Incremental Ramp Load Protocol to Assess Inspiratory Muscle Endurance in Healthy Individuals: Comparison with Incremental Step Loading Protocol.

INTRODUCTION: Protocols for obtaíníng the maxímum threshold pressure have been applied wíth límited precision to evaluate ínspiratory muscle endurance. In thís sense, new protocols are needed to allow more relíable measurements. The purpose of the present study was to compare a new incremental ramp load protocol for the evaluation of ínspíratory muscle endurance wíth the most used protocol in healthy indíviduals. METHODS: This was a prospective cross-sectional study carried out ín a síngle center. Nínety-two healthy indíviduals (43 men [22 ± 3 years] and 49 women [22 ± 3 years]) were randomly allocated to perform: (i) íncremental ramp load protocol and (íí) íncremental step loadíng protocol. The sustained pressure threshold (or maximum threshold pressure), maximum threshold pressure/dynamic strength índex ratío, time untíl task faílure, as well as dífference between the mean heart rate of the last five mínutes of baselíne and the peak heart rate of the last 30 seconds of each protocol were measured. RESULTS: Incremental ramp load protocol wíth small íncreases in the load and starting from mínímum values of strength index was able to evaluate the inspiratory muscle endurance through the maxímum threshold pressure of healthy indívíduals. CONCLUSION: The present study suggests that the íncremental ramp load protocol is able to measure maximum threshold pressure in a more thorough way, wíth less progression and greater accuracy in the load stratification compared to the límited incremental step loading protocol and with a safe and expected cardiovascular response in healthy individuals.

Effect of an exercise-based cardiac rehabilitation program on quality of life of patients with chronic Chagas cardiomyopathy: results from the PEACH randomized clinical trial.

To investigate the effect of an exercise-based cardiac rehabilitation program on the quality of life (QoL) of patients with chronic Chagas cardiomyopathy (CCC). PEACH study was a single-center, superiority randomized clinical trial of exercise training versus no exercise (control). The sample comprised Chagas disease patients with CCC, left ventricular ejection fraction < 45%, without or with HF symptoms (CCC stages B2 or C, respectively). QoL was assessed at baseline, after three months, and at the end of six months of follow-up using the SF-36 questionnaire. Patients randomized for the exercise group (n = 15) performed exercise training (aerobic, strength and stretching exercises) for 60 min, three times a week, during six months. Patients in the control group (n = 15) were not provided with a formal exercise prescription. Both groups received identical nutritional and pharmaceutical counseling during the study. Longitudinal analysis of the effects of exercise training on QoL, considering the interaction term (group × time) to estimate the rate of changes between groups in the outcomes (represented as beta coefficient), was performed using linear mixed models. Models were fitted adjusting for each respective baseline QoL value. There were significant improvements in physical functioning (ß = + 10.7; p = 0.02), role limitations due to physical problems (ß = + 25.0; p = 0.01), and social functioning (ß = + 19.2; p < 0.01) scales during the first three months in the exercise compared to the control group. No significant differences were observed between groups after six months. Exercise-based cardiac rehabilitation provided short-term improvements in the physical and mental aspects of QoL of patients with CCC.Trial registration: ClinicalTrials.gov Identifier: NCT02517632; August 7, 2015.

Incremental Ramp Load Protocol to Assess Inspiratory Muscle Endurance in Healthy Individuals: Comparison with Incremental Step Loading Protocol

ABSTRACT Introduction: Protocols for obtaining the maximum threshold pressure have been applied with limited precision to evaluate inspiratory muscle endurance. In this sense, new protocols are needed to allow more reliable measurements. The purpose of the present study was to compare a new incremental ramp load protocol for the evaluation of inspiratory muscle endurance with the most used protocol in healthy individuals. Methods: This was a prospective cross-sectional study carried out in a single center. Ninety-two healthy individuals (43 men [22 ± 3 years] and 49 women [22 ± 3 years]) were randomly allocated to perform: (i) incremental ramp load protocol and (ii) incremental step loading protocol. The sustained pressure threshold (or maximum threshold pressure), maximum threshold pressure/dynamic strength index ratio, time until task failure, as well as difference between the mean heart rate of the last five minutes of baseline and the peak heart rate of the last 30 seconds of each protocol were measured. Results: Incremental ramp load protocol with small increases in the load and starting from minimum values of strength index was able to evaluate the inspiratory muscle endurance through the maximum threshold pressure of healthy individuals. Conclusion: The present study suggests that the incremental ramp load protocol is able to measure maximum threshold pressure in a more thorough way, with less progression and greater accuracy in the load stratification compared to the limited incremental step loading protocol and with a safe and expected cardiovascular response in healthy individuals.

Association Between Upper Limb Strength Through 1-Repetition Maximum Test and V'O2peak in Heart Failure.

Purpose: This study aimed to evaluate whether there is a correlation between the maximum strength of upper limb when performing a multijoint exercise and peak oxygen uptake (V'O2peak) in Chronic Heart Failure (CHF) subjects. Method: This cross-sectional study involved CHF subjects with a left ventricular ejection fraction (LVEF) less than 50%, who underwent a cardiopulmonary exercise test (CPET) on a treadmill and 1-repetition maximum (1-RM) test for upper limb strength using a bench press exercise. Results: The sample consisted of 16 individuals aged 54 ± 12 years with a LVEF of 37 ± 7%. The V'O2peak was 14.98 ± 5.4 ml·min-1·kg-1 and mean maximum load in the 1-RM test was 38 ± 16 kg. There was strong correlation of V'O2peak with the load in the 1-RM test (r = 0.70; p = .037; r2 = 0.48). Conclusion: There is a strong correlation between the load in 1-RM test for upper limb with V'O2peak in CHF individuals. It is a safe, inexpensive and reproducible way to assess the muscle strength in this population.

Effects of an intradialytic cardiovascular rehabilitation program on functional capacity and cardiac function: ICRP trial

Abstract Introduction: Chronic kidney disease (CKD) is a worldwide public health problem associated with an increased risk of death from cardiovascular complications. Although previous studies have described significant improvements in exercise in functional capacity and quality of life in patients with end-stage kidney disease (ESKD), there is a lack of studies that propose to assess its impact on cardiac function using transthoracic echocardiogram (ECHO). In addition, most of the intradialytic exercise protocols are inconsistent, and incomplete regarding their intensity prescription, time of intervention, and monitoring. Methods: The present study aims to evaluate the effects of an intradialytic cardiovascular rehabilitation protocol (ICRP) using medium intensity aerobic exercises, for 30 min. on cardiac function and functional capacity. In this 6-month longitudinal study, heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, peripheral oxygen saturation (SpO2) and modified Borg scale will be analyzed in all HD sessions. The cardiac function will be evaluated by left ventricular ejection fraction (LVEF) through ECHO; functional capacity by the six-minute walk test (6MWT); quality of life through the SF-36 questionnaire and routine laboratory tests and KT/Vsp calculation before and after the ICRP. Conclusion: ICRP protocol will be examined and is expected to improve cardiac function, functional capacity, and quality of life in ESKD patients on hemodialysis.

Immediate effects of the high-velocity low-amplitude thrust on the heart rate autonomic modulation of judo athletes.

INTRODUCTION: There is controversy about the repercussions of high speed-low amplitude thrust (HVLAT) manipulation in the thoracic region on the autonomic nervous system. OBJECTIVE: To evaluate the immediate effects of the HVLAT in the high thoracic region on the heart rate autonomic modulation of judo athletes. METHODS: In the experimental study, thirty-eight healthy men divided into 2 groups (Judo athletes and non-athletes) having heart rate variability (HRV) collected beat-to-beat using a cardio-pacemater during all stages of the manipulation: i) rest, ii) time 1 (participant positioning), iii) time 2 (positioning of the participant together with the therapist), iv) HVLAT manipulation, v) post 5min, vi) post 10min and vii) post 15min HVLAT. Systolic blood pressure (SBP), diastolic blood pressure (DBP), breath frequency (BF), and HRV were also analyzed. RESULTS: A higher sympathetic modulation was observed with an increase in the standard deviation of successive normal R-R intervals (SDNN) and SD2 indices representing the total variability, however, there was no significant statistical difference in the root mean square of the mean squared differences (RMSSD), percentual of interval differences of successive NN intervals greater than 50 ms (pNN50), and SD1 variables, which represent the parasympathetic nervous system. CONCLUSION: HVLAT manipulation was able to decrease HRV during manipulation, reflecting sympathetic hyperactivity. However, the return of the HRV indices to the baseline conditions in the first minutes of recovery in Judo athletes and non-athletes reflected the safety of the application of the manipulation in these conditions studied.

Limited cardiopulmonary capacity in patients with liver cirrhosis when compared to healthy subjects.

OBJECTIVES: The present study compared cardiorespiratory capacity between cirrhotic patients and healthy subjects. METHODS: Nineteen cirrhotic patients and 19 healthy subjects, paired by age and gender, participated in the study. Volunteers performed an incremental cardiopulmonary test with a ramp protocol, a ventilatory and metabolic variables were obtained and analyzed. The recovery was analyzed by calculating the time needed for 50% of oxygen consumption (VO2) recovery to occur as the median between the peak of the exercise and the end of recovery on the VO2 curve (T1/2). The VE/VCO2 slope were performed by the linear regression of ventilation (VE) and carbon dioxide production (VCO2) data. RESULTS: During resting condition, cirrhotic patients presented significantly higher levels of VO2 compared to healthy subjects. The VE/ VO2 and VE/ VCO2 values were significantly higher in the control group at the anaerobic threshold and at the peak of the test compared to cirrhotic patients. Time under effort was significantly higher for healthy subjects. CONCLUSIONS: Based on these findings, it is possible to conclude that liver cirrhosis can compromise the patients' quality of life, mainly by inducing metabolic alterations which can impair functional capacity and lead to a sedentary lifestyle.

Avaliação da modulação autonômica da frequência cardíaca de pacientes com doença renal crônica em hemodiálise: estudo preliminar / Evaluación de la modulación autónoma de la frecuencia cardíaca en pacientes con enfermedad renal crónica sometidos a hemodiálisis: estudio preliminar / Evaluation of the autonomic heart rate modulation of patients with chronic renal disease in hemodyalysis: preliminare study

RESUMO A doença renal crônica (DRC) é definida como dano à função renal. Doentes renais crônicos atingem alta prevalência de morte por eventos cardiovasculares antes dos estágios finais, sendo maior a mortalidade em estágio dialítico, em que é evidenciado um desequilíbrio autonômico. Objetivamos avaliar a modulação simpatovagal de pacientes com DRC em tratamento de hemodiálise ambulatorial. Foram avaliados 23 pacientes, divididos em: Grupo DRC com DRC no estágio 5D (DRC-5D) em tratamento regular de hemodiálise ambulatorial; Grupo-controle com indivíduos saudáveis. A variabilidade da frequência cardíaca (VFC) foi coletada por um cardiofrequencímetro e analisada por índices lineares do domínio do tempo e do domínio da frequência. 14 pacientes no Grupo DRC com média de idade 48±16; e 9 pacientes saudáveis no Grupo-controle com média de idade 64±5. Nos resultados pelo domínio de tempo, o Grupo DRC mostrou valores significativamente maiores da frequência cardíaca (FC) comparado ao Grupo-controle (83,49±13,09 bpm vs. 67,88±9,43 bpm). Todavia, os índices média dos intervalos R-R (735,82±121,54 ms vs. 898,94±123,58 ms), RMSSD (11,75±11,86 ms vs. 20,03±6,80 ms), SDNN (17,06±9,81ms vs. 28,42±7,62 ms) do Grupo DRC mostraram valores significativamente menores comparados aos do Grupo-controle, respectivamente. Nos resultados pelo domínio da frequência, o Grupo DRC mostrou valores significativamente menores em comparação ao Grupo-controle nos índices BFab (129,7±184,3 ms vs. 262,31±168,15 ms) e AFab (82,70±227,66 ms vs. 180,77±119,85 ms). Pacientes com DRC em hemodiálise apresentaram redução da modulação parassimpática quando comparados com indivíduos saudáveis, sugerindo prejuízo do balanço simpatovagal e, consequente, disfunção autonômica cardíaca.

RESUMEN La enfermedad renal crónica (ERC) se define como la pérdida de la función renal. Los pacientes renales crónicos tienen una alta prevalencia de muerte por eventos cardiovasculares antes de la etapa final, con mayor mortalidad en la etapa de diálisis, en la que se evidencia un desequilibrio autonómico. Este estudio tuvo como objetivo evaluar la modulación simpatovagal de pacientes con ERC sometidos a tratamiento de hemodiálisis ambulatoria. Se evaluaron 23 pacientes, lo cuales fueron divididos en: Grupo ERC con ERC en etapa 5D (ERC-5D) en tratamiento de hemodiálisis ambulatoria regular; Grupo de control con individuos sanos. Para identificar la variabilidad de la frecuencia cardíaca (VFC) se utilizó un monitor de frecuencia cardíaca y los datos obtenidos fueron analizados por los índices lineales de tiempo y de dominio de frecuencia. En el grupo ERC 14 pacientes tenían un promedio de edad de 48±16 años; y en el grupo control 9 pacientes sanos tenían un promedio de edad de 64±5. En los resultados para el dominio del tiempo, el grupo ERC mostró valores significativamente más altos de frecuencia cardíaca (FC) en comparación con el grupo control (83,49±13,09 lpm vs. 67,88±9,43 lpm). Sin embargo, los índices medios de los intervalos R-R (735,82±121,54 ms vs. 898,94±123,58 ms), RMSSD (11,75±11,86 ms vs. 20,03±6,80 ms), SDNN (17,06±9,81 ms vs. 28,42±7,62 ms) del grupo ERC demostraron valores significativamente más bajos en comparación con el grupo control, respectivamente. En los resultados para el dominio de la frecuencia, en el grupo ERC se obtuvo valores significativamente más bajos en comparación con el grupo control en los índices BFab (129,7±184,3 ms vs. 262,31±168,15 ms) y AFab (82,70±227,66 ms vs. 180,77±119,85 ms). Los pacientes con ERC sometidos a hemodiálisis mostraron una modulación parasimpática reducida en comparación con los individuos sanos, lo que sugiere un deterioro del equilibrio simpaticovagal y, en consecuencia, una disfunción autonómica cardíaca.

ABSTRACT Chronic kidney disease (CKD) is defined as damage to kidney function. Patients have high prevalence of death by cardiovascular events before the final stages of the disease, with higher mortality in dialytic stage, in which autonomic imbalance is evidenced. This study seeks to evaluate sympathovagal modulation of patients with CKD undergoing hemodialysis treatment. We evaluated 23 subjects, divided into: CDK-group with CKD-stage 5D in regular hemodialysis treatment; and Control-group with healthy individuals. Heart rate variability (HRV) was collected by a heart rate monitor and analyzed by linear time domain and frequency domain indices. CDK-group had 14 patients, mean age of 48±16; and Control-group had 9 healthy patients, mean age of 64±5. In the time domain, CDK-group showed significantly higher heart rate values compared with Control-group (83.49±13.09 bpm vs. 67.88±9.43 bpm). However, the mean indices of the R-R intervals (735.82±121.54 ms vs. 898.94±123.58 ms), RMSSD (11.75±11.86 ms vs. 20.03±6.80 ms), and SDNN (17.06±9.81 ms vs. 28.42±7.62 ms) from CDK-group showed significantly lower values compared with Control-group. In frequency domain results, CDK-group showed significantly lower values compared with Control-group in LFab (129.7±184.3 ms vs. 262.31±168.15 ms) and HFab (82.70±227.66 ms vs. 180.77±119.85 ms). Patients with CKD on hemodialysis had reduced parasympathetic modulation compared with healthy subjects, suggesting impairment of the sympathovagal balance and, consequently, cardiac autonomic dysfunction.

Cardiovascular Physiotherapy on Respiratory Sinus Arrhythmia of Patients Undergoing Coronary Artery Bypass Grafting.

INTRODUCTION: Patients in the postoperative period of coronary artery bypass grafting (CABG) present respiratory and autonomic dysfunctions. In this sense, cardiovascular physiotherapy has been offered as an indispensable differential for the improvement of the prognosis of this population. Heart rate variability is a simple, noninvasive method to analyze autonomic modulation, as well as the accentuation maneuver of respiratory sinus arrhythmia, which demonstrates the parasympathetic autonomic control over the heart. Five patients undergoing cardiac surgery performed a protocol of cardiovascular physiotherapy in the postoperative period and had their data referring to the preoperative period, the 1st and 4th postoperative days analyzed.

Limited cardiopulmonary capacity in patients with liver cirrhosis when compared to healthy subjects

SUMMARY OBJECTIVES: The present study compared cardiorespiratory capacity between cirrhotic patients and healthy subjects. METHODS: Nineteen cirrhotic patients and 19 healthy subjects, paired by age and gender, participated in the study. Volunteers performed an incremental cardiopulmonary test with a ramp protocol, a ventilatory and metabolic variables were obtained and analyzed. The recovery was analyzed by calculating the time needed for 50% of oxygen consumption (VO2) recovery to occur as the median between the peak of the exercise and the end of recovery on the VO2 curve (T1/2). The VE/VCO2 slope were performed by the linear regression of ventilation (VE) and carbon dioxide production (VCO2) data. RESULTS: During resting condition, cirrhotic patients presented significantly higher levels of VO2 compared to healthy subjects. The VE/ VO2 and VE/ VCO2 values were significantly higher in the control group at the anaerobic threshold and at the peak of the test compared to cirrhotic patients. Time under effort was significantly higher for healthy subjects. CONCLUSIONS: Based on these findings, it is possible to conclude that liver cirrhosis can compromise the patients' quality of life, mainly by inducing metabolic alterations which can impair functional capacity and lead to a sedentary lifestyle.

Effect of combined physical exercise program on improving the functional capacity and the cardiac autonomic modulation of Chagas cardiomyopathy

Abstract Aims: Patients with Chagas cardiomyopathy (ChC) could have a significant reduction in functional capacity (FC). This study aimed to report the effect of a 24-week combined physical exercise program on the FC of a patient with ChC. Methods: A woman, 44 years old, with positive serology for ChC in stage B2 has submitted the following assessments: i) Physical assessment: ii) Cardiopulmonary exercise test; iii) Test of 1-maximum Repetition, iv) Evaluation of cardiac autonomic modulation by heart rate variability (HRV). Results: The results obtained revealed a reduction in the anthropometric parameters and the SBP after training. Additionally, we observed an improvement in FC (aerobic and strength condiction) and cardiac autonomic modulation after 24 weeks of combined training. Conclusion: Our findings show that of a 24-week combined physical exercise program improved either FC or HRVof the patient with ChC.

Concurrent Validity of the Static and Dynamic Measures of Inspiratory Muscle Strength: Comparison between Maximal Inspiratory Pressure and S-Index.

OBJECTIVE: To verify the concurrent validity between the inspiratory muscle strength (IMS) values obtained in static (maximal inspiratory pressure [MIP]) and dynamic (S-Index) assessments. METHODS: Healthy individuals were submitted to two periods of evaluation: i) MIP, static maneuver to obtain IMS, determined by the Mueller's maneuver from residual volume (RV) until total lung capacity (TLC); ii) and S-Index, inspiration against open airway starting from RV until TLC. Both measures were performed by the same evaluator and the subjects received the same instructions. Isolated maneuvers with differences < 10% were considered as reproducible measures. RESULTS: Data from 45 subjects (21 males) were analyzed and that showed statistical difference between MIP and S-Index values (133.5 ± 33.3 and 125.6 ± 32.2 in cmH2O, respectively), with P=0.014. Linear regression showed r2=0.54 and S-Index prediction formula = 39.8+(0.75×MIP). Pearson's correlation demonstrated a strong and significant association between the measures with r=0.74. The measurements showed good concordance evidenced by the Bland-Altman test. CONCLUSION: S-Index and MIP do not present similar values since they are evaluations of different events of the muscular contraction. However, they have a strong correlation and good agreement, which indicate that both are able to evaluate the IMS of healthy individuals.

Concurrent validity of the static and dynamic measures of inspiratory muscle strength: comparison between maximal inspiratory pressure and s-index

Abstract Objective: To verify the concurrent validity between the inspiratory muscle strength (IMS) values obtained in static (maximal inspiratory pressure [MIP]) and dynamic (S-Index) assessments. Methods: Healthy individuals were submitted to two periods of evaluation: i) MIP, static maneuver to obtain IMS, determined by the Mueller's maneuver from residual volume (RV) until total lung capacity (TLC); ii) and S-Index, inspiration against open airway starting from RV until TLC. Both measures were performed by the same evaluator and the subjects received the same instructions. Isolated maneuvers with differences < 10% were considered as reproducible measures. Results: Data from 45 subjects (21 males) were analyzed and that showed statistical difference between MIP and S-Index values (133.5 ± 33.3 and 125.6 ± 32.2 in cmH2O, respectively), with P=0.014. Linear regression showed r2=0.54 and S-Index prediction formula = 39.8+(0.75×MIP). Pearson's correlation demonstrated a strong and significant association between the measures with r=0.74. The measurements showed good concordance evidenced by the Bland-Altman test. Conclusion: S-Index and MIP do not present similar values since they are evaluations of different events of the muscular contraction. However, they have a strong correlation and good agreement, which indicate that both are able to evaluate the IMS of healthy individuals.

Similarity between predicted and obtained oxygen consumption during incremental cardiopulmonary exercise test in healthy men and chronic heart failure patients / Similaridade entre o consumo de oxigênio obtido e previsto durante teste de exercício cardiopulmonar incremental de homens saudáveis ou com insuficiência cardíaca crônica / Similitud entre el consumo de oxígeno predicho y obtenido durante la prueba de esfuerzo cardiopulmonar incremental de hombres sanos o con insuficiencia cardíaca crónica

ABSTRACT Cardiopulmonary exercise testing (CPX) is a noninvasive method for assessing physiological changes during physical exercise. Functional capacity has been evaluated using prediction equations. However, this evaluation method may yield different outcomes when applied to a healthy male population and patients with chronic heart failure (HF). This study aimed to compare the estimated and obtained values of oxygen consumption (VO2) during CPX both at the ventilatory anaerobic threshold (VAT) and at peak exercise for healthy men and HF patients. For that, 56 men were divided into 3 groups: (1) 18 young and healthy (YG) (27±6.01 years); (2) 14 healthy older adults (OG) (61±6.3 years); and (3) 24 chronic HF patients (HFG) (53±13.6 years). CPX in cycle ergometer was administered to all individuals for determining VO2 at the VAT and peak exercise. Then, VO2 was estimated at the two moments using a prediction equation, and estimated values were compared to those obtained. Estimated VO2 was significantly higher than obtained VO2 in OG (16.9±1.8 vs. 13.1±2.1mL/kg/min) and HFG (12±6.9 vs. 8.7±2.5mL/kg/min). We found no difference between estimated and obtained VO2 for the YG (22,6±5,5 vs. 23,1±8,7mL/kg/min). The prediction equation overestimated VO2 values for older adults and HF patients. However, the YG obtained similar values than those estimated.

RESUMO O teste exercício cardiopulmonar (CPX) é uma metodologia não invasiva de avaliação global da integridade dos ajustes fisiológicos durante o exercício físico. Como alternativa, a avaliação da capacidade funcional foi realizada por meio de fórmulas preditivas. No entanto, esse método de avaliação pode ter resultados diferentes quando usado em uma população de homens saudáveis e pacientes com insuficiência cardíaca (IC) crônica. Compararam-se os valores de consumo de oxigênio (VO2) obtidos e estimados durante o CPX no limiar anaeróbio ventilatório (LAV) e no pico do exercício para homens saudáveis e pacientes com IC crônica. Cinquenta e seis homens foram divididos em 3 grupos: (1) 18 eram jovens saudáveis (GJ) (27±6,01 anos); (2) 14 eram idosos saudáveis (GE) (61±6,3 anos); e, (3) 24 com IC crônica (HFG) (53±13,6 anos). Todos foram submetidos ao CPX em cicloergômetro para determinação do VO2 no LAV e no pico do exercício. Posteriormente, a estimativa do VO2 foi realizada na potência do LA e no pico do exercício por meio de uma fórmula de predição para exercício físico em cicloergômetro. Os valores de VO2 obtidos e a carga estimada foram comparados. O VO2 estimado foi significativamente maior que o VO2 obtido no GE e no HFG (16,9±1,8 vs. 13,1±2,1mL/kg/min e 12±6,9 vs. 8,7±2,5mL/kg/min, respectivamente). Por fim, não houve diferença nos valores de VO2 estimados e obtidos para o GJ (22,6±5,5 vs. 23,1±8,7mL/kg/min, respectivamente). A fórmula de predição superestimou os valores de VO2 para idosos e pacientes com IC crônica. Porém, no GJ os valores de VO2 se mostraram semelhantes para a fórmula de predição e o obtido durante o CPX em cicloergômetro.

RESUMEN La prueba de ejercicio cardiopulmonar (CPX) es una metodología no invasiva para evaluar la integridad global de los ajustes fisiológicos durante la práctica de ejercicio físico. Se realizó como alternativa la evaluación de la capacidad funcional por medio de fórmulas predictivas. Sin embargo, este método de evaluación puede presentar resultados distintos cuando se utiliza en una población de hombres sanos y de pacientes con insuficiencia cardíaca crónica (IC). Se compararon los valores de consumo de oxígeno (VO2) obtenido y estimado durante la CPX en el umbral anaeróbico ventilatorio (LAV) y en la cima del ejercicio para hombres sanos y pacientes con IC crónica. Se dividieron a 56 hombres en 3 grupos: i) 18 eran jóvenes sanos (GJ) (27±6,01 años); ii) 14 eran ancianos sanos (GE) (61±6,3 años); iii) 24 tenían IC crónica (HFG) (53±13,6 años). Todos se sometieron a CPX en un cicloergómetro para determinar el VO2 en LAV y en la cima del ejercicio. Posteriormente, la estimación de VO2 se realizó sobre la potencia de LA y en la cima del ejercicio mediante una fórmula predictiva del ejercicio físico en un cicloergómetro. Los valores de VO2 obtenidos y la carga estimada se compararon. El VO2 estimado fue significativamente mayor que el VO2 obtenido en GE y HFG (16,9±1,8 vs. 13,1±2,1ml/kg/min y 12±6,9 vs. 8,7±2,5ml/kg/min, respectivamente). No hubo diferencias en los valores de VO2 estimado y obtenido para el GJ (22,6±5,5 vs. 23,1±8,7ml/kg/min, respectivamente). La fórmula predictiva sobrestimó los valores de VO2 para ancianos y pacientes con IC crónica. Sin embargo, en GJ los valores de VO2 fueron similares para la fórmula predictiva y la obtenida durante el CPX en cicloergómetro.

Ventilatory and Near-Infrared Spectroscopy Responses Similarly Determine Anaerobic Threshold in Patients With Heart Failure.

PURPOSE: The present study compared the level of agreement of anaerobic threshold (AT) between ventilatory and near-infrared spectroscopy (NIRS) techniques in patients with chronic heart failure (CHF) and healthy subjects. METHODS: Patients with CHF (n = 9) and a control group (CG; n = 14) underwent cardiopulmonary exercise testing on a cycle ergometer until physical exhaustion. Determination of AT was performed visually by (1) ventilatory-expired gas analysis curves and (2) oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) curves assessed by NIRS. RESULTS: The CHF group presented significantly lower oxygen consumption (O2), heart rate, and workload at AT when compared with the CG measured by NIRS (P < .05). However, the effect size, measured by the Cohen d, revealed large magnitude (>0.80) in both techniques when compared between CHF patients and the CG. In addition, ventilatory and NIRS techniques demonstrated significant and very strong/strong correlations for relative O2 (r = 0.91) and heart rate (r = 0.85) in the detection of AT in the CHF group. CONCLUSION: Both ventilatory and NIRS assessments are correlated and there are no differences in the responses between CHF patients and healthy subjects in the determination of AT. These findings indicate both approaches may have utility in the assessment of submaximal exercise performance in patients with CHF.

Cardiovascular Acute Effects of Traditional vs. Paired Set Resistance Training in Patients With Liver Cirrhosis.

Purpose: This study compared the acute effects of two different resistance training methods on heart rate variability, blood pressure, and rating of perceived exertion in patients with liver cirrhosis. Methods: Ten patients with Child-Pugh A (seven women and three men) participated in two experimental sessions, in random order: The traditional set condition consisted of three sets of six exercises performed in a sequential manner, while the paired set condition consisted of alternating sets between two exercises (three pairs of exercises). Ten repetitions were performed for each set with 70% of a 10 repetition maximum load and with 2 min rest between sets. Blood pressure and heart rate variability were assessed pre-workout and for 60 min post-workout. The rating of perceived exertion was assessed at the end of the third set for each exercise. Results: Significant alterations in heart rate variability were observed when considering the lowest value obtained during recovery, in which the SDNN was reduced in both the traditional set and paired set conditions, as well as the root mean square of standard deviation for the traditional set condition (p < .05). Additionally, for the paired set condition, there was a significant reduction in the HFnu band and a significant increase in the LFnu band (p < .05). Effect size showed reductions in diastolic and mean blood pressure until 30 min in a small magnitude for traditional sets. Conclusion: Similar cardiovascular responses were observed between methods eliciting normal physiological responses within safe limits for patients with liver cirrhosis.

Importância do teste cardiopulmonar para a fisioterapia cardiovascular / Importance of cardiopulmonary testing for cardiovascular physical therapy

O teste de exercício cardiopulmonar (TECP) é um método não invasivo de avaliação global da integridade dos ajustes fisiológicos no organismo humano durante a execução do exercício físico. Na prática clínica, o TECP tem sido utilizado com as mais diversas finalidades. O profissional capacitado pode utilizá-lo principalmente para avaliar a capacidade funcional dos indivíduos submetidos ao teste, mas também pode ser realizado com a finalidade diagnóstica, prognóstica e principalmente para a reabilitação, na qual a prescrição de exercícios é determinada de forma segura e individualizada. Nos últimos anos este teste tem se tornado uma importante ferramenta para os fisioterapeutas e educadores físicos para a prescrição de exercício físico. Os índices de limitação funcional mais observados são: 1) o consumo de oxigênio pico (VO2pico) ou consumo máximo de oxigênio (VO2máx); 2) limiar anaeróbico ventilatório (LAV) em níveis de exercício físico submáximo. Desta forma, o objetivo do nosso trabalho foi disseminar o conhecimento sobre o TECP entre os nossos pares e outros profissionais da saúde. Neste sentido, promovendo a possibilidade de discussão sobre a potencial inserção do TECP nos programas de reabilitação cardíaca ambulatorial de forma precisa e segura, para melhora da capacidade funcional e a qualidade de vida dos pacientes. (AU)

The cardiopulmonary exercise test (CPT) is a noninvasive method of evaluating the overall integrity of the physiological adjustments in the human body during the execution of the physical exercise. In clinical practice the TECP has been used for a wide range of purposes. The trained professional can use it mainly to evaluate the functional capacity of the individuals submitted to the test. But it can also be performed for diagnostic purposes, prognosis and mainly for rehabilitation, in which the prescription of exercises is determined in a safe and individualized way. In recent years this test has become an important tool for physiotherapists and physical educators to prescribe physical exercise. The most observed functional limitation indices are: 1) peak oxygen consumption (VO2peak) or maximal oxygen consumption (VO2max); 2) Ventilatory threshold (VT) at submaximal physical exercise levels. In this way, the objective of our work was to disseminate the knowledge about CPT among our peers and other health professionals. In this sense, promoting the possibility of discussing the potential insertion of CPT in ambulatory cardiac rehabilitation programs is a precise and safe way to improve functional capacity and quality of life of patients. (AU)

Effect of Different Circuit Training on Cardiovascular Responses in Cirrhotic Patients.

The purpose of this study was to analyze and compare heart rate (HR), heart rate variability (HRV), and blood pressure (BP) responses during and after circuit resistance training with 1 min. (CIR1) vs. 2 min. (CIR2) rest intervals between exercises in liver cirrhosis patients. 10 patients (7 women, 3 men) participated in 2 experimental sessions (CIR1 and CIR2) in random order. Each experimental session consisted of 6 exercises performed for 3 sets of 10 repetitions with 70% of the 10-RM load. The only difference between experimental sessions was taking either 1 min. (CIR1) or 2 min. (CIR2) of rest between exercises. Prior and during each session, BP, HR and HRV (beat-to-beat intervals) were assessed. Training efficiency were significant higher for CIR1 when compared to CIR2, since same total training volume was performed in less time. Both protocols elicited significant changes in HR, SBP, and SampEn. Based on the ∆HR and ∆IRR between protocols, higher cardiovascular stress was observed for CIR1 vs. CIR2. However, the patients presented a similar recovery pattern between experimental sessions, and did not present significant alterations in the HRV at 60 min post-workout. In summary, the fast adjustment of autonomic modulation in HRV and BP suggests that circuit resistance training with 1-min or 2-min rest intervals between exercises elicits typical cardiovascular responses in liver cirrhosis patients.

Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery.

PURPOSE: We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting. METHODS: Fifty-two patients aged 60.9 ± 7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery. RESULTS: Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51 × 10-3 min2/ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics. CONCLUSIONS: Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay. Implications for rehabilitation Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression; The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes; Our findings suggest the importance of the rehabilitation in the pre-operative in order to "pre-habilitate" the patients to the surgical procedure; Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.