Heart failure worsens leg muscle strength and endurance in coexistence patients with COPD and heart failure reduced ejection fraction.

Purpose: Exercise intolerance and dyspnoea are clinical symptoms in both heart failure (HF) reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD), which are suggested to be associated with musculoskeletal dysfunction. We tested the hypothesis that HFrEF + COPD patients would present lower muscle strength and greater fatigue compared to compared to the COPD group. Methods: We included 25 patients with HFrEF + COPD (100% male, age 67.8 ± 6.9) and 25 patients with COPD alone (100% male, age 66.1 ± 9.1). In both groups, COPD severity was determined as moderate-to-severe according to the GOLD classification (FEV1/FVC < 0.7 and predicted post-bronchodilator FEV1 between 30%-80%). Knee flexor-extensor muscle performance (torque, work, power and fatigue) were measured by isokinetic dynamometry in age and sex-matched patients with HFrEF + COPD and COPD alone; Functional capacity was assessed by the cardiopulmonary exercise test, the 6-min walk test (6MWT) and the four-minute step test. Results: The COPD group exhibited reduced lung function compared to the HFrEF + COPD group, as evidenced by lower FEV1/FVC (58.0 ± 4.0 vs. 65.5 ± 13.9; p < 0.0001, respectively) and FEV1 (51.3 ± 17.0 vs. 62.5 ± 17.4; p = 0.026, respectively) values. Regarding musculoskeletal function, the HFrEF + COPD group showed a knee flexor muscles impairment, however this fact was not observed in the knee extensors muscles. Power peak of the knee flexor corrected by muscle mass was significantly correlated with the 6MWT (r = 0.40; p < 0.05), number of steps (r = 0.30; p < 0.05) and work ratepeak (r = 0.40; p < 0.05) in the HFrEF + COPD and COPD groups. Conclusion: The presence of HFrEF in patients with COPD worsens muscular weakness when compared to isolated COPD.

Noninvasive Ventilation Accelerates Oxygen Uptake Recovery Kinetics in Patients With Combined Heart Failure and Chronic Obstructive Pulmonary Disease.

PURPOSE: Oxygen uptake (V˙o2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V˙o2, heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD. METHODS: Nineteen males (10 HF/9 age- and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (Tlim), receiving either sham ventilation or NIPPV. RESULTS: Despite greater V˙o2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4 ± 14.0 sec vs 62.8 ± 15.2 sec, P < .05) and mean response time (MRT) (86.1 ± 19.1 sec vs 68.8 ± 12.0 sec, P < .05) with NIPPV and greater ΔNIPPV-sham (τ: 5.6 ± 19.5 vs -25.2 ± 22.4, P < .05; MRT: 4.1 ± 32.2 vs -26.0 ± 19.2, P < .05) compared with HF. There was no difference regarding Tlim between sham and NIPPV in both groups (P < .05). CONCLUSION: Our results suggest that NIPPV accelerated the V˙o2 recovery kinetics following high-intensity CLE to a greater extent in patients with coexisting HF and COPD compared with HF alone. NIPPV should be considered when the objective is to apply high-intensity interval exercise training as an adjunct intervention during a cardiopulmonary rehabilitation program.

Oxygen supplementation increases the total work and muscle damage markers but reduces the inflammatory response in COPD patients.

INTRODUCTION: Oxygen supplementation (O2-Suppl) is recommended for pulmonary rehabilitation with higher exercise intensities. However, high-intensity exercise tends toward muscle damage and a greater inflammatory response. We aimed to investigate the effect of O2-Suppl during exercise test (EET) on CRP level and muscle damage (CPK, LDH, lactate) in non-hypoxemic COPD patients. METHODS: Eleven non-depleted patients with COPD (FEV1 65.5 ± 4.3 %) performed two EET (room-air or O2-Suppl-100 %), through a blind, randomized, and placebo-controlled crossover design. CPK, LDH and CRP were measured before, immediately after and 24 h after EET. RESULTS: Exercise time was higher with O2-Suppl (49.9 ± 37.3 %; p = 0.001) and increases in CPK and LDH were observed compared to basal values in the O2-Suppl (28.4UI/L and 28.3 UI/L). The O2-Suppl protocol resulted in a lower increase in CRP (92.1 ± 112.4 % vs. 400.1 ± 384.9 %; p = 0.003). CONCLUSIONS: O2-Suppl increases exercise-tolerance, resulting in increased muscle injury markers in COPD. However, oxygen supplementation attenuates the inflammatory response, even upon increased physical exercise.

The relationship between heart rate and VO2 in moderate-to-severe asthmatics.

Objective: The main purpose of this study was to evaluate whether the %HRR-%VO2R relationship and %HRR-VO2peak relationship are affected in patients with moderate or severe asthma and whether airway obstruction and aerobic capacity influence these relationships.Methods: A linear regression was calculated using the paired %VO2R-%HRR and %VO2peak-%HRR for 93 subjects with asthma. The mean slope and y-intercept were calculated and compared with the line of identity (y-intercept = 0, slope = 1) for all patients and subgroups for the following conditions: low and normal VO2peak and low and normal FEV1.Results: The slope and intercepts of %VO2R-%HRR were similar to the line of identity for all groups (p > 0.05), and the regressions between %HRR and %VO2peak did not coincide with the line of identity for all groups (p < 0.05). There were no associations between the intercepts of the %HRR-VO2peak and the %HRR-%VO2R relationship with the VO2peak (p > 0.05) or FEV1 (p > 0.05).Conclusions: This is the first study to confirm a constant equivalence between %HRR and %VO2R in outpatients with moderate or severe asthma. Our data also suggest that the relationship between %HRR and %VO2peak is unreliable. These results support the use of %HRR in relation to %VO2R to estimate exercise intensity in this population, independently of the pulmonary function and fitness level.

Efeito agudo do salbutamol no sistema cardiovascular durante o exercício físico em pacientes com asma moderada ou grave: estudo aleatorizado, duplo-cego e cruzado / Efecto agudo del salbutamol en el sistema cardiovascular durante el ejercicio físico en pacientes con asma moderada o grave: estudio aleatorizado, doble ciego y cruzado / Acute effect of salbutamol on the cardiovascular system during exercise in patients with moderate or severe asthma: a randomized, double-blind, and cross-over study

RESUMO Salbutamol é um β2-agonista de curta duração frequentemente utilizado em pacientes com asma para prevenir os sintomas durante ou após exercício físico. Alterações hemodinâmicas em repouso estão bem descritas. Contudo são escassos os dados sobre os efeitos na frequência cardíaca (FC) e pressão arterial (PA) durante o exercício e na fase de recuperação em pacientes com asma moderada ou grave. Foi realizado um estudo aleatorizado, duplo-cego e cruzado, em que foram inclusos 15 indivíduos com asma moderada e grave, com média de idade de 46,4±9,3 anos. Os pacientes realizaram um teste de esforço máximo em dois dias não consecutivos, com administração de 400mcg de salbutamol ou 4 "puffs" de placebo. Durante todo o protocolo foi monitorada a FC, a PA, a percepção de esforço e o pico de fluxo expiratório (PFE). Após o uso do salbutamol, o valor do PFE aumentou em média de 28,0±47,7L/m, permanecendo maior nos tempos de 5, 10 e 15 minutos de recuperação passiva em relação ao placebo (p<0,05). As variáveis FC, PA e percepção de esforço foram semelhantes entre as intervenções em todas as fases do protocolo (p>0,05). Esses resultados sugerem que o uso de salbutamol é seguro, e que a FC não necessita de ser ajustada para prescrever a intensidade do exercício após a administração de salbutamol em indivíduos com asma moderada ou grave.

RESUMEN Salbutamol es un agonista β2 de corta duración frecuentemente utilizado en pacientes con asma para prevenir los síntomas durante o después del ejercicio físico. Los cambios hemodinámicos en descanso están bien descritos. Sin embargo, son escasos los datos sobre los efectos en la frecuencia cardíaca (FC) y la presión arterial (PA) durante el ejercicio y en la fase de recuperación en pacientes con asma moderada o grave. Se realizó un estudio aleatorizado, doble ciego y cruzado, donde fueron incluidos 15 individuos con asma moderada y grave, con una media de edad de 46,4 ± 9,3 años. Los pacientes realizaron una prueba de esfuerzo máximo en 2 días no consecutivos, con administración de 400mcg de salbutamol o 4 «puffs¼ de placebo. Durante el protocolo se supervisaron la FC, PA, percibe el esfuerzo y el Pico flujo espiratorio (PEF). Después del uso del salbutamol, el valor del PFE aumentó en promedio de 28,0 ± 47,7 L/m, permaneciendo mayor en los tiempos 5, 10 y 15 minutos de recuperación pasiva con relación al placebo (p < 0,05). Las variables FC, PA y percepción de esfuerzo fueron similares entre las intervenciones en todas las etapas del protocolo (p > 0,05). Los resultados sugieren que el uso de salbutamol es seguro y que la FC no necesita ser ajustada para prescribir la intensidad del ejercicio después de la administración de salbutamol en individuos con asma moderada o grave.

ABSTRACT Salbutamol is a β2-agonist of short duration commonly used in patients with asthma to prevent symptoms during or after exercise. Hemodynamic changes at rest are well described. However, there is little data on the effects on heart rate (HR) and blood pressure (BP) during exercise and recovery phase in patients with moderate or severe asthma A randomized, double-blind, cross-over study was conducted, including 15 individuals with moderate and severe asthma, mean age 46.4±9.3 years. Patients underwent a maximal 2-day exercise test with 400 mcg salbutamol or 4 placebo puffs. Throughout the protocol, HR, BP, perceived exertion and peak of expiratory flow (PEF) were monitored. After the use of salbutamol, the PEF value increased by a mean of 28.0±47.7L/m, remaining increased at 5, 10 and 15 minutes of passive recovery compared to placebo (p<0.05). The HR, BP and effort perception variables were similar across interventions at all stages of the protocol (p>0.05). These results suggest that the use of salbutamol is safe and that HR does not need to be adjusted to prescribe exercise intensity following salbutamol administration in subjects with moderate or severe asthma.

Are heart rate dynamics in the transition from rest to submaximal exercise related to maximal cardiorespiratory responses in COPD?

BACKGROUND: Poor exercise capacity is an important negative prognostic marker in patients with chronic obstructive pulmonary disease (COPD). Heart rate variability (HRV) responses can indicate alterations in cardiac autonomic control. Nevertheless, it remains unclear whether these abnormalities are related to cardiorespiratory responses to exercise in these patients. OBJECTIVE: To evaluate whether HRV at rest and submaximal exercise are related to impaired cardiopulmonary responses to exercise in COPD patients. METHODS: Fifteen men (66.2±8.7 years) with COPD (FEV1: 55.1±19.2%) were assessed. The R-R interval (RRi) data collection was performed at rest (stand position) and during the six-minute walk test (6MWT). All patients performed a symptom-limited cardiopulmonary exercise test on a cycle ergometer. The HRV changes from rest to submaximal exercise (Δ rest-6MWT) were calculated. RESULTS: We found significant correlations between low frequency (LF) and high frequency (HF) Δ rest-6MWT with Δ oxyhemoglobin saturation by pulse oximetry (r=-0.64 and r=0.65, respectively; p<0.05), minute ventilation/carbon dioxide output relationship from beginning to peak exercise (r=-0.52 and r=0.53, p<0.05), and exercise ventilatory power (r=0.52 and r=-0.53, p<0.05). Interestingly, there was a strong positive correlation (r=0.82, p<0.05) between six-minute walk distance (6MWD) and Δ LF/HF from rest to exercise. CONCLUSION: HRV analysis in the transition from rest to submaximal exercise is associated with exercise ventilatory and hemodynamic abnormalities in COPD patients. Rehabilitative strategies to improve HRV responses may provide an important tool to clinical practice in these patients.

Effect of salbutamol on the cardiovascular response in healthy subjects at rest, during physical exercise, and in recovery phase: a randomized, double-blind, crossover study

Aim: To evaluate the effect of the short-acting beta agonists (SABAs) salbutamol on cardiovascular response rest, exercise and recovery phase. Methods: This study was conducted as a randomized, double-blind, placebo controlled, crossover study in 15 healthy adults, with a mean age of 30.2±6.6 years. Participants underwent a maximal effort test on two non-consecutive days with 400 mcg of salbutamol or placebo. Throughout the protocol, the variables HR, blood pressure (BP), perceived rate of effort (modified Borg scale) and peak expiratory flow (PEF) were monitored. After salbutamol, baseline HR and PEF had increase from 71±8 to 80±11 bpm (p<0.05) and 454.0±64.5 to 475.3±71.4 L/min (p < 0.05), respectively. The variables HR, BP and Borg were similar between interventions during all the protocol phases (p>0.05). Conclusion: Administration of salbutamol increased rest heart rate; however, did not change heart rate, blood pressure and perceived exertion during exercise or recovery. This suggests that the salbutamol administration is safe and does not affect exercise intensity prescription in healthy subjects.(AU)

Microvascular oxygen extraction during maximal isometric contraction in patients with chronic obstructive pulmonary disease / Extração microvascular de oxigênio durante contração isométrica máxima em pacientes com DPOC não hipoxêmicos

Abstract Introduction: COPD presents decrease in oxidative metabolism with possible losses of cardiovascular adjustments, suggesting slow kinetics microvascular oxygen during intense exercise. Objective: To test the hypothesis that chronic obstructive pulmonary disease (COPD) patients have lower muscle performance in physical exercise not dependent on central factors, but also greater muscle oxygen extraction, regardless of muscle mass. Methods: Cross-sectional study with 11 COPD patients and nine healthy subjects, male, paired for age. Spirometry and body composition by DEXA were evaluated. Muscular performance was assessed by maximal voluntary isometric contraction (MVIC) in isokinetic dynamometer and muscle oxygen extraction by the NIRS technique. Student t-test and Pearson correlation were applied. A significance level of p<0.05 was adopted. Results: Patients had moderate to severe COPD (FEV1 = 44.5 ± 9.6% predicted; SpO2 = 94.6 ± 1.6%). Lean leg mass was 8.3 ± 0.9 vs. 8.9 ± 1.0 kg (p =0.033), when comparing COPD and control patients, respectively. The decreased muscle oxygen saturation corrected by muscle mass was 53.2% higher (p=0.044) in the COPD group in MVIC-1 and 149.6% higher (p=0.006) in the MVIC-2. Microvascular extraction rate of oxygen corrected by muscle mass and total work was found to be 114.5% higher (p=0.043) in the COPD group in MVIC-1 and 210.5% higher (p=0.015) in the MVIC-2. Conclusion: COPD patients have low muscle performance and high oxygen extraction per muscle mass unit and per unit of work. The high oxygen extraction suggests that quantitative and qualitative mechanisms can be determinants of muscle performance in patients with COPD.

Resumo Introdução: DPOC (doença pulmonar obstrutiva crônica) apresenta diminuição no metabolismo oxidativo com prejuízos dos ajustes cardiovasculares, sugerindo cinética de oxigênio microvascular lenta durante exercício intenso. Objetivo: Testar hipótese que pacientes com DPOC apresentam não só menor performance muscular em exercício físico não dependente dos fatores centrais, mas também maior extração muscular de O2 independentemente da massa muscular. Métodos: Estudo transversal, 11 pacientes DPOC e 9 indivíduos saudáveis, gênero masculino, pareados pela idade. Avaliado espirometria, composição corporal, performance muscular por contração isométrica voluntária máxima (CIVM) em dinamometria isocinética e extração muscular de oxigênio pela técnica de NIRS. Teste t-Student e correlação de Pearson foram aplicados. Adotado p<0,05 como nível de significância. Resultados: Pacientes com DPOC moderado para grave (VEF1 = 44,5 ± 9,6 % predito; SpO2 = 94,6 ± 1,6 %). Massa magra do membro inferior foi de 8,3 ± 0,9 vs. 8,9 ± 1,0 Kg (p= ,033), comparando DPOC e controle respectivamente. A redução saturação muscular de O2 corrigido pela massa muscular foi 53,2 % maior (p=0,044) no grupo DPOC na CIVM-1 e 149,6% maior (p=0,006) na CIVM-2. A taxa de extração microvascular de O2 corrigida pela massa muscular e trabalho total apresentou-se 114,5% maior (p=0,043) no grupo DPOC na CIVM-1 e 210,5% maior (p= 0,015) na CIVM-2. Conclusão: Pacientes com DPOC apresentam baixa performance muscular e alta extração de O2 por unidade de massa muscular e por unidade de trabalho. A elevada extração de O2 sugere que mecanismos quantitativos e qualitativos podem ser determinantes da performance muscular em pacientes com DPOC.

High oxygen extraction and slow recovery of muscle deoxygenation kinetics after neuromuscular electrical stimulation in COPD patients.

PURPOSE: It was hypothesized that patients with chronic obstructive pulmonary disease (COPD) would exhibit a slow muscle deoxygenation (HHb) recovery time when compared with sedentary controls. METHODS: Neuromuscular electrical stimulation (NMES 40 and 50 mA, 50 Hz, 400 µs) was employed to induce isometric contraction of the quadriceps. Microvascular oxygen extraction (µO2EF) and HHb were estimated by near-infrared spectroscopy (NIRS). Recovery kinetic was characterized by measuring the time constant Tau (HHb-τ). Torque and work were measured by isokinetic dynamometry in 13 non-hypoxaemic patients with moderate-to-severe COPD [SpO2 = 94.1 ± 1.6 %; FEV1 (% predict) 48.0 ± 9.6; GOLD II-III] and 13 age- and sex-matched sedentary controls. RESULTS: There was no desaturation in either group during NMES. Torque and work were reduced in COPD versus control for 40 and 50 mA [torque (Nm) 50 mA = 28.9 ± 6.9 vs 46.1 ± 14.2; work (J) 50 mA = 437.2 ± 130.0 vs. 608.3 ± 136.8; P < 0.05 for all]. High µO2EF values were observed in the COPD group at both NMES intensities (corrected by muscle mass 50 mA = 6.18 ± 1.1 vs. 4.68 ± 1.0 %/kg; corrected by work 50 mA = 0.12 ± 0.05 vs. 0.07 ± 0.02 %/J; P < 0.05 for all). Absolute values of HHb-τ (50 mA = 31.11 ± 9.27 vs. 18.08 ± 10.70 s), corrected for muscle mass (50 mA 3.80 ± 1.28 vs. 2.05 ± 1.45 s/kg) and corrected for work (50 mA = 0.08 ± 0.04 vs. 0.03 ± 0.02 s/J) were reduced in COPD (P < 0.05 for all). The variables behaviour for 40 mA was similar to those of 50 mA. CONCLUSIONS: COPD patients exhibited a slower muscle deoxygenation recovery time after NMES. The absence of desaturation, low torque and work, high µO2EF and high values for recovery time corrected by muscle mass and work suggest that intrinsic muscle dysfunction has an impact on muscle recovery capacity.

Relationship between linear and nonlinear dynamics of heart rate and impairment of lung function in COPD patients.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), functional and structural impairment of lung function can negatively impact heart rate variability (HRV); however, it is unknown if static lung volumes and lung diffusion capacity negatively impacts HRV responses. We investigated whether impairment of static lung volumes and lung diffusion capacity could be related to HRV indices in patients with moderate to severe COPD. METHODS: Sixteen sedentary males with COPD were enrolled in this study. Resting blood gases, static lung volumes, and lung diffusion capacity for carbon monoxide (DLCO) were measured. The RR interval (RRi) was registered in the supine, standing, and seated positions (10 minutes each) and during 4 minutes of a respiratory sinus arrhythmia maneuver (M-RSA). Delta changes (Δsupine-standing and Δsupine-M-RSA) of the standard deviation of normal RRi, low frequency (LF, normalized units [nu]) and high frequency (HF [nu]), SD1, SD2, alpha1, alpha2, and approximate entropy (ApEn) indices were calculated. RESULTS: HF, LF, SD1, SD2, and alpha1 deltas significantly correlated with forced expiratory volume in 1 second, DLCO, airway resistance, residual volume, inspiratory capacity/total lung capacity ratio, and residual volume/total lung capacity ratio. Significant and moderate associations were also observed between LF/HF ratio versus total gas volume (%), r=0.53; LF/HF ratio versus residual volume, %, r=0.52; and HF versus total gas volume (%), r=-0.53 (P<0.05). Linear regression analysis revealed that ΔRRi supine-M-RSA was independently related to DLCO (r=-0.77, r (2)=0.43, P<0.05). CONCLUSION: Responses of HRV indices were more prominent during M-RSA in moderate to severe COPD. Moreover, greater lung function impairment was related to poorer heart rate dynamics. Finally, impaired lung diffusion capacity was related to an altered parasympathetic response in these patients.

Lesão muscular induzida por eletroestimulação neuromuscular (EENM) com frequências de 30 Hz e 100 Hz / Muscle damage induced by neuromuscular electrical stimulation (NMES) with frequencies of 30 Hz and 100 Hz

A eletroestimulação-neuromuscular (EENM) é a ação de estímulos elétricos terapêuticos sobre o tecido muscular, visando a contração muscular e consequentemente a melhora dos status muscular. Objetivo: Avaliar a lesão muscular decorrente da contração muscular isométrica induzida por meio da EENM de baixa frequência (30 Hz) e de alta frequência (100 Hz). Métodos: Estudo experimental tipo Cross-over, randomizado e não cego. Participaram do estudo 10 universitários voluntários, gênero masculino, idade de 24,4 ± 6,0 anos, peso de 77,1 ± 11,8 kg, altura de 176,1 ± 5,6 cm e IMC de 24,8 ± 3,4 kg/m2. Dois protocolos (A) e (B) com intervalo de 7 dias entre eles. (A) - 20 minutos de EENM no quadríceps com frequência de 30 Hz. (B) - 20 minutos de EENM com frequência de 100 Hz. Analisado lactato, creatinafosfoquinase e desidrogenase láctica antes, imediatamente após, 6h e 48h após os protocolos. Resultados: Comparando 30 Hz vs. 100 Hz observou-se: lactato (23,7 ± 6,7 vs. 13,4 ± 3,0 mg/dL, p = 0,001); CPK (195,4 ± 116,1 vs. 262,9 ± 153,6 UI, p = 0,022); DHL (374,3 ± 64 vs. 366,6 ± 84,1 UI, ns). A percepção de eficiência contrátil diminuiu significativamente (p = 0,016) no protocolo com 100 Hz. Conclusão: Tanto a EENM de baixa frequência (30 Hz) quanto de alta frequência (100 Hz) elevam os marcadores sanguíneos de lesão muscular, sendo esta elevação, ainda mais acentuada na alta frequência. Entretanto os valores alcançados refletem uma resposta normal para um exercício de moderada intensidade

Neuromuscular electrical stimulation (NMES) is the action of therapeutic electrical stimulation on muscle tissue in order to contract the muscle and consequently improve the muscle status. Objective: To evaluate the muscle damage stemming from isometric muscle contraction induced by NMES of low frequency (30 Hz) and high frequency (100 Hz). Methods: Experimental crossover study, randomized, unblinded. The study included 10 male college students, age 24.4 ± 6.0 years, weight 77.1 ± 11.8 kg, height 176.1 ± 5.6 cm, and BMI of 24.8 ± 3 4 kg/m2. Two protocols (A) and (B) with an interval of 7 days between them. (A) - 20 minutes of NMES in the quadriceps at a frequency of 30 Hz (B) - 20 minutes of NMES at a frequency of 100 Hz. Measured lactate, creatine phosphokinase and lactate dehydrogenase before, immediately after, and 6 and 48 hours after the protocols. Results: Comparing 30 Hz vs. 100 Hz the following were observed: lactate (23.7 ± 6.7 vs. 13.4 ± 3.0 mg/dl, p = 0.001); CPK (195.4 ± 116.1 vs. 262.9 ± 153.6 IU, p = 0.022); LDH (374.3 ± 64 vs. 366.6 ± 84.1 IU, ns). The perception of contractile efficiency decreased significantly (p = 0.016) in the 100 Hz Protocol. Conclusion: Both the low-frequency NMES (30 Hz) and the high-frequency (100 Hz) elevate blood markers of muscle damage, most strikingly at the higher frequency. However, the achieved values reflect a normal response to a moderate-intensity exercise

Effect of a physical exercise program in a patient with Marfan syndrome and ventricular dysfunction.

Marfan syndrome (MS) is an autosomal dominant disorder that affects multiple organs and systems. Several cardiac alterations are present, with the main ones being aortic root and ascending aorta dilatation, mitral valve prolapse and left ventricle (LV) dilatation. Aerobic exercise has not shown to be a non-drug therapy that promotes anti-remodeling effect in patients with heart failure. This case report describes the echocardiographic changes in a patient with Marfan syndrome during four years of cardiovascular physical therapy.

Efeito de um programa de exercício físico em portador da Síndrome Marfan com disfunção ventricular / Effect of a physical exercise program in a patient with Marfan Syndrome and ventricular dysfunction / Efecto de un programa de ejercicio físico en portador del Síndrome Marfan con disfunción ventricular

A Síndrome de Marfan (SM) é uma desordem autossômica dominante que afeta múltiplos órgãos e sistemas. Diversas alterações cardíacas estão presentes, sendo as principais a dilatação da raiz da aorta e da aorta ascendente, o Prolapso de Valva Mitral e a dilatação do Ventrículo Esquerdo (VE). O exercício aeróbico tem-se mostrado um recurso terapêutico não medicamentoso, por promover efeito de antirremodelamento em pacientes com insuficiência cardíaca. Este relato de caso descreve as alterações ecocardiográficas de um paciente com Síndrome de Marfan durante quatro anos de um programa de fisioterapia cardiovascular.

Marfan syndrome (MS) is an autosomal dominant disorder that affects multiple organs and systems. Several cardiac alterations are present, with the main ones being aortic root and ascending aorta dilatation, mitral valve prolapse and left ventricle (LV) dilatation. Aerobic exercise has not shown to be a non-drug therapy that promotes anti-remodeling effect in patients with heart failure. This case report describes the echocardiographic changes in a patient with Marfan syndrome during four years of cardiovascular physical therapy.

El Síndrome de Marfan (SM) es un desorden autosómico dominante que afecta múltiples órganos y sistemas. Diversas alteraciones cardíacas están presentes, siendo las principales la dilatación de la raíz de la aorta y de la aorta ascendente, el Prolapso de Válvula Mitral y la dilatación del Ventrículo Izquierdo (VI). El ejercicio aeróbico ha mostrado ser un recurso terapéutico no medicamentoso, por promover efecto de antirremodelado en pacientes con insuficiencia cardíaca. Este relato de caso describe las alteraciones ecocardiográficas de un paciente con Síndrome de Marfan durante cuatro años de un programa de fisioterapia cardiovascular.

Lesões no Karate Shotokan e no Jiu-Jitsu: trauma direto versus indireto / Lesions in Shotokan Karate and Jiu-Jitsu: direct trauma versus indirect

INTRODUÇÃO: Artes marciais como Karate e Jiu-Jitsu têm uma origem comum, porém apresentam biomecânica de movimento distintas. O Karate Shotokan tem como principal característica os golpes de impacto, já o Jiu-Jitsu utiliza projeções, estrangulamentos, torções e imobilizações. Estas diferenças poderiam promover diferentes locais de lesão. OBJETIVO: Verificar a frequência de lesões no Karate e no Jiu-Jitsu e comparar estas lesões entre os dois grupos estudados. MÉTODOS: Avaliou-se transversalmente, através de questionário aberto/fechado, 94 atletas dos três níveis de competição: internacional, nacional e estadual. Dados sobre idade de início e tempo de treino também foram avaliados. Para a comparação entre os grupos utilizou-se o teste t de student e o teste do Qui-quadrado. As diferenças foram consideradas significativas quando p < 0,05. RESULTADOS: 148 lesões foram relatadas em uma amostra de 53 Karatecas e 160 lesões em 41 atletas de Jiu-Jitsu. O local de maior incidência de lesão no Karate foram as mãos e dedos (15,5 por cento) e no Jiu-Jitsu foi o joelho (16,3 por cento). Os locais que apresentaram diferenças significativas entre os dois grupos foram: perna (0,042), boca e dentes (0,028), pescoço (0,038), ombro (0,000), cotovelo (0,001), joelho (0,000), tornozelo (0,015), orelha (0,000). CONCLUSÃO: Karate e Jiu-Jitsu apresentam diferenças quanto à frequência e incidência de locais de lesão. Estes achados contribuem para a elaboração de condutas preventivas e terapêuticas específicas a cada esporte.

INTRODUCTION: Karate and Jiu-Jitsu are martial arts sharing a common origin but showing distinct movement biomechanics. The main features of Shotokan karate are the impact blows, whereas Jiu-Jitsu utilizes projections, strangulations, torsions and immobilizations. These differences can provoke different sites of lesion. OBJECTIVE: To verify the frequency of lesions in Karate and Jiu-Jitsu and confront their respective lesions between the two studied groups. METHODS: Ninety-four athletes from three different competitive levels (international, national and state) were transversally evaluated through an open-closed-question questionnaire. Data regarding starting age and period of training were also assessed. The T-Student test and Chi-Square test were applied for the group comparison. Statistically significant differences were considered when p<0,05. RESULTS: 148 lesions were reported from a sample of 53 karate players, and 160 lesions from 41 Jiu-Jitsu athletes. The most frequency site of lesion in karate was the hands and fingers (15.5 percent) and, in Jiu- Jitsu, the knees (16.3 percent). The places which presented significant differences between the two groups were: legs (p=0.042), mouth and teeth (p=0,028), neck (p=0,038), shoulder (p=0,000), elbow (p=0,001), and ear (p=0,000). CONCLUSION: Karate and Jiu-Jitsu show differences as regards frequency and incidence of lesion sites. These findings contribute to the elaboration of specific preventive and therapeutic measures for each sport.

Alterações no segmento ST, freqüência cardíaca, pressão arterial e percepção de esforço durante treino de força, de resistência muscular localizada e isometria entre pacientes pós-infarto agudo do miocárdio pós-treinamento aeróbio / Alterations in the ST segment, heart rate, blood pressure and perception of effort during strength training, located muscular resistance and isometric among patients early after acute myocardial infarction after aerobic training

Objetivo: Verificar as diferenças de PAS/PAD/FC, percepção de esforço e segmento ST durante o treino de força, de resistência muscular localizada (RML) e isometria, em pacientes pós-IAM, treinados e não-treinados. Randomizados dois grupos: controle (NT), 14 pacientes, 53,5 anos, sedentários. Treinado (T), 14 pacientes, 54,2 anos, submetidos a exercícios aeróbios durante 1 mês, 3/semana, 30minutos. Avaliados: Segmento ST e FC, PAS/PAD, oximetria e ipeBorg nos momentos A,B,C,D. A) 4 repetições 80 por cento 1RM extensão de joelho, B) 15 repetições 50 por cento 1RM extensão de joelho, (C) 4 repetições 80 por cento 1RM flexão de cotovelo, D) isometria de 40 seg em flexão de cotovelo 80 por cento 1RM e Teste Ergométrico. ANOVA, post-hoc de Tukey’s e o teste Chi-square. Nível de significância p < 0,05. Resultados: Segmento ST e oximetria sem alterações. PAS/PAD/FC do grupo NT apresentou médias superiores ao do grupo T nas situações C,D. Conclusão: Treinamento de força e de RML foram seguros para infartados sedentários e treinados. Exercícios de RML apresentam maiores valores de PAS/PAD/FC em relação aos exercícios de força. Exercícios com membros superiores apresentaram maiores respostas de PAS/PAD/FC em infartados treinados ou não. A ausência de um treinamento aeróbio não foi contra-indicação para os exercícios resistidos, exercícios isométricos entram numa faixa de risco para pacientes com ou sem um treinamento prévio.

Objective: To verify differences of SBP/DBP/HR, perception of effort and ST segment during strength training, training of located muscular resistance (LMR), isometric, in patients after myocardial infarct, trained and not trained. Two groups were randomized: control (S) 14 patients, 53.5 years, sedentary. (T) 14 patients, 54.2 years, submitted to aerobic exercises for 1 month, 3/week, 30 minutes. Parameters: Segment-ST, SBP/DBP/HR, Oximetry and Borg in moments A,B,C,D. A) 4 repetitions 80 percent 1RM knee extension, B) 15 repetitions 50 percent 1RM knee extension, C) 4 repetitions 80 percent 1RM elbow flex, D) isometry of 40 sec. in flex elbow 80 percent 1RM and the treadmill test. ANOVA, Tukey’s post-hoc and chi-square for statistical analysis were performed. Statistical Significance p > 0.05. Results: Segment-ST and Oximetry without alterations. Average of SBP/DBP/HR of group S are higher than group T in C,D. Conclusion: Strength training and LRM are safe for infarct sedentary as well as for trained subjects. Exercises of LRM showed higher values of SBP/DBP/HR in relation to the strength exercises. Exercises with upper members showed outstanding variations for SBP/DBP/HR in physically active or sedentary infarcted patients. Absence of aerobic training is not contraindicated for the resistance exercises, and isometric exercises are considered of risk for patients physically trained or not.

Reabilitação em artrite idiopática juvenil / Rehabilitation in juvenile idiopathic arthritis

INTRODUÇÃO E OBJETIVOS: a artrite idiopática juvenil (AIJ) pode acarretar em seu curso clínico incapacidades físicas permanentes em crianças e adolescentes. Este estudo teve como objetivos a des-crição das diversas modalidades de reabilitação, desde a avaliação até a prescrição de exercícios, bem como a elaboração de um guia prático de reabilitação para pacientes com AIJ. FONTE DE DADOS: a pesquisa foi realizada nas bases de dados do Medline e do Lilacs. Na discussão dos diversos tópicos, foi considerada a experiência dos especialistas em reumatologia pediátrica e reabilitação do Lar Escola São Francisco e da Universidade Federal de São Paulo. RESUMO: os pacientes com AIJ podem apresentar dor e limitação da amplitude de movimento articular e conseqüente diminuição da capacidade física, com comprometimento das capacidades aeróbia e anaeróbia. Não só o comprometimento articular, mas as disfunções cardíacas e autonômicas colaboram nesse processo, tendo como conseqüência uma baixa capacidade de executar atividades esportivas e atividades de vida diárias (AVDs). O American College of Rheumatology recomenda 30 minutos de atividade com intensidade moderada de duas a três vezes por semana. A hidroterapia está relacionada a uma maior aderência ao tratamento, além de auxiliar na diminuição da percepção dolorosa e dificuldade apresentada na realização das AVDs. As outras modalidades de reabilitação, tais como massagem, educação, proteção articular, conservação de ener-gia e órteses, também são discutidas nesta revisão. CONCLUSÃO: há poucos estudos na literatura sobre reabilitação em crianças com AIJ, especialmente no que se refere a temas como prescrição adequada de exercícios, cargas, número de séries e repetições, bem como qual a melhor opção a ser utilizada - solo ou piscina. Acreditamos que mais estudos científicos são necessários para que possamos prescrever adequadamente os diversos tipos de exercícios.

INTRODUCTION AND AIMS: juvenile idiopathic arthritis (JIA) may cause permanent physical disabilities in children and adolescents. This study aimed to describe the several kinds of rehabilitation procedures, ranging from evaluation to prescription of exercises, as well as the elaboration of a practical rehabilitation guide for JIA patients. SOURCES OF DATA: the research was based on data from Medline and Lilacs. The opinion of experts working on the Pediatric Rheumatology service from Lar Escola São Francisco and Universidade Federal de São Paulo was considered on the debate of several topics. SUMMARY: JIA patients may present pain and limitation of joint movement thereby leading to decrease in physical capacity, affecting both aerobic and anaerobic activities. In addition to the joint compromise, cardiac and autonomic dysfunctions collaborate on this process, impairing sport and everyday activities. The American College of Rheumatology recommends 30-minute activity with moderate intensity, two to three times weekly. Hydrotherapy is associated to treatment adherence, besides helping in decreasing pain perception and adding to cope with daily activities. Other rehabilitation modalities, such as massage, education, joint protection, energy conservation, and splints are also considered in the present review. CONCLUSION: there are few studies in the literature focusing on rehabilitation in children with JIA. Particularly, there is a lack of studies concerning aspects of adequate prescription of exercises, weight-bearing, number of series and repetitions, as well as the best choice regarding ground or water activity. We believe that additional information is needed in order to improve the physical care to these patients.

Alterações do sistema nervoso autônomo decorrentes da mobilização articular cervical / Alterations of the autonomic nervous system after mobilization of the cervical spine

As técnicas de mobilização articular são, muitas vezes, aplicadas com o propósito de promover analgesia. Sabe-se que essa analgesia sofre influência do sistema nervoso autônomo. A variabilidade da freqüência cardíaca possui variáveis que estão intimamente ligadas a este sistema. Os trabalhos pesquisados não usaram métodos de análises fidedignos, resolveu-se, assim, fazer um estudo mais completo e com variáveis fiéis ao estudo. O estudo foi realizado no Hospital Geral do Grajaú, onde 15 universitários, com média etária de 22,0 anos, sem histórico de alguma patologia, foram submetidos à mobilização articular cervical. Para a análise estatística, usou-se o Teste de Friedman, apresentando significância na maioria das variáveis estudadas. Evidenciou-se a atuação do sistema nervoso autônomo durante todo o processo de mobilização articular, havendo um maior predomínio do sistema nervoso parassimpático, antes e durante a mobilização. Após a mobilização, houve predomínio do sistema nervoso simpático.

Joint mobilization techniques are very often used for analgesic purposes. It is known that this analgesia occurs under the influence of the Autonomous Nervous System. The heart rate variability depends on parameters intimately connected to the Autonomous Nervous System. The current studies did not used reliable analysis methods, and, for this study, more complete and credible variables were chosen. The present study took place at The Hospital Geral do Grajaú, where 15 college students, average 22 years old, without any pathology, were submitted to cervical joint mobilization. To the statistical analysis the Friedman test was used, showing significance in the majority of the studied variables. The performance of the Autonomous Nervous System was evident during all the mobilization process. There was a major predominance of the Parasympathic Nervous System before and while the mobilizations, and the Sympathic Nervous System was more predominating after the mobilization.