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1.
J Phys Act Health ; : 1-7, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31810064

RESUMO

PURPOSE: To investigate the effect of high-intensity interval training (HIIT) versus moderate-intensity continuous exercise training (MICE) on hemodynamic and functional variables in individuals with Parkinson's disease. METHODS: Twenty participants (13 men) were randomly assigned to a thrice-weekly HIIT (n = 12) or MICE (n = 8) for 12 weeks. Hemodynamic (resting heart rate and blood pressure, carotid femoral pulse wave velocity, endothelial reactivity, and heart rate variability) and functional variables (5-time sit-to-stand, timed up and go, and 6-min walking tests) assessed before and after training. RESULTS: Demographic, hemodynamic and functional variables were similar between groups at baseline. Endothelial reactivity tended to increase after HIIT, but not after MICE, resulting in improved level (∼8%, P < .01) of this variable in HIIT versus MICE during follow-up. Six-minute walking test improved after HIIT (10.4 ± 3.8%, P < .05), but did not change after MICE. Sit to stand improved similarly after HIIT (27.2 ± 6.1%, P < .05) and MICE (21.5 ± 5.4%, P < .05). No significant changes were found after HIIT or MICE in any other variable assessed. CONCLUSION: These results suggest that exercise intensity may influence training-induced adaptation on endothelial reactivity and aerobic capacity in individuals with Parkinson's disease.

2.
Int J Sports Med ; 40(4): 283-291, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791079

RESUMO

Blood pressure (BP) and hemodynamic response to heated water-based (HEx) vs. land-based exercise (LEx) were assessed in 15 (6 men) older hypertensives (age 66.4±4.9 yr) under pharmacological treatment. Participants were randomly assigned to perform 30 min of moderate-intensity HEx (walking inside the pool), LEx (walking on a treadmill) and non-exercise control (CON) intervention. Resting BP, arterial stiffness, endothelial reactivity and heart rate variability (HRV) were measured before, immediately after, and 45 min after interventions. 24-h ambulatory BP monitoring was performed after interventions. Resting systolic (but not diastolic) BP reduced 9.9±3.1 mmHg (P<0.01) 45 min after HEx only. 24-h systolic and diastolic, daytime diastolic and nightime systolic BP were lower (P<0.05) after HEx than both LEx and CON. Daytime systolic BP was also lower (P<0.05) after HEx than CON. Nighttime diastolic was not different between interventions. HEx-induced ambulatory BP reduction ranged 4.5±1.3 mmHg (24-h diastolic BP) to 9.5±3.0 mmHg (nighttime systolic BP), and persisted for 18/11 h in systolic/diastolic BP, when compared with CON. No significant changes in arterial stiffness, endothelial reactivity and HRV were found during any intervention. These results suggest that HEx may have important implications for managing BP in older hypertensive under pharmacological treatment.


Assuntos
Terapia por Exercício/métodos , Hidroterapia/métodos , Hipertensão/terapia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Endotélio Vascular/fisiologia , Feminino , Frequência Cardíaca , Temperatura Alta , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rigidez Vascular
3.
Appl Physiol Nutr Metab ; 44(4): 348-356, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30230920

RESUMO

We tested the hypothesis that rating of perceived exertion (RPE) is a tool as efficient as the heart rate (HR) response to the cardiopulmonary exercise test (CPX) for prescribing and self-regulating high-intensity interval exercise (HIIE), and that metabolic and hemodynamic response to HIIE is superior than to continuous moderate-intensity exercise (MICE) in individuals with type 2 diabetes mellitus (T2DM). Eleven participants (age = 52.3 ± 3 years) underwent HIIE prescribed and self-regulated by RPE (HIIERPE; 25 min), HIIE prescribed and regulated by an individual's HR response to CPX (HIIEHR; 25 min), MICE prescribed and self-regulated by RPE (30 min) and control (30 min of seated resting) intervention in random order. HR, blood pressure (BP), capillary glucose, endothelial reactivity, and carotid-femoral pulse wave velocity were assessed before, immediately after, and 45 min after each intervention. Exercise HR, speed, and distance were measured during exercise sessions. Twenty-four-hour ambulatory BP was measured after each intervention. Exercise HR, speed, and distance were similar between HIIERPE and HIIEHR. BP response was not different among HIIERPE, HIIEHR, and MICE. Capillary glycaemia reduction was greater (P < 0.05) after HIIERPE (48.6 ± 9.6 mg/dL) and HIIEHR (47.2 ± 9.5 mg/dL) than MICE (29.5 ± 11.5 mg/dL). Reduction (P < 0.05) in 24-h (6.7 ± 2.2 mm Hg) and tendency toward reduction (P = 0.06) in daytime systolic (7.0 ± 2.5 mm Hg) ambulatory BP were found only after HIIERPE. These results suggest that HIIE is superior to MICE for reducing glycaemia and ambulatory BP, and that the 6-20 RPE scale is a useful tool for prescribing and self-regulating HIIE in individuals with T2DM.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Metabolismo Energético , Hemodinâmica , Treinamento Intervalado de Alta Intensidade , Esforço Físico , Adulto , Idoso , Biomarcadores/sangue , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Brasil , Estudos Cross-Over , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Tempo , Resultado do Tratamento , Rigidez Vascular
4.
Can J Cardiol ; 34(12): 1641-1647, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527153

RESUMO

BACKGROUND: Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. METHODS: We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. RESULTS: HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. CONCLUSIONS: BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.


Assuntos
Terapia por Exercício , Temperatura Alta/uso terapêutico , Hipertensão/terapia , Água , Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio
5.
J Am Coll Cardiol ; 71(20): 2281-2290, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29540327

RESUMO

BACKGROUND: Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with ß-blockers remains controversial. OBJECTIVES: This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS: The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m2) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a ≥10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS: Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 ± 3.64 mm to 45.2 ± 3.2 mm vs. 44.9 ± 3.6 mm to 46.4 ± 4.0 mm; p = 0.057). CONCLUSIONS: In this largest clinical trial of ß-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction. (Carvedilol Effect in Preventing Chemotherapy-Induced Cardiotoxicity [CECCY]; NCT01724450).


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antineoplásicos/efeitos adversos , Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/prevenção & controle , Carvedilol/uso terapêutico , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Cardiotoxicidade/epidemiologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Arq Bras Cardiol ; 110(2): 188-194, 2018 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29466487

RESUMO

Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS and Mesh were: "heart transplantation'' OR "cardiac transplantation". The words used in combination (AND) were: "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.


Assuntos
Transplante de Coração/reabilitação , Treinamento Intervalado de Alta Intensidade/normas , Transplantados , Feminino , Humanos , Masculino , Consumo de Oxigênio/fisiologia
7.
Arq. bras. cardiol ; 110(2): 188-194, Feb. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-888012

RESUMO

Abstract Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS and Mesh were: "heart transplantation'' OR "cardiac transplantation". The words used in combination (AND) were: "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.


Resumo O transplante de coração é considerado procedimento eficiente e padrão ouro para pacientes com quadro de insuficiência cardíaca terminal. Verifica-se que após o procedimento cirúrgico os pacientes apresentam menor valor de potência aeróbia (VO2máx) e respostas hemodinâmicas descompensadas. O objetivo do presente estudo foi de verificar por meio de uma revisão sistemática com meta-análise se o treinamento intervalado de alta intensidade é capaz de proporcionar benefícios a tais capacidades. Trata-se de uma revisão sistemática com meta-análise, que realizou buscas em pares nas bases e portais de dados PubMed, Web of Science, Scopus, Science Direct e Wiley até dezembro de 2016. Para busca dos artigos utilizaram-se os termos e descritores: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Os descritores pelo DeCS e Mesh foram: "heart transplantation'' OR "cardiac transplantation". As palavras utilizadas em combinação (AND) foram "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". A busca inicial identificou 1064 estudos. Em seguida, apenas os estudos que analisaram a influência do treinamento intervalado de alta intensidade no período pós transplante foram adicionados, sendo, assim, três estudos analisados. O nível adotado nas análises estatísticas para determinar significância foi de 0,05. Verificou-se que, entre 8 e 12 semanas de intervenção, os pacientes transplantados de coração apresentaram melhoras significativas em VO2pico, frequência cardíaca e pressão arterial pico.

8.
ESC Heart Fail ; 5(3): 249-256, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29266804

RESUMO

AIMS: The SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients. METHODS AND RESULTS: SHIFT was a randomized, double-blind, placebo-controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta-blocker. ChD HF presented a poor prognosis (all-cause mortality at 2 years was ~60%). The mean twice-daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all-cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope. CONCLUSIONS: ChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit-risk profile in ChD HF patients.


Assuntos
Doença de Chagas/complicações , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Ivabradina/administração & dosagem , Volume Sistólico/efeitos dos fármacos , Argentina/epidemiologia , Brasil/epidemiologia , Fármacos Cardiovasculares/administração & dosagem , Doença de Chagas/diagnóstico , Doença de Chagas/fisiopatologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Insuficiência Cardíaca Sistólica/etiologia , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências , Resultado do Tratamento , Função Ventricular Esquerda
10.
Circ J ; 81(3): 339-345, 2017 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-28049937

RESUMO

BACKGROUND: The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based exercise (HEx) in resistant hypertension (HT) patients remain undefined.Methods and Results:We investigated these in 44 true resistant HT patients (age 53.3±0.9 years, mean±SEM). They were randomized and allocated to 2 groups, 28 to a HEx training protocol, which consisted of callisthenic exercises and walking in a heated pool for 1 h, three times weekly for 12 weeks and 16 patients to a control group maintaining their habitual activities. Measurements made before and after 12 weeks of HEx included clinic and 24-h BP, plasma levels of nitric oxide, endothelin-1, aldosterone, renin, norepinephrine and epinephrine, as well as peak V̇O2, and endothelial function (reactive hyperemia). After 12 weeks of HEx patients showed a significant decrease in clinic and 24-h systolic and diastolic BPs. Concomitantly, nitric oxide increased significantly (from 25±8 to 75±24 µmol/L, P<0.01), while endothelin-1 (from 41±5 to 26±3 pg/mL), renin (from 35±4 to 3.4±1 ng/mL/h), and norepinephrine (from 720±54 to 306±35 pg/mL) decreased significantly (P<0.01). Plasma aldosterone also tended to decrease, although not significantly (from 101±9 to 76±4 pg/mL, P=NS). Peak V̇O2increased significantly after HEx (P<0.01), while endothelial function was unchanged. No significant change was detected in the control group. CONCLUSIONS: The BP-lowering effects of HEx in resistant HT patients were accompanied by a significant reduction in the marked neurohumoral activation characterizing this clinical condition.


Assuntos
Banhos , Endotélio Vascular , Terapia por Exercício , Hipertensão , Adulto , Idoso , Aldosterona/sangue , Endotelina-1/sangue , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Epinefrina/sangue , Feminino , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Norepinefrina/sangue , Renina/sangue
11.
Arq. bras. cardiol ; 106(6): 502-509, tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-787319

RESUMO

Abstract Background: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. Objective: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. Method: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. Results: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). Conclusion: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.


Resumo Fundamento: A cardiomiopatia dilatada idiopática (CMDid) possui poucos preditores de mortalidade descritos: a baixa fração de ejeção de ventrículo esquerdo (FEVE) e a baixa capacidade funcional, sendo esta subjetiva. Objetivo: Os objetivos desse estudo foram (i) Avaliar se as classes funcionais propostas pela NYHA, modificada para crianças, estiveram associadas entre a percepção médica (CFm), dos pais ou representantes (CFp) e das próprias crianças avaliadas (CFc). (ii) Avaliar se houve correlação entre VO2 max e a classificação proposta por Weber. Método: Crianças com CMDid e com IC por CMDid prévia com FEVE preservada, na fase pré-puberdade foram selecionadas submetidas a avaliações de ergoespirometria e classificação da classe funcional. As crianças utilizaram uma representação gráfica para se intitular quanto à classe funcional. Resultado: O teste Chi-quadrado mostrou que houve associação ente a CFm e CFp (1, n = 31) = 20,6; p = 0,002. Não houve associação significativa entre CFp e CFc (1, n = 31) = 6,7; p = 0,4. As CF segundo médico e CFc não foram, tampouco, associadas (1, n = 31) = 1,7; p = 0,8. A classificação de Weber foi significativamente associada às três classes funcionais (classificação de Weber e CFm (1, n = 19) = 11,8; p = 0,003; classificação de Weber e CFp (1, n = 19) = 20,4; p = 0,0001; classificação de Weber e CFc (1, n = 19) = 6.4; p = 0.04.). Conclusão: A representação gráfica serviu para que as crianças pudessem se classificar segundo a NYHA, que se demonstrou associada com a estratificação de Weber.

12.
Arq Bras Cardiol ; 106(6): 502-9, 2016 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27168472

RESUMO

BACKGROUND: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. OBJECTIVE: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. METHOD: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. RESULTS: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). CONCLUSION: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Consumo de Oxigênio/fisiologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Cardiomiopatia Dilatada/classificação , Criança , Pré-Escolar , Estudos Transversais , Teste de Esforço , Feminino , Humanos , Masculino , Ventilação Voluntária Máxima/fisiologia , Esforço Físico/fisiologia , Projetos Piloto , Estudos Prospectivos , Distribuição Aleatória
13.
MedicalExpress (São Paulo, Online) ; 3(1)Jan.-Feb. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-773531

RESUMO

The objective of the paper was to analyze cardiopulmonary data and functional capacity in healthy children who have undergone ergospirometry. A systematic meta-analysis review of ergospirometry in children was performed based on reports indexed in PubMed, Bireme, and Embase. End points were age, sex, body mass index, maturation evaluation, the type of ergometer used for ergospirometry, and cardiopulmonary related values (peak heart rate and peak oxygen consumption [VO2]). Twenty articles were selected, which included 3,808 children, averaging 9.1years of age. A treadmill was used in 55% of the trials, and a cycle ergometer in the other 45% studies included in this analysis. The following statistically significant results were found: on subgroup analysis, peak VO2 values in boys on the treadmill was 20% higher than peak VO2 values in girls on the cycle ergometer; peak VO2 values in boys on the treadmill were 18% greater than that for girls on the same ergometer. BMI was inversely correlated with peak VO2 in the total analysis, and in female subjects on cycle ergometers. Peak heart rate during the ergospirometrical test was 5.6 BPM higher than the estimated 95% maximum heart rate. Most of the ergospirometrical parameters had not been reported in the original trials analyzed here. We conclude that peak VO2 value for pre-pubertal children are circa 18% higher in boys vs. girls and overall higher in treadmill vs. cycle ergometers.


O objetivo do trabalho foi analisar dados relativos à função cardiopulmonar e capacidade funcional em crianças saudáveis submetidas a ergoespirometria. Uma revisão meta-analítica sistemática de ergoespirometria em crianças foi realizada com base na literatura indexada no PubMed, Bireme, e Embase. Os parâmetros pesquisados foram: idade, sexo, índice de massa corporal, avaliação da maturação, tipo de ergômetro utilizado para ergoespirometria, e os valores cardiopulmonares relacionados (frequência cardíaca máxima e consumo máximo de oxigênio [VO2]). Vinte artigos foram selecionados, que incluíram 3808 crianças, com uma média de 9,1 anos de idade. Esteiras erogmétricas foram utilizadas em 55% dos ensaios, e bicicletas erogmétricas em outros 45% incluídos nesta análise. Os seguintes resultados estatisticamente significantes foram encontradas: em análise de subgrupo, valores de VO2 de pico em meninos, obtidos na esteira foram 20% maiores do que os respectivos valores em meninas na bicicleta ergométrica valores de VO2 pico em meninos na esteira foram 18% maiores do que para meninas no mesmo ergômetro. O Índice de massa corpórea correlacionou-se inversamente com VO2 de pico na análise total e em meninas testadas em ciclo-ergômetro. A frequência cardíaca máxima durante o teste ergo-espirométrico foi 5,6 BPM superior aos 95% da freqüência cardíaca máxima prevista. A maior parte dos parâmetros ergo-espirométricos não havia sido relatada nos estudos originais por nós analisados. A conclusão desta metanálise é que o valor de VO2 de pico para crianças pré-púberes é cerca de 18% maior nos meninos versus meninas e em esteira vs. ciclo-ergômetro.


Assuntos
Humanos , Criança , Consumo de Oxigênio , Espirometria/métodos , Capacidade Residual Funcional , Testes de Função Cardíaca
14.
Med Sci Sports Exerc ; 48(5): 804-10, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26673130

RESUMO

PURPOSE: Heart transplant recipients (HTx) have a high prevalence of hypertension. Although exercise training promotes blood pressure (BP) reduction in HTx, the effects of a single exercise bout are unknown. Thus, we analyzed the acute effects of heated water-based exercise (HEx) versus land-based exercise (LEx) on ambulatory BP (ABP) in HTx. METHODS: Eighteen (six females) clinically stable HTx (time since surgery = 5.0 ± 0.7 yr) age 45.7 ± 2.7 yr underwent 30 min of HEx (walking inside the pool), LEx (walking on a treadmill), and nonexercise control (CON) intervention in random order (2-5 d between interventions). HEx and LEx intensity was set at 11-13 in the 6-20 RPE scale. Twenty-four-hour (24-h) ABP monitoring was performed after each intervention. RESULTS: No significant differences between interventions were found in 24-h and nighttime BP. However, daytime diastolic BP was significantly lower after HEx than CON (-4 ± 1.6 mm Hg, P = 0.03), and daytime diastolic BP tended to be lower after LEx than CON (-2.3 ± 1.1 mm Hg, P = 0.052). Hourly analysis showed that systolic and diastolic BP values were lower after HEx (average reductions of 6.6 to 12.3 mm Hg, P < 0.01) and LEx (average reductions of 5 to 8.3 mm Hg, P < 0.05) than after CON in several hours. No significant differences between HEx and LEx were found in any ABP data. CONCLUSION: HEx and LEx promoted similar reductions in ABP of heart transplant recipients, which suggests that they may be a tool to counteract hypertension in this high-risk population.


Assuntos
Terapia por Exercício/métodos , Transplante de Coração , Hipotensão Pós-Exercício/prevenção & controle , Caminhada/fisiologia , Adulto , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Estudos Cross-Over , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Piscinas , Transplantados , Adulto Jovem
15.
Arq. bras. cardiol ; 105(3): 265-275, Sept. 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-761503

RESUMO

Background:Polypharmacy is a significant economic burden.Objective:We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients.Methods:We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost.Results:The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively.Conclusion:RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.


Fundamento:A polifarmácia tem um significativo peso econômico.Objetivo:Testar se o uso de pregão em comparação ao de farmácias comerciais (FC) para a compra de medicamentos reduz o custo do tratamento de pacientes ambulatoriais de insuficiência cardíaca (IC) e transplante cardíaco (TC).Métodos:Comparação dos custos do tratamento através de pregão versus FC em pacientes de IC (808) e TC (147) acompanhados de 2009 a 2011, avaliando-se a influência de variáveis clínicas e demográficas no custo.Resultados:Os custos mensais por paciente para medicamentos de IC adquiridos através de pregão e através de FC foram $10,15 (IQ 3,51-40,22) e $161,76 (IQ 86,05-340,15), respectivamente. Para TC, aqueles custos foram $393,08 (IQ 124,74-774,76) e $1.207,70 (IQ 604,48-2.499,97), respectivamente.Conclusão:O pregão pode reduzir o custo dos medicamentos prescritos para IC e TC, podendo tornar o tratamento de IC mais acessível. As características clínicas podem influenciar o custo e os benefícios do pregão, que pode ser uma nova estratégia de política de saúde para baixar os custos dos medicamentos prescritos para IC e TC, diminuindo o peso econômico do tratamento. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0).


Assuntos
Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Proposta de Concorrência/economia , Custos de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/economia , Insuficiência Cardíaca/economia , Transplante de Coração/economia , Brasil , Controle de Custos , Análise Custo-Benefício , Prescrições de Medicamentos/economia , Insuficiência Cardíaca/tratamento farmacológico , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Volume Sistólico , Função Ventricular Esquerda
16.
Arq Bras Cardiol ; 105(3): 265-75, 2015 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26200898

RESUMO

BACKGROUND: Polypharmacy is a significant economic burden. OBJECTIVE: We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients. METHODS: We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost. RESULTS: The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05­340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively. CONCLUSION: RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.


Assuntos
Proposta de Concorrência/economia , Custos de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/economia , Insuficiência Cardíaca/economia , Transplante de Coração/economia , Adulto , Idoso , Brasil , Controle de Custos , Análise Custo-Benefício , Prescrições de Medicamentos/economia , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Volume Sistólico , Função Ventricular Esquerda , Adulto Jovem
17.
Rev Bras Cir Cardiovasc ; 30(1): 9-15, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25859862

RESUMO

OBJECTIVE: To establish the determinants of the peak VO2 in heart transplant recipients. METHODS: Patient's assessment was performed in two consecutive days. In the first day, patients performed the heart rate variability assessment followed by a cardiopulmonary exercise test. In the second day, patients performed a resting echocardiography. Heart transplant recipients were eligible if they were in a stable condition and without any evidence of tissue rejection diagnosed by endomyocardial biopsy. Patients with pacemaker, noncardiovascular functional limitations such as osteoarthritis and chronic obstructive pulmonary disease were excluded from this study. RESULTS: Sixty patients (68% male, 48 years and 64 months following heart transplantation) were assessed. Multivariate analysis selected the following variables: receptor's gender (P=0.001), receptor age (P=0.049), receptor Body Mass Index (P=0.005), heart rate reserve (P <0.0001), left atrium diameter (P=0.016). Multivariate analysis showed r=0.77 and r2=0.6 with P <0.001. Equation: peakVO2=32.851 - 3.708 (receptor gender) - 0.067 (receptor age) - 0.318 (receptor BMI) + 0.145 (heart rate reserve) - 0.111 (left atrium diameter). CONCLUSION: The determinants of the peak VO2 in heart transplant recipients were: receptor sex, age, Body Mass Index, heart rate reserve and left atrium diameter. Heart rate reserve was the unique variable positively associated with peak VO2. This data suggest the importance of the sympathetic reinnervation in peak VO2 in heart transplant recipients.


Assuntos
Transplante de Coração , Miocárdio/metabolismo , Consumo de Oxigênio/fisiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Ecocardiografia , Teste de Esforço , Feminino , Átrios do Coração/anatomia & histologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores Sexuais , Fatores de Tempo
18.
J Heart Lung Transplant ; 34(5): 693-700, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25662857

RESUMO

BACKGROUND: Hypertension is the most prevalent comorbidity after heart transplantation (HT). Exercise training (ET) is widely recommended as a key non-pharmacologic intervention for the prevention and management of hypertension, but its effects on ambulatory blood pressure (ABP) and some mechanisms involved in the pathophysiology of hypertension have not been studied in this population. The primary purpose of this study was to investigate the effects of ET on ABP and arterial stiffness of HT recipients. METHODS: 40 HT patients, randomized to ET (n = 31) or a control group (n = 9) underwent a maximal graded exercise test, 24-hour ABP monitoring, and carotid-femoral pulse wave velocity (PWV) assessment before the intervention and at a 12-week follow-up assessment. The ET program was performed thrice-weekly and consisted primarily of endurance exercise (40 minutes) at ~70% of maximum oxygen uptake (Vo2MAX). RESULTS: The ET group had reduced 24-hour (4.0 ± 1.4 mm Hg, p < 0.01) and daytime (4.8 ± 1.6 mm Hg, p < 0.01) systolic ABP, and 24-hour (7.0 ± 1.4 mm Hg, p < 0.001) daytime (7.5 ± 1.6 mm Hg, p < 0.001) and nighttime (5.9 ± 1.5 mm Hg, p < 0.001) diastolic ABP after the intervention. The ET group also had improved Vo2MAX (9.7% ± 2.6%, p < 0.001) after the intervention. However, PWV did not change after ET. No variable was changed in the control group after the intervention. CONCLUSIONS: The 12-week ET program was effective for reducing ABP but not PWV in heart transplant recipients. This result suggests that endurance ET may be a tool to counteract hypertension in this high-risk population.


Assuntos
Pressão Sanguínea/fisiologia , Terapia por Exercício/métodos , Transplante de Coração/reabilitação , Hipertensão/reabilitação , Transplantados , Rigidez Vascular/fisiologia , Adulto , Monitorização Ambulatorial da Pressão Arterial , Exercício/fisiologia , Feminino , Seguimentos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Rev. bras. cir. cardiovasc ; 30(1): 9-15, Jan-Mar/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-742890

RESUMO

Objective: To establish the determinants of the peak VO2 in heart transplant recipients. Methods: Patient's assessment was performed in two consecutive days. In the first day, patients performed the heart rate variability assessment followed by a cardiopulmonary exercise test. In the second day, patients performed a resting echocardiography. Heart transplant recipients were eligible if they were in a stable condition and without any evidence of tissue rejection diagnosed by endomyocardial biopsy. Patients with pacemaker, noncardiovascular functional limitations such as osteoarthritis and chronic obstructive pulmonary disease were excluded from this study. Results: Sixty patients (68% male, 48 years and 64 months following heart transplantation) were assessed. Multivariate analysis selected the following variables: receptor's gender (P=0.001), receptor age (P=0.049), receptor Body Mass Index (P=0.005), heart rate reserve (P <0.0001), left atrium diameter (P=0.016). Multivariate analysis showed r=0.77 and r2=0.6 with P <0.001. Equation: peakVO2=32.851 - 3.708 (receptor gender) - 0.067 (receptor age) - 0.318 (receptor BMI) + 0.145 (heart rate reserve) - 0.111 (left atrium diameter). Conclusion: The determinants of the peak VO2 in heart transplant recipients were: receptor sex, age, Body Mass Index, heart rate reserve and left atrium diameter. Heart rate reserve was the unique variable positively associated with peak VO2. This data suggest the importance of the sympathetic reinnervation in peak VO2 in heart transplant recipients. .


Objetivo: Estabelecer os determinantes do VO2 pico em transplantados de coração. Métodos: Avaliação do paciente foi realizada em dois dias consecutivos. No primeiro dia, os pacientes realizaram a avaliação da variabilidade da frequência cardíaca seguida de um teste de esforço cardiopulmonar. No segundo dia, os pacientes realizaram ecocardiografia de repouso. Os transplantados foram elegíveis se estivessem em uma condição estável e sem qualquer evidência de rejeição diagnosticada por biópsia endomiocárdica. Pacientes com marca-passo, limitações funcionais não cardiovasculares, tais como osteoartrite e doença pulmonar obstrutiva crônica foram excluídos deste estudo. Resultados: Sessenta pacientes (68% do sexo masculino, 48 anos e 64 meses após o transplante cardíaco) foram avaliados. A análise multivariada selecionou as seguintes variáveis: sexo (P=0,001), idade (P=0,049), Índice de Massa Corporal (P=0,005), frequência cardíaca de reserva (P <0,0001), diâmetro do átrio esquerdo (P=0,016), variáveis do receptor. A análise multivariada mostrou r=0,77 e r2=0,6, com P <0,001. Equação: VO2=32,851 - 3,708 (sexo receptor) - 0,067 (idade receptor) - 0,318 (IMC receptor) + 0,145 (frequência cardíaca de reserva) - 0,111 (diâmetro de átrio esquerdo). Conclusão: Os determinantes do pico de VO2 em transplantados de coração foram: sexo receptor, idade, Índice de Massa Corporal, frequência cardíaca de reserva e diâmetro do átrio esquerdo. A frequência cardíaca de reserva foi a única variável positivamente associada com o pico de VO2. Estes dados sugerem a importância da reinervação simpática no pico de VO2 em transplantados de coração. .


Assuntos
Animais , Feminino , Humanos , Masculino , Camundongos , Asma/imunologia , Asma/fisiopatologia , Calpaína/metabolismo , /metabolismo , Poli(ADP-Ribose) Polimerases/metabolismo , /metabolismo , Alérgenos/imunologia , Asma/metabolismo , Modelos Animais de Doenças , Eosinofilia/imunologia , Inflamação/imunologia , /antagonistas & inibidores , /imunologia , Camundongos Endogâmicos BALB C , Camundongos Knockout , Poli(ADP-Ribose) Polimerases/genética , Sistema Respiratório/imunologia , Sistema Respiratório/fisiopatologia
20.
Med Sci Sports Exerc ; 47(7): 1321-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25343537

RESUMO

PURPOSE: The objective of this study is to analyze the use of the 6-20 RPE scale for prescribing and self-regulating heated water-based exercise (HEx) and land-based exercise (LEx) in heart transplant recipients. METHODS: Fifteen (five females) clinically stable heart transplant recipients (time since surgery = 4.0 ± 2.5 yr) age 46.7 ± 11.8 yr underwent a symptom-limited maximal graded exercise test on a treadmill to determine their HR at anaerobic threshold (HRAT), respiratory compensation point (HRRCP), and maximal effort (HRmax). After a week, patients were randomized to perform 30 min of both HEx (walking inside the pool) and LEx (treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE scale and had their HR measured every 4 min. The interval between sessions was 48-72 h. RESULTS: No significant differences between sessions were found in the average HR during HEx and LEx. Patients showed a delay in HR increase during both interventions, with the stabilization beginning after 8 min of exercise. Exercise HR was maintained between the HRAT and HRRCP (in the aerobic exercise training zone) for the most part of both HEx (72% of HR measurements) and LEx (66% of HR measurements). Only a few HR measurements stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx = 21%) during both exercise sessions. CONCLUSION: Exercise HR was maintained in the aerobic exercise training zone (between HRAT and HRRCP) for the most part of both sessions, suggesting that the 6-20 RPE scale may be an efficient tool for prescribing and self-regulating HEx and LEx in heart transplant recipients.


Assuntos
Terapia por Exercício/métodos , Transplante de Coração/reabilitação , Esforço Físico/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Piscinas , Caminhada
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