Autonomic modulation of heart rate during physical activity in pregnant women: A systematic review of literature.

BACKGROUND: There are important physiological changes in the heart rate autonomic modulation in pregnant women and these changes may affect the way their bodies respond to exercise stimulus. The objective of this review is to verify the physical exercise influence on autonomic modulation of heart rate in pregnant women. METHODS: This study is a Systematic Review. The electronic databases used to search for the studies were Cochrane Library, MEDLINE via PUBMED, Regional Health Portal and EMBASE. Experimental studies that evaluated heart-rate variability in pregnant women practicing physical exercises were included. And articles that addressed only fetal heart-rate variability, case reports, congress abstracts, clinical trial protocols without results, preprints, and gray literature were excluded. There were no language or publication year restrictions. The descriptors used in the Search were Cardiac Chronotropism, Sympathetic Nervous System, Pregnancy, and Physical Exercise. For statistical analysis, the fixed effect model was used. RESULTS: A total of 3106 articles were found, and 12 studies were included, which 5 were nonrandomized clinical trials, 4 were randomized clinical trials, and 3 were cross-sectional studies. Three hundred and four pregnant women were included in the studies. The application of physical exercise was varied, but in general they used aerobic exercises and with increased variability of the heart rate and reflex on the autonomic modulation of heart rate. CONCLUSION: Most studies demonstrate benefits heart rate in pregnant women, but limited research makes it hard to compare specific types of exercise and larger studies are needed to identify the best exercise.

The impact of heart failure on the sexual response cycle: A systematic review.

BACKGROUND: Heart failure (HF) is the most prevalent disease among chronic diseases and has been associated with a high prevalence of erectile dysfunction (ED). OBJECTIVE: this study aims to analyze research that has as its object of study the sexual activity of patients with HF. METHODS: A high-sensitivity search was performed in databases (PUBMED via MEDLINE, Cochrane, EMBASE, Web of Science, SCOPUS AND CINAHL) using descriptors linked to sexuality and heart failure. RESULTS: Fifteen studies from 7 countries with a total sample of 6244 participants were included. CONCLUSION: It was identified that patients with HF have alterations in their sexual activities, which are more common in males. Among men, it was noticed that the most reported sexual disorder was erectile dysfunction.

Exercise regimens other than pelvic floor muscle training cannot increase pelvic muscle strength-a systematic review.

BACKGROUND: Although pelvic floor muscle training is widely recommendedin the literature as the gold standard for the treatment of pelvic floor dysfunctions, such as urinary incontinence, interest in other exercise regimens is increasing. However, it is unknown whether other exercise regimens increase pelvic floor muscle strength. METHODS: This was a systematic review of randomized clinical trials found in PEDro, tridatabase, Cochrane and PubMed on the efficacy of nonspecific exercises, such as Pilates, the Paula method, and hypopressive exercises, in strengthening pelvic floor muscles in adults without underlying neurological disorders and with or without pelvic floor dysfunction. RESULTS: Seven studies were analyzed, and the results demonstrated that Pilates, the Paula method, and hypopressive exercises are ineffective in increasing pelvic muscle strength unless they are performed in conjunction with pelvic floor muscle training. The protocol was registered in the PROSPERO database (www.crd.york.ac.uk/prospero/) under the number CRD42019123396. CONCLUSION: Considering the available studies, we have concluded that Pilates, the Paula method and hypopressive exercises performed alone do not increase pelvic floor muscle strength. Pelvic floor muscle training continues to be the gold standard for increasing pelvic muscle strength.

Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial.

OBJECTIVES: To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS: Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS: Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION: Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.

Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial

OBJECTIVES: To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS: Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS: Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION: Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.

Factors associated with overactive bladder syndrome in the elderly community: a cross-sectional study / Fatores associados à síndrome da bexiga hiperativa em idosas: um estudo transversal

Abstract Objective: to identify risk factors related to overactive bladder syndrome. Method: a cross-sectional study was performed with elderly women (>60 years) from the community of Ceilândia, in the Distrito Federal, Brazil, with or without symptoms of OBS, who were evaluated through interviews and questionnaires. The clinical and sociodemographic variables analyzed were: age; body mass index (BMI); parity, schooling, previous abdominal and urogynecologic surgeries, physical activity, smoking, constipation, systemic arterial hypertension (SAH), diabetes mellitus; depression and anxiety. The questionnaires applied were the Overactive Bladder Awareness Tool (OAB-V8), the Geriatric Depression Scale and the Beck Anxiety Scale. Data were analyzed descriptively. Binary logistic regression was used to evaluate the significant associations between the independent variables and the outcome of interest. Risk ratios were calculated for each independent variable with 95% confidence intervals. Result: A total of 372 volunteers were recruited, 292 of whom were eligible. Of these, 172 were allocated to the case group (58.9%) and 120 (41.1%) were control subjects. The two groups were homogeneous between one another. There was a high prevalence of OBS in the study population and significant differences for the variables presence of SAH, abdominal surgery and pelvic surgery, with the case group presenting a higher frequency of these events. In multivariate analysis, it was observed that an active sexual life reduces the chance of having OBS by 70.8%, while urogynecologic surgeries increase this risk 3.098 times. Conclusion: In univariate logistic regression analysis, BMI, SAH, a previous history of abdominal and urogynecologic surgery, number of abortions and the presence of symptoms of depression and anxiety, were found to be factors associated with OBS. AU

Resumo Objetivo: Identificar os fatores clínicos e sociodemográficos associados à Síndrome da Bexiga Hiperativa (SBH). Método: Estudo transversal, realizado com idosas (>60 anos) da comunidade de Ceilândia, DF, Brasil; avaliadas por meio de entrevistas e questionários. As variáveis clínicas e sociodemográficas analisadas foram: idade; índice de massa corpórea (IMC); paridade, escolaridade, cirurgias abdominais e uroginecológicas prévias, prática de atividade física, tabagismo, constipação, hipertensão arterial sistêmica (HAS), diabetes mellitus; depressão e ansiedade. Os questionários aplicados foram Overactive Bladder Awerenees Tool (OAB-V8), Escala de Depressão Geriátrica e Escala de Ansiedade de Beck. Os dados foram analisados descritivamente. Utilizou-se a regressão logística binária para avaliar as associações significativas entre as variáveis independentes e o desfecho de interesse. As razões de risco foram calculadas para cada variável independente com intervalos de 95% de confiança. Resultados: Recrutou-se 372 voluntárias, sendo elegíveis 292, destas, 172 eram grupo caso (58,9%) e 120 (41,1%) eram grupo controle. Observou-se alta prevalência de SBH na população estudada, além de diferenças significativas para as variáveis: presença de HAS; ter realizado cirurgia abdominal ou cirurgia pélvica, sendo que o grupo caso apresentou maior frequência desses eventos. Na análise multivariada, observou-se que vida sexual ativa reduz em 70,8% a chance de ter SBH, e cirurgias uroginecológicas aumentam em 3,098 vezes esse risco. Conclusão: Na análise de regressão logística univariada, o IMC, a HAS, a história prévia de cirurgia abdominal e uroginecológica, quantidade de abortos, presença de sintomas de depressão e ansiedade, apresentaram-se como fatores associados à SBH. AU

Intervenção educativa nos cuidados da dermatite da fralda em idosos institucionalizados / Educational intervention in the care of diaper dermatitis in institutionalized elderly

Este estudo teve por objetivo analisar a efetividade da intervenção educativa na prevenção e tratamento da dermatite da fralda de idosos institucionalizados. Trata-se de um estudo qualitativo, longitudinal e prospectivo a partir de uma amostra de 38 idosos. O instrumento foi composto por uma cartilha, entregue aos agentes de saúde, na qual ela apresentava medidas para minimizar os problemas da dermatite. Foi realizada uma avaliação clínica da dermatite da fralda antes e após a aplicação das medidas. Verificou-se que apenas 7 idosos com dermatite leve persistiram com o quadro. Vinte obtiveram a cura dos Sintomas, representando, assim, 81,58% dos idosos. Houve também uma diminuição dos sintomas, na qual a descamação foi representada por 93,33% de melhora, a hiperemia por 77,41% e o edema por 93,75%. Diante dos resultados deste estudo, constatou-se que as medidas propostas foram adequadas e eficazes no tratamento da dermatite de grau leve em idosos institucionalizados. (AU)

This study aimed to examine the effectiveness of educational interventions in the prevention and treatment of diaper dermatitis in the institutionalized elderly. This is a prospective, qualitative and longitudinal study from a sample of 38 old people. The instrument consisted of a booklet given to health workers with instructions to minimize the problems of dermatitis. We performed a clinical assessment of diaper dermatitis before and after implementing the measures. It was found that only 7 elderly patients with mild dermatitis persisted in the frame. Twenty of them obtained the cure of symptoms, representing 81.58% of the elderly. There was also a decrease of symptoms, in which the improvement of peeling was represented by 93.33%, hyperemia by 77.41%, and edema by 93.75%. According to the results of this study, the proposed measures are appropriate and effective in the treatment of mild dermatitis in the institutionalized elderly. (AU)

Intervenção educativa nos cuidados da dermatite da fralda em idosos institucionalizados / Educational intervention in the care of diaper dermatitis in institutionalized elderly

Este estudo teve por objetivo analisar a efetividade da intervenção educativa na prevenção e tratamento da dermatite da fralda de idosos institucionalizados. Trata-se de um estudo qualitativo, longitudinal e prospectivo a partir de uma amostra de 38 idosos. O instrumento foi composto por uma cartilha, entregue aos agentes de saúde, na qual ela apresentava medidas para minimizar os problemas da dermatite. Foi realizada uma avaliação clínica da dermatite da fralda antes e após a aplicação das medidas. Verificou-se que apenas 7 idosos com dermatite leve persistiram com o quadro. Vinte obtiveram a cura dos Sintomas, representando, assim, 81,58% dos idosos. Houve também uma diminuição dos sintomas, na qual a descamação foi representada por 93,33% de melhora, a hiperemia por 77,41% e o edema por 93,75%. Diante dos resultados deste estudo, constatou-se que as medidas propostas foram adequadas e eficazes no tratamento da dermatite de grau leve em idosos institucionalizados.

This study aimed to examine the effectiveness of educational interventions in the prevention and treatment of diaper dermatitis in the institutionalized elderly. This is a prospective, qualitative and longitudinal study from a sample of 38 old people. The instrument consisted of a booklet given to health workers with instructions to minimize the problems of dermatitis. We performed a clinical assessment of diaper dermatitis before and after implementing the measures. It was found that only 7 elderly patients with mild dermatitis persisted in the frame. Twenty of them obtained the cure of symptoms, representing 81.58% of the elderly. There was also a decrease of symptoms, in which the improvement of peeling was represented by 93.33%, hyperemia by 77.41%, and edema by 93.75%. According to the results of this study, the proposed measures are appropriate and effective in the treatment of mild dermatitis in the institutionalized elderly.

The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review / Efeito do treinamento dos músculos do assoalho pélvico na incontinência urinária de mulheres idosas: revisão sistemática

Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.

Introdução A Sociedade Internacional de Continência (SIC) determina que o treinamento dos músculos do assoalho pélvico (TMAP) seja considerado como primeira opção de tratamento dos sintomas urinários nas mulheres. Objetivo O objetivo deste estudo foi sistematizar ensaios clínicos randomizados e controlados que abordam os efeitos do TMAP no tratamento dos sintomas urinários em mulheres idosas utilizando medidas de desfecho objetivas. Método Revisão sistemática no qual foi feita uma busca eletrônica nas seguintes bases de dados: Medline, Pubmed, Lilacs, PEDro e pesquisa manual realizada nas referências bibliográficas dos estudos. Consideraram-se elegíveis mulheres idosas acima de 60 anos, que realizaram o TMAP de forma isolada, sem envolvimento de outra técnica. O TMAP realizado em ambulatório ou em domicílio, com ou sem a supervisão de um terapeuta e com ou sem o uso do biofeedback como adjuvante. Considerou-se como medidas de desfecho o estudo urodinâmico, o diário miccional que avalia a frequência urinária diurna, a frequência urinária noturna, perda urinária aos esforços e a troca de absorventes, e, por fim, o teste do absorvente que quantifica a perda urinária em gramas. A avaliação da qualidade metodológica dos estudos foi realizada pela escala PEDro. Resultados Três estudos foram revisados na íntegra. Apenas um artigo foi classificado como de alta qualidade metodológica. Houve melhora significativa dos sintomas miccionais após o tratamento proposto nos três estudos selecionados. Conclusão Considerando os estudos disponíveis até o momento são fracas as evidências favoráveis à utilização do TMAP no tratamento dos sintomas urinários de mulheres idosas.

Relationship between anxiety and overactive bladder syndrome in older women.

PURPOSE: The objective of this study was to investigate the relationship between overactive bladder syndrome and anxiety in older women. METHODS: Of the 198 older women who were invited, 29 were excluded and 166 were then divided into two groups according to the Advanced Questionnaire of Overactive Bladder (OAB-V8): one group with overactive bladder symptoms (OAB-V8≥8) and the other without the symptoms of an overactive bladder (OAB-V8<8). The purpose was to conduct a frequency analysis and to investigate the relation of the social demographic data and anxiety in the two groups. The Beck Anxiety Inventory (BAI) was used to evaluate the level of anxiety. The Kolmogorov-Smirnov test was used to determine the distribution of the data. The differences between the two groups for the continuous variables were analyzed by the Mann-Whitney U test, the differences for the categorical variables were analyzed by the Chi-Square test and the association between the continuous variables was analyzed by the Spearman Correlation test. The tests were two-tailed with a confidence level of 5%. RESULTS: Overall, the frequency of an overactive bladder was present in 117 (70.5%) of the participants. The body mass index (BMI) of the group with overactive bladder symptoms was significantly higher than the BMI of those without these symptoms (p=0.001). A higher prevalence of mild, moderate and severe anxiety was observed among older women with overactive bladder symptoms. In addition, the overactive bladder symptoms group presented a positive low correlation with anxiety symptoms (r=0.345) and with BMI (r=0.281). There was a small correlation between BMI and anxiety symptoms (r=0.164). CONCLUSIONS: Overactive bladder syndrome was prevalent among older women and the existence of these symptoms was linked to the presence of mild, moderate and/or severe anxiety symptoms.

Relationship between anxiety and overactive bladder syndrome in older women / Relação entre ansiedade e síndrome da bexiga hiperativa em mulheres mais velhas

PURPOSE: The objective of this study was to investigate the relationship between overactive bladder syndrome and anxiety in older women. METHODS: Of the 198 older women who were invited, 29 were excluded and 166 were then divided into two groups according to the Advanced Questionnaire of Overactive Bladder (OAB-V8): one group with overactive bladder symptoms (OAB-V8≥8) and the other without the symptoms of an overactive bladder (OAB-V8<8). The purpose was to conduct a frequency analysis and to investigate the relation of the social demographic data and anxiety in the two groups. The Beck Anxiety Inventory (BAI) was used to evaluate the level of anxiety. The Kolmogorov-Smirnov test was used to determine the distribution of the data. The differences between the two groups for the continuous variables were analyzed by the Mann-Whitney U test, the differences for the categorical variables were analyzed by the Chi-Square test and the association between the continuous variables was analyzed by the Spearman Correlation test. The tests were two-tailed with a confidence level of 5%. RESULTS: Overall, the frequency of an overactive bladder was present in 117 (70.5%) of the participants. The body mass index (BMI) of the group with overactive bladder symptoms was significantly higher than the BMI of those without these symptoms (p=0.001). A higher prevalence of mild, moderate and severe anxiety was observed among older women with overactive bladder symptoms. In addition, the overactive bladder symptoms group presented a positive low correlation with anxiety symptoms (r=0.345) and with BMI (r=0.281). There was a small correlation between BMI and anxiety symptoms (r=0.164). CONCLUSIONS: Overactive bladder syndrome was prevalent among older women and the existence of these symptoms was linked to the presence of mild, moderate and/or severe anxiety symptoms. .

OBJETIVO: Investigar a relação entre a síndrome da bexiga hiperativa e ansiedade em mulheres mais velhas. MÉTODOS: Das 198 mulheres mais velhas que foram convidadas, 29 foram excluídas, restando 166, que foram divididas em dois grupos de acordo com o Questionário Avançado de Bexiga Hiperativa (OAB-V8): um grupo com sintomas de bexiga hiperativa (OAB-V8≥8) e outro sem os sintomas da bexiga hiperativa (OAB-V8<8). O objetivo foi realizar uma análise de frequência e investigar a relação entre os dados sócio-demográficos e ansiedade entre os grupos. A Escala de Ansiedade de Beck (EAB) foi utilizada para avaliar o nível de ansiedade. O teste de Kolmogorov-Smirnov foi utilizado para determinar a distribuição dos dados. As diferenças entre os dois grupos para as variáveis ​​contínuas foram analisadas pelo teste de Mann-Whitney, e para as variáveis ​​categóricas foi utilizado o teste Qui-quadrado. Para analisar a associação entre as variáveis ​​contínuas, foi utilizado o teste de Correlação de Spearman. Os testes foram bi-caudais com um nível de confiança de 5%. RESULTADOS: Em geral, a frequência de bexiga hiperativa estava presente em 117 (70,5%) das participantes. O grupo com sintomas de bexiga hiperativa apresentou um IMC (índice de massa corporal) significativamente maior do que aqueles sem esses sintomas (p=0,001). Observou-se maior prevalência de ansiedade leve, moderada e grave entre as mulheres mais velhas com sintomas de bexiga hiperativa. Além disso, o grupo com sintomas de bexiga hiperativa apresentou correlação positiva baixa com sintomas de ansiedade (r=0,345) e com o IMC (r=0,281). Houve uma pequena correlação entre IMC e sintomas de ansiedade (r=0,164). CONCLUSÕES: Síndrome da bexiga ...

O prolapso genital associado à incontinência urinária de esforço altera a função muscular do assoalho pélvico? / The association between pelvic organ prolapse and stress urinary incontinence changes the pelvic fl oor muscle function?

Prolapso genital é defi nido como deslocamento dasvísceras pélvicas em sentido caudal. Trata-se de afecção comum,especialmente em mulheres menopausadas e, não obstante, podeestar associado à incontinência urinária de esforço (IUE). Estudosmostram que mulheres com prolapso genital possuem funçãomuscular do assoalho pélvico diminuída. Objetivo: Verifi car se hádiferença entre a função dos músculos do assoalho pélvico (MAP)de mulheres incontinentes com ou sem prolapso genital. Métodos:Participaram dessa pesquisa 24 voluntárias divididas em dois grupos,a saber: Grupo I composto por 12 mulheres com IUE associada aoprolapso genital; e Grupo II, composto por 12 mulheres com IUEe sem prolapso genital associado. Avaliou-se a função dos MAP pormeio de palpação bidigital, utilizando-se as escalas de AvaliaçãoFuncional do Assoalho Pélvico (AFA) e Oxford, teste de tempomáximo de contração (endurance) e exame com perineômetro. Paraa análise estatística, utilizou-se o test t de Student, para comparar asmédias obtidas e o nível de signifi cância. Resultados: as mulheres comprolapso genital associado apresentaram menor AFA (p = 0,043),Oxford (p = 0,043) e tempo de sustentação da contração mensuradopelo perineômetro (p = 0,044). Conclusão: mulheres incontinentescom prolapso genital apresentam menor função muscular e menortempo de sustentação da contração...

Pelvic organ prolapse is defi ned as pelvic viscera displacementin caudal direction. In menopausal women is particularlycommon and it can be associated with stress urinary incontinence(SIU). Studies show that in women with pelvic organ prolapse,the pelvic fl oor muscle (PFM) function loses strength. Aim: Toverify if there is any diff erence between the function of the pelvicfl oor muscles (PFM) of incontinent women with or without pelvicorgan prolapse. Methods: Twenty four patients were divided intotwo groups: Group I with 12 women with SUI and Group II, with12 women with SUI associated with pelvic organ prolapse. Th efunction of PFM was evaluated using bidigital palpation, measuredby Functional Pelvic Floor Evaluation (AFA) and Oxford scales,maximum time of contraction test (endurance) and perineometerexam. Regarding the statistical analysis, the student test t was usedto compare the means and signifi cance level. Results: Women withpelvic organ prolapse associated showed lower AFA (p = 0,043),Oxford (p = 0,043) and holding contraction time measured byperineometer (p = 0,044). Conclusion: Incontinent women withpelvic organ prolapse showed lower PFM function and decrease ofmuscular endurance...