Inspiratory Muscle Training in Patients in the Postoperative Phase of Cardiac Surgery: A Systematic Review and Meta-Analysis.

To review the evidence about inspiratory muscle training (IMT) in patients in postoperative of cardiac surgery. We conducted this systematic review used the databases Ovid, LILACS, CINAHL, PubMed, PEDro, and CENTRAL. Randomized clinical trials that addressed IMT after cardiac surgery were selected. The outcomes assessed were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (TV), peak expiratory flow (PEF), functional capacity (6-minute walk test) and length of hospital stay. The mean difference between groups and the respective 95% confidence interval (CI) were calculated and used to quantify the effect of continuous outcomes. Seven studies were selected. The IMT was superior to the control over MIP 15.77 cmH2O (95% CI, 5.95-25.49), MEP 15.87 cmH2O (95% CI, 1.16-30.58), PEF 40.98 L/min (95% CI, 4.64-77.32), TV 184.75 mL (95% CI, 19.72-349.77), hospital stay -1.25 days (95% CI, -1.77 to -0.72), but without impact on functional capacity 29.93 m (95% CI, -27.59 to 87.45). Based on the results presented, IMT was beneficial as a form of treatment for patients after cardiac surgery.

Inspiratory muscle training on quality of life and functional capacity after hospital discharge in patients submitted to coronary artery bypass grafting: A controlled clinical trial.

INTRODUCTION: There is a gap in knowledge about functional capacity and quality of life in patients undergoing coronary artery bypass grafting (CABG) after hospital discharge and the contribution of inspiratory muscle training (IMT). OBJECTIVE: To evaluate the influence of IMT on functional capacity and quality of life after hospital discharge of patients undergoing CABG. METHODOLOGY: Clinical trial. In the preoperative period, patients assessed maximum inspiratory pressure (MIP), quality of life using the SF-36 and functional capacity using the Six-Minute Walk Test (6MWT). On the first postoperative day, they were randomized into: control group (CG) receiving routine assistance from the hospital; intervention group(IG) in addition to conventional physical therapy and submitted to an IMT protocol based on the glycemic threshold. Being reevaluated on the day of hospital discharge and post-discharge month. RESULTS: 41 patients were included. In the preoperative period of the MIP assessment of the CG, it was 104 ± 14 cmH2O already in GI it was 103 ± 19cmH2O (p = 0.78) CG at discharge 80 ± 13 cmH2O already in GI it was 92 ± 15cmH2O(p < 0.01), revaluation CG 91 ± 11 cmH2O versus 98 ± 12 cmH2O (p < 0.01) of the IG. In the 6MWT the preoperative of the GC group was 420 ± 70 m already in GI it was 429 ± 71 m (p = 0,89), CG at discharge 326 ± 79 m versus 373 ± 55 m and revaluation of the CG 377 ± 75 m and IG 410 ± 57 m (p < 0.01). Functional capacity, general health status, emotional aspects and limitations due to physical aspects were significant when the three moments were compared. CONCLUSION: IMT increases functional capacity, inspiratory muscle strength and quality of life after discharge from patients undergoing CABG.

A resistência do fluxo inspiratório modifica a intensidade de uma sessão de pilates? / Does inspiratory flow resistance modify the intensity of a pilates session?

INTRODUÇÃO: As evidências sobre a melhora da capacidade funcional utilizando o Método Pilates não são contundentes. Uma possibilidade de melhorar o efeito de uma sessão de Pilates sobre a capacidade cardiorrespiratória de seus praticantes é utilizar a resistência de fluxo inspiratório (RFI) de forma concomitante. Esse efeito pode ser visualizado através da determinação do limiar glicêmico (LG), técnica utilizada como marcador de intensidade do exercício. OBJETIVO: Testar a hipótese de que a utilização de RFI em uma sessão de pilates antecipa o LG. MÉTODOS: Estudo crossover de corte transversal. Foram avaliados 26 indivíduos de ambos os sexos, sendo 10 do sexo masculino, sadios e com idade entre 20 e 40 anos. Os voluntários foram randomizados para dois protocolos: Protocolo RFI ­ 11 movimentos do Método Pilates com RFI utilizando 20% da pressão inspiratória máxima; e Protocolo sem RFI (SRFI) ­ 11 movimentos do Método Pilates sem RFI. Os dois protocolos foram realizados no mesmo dia, sendo um pela manhã e outro à tarde, conforme randomização feita por sorteio aleatório simples. No repouso e ao final de cada movimento coletas de sangue capilar foram realizadas para dosagem da glicemia e construção da curva glicêmica. O LG foi determinado no menor ponto da curva. RESULTADOS: O LG foi antecipado no protocolo que utilizou RFI, ou seja, no protocolo com RFI o LG foi visualizado no sexto exercício, enquanto no protocolo SRFI o LG foi visualizado no nono exercício (p<0,05). CONCLUSÃO: A RFI antecipou o LG, o que sugere que a RFI aumenta a intensidade de uma sessão de pilates. Isso aventa a hipótese de que a RFI pode proporcionar a médio e longo prazo benefícios adicionais aos praticantes do Método Pilates.

INTRODUCTION: The evidence on the improvement of functional capacity using the Pilates Method is not conclusive. One possibility to improve the effect of a Pilates session on the cardiorespiratory capacity of its practitioners is to use the inspiratory flow resistance (IFR) concomitantly. This effect can be visualized by determining the glycemic threshold (GT), a technique used as an exercise intensity marker. OBJECTIVE: To test the hypothesis that the use of IFR in a Pilates session anticipates GT. METHODS: Cross-sectional crossover study. A total of 26 individuals of both genders were evaluated, 10 of whom were male, healthy, and aged between 20 and 40 years. The volunteers were randomized to two protocols: Protocol IFR - Eleven movements of the Pilates method with IFR using 20% of the maximum inspiratory pressure, and Protocol no IFR (NIFR) - Eleven movements of the Pilates method without IFR. The two protocols were performed on the same day, one in the morning and the other in the afternoon, according to randomization by simple random draw. At rest and at the end of each movement, capillary blood collections were performed to measure blood glucose and construct the glycemic curve. GT was determined at the smallest point on the curve. RESULTS: The GT was anticipated in the protocol that used IFR; that is, in the protocol with IFR, the GT was visualized in the sixth exercise, while in the NIFR protocol, the GT was visualized in the ninth exercise (p<0.05). CONCLUSION: IFR anticipated GT, which suggests that IFR increases the intensity of a Pilates session. This suggests the hypothesis that IFR can provide additional medium and long-term benefits to Pilates method practitioners.

Chronic dilated heart failure: what is the benefit of cardiovascular rehabilitation?

INTRODUCTION: Physical exercise promotes beneficial changes in cardiac geometry, called reverse myocardial remodeling. Recent studies show that physical exercise is capable of reorganizing the cellular signal in cardiac tissue and reversing concentric hypertrophy or ventricular dilation. However, there are few reports about this in patients with Chronic Dilated Heart Failure (CHF). OBJECTIVE: To describe the effect of a Cardiovascular Rehabilitation (CR) program on the functional capacity, quality of life and myocardial geometry of a patient with chronic dilated heart failure. CASE DESCRIPTION: Woman, 67 years old, with Implantable Cardiodefibrillator, hypertensive for 30 years, dilated heart failure with reduced ejection fraction 20% (Teicholz), left bundle branch block, CHF grade III-IV (NYHA). The supervised CR program lasted twelve months, with three weekly sessions. Initially, only low-load resistive neuromuscular exercises and inspiratory muscle training were performed. Both evolved gradually, respecting the patient's clinical and functional condition. Functional exercises such as sitting and, standing and climbing stairs were later introduced. The treadmill was also introduced into the program in an interval format (three sets of 1-minute active for 2 minutes of passive rest). The work was periodized every 2 months. Drugs were not optimized during this period, and digoxin was withdrawn. RESULTS: In the pre and post-CR echocardiogram, the ejection fraction increased from 20% to 40%, the left ventricular mass from 255 g to 128 g, with a decrease in the volumes and diameters of the left ventricular cavities, showing reverse myocardial remodeling. After CR, an exercise test was performed in which the patient reached 84% of the maximum predicted frequency (6.5 METS). The patient resumed life activities that she had not previously performed, such as going shopping at the market. CONCLUSION: In this case, the CR program was important to promote improvement in functional capacity, reverse myocardial remodeling and improvement in the quality of life of a woman with Chronic Dilated Heart Failure.

Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training.

Treinamento muscular inspiratório na qualidade de vida e capacidade funcional na cardiotoxicidade: relato de caso / Entrenamiento muscular inspiratorio en la calidad de vida y capacidad funcional en la cardiotoxicidad: reporte de un caso / Inspiratory muscle training in quality of life and functional capacity in cardiotoxicity: case report

RESUMO Pacientes oncológicos desenvolvem problemas cardíacos frequentes devido à toxidade dos quimioterápicos, com consequente impacto na capacidade funcional (CF) e na qualidade de vida (QV). O treinamento muscular inspiratório (TMI) pode ser um recurso terapêutico viável, já que estudos de causa-efeito demonstraram melhora da CF e da QV em outras populações. Contudo, seu efeito ainda não foi avaliado em pacientes cardio-oncológicos. Assim, o objetivo deste estudo foi descrever o efeito de um programa de TMI sobre a CF e a QV de uma paciente com cardiotoxicidade: LDM, com 41 anos, mulher e sedentária, que desenvolveu insuficiência cardíaca após tratamento quimioterápico. A QV foi avaliada pelo teste de Minnesota. Foram avaliados também a força muscular inspiratória dinâmica (S-Index) e o limiar glicêmico (LG) dos músculos inspiratórios. O LG foi determinado pela glicemia capilar por meio do glicosímetro digital (Accu-Chek - Roche) no menor valor da glicemia da carga correspondente ao teste muscular inspiratório incremental (TMII). A progressão da carga foi realizada a cada duas semanas. Ao final de dois meses, todos os testes foram reaplicados. No teste de Minnesota, os valores relacionados à CF, antes e após o TMI, foram de 36 vs. 8 (melhora de 78%); aos aspectos clínicos e psicológicos foram de 32 vs. 7 (melhora de 78%), a S-Index foram de 41 vs. 51cmH2O (melhora de 24%). O TMI melhorou a CF e a QV de uma paciente cardio-oncológica, configurando-se como um recurso terapêutico viável para essa população.

RESUMEN Los pacientes con cáncer desarrollan problemas cardíacos frecuentes debido a la cardiotoxicidad de la quimioterapia, con el consiguiente impacto en la capacidad funcional (FC) y la calidad de vida (CV). El entrenamiento muscular inspiratorio (IMT) puede ser un recurso terapéutico viable, ya que los estudios de causa-efecto han demostrado una mejora en la FC y la CV en otras poblaciones. Sin embargo, su efecto aún no se ha evaluado en pacientes cardio-oncológicos. Por lo tanto, el objetivo de este estudio fue describir el efecto de un programa de IMT sobre la FC y la CV de un paciente con cardiotoxicidad: LDM, 41 años, mujer y sedentaria, que desarrolló insuficiencia cardíaca después del tratamiento de quimioterapia. La CV se evaluó mediante la prueba de Minnesota. También se evaluaron la fuerza muscular inspiratoria dinámica (índice S) y el umbral glucémico (LG) de los músculos inspiratorios. El LG se determinó por glucemia capilar mediante el glucómetro digital (Accu-Chek - Roche) al valor más bajo de la carga glucélica correspondiente a la prueba muscular inspiratoria incremental (IMI). La progresión de la carga se realizó cada dos semanas. Después de dos meses, todas las pruebas se volvieron a aplicar. En la prueba de Minnesota, los valores relacionados con la FC, antes y después de THE, fueron 36 vs. 8 (78% de mejora); los aspectos clínicos y psicológicos fueron 32 vs. 7 (mejora del 78%), el índice S fue de 41 vs. 51cmH2O (mejora del 24%). El IMT mejoró la FC y la CV de un paciente cardio-oncológico, constituyendo un recurso terapéutico viable para esta población.

ABSTRACT Cancer patients develop frequent cardiac problems due to chemotherapy toxicity, which impacts functional capacity (FC) and quality of life (QoL). Inspiratory Muscle Training (IMT) may be a viable therapeutic resource since cause-effect studies have shown improvement in FC and QoL in other populations. However, its effect was not evaluated in cardio-oncology patients. The study aimed to describe the effect of an IMT program on the FC and QoL of a patient with cardiotoxicity, LDM, aged 41 years, female and, sedentary that developed heart failure after chemotherapy. The QoL was evaluated by the Minnesota test. Dynamic Inspiratory Muscle Strength (S-Index) and Glycemic Threshold (GT) of the inspiratory muscles were also evaluated. The GT was determined by capillary glycemia with a digital glucometer (Accu-Chek - Roche), at the lowest value of glycemia of the load corresponding to the Incremental Inspiratory Muscle Test (IIMT). The load progression was performed every two weeks. After two months, all tests were reapplied. In the Minnesota test, the values related to FC, pre and post IMT, were 36 v. 8 (78% improvement); the clinical and psychological aspects 32 v. 7 (78% improvement); S-Index was 41 v. 51cmH2O (24% improvement). IMT improved the FC and QoL of a cardio-oncology patient, configuring itself as a possible and viable therapeutic resource for this population.

Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients: A pilot randomized and controlled trial.

Background: Coronary artery bypass graft (CABG) surgery is associated with worsened functional capacity, pulmonary complications, and increased length of hospital stay. These negative effects are exacerbated in patients who are at high risk of post-operative (PO) pulmonary complications before CABG. Inspiratory muscle training (IMT) has been shown to benefit CABG patients in their recovery process. However, in high-risk patients, there is little evidence to support the post-operative implementation of IMT for purposes of faster recovery. Aim: The aim of the study was to test the hypothesis that IMT improves the functional capacity, pulmonary complications, and length of hospital stay in patients prone to pulmonary complications who had undergone CABG. Methods: This is a pilot clinical trial carried out with patients at high risk for pulmonary complications in the PO phase. In the pre-operative period, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walk test (6MWT) were determined and administered. On the first PO day, patients were divided into two groups: A control group (CG) that received routine intervention and an IMT group that, in addition to routine care, was subjected to an IMT protocol until hospital discharge. On the day of discharge, the patients were reassessed with respect to ventilatory muscle strength, functional capacity, PO complications, and length of stay. Results: Twenty-nine patients were evaluated, 15 in the CG and 14 in the IMT group. No significant differences were observed in relation to MIP (difference between the mean of -7 cmH2O; 95% CI = -16.52-2.52), MEP (difference between the mean of -7cm H2O; 95% CI = -15.39-1.39), and in the 6MWT (difference between the mean of -9 m; 95% CI = -43.71-25.71). There was a decrease in the length of stay in the IMT group compared to the CG (9 ± 3 vs. 12 ± 4 days; P = 0.04). The IMT group had a lower rate of atelectasis and pneumonia. Conclusion: IMT does not minimize the loss of functional capacity, but it reduces pulmonary complications and the length of stay of patients undergoing CABG who are preoperatively at a high risk of pulmonary complications. Relevance for Patients: The increase in ventilatory muscle strength, associated with IMT, can reduce PO pulmonary complications, resulting in shorter hospital stays, and improved quality of life.

Effects of Physical Exercise on Lipid and Inflammatory Profile of Women Using Combined Oral Contraceptive: A Cross-Over Study

Abstract Background: The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease, and physical exercise can minimize this condition. Objective: To verify if high intensity interval training (HIIT) promotes changes in the lipid and inflammatory profile of women using COC. Methods: Sequential crossover study with women aged 20-30 years, classified as irregularly active by the international physical activity questionnaire (IPAQ), when using COC. A physical-clinical assessment was performed with anthropometric measurements, VO2max, and analysis of lipid and inflammatory profile. Participants were divided into 2 groups: the initial intervention group (GII), which began practicing HIIT for 2 months, and the posterior intervention group (GIP), which remained inactive for the same period. The GII and GIP would then alternate their conditions. The collected data was divided into: Initial moment (IM), post-exercise moment (PEM) and post-inactivity (PIM). The statistical analyses were performed using the Statistical Package for the Social Sciences, adopting a significance level of p <0.05 . Results: Twelve women were evaluated. After crossing the GII and GIP data, there was a difference in the C-reactive protein values between the IM of 4 (1.6-6.3 mg/dL) vs. PEM 2 (1.5-5 mg/dL); as well as between the PEM vs. the PIM= 4 (1.5-5.8 mg/dL), with a p -value = 0.04 in the comparisons. There was no change between the "moments" of the lipid profile, although it was possible to notice a reduction in resting HR and an increase in indirect VO2max. Conclusion: The HIIT program was able to reduce the inflammatory profile, but it did not alter the lipid profile of irregularly active women using COC.

Renin-Angiotensin-Aldosterone System in Women Using Combined Oral Contraceptive: A Systematic Review / Sistema renina-angiotensina-aldosterona em mulheres usuárias de contraceptivo oral combinado: Revisão sistemática

Abstract Objective To describe the effects of combined oral contraceptives (COC) on the renin-angiotensin-aldosterone system (RAAS). Data sourcesThis is a systematic review according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registered in PROSPERO under the ID: CRD42020200019. Searches were performed between August 2020 and December 2021, in the following databases: Medline via Pubmed, Cochrane Central Library, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences via Virtual Health Library. The effects of the combined oral contraceptive on plasma renin activity values, plasma renin values, angiotensinogen values— also known as plasma renin substrate— angiotensin, and/or aldosterone values. Study selectionA total of 877 studies were selected and, of these, 10 articles met the eligibility criteria and were included in this review. Data collectionData were combined through qualitative synthesis and included in a spreadsheet previously prepared by the authors. Data synthesisThe collected samples ranged from 18 to 137 participants, totaling 501 women aged between 18 and 49 years throughout all studies. The studies showed increased activity of plasma renin, plasma renin substrate, angiotensin II, and aldosterone in this population. Conclusion The findings of this study suggest that the COC promotes greater activation of the RAAS. Supporting the idea that its use is related to an increased risk of cardiovascular events, including systemic arterial hypertension.

Resumo Objetivo Descrever os efeitos do contraceptivo oral combinado (COC) no sistema renina-angiotensina-aldosterona (SRAA). Fontes dos dadosTrata-se de uma revisão sistemática de acordo com os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada no PROSPERO sob ID: CRD42020200019. As buscas foram realizadas entre agosto de 2020 e dezembro de 2021 nas bases de dados: Medline via Pubmed, Biblioteca Cochrane Central, Scientific Electronic Library Online, e Literatura Latino-americana e do Caribe em Ciências da Saúde via Biblioteca Virtual em Saúde. Consultado os artigos sobre os efeitos do contraceptivo oral combinado nos valores da atividade da renina plasmática, valores plasmáticos da renina, valores do angiotensinogênio - também conhecido como substrato da renina plasmática -, valores da angiotensina e/ou aldosterona. Seleção dos estudosForam selecionados 877 estudos e, destes, 10 artigos preencheram os critérios de elegibilidade e foram incluídos nesta revisão. Coleta de dadosOs dados foram combinados por meio de síntese qualitativa e inclusos em uma planilha elaborada previamente pelos autores. Síntese dos dadosAs amostras coletadas variavam entre 18 e 137 participantes, totalizando 501 mulheres com idade entre 18 e 49 anos em todos os estudos. Os estudos apresentaram aumento da atividade da renina plasmática, do substrato da renina plasmática, da angiotensina II e da aldosterona nessa população. Conclusão Os achados deste estudo sugerem que o COC promove maior ativação do SRAA. Apoiando a ideia de que o seu uso esteja relacionado ao aumento do risco de eventos cardiovasculares, incluindo a hipertensão arterial sistêmica.

Renin-Angiotensin-Aldosterone System in Women Using Combined Oral Contraceptive: A Systematic Review.

OBJECTIVE: To describe the effects of combined oral contraceptives (COC) on the renin-angiotensin-aldosterone system (RAAS). DATA SOURCES: This is a systematic review according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registered in PROSPERO under the ID: CRD42020200019. Searches were performed between August 2020 and December 2021, in the following databases: Medline via Pubmed, Cochrane Central Library, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences via Virtual Health Library. The effects of the combined oral contraceptive on plasma renin activity values, plasma renin values, angiotensinogen values- also known as plasma renin substrate- angiotensin, and/or aldosterone values. STUDY SELECTION: A total of 877 studies were selected and, of these, 10 articles met the eligibility criteria and were included in this review. DATA COLLECTION: Data were combined through qualitative synthesis and included in a spreadsheet previously prepared by the authors. DATA SYNTHESIS: The collected samples ranged from 18 to 137 participants, totaling 501 women aged between 18 and 49 years throughout all studies. The studies showed increased activity of plasma renin, plasma renin substrate, angiotensin II, and aldosterone in this population. CONCLUSION: The findings of this study suggest that the COC promotes greater activation of the RAAS. Supporting the idea that its use is related to an increased risk of cardiovascular events, including systemic arterial hypertension.

OBJETIVO: Descrever os efeitos do contraceptivo oral combinado (COC) no sistema renina-angiotensina-aldosterona (SRAA). FONTES DOS DADOS: Trata-se de uma revisão sistemática de acordo com os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada no PROSPERO sob ID: CRD42020200019. As buscas foram realizadas entre agosto de 2020 e dezembro de 2021 nas bases de dados: Medline via Pubmed, Biblioteca Cochrane Central, Scientific Electronic Library Online, e Literatura Latino-americana e do Caribe em Ciências da Saúde via Biblioteca Virtual em Saúde. Consultado os artigos sobre os efeitos do contraceptivo oral combinado nos valores da atividade da renina plasmática, valores plasmáticos da renina, valores do angiotensinogênio ­ também conhecido como substrato da renina plasmática ­, valores da angiotensina e/ou aldosterona. SELEçãO DOS ESTUDOS: Foram selecionados 877 estudos e, destes, 10 artigos preencheram os critérios de elegibilidade e foram incluídos nesta revisão. COLETA DE DADOS: Os dados foram combinados por meio de síntese qualitativa e inclusos em uma planilha elaborada previamente pelos autores. SíNTESE DOS DADOS: As amostras coletadas variavam entre 18 e 137 participantes, totalizando 501 mulheres com idade entre 18 e 49 anos em todos os estudos. Os estudos apresentaram aumento da atividade da renina plasmática, do substrato da renina plasmática, da angiotensina II e da aldosterona nessa população. CONCLUSãO: Os achados deste estudo sugerem que o COC promove maior ativação do SRAA. Apoiando a ideia de que o seu uso esteja relacionado ao aumento do risco de eventos cardiovasculares, incluindo a hipertensão arterial sistêmica.

Reverse Myocardial Remodeling in Hypertrophic Cardiomyopathy: Little Explored Benefit of Exercise.

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease that causes myocardial remodeling. Physical exercise (PE) is a therapeutic resource used in Supervised Cardiac Rehabilitation (SCR) to improve Quality of Life (QL), reducing cardiovascular morbidity and mortality. Therefore, the aim of this study is to report how SCR using a personalized exercise prescription, promoted Reverse Myocardial Remodeling (RMR), improved functionality and QL of a patient with HCM. This is a case report of a 43-year-old sedentary female patient with a Body Mass Index (BMI) of 24.7 kg/m2. The patient was diagnosed with Septal Type Asymmetric HCM. Heart Failure (HF) grade III / IV, according to the New York Heart Association (NYHA), was initially treated with 40mg of Propranolol Hydrochloride twice a day, and presented with excessive fatigue, and angina. The echocardiogram showed a final diastolic volume (FDV) of 130 ml, a final systolic volume (FSV) of 44 ml, a left ventricular mass (LVM) of 236 g, interventricular septum thickness of 14 mm, left ventricular posterior wall (LVPW) thickness of 9 mm, left atrium diameter 46 mm, left ventricular end diastolic diameter of 52mm, septum/left ventricular wall ratio of 1.55 mm, and ejection fraction (EF) of 66% (Teicholz). It was obtained as a result of decreased FDV 130 vs. 102ml, decreased FSV 44 vs. 32 ml, decreased LVM 236 vs. 201 g, increased EF 66 vs. 69%, 26% improvement in QL, and 50% reduction in the dosage of Propranolol Hydrochloride. These results suggest that a personalized SCR program is an adjuvant treatment capable of promoting RMR and improving QL and functionality in a patient with HCM.

Blood glucose threshold of the inspiratory muscles: is it possible to determine it by Borg? / Umbral de glucosa en sangre de los músculos inspiratorios: ¿es posible determinarlo por Borg? / Limiar glicêmico dos músculos inspiratórios: é possivel determiná-lo pelo Borg?

Objective: To test the hypothesis that it is possible to estimate the glycemic threshold (GT) of inspiratory muscles using the subjective perception scale to Borg's effort.Methods: Observational association and cross-sectional study, in which 21 male individuals, eutrophic, irregularly active, aged between 18 and 30 years evaluated. All submitted to an incremental inspiratory muscle test to determine the GT. During the test, the traditional Borg scale was applied at each stage of the test. Pearson's test was used to verify the correlation between GT and Borg.Results: A descriptive analysis that GT occurred 23±9.1% of MIP in an absolute load of 32±14.6cmH2O and was compatible with the score of 13±1.5 on the BORG scale (r=0.67) and (r=0.58) respectively.Conclusions: Our results provide evidence that the Borg scale is a viable method to determine the GT of inspiratory muscles and consequently be used for prescribing Inspiratory Muscle Training. (AU)

Objetivo: Probar la hipótesis de que es posible estimar el umbral glucémico (UG) de los músculos inspiratorios utilizando la escala de percepción subjetiva al esfuerzo de Borg.Métodos: asociación observacional y estudio transversal, en el que se evaluaron 21 individuos del sexo masculino, eutróficos, irregularmente activos, con edades comprendidas entre 18 y 30 años. Todos sometidos a una prueba de músculo inspiratorio incremental para determinar el UG. Durante la prueba, se aplicó la escala de Borg tradicional en cada etapa de la prueba. Se utilizó la prueba de Pearson para verificar la correlación entre UG y Borg.Resultados: Un análisis descriptivo que UG ocurrió 23 ± 9.1% de MIP en una carga absoluta de 32 ± 14.6cmH2O y fue compatible con la puntuación de 13±1.5 en la escala BORG (r=0.67) y (r=0.58) respectivamente. .Conclusiones: Nuestros resultados proporcionan evidencia de que la escala de Borg es un método viable para determinar el UG de los músculos inspiratorios y, en consecuencia, se puede utilizar para prescribir el entrenamiento de los músculos inspiratorios. (AU)

Objetivo: Testar a hipótese de que é possível estimar o LG dos músculos inspiratórios, por meio da escala de percepção subjetiva ao esforço de Borg.Métodos: Estudo observacional de associação e corte transversal, no qual foram avaliados 21 indivíduos do sexo masculino, eutróficos, irregularmente ativos, com idades entre 18 e 30 anos. Todos foram submetidos a um teste muscular inspiratório incremental para determinação do LG. Durante o teste foi aplicado a escala de Borg tradicional em cada estágio do teste. Para análise descritiva foi utilizado a média e desvio padrão por se tratar de uma amostra linear. Utilizado o teste de Pearson para verificar a correlação entre o LG e o Borg.Resultados: A análise descritiva mostrou que o LG ocorreu 23±9,1% da PImáx em uma carga absoluta de 32±14,6cmH2O e foi compatível com o escore de 13±1,5 da escala de BORG (r=0,67) e (r=0,58) respectivamente.Conclusões: Nossos resultados fornecem evidências de que a escala de Borg é um método viável para determinar o Limiar Glicêmico dos músculos inspiratórios e consequentemente ser utilizado para prescrição do Treinamento Muscular Inspiratório. (AU)

Physical exercise in sickle cell anemia: a systematic review

Introduction and objective: Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. Methodology: We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. Results: Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. Conclusion: Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.

Sistema Renina Angiotensina Aldosterona em mulheres que utilizam contraceptivo hormonal injetável: protocolo de um estudo observacional comparativo de corte transversal / Renin Angiotensin Aldosterone System in women using injectable hormonal contraceptive: protocol of a comparative observational study of cross-sectional

INTRODUÇÃO: Os contraceptivos orais são a forma mais utilizada para o controle de natalidade, chegando a 200 milhões de usuárias desde sua iniciação na década de 1960. Desde 2013, nosso grupo de pesquisa tem apresentado resultados que sugerem que mulheres em uso de Contraceptivos Orais Combinados (COC), e sem outros fatores de risco, apresentam maior valor de proteína C reativa, lipemia pós-prandial, lipoproteína de baixa densidade oxidada e diminuição da sensibilidade insulínica, quando comparadas a suas congêneres sem uso de COC. Recentemente, foi verificado que o uso de COC eleva os valores de renina plasmática em 600%, podendo explicar por que o uso desse fármaco é um fator de risco para o desenvolvimento de hipertensão arterial sistêmica. Apesar de o uso de Contraceptivo Hormonal Injetável (CHI) estar aumentando, não encontramos estudos clínicos que abordassem o tema, demonstrando uma lacuna na literatura científica. OBJETIVO: Comparar os valores de renina plasmática, enzima conversora de angiotensina 1 e aldosterona de mulheres que utilizam CHI com mulheres que não utilizam nenhum contraceptivo à base de hormônio. MÉTODOS: Protocolo de um estudo observacional comparativo de corte transversal, composto por mulheres com idade entre 18 e 30 anos, eutróficas, irregularmente ativas pelo Questionário Internacional de Atividade Física, versão curta, que estão em uso continuado de CHI há pelo menos 6 meses ou que não fazem uso. A amostra será por conveniência, as participantes selecionadas assinarão o termo de consentimento livre e esclarecido. Posteriormente, responderão a um questionário padrão, serão submetidas a um exame físico, e serão encaminhadas para coleta das amostras sanguíneas.

INTRODUCTION: Oral contraceptives are the most widely used form of birth control, reaching 200 million users since its inception in the 1960. Since 2013, our research group has presented results that suggest that women using Combined Oral Contraceptives (COC) and without other risk factors, have a higher value of C-reactive protein, postprandial lipemia, oxidized low-density lipoprotein and decreased insulin sensitivity, when compared to their counterparts without the use of COC. Recently, it was found that the use of COC increases plasma renin values by 600%, which may explain why the use of this drug is a risk factor for the development of systemic arterial hypertension. Although the use of Injectable Hormonal Contraceptives (IHC) is increasing, we have not found clinical studies that addressed the topic, demonstrating a gap in the scientific literature. OBJECTIVE: Compare the values of plasma renin, angiotensin-converting enzyme 1 and aldosterone of women using IHC with women who do not use any hormone-based contraceptives. METHODS: Protocol of a comparative observational cross-sectional study, composed of women aged between 18 and 30 years, eutrophic, irregularly active by the International Physical Activity Questionnaire, short version, who have been in continuous use of IHC for at least 6 months or that do not use. The sample will be for convenience and the selected participants will sign the informed consent form. Subsequently, they will answer a standard questionnaire, undergo a physical examination, and be sent to collect blood samples.

Two types of inspiratory muscle training on muscle strength in patients submitted to coronary artery bypass grafting: clinical trial / Dois tipos de treinamento muscular inspiratório sobre a força muscular de pacientes após revascularização do miocárdio: ensaio clínico

Introduction: Coronary artery bypass grafting (CABG) causes changes in the respiratory musculature that affects functional capacity and postoperative complications (POC). Inspiratory muscle training (IMT) is a tool used for these patients, but it is not known what the best form is to increase strength. Objective: To investigate whether IMT with a linear pressure load device is superior to the inspiratory incentive on functional capacity and muscle strength of patients undergoing CABG. Methods: This is a clinical trial. Patients were assessed preoperatively for inspiratory muscle pressure (MIP), expiratory pressure (MEP), peak expiratory flow (PEF), six-minute walk test (6MWT) and functional independence measure (FIM). After surgery, they were divided into three groups: control group (CG), training group with linear pressure load (IMT) and inspiratory incentive group (IG). On the day of discharge, all patients had their previous variables reassessed. Results: The study included 56 patients, 31 (55.4%) were male and an average age of 55 ± 12 years. There was a significant reduction in all variables, in relation to MIP, the IMT showed a higher value in the postoperative period 83 ± 19 cmH2O, against 70 ± 15 cmH2O in the CG and 80 ± 15 cmH2O in the IG (p < 0.001). The same behavior was observed in MEP, 77 ± 12 cm H2O in IMT, 67 ± 14 cmH2O in CG and 75 ± 10 cmH2O in IG (p < 0.001). Regarding the 6 MWT, there was a lesser loss in the IMT from 434 ± 15 m to 398 ± 20 m in IG (p < 0.001). Conclusion: It is concluded that muscle training with a linear pressure load device is superior to training with incentive on functional capacity and muscle strength in patients undergoing CABG. (AU)

Introdução: A cirurgia de revascularização do miocárdio (CRM) causa alterações na musculatura respiratória que afetam a capacidade funcional e complicações pós-operatórias (DCP). O treinamento muscular inspiratório (TMI) é uma ferramenta utilizada por esses pacientes, mas não se sabe qual é a melhor forma de aumentar a força. Objetivo: Investigar se o TMI com dispositivo de carga de pressão linear é superior ao incentivo inspiratório na capacidade funcional e força muscular de pacientes submetidos à CRM. Métodos: Este é um ensaio clínico. Os pacientes foram avaliados no pré-operatório para pressão muscular inspiratória (PImáx), pressão expiratória (PEF), pico de fluxo expiratório (PFE), teste de caminhada de seis minutos (TC6) e medida de independência funcional (MIF). Após a cirurgia, eles foram divididos em três grupos: grupo controle (GC), grupo treinamento com carga linear de pressão (IMT) e grupo incentivo inspiratório (GI). No dia da alta, todos os pacientes tiveram suas variáveis anteriores reavaliadas. Resultados: O estudo incluiu 56 pacientes, 31 (55,4%) eram do sexo masculino e idade média de 55 ± 12 anos. Houve redução significativa em todas as variáveis, em relação à PImáx, o IMT apresentou valor maior no pós-operatório 83 ± 19 cmH2O, contra 70 ± 15 cmH2O no GC e 80 ± 15 cmH2O no GI (p < 0,001). O mesmo comportamento foi observado na PEmáx, 77 ± 12 cmH2O no IMT, 67 ± 14 cmH2O no GC e 75 ± 10 cmH2O no GI (p < 0,001). Em relação ao TC6, houve menor perda no TMI de 434 ± 15 metros para 398 ± 20 metros no GI (p < 0,001). Conclusão: Conclui-se que o treinamento muscular com dispositivo de carga pressórica linear é superior ao treinamento com incentivo inspiratório na capacidade funcional e da força muscular em pacientes submetidos à CRM. (AU)

Efeitos do exercício físico sobre o perfil lipídico e inflamatório de mulheres jovens em uso de contraceptivo oral combinado: protocolo de um estudo sequencial cruzado / Effects of physical exercise on the lipid and inflammatory profile of young women using combined oral contraceptives: protocol of a crosssectional study

INTRODUÇÃO: O uso de contraceptivos orais combinados (COC) trata-se de um fator de risco para a doença aterosclerótica por comprometer o perfil lipídico e inflamatório, podendo o exercício físico minimizar essas condições. OBJETIVO: Testar a hipótese de que exercício físico pode modificar o perfil lipídico e inflamatório de mulheres em uso COC. MÉTODOS: Protocolo de um estudo sequencial cruzado com mulheres de 20 e 30 anos, irregularmente ativas, em uso de COC há pelo menos 6 meses. Realizouse uma avaliação físico-clínica (AFC) nas participantes com medidas antropométricas, VO2máx. indireto e análise do perfil lipídico e inflamatório. Na sequência separou-se as participantes em 2 grupos: O grupo intervenção inicial (GII) que iniciou praticando exercícios intervalados de alta intensidade por 2 meses, e o grupo intervenção posterior (GIP), que seguiu irregularmente ativo pelo mesmo período. Em seguida o GII e o GIP alternariam suas condições por mais 2 meses, totalizando 4 meses de acompanhamento e 3 AFC, realizadas no início, após 2 meses e ao final do estudo. As informações colhidas foram divididas em 3 momentos: Momento inicial (MI), momento pós exercício (MPE) e pós inatividade (MPI).

INTRODUCTION: The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease because it compromises the lipid and inflammatory profile, and physical exercise can minimize these conditions. OBJECTIVE: To test the hypothesis that high intensity interval physical exercise promotes changes in the lipid and inflammatory profile of women who are irregularly active using COC. METHODS: Protocol of a crosssectional study with women of 20 and 30 years, irregularly active, using COC for at least 6 months. A physicalclinical assessment (AFC) was performed on the participants with anthropometric measurements, VO2max. analysis and analysis of the lipid and inflammatory profile. Afterwards, the participants were divided into 2 groups: the initial intervention group (GII) that started practicing high intensity interval exercises for 2 months, and the posterior intervention group (GIP), which remained irregularly active for the same period. Then the GII and GIP would alternate their conditions for another 2 months, totaling 4 months of follow-up and 3 AFC, performed at the beginning, after 2 months and at the end of the study. The information collected was divided into 3 moments: Initial moment (MI), post-exercise moment (MPE) and post-inactivity (MPI).

Physical exercise in sickle cell anemia: a systematic review.

INTRODUCTION AND OBJECTIVE: Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. METHODOLOGY: We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. RESULTS: Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. CONCLUSION: Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.

Inspiratory muscle training based on anaerobic threshold on the functional capacity of patients after coronary artery bypass grafting: clinical trial

Abstract Introduction: Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG. Methods: This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT). Results: Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs. 11±10 cmH2O in the IMT-AT group (P<0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs. 57±30 meters in the IMT-AT group (P=0.04). Conclusion: IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.

Inspiratory Muscle Training Based on Anaerobic Threshold on the Functional Capacity of Patients After Coronary Artery Bypass Grafting: Clinical Trial.

INTRODUCTION: Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG. METHODS: This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT). RESULTS: Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs. 11±10 cmH2O in the IMT-AT group (P<0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs. 57±30 meters in the IMT-AT group (P=0.04). CONCLUSION: IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.