Instrumento para la evaluación del riesgo de arritmias durante el entrenamiento no aeróbico en pacientes con enfermedad cardiovascular / Prediction of arrhythmias during non-aerobic training in patients with cardiovascular disease

Objetivo: El entrenamiento físico de fuerza, flexibilidad, coordinación, propiocepción y equilibrio neuromuscular (fisioterapia) está recomendado en programas de rehabilitación cardiaca. Sin embargo, los pacientes pueden presentar arritmias no pronosticadas en la estratificación del riesgo. El objetivo de este estudio fue realizar un modelo de predicción de arritmias en las sesiones de fisioterapia. Material y método: Estudiamos una cohorte de pacientes (n = 412) que realizaron ejercicios de fisioterapia durante 30 min al día, 3 veces por semana, a intensidad moderada, mientras un cardiólogo supervisaba el trazo electrocardiográfico. Se comparó la presencia de arritmias en sesiones de fisioterapia según su aparición en la prueba de ejercicio (PE) de estratificación. Todo valor de p < 0,05 fue significativo. Finalmente, se realizó un modelo multivariable de regresión logística. Resultados: De los 412 pacientes, 270 (65%) presentaron arritmias en kinesioterapia y no hubo complicaciones mayores. El riesgo relativo para tener arritmias en fisioterapia fue de 1,89 (IC95% 1,25-2,86, p < 0,01), acorde a su presencia en la PE. Otras variables asociadas fueron miocardiopatía dilatada, baja fracción de eyección, uso de digoxina, diuréticos, bajo consumo pico de oxígeno y baja eficiencia ventilatoria (VE/VCO2). En el modelo de regresión, las variables que se mantuvieron significativas fueron: arritmias en la PE, consumo pico de oxígeno y uso de diuréticos. Conclusión: Las arritmias son frecuentes en pacientes con cardiopatía durante las sesiones de fisioterapia y las variables predictivas fueron el uso de diuréticos, el consumo pico de oxígeno y la ocurrencia de arritmias en la PE. Se recomienda supervisar con monitorización electrocardiográfica continua estas sesiones en sujetos de riesgo

Aim: Non-aerobic physical training (NAPhT) sessions with strength, flexibility, coordination, proprioception and neuromuscular balance exercises is recommended in cardiac rehabilitation programs. However, some patients have arrhythmias that are not detected in the risk stratification. The aim of this study was to make a prediction model of arrhythmias during NAPhT sessions. Material and method: We studied a cohort of patients (n= 412) undergoing NAPhT for 30 min, 3 times a week, with a moderate intensity. A cardiologist monitored the electrocardiographic signal. The occurrence of arrhythmia during NAPhT was compared with its presence in the risk stratification stress testing. All P values <.05 were considered significant. Multivariate logistic regression model was also performed. Results: From a total of 412 patients, 270 (65%) showed arrhythmias in NAPhT, without major complications. Relative risk of arrhythmia in NAPhT was 1.89 (95% CI 1.25-2.86, P < .01), when arrhythmia was present during stress testing. In the bivariate analysis, other variables associated were dilated cardiomyopathy, low ejection fraction, use of digoxin, diuretics, low peak oxygen uptake and low ventilatory efficiency. In the regression model, 3 variables remained significant: arrhythmias in stress test, peak oxygen uptake and diuretic. Conclusion: The presence of arrhythmias during NAPhT sessions in patients with heart disease is elevated, and they are associated with diuretic use, peak oxygen uptake values and the presence of arrhythmias in stress testing. Therefore, continuous electrocardiographic monitoring is recommended in these kind of patients

Impacto de la adherencia a las recomendaciones de hábitos de vida cardiosaludables en la capacidad funcional a largo plazo en pacientes que han completado un programa de rehabilitación cardíaca / Impact of adherence to recommendations on a healthy heart lifestyle on long-term functional capacity in patients completing a cardiac rehabilitation programme

Objetivo. Estudiar el grado de adherencia a largo plazo a los hábitos de vida cardiosaludables en pacientes isquémicos que han completado un programa de rehabilitación cardíaca y prevención secundaria (PRCyPS) y su impacto en la capacidad funcional. Diseño. Estudio analítico de cohortes histórico de pacientes isquémicos de riesgo moderado que completaron un PRCyPS en una Unidad de Rehabilitación Cardíaca en 2006-2007. Material y método. Las variables de estudio se recogieron en 3períodos: antes de empezar, tras terminar y a los 6 años de finalizar el PRCyPS. Como instrumentos de medida se utiliza el cuestionario sobre dieta mediterránea de Trichopoulou, el test de Morisky Green, el cuestionario internacional sobre actividad física y una ergometría. Se consideró cumplidor al paciente que seguía los 4 consejos cardiosaludables. La significación estadística se estableció en p<0,05. Resultados. Un total de 41 pacientes revisados a los 6 años (38 hombres, con 56 años de edad media). La adherencia a las recomendaciones cardiosaludables a los 6 años la cumplían 13 pacientes (32%). Los no cumplidores alcanzaron una capacidad funcional al finalizar el programa y a los 6 años de 10,4 y 8,3 respectivamente, mientras que los cumplidores alcanzaron 9,8 y 8,9. La pérdida de capacidad funcional en los no cumplidores fue del 20% frente a solo el 6% en los cumplidores (p=0,02). Conclusión. La adherencia a las recomendaciones de hábitos de vida cardiosaludables transmitidas en los PRCyPS a los 6 años es bajo (32%). Los pacientes que siguen todas las recomendaciones solo pierden un 6% de la capacidad funcional a los 6 años frente al 20% de la capacidad funcional que pierden los pacientes que no tienen una buena adherencia (AU)

Objective. To evaluate long-term adherence to healthy heart lifestyle habits in ischemic patients completing a cardiac rehabilitation/secondary prevention (CR/SP) programme and its impact on functional capacity. Design. Analytic historical cohort study of ischemic patients at moderate-risk who completed a CR/SP programme in a Cardiac Rehabilitation Unit from 2006-2007. Material and method. The study variables were collected in 3periods: Before and after the programme and 6 years later. Measurement instruments included Trichopoulou's Mediterranean diet questionnaire, the Morisky Green test, the International Physical Activity Questionnaire and a stress test. Patients following 4 healthy heart recommendations were considered to be adherent. Statistical significance was set at P<.05. Results. A total of 41 patients were evaluated at 6 years; 38 were men and the mean age was 56 years. Thirteen patients (32%) were considered adherent to healthy heart recommendations at 6 years. At the end of the programme and at 6 years, functional capacity was 10.4 and 8.3, respectively, in adherent patients and 9.8 and 8.9 in non-adherent patients. Loss of functional capacity in non-adherent patients was 20% compared with only 6% in adherent patients (P=.02). Conclusion. Adherence to healthy heart recommendations made in a CP/SP programme was low (32%). Patients who adhered to all the recommendations lost only 6% of their functional capacity at 6 years compared with 20% of functional capacity in non-adherent patients (AU)

Edad y deseos de reanimación cardiopulmonar en pacientes cardiológicos / Age and cardiopulmonary resuscitation wishes of patients with heart disease

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Paciente fumadora en programa de rehabilitación cardiaca / The patient who smokes in cardiac rehabilitation program

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Indicadores pronósticos clínicos en el posoperatorio de cirugía cardiovascular pediátrica y su relación con la cinética del estrés oxidativo / Prognostic indicators after cardiac surgery in children and their relationship with the oxidative stress response

Objetivos. Analizar la evolución de parámetros de estrés oxidativo en el posoperatorio de cirugía cardiovascular pediátrica y correlacionarlos con diferentes indicadores clínicos pronósticos. Material y métodos. Treinta niños, de entre un mes y 14 años, peso > 5 kg, sometidos a circulación extracorpórea. Se obtuvieron muestras preoperatoria, posoperatoria inmediata y tras 18-20 h. Se analizó la capacidad de peroxidación lipídica de las membranas celulares mediante la cuantificación de productos de reacción con el ácido tiobarbitúrico, cuyo principal representante es el malondialdehído; se cuantificó el contenido celular de glutatión total, oxidado y reducido (representantes de la respuesta antioxidante). Se analizaron las variables clínicas que permitieran establecer una puntuación para el síndrome de respuesta inflamatoria sistémica asociado a circulación extracorpórea. Resultados. Treinta pacientes con una mediana de edad de 4,1 años (rango intercuartílico [RIC]: 2,7; 8,0); el 62,1% eran niñas; mediana de desviaciones estándar de peso −0,39 (RIC: −0,76; 0,24), de talla −0,22 (RIC: −0,74; 0,27) y de IMC −0,43 (RIC: −1; 0,45). Mediana de tiempo quirúrgico 79 min (RIC: 52,5; 125,5), mediana de pinzamiento 38,5 min (RIC: 22; 59). Aumentó el malondialdehído y disminuyó el glutatión en ambos momentos posoperatorios, con clara correlación directa, estadísticamente significativa, del tiempo de circulación extracorpórea con el porcentaje de descenso de glutatión total entre preoperatorio y posoperatorio inmediato y entre el preoperatorio y el posoperatorio tardío. Hubo una correlación estadística entre los niveles de glutatión total tras 18-20 h posoperatorias y el tiempo de duración de la ventilación mecánica y la pertenencia al grupo de síndrome de respuesta inflamatoria sistémica. Conclusiones. La circulación extracorpórea activa mediadores inflamatorios, máximo tras el pinzamiento aórtico, mejorando tras 24 h, siendo dependiente de los tiempos quirúrgicos. El desarrollo de respuesta inflamatoria está asociado a una mayor duración de la ventilación mecánica, una estancia más prolongada en Cuidados Intensivos, puntuaciones mayores del Modelo de Aristóteles y tiempos más largos quirúrgicos. Los que no cumplen criterios de respuesta inflamatoria tienen más niveles de glutatión en el posoperatorio tardío (AU)

Objectives. To analyse the trend in lipid peroxidation and antioxidant response as key markers of oxidative stress after paediatric cardiovascular surgery, and compare them with other internationally accepted clinical prognostic indicators. Patients and methods. A prospective study was conducted on 30 children aged one month to 14 years, weight > 5 kg, undergoing cardiopulmonary bypass surgery. Blood samples were taken just before the intervention, immediately after surgery, and after 18-20 h. Cell membrane lipid peroxidation was analysed by quantifying malondialdehyde, as well as measuring total glutathione (oxidized and reduced), as representatives of antioxidant response. An analysis was also performed on clinical variables for establishing a score for the systemic inflammatory response syndrome associated with cardiopulmonary bypass. Results. The study included 30 children with a mean age of 4.1 years old (interquartile range [IQR]: 2.7; 8.0). Of these, 62.1% were girls. The standard deviation of the median weight was −0.39 (IQR: −0.76; 0.24), the median height was −0.22 (IQR: −0.74; 0.27), and the median BMI was −0.43 (IQR: −1; 0.45). The final surgery times were divided into 2 parts: total time of extracorporeal circulation, with a mean of 79 min (IQR: 52.5; 125.5), and the clamping time, a measurement included in the previous figure with a mean value of 38.5 min (IQR: 22; 59). Malondialdehyde increased and glutathione decreased in postoperative time, with clear, statistically significant direct correlation between time of extracorporeal circulation and percentage decrease in total glutathione between preoperative and immediate postoperative time, and a decline between the preoperative and late postoperative. There was a statistical correlation between total glutathione levels at 18-20 h postoperatively and the duration of mechanical ventilation and inflammatory systemic response syndrome. Conclusions. Surgery with extracorporeal circulation performed in children activates inflammatory mediators, being maximum after aortic clamping, and improving after the first 24 h. The level of oxidative stress activation depends on surgical times. The development of systemic inflammatory response syndrome is associated with longer duration of mechanical ventilation, longer stay in intensive care, higher scores in the Aristotle model and longer surgical times. Those who do not meet criteria for inflammatory response have higher levels of glutathione in first 24 h (AU)

Nivel de satisfacción del paciente sobre la calidad de atención de enfermería en el Programa de Rehabilitación Cardíaca Hospital Nacional Guillermo Almenara Irigoyen / Level of patient satisfaction about the quality of nursing care in the Program of Cardiac Rehabilitation, National Hospital Guillermo Almenara Irigoyen

El Objetivo fue determinar el nivel de satisfacción del paciente sobre la calidad de atención de Enfermería en el Programa de Rehabilitación Cardiaca Hospital Nacional Guillermo Almenara Irigoyen. Material y Método: El estudio fue de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 50. La técnica fue la entrevista y el instrumento el cuestionario aplicado previo consentimiento informado. Resultados: Del 100 por ciento (50), 60 por ciento (30) tienen satisfacción media, 22 por ciento (11) baja y 18 por ciento (9) alto. En la dimensión técnica 72 por ciento (32) media, 20 por ciento (10) baja, y 8 por ciento (4) alta; en la dimensión humana, 86 por ciento (43) media, 8 por ciento (4) baja y 6 por ciento (3) alta; en la dimensión entorno 62 por ciento (31) medio, 24 por ciento (12) bajo y 14 por ciento (7) alto. Conclusiones: El mayor porcentaje tienen un nivel de satisfacción de media a baja ya que la enfermera demuestra un trato cordial y amable, se presenta con su nombre, tienen equipos suficientes, cuenta con buena iluminación; desconoce el uso de aparatos utilizados en la sesión, emplea términos difíciles de entender, consideran que el espacio físico es inadecuado; seguido de un mínimo porcentaje significativo con satisfacción alta ya que la enfermera acude a atenderlo de inmediato, coordina los cuidados con otros profesionales, se presenta con su nombre cuando lo atiende, demuestra un trato cordial y amabl.

The objective was to determine the level of patient satisfaction on the quality of nursing care in the Cardiac Rehabilitation Program at National Hospital Guillermo Almenara Irigoyen. Materials and Methods: The study was applicative level, quantitative type, descriptive method of cross section. The population consisted of 50. The technique was the interview and the questionnaire administered instrument prior informed consent. Results: 100 per cent (50), 60 per cent (30) have average satisfaction, 22 per cent (11) lower and 18 per cent (9) high. In the technical dimension 72 per cent (32) average, 20 per cent (10) low, and 8 per cent (4) high; Human dimension, 86 per cent (43) average, 8 per cent (4) low and 6 per cent (3) high; environment dimension in 62 per cent (31) average, 24 per cent (12) low and 14 per cent (7) high. Conclusions: The oldest percent have a medium level of satisfaction low as nurse demonstrates a friendly and kind attention, he appears with your name, have enough equipment, has good lighting; using known equipment used in the session, used terms difficult to understand, they consider that the physical space is inadequate; followed by a significant percentage least as high satisfaction with nurse comes to see you right away, coordinates care with other professionals, it is presented with his name when attending shows a cordial and friendly treatment.

Conocimientos y actitudes del paciente sobre entrenamiento físico y control de factores de riesgo cardiovascular en el Programa de Rehabilitación Cardiaca Hospital Nacional Guillermo Almenara Irigoyen EsSalud / Knowledge and attitudes of the patient about physical training and control of factors of risk cardiovascular in the Cardiac Rehabilitation Program at the National Hospital Guillermo Almenara Irigoyen EsSalud

El Objetivo fue determinar los Conocimientos y Actitudes del Paciente sobre Entrenamiento Físico y Control de Factores de Riesgo Cardiovascular en el Programa de Rehabilitación Cardiaca. Hospital Nacional Guillermo Almenara Irigoyen Es Salud. Lima-Perú 2015. Material y Método. El estudio fue de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 20. La técnica fue la encuesta y los instrumentos fueron un cuestionario y una escala de actitud aplicados previo consentimiento informado. Resultados: Del 100 por ciento (20), 60 por ciento (12) conocen, 40 por ciento (8) no conocen; y en cuanto a las actitudes 65 por ciento (13) eran desfavorables y 35 por ciento (7) favorables. Los ítems que conocen está referido al beneficio del entrenamiento físico orientada a mejorar la tolerancia al ejercicio, disminuir el colesterol y mejorar los síntomas de enfermedad del corazón, que la dieta del paciente con diabetes consiste en restringir alimentos ricos en azúcares, disminuir el consumo de harinas, carbohidratos y grasas, y para evitar el incremento de la presión arterial debe realizar ejercicios, evitar el consumo de tabaco, ingerir alimentos libre de grasas, sin exceso de azúcar; seguido de ítems que no conocen que 1a obesidad se puede evitar mediante 1a ingesta de una dieta saludable a base de pescado, pollo, alimentos bajo en grasa y azúcar, ingerir abundantes verduras y realizar ejercicios, y el efecto del tabaco en las arterias del corazón; en cuanto a las actitudes favorables los pacientes acuden a las sesiones, algunas veces incumplen los ejercicios porque le da pereza, y asisten a las sesiones de charla educativa; mientras que los ítems con actitud desfavorable está dado porque omiten el control de la presión arterial, faltan a las sesiones, les resulta imposible dejar los gustos alimentarios y no cumplen con la dieta restringida en grasas. Conclusiones: El mayor porcentaje conocen que el objetivo del...

The objective was to determine the Patient Knowledge and Attitudes about Physical Training and Control of Cardiovascular Risk Factors in Cardiac Rehabilitation Program. Guillermo Almenara Irigoyen National Hospital's Health. Lima-Peru 2015. Material and Methods: The study was applicative level, quantitative type, descriptive method of cross section. The population consisted of 20. The technique was the survey and the instruments were a questionnaire and attitude scale applied prior informed consent. Results: 100 per cent (20), 60 per cent (12) known, 40 per cent (8) do not know; and attitudes regarding 65 per cent (13) were unfavorable and 35 per cent (7) favorable. The items they know is based on the benefit of physical training aimed at improving exercise tolerance, lower cholesterol and improve symptoms of heart disease, the diet of patients with diabetes is to restrict foods high in sugar, reduce consumption flours, carbohydrates and fats, and to avoid increasing blood pressure should perform exercises, avoid eating snuff, eating fat-free foods, without excess sugar; followed by items that do not know that obesity can be prevented by eating a healthy diet of fish, chicken, low-fat foods and sugar, eating plenty of vegetables and exercise, and the effect of snuff in the heart arteries ; as to the favorable attitudes patients attend meetings, sometimes violate the exercises because you get lazy, and attend educational talk sessions; whereas items with unfavorable attitude is given because they omit the control of blood pressure, missing sessions, they find it impossible to leave food tastes and do not meet the fat-restricted diet. Conclusions: The highest percentage know that the goal of physical training is to keep the heart healthy and strong, and items that do not know is that being a smoker is considered when the person smokes 1 cigarette a week. The highest percentage have an unfavorable attitude as they find it impossible to leave the food tastes and...

Efecto del ejercicio físico para el control de los factores de riesgo cardiovascular modificables del adulto mayor: revisión sistemática / Effects of physical exercise on cardiovascular risk factors of elderly people: systematic review

Objetivo. Determinar el efecto del ejercicio físico para el control de los factores de riesgo cardiovascular modificables en el adulto mayor. Materiales y métodos. Se desarrolló una búsqueda en las bases de datos PubMed, ScienceDirect, EBSCO, Annual Reviews, Medline, además de en las de organizaciones como el Colegio Americano de Medicina del Deporte (ACSM) durante el periodo 2008-2014. Resultados. Se analizaron 47 estudios. La mayoría de los estudios proponen intensidades moderadas y vigorosas de ejercicio físico, con una frecuencia de 2 a 5 días por semana y una duración por sesión de 150-300 min con el objetivo de modificar positivamente los factores de riesgo cardiovascular. Conclusión. Los programas de ejercicios aeróbicos y anaeróbicos informan sobre cambios significativos para el control de factores de riesgo cardiovascular que merecen ser incorporados en los nuevos modelos de programación con adultos mayores (AU)

Objective. To perform a systematic review analysing the relationship between physical activity and modifiable cardiovascular risk factors in elderly people. Materials and methods. We conducted a search of PubMed, ScienceDirect, EBSCO, Annual Reviews, and Medline, as well as organisations such as the American College of Sport and Medicine, to include all studies published on the topic from 2008 to 2014. Results. Forty-seven studies were analysed. Most studies proposed protocols for moderate to vigorous intensity exercise, with a frequency of between 2 and 5 times per week and a duration per session of 150 to 300 min, to achieve positive changes on modifiable cardiovascular risk factors. Conclusion. Both anaerobic and aerobic exercise have significant benefits on control of cardiovascular risk factors and should be included in physical activity programmes for elderly people (AU)

Resumen de las evidencias científicas de la eficacia del ejercicio físico en las enfermedades cardiovasculares / / Um resumo da evidência científica da efetividade do exercício físico nas doenças cardiovasculares / A summary of evidence of the effectiveness of physical exercise on cardiovascular disease

Las enfermedades cardiovasculares son las más prevalentes en la sociedad occidental. En las últimas décadas, innumerables publicaciones informan del poder terapéutico del ejercicio físico (EF) en estas patologías. El objetivo de este trabajo ha sido buscar, valorar y resumir los resultados de las mejores pruebas científicas publicadas, sobre el efecto del EF, en la mortalidad y morbilidad de pacientes con enfermedad coronaria, insuficiencia cardiaca, hipertensión arterial, claudicación intermitente e ictus. Se buscaron revisiones sistemáticas en Medline, Embase, Cochrane Database of Systematic Reviews y Database of Abstracts of Reviews of Effects. Se concluye que, tanto el entrenamiento aeróbico, como el de fuerza son seguros y eficaces en la disminución de la mortalidad y morbilidad en la mejora de algunos signos y síntomas, y en el incremento de la función física en enfermos cardiovasculares (AU)

Cardiovascular diseases are among the most widespread in Western culture. In recent decades, numerous publications have assessed the effectiveness of physical exercise (PE) in these pathologies. The aim of this study was to search for, evaluate and summarize the results of the most conclusive scientific evidence published on the effectiveness of PE on mortality and morbidity in patients with coronary artery disease, heart failure, hypertension, intermittent claudication, and stroke. We searched for systematic reviews in Medline, Embase, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects. In conclusion, both aerobic and strength training are safe and effective in reducing mortality and morbidity, improving signs and symptoms, and increasing physical function in patients with cardiovascular disease (AU)

As doenças cardiovasculares são as mais prevalentes na sociedade ocidental. Nas últimas décadas, inúmeras publicações informaram o poder terapêutico do exercício físico (EF) nestas patologias. O objetivo deste trabalho foi procurar avaliar e resumir os resultados das maiores evidências científicas publicadas sobre o efeito do EF na mortalidade e morbidade de pacientes com doença coronariana, insuficiência cardíaca, hipertensão arterial, claudicação intermitente e ictus. Foi realizada uma busca por revisões sistemáticas nas seguintes bases de dados: Medline, Embase, Cochrane Database of Systematic Reviews y Database of Abstracts of Reviews of Effects. Conclui-se que tanto o treinamento aeróbico como o de força são seguros e eficazes na diminuição da mortalidade e morbidade, na melhora de alguns sinais e sintomas, e no incremento da função física em enfermos cardiovasculares

Effects of exercise on inflammation in cardiac rehabilitation / Efectos del ejercicio sobre la inflamación en rehabilitación cardíaca

Background: programs of weight loss and a healthy diet are recommended for patients with cardiovascular risk but the effectiveness of these programs in decreasing cardiovascular mortality is controversial. Aim: to examine the acute and long-term effects of a 2-month cardiac rehabilitation program on chemokines related to inflammation in subjects with cardiovascular disease. Design: prospective cohort study. Methods: twenty-six patients with cardiovascular disease enrolled in a cardiac rehabilitation program based on nutritional and exercise interventions were studied. Lifestyle and clinical, metabolic and inflammatory variables were analysed. Results: 88.5% were men and the mean age was 54.9 ± 7.8 years. At the end of the cardiac rehabilitation program the levels of carbohydrate and lipid metabolism were lower, except for high density lipoprotein cholesterol which was higher. The levels of uric acid, interleukin-6, interleukin-1Beta, adiponectin and leptin remained stable. Interleukin-6 correlated positively with levels of C-reactive protein and negatively with blood glucose. Interleukin-1Beta correlated positively with C-reactive protein levels and negatively with blood pressure figures. Significant correlations were seen between the changes in levels of interleukin-6 and interleukin-1Beta and changes in metabolic equivalents, and in C-reactive protein levels before and after the cardiac rehabilitation program. No significant correlations were observed with weight, waist circumference or fat mass. Conclusions: a cardiac rehabilitation program decreased anthropometric variables and blood pressure figu res, and improved lipid metabolism and ergometry data. However, no changes regarding the inflammatory state were observed (AU)

Introducción: a los pacientes con riesgo cardiovascular se les recomiendan programas de pérdida de peso y dieta saludable, pero la eficacia de estos programas a la hora de reducir la mortalidad es controvertida. Objetivo: examinar los efectos agudos y a largo plazo de un programa de rehabilitación cardíaca de dos meses de duración sobre las quemocinas relacionadas con la inflamación en pacientes con enfermedad cardiovascular. Diseño: estudio de cohortes prospectivo. Métodos: se estudiaron 26 pacientes con enfermedad cardiovascular inscritos en un programa de rehabilitación cardíaca basado en intervenciones nutricionales y de ejercicio. Se analizaron el estilo de vida y variables clínicas, metabólicas e inflamatorias. Resultados: 88,5% eran hombres y la edad media fue de 54,9 ± 7,8 años. Al final del programa de rehabilitación cardíaca las variables del perfil glucémico y lipídico descendieron, excepto el colesterol de lipoproteínas de alta densidad, que aumentó. Ácido úrico, interleucina-6, interleucina-1 beta, adiponectina y leptina se mantuvieron estables. Interleucina-6 correlacionó positivamente con proteína C reactiva y negativamente con glucosa en sangre. Interleucina-1 beta correlacionó positivamente con proteína C-reactiva y negativamente con las cifras de presión arterial. Encontramos correlaciones significativas entre los cambios en interleucina-6 e interleucina-1 beta y los cambios en los equivalentes metabólicos y proteína C-reactiva, antes y después del programa de rehabilitación cardíaca. No se observaron correlaciones significativas con peso, circunferencia de cintura o masa grasa. Conclusiones: la rehabilitación cardiaca mejora las variables antropométricas, las cifras de presión arterial, así como el perfil de lípidos y los resultados de la ergometría. Sin embargo, no se observaron cambios con respecto al estado inflamatorio (AU)

Impacto de 6 semanas de rehabilitación cardiaca en la capacidad funcional y en la calidad de vida de pacientes con enfermedades cardiovasculares / Impact of 6 weeks of cardiac rehabilitation on functional capacity and quality of life in patients with cardiovascular disease

Introducción. Las enfermedades cardiovasculares constituyen la primera causa de morbilidad en el mundo y afectan a una gran población en edad productiva, haciéndola vulnerable al deterioro de su capacidad funcional. La rehabilitación cardiaca forma parte del manejo integral de estos pacientes, y el test de caminata de 6 min se ha convertido en una prueba fiable para la medición de la capacidad funcional; sin embargo, en Colombia son escasos los reportes que mencionan el uso de este test como parte de las baterías de medición en los programas de rehabilitación cardiaca. Objetivo. Determinar el impacto de las primeras 6 semanas de rehabilitación cardiaca en la capacidad funcional de pacientes con enfermedad cardiovascular y cómo influye en la percepción de la calidad de vida. Material y métodos. Estudio descriptivo longitudinal. Se midió la capacidad funcional con el test de caminata de 6 min, y la calidad de vida con el cuestionario SF-36 al inicio y 6 semanas después de rehabilitación cardiaca en 15 pacientes. Resultados. Mejoría estadísticamente significativa en el test de caminata: 43 ± 44 m (p = 0,007). Mejoría en todas las dimensiones y componentes del SF-36: salud mental 28 ± 20 (p = 0,000) y salud física 31 ± 14 (p = 0,000). Conclusión. Seis semanas de rehabilitación cardiaca permitieron una mejoría significativa de la capacidad funcional en pacientes con enfermedades cardiovasculares, generando un impacto positivo en la calidad de vida (AU)

Introduction. Cardiovascular diseases are the leading cause of morbidity worldwide and affect a large population of working age, making them vulnerable to deterioration in functional capacity. Cardiac rehabilitation is part of the integrated management of these patients. The Six-Minute Walk Test has become a reliable tool for measuring functional capacity. However, in Colombia there are few reports that mention the use of this test as part of the battery employed in cardiac rehabilitation programs. Objective. To determine the impact of the first 6 weeks of cardiac rehabilitation on the functional capacity of patients with cardiovascular disease and how this treatment affects perceived quality of life. Material and methods. A longitudinal descriptive study was carried out in 15 patients. We assessed functional capacity with the Six-Minute Walk Test and quality of life with the SF-36 questionnaire at baseline and 6 weeks after cardiac rehabilitation. Results. The Six-Minute Walk Test showed a statistically significant improvement (43 ± 44 m; P = .007). All aspects and components of the SF-36 improved: 28 ± 20 mental health (P = .000) and 31 ± 14 physical health (P = .000). Conclusion. Six weeks of cardiac rehabilitation significantly improved functional capacity in patients with heart disease and had a positive impact on quality of life (AU)

Mortalidad total y morbilidad cardiovascular a largo plazo en pacientes con cardiopatía isquémica que han completado un programa de rehabilitación cardíaca y prevención secundaria / Long-term total mortality and cardiovascular morbidity in patients with ischemic cardiac disease who completed a cardiac rehabilitation and secondary prevention program

Introducción y objetivos. Estudiar mortalidad total y morbilidad cardiovascular a largo plazo en pacientes isquémicos que han completado un programa de rehabilitación cardíaca y prevención secundaria analizando qué factores pueden predecir la presentación de dicha morbimortalidad. Métodos. Análisis retrospectivo de una muestra recogida prospectivamente de 342 pacientes que completaron un programa de rehabilitación cardíaca y prevención secundaria en el período 2005-2008. Se revisaron ingresos hospitalarios por causa cardiovascular, tipo de reingreso (urgencias/hospitalario), necesidad de revascularización (percutánea/quirúrgica) y mortalidad. La asociación de los factores estudiados con la morbimortalidad fueron analizados mediante análisis univariante y curvas de supervivencia Kaplan-Meier. La significación estadística se establece en p < 0,05. Resultados. Durante el seguimiento (media de 2.105 días) fallecieron 12 pacientes (3,5%). La principal causa fue el cáncer. Reingresaron 116 pacientes (34%). El 10,5% precisó nueva revascularización coronaria. El accidente vascular cerebral fue el evento vascular no cardíaco más frecuente (4,7%), seguido de claudicación intermitente (2,3%). Un paciente precisó amputación. Los factores predictores de morbimortalidad fueron edad (p = 0,005), hábito tabáquico (p = 0,016) y grupo de riesgo (p = 0,002). La diabetes mellitus mostró mayor morbimortalidad durante el seguimiento. Conclusiones. Nuestros resultados muestran baja mortalidad en los pacientes que han completado un programa de rehabilitación cardíaca y prevención secundaria tras sufrir un evento coronario pero con una morbilidad cardiovascular alta (34% a 5 años). Los factores asociados con la aparición de morbimortalidad fueron edad mayor de 65 años, grupo de riesgo moderado-alto, hábito tabáquico y presencia de diabetes mellitus. Estos resultados muestran la necesidad de establecer estrategias individuales para aumentar la adherencia a las medidas de prevención secundaria de eventos cardiovasculares (AU)

Introduction and objectives. To study long-term mortality and cardiovascular morbidity in ischemic patients who completed a cardiac rehabilitation and secondary prevention program by analyzing the factors that may predict the occurrence of these events. Methods. We carried out a retrospective analysis of a prospectively enrolled sample of 342 patients who completed a cardiac rehabilitation and secondary prevention program between 2005 and 2008. We reviewed hospital admissions for cardiovascular causes, type of readmission (emergency unit/hospital), need for revascularization (percutaneous versus surgical) and mortality. The association of the studied factors with morbidity and mortality was determined by univariate analysis and Kaplan-Meier survival curves. Statistical significance was set at p < 0.05. Results. During follow-up (mean 2105 days), 12 patients (3.5%) died. The main cause was cancer. A total of 116 patients (34%) were readmitted for cardiovascular causes, while 10.5% needed revascularization. The most frequent non cardiac vascular event was stroke (4.7%), followed by intermittent claudication (2.3%). One patient required amputation. Predictors associated with morbidity and mortality were age (p = 0.005), smoking (p = 0.016), and risk group (p = 0.002). Diabetes mellitus also increased morbidity and mortality during follow-up. Conclusions. Patients who completed a cardiac rehabilitation and secondary prevention program after a coronary event had low mortality but high cardiovascular morbidity (34% at 5 years). The factors associated with this morbidity and mortality were age over 65 years, belong to a moderate to high risk group, smoking, and diabetes mellitus. These results demonstrate the need for individual strategies to increase adherence to secondary prevention measures for cardiovascular events (AU)

Support groups and cardiac rehabilitation: effects of partner participation on anxiety and depression

This study analyzes the effect on levels of patient anxiety and depression of a partner joining a cardiac rehabilitation program support group, also taking into account the sex of the patient. The study was undertaken using a two-group comparison design with pre-and post-test measures in non-equivalent groups. The sample comprised patients in the cardiac rehabilitation program (CRP) at the Ramón y Cajal Hospital, Madrid (Spain). Analysis of covariance (ANCOVA) showed direct effects of sex and partner participation in support groups on the anxiety trait. Similarly, interaction effects were observed between the sex variable and partner participation. These results indicate the pertinence of designing separate groups for patients and partners (AU)

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South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation / Diretriz Sul-Americana de Prevenção e Reabilitação Cardiovascular

In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

Com este documento, o Comitê Interamericano de Prevenção e Reabilitação Cardiovascular, em posição conjunta com a Sociedade Sul-Americana de Cardiologia, mostra seu interesse no desenvolvimento de estratégias, medidas e intervenções para a prevenção e a reabilitação cardiovascular. Com o objetivo de implementar na América Latina uma política de saúde regional e nacional dos países membros, tem-se o objetivo de promover a saúde cardiovascular e, consequentemente, diminuir a morbimortalidade. O grupo de estudos em Reabilitação Cardiopulmonar e Metabólica do Departamento de Exercício, Ergometria e Reabilitação Cardiovascular de Sociedade Brasileira de Cardiologia (DERC/SBC) criou uma comissão de experts para revisar a versão em português e adaptá-la à realidade nacional. Este documento tem como missão principal auxiliar os profissionais de saúde a alcançarem medidas efetivas de prevenção e reabilitação cardiovascular (RCV) na prática clínica diária. Com a difusão deste documento, bem como com a sua implementação de forma mais abrangente, contribuiremos com a meta da Organização Mundial de Saúde de diminuir a mortalidade cardiovascular no mundo em 25% até o ano de 2025. As prioridades deste grupo de trabalho são: • Enfatizar o caráter prioritário da RCV como instrumento de prevenção secundária com importante impacto na morbimortalidade cardiovascular; • Unir esforços para melhorar o conhecimento da RCV, sua difusão e aplicação na maioria dos centros e institutos cardiovasculares da América do Sul, priorizando a utilização de um método de prevenção cardiovascular integral, prático, de fácil aplicação e de custo/benefício comprovado; • Melhorar a educação do pessoal da saúde e dos pacientes por meio de programas educativos dirigidos, que permitam envolver diretamente os sistemas de saúde, pessoal médico, pacientes e líderes comunitários sobre a importância dos serviços de RCV, a fim de diminuir as barreiras para a sua implantação.

Síndrome metabólica em pacientes atendidos em programa de reabilitação cardíaca / Metabolic syndrome among patients enrolled in a cardiac rehabilitation program

Fundamentos: Síndrome metabólica (SM) constitui importante fator de risco para o desenvolvimento de doenças cardiovasculares e, quando associada às cardiopatias, torna-se responsável por alto e crescente número de mortalidade. Objetivo: Estimar a frequência de SM em cardiopatas do Programa de Reabilitação Cardíaca de hospital universitário do Rio de Janeiro. Métodos: Estudo transversal, descritivo, com participantes do programa de Reabilitação Cardíaca,a partir de avaliação antropométrica e laboratorial,utilizando-se para diagnóstico de SM os critérios da International Diabetes Federation, 2005. Resultados: Foram avaliados 40 indivíduos, 26 homens e 14 mulheres, com média de idade 61,1±8,4 anos. De acordo com o índice de massa corporal, 77,5 % apresentavam sobrepeso e obesidade. Os valores médios de circunferência da cintura e relação cintura/altura encontravam-se, em ambos os sexos, superiores ao recomendado. A frequência de SM foi 83,0 %, sendo 77,0 % no sexo masculino e 93,0 % no sexo feminino. Entre os pacientes com diagnóstico de SM, as médias das medidas antropométricas foram significativamente maiores do que entre aqueles sem diagnóstico. Conclusões: Verificou-se elevada frequência de SM nos pacientes submetidos ao programa de RC, alertando para a importância da implementação de ações terapêuticas que visem à reversão da SM em pacientes já cardiopatas.

Background: Metabolic syndrome is a major risk factor for the development of cardiovascular disease, resulting in a high (and still rising) mortality rate when associated with cardiopathies. Objective: To estimate the frequency of metabolic syndrome in a Cardiac Rehabilitation Program at auniversity hospital in Rio de Janeiro. Methods: Cross-sectional descriptive study conducted with patients participating in a Cardiac Rehabilitation Program, grounded on anthropometric and laboratory assessments, with metabolic syndrome diagnosed through the criteria established by the International Diabetes Federation, 2005. Results: Forty subjects were assessed (26 men and14 women), with a mean age of 61.1±8.4 years. Based on the Body Mass Index, 77.5% were overweight and obese. The mean waist circumference and waist/height values were higher than recommended for both genders, with the overall prevalence of metabolic syndrome reaching 83.0% (77.0% males and 93.0%females). Among patients diagnosed with metabolic syndrome, the mean anthropometric measurements were significantly larger than among those without this diagnosis. Conclusions: A high frequency of metabolic syndrome was found among patients in a Cardiac Rehabilitation Program, underscoring the importance of implementing therapeutic actions aimed at reversing metabolic syndrome among patients with heart disease.

Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols / Estratificação de risco cardíaco em programas de reabilitação cardíaca: revisão de protocolos

Objective: Gather and describe general characteristics of different protocols of risk stratification for cardiac patients undergoing exercise. Methods: We conducted searches in LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO electronic databases, using the following descriptors: Cardiovascular Disease, Rehabilitation Centers, Practice Guideline, Exercise and Risk Stratification in the past 20 years. Results: Were selected eight studies addressing methods of risk stratification in patients undergoing exercise. Conclusion: None of the methods described could cover every situation the patient can be subjected to; however, they are essential to exercise prescription. .

Objetivo: Reunir e descrever características gerais dos diferentes protocolos de estratificação de risco existentes para cardiopatas submetidos ao exercício. Métodos: Realizou-se busca nas bases eletrônicas LILACS, IBECS, MEDLINE, Biblioteca Cochrane, SciELO, por meio dos descritores: Doenças cardiovasculares, Centros de Reabilitação, Guia de Prática Clínica, Exercício e Estratificação de Risco e a palavra-chave "Risk Stratification", nos últimos 20 anos. Resultados: Foram selecionados oito trabalhos abordando métodos de estratificação de risco em indivíduos submetidos a exercício. Conclusão: Nenhum dos métodos descritos conseguiu abranger todas as situações de risco a que o paciente está sujeito, porém eles são fundamentais para prescrição do exercício. .

Efeitos da reabilitação cardiopulmonar sobre o tempo de tolerância ao exercício e a cinética do consumo de oxigênio em cardiopatas isquêmicos / Effects of cardiopulmonary rehabilitation in exercise tolerance time and oxygen kinetics in ischemic heart disease

Introdução: A reabilitação cardiopulmonar e metabólica (RCPM) é uma importante estratégia no tratamento da insuficiência cardíaca isquêmica. Entretanto, os seus principais mecanismos de melhora e as correlações com aumento na capacidade de exercício e menos sintomas ainda não estão totalmente esclarecidos. Objetivos: Investigar os efeitos de um programa multidisciplinar de RCPM sobre o tempo de tolerância ao esforço (TLim) e a resposta da fase rápida (fase II) da cinética do consumo de oxigênio (variável relacionada ao desempenho oxidativo muscular) em cardiopatas isquêmicos. Adicionalmente, avaliar as variáveis cardiovasculares, ventilatórias e metabólicas nos TCPE máximo (TRIM) e de endurance (TSCC), além da composição corporal pela bioimpedância elétrica, fração de ejeção (FE) e qualidade de vida. Métodos: Cento e seis pacientes com cardiopatia isquêmica encaminhados ao PRCPM foram submetidos ao TRIM em esteira rolante e, após intervalo de 1 a 7 dias, ao TSCC, com 80% da carga atingida no TRIM. Trinta e sete (37) pacientes foram excluídos, 31 por adesão < 50% às sessões de treinamento, 3 com IMC> 35kg.m-2 e 3 com FE<35%. Após 12 semanas de RCPM, 69 pacientes foram ressubmetidos aos mesmos testes e analisados os efeitos sobre o TLim, fase II da cinética do V'O2 e a qualidade de vida. Resultados: Os pacientes tiveram evidente redução da sua limitação funcional e 95,6% tornaram-se classe I (pré-RCPM era 62,3%), 4,3% classe II (31,8% antes intervenção) e nenhum mais na classe III da NYHA (5,8% anteriormente), após a intervenção da RCPM. Apresentaram melhora significativa no desempenho ao esforço em ambos protocolos TRIM e TSCC, no entanto, o aumento no tempo de tolerância ao esforço foi quase 3 vezes superior no TSCC. Dentre os diversos sistemas avaliados pelo TCPE, o componente periférico foi o que apresentou melhora mais significativa, principalmente pelo incremento na fase II da cinética do V'O2, com redução da constante de tempo (tau) ? (p<0,001)...

Introduction: Cardiopulmonary and Metabolic Rehabilitation (CPMR) is an important strategy in the treatment of ischemic heart failure. However, their main mechanisms of improvement and correlations with increased exercise capacity and fewer symptoms are still not fully understood. Objectives: To investigate the effects of a multidisciplinary CPMR program on exercise tolerance time (TLim) and the response of the fast phase (phase II) of the kinetics of oxygen consumption (variable related to muscle oxidative performance) in ischemic cardiomyopathy. Additionally, to evaluate cardiovascular, ventilatory and metabolic variables in maximal (Max) and endurance (End) cardiopulmonary tests, and body composition by bioelectrical impedance analysis, ejection fraction (EF) and quality of life. Methods: One hundred and six patients with ischemic cardiomyopathy referred to CPMR underwent Max on a treadmill and, after an interval of 1 to 7 days, the End with 80% load achieved in Max. Thirty-seven (37) patients were excluded, 31 with participation of <50% in the training sessions, 3 with BMI> 35kg.m-2 and 3 with EF <35%. After 12 weeks of CPMR, 69 patients underwent the same tests and analyzed the effects on TLim. Results: The patients had an evident reduction in functional limitation and 95.6% became Class I (pre-CPMR was 62.3%), 4.3% class II (31.8% before intervention) and no longer in class III (5.8% previously), after the intervention of the CPMR. They had significant improvement in performance when effort on both Max and End protocols, however, the increase in exercise tolerance time was nearly 3 times higher in End. Among the various systems assessed by CPET, peripheral component showed the most significant improvement, especially the increase in the phase II kinetics V'O2, reducing the time constant (tau) ? (p <0.001)...

Estratificación de riesgo en rehabilitacion cardiaca / Risk stratification in cardiac rehabilitation

Las enfermedades cardiovasculares son la mayor causa de mortalidad, a nivel global, con diferentes índices de mortalidad en sus variadas presentaciones. Los adelantos científicos han prolongado la expectativa de vida y la población expuesta a tener un evento es cada vez mayor. La Rehabilitación Cardíaca es una segura alternativa de Prevención Secundaria, sustentada en los beneficios evidentes de las numerosas comunicaciones y el apoyo de OMS. Estratificar el Riesgo es tarea imprescindible para iniciar un programa de Rehabilitación Cardíaca, siendo las herramientas para hacerlo una Historia Clínica, la Prueba de Esfuerzo y un Ecocardiograma, los que en sus variadas manifestaciones nos brindan un perfil propio para cada paciente, con un pronóstico a corto y mediano plazo lo cual nos permite ubicarlo en un nivel de riesgo y ver la necesidad de tener supervisión y/o monitorización, durante el tiempo necesario para su recuperación integral.

The cardiovascular diseases are the leading cause of death in the World;with different numbers in their several clinical manifestations.The life expentancy by now have been prolonged by cientifical advances and the exposed population to cardiovascular events is growly A safety choice of Secondary Prevention is the Cardiac Rehabilitation,based in evident clinical benefits, numerous trials and support of OMS. The Risk Stratification is the first step to start a Cardiac Rehabilitation Program,using like tools the Clinical History,exercise stress test and ecocardiogram ,which in several manifestations give us a profile for each patient,with prognostic at short or medium term,which determine his level of risk and help us to see the necessity of supervising/monitorization during the development of the program.

Hipertensos praticantes de exercício físico têm melhor qualidade de vida que os sedentários / Hypertensive exercise practitioners have better quality of life than sedentary

No presente estudo, foi comparada a percepção subjetiva daqualidade de vida relacionada à saúde de hipertensos sedentáriose hipertensos regularmente ativos. Foram selecionados 117pacientes de ambos os sexos, com média de idade de 59 ± 11anos, divididos intencionalmente em dois grupos: a) GrupoSedentário e b) Grupo Exercício. Os indivíduos do gruposedentário foram atendidos por no mínimo seis meses emambulatório e os do grupo exercício participaram no mínimo seismeses de programas de exercícios supervisionados. Foi utilizadoum questionário para caracterização dos participantes e, paraavaliação da qualidade de vida, foi aplicado o Mini-Questionáriode Qualidade de Vida em Hipertensão Arterial - MINICHALBrasil. Para análise estatística, foram utilizados: mediana, médiae desvio-padrão, teste t independente, Mann-Whitney, teste d deCohen, Qui-Quadrado e correlação de Spearman. Foi adotadonível de significância p < 0,05. Os indivíduos do grupo exercícioapresentaram melhor escore tanto no domínio estado mental(p < 0,01) quanto no domínio manifestações somáticas, porém esteúltimo sem diferença significativa (p = 0,36). Segundo os valoresde magnitude do efeito (d de Cohen), a diferença entre os gruposfoi maior em relação ao aspecto mental (d = 0,55) comparadoao físico (d = 0,36). Esses achados sugerem um “médio efeito”no domínio estado mental. Hipertensos praticantes de exercíciofísico apresentaram melhor qualidade de vida relacionada àsaúde, sugerindo que o exercício físico, além dos já conhecidosbenefícios à saúde, influencia positivamente no comportamentopsicológico dos pacientes.

This study compared the subjective perception of qualityof life related to health among hypertensive sedentary andregularly active. A group of 117 patients, of both genderswith a mean age of 59 ± 11 years, were divided in twogroups: a) Sedentary Group and b) Exercise Group. Sedentarysubjects were treated for at least six months in outpatientand active individuals attended at least six months withsupervised exercises programs. The Mini-Questionnaire ofQuality of Life in Hypertension was used to characterize theparticipants and to asses quality of live MINICHAL Brazil.For the statistical analysis we used: median, mean, standarddeviation, independent t test, Mann-Whitney, Cohen’s dtest, chi-square and Spearman correlation. A significancelevel of p < 0.05 was adopted. Subjects in the exercise grouphad better scores in both, mental state domain (p < 0.01) andsomatic manifestations domain, however the last one withno significant difference (p = 0.36). According to the effectsize values (Cohen’s d), the difference between groups washigher in mental aspect (d = 0.55) compared to the physical(d = 0.36). These findings suggest a “medium effect” in themental state domain. Hypertensive-exercising showed betterquality of life related to health suggesting that physicalexercise in addition to health benefits positively influencespsychological behavior of patients.