación cardíaca de fase I. Se emplearon las bases de datos Scopus, ScienceDirect, Embase y Embase classic OVID. La búsqueda se limitó a los artículos publicados entre los años 2000 y 2017, en inglés, portugués y español. Los estudios que cumplieron los criterios de inclusión recibieron un análisis de la calidad metodológica, el nivel de evidencia y el grado de recomendación según las escalas PEDro y Scottish. Resultados: Fueron elegibles 298 artículos, de los cuales cuatro fueron seleccionados y analizados; todos estos incluyeron población que había sido sometida a revascularización quirúrgica cardíaca y dos a población con reparación o reemplazo valvular quirúrgico. En cuanto a la calidad metodológica, dos fueron categorizados como de buena calidad con un nivel de evidencia 1+ y 1++ y un grado de recomendación A y B. Los protocolos de tratamiento utilizados fueron las técnicas respiratorias, los ejercicios activos de extremidades y la deambulación. Conclusiones: La literatura analizada sugiere incluir los procesos de rehabilitación cardíaca de fase I, lo cual puede mejorar la función pulmonar y disminuir la ansiedad, variable que se asoció de manera directa con la estancia hospitalaria en los pacientes posquirúrgicos cardíacos.

Abstract Introduction: The phase I of cardiac rehabilitation have the proposed decrease the effects on the bed rest and better adherence at the phase II. Objective: To analyze the effects of phase I CR in patients undergoing myocardial revascularization and valve changes, through a systematic review of the literature. Method: The review includes randomized clinical trials looking at the effects of phase I. The base date Scopus, Science Direct, Embase & Embase classic OVID. The search was limited between 2000 and 2017, in English Portuguese and Spanish. Results: 298 articles were were eligible, and only four were selected and analyzed. The articles included a population with bypass coronary and two articles with surgery to valve replacement or repair. Regarding quality methodology, Two were rated to be good quality with an evidence level of 1+ and 1++ and a degree of recommendation A y B. The protocols used for treatment include breathing techniques, upper and lower limps exercise and ambulation. Conclusions: The phase I cardiac rehabilitation, could improve lung function and reduce anxiety, this is associated directly with stay hospital post-surgical cardiac patients

Factores determinantes de la limitación física funcional en pacientes revascularizados por síndrome coronario agudo / Determining factors with regard to physical functional impairment in revascularized patients with acute coronary syndrome

Introducción: La capacidad física funcional se asocia de manera indirecta con la mortalidad, y frecuentemente se ve comprometida después de un evento cardiovascular, de ahí la importancia de considerar sus factores pronósticos durante el tratamiento en los pacientes cardiópatas. Objetivo: Identificar los factores pronósticos de la limitación física funcional en pacientes revascularizados por Síndrome Coronario Agudo (SCA). Material y método: Se realizó un análisis retrospectivo de 29 historias clínicas tomadas de pacientes sometidos a una prueba de esfuerzo (Protocolo Bruce o Bruce modificado) posterior a una revascularización miocárdica durante los meses de enero a diciembre del 2019. Para el análisis estadístico se realizó una regresión logística univariada y multivariada (odds ratio-OR), así como un análisis de regresión linear simple entre las variables de interés. Resultados: los pacientes analizados tenían una media de edad de 60 ± 9,2 años, y el 76% fueron hombres. La presencia de hipertensión arterial sistémica (HAS), menores valores de Frecuencia Cardíaca (FC) máxima (ß = 0,112; CI: 0,074, 0,149; p <0,001), altos valores de Presión Arterial Sistólica (PAS) (ß = - 0,083; CI 95%: -0,152, -0,014; p <0,020), y un mayor número de factores de riesgo (ß = - 1,580; CI 95%: -2,456-0,868; p <0,001), son considerados predictores de limitación física funcional (<7 METs). Conclusión: La presencia de HAS, un mayor número de factores de riesgo, así como altos niveles de PAS máxima y menores valores de FC máxima alcanzadas durante la prueba de esfuerzo, mostraron ser factores pronósticos de la limitación funcional en sujetos revascularizados por SCA.(AU)

Introduction: Functional physical capacity is indirectly associated with mortality, and may be compromised after a cardiovascular event, hence the importance of considering its prognostic factors during treatment in heart disease patients. Aim: To identify the prognostic factors of functional physical limitation in patients with myocardial revascularization for acute coronary syndrome. Material and method: A retrospective analysis was carried out of 29 medical records taken from patients submitted to a stress test (Bruce, modified Bruce) after myocardial revascularization during the months of January to December 2019. For the statistical analysis, a univariate and multivariate logistic regression (Odds Ratio-OR) was performed, as well as a simple linear regression analysis between the variables of interest. Results: the analyzed patients had a mean age of 60 ± 9,2 years, and 76% were men. The presence of systemic arterial hypertension (SAH), lower values of Maximum Heart Rate (HR) (ß = 0,112; CI: 0,074, 0,149; p <0.001), high values of Systolic Arterial Pressure (SBP) (ß = - 0,083; CI 95%: -0,152, -0,014; p <0.020), and a greater number of risk factors (ß = - 1,580; CI 95%: -2,456-0,868; p <0.001), are considered predictors of functional limitation (<7 METs). Conclusion: The presence of SAH, a greater number of risk factors, as well as high maximum SBP levels and lower maximum HR values reached during the stress test, were shown to be prognostic factors of functional limitation in subjects revascularized for ACS.(AU)

The effects of maintenance cardiac rehabilitation: A systematic review and Meta-analysis, with a focus on sex.

Phase III/IV cardiac rehabilitation (CR) is recommended to promote maintenance of benefits achieved during Phase II; there has been no meta-analysis to test this to date. This study determined the effects of maintenance CR on any outcome, with consideration of sex. Seven databases were searched from inception-January 2020. Randomized controlled trials on the effects of maintenance CR in cardiovascular disease patients who had graduated from CR were included. Level of evidence was evaluated with GRADEPro. 819 citations were identified, with 10 trials (21 papers) included (5238 participants; 859 [16.4%] female). Maintenance CR resulted in lower low-density lipoprotein (mean difference [MD]=-0.58; 95% confidence interval [CI]=-1.06--0.10, n = 392) and greater quality of life (MD = 0.28, 95% CI = 0.05-0.52, n = 118) when compared to usual care only. Outcomes for women and sex differences were mixed. In conclusion, maintenance programs appear to sustain patient's quality of life, but more focus on women's outcomes is needed.

Study of heart rate recovery and cardiovascular autonomic modulation in healthy participants after submaximal exercise.

Heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) provide important information on cardiovascular autonomic control. However, little is known about the reorganization of HRV, BPV, and BRS after aerobic exercise. While there is a positive relationship between heart rate (HR) recovery rate and cardiorespiratory fitness, it is unclear whether there is a relationship between cardiorespiratory fitness and reorganization of cardiovascular autonomic modulation during recovery. Thus, this study aimed to investigate whether cardiorespiratory fitness influences the cardiovascular autonomic modulation recovery, after a cardiopulmonary exercise test. Sixty men were assigned into groups according to their cardiorespiratory fitness: low cardiorespiratory fitness (LCF = VO2: 22-38 mL kg-1 min-1), moderate (MCF = VO2: 38-48 mL kg-1 min-1), and high (HCF = VO2 > 48 mL kg-1 min-1). HRV (linear and non-linear analysis) and BPV (spectral analysis), and BRS (sequence method) were performed before and after a cardiopulmonary exercise test. The groups with higher cardiorespiratory fitness had lower baseline HR values and HR recovery time after the cardiopulmonary exercise test. On comparing rest and recovery periods, the spectral analysis of HRV showed a decrease in low-frequency (LF) oscillations in absolute units and high frequency (HF) in absolute and normalized units. It also showed increases in LF oscillations of blood pressure. Nonlinear analysis showed a reduction in approximate entropy (ApEn) and in Poincare Plot parameters (SD1 and SD2), accompanied by increases in detrended fluctuation analysis (DFA) parameters α1 and α2. However, we did not find differences in cardiovascular autonomic modulation parameters and BRS in relation to cardiorespiratory fitness neither before nor after the cardiopulmonary test. We concluded that cardiorespiratory fitness does not affect cardiovascular autonomic modulations after cardiopulmonary exercise test, unlike HR recovery.

Efectos de un programa de ejercicio físico propioceptivo sobre el equilibrio en jóvenes patinadores entre los 11 y 15 años / Effects of a proprioceptive physical exercise program on balance in young skaters aged between 11 to 15 years

Introducción: Un estado de equilibrio corporal apropiado permite al patinador mantener el control y la técnica adecuada en la ejecución de cada gesto deportivo. Así, un buen estado reduce movimientos accesorios que llevan al deportista a un incremento del estrés articular, que finalmente puede repercutir en el estado de salud y el rendimiento de estos atletas. Objetivo: Determinar el efecto de un programa de ejercicio físico propioceptivo sobre el equilibrio de patinadores en edades comprendidas entre los 11 a 15 años. Material y método: Estudio experimental con dos grupos de intervención en paralelo, realizado en 58 deportistas pertenecientes a la Liga Santandereana de Patinaje de la ciudad de Bucaramanga, quienes fueron aleatorizados en dos grupos: Grupo Experimental (GE) (n = 29) que recibió entrenamiento propioceptivo y Grupo Control (GC) (n = 29) que recibió entrenamiento convencional. Ambos protocolos fueron desarrollados durante doce (12) semanas, con una frecuencia de tres veces por semana y una duración de treinta minutos en cada sesión. El equilibrio dinámico y estático fue evaluado antes y después de cada intervención mediante Star Excursion Balance Test (SEBT ) y Balance Error Scoring System (BESS). Resultados: Después de la intervención, ambos grupos mostraron cambios positivos en cuanto al equilibrio dinámico; éstos fueron superiores en el GE (p < 0.05). En cuanto al equilibrio estático, los cambios fueron positivos y significativos en el grupo que recibió ejercicio propioceptivo (p < 0.05). En contraste, el grupo que recibió tratamiento convencional no mostró cambios en esta variable. Conclusión: El entrenamiento propioceptivo produce resultados superiores en el equilibrio estático y dinámico de los patinadores evaluados, en comparación con los resultados generados por el entrenamiento convencional

Introduction: Having an adequate state of body balance allows the skater to maintain an adequate technique and control in the execution of each sporting gesture, this may limit accessory movements that lead to an inadequate increase in joint stress, which can ultimately impact on the health status and performance of these athletes. Aim: To determine the effects of a proprioceptive physical exercise program on balance in skaters between the ages of 11 and 15 years. Methodology: A experimental study conducted in 58 skaters belonging to the Santander Skating League of Bucaramanga, who were randomized into two groups, one received proprioceptive training (n = 29) and the other group performed a conventional training (n = 29), both were developed for 12 weeks with a frequency of 3 times a week and a duration per session of 30 minutes. Results: The dynamic balance assessed with the Star Excursion Balance Test (SEBT), showed changes in all directions after the intervention of both groups. In relation to the static balance determined with the Balance Error Scoring System (BESS) showed positive changes in the experimental group. Conclusions: The proprioceptive training program produces results superior to the conventional one, in terms of the static and dynamic balance of the skaters evaluated

Respuesta de la glucemia frente a dos intensidades de ejercicio físico realizado en ayunas en mujeres jóvenes / Blood glucose response to two intensities of physical exercise in young women during fasting

Introducción: La práctica de Ejercicio Físico (EF) en estado de ayuno ha sido controvertida; no obstante, algunas investigaciones evidencian mayor pérdida de grasa corporal y mejor control glucémico en quienes participan de entrenamiento aeróbico en estado de ayuno. Objetivo: Evaluar la respuesta de la glucemia después de una sesión de ejercicio físico de intensidad moderada o vigorosa realizado en ayunas en mujeres jóvenes. Materiales y métodos: Se realizó un ensayo clínico controlado aleatorizado. Veinticuatro mujeres (19 a 22 años) fueron asignadas de manera aleatoria a dos grupos de intervención. El primero fue sometido a una intensidad de ejercicio del 70% de la Frecuencia Cardíaca Máxima (FCM) durante 30 minutos y el segundo a una intensidad del 90% de la FCM durante 15 minutos. Se evaluaron la talla (cm), peso (Kg), índice de masa corporal (IMC), porcentaje de grasa y consumo máximo de oxígeno (VO2máx) mediante una prueba de esfuerzo. Los niveles de glucemia fueron determinados antes y después de la sesión de ejercicio de cada grupo. Resultados: No se encontraron cambios significativos en los niveles de glucosa en sangre post ejercicio en ningún grupo experimental, y las diferencias existentes no fueron estadísticamente significativas. Conclusión: El ejercicio físico moderado o vigoroso en estado de ayuno no mostró variaciones significativas en la glucemia posterior a su ejecución, lo que sugiere seguridad en el desarrollo del entrenamiento en ayuno en mujeres jóvenes saludables

Introduction: Physical exercise in the fasting state has been a controversial topic; however, some studies have shown a greater loss of body fat and better glycemic control in those who participate in aerobic training when fasting. Aim: To evaluate the glycemic response after a session of moderate or vigorous physical exercise in young women in the state of fasting. Material and method: A randomized clinical trial was carried out. Twenty-six women (19 to 22 years old) were randomly assigned to two intervention groups. The first group was trained at an intensity of 70% of maximum heart rate (MHR) for 30 minutes, and the second group at an intensity of 90% MHR for 15 minutes. Height (cm), weight (Kg), body mass index (BMI), fat percentage, and maximum oxygen consumption (VO2max) during a stress test were evaluated. Blood glucose levels were checked before and after the exercise session of each group. Results: No significant changes were found in post-exercise blood glucose levels in any experimental group, and the existing differences were not statistically significant. Conclusions: Moderate or vigorous physical exercise during fasting did not show significant variations in blood glucose, which suggests that it is safe for healthy young women to train when fasting

The blood pressure variability and baroreflex sensitivity in healthy participants are not determined by sex or cardiorespiratory fitness.

BACKGROUND: Heart rate (HR) and blood pressure (BP) autonomic modulation and baroreflex sensitivity (BRS) are important indexes of cardiovascular homeostasis. However, methodological errors are often observed, such as joint analysis of men and women. Another important aspect is that we still do not know whether cardiorespiratory fitness influences these autonomic parameters in healthy individuals. OBJECTIVES: This study aimed to investigate whether sex can affect BRS, autonomic modulation of HR and BP variabilities (HRV and BPV, respectively), as well as the influence of cardiorespiratory fitness on these autonomic parameters. METHODS: Healthy men and women (N=120) were assigned to groups according to the peak oxygen consumption (VO2 peak) obtained in the cardiorespiratory test: low cardiorespiratory fitness (VO2 peak: 22-38 ml/kg/min), moderate cardiorespiratory fitness (VO2 peak: 38-48 ml/kg/min), and high cardiorespiratory fitness (VO2 peak>48 ml/kg/min). HRV and BPV evaluations were performed for all groups in the frequency domain by spectral analysis. Spontaneous BRS was assessed using the sequence method. RESULTS: Women presented lower BP values compared with men. HR did not differ between sexes, but showed an inverse relationship with cardiorespiratory performance. The HRV analysis showed greater sympathetic modulation for men and greater vagal modulation for women. Men and women presented similar results for systolic BPV and BRS, and cardiorespiratory performance did not influence any of the autonomic parameters evaluated. CONCLUSION: Cardiorespiratory fitness does not interfere with HRV and BPV autonomic modulation or BRS. However, the cardiac modulatory balance differs between sexes, with a greater influence of the autonomic vagal component in women and the sympathetic component in men.