In the Cardiac Rehabilitation Era, is There a "No-Option" Refractory Angina Patient?: A Case Report. / Na Era da Reabilitação Cardíaca, Ainda Existem Pacientes Portadores de Angina Refratária "Sem Opção"?: Um Relato de Caso.

Exercise-based cardiac rehabilitation, an effective and safe adjuvant treatment recommended to patients with coronary artery disease, is scarcely applied to patients with refractory angina (RA) due to difficulties related to safety, trainning prescription and their clinical management. This case report presents an instance of a "no-option" patient with RA, who was included in a 12-week exercise program, in sessions consisted of 40 minutes of treadmill aerobic exercise, three times a week, and intensity prescribed between ischemic/angina threshold and ventilatory threshold 1, obtained in the cardiopulmonary exercise test; mild to moderate angina was allowed during training. Furthermore, 15 minutes of moderate-intensity resistance training (large group muscle exercises, two sets of 8 to 12 repetitions) was performed. At the end of the protocol, the patient presented an important improvement in functional performance (VO 2 peak 17.0 ml/kg/min to 27.3 ml/kg/min), angina threshold (HR 68 bpm to 95 bpm), and intensity chest pain (levels 7 to 5) with no clinical adverse events during the period. Exercise-based cardiac rehabilitation was safe, even in the occurrence of angina/ischemia during training, according to tolerability to symptoms and other warning clinical signs.

A reabilitação cardíaca baseada em exercícios, um tratamento adjuvante eficaz e seguro recomendado para pacientes com doença arterial coronariana, é pouco aplicada em pacientes com angina refratária (AR) devido a dificuldades relacionadas à segurança, prescrição do treinamento e o seu manejo clínico. Este relato de caso apresenta um paciente "sem opção" com AR, incluído em um programa de exercícios de 12 semanas de duração, composto de 40 minutos de exercício aeróbico em esteira por sessão, três vezes por semana, e intensidade prescrita entre limiares isquêmicos/anginosos e limiar ventilatório 1, conforme obtidos no teste de exercício cardiopulmonar; angina leve a moderada foi permitida durante o treinamento. Além disso, foram realizados 15 minutos de treinamento de resistência de intensidade moderada (exercícios de grandes grupos musculares, duas séries de 8 a 12 repetições). Ao final do protocolo, o paciente apresentou melhora importante no desempenho funcional (VO 2 máximo de 17,0 ml/kg/min para 27,3 ml/kg/min), limiar anginoso (FC de 68 bpm para 95 bpm) e na intensidade da dor torácica (nível 7 para 5) sem eventos clínicos adversos durante o período. A reabilitação cardíaca baseada em exercícios se mostrou segura, mesmo na ocorrência de angina/isquemia durante o treinamento, de acordo com a tolerabilidade aos sintomas e outros sinais clínicos de alerta.

Is physical inactivity and sedentary behavior associated with tumor stage in breast cancer patients? A cross-sectional study of Brazilian women.

OBJECTIVE: A comparative analysis of the association between sedentary behavior versus physical activity levels and tumor staging in women with breast cancer. METHODS: The present research adopted a cross-sectional study design to recruit a total of 55 adult and elderly women newly diagnosed with breast cancer for data collection and analysis. Inclusion criteria involved patients in procession of a formal approval for participation in the study by the treating physician and those not hitherto subjected to the first cycle of chemotherapy. RESULTS: Physical activity levels did not influence the pathological stage of breast cancer (p=0.26) or histological tumor grade (p=0.07) in the analyzed subjects. However, there was a significant association between physical activity levels and responsiveness to hormones (epidermal growth factor receptor (HER2), p<0.05) in the analyzed subjects. Significant difference was detected in the histological tumor grade in relation to the mean time spent sitting during the weekend (p<0.05). However, sedentary behavior had no influence on the tumor stage (p>0.05). CONCLUSION: Physical activity levels did not influence the tumor stage and histological tumor grade. Sedentary behavior had a significant influence on the histological tumor grade.

The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19

INTRODUCTION: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. METHODS: Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. RESULTS: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). DISCUSSION: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

Is physical inactivity and sedentary behavior associated with tumor stage in breast cancer patients? A cross-sectional study of Brazilian women

ABSTRACT Objective A comparative analysis of the association between sedentary behavior versus physical activity levels and tumor staging in women with breast cancer. Methods The present research adopted a cross-sectional study design to recruit a total of 55 adult and elderly women newly diagnosed with breast cancer for data collection and analysis. Inclusion criteria involved patients in procession of a formal approval for participation in the study by the treating physician and those not hitherto subjected to the first cycle of chemotherapy. Results Physical activity levels did not influence the pathological stage of breast cancer (p=0.26) or histological tumor grade (p=0.07) in the analyzed subjects. However, there was a significant association between physical activity levels and responsiveness to hormones (epidermal growth factor receptor (HER2), p<0.05) in the analyzed subjects. Significant difference was detected in the histological tumor grade in relation to the mean time spent sitting during the weekend (p<0.05). However, sedentary behavior had no influence on the tumor stage (p>0.05). Conclusion Physical activity levels did not influence the tumor stage and histological tumor grade. Sedentary behavior had a significant influence on the histological tumor grade.

Na Era da Reabilitação Cardíaca, Ainda Existem Pacientes Portadores de Angina Refratária "Sem Opção"?: Um Relato de Caso / In the Cardiac Rehabilitation Era, is There a "No-Option" Refractory Angina Patient?: A Case Report

Resumo A reabilitação cardíaca baseada em exercícios, um tratamento adjuvante eficaz e seguro recomendado para pacientes com doença arterial coronariana, é pouco aplicada em pacientes com angina refratária (AR) devido a dificuldades relacionadas à segurança, prescrição do treinamento e o seu manejo clínico. Este relato de caso apresenta um paciente "sem opção" com AR, incluído em um programa de exercícios de 12 semanas de duração, composto de 40 minutos de exercício aeróbico em esteira por sessão, três vezes por semana, e intensidade prescrita entre limiares isquêmicos/anginosos e limiar ventilatório 1, conforme obtidos no teste de exercício cardiopulmonar; angina leve a moderada foi permitida durante o treinamento. Além disso, foram realizados 15 minutos de treinamento de resistência de intensidade moderada (exercícios de grandes grupos musculares, duas séries de 8 a 12 repetições). Ao final do protocolo, o paciente apresentou melhora importante no desempenho funcional (VO 2 máximo de 17,0 ml/kg/min para 27,3 ml/kg/min), limiar anginoso (FC de 68 bpm para 95 bpm) e na intensidade da dor torácica (nível 7 para 5) sem eventos clínicos adversos durante o período. A reabilitação cardíaca baseada em exercícios se mostrou segura, mesmo na ocorrência de angina/isquemia durante o treinamento, de acordo com a tolerabilidade aos sintomas e outros sinais clínicos de alerta.

Abstract Exercise-based cardiac rehabilitation, an effective and safe adjuvant treatment recommended to patients with coronary artery disease, is scarcely applied to patients with refractory angina (RA) due to difficulties related to safety, trainning prescription and their clinical management. This case report presents an instance of a "no-option" patient with RA, who was included in a 12-week exercise program, in sessions consisted of 40 minutes of treadmill aerobic exercise, three times a week, and intensity prescribed between ischemic/angina threshold and ventilatory threshold 1, obtained in the cardiopulmonary exercise test; mild to moderate angina was allowed during training. Furthermore, 15 minutes of moderate-intensity resistance training (large group muscle exercises, two sets of 8 to 12 repetitions) was performed. At the end of the protocol, the patient presented an important improvement in functional performance (VO 2 peak 17.0 ml/kg/min to 27.3 ml/kg/min), angina threshold (HR 68 bpm to 95 bpm), and intensity chest pain (levels 7 to 5) with no clinical adverse events during the period. Exercise-based cardiac rehabilitation was safe, even in the occurrence of angina/ischemia during training, according to tolerability to symptoms and other warning clinical signs.

Prevalence and Association Between Cognition, Anxiety, and Depression in Patients Hospitalized with Heart Failure

Abstract Background Cognitive impairment, anxiety, and depression are present in patients with heart failure (HF), but their mutual correlation in hospitalized patients is not well established. Objectives The aims of this study were to identify the presence of cognitive impairment and the most affected domain, to investigate possible associations of cognitive impairment with depression and/or anxiety, and to observe whether they correlated with occurrence of readmission within 30 days following hospital discharge. Methods This is a prospective observational study including patients with HF from a private hospital. Psychological distress and cognition were evaluated by the Hospital Anxiety and Depression Scale (HADS) and by the Mini Mental State Exam (MMSE), respectively. Clinical data were obtained from the medical record at the time of inclusion, and outpatient follow-up was performed 30 days after discharge via telephone calls. Results This study included 71 patients (83% men, 75 ± 11 years). Cognitive impairment was present in 53.5% of the patients, and recall memory was the most altered cognitive domain. The proportion of possible/probable anxiety and depression was 21.1% and 34.2% in patients with cognitive impairment, respectively. However, only depression demonstrated association with cognitive impairment (p = 0.018). Cognitive impairment, anxiety, and depression showed no relationship with the occurrence of readmission within 30 days. Conclusions Cognitive impairment and depressive symptoms are prevalent and associated, and recall memory was the most altered cognitive domain in patients hospitalized with HF. However, there was no relationship between these factors and readmission within 30 days.

Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina? / Ocorre Lesão Miocárdica após uma Sessão de Exercício Aeróbico Agudo em Pacientes com Angina Refratária?

BACKGROUND: It is unclear whether exercise is safe in patients with more advanced forms of coronary artery disease, such as those with refractory angina (RA). OBJECTIVE: We aimed to determine the effect of an acute aerobic exercise session (AAES) on high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with RA. METHODS: This was a longitudinal, non-randomized, and non-controlled clinical study. Participants were recruited from April 2015 to January 2019. On a visual pain scale from 0 to 10, pain rated up to 3 was considered as the top level allowed to continue exercising. We assessed hs-cTnT at baseline and 3 hours after the AAES. The protocol consisted of 5 minutes of warm-up, 30 minutes of continuous aerobic exercise at heart rate corresponding to the anaerobic threshold or angina threshold obtained in the cardiopulmonary exercise testing, and 5 minutes of cooling down. P values less than 0.05 were considered statistically significant. RESULTS: Thirty-two patients with RA were included (61 ± 9 years, 59.4% male). The baseline hs-cTnT concentration was 10.9 ng/L (95% confidence interval: 9.1 to 13.0 ng/L). The hs-cTnT collected 3 hours after the AAES was 11.1 ng/L (95% confidence interval: 9.1 to 13.5 ng/L). No difference occurred in hs-cTnT before and after AAES (p = 0.657). CONCLUSIONS: A single AAES performed at the angina threshold with corresponding visual pain scale did not alter hs-cTnT in patients with RA, suggesting that no significant myocardial injury was elicited by exercising and that this exercise protocol can be considered safe.

FUNDAMENTO: Não está claro se o exercício é seguro em pacientes com formas mais avançadas de doença arterial coronariana, como aqueles com angina refratária (AR). OBJETIVO: Visamos determinar o efeito de uma sessão de exercício aeróbico agudo (SEAA) nos níveis de troponina T cardíaca de alta sensibilidade (TnT-as) em pacientes com AR. MÉTODOS: Trata-se de um estudo clínico longitudinal, não randomizado e não controlado. Os participantes foram recrutados de abril de 2015 a janeiro de 2019. Em uma escala visual de dor de 0 a 10, a dor classificada até 3 foi considerada como o nível máximo permitido para continuar o exercício. Avaliamos TnT-as na linha de base e 3 horas após a SEAA. O protocolo consistiu em 5 minutos de aquecimento, 30 minutos de exercício aeróbico contínuo na frequência cardíaca correspondente ao limiar anaeróbio ou limiar de angina obtido no teste de esforço cardiopulmonar e 5 minutos de resfriamento. Foram considerados estatisticamente significativos valores de p menores que 0,05. RESULTADOS: Foram incluídos 32 pacientes com AR (61 ± 9 anos, 59,4% do sexo masculino). A concentração basal de TnT-as foi de 10,9 ng/L (intervalo de confiança de 95%: 9,1 a 13,0 ng/L). A TnT-as coletada 3 horas após a SEAA foi de 11,1 ng/L (intervalo de confiança de 95%: 9,1 a 13,5 ng/L). Nenhuma diferença ocorreu na TnT-as antes e após a SEAA (p = 0,657). CONCLUSÕES: Uma única SEAA realizada no limiar de angina com correspondente escala visual de dor não alterou a TnT-as em pacientes com AR, sugerindo que nenhuma lesão miocárdica significativa foi provocada pelo exercício e que este protocolo de exercício pode ser considerado seguro.

Ocorre Lesão Miocárdica após uma Sessão de Exercício Aeróbico Agudo em Pacientes com Angina Refratária? / Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina?

Resumo Fundamento Não está claro se o exercício é seguro em pacientes com formas mais avançadas de doença arterial coronariana, como aqueles com angina refratária (AR). Objetivo Visamos determinar o efeito de uma sessão de exercício aeróbico agudo (SEAA) nos níveis de troponina T cardíaca de alta sensibilidade (TnT-as) em pacientes com AR. Métodos Trata-se de um estudo clínico longitudinal, não randomizado e não controlado. Os participantes foram recrutados de abril de 2015 a janeiro de 2019. Em uma escala visual de dor de 0 a 10, a dor classificada até 3 foi considerada como o nível máximo permitido para continuar o exercício. Avaliamos TnT-as na linha de base e 3 horas após a SEAA. O protocolo consistiu em 5 minutos de aquecimento, 30 minutos de exercício aeróbico contínuo na frequência cardíaca correspondente ao limiar anaeróbio ou limiar de angina obtido no teste de esforço cardiopulmonar e 5 minutos de resfriamento. Foram considerados estatisticamente significativos valores de p menores que 0,05. Resultados Foram incluídos 32 pacientes com AR (61 ± 9 anos, 59,4% do sexo masculino). A concentração basal de TnT-as foi de 10,9 ng/L (intervalo de confiança de 95%: 9,1 a 13,0 ng/L). A TnT-as coletada 3 horas após a SEAA foi de 11,1 ng/L (intervalo de confiança de 95%: 9,1 a 13,5 ng/L). Nenhuma diferença ocorreu na TnT-as antes e após a SEAA (p = 0,657). Conclusões Uma única SEAA realizada no limiar de angina com correspondente escala visual de dor não alterou a TnT-as em pacientes com AR, sugerindo que nenhuma lesão miocárdica significativa foi provocada pelo exercício e que este protocolo de exercício pode ser considerado seguro.

Abstract Background It is unclear whether exercise is safe in patients with more advanced forms of coronary artery disease, such as those with refractory angina (RA). Objective We aimed to determine the effect of an acute aerobic exercise session (AAES) on high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with RA. Methods This was a longitudinal, non-randomized, and non-controlled clinical study. Participants were recruited from April 2015 to January 2019. On a visual pain scale from 0 to 10, pain rated up to 3 was considered as the top level allowed to continue exercising. We assessed hs-cTnT at baseline and 3 hours after the AAES. The protocol consisted of 5 minutes of warm-up, 30 minutes of continuous aerobic exercise at heart rate corresponding to the anaerobic threshold or angina threshold obtained in the cardiopulmonary exercise testing, and 5 minutes of cooling down. P values less than 0.05 were considered statistically significant. Results Thirty-two patients with RA were included (61 ± 9 years, 59.4% male). The baseline hs-cTnT concentration was 10.9 ng/L (95% confidence interval: 9.1 to 13.0 ng/L). The hs-cTnT collected 3 hours after the AAES was 11.1 ng/L (95% confidence interval: 9.1 to 13.5 ng/L). No difference occurred in hs-cTnT before and after AAES (p = 0.657). Conclusions A single AAES performed at the angina threshold with corresponding visual pain scale did not alter hs-cTnT in patients with RA, suggesting that no significant myocardial injury was elicited by exercising and that this exercise protocol can be considered safe.

Barriers to enrollment in pulmonary rehabilitation: medical knowledge analysis.

OBJECTIVE: To assess clinicians' knowledge about pulmonary rehabilitation, and identify the barriers faced when referring patients with health insurance to pulmonary rehabilitation. METHODS: This was a survey-based cross-sectional study conducted in 2019, at a private reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: internal medicine, geriatrics, cardiology, pulmonology or thoracic surgery. RESULTS: We collected 72 responses, and 99% of participants recognized chronic obstructive pulmonary disease as a potential indication for pulmonary rehabilitation; less often (75%), they listed interstitial lung disease, bronchiectasis and pulmonary hypertension. Most participants (67%) incorrectly associated pulmonary rehabilitation with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended pulmonary rehabilitation only to patients on supplemental oxygen and 14% prescribed only home physical therapy, patterns more commonly seen among non-respiratory physicians. The three most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to pulmonary rehabilitation center (63%) and lack of social support (29%). CONCLUSION: Financial, logistic and social constraints pose challenges to pulmonary rehabilitation enrollment, even for patients with premium healthcare insurance. Moreover, physician knowledge gaps may be an additional barrier to pulmonary rehabilitation referral and adherence. Providing continued medical education, incorporating automatic reminders in electronic medical records, and using telerehabilitation tools may improve pulmonary rehabilitation referral, adherence, and ultimately, patient care.

Barriers to enrollment in pulmonary rehabilitation: medical knowledge analysis / Barreiras à inclusão na reabilitação pulmonar: análise do conhecimento médico

ABSTRACT Objective To assess clinicians' knowledge about pulmonary rehabilitation, and identify the barriers faced when referring patients with health insurance to pulmonary rehabilitation. Methods This was a survey-based cross-sectional study conducted in 2019, at a private reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: internal medicine, geriatrics, cardiology, pulmonology or thoracic surgery. Results We collected 72 responses, and 99% of participants recognized chronic obstructive pulmonary disease as a potential indication for pulmonary rehabilitation; less often (75%), they listed interstitial lung disease, bronchiectasis and pulmonary hypertension. Most participants (67%) incorrectly associated pulmonary rehabilitation with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended pulmonary rehabilitation only to patients on supplemental oxygen and 14% prescribed only home physical therapy, patterns more commonly seen among non-respiratory physicians. The three most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to pulmonary rehabilitation center (63%) and lack of social support (29%). Conclusion Financial, logistic and social constraints pose challenges to pulmonary rehabilitation enrollment, even for patients with premium healthcare insurance. Moreover, physician knowledge gaps may be an additional barrier to pulmonary rehabilitation referral and adherence. Providing continued medical education, incorporating automatic reminders in electronic medical records, and using telerehabilitation tools may improve pulmonary rehabilitation referral, adherence, and ultimately, patient care.

RESUMO Objetivo Avaliar o conhecimento dos médicos sobre reabilitação pulmonar e identificar as barreiras que eles encontram ao encaminhar pacientes com seguro saúde para reabilitação pulmonar. Métodos Trata-se de estudo transversal com uso de questionário, realizado em 2019, em um hospital privado de referência em São Paulo. Os participantes elegíveis eram médicos registrados nas seguintes especialidades: clínica médica, geriatria, cardiologia, pneumologia ou cirurgia torácica. Resultados Foram coletadas 72 respostas, e 99% dos participantes reconheceram doença pulmonar obstrutiva crônica como possível indicação para reabilitação pulmonar; com menor frequência (75%), listaram doença pulmonar intersticial, bronquiectasia e hipertensão pulmonar. A maioria dos participantes (67%) associou incorretamente a reabilitação pulmonar à melhora da função pulmonar, ao passo que 28% dos cardiologistas e 35% dos clínicos/geriatras deixaram de reconhecer os benefícios nos transtornos de humor. Notavelmente, 18% dos participantes somente recomendaram reabilitação pulmonar para pacientes em uso de oxigênio suplementar, e 14% prescreveram apenas fisioterapia domiciliar, padrão mais comumente visto entre médicos que não são especialistas em transtornos respiratórios. As três barreiras mais percebidas para encaminhamento e adesão foram cobertura de seguro saúde (79%), transporte para centro de reabilitação pulmonar (63%) e falta de apoio social (29%). Conclusão Restrições financeiras, logísticas e sociais representam desafios para a inclusão na reabilitação pulmonar, mesmo para pacientes com planos de seguro de saúde da categoria premium. Além disso, as lacunas de conhecimento dos médicos podem ser uma barreira adicional para o encaminhamento e a aceitação da reabilitação pulmonar. Educação médica continuada, lembretes automáticos nos prontuários eletrônicos e ferramentas de telerreabilitação podem melhorar o encaminhamento para reabilitação pulmonar, a adesão e, por fim, o atendimento ao paciente.

Diretriz Brasileira de Reabilitação Cardiovascular ­ 2020 / Brazilian Cardiovascular Rehabilitation Guideline - 2020

INTRODUÇÃO: Está cientificamente comprovado, sendo algo incorporado ao senso comum, que ser fisicamente ativo contribui para preservar e recuperar a boa saúde do corpo e da mente. Os efeitos favoráveis da reabilitação cardiovascular (RCV) com ênfase nos exercícios físicos têm sido consistentemente documentados, inclusive em meta-análises de estudos clínicos randomizados, que demonstram significativas reduções da morbimortalidade cardiovascular e global,1 bem como da taxa de hospitalização,1,2 com expressivo ganho de qualidade de vida,1,2 justificando a sua consensual e enfática recomendação pelas principais sociedades médicas mundiais.3-6 O sedentarismo, que apresenta elevada prevalência no Brasil e no mundo, está fortemente relacionado às doenças cardiovasculares (DCV) e à mortalidade precoce.7,8 Em contrapartida, maiores volumes de atividade física são positivamente associados à melhor qualidade e à maior expectativa de vida,9-13 existindo uma forte e inversa associação dos diferentes componentes da aptidão física com a mortalidade por todas as causas e com a ocorrência de eventos cardiovasculares desfavoráveis. Ou seja, quanto menor o nível de aptidão física, maior tende ser a taxa de mortalidade.14-21 Portanto, o principal objetivo da RCV com ênfase nos exercícios físicos é propiciar uma melhora dos componentes da aptidão física, tanto aeróbico quanto não aeróbicos (força/ potência muscular, flexibilidade, equilíbrio), algo que exige a combinação de diferentes modalidades de treinamento. Assim, a RCV deve proporcionar os mais elevados níveis de aptidão física passíveis de obtenção, de modo a reduzir o risco de eventos cardiovasculares e promover todos os outros benefícios a serem auferidos pela prática regular de exercícios físicos, culminando com a redução da mortalidade geral.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals.

OBJECTIVE: To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. METHODS: The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. RESULTS: Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). CONCLUSION: Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals / Associação entre capacidade respiratória, qualidade de vida e cognição em idosos

ABSTRACT Objective To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. Methods The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. Results Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). Conclusion Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

RESUMO Objetivo Investigar a associação entre capacidade respiratória, qualidade de vida e função cognitiva em idosos. Métodos A amostra incluiu 386 idosos (232 mulheres). A capacidade respiratória foi avaliada pela pressão expiratória máxima obtida no pico de fluxo expiratório. Com base nos resultados máximos de fluxo expiratório, os indivíduos foram classificados de acordo com o valor previsto para sexo, idade e estatura em capacidade respiratória normal (curva de fluxo expiratório de pico inferior a 80% e superior a 60%) ou capacidade respiratória reduzida (curva de fluxo expiratório de pico menor que 60%). O questionário World Health Organization Quality of Life e o Miniexame do Estado Mental foram utilizados para avaliar a qualidade de vida e a função cognitiva, respectivamente. Resultados Em comparação com mulheres idosas com capacidade respiratória normal, as pessoas com capacidade respiratória reduzida apresentaram escores mais baixos para o Miniexame do Estado Mental (p=0,048) e qualidade de vida (p=0,040). Nos homens, não foram observadas diferenças (p>0,05). Conclusão Capacidade respiratória reduzida foi associada à pior qualidade de vida e à função cognitiva em mulheres idosas. Essas associações não foram observadas em idosos do sexo masculino.