Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of early use of a cycle ergometer, compared to a standard care protocol, in postoperatory in-hospital mobility following cardiac surgery. DESIGN: A randomized controlled trial. SETTING: Tertiary hospital in Salvador, Bahia, Brazil. SUBJECTS: Patients submitted to elective cardiac surgery (valvular or coronary bypass surgery by sternotomy). INTERVENTION: Patients were randomly allocated in two groups: (1) cycle ergometer training group (10-minute session) and (2) control group submitted standard physiotherapy protocol (10-minute session). Training was provided twice a day, immediately following extubation and until patient was discharged from the intensive care. MAIN MEASURES: The primary outcome was the difference in the total number of steps recorded on the pedometer over three days. Secondary outcomes were mobility in different subgroups and the reasons that prevented individuals from walking during early cardiac rehabilitation. RESULTS: A total of 228 participants completed the study. No significant difference was found in the total number of steps between the groups after intervention: 2183 (range: 1729-2772) in the intervention group versus 2006 (1517-2657) in the control group (P = 0.167). However, self-reports indicated better motivation in the intervention group (P = 0.044). No adverse events occurred during the study. CONCLUSION: As a strategy for early mobilization following cardiac surgery, the use of a cycle ergometer failed to increase independent physical activity compared to a standard care protocol. Nevertheless, it was safe and could be an alternative to make rehabilitation more attractive and motivational for this patient population.

Estresse gravitacional no pós-operatório de cirurgia cardíaca / Gravitational stress in postoperative heart surgery

INTRODUÇÃO: Após a cirurgia cardíaca, a mobilização precoce busca o ganho funcional e um melhor condicionamento para as próximas fases da reabilitação cardiovascular, tendo o estresse gravitacional(EG)um importante papel para o retorno destas atividades, através da integridade dos mecanismos compensatórios cardiovasculares. OBJETIVO: verificar o comportamento de variáveis circulatórias e respiratórias durante o EG no pós-operatório de cirurgia cardíaca. MÉTODOS E MATERIAIS: Estudo observacional, transversal e analítico, composto por 83 indivíduos adultos clinicamente estáveis, submetidos a cirurgia de revascularização do miocárdio ou abordagem valvar. Excluídos aqueles com dificuldade de compreensão das atividades realizadas, além de comprometimento motor e/ou neurológico que impossibilitassem a realização do EG, de forma adaptada. Foram coletados os dados circulatórios e respiratórios no 1° minuto para cada etapa através do monitor multiparamétrico Gemedical Systems@. RESULTADOS: As frequências cardíaca e respiratória apresentaram um aumento com significância estatística (p ≤ 0,01), quando analisado seus valores de variação de decúbito dorsal para sedestação e decúbito dorsal para ortostase. CONCLUSÃO: As variáveis hemodinâmicas e respiratórias se comportam de acordo com a resposta fisiológica durante o EG, sugerindo que esse procedimento é seguro no ambiente da terapia intensiva, mesmo se tratando de um pós-operatório de alta complexidade. [AU]

INTRODUCTION: after cardiac surgery, early mobilization seeks functional gain and better conditioning for the next phases of cardiac rehabilitation, with gravitational stress (GS) playing an important role in the return of these activities through the integrity of cardiovascular compensatory mechanisms. OBJECTIVE: to verify the behavior of circulatory and respiratory variables during (GS) in the postoperative period of cardiac surgery. METHODS AND MATERIALS: observational cross-sectional analytical study, consisted of 83 clinically stable adults undergoing coronary artery bypass or valve surgery approach. Excluded those with difficulty understanding the activities performed, in addition to motor and / or neurological impairment that made it impossible to perform GS, an adapted form. Circulatory and respiratory data were collected in the 1st minute for each stage using the multi-parameter monitor Gemedical Systems@.RESULTS: The heart and respiratory rates showed an increase was statistically significant (p ≤ 0.01) when analyzed their dorsal range of values for sedestation and supine to standing position. CONCLUSION: hemodynamic and respiratory variables behave in accordance with the physiological response during GS, suggesting that this procedure is safe within the intensive care setting, even if a treating postoperative high complexity. [AU]

Efeito de um programa regular de exercício físico sobre a proteína C-reativa de indivíduos com risco de doenças cardiovasculares / Effect of a Regular Aerobic Exercise Program on C-Reactive Protein among People at Risk for Cardiovascular Disease

Fundamentos: Estudos observacionais sugerem que exercício físico possui efeito anti-inflamatório, no entanto essa hipótese não está definitivamente confirmada por ensaios clínicos randomizados.Objetivo: Verificar o efeito da atividade física aeróbica sobre o processo inflamatório sistêmico em indivíduos com risco cardiovascular. Métodos: Ensaio clínico randomizado, em que foram incluídos indivíduos sedentários, com pelo menos dois fatores de risco para doença coronariana ou doença cardiovascular estabelecida. Os voluntários foram randomizados para três meses de treinamento aeróbico supervisionado (grupo-treino) ou apenas aconselhamento quando a hábitos de vida saudáveis (grupo-controle). Proteína C-reativa (PCR) foi mensurada por método de alta sensibilidade antes e após a intervenção. Resultados: Avaliados 68 indivíduos. Os grupos treino e controle apresentaram características basais semelhantes. Houve melhora da capacidade funcional apenas nos pacientes do grupo-treino. Observou-se aumento de PCR após três meses no grupo-controle, cuja mediana evoluiu de 2,2 mg/L (IIQ =1,0 mg/L - 4,3 mg/L)para 3,2 mg/L (IIQ =2,4 mg/L - 5,5 mg/L), p=0,006.Esse fenômeno não foi observado no grupo-treino,que apresentou mediana basal de 1,7 mg/L(IIQ =0,97 mg/ L - 4,8 mg/L), estatisticamente semelhante ao valor final de 2,5 mg/L (1,0 mg/L - 4,7 mg/L), p=0,46.Quando a variação percentual da PCR foi comparada entre os grupos, houve maior incremento no grupo controle(+58,0 %; IIQ =11,0 % - 151,0 %), comparado ao grupo-treino (+17,0 %; IIQ =-36,0 % - 79,0 %),p intergrupo=0,046.

Background: Although observational studies suggest that exercise has anti-inflammatory effects, this possibility has not been confirmed definitively through randomized clinical trials. Objective: To assess the effects of aerobic activities on systemic inflammatory processes among people at cardiovascular risk. Methods: A randomized clinical trial encompassing sedentary subjects with at least two risk factors for heart disease or established cardiovascular disease. These volunteers were assigned randomly to three months of supervised aerobic training (training group) or just counseling on healthy lifestyle habits (control group). C-reactive protein (CRP) was measured by a highly sensitive method before and after these interventions. Results: Assessing 68 subjects. The training and control groups had similar baseline characteristics. There was improvement in functional capacity among only the training group patients. After three months, an increase in the CRP was noted in the control group, whose median rose from 2.2mg/L(IQR=1.0 to 4.3mg/L) to 3.2mg/L (IQR=2.4 to5.5mg/L) - p=0.006. This phenomenon was not found in the training group, which presented a baseline median of 1.7mg/L (IQR =0.97 to 4.8mg/L),statistically similar to the final value of 2.5mg/L(1.0 to 4.7mg/L) - p=0.46. When the percentage variation in the CRP was compared for these groups, there was a greater increase in the control group (+58%, IQR=11% to 151%), compared to the training group (+17%, IQR= -36% to 79%) - intergroupp=0.046.