Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review.

QUESTIONS: What is the effect of preoperative respiratory muscle training (RMT) on the incidence of postoperative pulmonary complications (PPCs) after open cardiac surgery? What is the effect of RMT on the duration of mechanical ventilation, postoperative length of stay and respiratory muscle strength? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Adults undergoing elective open cardiac surgery. INTERVENTION: The experimental groups received preoperative RMT and the comparison groups received no intervention. OUTCOME MEASURES: The primary outcomes were PPCs, length of hospital stay, respiratory muscle strength, oxygenation and duration of mechanical ventilation. The methodological quality of studies was assessed using the PEDro scale and the overall certainty of the evidence was assessed using the GRADE approach. RESULTS: Eight trials involving 696 participants were included. Compared with the control group, the respiratory training group had fewer PPCs (RR 0.51, 95% CI 0.38 to 0.70), less pneumonia (RR 0.44, 95% CI 0.25 to 0.78), shorter hospital stay (MD -1.7 days, 95% CI -2.4 to -1.1) and higher maximal inspiratory pressure values at the end of the training protocol (MD 12 cmH2O, 95% CI 8 to 16). The mechanical ventilation time was similar in both groups. The quality of evidence was high for pneumonia, length of hospital stay and maximal inspiratory pressure. CONCLUSION: Preoperative RMT reduced the risk of PPCs and pneumonia after cardiac surgery. The training also improved the maximal inspiratory pressure and reduced hospital stay. The effects on PPCs were large enough to warrant use of RMT in this population. REGISTRATION: CRD42021227779.

Mild to moderate post-COVID-19 alters markers of lymphocyte activation, exhaustion, and immunometabolic responses that can be partially associated by physical activity level- an observational sub-analysis fit- COVID study.

Aim: This study aimed to evaluate if physical activity is associated with systemic and cellular immunometabolic responses, in young adults after mild-to-moderate COVID-19 infection. Methods: Mild- to- moderate post-COVID-19 patients (70.50 ± 43.10 days of diagnosis; age: 29.4 (21.9- 34.9) years; BMI: 25.5 ± 4.3 kg m2 n = 20) and healthy age-matched controls (age: 29.3 (21.2 - 32.6) years; BMI: 25.4 ± 4.7 kg m2; n = 20) were evaluated. Physical activity levels (PAL), body composition, dietary habits, muscular and pulmonary function, mental health, sleep quality, metabolic parameters, immune phenotypic characterization, stimulated whole blood and PBMC culture (cytokine production), mRNA, and mitochondrial respiration in PBMCs were evaluated. Results: The post-COVID-19 group exhibited lower levels of moderate to vigorous physical activity (MVPA) (p = 0.038); therefore, all study comparisons were performed with adjustment for MVPA. Post-COVID-19 impacted the pulmonary function (FEV1, FEV1%pred, FVC, and FVC %pred) compared with the control (p adjusted by MVPA (p adj) <0.05). Post-COVID-19 exhibited lower levels of serum IL-6 (p adj <0.01), whereas it showed higher serum IL-10, triglyceride, leptin, IgG, ACE activity, TNFRSF1A, and PGE2 (p adj <0.05) levels compared with controls. Post-COVID-19 presented a lower percentage of Treg cells (p adj = 0.03) and altered markers of lymphocyte activation and exhaustion (lower CD28 expression in CD8+ T cells (p adj = 0.014), whereas CD4+T cells showed higher PD1 expression (p adj = 0.037)) compared with the control group. Finally, post- COVID-19 presented an increased LPS-stimulated whole- blood IL-10 concentration (p adj <0.01). When exploring mitochondrial respiration and gene expression in PBMCs, we observed a higher LEAK state value (p adj <0.01), lower OXPHOS activity (complex I) (p adj = 0.04), and expression of the Rev-Erb-α clock mRNA after LPS stimulation in the post-COVID-19 patients than in the control (p adj <0.01). Mainly, PAL was associated with changes in IL-10, triglyceride, and leptin levels in the plasma of post-COVID-19 patients. PAL was also associated with modulation of the peripheral frequency of Treg cells and the expression of PD-1 in CD8+ T cells, although it abrogated the statistical effect in the analysis of TNF-α and IL-6 production by LPS- and PMA-stimulated PBMC of post-COVID-19 patients. Conclusion: Young adults after mild-to-moderate SARS-CoV-2 infection appeared to have lower physical activity levels, which can be associated with clinical and immunometabolic responses in a complex manner.

Myofascial stiffness of plantar fascia and Achilles tendon in individuals with plantar fasciopathy: An observational cross-sectional study.

BACKGROUND: Assessment of myofascial tissue stiffness have a role in identifying physical impairments in plantar fasciopathy (PF). It is still unclear which specific functional and tissue differences exist between individuals with PF. AIM: To compare myofascial stiffness of plantar fascia, Achilles tendon, and triceps surae between symptomatic and asymptomatic limbs in individuals with PF and between individuals with and without PF. METHODS: Thirty nine individuals diagnosed with PF and individuals with no history of PF were recruited. Myofascial stiffness of the plantar fascia, Achilles tendon, and triceps surae, range of motion, and clinical tests were performed. Mean difference (MD) and 95% confidence interval (CI) were calculated. RESULTS: Individuals with PF showed lower mean stiffness in Achilles tendon insertion (MD = -1.00 N/mm; 95%CI: -1.80,-0.21) on the symptomatic limb compared to the corresponding symptomatic limb in control group, a lower mean stiffness in plantar fascia (MD = -0.16 N/mm; 95%CI: -0.30, -0.01) on the symptomatic limb compared to asymptomatic limb, and a lower mean stiffness in the region 3 cm above the Achilles tendon insertion (MD = -0.79; 95%CI: -1.59, -0.00) compared to control. Individuals with PF showed fewer repetitions in heel rise test (MD = -3.97 reps; 95%CI: -5.83, -2.12) and in the step-down test (MD = -5.23 reps; 95%CI: -7.02, -3.44) compared to control. CONCLUSIONS: Individuals with PF present reduced stiffness in Achilles tendon insertion and plantar fascia. The reduced stiffness was more evident in Achilles tendon in individuals with PF compared to individuals without PF. Individuals with PF showed lower performance in clinical tests.

Autonomic Function Recovery and Physical Activity Levels in Post-COVID-19 Young Adults after Immunization: An Observational Follow-Up Case-Control Study.

Coronavirus disease 2019 (COVID-19) has detrimental multi-system consequences. Symptoms may appear during the acute phase of infection, but the literature on long-term recovery of young adults after mild to moderate infection is lacking. Heart rate variability (HRV) allows for the observation of autonomic nervous system (ANS) modulation post-SARS-CoV-2 infection. Since physical activity (PA) can help improve ANS modulation, investigating factors that can influence HRV outcomes after COVID-19 is essential to advancements in care and intervention strategies. Clinicians may use this research to aid in the development of non-medication interventions. At baseline, 18 control (CT) and 20 post-COVID-19 (PCOV) participants were observed where general anamnesis was performed, followed by HRV and PA assessment. Thus, 10 CT and 7 PCOV subjects returned for follow-up (FU) evaluation 6 weeks after complete immunization (two doses) and assessments were repeated. Over the follow-up period, a decrease in sympathetic (SNS) activity (mean heart rate: p = 0.0024, CI = -24.67--3.26; SNS index: p = 0.0068, CI = -2.50--0.32) and increase in parasympathetic (PNS) activity (mean RR: p = 0.0097, CI = 33.72-225.51; PNS index: p = 0.0091, CI = -0.20-1.47) were observed. At follow-up, HRV was not different between groups (p > 0.05). Additionally, no differences were observed in PA between moments and groups. This study provides evidence of ANS recovery after SARS-CoV-2 insult in young adults over a follow-up period, independent of changes in PA.

Isotemporal Substitution of Sedentary Behavior by Different Physical Activity Intensities on Pain and Disability of Patients With Chronic Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: To investigate the association of isotemporal substitution modeling (ISM) of time spent in sedentary activities with physical activity in different intensities on pain and disability of patients with chronic low back pain (LBP). DESIGN: Observational and cross-sectional study. Device-measured physical activity levels were assessed using an actigraph. Pain intensity was measured using the 11-point numeric rating scale, and disability was measured using the Roland Morris Disability Questionnaire. The ISM was used to estimate the theoretical substitution association of reallocating time from 1 exposure variable to an equal amount of time in another exposure variable while holding total activity time constant. SETTINGS: Outpatient physical therapy clinic. PARTICIPANTS: This study included data from 358 patients (N=358) with chronic LBP aged between 18 and 60 years. MAIN OUTCOME MEASURES: Pain and disability. RESULTS: Our results suggest that replacing 60 minutes of sedentary behavior with 60 minutes of vigorous activity in a week is significantly associated with a decrease in pain (ß=-1.67; 95% confidence interval [CI], -3.18 to -0.15). Additionally, replacing 60 minutes of light physical activity (ß=-1.67; 95% CI, -3.18 to -0.16) or moderate activity (ß=-1.67; 95% CI, -3.21 to -0.13) with the same amount of time of vigorous activity per week may also favorable reductions in pain. For the analysis of disability, no significant associations (P>.05) for disability in any of the isotemporal models were found. CONCLUSIONS: Our results showed that replacing 60 minutes of sedentary behavior with equal amounts of vigorous activity per week was associated with reductions in pain intensity. Similarly, replacing a light or moderate activities with vigorous activity was also associated with reductions in pain intensity. Finally, no significant associations were observed between time spent in sedentary activities with physical activity in different intensities for disability.

Role of Body Mass and Physical Activity in Autonomic Function Modulation on Post-COVID-19 Condition: An Observational Subanalysis of Fit-COVID Study.

The harmful effects of coronavirus disease 2019 (COVID-19) can reach the autonomic nervous system (ANS) and endothelial function. Therefore, the detrimental multiorgan effects of COVID-19 could be induced by deregulations in ANS that may persist after the acute SARS-CoV-2 infection. Additionally, investigating the differences in ANS response in overweight/obese, and physically inactive participants who had COVID-19 compared to those who did not have the disease is necessary. The aim of the study was to analyze the autonomic function of young adults after mild-to-moderate infection with SARS-CoV-2 and to assess whether body mass index (BMI) and levels of physical activity modulates autonomic function in participants with and without COVID-19. Patients previously infected with SARS-CoV-2 and healthy controls were recruited for this cross-sectional observational study. A general anamnesis was taken, and BMI and physical activity levels were assessed. The ANS was evaluated through heart rate variability. A total of 57 subjects were evaluated. Sympathetic nervous system activity in the post-COVID-19 group was increased (stress index; p = 0.0273). They also presented lower values of parasympathetic activity (p < 0.05). Overweight/obese subjects in the post-COVID-19 group presented significantly lower parasympathetic activity and reduced global variability compared to non-obese in control group (p < 0.05). Physically inactive subjects in the post-COVID-19 group presented significantly higher sympathetic activity than active subjects in the control group. Parasympathetic activity was significantly increased in physically active subjects in the control group compared to the physically inactive post-COVID-19 group (p < 0.05). COVID-19 promotes changes in the ANS of young adults, and these changes are modulated by overweight/obesity and physical activity levels.

Comparação da resposta hemodinâmica entre terapia convencional e realidade virtual em pacientes com insuficiência cardíaca internados na unidade de emergência / Comparación de la respuesta hemodinámica entre la terapia convencional y la realidad virtual en pacientes con insuficiencia cardiaca ingresados en urgencias / Comparison of hemodynamic responses between conventional and virtual reality therapies in patients with heart failure admitted to an emergency room

RESUMO O objetivo deste estudo foi avaliar e comparar a resposta aguda de parâmetros hemodinâmicos de acordo com o uso de realidade virtual (RV) semi-imersiva e terapia convencional (TC) em indivíduos internados no serviço hospitalar de emergência por insuficiência cardíaca (IC). Trata-se de estudo de viabilidade com 11 indivíduos submetidos a sessões de terapia com e sem o uso da RV. Na TC, os participantes realizaram alongamentos, exercícios ativos ou ativo-assistidos e inspiração fracionada. Já na terapia com realidade virtual (TRV) utilizou-se os óculos VR box - virtual reality glasses aplicando VR relax associado à TC. Os parâmetros hemodinâmicos avaliados foram: frequência cardíaca, pressão arterial sistólica e diastólica e saturação de oxigênio. Para análise, foram utilizados os testes t de Student e de Mann-Whitney (p<0,05). Ao avaliar os parâmetros hemodinâmicos basal e final em ambos os grupos, não foi verificada diferença significativa entre os momentos (p>0,05). Com relação à comparação das variações absolutas entre a TC e a TRV, não foi observada diferença significativa entre as respostas hemodinâmicas (p>0,05). Os resultados demonstraram que a implementação da TRV e da TC promoveram alterações fisiológicas nas respostas dos parâmetros hemodinâmicos em indivíduos com IC hospitalizados em uma unidade de emergência, não havendo diferenças significativas entre as duas intervenções. O estudo sugere que a RV é um método hemodinamicamente seguro para aplicação em unidade de emergência.

RESUMEN El objetivo de este estudio fue evaluar y comparar la respuesta aguda de los parámetros hemodinámicos según el uso de realidad virtual (RV) semiinmersiva y terapia convencional (TC) en individuos ingresados por insuficiencia cardiaca (IC) en el servicio de urgencias de un hospital. Este es un estudio de factibilidad con la participación de 11 personas, quienes se sometieron a sesiones de terapia con el uso de RV y sin este. En la TC, los participantes realizaron estiramientos, ejercicios activos o activos-asistidos e inspiración fraccionada. En la terapia de realidad virtual (TRV), utilizaron gafas VR box virtual reality glasses aplicando realidad virtual VR relax asociada a la TC. Los parámetros hemodinámicos que se evaluaron fueron los siguientes: frecuencia cardiaca, presión arterial sistólica y diastólica, y saturación de oxígeno. El análisis de datos utilizó las pruebas t de Student y de Mann-Whitney (p<0,05). Al evaluar los parámetros hemodinámicos basales y finales en ambos grupos, se observó que no hubo diferencia significativa entre los momentos (p>0,05). En cuanto a la comparación de las variaciones absolutas entre TC y TRV, no se observó diferencia significativa entre las respuestas hemodinámicas (p>0,05). Los resultados mostraron que la implementación de la TRV y la TC posibilitó cambios fisiológicos en las respuestas de los parámetros hemodinámicos en individuos con IC hospitalizados en una unidad de urgencias, sin diferencias significativas entre las dos intervenciones. El estudio apunta que la RV es un método hemodinámico seguro para aplicarse en la unidad de urgencias.

ABSTRACT This study aimed to evaluate and to compare the acute response, due to semi-immersive virtual reality (VR) and conventional therapies (CT), of hemodynamic parameters in hospitalized individuals admitted to an emergency unity for heart failure (HF). This is a viability study with 11 individuals subjected to sessions with and without VR. At CT, stretching, active or active-assisted exercises, and fractional inspiration were performed. In VR therapy (VRT), VR box glasses were used to promote VR relaxation associated with CT. The hemodynamic parameters evaluated were heart rate, systolic and diastolic blood pressure, oxygen saturation, and double product. To analyze them, Student's t- and Mann Whitney tests were used (p<0.05). Comparing baseline and final evaluations showed no significant differences in the hemodynamic parameters of both groups (p>0.05). Comparing absolute variations between CT and VRT also produced no significant differences between hemodynamic responses (p>0.05). Results showed that administering VRT and CT promoted physiological changes in the responses of hemodynamic parameters in individuals with HF hospitalized in an emergency unit without significant differences between the two interventions. This study suggests that VRT is a hemodynamically safe method for treating patients in emergency units.

Resistance training using different elastic components offers similar gains on muscle strength to weight machine equipment in Individuals with COPD: A randomized controlled trial.

Purpose: To compare the effects of three modalities of resistance training, two using elastic components and one using conventional weight machine on peripheral muscle strength in Individuals with chronic obstructive pulmonary disease (COPD). Effects on exercise capacity, impact of disease on health status, body composition and daily level of physical activity were investigated as secondary endpoints.Methods: Forty-eight participants were randomly allocated (Trials Registry #RBR-6V9SJJ) into Elastic band group (Theraband®) (EBG), Elastic tubes training using Lemgruber® (ETG), and Conventional training with weight machine equipment (CG). Participants were evaluated before and after 12 weeks of training regarding peripheral muscle strength by dynamometry; impact of disease on health status via COPD Assessment Test, CAT; exercise capacity by 6-min walk test, 6MWT; body composition by bioelectrical impedance; and daily level of physical activities via accelerometry.Results: Inter-group comparison of training effects did not elucidate significant differences between the modalities in muscle strength (p ≥ .2). Likewise, all training modalities showed similar effects on CAT, body composition and daily physical activity variables with no statistical significance observed (p ≥ .15).Conclusions: Modalities of resistance training using elastic components presented similar effects on muscle strength, health status, exercise capacity, body composition and daily level of physical activity in individuals with COPD. The effects of elastic resistance were similar to conventional resistance training.

Modulatory Effects of Physical Activity Levels on Immune Responses and General Clinical Functions in Adult Patients with Mild to Moderate SARS-CoV-2 Infections-A Protocol for an Observational Prospective Follow-Up Investigation: Fit-COVID-19 Study.

Background: This proposal aims to explain some of the gaps in scientific knowledge on the natural history of coronavirus disease (COVID-19), with a specific focus on immune, inflammatory, and metabolic markers, in parallel with temporal assessment of clinical and mental health in patients with COVID-19. The study will explore the temporal modulatory effects of physical activity and body composition on individual trajectories. This approach will provide a better understanding of the survival mechanisms provided by the immunomodulatory role of physical fitness. Methods: We will conduct a prospective observational cohort study including adult patients previously infected with the SARS-CoV-2 virus who have expressed a mild to moderate COVID-19 infection. Procedures will be conducted for all participants at baseline, six weeks after vaccination, and again at 12 months. At each visit, a venous blood sample will be collected for immune phenotypic characterization and biochemistry assays (inflammatory and metabolic parameters). Also, body composition, physical activity level, cardiovascular and pulmonary function, peripheral and respiratory muscle strength, functional exercise capacity, and mental health will be evaluated. Using the baseline information, participants will be grouped based on physical activity levels (sedentary versus active), body composition (normal weight versus overweight or obese), and SARS-CoV-2 status (positive versus negative). A sub-study will provide mechanistic evidence using an in-vitro assay based on well-trained individuals and age-matched sedentary controls who are negative for SARS-CoV-2 infection. Whole blood will be stimulated using recombinant human coronavirus to determine the cytokine profile. Peripheral blood mononuclear cells (PBMCs) from healthy well-trained participants will be collected and treated with homologous serum (from the main study; samples collected before and after the vaccine) and recombinant coronavirus (inactive virus). The metabolism of PBMCs will be analyzed using Respirometry (Seahorse). Data will be analyzed using multilevel repeated-measures ANOVA. Conclusions: The data generated will help us answer three main questions: (1) Does the innate immune system of physically active individuals respond better to viral infections compared with that of sedentary people? (2) which functional and metabolic mechanisms explain the differences in responses in participants with different physical fitness levels? and (3) do these mechanisms have long-term positive modulatory effects on mental and cardiovascular health? Trial registration number: Brazilian Registry of Clinical Trials: RBR-5dqvkv3. Registered on 21 September 2021.

Short-Term Effects of a Resistance Training Program Using Elastic Tubing in Patients with Heart Disease

Abstract Background Resistance training is effective in cardiac rehabilitation; however, it is conventionally performed using free weights or machines, which can pose logistic challenges to patients with restricted mobility. For its ease of access and cost-effectiveness, elastic tubing is a particularly appealing alternative, but it remains underutilized for this purpose. Objective To evaluate muscle strength, functional capacity, aerobic capacity, and quality of life in patients with heart disease in phase II of cardiovascular rehabilitation after a resistance training intervention based solely on elastic tubing. Methods Thirteen patients with heart disease (age 63.33±10.80 years) trained with elastic tubing twice weekly for 6 weeks, with progressive load increase every 15 days. The following muscle groups were evaluated and trained: shoulder abductors and flexors, elbow flexors, and knee flexors and extensors. Muscle strength was evaluated using a dynamometer; functional capacity, with a 6-minute walk test and cardiopulmonary exercise test; and quality of life, using the SF-36 questionnaire. Data normality was assessed using the Shapiro-Wilk test. The paired Student's t-test was used for comparisons before and after training, at a significance level of <5%. Results There were significant differences in muscle strength (except for elbow flexion) and functional capacity (485.5 ± 123.3 vs 578.7 ± 110.5; p=0.0399) after the intervention. No statistical differences were found in cardiorespiratory fitness or quality of life. Conclusions Short-term resistance training with elastic tubing improved peripheral muscle strength and functional capacity in patients with heart disease, and should be encouraged for this population. (Int J Cardiovasc Sci. 2020; xx(x):xxx-xxx)

Body image in COPD and its relation with physical activity levels, lung function and body composition: An observational study.

INTRODUCTION: Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD. OBJECTIVES: To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects. MATERIALS AND METHODS: 109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance). RESULTS: BothCOPD and control subjects presented alterations in body image. Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14). CONCLUSION: In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.

Analysis of the heart rate deflection point as a tool for exercise prescription in subjects with COPD - a cross-sectional study.

Background: Prescription of exercise training in subjects with chronic obstructive pulmonary disease (COPD) remains a challenge in clinical practice. The heart rate deflection point (HRDP) is an option to reduce costs, reflects the anaerobic threshold and it is noninvasive; however its applicability in COPD is still unknown. Aim: To compare HRDP with gas exchange threshold values (GET) in subjects with COPD. Methods: Thirty-one subjects were evaluated in this cross-sectional study, diagnosed with COPD. The subjects performed an incremental exercise test on a treadmill to determine the GET, peak oxygen consumption (VO2PEAK), speed corresponding to VO2PEAK (sVO2PEAK), and peak values of heart rate (HRPEAK). To determine HRDP the heart rate values observed were plotted as a function of intensity. Results: The HRDP was visible in 96.77% of subjects. There was no difference between HRDP and GET (p = 0.07) and a moderate intraclass correlation coefficient (ICC): 0.74 [0.52-0.87] and high limits of agreements were presented (±1.1 km·h-1). Conclusion: The HRDP cannot be used to determine the limits between the physiological domains of these subjects. Thus, although significant correlation was found between HRDP and GET, their application for training prescription and monitoring in subjects with COPD proved to be limited.

Percepção da enfermagem sobre a adesão e o abandono do tratamento da tuberculose / Percepción de la enfermería sobre la adherencia y el abandono del tratamiento de la tuberculosis / Perception of the Nursing team on the adherence and abandonment of tuberculosis treatment

Objetivo: conhecer a percepção da enfermagem sobre os fatores envolvidos na adesão e no abandono do tratamento da tuberculose. Método: estudo qualitativo, descritivo-exploratório realizado no Centro de Referência em Tuberculose no município de Porto Alegre no Rio Grande do Sul. Nove profissionais da enfermagem responderam à entrevista semiestruturada e foi realizada a análise de conteúdo de Bardin. Resultados: identificou-se quatro categorias temáticas: a organização do serviço e o papel da enfermagem no processo de trabalho; a raiz social da tuberculose; a consulta de enfermagem como artifício para o fortalecimento da adesão ao tratamento; rede de serviços como estratégia para reduzir o abandono do tratamento. Conclusão: os profissionais de enfermagem reconhecem sua responsabilidade na adesão ao tratamento da tuberculose e percebem no cotidiano de trabalho os fatores que influenciam o abandono. Reconhecem a necessidade de um trabalho em rede, intersetorial e de proteção social para o controle da doença.

Objective: to know the perception of the nursing team about the factors involved in adherence and abandonment of tuberculosis treatment. Method: qualitative, descriptive-exploratory study carried out at the Tuberculosis Reference Center in the city of Porto Alegre, in Rio Grande do Sul. Nine nursing professionals responded to the semi-structured interview and Bardin's content analysis was carried out. Results: four thematic categories were identified: the organization of the service and the role of the nursing team in the work process; the social root of tuberculosis; nursing consultation as a device for strengthening treatment adherence; service network as a strategy to reduce treatment abandonment. Conclusion: nursing professionals recognize their responsibility in the adherence to the treatment of tuberculosis and perceive the factors that influence abandonment in their daily work. They recognize the need for a networked, intersectoral, and of social protection effort to control the disease.

Objetivo: conocer la percepción de la enfermería sobre los factores implicados en el cumplimiento y abandono del tratamiento antituberculoso. Método: estudio cualitativo, descriptivo-exploratorio realizado en el Centro de Referencia de Tuberculosis en la ciudad de Porto Alegre, Rio Grande do Sul. Nueve profesionales de enfermería respondieron a la entrevista semiestructurada y se realizó el análisis de contenido de Bardin. Resultados: se identificaron cuatro categorías temáticas: la organización del servicio y el papel de la enfermería en el proceso de trabajo; la raíz social de la tuberculosis; consulta de enfermería como dispositivo para fortalecer la adherencia al tratamiento; red de servicios como estrategia para reducir el abandono del tratamiento. Conclusión: los profesionales de enfermería reconocen su responsabilidad de adherirse al tratamiento de la tuberculosis y perciben los factores que influyen en el abandono en su trabajo diario. Reconocen la necesidad de redes, protección intersectorial y social para controlar la enfermedad.

The perceptions of physical therapists about facilitators and challenges in the use of different tools for resistance training in COPD patients: a mixed-method study / Percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com DPOC: estudo de método mistos / Percepción de fisioterapeutas sobre facilitadores y barreras en el uso de diferentes herramientas de entrenamiento de resistencia en pacientes con EPOC: estudio de método mixto

ABSTRACT This study sought to quantify and qualitatively analyze the perception of physical therapists about facilitators and the challenges in the use of different types of tools for resistance training in chronic obstructive pulmonary disease (COPD) patients. This was a mixed-model study with qualitative analysis developed in a rehabilitation center. Six physical therapists who performed a randomized clinical trial were interviewed. The protocol consisted of the evaluation of three types of resistance training: elastic tubes, elastic bands, and training with conventional weight machines. After completion of the randomized trial, therapists were invited to participate in a focus group to collect qualitative data. Physical therapists also answered a quantitative questionnaire containing closed questions. The main outcome measures were the opinion of physical therapists about the advantages and disadvantages in clinical practice of each of the analyzed tools. The focus group analysis resulted in eight themes: Insecurities regarding load and handling tools, implementation of home-based treatment, improvements of tools, advantages and disadvantages of tools, incidence of injuries with elastic tools, patient's preferences, and particularities of the tools. Physical therapists pointed out different challenges and facilitators for resistance training. Characteristics of the tools such as costs, portability, handling and practicality were cited as factors that influence clinical practice. In the quantitative analysis, no differences were observed when comparing the scores of each instrument. The three tools analyzed are applicable and feasible in the clinical practice of physical therapists; moreover, they present different characteristics and particularities that should be considered, such as cost, clinical applicability, portability and perception of the patient and therapists.

RESUMO O objetivo do estudo foi quantificar e analisar qualitativamente a percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com doença pulmonar obstrutiva crônica (DPOC). O método utilizado foi desenvolvido em um centro de reabilitação. Seis fisioterapeutas que participaram como terapeutas de um ensaio clínico randomizado foram entrevistados. O protocolo consistiu na avaliação de três ferramentas para treinamento resistido: tubos elásticos, bandas elásticas e treinamento convencional com equipamentos de musculação. Depois da finalização do ensaio clínico randomizado, os fisioterapeutas foram convidados a participar de um grupo focal para análise qualitativa e responder questionário fechado para análise quantitativa. Os profissionais opinaram sobre vantagens e desvantagens de cada uma das três ferramentas na prática clínica. A análise do grupo focal resultou em oito temas: insegurança em relação à carga e manuseio das ferramentas; implementação de tratamento domiciliar; melhorias para ferramentas; vantagens e desvantagens das ferramentas; incidência de lesões com ferramentas elásticas; preferência dos pacientes; e particularidades de cada ferramenta. Fisioterapeutas apontaram diferentes barreiras e facilitadores para o treinamento resistido. Características das ferramentas - como custo, portabilidade, manuseio, praticidade e percepção do paciente e fisioterapeuta - foram citadas como fatores que influenciam a prática clínica. Na análise quantitativa, nenhuma diferença foi observada quando comparados os escores para cada instrumento. As três ferramentas são aplicáveis na prática clínica do fisioterapeuta. Adicionalmente, as características e particularidades de cada uma delas devem ser consideradas.

RESUMEN El objetivo del estudio fue cuantificar y analizar cualitativamente la percepción de fisioterapeutas sobre facilitadores y barreras en el uso de diferentes herramientas de entrenamiento de resistencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). El método utilizado fue desarrollado en un centro de rehabilitación. Seis profesionales que participaron como terapeutas en un ensayo clínico aleatorizado fueron entrevistados. El protocolo consistió en la evaluación de tres herramientas de entrenamiento de resistencia: tubos elásticos, bandas elásticas y entrenamiento convencional con equipo de entrenamiento con pesas. Después del ensayo clínico aleatorizado, se invitó a los fisioterapeutas a participar en un grupo focal para análisis cualitativo y a responder un cuestionario cerrado para análisis cuantitativo. Los profesionales opinaron sobre las ventajas y desventajas de cada una de las tres herramientas en la práctica clínica. El análisis del grupo resultó en ocho temas: falta de fiabilidad en lo referente a la carga y al manejo de las herramientas; puesta en práctica del tratamiento domiciliario; mejoras en las herramientas; ventajas y desventajas de las herramientas; incidencia de lesiones con las herramientas elásticas; preferencia de los pacientes; particularidades de cada herramienta. Los fisioterapeutas señalaron diferentes barreras y facilitadores para el entrenamiento de resistencia. Características de la herramienta - como costo, portabilidad, manejo, practicidad y percepción del paciente y del fisioterapeuta - fueron mencionadas como factores que influyen en la práctica clínica. En el análisis cuantitativo no se observaron diferencias de puntaje entre los instrumentos. Las tres herramientas son aplicables en la práctica clínica del fisioterapeuta. Además, se deben considerar las características y particularidades de cada una de ellas.

Burnt sugarcane harvesting is associated with rhinitis symptoms and inflammatory markers / Colheita de cana-de-açúcar queimada está associada a sintomas de rinite e marcadores inflamatórios

Abstract Introduction: Burnt sugarcane harvesting requires intense physical exertion in an environment of high temperature and exposure to particulate matter. Objective: To evaluate the effects of burnt sugarcane harvesting on rhinitis symptoms and inflammatory markers in sugarcane workers. Methods: A total of 32 male sugarcane workers were evaluated with questionnaire for rhinitis symptoms, and for inflammatory markers on peripheral blood and nasal lavage, in the non-harvesting, and 3 and 6 months into the sugarcane harvesting period. Weather data and particulate matter fine concentrations were measured in the same day. Results: The particulate matter concentrations in sugarcane harvesting were 27 (23-33 µg/m3), 112 (96-122 µg/m3), and 63 (17-263 µg/m3); 24 h temperatures were 32.6 (25.4-37.4 ºC), 32.3 (26.7-36.7 ºC) and 29.7 (24.1-34.0 ºC) and relative humidities were 45.4 (35.0-59.7%), 47.9 (39.1-63.0%), and 59.9 (34.7-63.2%) in the non-harvesting period, three and 6 months of the harvesting period. The age was 37.4 ± 10.9 years. The prevalence of rhinitis symptoms was significantly higher at 3 months of the harvesting period (53.4%), compared to non-harvesting period (26.7%; p = 0.039) and at 6 months into the harvesting period (20%; p = 0.006). Concentrations of interleukin 6 (IL-6) in nasal lavage increased after 3 months of the harvesting period compared to the non-harvesting period (p = 0.012). The presence of rhinitis symptoms, after 3 months of the harvesting period, was directly associated with blood eosinophils and inversely associated with neutrophils. Conclusions: After 3 months of work in burnt sugarcane harvesting the prevalence of rhinitis symptoms and IL-6 in nasal lavage increased. Furthermore, eosinophil counts were directly associated with the rhinitis symptoms in the period of higher concentration of particulate matter.

Resumo Introdução: A colheita de cana-de-açúcar queimada requer esforço físico intenso em um ambiente com altas temperaturas e exposição a material particulado. Objetivo: Avaliar os efeitos da colheita de cana-de-açúcar queimada nos sintomas de rinite e marcadores inflamatórios de cortadores de cana-de-açúcar. Método: Foram avaliados 32 cortadores de cana-de-açúcar do sexo masculino por meio de um questionário para sintomas de rinite, e marcadores inflamatórios em sangue periférico e lavado nasal, no período de entressafra, e em 3 e 6 meses após o início da colheita da cana-de-açúcar. Os dados climáticos e as concentrações de material particulado fino foram medidos no mesmo dia. Resultados: O material particulado fino na entressafra e em 3 e 6 meses de safra foi 27 (23-33 µg/m3), 112 (96-122 µg/m3) e 63 (17-263 µg/m3), respectivamente; a temperatura de 24 horas foi 32,6 (25,4º-37,4ºC), 32,3 (26,7º-36,7ºC) e 29,7 (24,1º-340ºC) e a umidade relativa do ar foi 45,4 (35,0%-59,7%), 47,9 (39,1%-63,0%), e 59,9 (34,7%-63,2%), na entressafra, 3 e 6 meses após o início da colheita. A idade foi de 37,4 ± 10,9 anos. A prevalência de sintomas de rinite foi significativamente maior em 3 meses da S (53,4%), comparado com a entressafra (26,7%; p = 0,039) e 6 meses da safra (20%; p = 0,006). As concentrações de interleucina 6 (IL-6) no lavado nasal aumentaram após 3 meses do início da colheita comparado com a entressafra (p = 0,012). A presença de sintomas de rinite, após 3 meses do início da colheita, foi diretamente associada com eosinófilos e inversamente associada com neutrófilos. Conclusões: Após 3 meses do início da colheita da cana-de-açúcar queimada, houve aumento na prevalência de sintomas de rinite e IL-6 em LN. Além disso, as contagens de eosinófilos foram diretamente associadas aos sintomas de rinite no período de maior concentração de material particulado.

Resistance Training With Elastic Tubing Improves Muscle Strength, Exercise Capacity, and Post-Exercise Creatine Kinase Clearance in Subjects With COPD.

BACKGROUND: Among the types of physical exercise, resistance exercises have been gaining significant attention in the COPD population. The aim of this study was to compare effects of conventional resistance training and of training by using elastic tubes on muscle strength, exercise capacity, and creatine kinase clearance in subjects with COPD. METHODS: Twenty-eight subjects with COPD were randomized into the following: resistance training with the elastic tubing group and resistance training with the weight-machine training group (conventional resistance group), performed 3 times a week for 12 weeks. The subjects were submitted to spirometry, functional exercise capacity (the 6-min walk test), muscle strength (dynamometry), and the repetition maximum test. Differences between the initial and final evaluations (Δ) and the (final - initial evaluations)/initial evaluations ×100 (Δ%) of each group were expressed as mean [95% CI]. RESULTS: Nineteen subjects (FEV1 % predicted, 52 ± 18; years, 65 ± 8) completed the training program. Similar improvements were observed in both modalities on muscle strength (knee extension, Δ%18 [6 to 29]; knee flexion, Δ%35 [17 to 54]; elbow flexion, Δ%28 [9 to 48]; shoulder abduction, Δ%41 [25 to 58] and shoulder flexion, Δ%31 [11 to 51] in the weight-machine training group (conventional resistance group); knee extension, Δ%15 [8 to 21]; knee flexion, Δ%28 [15 to 41]; elbow flexion, Δ%36 [22 to 51]; and shoulder abduction, Δ%43 [32 to 55] and shoulder flexion, Δ%43 [25 to 61] in the elastic tubing group, P < .05 for intra-group analysis and P > .05 for between groups analysis), 6-min walk test (baseline 493 ± 67m vs 12 weeks 526 ± 78 in the weight-machine training group (P = .10); baseline 493 ± 71 vs 12 weeks 524 ± 68 in the elastic tubing group (P < .01), P = .88 between groups). The elastic tubing group had lower accumulated creatine kinase levels between 24 and 72 h ((Δ%-24 [-31 to 16] than subjects in the weight-machine training group Δ%3 [-21 to 28], P = .042 between the groups. CONCLUSIONS: Training with elastic resistance provided similar changes in muscle strength and exercise capacity to conventional resistance group in the subjects with COPD. The elastic tubing group had faster creatine kinase clearance after a training session than the weight-machine training group (conventional resistance group). The ease of its application associated with similar training benefits to conventional training supported its application in clinical routine.

Particularities and Clinical Applicability of Saccharin Transit Time Test.

Introduction The importance of mucociliary clearance (MCC) for the respiratory system homeostasis is clear. Therefore, evaluating this defense mechanism is fundamental in scientific research and in the clinical practice of pulmonology and of associated areas. However, MCC evaluation has not been so usual due to the complexity of methods that use radiolabeled particles. Nevertheless, as an interesting alternative, there is the saccharin transit time (STT) test. This method is reproducible, simple to perform, noninvasive, does not demand high costs, and has been widely used in studies of nasal MCC. Although the STT test is widely used, there is still lack of a detailed description of its realization. Objective The present literature review aims to provide basic information related to the STT test and to present the findings of the previous studies that used this method, discussing variations in its execution, possible influences on the obtained results and limitations of the method, as well as to relate our experience with the use of STT in researches. Data Synthesis There are several factors that can alter the results obtained from STT tests, which would raise difficulties with proper interpretation and with the discussion of the results among different studies. Conclusions Saccharin transit time is a widely used method for the evaluation of nasal MCC, and therefore, the standardization related to the previous and concurrent to test orientations, and also its execution, become essential to improve its accuracy, and allow comparisons among different studies.