Submaximal Field Walking Tests Applied in the Cardiopulmonary Assessment in Congenital Heart Diseases: A Systematic Review.

INTRODUCTION: Submaximal field walking tests are easy to apply and low cost, but it is necessary to standardize their application, especially in the pediatric population. The feasibility and its use in patients with congenital heart disease have been studied. To verify which are the submaximal field walking tests applied in the cardiopulmonary assessment of children and adolescents with CHD and to verify if they are being performed as recommended by the standardization protocols/guidelines. METHODS: Literature review through a search in six electronic databases, structured in PICO format, without date restrictions. Looking for studies that used submaximal field walking tests in children and adolescents with congenital heart disease aged 5 to 18 years. Methodological quality, effectiveness and safety and risk of bias were assessed. RESULTS: Five studies met the eligibility criteria with a sample of 160 individuals with congenital heart disease, and all used the six-minute walk test. Note that different methodologies and modifications are used. Only the clinical trial showed good methodological quality.Four studies had low risk of bias and one study had moderate risk. CONCLUSION: Although the six-minute walk test is the only test used as a field test found in our research, there is no standardization in the application of the test, making it difficult to compare the results. In this sense, reducing the limitations and heterogeneity in the application of the test will enable more concrete outcomes and facilitate their reproduction in clinical practice.

Prevalência e Fatores Associados à SRAG por COVID-19 em Adultos e Idosos com Doença Cardiovascular Crônica / Prevalence and Associated Factors of SARS by Covid-19 in Adults and Aged People with Chronic Cardiovascular Disease

Resumo Fundamento A presença de Doença Cardiovascular (DCV) em indivíduos infectados pela COVID-19 pode implicar em um pior prognóstico. Objetivo Descrever a prevalência da Síndrome Respiratória Aguda Grave (SRAG) por COVID-19 e analisar os fatores associados a essa condição em adultos e idosos com doença cardiovascular no Brasil até a 30ª Semana Epidemiológica de 2020. Métodos Estudo transversal realizado com dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe), referente às fichas de notificação de SRAG de indivíduos hospitalizados no Brasil, entre a 1a e 30a Semana Epidemiológica de 2020. Foram incluídos adultos e idosos (≥ 18 anos) com DCV. A variável dependente foi a confirmação de SRAG por COVID-19 e foram analisados fatores relacionados a características sociodemográficas, sinais e sintomas e fatores clínicos. Aplicou-se a regressão de Poisson com variância robusta. O nível de significância adotado foi de 5%. Resultados Foram analisadas as notificações de 116.343 indivíduos. Destes, 61,9% obtiveram diagnóstico de SRAG por COVID-19. A prevalência do desfecho foi 4% menor nas mulheres (IC95%: 0,94-0,99) e 18% menor em zonas rurais (IC95%: 0,77-0,87). Observou-se prevalência maior na faixa etária de 50 a 59 anos (IC95%: 1,09-1,48) e na região nordeste (IC95%: 1,72-1,91). Febre, tosse, internação em UTI, uso de suporte ventilatório e caso nosocomial também foram significativamente associados a uma maior probabilidade de SRAG por COVID-19 nesses indivíduos. Conclusão Há alta prevalência de SRAG por COVID-19 em adultos e idosos com DCV no Brasil. Associaram-se fatores relacionados a características sociodemográficas, clínicas, sinais e sintomas.

Abstract Background The presence of Cardiovascular Disease (CVD) in individuals infected with COVID-19 may imply a worse prognosis. Objective To describe the prevalence of Severe Acute Respiratory Syndrome (SARS) by COVID-19 and to analyze the factors associated with this condition in adults and the elderly with cardiovascular disease in Brazil until the 30th Epidemiological Week of 2020. Methods Cross-sectional study conducted with data from the Influenza Epidemiological Surveillance Information System (Sistema de Informação de Vigilância Epidemiológica da Gripe - SIVEP-Gripe), referring to the SARS notification forms of hospitalized individuals in Brazil, between the 1st and 30th Epidemiological Week of 2020. Adults and the aged (≥ 18 years old) with CVD. The dependent variable was SRAG confirmation by COVID-19 and factors related to sociodemographic characteristics, signs and symptoms, and clinical factors were analyzed. Poisson regression with robust variance was applied. The level of significance adopted was 5%. Results Notifications from 116,343 individuals were analyzed. Of these, 61.9% were diagnosed with SARS by COVID-19. The prevalence of the outcome was 4% lower in women (95%CI: 0.94-0.99) and 18% lower in rural areas (95%CI: 0.77-0.87). There was a higher prevalence in the 50 to 59 age group (95%CI: 1.09-1.48) and in the northeast region (95%CI: 1.72-1.91). Fever, cough, admission to the ICU, use of ventilatory support, and nosocomial cases were also significantly associated with a higher probability of SRAS by COVID-19 in these individuals. Conclusion There is a high prevalence of SARS by COVID-19 in adults and aged people with CVD in Brazil. Factors associated with sociodemographic and clinical characteristics, signs, and symptoms were associated.

Effectiveness of early therapeutic intervention in phases one and two after COVID-19 infection: systematic review.

OBJECTIVES: Although research in relation to new vaccines for the coronavirus, SARS-CoV-2 (COVID-19), is ongoing, it has been reported that medical teams are also considering the use of antiviral drugs in patients in order to verify their effectiveness when infection signs and symptoms present, mainly in stages one and two of the disease. METHODS: For the selection of studies, the combination based on the Medical Subject Heading Terms (MeSH) was used, and the databases Medline (Pubmed), LILACS, SciELO, SCOPUS, Web of Science, and BIREME were searched. The search period for articles consisted of manuscripts published between January 2010 and July 2020 without language and localization restrictions. RESULTS: Initially, 20 articles were selected and then reduced to 19 after exclusion based on repetititve articles. Titles and abstracts were analyzed, and 14 articles were excluded because they did not meet the inclusion criteria and did not answer the guiding question. Studies show that patients receiving certain medications in the initial stages (one and two) indicate a reversal of complications during hospitalization or often do not require hospitalization in addition to being discharged in a shorter period of time. CONCLUSION: Studies have reported that effective drugs for treating COVID-19 exist. In addition, this study emphasizes the importance of performing therapeutic interventions in the initial stages of infection aimed at reversing the disease and minimizing public health costs.

Prevalence and Associated Factors of SARS by Covid-19 in Adults and Aged People with Chronic Cardiovascular Disease. / Prevalência e Fatores Associados à SRAG por COVID-19 em Adultos e Idosos com Doença Cardiovascular Crônica.

BACKGROUND: The presence of Cardiovascular Disease (CVD) in individuals infected with COVID-19 may imply a worse prognosis. OBJECTIVE: To describe the prevalence of Severe Acute Respiratory Syndrome (SARS) by COVID-19 and to analyze the factors associated with this condition in adults and the elderly with cardiovascular disease in Brazil until the 30th Epidemiological Week of 2020. METHODS: Cross-sectional study conducted with data from the Influenza Epidemiological Surveillance Information System (Sistema de Informação de Vigilância Epidemiológica da Gripe - SIVEP-Gripe), referring to the SARS notification forms of hospitalized individuals in Brazil, between the 1st and 30th Epidemiological Week of 2020. Adults and the aged (≥ 18 years old) with CVD. The dependent variable was SRAG confirmation by COVID-19 and factors related to sociodemographic characteristics, signs and symptoms, and clinical factors were analyzed. Poisson regression with robust variance was applied. The level of significance adopted was 5%. RESULTS: Notifications from 116,343 individuals were analyzed. Of these, 61.9% were diagnosed with SARS by COVID-19. The prevalence of the outcome was 4% lower in women (95%CI: 0.94-0.99) and 18% lower in rural areas (95%CI: 0.77-0.87). There was a higher prevalence in the 50 to 59 age group (95%CI: 1.09-1.48) and in the northeast region (95%CI: 1.72-1.91). Fever, cough, admission to the ICU, use of ventilatory support, and nosocomial cases were also significantly associated with a higher probability of SRAS by COVID-19 in these individuals. CONCLUSION: There is a high prevalence of SARS by COVID-19 in adults and aged people with CVD in Brazil. Factors associated with sociodemographic and clinical characteristics, signs, and symptoms were associated.

FUNDAMENTO: A presença de Doença Cardiovascular (DCV) em indivíduos infectados pela COVID-19 pode implicar em um pior prognóstico. OBJETIVO: Descrever a prevalência da Síndrome Respiratória Aguda Grave (SRAG) por COVID-19 e analisar os fatores associados a essa condição em adultos e idosos com doença cardiovascular no Brasil até a 30ª Semana Epidemiológica de 2020. MÉTODOS: Estudo transversal realizado com dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe), referente às fichas de notificação de SRAG de indivíduos hospitalizados no Brasil, entre a 1a e 30a Semana Epidemiológica de 2020. Foram incluídos adultos e idosos (≥ 18 anos) com DCV. A variável dependente foi a confirmação de SRAG por COVID-19 e foram analisados fatores relacionados a características sociodemográficas, sinais e sintomas e fatores clínicos. Aplicou-se a regressão de Poisson com variância robusta. O nível de significância adotado foi de 5%. RESULTADOS: Foram analisadas as notificações de 116.343 indivíduos. Destes, 61,9% obtiveram diagnóstico de SRAG por COVID-19. A prevalência do desfecho foi 4% menor nas mulheres (IC95%: 0,94­0,99) e 18% menor em zonas rurais (IC95%: 0,77­0,87). Observou-se prevalência maior na faixa etária de 50 a 59 anos (IC95%: 1,09­1,48) e na região nordeste (IC95%: 1,72­1,91). Febre, tosse, internação em UTI, uso de suporte ventilatório e caso nosocomial também foram significativamente associados a uma maior probabilidade de SRAG por COVID-19 nesses indivíduos. CONCLUSÃO: Há alta prevalência de SRAG por COVID-19 em adultos e idosos com DCV no Brasil. Associaram-se fatores relacionados a características sociodemográficas, clínicas, sinais e sintomas.

Impact of super-spreaders on COVID-19: systematic review.

BACKGROUND: Spreader and super-spreader are terms that refer to people who have greater potential for disease transmission, to infect other people. OBJECTIVE: To present scientific evidence regarding the impact of COVID-19 spreaders. DESIGN AND SETTING: Systematic review of the literature (using the PRISMA framework), performed at the Federal University of Santa Catarina (UFSC), Florianópolis (SC), Brazil. METHODS: A search for articles was carried out in the SciELO, LILACS, PubMed, Scopus, Bireme and Web of Science databases. A search for gray literature was also conducted via Google Scholar. There was no restriction regarding place or language, and the search covered the period from January 2010 to August 2020. Studies were selected based on a combination of descriptors from the Medical Subject Headings (MeSH). RESULTS: Isolated cases of people diagnosed with COVID-19 who were classified as super-spreaders were found. They had been classified thus because they may have had greater potential for infecting other individuals. However, greater numbers of interventions are needed in order to identify and manage COVID-19 cases. There is little evidence regarding this detection, which further hinders recognition and understanding of super-spreading events. CONCLUSION: The scientific community needs greater depth of evaluation and understanding of how these patients physiologically develop the ability to propagate COVID-19 more intensely. A simpler way of tracking them is also necessary, given that many infected people are asymptomatic. Many patients also have mild symptoms, suggesting that these individuals could also be classified as possible COVID-19 spreaders.PROSPERO Number: ID 217874 (submitted for publication and is being assessed by the editorial team).

Effectiveness of early therapeutic intervention in phases one and two after COVID-19 infection: systematic review

SUMMARY OBJECTIVES: Although research in relation to new vaccines for the coronavirus, SARS-CoV-2 (COVID-19), is ongoing, it has been reported that medical teams are also considering the use of antiviral drugs in patients in order to verify their effectiveness when infection signs and symptoms present, mainly in stages one and two of the disease. METHODS: For the selection of studies, the combination based on the Medical Subject Heading Terms (MeSH) was used, and the databases Medline (Pubmed), LILACS, SciELO, SCOPUS, Web of Science, and BIREME were searched. The search period for articles consisted of manuscripts published between January 2010 and July 2020 without language and localization restrictions. RESULTS: Initially, 20 articles were selected and then reduced to 19 after exclusion based on repetititve articles. Titles and abstracts were analyzed, and 14 articles were excluded because they did not meet the inclusion criteria and did not answer the guiding question. Studies show that patients receiving certain medications in the initial stages (one and two) indicate a reversal of complications during hospitalization or often do not require hospitalization in addition to being discharged in a shorter period of time. CONCLUSION: Studies have reported that effective drugs for treating COVID-19 exist. In addition, this study emphasizes the importance of performing therapeutic interventions in the initial stages of infection aimed at reversing the disease and minimizing public health costs.

Smell and taste alterations in COVID-19 patients: a systematic review.

OBJECTIVE: To present scientific evidence based on a systematic review of the literature (PRISMA) to systematize information on smell and taste alterations in patients diagnosed with COVID-19. METHODS: The studies were selected through combinations based on the Medical Subject Headings (MeSH). The MEDLINE (PubMed), LILACS, SciELO, and BIREME databases were used. The search encompassed articles published from January 2010 to May 2020, with no restriction of language or localization. RESULTS: A total of 665 retrieved articles had the potential for inclusion. Of these, two answered the research question, which was to verify the smell and taste alterations in patients diagnosed with COVID-19. CONCLUSION: The results found in this review demonstrated that there likely is an association between self-reported smell and taste dysfunctions and COVID-19 infection in such patients.

Smell and taste alterations in COVID-19 patients: a systematic review

SUMMARY OBJECTIVE: To present scientific evidence based on a systematic review of the literature (PRISMA) to systematize information on smell and taste alterations in patients diagnosed with COVID-19. METHODS: The studies were selected through combinations based on the Medical Subject Headings (MeSH). The MEDLINE (PubMed), LILACS, SciELO, and BIREME databases were used. The search encompassed articles published from January 2010 to May 2020, with no restriction of language or localization. RESULTS: A total of 665 retrieved articles had the potential for inclusion. Of these, two answered the research question, which was to verify the smell and taste alterations in patients diagnosed with COVID-19. CONCLUSION: The results found in this review demonstrated that there likely is an association between self-reported smell and taste dysfunctions and COVID-19 infection in such patients.

Kawasaki and COVID-19 disease in children: a systematic review.

OBJECTIVE: To present scientific evidence based on a systematic literature review (PRISMA) evaluating the association of Kawasaki Disease (DK) and COVID-19 in children. METHODS: For the selection of studies, a combination based on the Medical Subject Heading Terms (MeSH) was used. The Medline (Pubmed), LILACS, SciELO, COCHRANE, and BIREME databases were used. The search period for the articles comprised the last 10 years (2010 to 2020). RESULTS: 840 articles with potential for inclusion were retrieved, one of which met the inclusion criteria and the guiding question that consisted of evaluating the association of Kawasaki disease and COVID-19 in children. CONCLUSION: A significant increase in the incidence of Kawasaki-type diseases after the onset of the epidemic has been reported, suggesting an association between the COVID-19 epidemic and the high incidence of a severe form of KD. However, further studies are needed to conduct an investigation of the association between these two diseases.

Kawasaki and COVID-19 disease in children: a systematic review

SUMMARY OBJECTIVE To present scientific evidence based on a systematic literature review (PRISMA) evaluating the association of Kawasaki Disease (DK) and COVID-19 in children. METHODS For the selection of studies, a combination based on the Medical Subject Heading Terms (MeSH) was used. The Medline (Pubmed), LILACS, SciELO, COCHRANE, and BIREME databases were used. The search period for the articles comprised the last 10 years (2010 to 2020). RESULTS 840 articles with potential for inclusion were retrieved, one of which met the inclusion criteria and the guiding question that consisted of evaluating the association of Kawasaki disease and COVID-19 in children. CONCLUSION A significant increase in the incidence of Kawasaki-type diseases after the onset of the epidemic has been reported, suggesting an association between the COVID-19 epidemic and the high incidence of a severe form of KD. However, further studies are needed to conduct an investigation of the association between these two diseases.

RESUMO OBJETIVO Apresentar evidências científicas com base em revisão sistemática da literatura (Prisma) avaliando a associação da Doença de Kawasaki (DK) e COVID-19 em crianças. MÉTODOS Para a seleção dos estudos foi utilizada a combinação baseada no Medical Subject Heading Terms (MeSH). Foram utilizadas as bases de dados Medline (PubMed), Lilacs, SciELO, Cochrane e Bireme.O período de busca dos artigos compreendeu os últimos dez anos (2010 a 2020). RESULTADOS Foram recuperados 840 artigos com potencial de inclusão, sendo que um respondeu aos critérios de inclusão e à pergunta norteadora que consistiu em avaliar a associação da Doença de Kawasaki e COVID-19 em crianças. CONCLUSÃO Um aumento significativo na incidência de doenças do tipo Kawasaki após o início da epidemia já foi relatado, sugerindo a associação entre a epidemia de COVID-19 e a elevada incidência de uma forma grave da DK. Contudo, mais estudos são necessários para conduzir a investigação da associação entre essas duas doenças.

Respostas hemodinâmicas do método Pilates em hipertensos: uma revisão sistemática / Hemodynamic responses of the Pilates method in hypertensens: a systematic review

O objetivo do presente estudo foi levantar, na literatura atual, estudos relevantes que identifiquem as possíveis respostas hemodinâmicas encontradas em indivíduos hipertensos praticantes do Método Pilates. A revisão sistemática conduzida conforme as recomendações PRISMA em cinco bases de dados eletrônicas (PEDro, PubMed, SciELO, LILACS e Cochrane), disponibilizado desde o início das bases até Março de 2019, com descritores MESH conforme segue: [("Adult" OR "Young adult" OR "Middle Aged" OR "Aged" OR "Elderly") AND ("exercise movement techniques" OR "Pilates-Based Exercises" OR "Pilates Training") AND ("Hemodynamics" OR "Heart Rate" OR "Cardiac Chronotropy" OR "Heart Rate Control" OR "hypertension" OR "Blood Pressure" OR "High Blood Pressure" OR "Systolic Pressure" OR "Diastolic Pressure" OR "High Blood Pressure" OR "Pulse Rate Determination")], posteriormente ajustado para as demais bases. Busca complementar manual nas referências dos artigos incluídos na pesquisa e Google Scholar. Foram incluídos estudos de intervenção, com idade maior ou igual a 18 anos; diagnóstico de hipertensão arterial sistêmica (HAS); submetidos a exercícios de pilates solo e/ou pilates aparelhos como método de intervenção e incluído a descrição de análise das variáveis hemodinâmicas de pressão arterial (PA), frequência cardíaca (FC) e duplo produto (DP). Após processo de seleção foi selecionado apenas um único estudo que tenha contemplado todos os critérios de elegibilidade, totalizando 44 indivíduos do sexo feminino, com média de idade de 50,5 anos (±6,3 anos), hipertensas com utilização de medicação, onde 22 foram submetidas ao pilates solo e 22 permaneceram no grupo controle. O estudo apresentou resultados positivos na frequência cardíaca (FC), pressão arterial (PA) e no duplo-produto (DP) em comparação ao grupo controle. Apesar do número limitado de manuscritos encontrados nesta revisão, os resultados das variáveis hemodinâmicas nos levam a considerar plausível a utilização do Mat pilates em pacientes com HAS. Entretanto, novos estudos devem ser realizados para a confirmação dos achados...(AU)

The aim this study was to raise in the current literature relevant studies that identify the possible hemodynamic responses found in hypertensive individuals practicing the Pilates Method. The systematic review conducted according to PRISMA recommendations in five electronic databases (PEDro, PubMed, SciELO, LILACS and Cochrane), available from the beginning of the databases until March 2019, with MESH descriptors as follows: [("Adult "OR" Young adult "OR" Middle Aged "OR" Aged "OR" Elderly ") AND (" Exercise Movement Techniques "OR" Pilates-Based Exercises "OR" Pilates Training ") AND (" Hemodynamics "OR" Heart Rate " OR "Cardiac Chronotropy" OR "Heart Rate Control" OR "Hypertension" OR "Blood Pressure" OR "High Blood Pressure" OR "Systolic Pressure" OR "Diastolic Pressure" OR "High Blood Pressure" OR "Pulse Rate Determination")] , later adjusted to the other bases. Manual complementary search in the references of the articles included in the search and Google Scholar. Intervention studies, 18 years of age or older were included; diagnosis of systemic arterial hypertension (SAH); submitted to solo pilates exercises and / or pilates apparatus as intervention method and included the description of analysis of hemodynamic variables of blood pressure (BP), heart rate (HR) and double product (SD). After the selection process, only one study was selected that met all the eligibility criteria, totaling 44 female individuals, with a mean age of 50.5 years (± 6.3 years), hypertensive with medication use, where 22 were submitted to solo pilates and 22 remained in the control group. The study showed positive results in heart rate (HR), blood pressure (BP) and double product (SD) compared to the control group. Despite the limited number of manuscripts found in this review, the results of hemodynamic variables lead us to consider the use of Mat pilates in patients with hypertension to be plausible. However, further studies should be performed to confirm the findings...(AU)

Influence of exercise on oxidative stress in patients with heart failure.

Reactive oxygen species play an important role in the pathophysiology of heart failure (HF). In contrast, regular physical exercise can promote adaptations to reactive oxygen species that are beneficial for patients with HF. We completed a systematic review of randomized controlled trials that evaluate the influence of exercise on oxidative stress in patients with HF. Articles were searched in the PubMed, Cochrane, SciELO, and LILACS databases. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the included studies was assessed using the Physiotherapy Evidence Database scale. We selected 12 studies with a total of 353 participants. The included patients had a left ventricle ejection fraction of < 52% and New York Heart Association functional class II or III disease. A significant increase was observed in peak oxygen consumption (between 10 and 46%) in the group that underwent training (TG). There was an improvement in the oxidative capacity of skeletal muscles in the TG, related to the positive activity of mitochondrial cytochrome c oxidase (between 27 and 41%). An increase in the expression of the enzymes glutathione peroxidase (41%), catalase (between 14 and 42%), and superoxide dismutase (74.5%), and a decrease in lipid peroxidation (between 28.8 and 58.5%) were observed in the TG. Physical training positively influenced the cardiorespiratory capacity and enhanced the benefits of oxidant and antioxidant biomarkers in patients with HF. High-intensity training promoted a 15% increase in the plasma total antioxidant capacity, whereas moderate training had no effect.

Critérios de segurança para iniciar a mobilização precoce em unidades de terapia intensiva. Revisão sistemática / Safety criteria to start early mobilization in intensive care units. Systematic review

RESUMO Pacientes críticos internados em unidade de terapia intensiva devem ser mobilizados com base em critérios de segurança. O objetivo desta revisão foi verificar os critérios de segurança mais utilizados para iniciar a mobilização precoce em pacientes sob ventilação mecânica internados em unidade de terapia intensiva. Os artigos foram pesquisados nas bases de dados PubMed, PEDro, LILACS, Cochrane e CINAHL, tendo sido incluídos ensaios clínicos randomizados e controlados, ensaios clínicos quase randomizados, coortes, estudos comparativos com ou sem controles simultâneos, séries de casos com dez ou mais casos consecutivos, e estudos descritivos. O mesmo foi feito para estudos prospectivos, retrospectivos e transversais, nos quais, em sua metodologia, deveria constar a descrição dos critérios de segurança utilizados para iniciar a mobilização precoce. Dois revisores selecionaram, independentemente, estudos em potencial, de acordo com os critérios de inclusão, extraíram os dados e avaliaram a qualidade metodológica. Na análise dos dados, foi utilizada descrição narrativa para resumir as características e os resultados dos estudos obtidos, sendo os critérios de segurança categorizados nos seguintes subgrupos: cardiovasculares, respiratórios, neurológicos, ortopédicos e outros. Obtivemos 37 estudos elegíveis. O critério de segurança cardiovascular apresentou o maior número de variáveis identificadas. No entanto, o critério de segurança respiratório apresentou maior concordância. Houve maior divergência entre os autores em relação aos critérios neurológicos. Faz-se necessário reforçar o reconhecimento dos critérios de segurança utilizados para segurança da mobilização precoce do paciente crítico, ao mesmo tempo em que os parâmetros e as variáveis encontradas poderão auxiliar na incorporação à rotina dos serviços, com a intenção de iniciar, progredir e guiar a prática clínica.

ABSTRACT Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.

Safety criteria to start early mobilization in intensive care units. Systematic review. / Critérios de segurança para iniciar a mobilização precoce em unidades de terapia intensiva. Revisão sistemática.

Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.

Pacientes críticos internados em unidade de terapia intensiva devem ser mobilizados com base em critérios de segurança. O objetivo desta revisão foi verificar os critérios de segurança mais utilizados para iniciar a mobilização precoce em pacientes sob ventilação mecânica internados em unidade de terapia intensiva. Os artigos foram pesquisados nas bases de dados PubMed, PEDro, LILACS, Cochrane e CINAHL, tendo sido incluídos ensaios clínicos randomizados e controlados, ensaios clínicos quase randomizados, coortes, estudos comparativos com ou sem controles simultâneos, séries de casos com dez ou mais casos consecutivos, e estudos descritivos. O mesmo foi feito para estudos prospectivos, retrospectivos e transversais, nos quais, em sua metodologia, deveria constar a descrição dos critérios de segurança utilizados para iniciar a mobilização precoce. Dois revisores selecionaram, independentemente, estudos em potencial, de acordo com os critérios de inclusão, extraíram os dados e avaliaram a qualidade metodológica. Na análise dos dados, foi utilizada descrição narrativa para resumir as características e os resultados dos estudos obtidos, sendo os critérios de segurança categorizados nos seguintes subgrupos: cardiovasculares, respiratórios, neurológicos, ortopédicos e outros. Obtivemos 37 estudos elegíveis. O critério de segurança cardiovascular apresentou o maior número de variáveis identificadas. No entanto, o critério de segurança respiratório apresentou maior concordância. Houve maior divergência entre os autores em relação aos critérios neurológicos. Faz-se necessário reforçar o reconhecimento dos critérios de segurança utilizados para segurança da mobilização precoce do paciente crítico, ao mesmo tempo em que os parâmetros e as variáveis encontradas poderão auxiliar na incorporação à rotina dos serviços, com a intenção de iniciar, progredir e guiar a prática clínica.

QUESTIONÁRIO PARA AVALIAÇÃO DA DOR MUSCULOESQUELÉTICA EM PRATICANTES DE EXERCÍCIO (Q-ADOM) / QUESTIONNAIRE FOR EVALUATION OF MUSCULOSKELETAL PAIN IN EXERCISE PRACTITIONERS (Q-ADOM) / CUESTIONARIO PARA LA EVALUACIÓN DEL DOLOR MUSCULOESQUELÉTICO EN PRACTICANTES DE EJERCICIO (Q-ADOM)

RESUMO Introdução: As doenças cardiovasculares têm sido associadas à presença de desordens musculoesqueléticas. A dor presente nessas comorbidades pode constituir fator limitante para prática de exercício. No entanto, não foram encontrados instrumentos que proporcionem mensuração mais criteriosa e com informações precisas, que possam ser facilmente utilizados na prática clínica. Neste sentido, torna-se relevante a construção e validação de um instrumento mais específico para obtenção de informações detalhadas sobre a presença e gravidade desses sintomas e sua interferência nos aspectos funcionais, custos e fatores psicossociais, em diferentes momentos, resultando em uma avaliação mais precisa. Com isso, profissionais da equipe multidisciplinar envolvidos nos programas de reabilitação cardiopulmonar e metabólica (RCPM) podem utilizá-lo na prática clínica e abrir mão de estratégias especificamente direcionadas a essas afecções. Objetivo: Construir e validar um instrumento para avaliação da dor musculoesquelética em repouso e durante o exercício em participantes de RCPM. Métodos: Foram realizados procedimentos teóricos, empíricos e analíticos. A análise de concordância entre avaliadores (juízes) foi verificada pelo teste W de Kendall, a consistência interna dos itens, por meio do alfa de Cronbach e a reprodutibilidade e estabilidade de medidas, por meio do teste e reteste (coeficiente de correlação intraclasse - CCI e coeficiente de Kappa). Resultados: A concordância entre avaliadores foi significativa (p = 0,001) e a consistência interna apresentou valores satisfatórios (alfa de Cronbach > 0,82). O teste-reteste sinalizou boa reprodutibilidade e estabilidade de medidas (CCI < 0,40 e Kappa < 0,60). Conclusão: O questionário para avaliação da dor musculoesquelética em praticantes de exercício (Q-ADOM) mostrou-se válido, reprodutível e confiável para ser utilizado na avaliação da dor musculoesquelética de participantes de RCPM.

ABSTRACT Introduction: Cardiovascular diseases have been associated with the presence of musculoskeletal disorders. The presence of pain in these comorbidities may be a limiting factor for exercise practice. However, no instruments were found that provide more thorough measurement and accurate information that can be easily used in clinical practice. In this sense, the construction and validation of a more specific instrument becomes relevant to obtain detailed information on the presence and severity of these symptoms and its interference in the functional aspects, costs, and psychosocial factors at different times that result in a more precise evaluation. Thus, professionals of the multidisciplinary team involved in cardiopulmonary and metabolic rehabilitation (CPMR) programs can use it in clinical practice and put aside the strategies specifically directed to these conditions. Objectives: To construct and validate an instrument to assess musculoskeletal pain at rest and during exercise in participants of CPMR. Methods: Theoretical, empirical, and analytical procedures were performed. The concordance analysis among evaluators (judges) was verified by Kendall's W test, the internal consistency of the items through Cronbach's alpha, and reproducibility and stability measures through the test and retest (intraclass correlation coefficient - ICC and Kappa coefficient). Results: The concordance among evaluators was significant (p=0.001) and showed satisfactory internal consistency values (Cronbach's alpha > 0.82). The test-retest indicated good reproducibility and stability measures (ICC<0.40 and Kappa<0.60). Conclusion: The questionnaire for the evaluation of musculoskeletal pain in exercise practitioners (Q-ADOM) proved to be valid, reproducible, and reliable to be used in the evaluation of musculoskeletal pain in CPMR participants.

RESUMEN Introducción: Las enfermedades cardiovasculares se han asociado con la presencia de trastornos musculoesqueléticos. El dolor presente en estas comorbilidades puede ser un factor limitante para el ejercicio. Sin embargo, no se encontraron instrumentos que proporcionan la medición más criteriosa y con informaciones precisas que se puede utilizar fácilmente en la práctica clínica. En este sentido, es relevante la construcción y validación de un instrumento más específico para obtener información detallada acerca de la presencia y severidad de estos síntomas, y su interferencia en los aspectos funcionales, los costos y los factores psicosociales en diferentes momentos, lo que resulta en una evaluación más precisa. Por lo tanto, los profesionales del equipo multidisciplinario que participan en programas de rehabilitación cardiopulmonar y metabólica (RCPM) pueden utilizarlo en la práctica clínica y poner al lado las estrategias dirigidas específicamente a estas condiciones. Objetivo: Desarrollar y validar un instrumento para evaluar el dolor musculoesquelético en reposo y durante el ejercicio en los participantes de la RCPM. Métodos: Se llevaron a cabo los procedimientos teóricos, empíricos y analíticos. El análisis de la concordancia entre evaluadores (jueces) se verificó por la prueba W de Kendall, la consistencia interna de los ítems a través del alfa de Cronbach y las medidas de reproducibilidad y estabilidad a través de prueba-reprueba (coeficiente de correlación intraclase - CCI y el coeficiente Kappa). Resultados: La concordancia entre evaluadores fue significativa (p = 0,001) y mostró valores de consistencia interna (alfa de Cronbach > 0,82). La prueba-reprueba indica buenas medidas de reproducibilidad y estabilidad (CCI < 0,40 y Kappa < 0,60). Conclusión: El cuestionario para la evaluación del dolor musculoesquelético en los practicantes de ejercicio (Q-ADOM) demostró ser válido, reproducible y fiable para ser utilizado en la evaluación del dolor musculoesquelético de los participantes de RCPM.

Pilates Exercise for Hypertensive Patients: A Review of the Literature.

Systemic arterial hypertension (SAH) has a prevalence of approximately 1 billion cases worldwide. The main goals for its treatment involve changes in a patient's lifestyle, with a strategy of management that aims to increase his or her level of physical activity, with a recommendation for aerobic and resistance exercise. Some evidence has suggested that training with isometric exercises can produce effects similar to aerobic exercise on blood pressure reduction. Conventional exercises that are currently used in rehabilitation of hypertensive patients show low adherence, with a lack of motivation on the part of those patients. In that context, the Pilates method, which uses isometric exercises, has been gaining in popularity and worldwide acceptance, and it has the potential to be an effective method. The current literature review shows the possible benefits of the Pilates method for rehabilitation of hypertensive patients. However, even though the method is a promising modality, the authors have found that future research appears to be necessary to evaluate the benefits of Pilates for hypertensive patients.

Orientação para a atividade sexual após infarto agudo do miocárdio: estamos negligenciando? / Counseling on sexual activity after acute myocardial infarction: are we overlooking it?

A ocorrência de infarto agudo do miocárdio (IAM) causa mudanças consideráveis na vida do paciente, que se defronta com desafios físicos e psicológicos. Destaca-se a importante redução da atividade sexual, fator influenciador da qualidade de vida. É, portanto, importante que os profissionais da saúde estejam capacitados a orientar os pacientes na retomada da atividade sexual após o IAM e como realizar tal atividade de forma segura. Este trabalho tem por objetivo enfatizar a necessidade, ainda negligenciada, de os profissionais de saúde realizarem tal orientação de forma adequada, contribuindo assim para a qualidade de vida do paciente.

Acute myocardial infarction (AMI) causes significant changes in the life of patients, who face physical and psychological challenges.These include reduction in sexual activity, a factor that influences the quality of life. It is therefore important that health professionals be able to advise patients on the resumption of sexual activity after AMI and how to do that safely. This study is designed to emphasize the neglected need for healthcare professionals to perform such guidance properly, thus contributing to the quality of life of the patient.

ÍNDICE DA QUALIDADE DO SONO DE PITTSBURGH PARA USO NA REABILITAÇÃO CARDIOPULMONAR E METABÓLICA / PITTSBURGH SLEEP QUALITY INDEX FOR USE IN CARDIOPULMONARY AND METABOLIC REHABILITATION / ÍNDICE DE CALIDAD DEL SUEÑO DE PITTSBURGH PARA USO EN LA REHABILITACIÓN CARDIOPULMONAR Y METABÓLICA

Introdução A qualidade do sono constitui-se em parâmetro relevante na avaliação da saúde em geral, sendo um fator relevante na determinação do risco das doenças cardiovasculares. Objetivo Validar a versão adaptada do questionário de avaliação do Índice de Qualidade do Sono de Pittsburgh (PSQI) para uso em programas de reabilitação cardiopulmonar e metabólica (RCPM). Métodos Estudo descritivo transversal realizado com 101 pacientes de ambos os sexos, com média de idade de 66,05 (± 13,9) anos. Para a análise estatística foi considerado intervalo de confiança de 95% e valor de significância p <0,05; para a análise de consistência interna foi utilizado o coeficiente de alfa de Cronbach e para a análise da relação entre componentes e itens com o escore total do questionário foi utilizado o coeficiente de correlação de Spearman. Resultados Todos os componentes do questionário apresentaram boa consistência interna com valor de 0,72. Os componentes que mais se relacionaram com o escore total foram "duração do sono" e "qualidade subjetiva do sono", sendo que o componente que menos se relacionou foi "alterações do sono". Dentre os itens a variação foi de 0,584 no item "durante a última semana, em geral, como você classificaria a qualidade do seu sono?", até -0,611 no item "durante a última semana, quantas horas você conseguia dormir durante a noite?". Foi possível observar que os itens "tossir ou roncar muito alto" e "frequência para dificuldades do sono por outras razões" não apresentaram correlação com o escore total do questionário. Conclusão A versão adaptada do PSQI mostrou-se válida para ser utilizada na avaliação do sono em programas de RCPM.

Introduction Sleep quality is a relevant parameter in the assessment of overall health, and a relevant factor in determining the risk of cardiovascular diseases. Objective To validate the adapted version of the Pittsburgh Sleep Quality Index (PSQI) for use in cardiopulmonary and metabolic rehabilitation (CPMR) programs. Methods Descriptive cross-sectional study conducted with 101 patients of both sexes, average age of 66.05 (± 13.9) years. For statistical analysis, it was considered a confidence interval of 95% and significance value of p <0.05; for internal consistency analysis the Cronbach's alpha was used and for analysis of the relationship among components and items and the total score of the questionnaire the Spearman correlation was used. Results All components of the questionnaire showed good internal consistency with a value of 0.72. The components that most closely related to the total score were "duration of sleep" and "subjective quality of sleep", and the least related was "sleep changes". Among the items, the variation was 0.584 in item "during the last week, in general, how would you rate the quality of your sleep?", until -0.611 in item "during the last week, how many hours could you sleep at night? ". We could observe that the items "cough or snore too high" and "frequency of sleep difficulties for other reasons" were not correlated with the total score of the questionnaire. Conclusion The adapted PSQI version is valid for use in sleep assessment in CPMR programs.

Introducción La calidad del sueño constituye un parámetro relevante en la evaluación de la salud en general, y es un factor importante para determinar el riesgo de enfermedades cardiovasculares. Objetivo Validar la versión adaptada del cuestionario de evaluación del Índice de Calidad del Sueño de Pittsburgh (PSQI) para su uso en programas de rehabilitación cardiopulmonar y metabólica (RCPM). Métodos Estudio descriptivo de corte transversal que se llevó a cabo con 101 pacientes de ambos sexos, con edad promedio de 66,05 (± 13,9) años. Para el análisis estadístico, un intervalo de confianza del 95% y valor de significación de p <0,05 fueran considerados; para el análisis de consistencia interna se utilizó el alfa de Cronbach y para el análisis de la relación entre los componentes y elementos con la puntuación total del cuestionario fue utilizado el el coeficiente de correlación de Spearman. Resultados Todos los componentes del cuestionario mostraron una buena consistencia interna, con un valor de 0,72. Los componentes más estrechamente relacionados con la puntuación total fueron "duración del sueño" y "calidad subjetiva del sueño", y el componente menos relacionado fue "cambios en el sueño". Entre los elementos, la variación fue de 0,584 en "¿durante la última semana, en general, cómo usted calificaría la calidad de su sueño?", hasta -0,611 en "¿durante la última semana, cuántas horas se podía dormir por la noche?". Se observó que los elementos "tos o ronquido demasiado alto" y "frecuencia de dificultades para dormir por otras razones" no se correlacionaron con la puntuación total del cuestionario. Conclusión La versión adaptada del PSQI ha demostrado ser válida para su uso en la evaluación del sueño en programas del RCPM.

Protocolo de samba brasileiro para reabilitação cardíaca / The brasilian samba protocol for cardiac rehabilitation / Protocolo de samba brasileño para rehabilitación cardiaca

RESUMOIntrodução:O samba é uma dança de movimentos intensos e variados que proporcionam alegria e boa resposta cronotrópica, sendo plausível a expectativa de que beneficie o sistema cardiovascular.Objetivo:Desenvolver e avaliar um protocolo de samba brasileiro visando o treinamento físico na reabilitação cardíaca. Métodos: Quinze indivíduos com doença arterial coronariana estável, idade 60,74±5,96 anos, realizaram teste cardiopulmonar máximo com determinação da frequência cardíaca (FC) correspondente ao VO2pico e primeiro e segundo limiares ventilatórios. Durante seis sessões executaram vinte passos de samba, em três andamentos musicais, classificados por metrônomo em lento, médio ou rápido. Posteriormente, realizaram três sessões para verificar o comportamento da FC e a percepção de esforço. A análise descritiva foi utilizada na caracterização da amostra e verificação da FC, o testet ou teste de Wilcoxon foram utilizados para comparar o comporta-mento da FC (nas diferentes sessões), com nível de significância de 5%.Resultados:Houve boa adaptação aos passos de samba, com FC situando-se entre 62% e 72% da FCpico. Durante as sessões de dança os pacientes mantiveram-se em 86 ±4,17% do tempo na zona alvo proposta para treinamento físico na reabilitação (60% a 90% da FCpico) e 77±2,26% do tempo na zona alvo considerada ideal, com a FC situada entre o primeiro e o segundo limiares ventilatórios. Durante todo o tempo os pacientes referiram percepção de esforço de leve a moderada.Conclusão:Os pacientes demonstraram boa adaptação ao protocolo de samba, que se mostrou em condições de ser adotado como proposta de treinamento na reabilitação cardíaca.

ABSTRACTIntroduction:Samba requires intense and varied movements that provide happiness and good chronotropic res-ponse making plausible to expect its benefits on cardiovascular health.Objective:To develop and evaluate a brazilian samba protocol aiming at physical training in cardiac rehabilitation.Methods:Fifteen patients with stable coronary artery disease, aged 60.74±5.96 years, underwent maximal cardiopulmonary test with determination of heart rate (HR) corresponding to the peak VO2 and first and second ventilation thresholds. During six sessions, they underwent twenty samba steps, in three music tempo classified by a metronome (slow, medium and fast). Subsequently, they underwent three sessions to verify the HR behavior and perception of effort. Descriptive analysis has been utilized in order to characterize the sample and check HR; T test or Wilcoxon test have been used to compare HR behavior (in different sessions) with significance level of 5%.Results:There was good adaptation to the samba steps, with HR between 62% and 72% of peak HR. During the dance sessions patients remained 86±4.17% of time in the target zone proposed for physical training in rehabilitation (60% to 90% of HR peak) and 77±2.26% of time in the target zone considered ideal, with HR situated between the first and the second ventilation threshold. Throughout the time the patients reported having perceived mild to moderate effort.Conclusion: Patients showed good adaptation to samba protocol, which proved being able to be adopted as a proposal for training in cardiac rehabilitation.

RESUMENIntroducción:Samba es una danza de movimientos intensos y variados que traen alegría y buena respuesta cronotrópica, y es plausible esperar que beneficia el sistema cardiovascular.Objetivo:Desarrollar y evaluar un proto-colo de samba brasileño destinado a entrenamiento físico en la rehabilitación cardiaca.Métodos:Quince pacientes con enfermedad coronaria estable, edad 60,74 ± 5,96 años, fueron sometidos a prueba de esfuerzo cardiopulmonar máximo para determinar la frecuencia cardíaca (FC) correspondiente a VO2pico y primer y segundo umbrales ventila-torios. Durante seis sesiones realizaron veinte pasos de samba, en tres movimientos musicales clasificados en orden de metrónomo a lento, medio o rápido. Posteriormente se realizaron tres sesiones para comprobar el comportamiento de la FC y el esfuerzo percibido. Se realizó un análisis descriptivo para la caracterización de la muestra y la verificación de la FC; se utilizaron la prueba t o prueba de Wilcoxon para comparar el comportamiento de la FC (en diferentes sesiones), con un nivel de significación del 5%.Resultados:Hubo una buena adaptación a los pasos de samba, com la FC entre el 62% y el 72% de FCpico. Durante las sesiones de baile, los pacientes se mantuvieron en 86 ± 4,17% del tiempo en la zona de destino propuesta para el entrenamiento físico en rehabilitación (60% a 90% de FCpico) y 77 ± 2,26% del tiempo en la zona de destino considerado óptimo, con la FC situada entre el primero y el segundo umbral ventilatorio. Todo el tiempo la percepción percibida pelos pacientes fue de esfuerzos leves a moderados.Conclusión:Los pacientes mostraron una buena adaptación al protocolo de samba, que resultó en condiciones de ser adoptado como una propuesta para el entrenamiento en rehabilitación cardiaca.