Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials.

OBJECTIVE: This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN: Systematic review and meta-analysis of RCTs. DATA SOURCES: We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS: Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS: Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION: Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.

Some types of exercise interventions are more effective than others in people with coronary heart disease: systematic review and network meta-analysis.

QUESTION: What are the effects of different types of exercise treatments on oxygen consumption, quality of life and mortality in people with coronary heart disease? DESIGN: Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS: Adults with coronary heart disease. INTERVENTION: Exercise interventions including aerobic (continuous or high-intensity interval) training, resistance training, respiratory muscle exercises, water-based exercises, yoga, Tai chi, Qigong exercises and a combination of different types of exercise. OUTCOME MEASURES: Oxygen consumption, quality of life and mortality. RESULTS: This review included 178 randomised controlled trials with 19,143 participants. Several exercise interventions improved peak oxygen consumption (mL/kg/min): high-intensity interval training (MD 4.5, 95% CI 3.7 to 5.4); combined water-based exercises and moderate-intensity continuous training (MD 3.7, 95% CI 1.3 to 6.0); combined aerobic and resistance exercise (MD 3.4, 95% CI 2.5 to 4.3); water-based exercises (MD 3.4, 95% CI 0.6 to 6.2); combined respiratory muscle training and aerobic exercise (MD 3.2, 95% CI 0.6 to 5.8); Tai chi (MD 3.0, 95% CI 1.0 to 5.0); moderate-intensity continuous training (MD 3.0, 95% CI 2.3 to 3.6); high-intensity continuous training (MD 2.7, 95% CI 1.6 to 3.8); and resistance training (MD 2.2, 95% CI 0.6 to 3.7). Quality of life was improved by yoga (SMD 1.5, 95% CI 0.5 to 2.4), combined aerobic and resistance exercise (SMD 1.2, 95% CI 0.6 to 1.7), moderate-intensity continuous training (SMD 1.1, 95% CI 0.6 to 1.6) and high-intensity interval training (SMD 0.9, 95% CI 0.1 to 1.6). All-cause mortality was reduced by continuous aerobic exercise (RR 0.67, 95% CI 0.53 to 0.86) and combined aerobic and resistance exercise (RR 0.58, 95% CI 0.36 to 0.94). Continuous aerobic exercise also reduced cardiovascular mortality (RR 0.56, 95% CI 0.42 to 0.74). CONCLUSION: People with coronary heart disease may use a range of exercise modalities to improve oxygen consumption, quality of life and mortality. REGISTRATION: PROSPERO CRD42022344545.

Water-Based Exercises on Peak Oxygen Consumption, Exercise Time, and Muscle Strength in Patients with Coronary Artery Disease: A Systematic Review with Meta-Analysis.

Background: There is a growing use of water-based exercises in cardiac rehabilitation programs. However, there is little data concerning the effects of water-based exercise on the exercise capacity of coronary artery disease (CAD) patients. Objective: To perform a systematic review to investigate the effects of water-based exercise on peak oxygen consumption, exercise time, and muscle strength in patients with CAD. Methods: Five databases were searched to find randomized controlled trials that evaluated the effects of water-based exercise for coronary artery disease patients. Mean differences (MD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Results: Eight studies were included. Water-based exercise resulted in an improvement in peak VO2 of 3.4 mL/kg/min (95% CI, 2.3 to 4.5; I2 = 0%; 5 studies, N = 167), exercise time of 0.6 (95% CI, 0.1 to 1.1; I2 = 0%; 3 studies, N = 69), and total body strength of 32.2 kg (95% CI, 23.9 to 40.7; I2 = 3%; 3 studies, N = 69) when compared to no exercising controls. Water-based exercise resulted in an improvement in peak VO2 of 3.1 mL/kg/min (95% CI, 1.4 to 4.7; I2 = 13%; 2 studies, N = 74), when compared to the plus land exercise group. No significant difference in peak VO2 was found for participants in the water-based exercise plus land exercise group compared with the land exercise group. Conclusions: Water-based exercise may improve exercise capacity and should be considered as an alternative method in the rehabilitation of patients with CAD.

Comment on: "exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis".

BACKGROUND: Low cardiorespiratory fitness is associated with poor prognosis in individuals with coronary artery disease and after coronary artery bypass grafting surgery. Thus, we comment about a meta-analysis that adds important information about the effect of exercise training on cardiac autonomic function in individuals following coronary artery bypass grafting surgery. MAIN BODY: The study by Kushwaha et al. showed positive effects for heart rate variability and heart rate recovery in subjects after coronary artery bypass grafting surgery in response to acute physical training. These data are relevant, since heart rate variability is an independent predictor of for all-cause and cardiovascular mortality for individuals with cardiovascular disorders. Additionally, attenuated heart rate recovery is associated with increased risk for the same outcomes. Moreover, we summarize the quantitative data from studies that compared the effect of physical training in comparison with control group in cardiorespiratory fitness in adults following coronary artery bypass grafting. CONCLUSIONS: Our findings suggest that improvements in peak oxygen consumption result in an additional benefit in adults following coronary artery bypass grafting. Considered that, the increased cardiorespiratory fitness is an independent predictor of longer survival in coronary artery disease.

Eficácia do exergaming na aderência a reabilitação cardíaca fase II: um protocolo de ensaio clínico randomizado / Effectiveness of exergaming on the phase II cardiac rehabilitation adherence: a randomized clinical trial protocol

Introdução: O exergaming, dado o seu perfil lúdico, pode tornar a Reabilitação Cardíaca (RC) mais atrativa. Assim, questiona-se se o exergaming pode reduzir a evasão dos pacientes à RC. Objetivo: Analisar a eficácia do exergaming na aderência à RC fase dois. Métodos: Ensaio clínico randomizado, incluindo pacientes com doenças cardíacas, de ambos os sexos, maiores de 18 anos, admitidos na RC fase dois; excluídos os com contraindicações a essa intervenção. Os participantes serão alocados em dois grupos, com 30 indivíduos cada: grupo intervenção, que realizará o exergaming no Nintendo Wii; grupo controle, realizará exercício em esteira. A intervenção de ambos os grupos será de intensidade moderada, 30 minutos por sessão, três vezes por semana, por 12 semanas. A aderência à RC será identificada através da porcentagem do comparecimento às sessões. Resultados: As variáveis dos grupos serão comparadas por meio do Teste T de Student ou MannWhitney. O teste do qui-quadrado será utilizado para comparação das variáveis categóricas, quando inadequado, o exato de Fischer. Nível de significância será 5%. Conclusão: Esta investigação auxiliará na elucidação da eficácia do exergame na adesão à RC fase dois e quanto a outros desfechos secundários, como a melhora da capacidade de exercício.

Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial.

OBJECTIVE: To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. DESIGN: A prospective, randomized controlled trial. SETTING: A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. INTERVENTION: The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. MAIN MEASURES: The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. RESULTS: Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked (p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed (p = 0.363), lactate levels (p = 0.302), knee extensor strength (p = 0.117), handgrip strength (p = 0.882), global muscle strength (p = 0.104), electromyographic activity (p = 0.179) and Functional Independence Measure (p = 0.059). CONCLUSIONS: Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.

Effect of high-intensity interval training on aerobic capacity and heart rate control of heart transplant recipients: a systematic review with meta-analysis

Abstract Introduction: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. High-intensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderate-intensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. Methods: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Meta-analysis was performed using the random-effects, generic inverse variance method. Results: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. Conclusion: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

Effect of ivabradine on exercise capacity in individuals with heart failure with preserved ejection fraction.

The prevalence of heart failure with preserved ejection fraction (HFpEF) is about 30-75% of the patients living with heart failure. A hallmark symptom of these patients is exercise intolerance. Ivabradine can, eventually, increase exercise capacity by heart rate control. However, clinical trials show conflicting results about the effects of ivabradine on exercise capacity, an important prognostic variable. The aim of this study was to investigate the effects of ivabradine on exercise capacity in individuals with HFpEF. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and supplemented by guidance from the Cochrane Collaboration Handbook for Systematic Reviews of Interventions. For the meta-analysis, a forest plot was used to graphically present the effect sizes and the 95% CIs. Four randomized controlled trials were included. Ivabradine did not change exercise capacity expressed by peak VO2 and 6MWT (MD = 0.8; 95% CI - 2.5 to 4.3; P = 0.62) (Fig. 4a). In our secondary analysis, the ivabradine group showed a significant resting HR reduction when compared with placebo (MD = - 13.2; 95% CI - 16.6 to -9.8; P < 0.00001) and ivabradine showed increased values of E/e' ratio compared with placebo (MD = 0.8; 95% CI 0.0 to 1.6; P = 0.04). Current available evidence suggests that there is no effect of ivabradine on exercise capacity in patients with HFpEF. Also, questions about negative effects on E/e' values and adverse events associated with ivabradine treatment need to be considered in future studies.

Effect of High-Intensity Interval Training on Aerobic Capacity and Heart Rate Control of Heart Transplant Recipients: a Systematic Review with Meta-Analysis.

INTRODUCTION: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. Highintensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderateintensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. METHODS: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Metaanalyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Metaanalysis was performed using the random-effects, generic inverse variance method. RESULTS: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. CONCLUSION: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

Hemodynamic and creatine kinase changes after a 12-week equipment-based Pilates training program in hypertensive women.

Exercise therapy is a conservative strategy to manage hypertension. The aim of this study was to investigate the effects of a 12-week equipment-based Pilates training program on the hemodynamics of medication-controlled hypertensive women. Forty-five women were classified into two groups: medication-controlled hypertensive (n = 30) or control (n = 15). To be eligible for the hypertensive group, participants had to have a clinical diagnosis of hypertension, be taking medication to control their blood pressure and not to have done any exercise activity in the previous three months. In the control group, the participants needed to have normal blood pressure levels and not to have done any exercise activity in the previous three months. All women participated in a 12-week equipment-based Pilates training program (2 × 60min sessions per week). Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR) and creatine kinase levels (CK) were assessed before and after the program. SBP, DBP and heart rate were also assessed before and after each session. There was no statistically significant difference after Pilates training for systolic (normotensive MD 4.1, 95%CI -9.2 to 17.5, hypertensive MD 3.8, 95%CI -5.3 to 13.1) and diastolic (normotensive MD 5.8, 95%CI -2.0 to 13.7, hypertensive MD 4.0, 95%CI -4.3 to 12.4) blood pressure. Heart rate was reduced after Pilates training in both normotensive (MD 4.5, 95%CI 1.1 to 7.8) and medication-controlled hypertensive (MD 7.9, 95%CI 4.4 to 11.4) women. Creatine kinase activity was reduced after Pilates training in medication-controlled hypertensive women (p = 0.019). Blood pressure was not altered, but heart rate and creatinine kinase activity were reduced following 12 weeks of Equipment-based Pilates training.

Evidências científicas sobre Fisioterapia e funcionalidade em pacientes com COVID-19 adulto e pediátrico / Evidence-based Physiotherapy and Functionality in adult and pediatric patients with COVID-19

Introdução: O corona vírus (2019-nCoV OU HCOV-19 ou CoV2), emergiu na China como a principal causa de pneumonia viral (COVID-19, Doença do Coronavírus 19). Objetivo: Avaliar evidências científicas sobre Fisioterapia e Funcionalidade em pacientes com COVID-19 adulto e pediátrico. Métodos: Trata-se de uma revisão de literatura do tipo integrativa utilizando a bases de dados do MedLine/PubMed, bioblioteca da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Physiotherapy Evidence Database (PEDRo).Resultados:Os pacientes com COVID-19 apresentam sinais de deficiência respiratória com hipoxemia, com baixo impacto em crianças estas evoluem sem sintomas ou com quadro de baixa gravidade. além de observar impacto na restrição da participação. a fisioterapia atua na oxigenioterapia e ventilação dos pacientes.Conclusão: A COVID-19 causa alterações na função pulmonar com formação de deficiência respiratória hipoxêmica e de complacência, com repercussões cardiovasculares que leva a necessidade da fisioterapia no desfecho desta pandemia, seja por meio da oxigenioterapia e/ou do suporte ventilatório (invasivo e não-invasivo).(AU)

Introduction: The corona virus (2019-nCoV OR HCOV-19 or CoV2), has emerged in China as the main cause of viral pneumonia (COVID-19, Coronavirus Disease-19). Aim: To provide evidence-based Physiotherapy and functionality in patients with adult and pediatric COVID-19. Methods: This is an integrative literature review using the MedLine / PubMed databases, library of Latin American and Caribbean Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDRo). Results: Part of the patients with covid 19 show signs of respiratory deficiency with hypoxemia, with low severity in children. Impaired functionality is also expected. Conclusion: COVID-19 causes low pulmonary compliance and important changes in lung function with hypoxemia and cardiovascular repercussions. These changes lead to the need for Physiotherapy and the management of oxygen therapy and ventilatory support (invasive and non-invasive) for these patients.