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1.
Wiad Lek ; 74(2): 278-281, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813486

RESUMO

OBJECTIVE: The aim: Was to find the possible relationship between spirometry tests, the BODE index (body mass index (BMI), airflow obstruction, dyspnea, and exercise tolerance) with bioimpedance parameters in overweight and class I obese patients. PATIENTS AND METHODS: Materials and methods: 47 patients with stable ischemic heart disease (IHD) (I-II functional class), chronic obstructive pulmonary disease (COPD) (GOLD II, III, IV; groups B, C, D) were divided into 3 groups: G1: 15 normal-weight patients, G2: 15 overweight subjects, and G3: 17 class I obese patients. Spirometry tests, bioimpedance parameters, 6MWT (6-minute walk test) were measured. RESULTS: Results: FEV1 was significantly higher in overweight (p = 0.033) and class I obese (p = 0.049) subjects, the BODE index was lower in overweight (p = 0.033) and class I obese (p = 0.037) patients, compared with normal-weight subjects. The statistically significant positive relationship was between BMI and FEV1 and the negative correlation was between BMI and the BODE index in all groups of patients (p < 0.05). CONCLUSION: Conclusions: In our study, we found better FEV1, 6MWT, the BODE index, the statistically significant association between FEV1 and the BODE index with BMI in overweight and class I obese patients. That's why we can suppose the presence of the "obesity paradox" in comorbid overweight or class I obese stable IHD, COPD patients.


Assuntos
Isquemia Miocárdica , Doença Pulmonar Obstrutiva Crônica , Índice de Massa Corporal , Dispneia , Tolerância ao Exercício , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença
2.
BMJ Open Respir Res ; 8(1)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33762360

RESUMO

INTRODUCTION: SARS-CoV-2 has restricted access to face-to-face delivery of pulmonary rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR. However, it is unknown whether patients who have been referred to face-to-face programmes can feasibly complete an online-PR programme. METHODS: This service evaluation used a mixed-methods approach to investigate a rapid PR service remodelling using the University of Gloucestershire eLearn Moodle platform. Quantitative baseline demographic and PR outcome data were collected from online-PR participants, and semistructured interviews were completed with PR staff and participants. RESULTS: Twenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and 14 completed PR. Significant pre-post online PR improvements were achieved in 1 min sit-to-stand (CI 2.1 to 9 (p=0.004)), Generalised Anxiety Disorder (CI -0.3 to -2.6 (p=0.023)), Primary Health Questionnaire-9 (CI -0.3 to -5.1 (p=0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 to 1.3 (p=0.001)), fatigue (CI 0.7 to 2 (p=0.0004)), emotion (CI 0.7 to 1.7 (p=0.0002)), mastery (CI 0.4 to 1.3 (p=0.001)). Interviews indicated that patient PR inclusion was made possible with digital support and a PR introduction session improved participant engagement and safety. Incremental progression of exercise was perceived as more successful online compared with face-to-face PR. However, perceptions were that education sessions were less successful. Online-PR required significant staff time resource. DISCUSSION: Online-PR improves patient outcomes and is feasible and acceptable for individuals referred for face-to-face PR in the context of a requirement for social distancing. Face-to-face programmes can be adapted in a rapid fashion with both staff and participants perceiving benefit. Future pragmatic trials are now warranted comparing online-PR including remote assessments to centre-based PR with suitably matched outcomes, and patient and staff perceptions sought regarding barriers and facilitators of online delivery.


Assuntos
Internet , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Telerreabilitação/métodos , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Asma/fisiopatologia , Asma/psicologia , Asma/reabilitação , Depressão/psicologia , Tolerância ao Exercício , Estudos de Viabilidade , Feminino , Humanos , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/psicologia , Doenças Pulmonares Intersticiais/reabilitação , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Resultado do Tratamento
3.
Int Heart J ; 62(2): 230-237, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731517

RESUMO

Arterial stiffness contributes to the development of cardiovascular disease (CVD). However, the relationship between the arterial stiffness and exercise tolerance in CVD patients with preserved ejection fraction (pEF) and those with reduced EF (rEF) is unclear. We enrolled 358 patients who participated in cardiac rehabilitation and underwent cardiopulmonary exercise testing at Juntendo University Hospital. After excluding 195 patients who had undergone open heart surgery and 20 patients with mid-range EF, the patients were divided into pEF (n = 99) and rEF (n = 44) groups. Arterial stiffness was assessed using arterial velocity pulse index (AVI) and arterial pressure volume index (API) at rest. The patients in the pEF group were significantly older and had a higher prevalence of coronary artery disease than the rEF group. The pEF group had significantly lower AVI levels and higher API levels than the rEF group. In the pEF group, the peak oxygen uptake (peak VO2) and the anaerobic threshold was significantly higher than those in the rEF group. The peak VO2 was significantly and negatively correlated with AVI and API in the pEF group (All, P < 0.05), but not in the rEF group. Multivariate linear regression analyses demonstrated that AVI was independently associated with peak VO2 (ß = -0.34, P < 0.05) in the pEF group. In conclusion, AVI may be a useful factor for assessing exercise tolerance, particularly in CVD patients with pEF.


Assuntos
Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/terapia , Tolerância ao Exercício/fisiologia , Volume Sistólico/fisiologia , Rigidez Vascular/fisiologia , Idoso , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos
4.
Heart Fail Clin ; 17(2): 263-271, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673950

RESUMO

Exercise training is recommended for patients with heart failure by major societies' guidelines. It improves exercise capacity and quality of life, reduces symptoms of depression, can improve survival, and reduce the risk for hospitalizations. Exercise-based cardiac rehabilitation can be offered with different modalities, such as continuous or interval aerobic training, resistance, and inspiratory muscle training. The intervention must follow an accurate evaluation of the patient's cardiovascular conditions and functional capacity. Despite the multiple benefits of exercise training, there is a lack of adherence to exercise-based programs, due to socioeconomic factors, patients' characteristics, and lack of referral.


Assuntos
Reabilitação Cardíaca/métodos , Terapia por Exercício/métodos , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/reabilitação , Qualidade de Vida , Insuficiência Cardíaca/fisiopatologia , Humanos
5.
Heart Fail Clin ; 17(2): 273-278, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673951

RESUMO

Patients with heart failure suffered by a complex syndrome, where the filling of the ventricle or ejection of the blood is impaired. In this setting, the exercise capacity decreases for many reasons, one of them being the insufficient oxygen transfer due to reduced cardiac output and anemia. Ventricular assist device has emerged as a durable and safe therapy for patients with end-stage heart failure. The benefits of cardiac rehabilitation in ventricular assist device patients are enormous: the first aim is to progressively reduce the physical and functional impairments of these patients, so that they will be able to resume meaningful daily activities.


Assuntos
Reabilitação Cardíaca/métodos , Insuficiência Cardíaca/reabilitação , Ventrículos do Coração/fisiopatologia , Coração Auxiliar , Teste de Esforço , Tolerância ao Exercício , Insuficiência Cardíaca/fisiopatologia , Humanos
6.
Chron Respir Dis ; 18: 1479973121999205, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33645261

RESUMO

We propose the use of the 1-minute sit-to-stand test (1STST) to evaluate the physical capacity and exertional desaturation one month after discharge in a sample of patients who survived COVID-19 pneumonia. This was a cross-sectional study that collected routine data from consecutive patients admitted to the outpatient program in a public hospital in Chile. Patients were asked to complete a 1STST. Data were analyzed according to those with and without a prolonged hospital stay of >10 days. Eighty-three percent of the patients were able to complete the test (N = 50). The median age was 62.7 ± 12.5 years. The average number of repetitions in the 1STST was 20.9 ± 4.8. Thirty-two percent of patients had a decrease in pulse oxygen saturation (SpO2) ≥ 4 points. The prolonged hospital stay subgroup had a significant increase in exertional desaturation (mean difference = 2.6; 95% CI = 1.2 to 3.9; p = 0.001) and dyspnea (mean difference = 1.1; 95% CI = 0.4 to 2.1; p = 0.042) compared to the group of length of stay ≤10 days. In-hospital survivors of COVID-19, the 1STST showed a decrease in physical capacity at one month in those 90% who were able to complete it. The 1STST was able to discriminate between those with and without a prolonged hospital stay and was able to detect exertional desaturation in some patients.


Assuntos
/reabilitação , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Exercício Físico/fisiologia , /epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
7.
Arq Bras Cardiol ; 116(2): 259-265, 2021 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33656074

RESUMO

BACKGROUND: Exertional dyspnea is a common complaint of patients with heart failure with preserved ejection fraction (HFpEF) and chronic obstructive pulmonary disease (COPD). HFpEF is common in COPD and is an independent risk factor for disease progression and exacerbation. Early detection, therefore, has great clinical relevance. OBJECTIVES: The aim of the study is to detect the frequency of masked HFpEF in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease, and to analyze the correlation between masked HFpEF and the cardiopulmonary exercise testing (CPET) parameters. METHODS: We applied the CPET in 104 non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. Echocardiography was performed before and at peak CPET. Cut-off values for stress-induced left and right ventricular diastolic dysfunction (LVDD/ RVDD) were E/e'>15; E/e'>6, respectively. Correlation analysis was done between CPET parameters and stress E/e'. A p-value <0.05 was considered significant. RESULTS: 64% of the patients had stress-induced LVDD; 78% had stress-induced RVDD. Both groups with stress LVDD and RVDD achieved lower load, lower V'O2 and O2-pulse, besides showing reduced ventilatory efficiency (higher VE/VCO2 slopes). None of the CPET parameters were correlated to stress-induced left or right E/e'. CONCLUSION: There is a high prevalence of stress-induced diastolic dysfunction in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. None of the CPET parameters correlates to stress-induced E/e'. This demands the performance of Exercise stress echocardiography (ESE) and CPET for the early detection and proper management of masked HFpEF in this population. (Arq Bras Cardiol. 2021; 116(2):259-265).


Assuntos
Insuficiência Cardíaca , Doença Pulmonar Obstrutiva Crônica , Ecocardiografia sob Estresse , Tolerância ao Exercício , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Volume Sistólico
8.
Medicine (Baltimore) ; 100(9): e24930, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655957

RESUMO

BACKGROUND: Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS: We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS: Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P  < .0001 and -0.44, -0.65 to -0.24, P  < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION: There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.


Assuntos
Dispneia/reabilitação , Tolerância ao Exercício/fisiologia , Expiração/fisiologia , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto , Músculos Respiratórios/fisiopatologia , Dispneia/etiologia , Dispneia/fisiopatologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida
9.
Circ Heart Fail ; 14(3): e007767, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33724883

RESUMO

BACKGROUND: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. METHODS: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (>40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. RESULTS: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04252287.


Assuntos
Canagliflozina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Telemedicina , Actigrafia/instrumentação , Canagliflozina/efeitos adversos , Método Duplo-Cego , Tolerância ao Exercício/efeitos dos fármacos , Monitores de Aptidão Física , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Aplicativos Móveis , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Volume Sistólico/efeitos dos fármacos , Telemedicina/instrumentação , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Função Ventricular Esquerda/efeitos dos fármacos
10.
Eur J Clin Invest ; 51(4): e13509, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33548060

RESUMO

BACKGROUND: No data are available about whether Coronavirus disease 2019 (COVID-19) pandemic have led to changes in clinical profiles or results of exercise testing once the usual activity was reassumed, as well as if wearing a facemask has any impact on the tests. The aim of this study is to evaluate differences in the patients referred to exercise stress testing in the context of COVID-19 pandemic and analyse the feasibility and results of these tests wearing a facemask. METHODS: We included all patients referred for an exercise test from 1 June to 30 September 2020 and compared them with the patients attended within the same period in 2019 before and after propensity score matching. All patients referred in 2020 wore a facemask. RESULTS: A total of 854 patients were included: 398 in the 2020 group and 456 in 2019. No significant differences in baseline characteristics of the patients were observed, with the exception of dyspnoea, which was nearly twice as high in 2020 as compared with 2019. Regarding the results of the tests, no differences were observed, with almost 80% of maximal tests, similar functional capacity and over a 20% of positive exercise tests in both groups. These results remained after propensity score matching. CONCLUSION: COVID-19 pandemic has not changed the clinical profile of patients referred to exercise testing. In addition, performing exercise testing wearing a facemask is feasible, with no influence in functional capacity and clinical results.


Assuntos
/prevenção & controle , Ecocardiografia sob Estresse/métodos , Eletrocardiografia , Teste de Esforço/métodos , Máscaras , Isquemia Miocárdica/diagnóstico , Idoso , Tolerância ao Exercício , Feminino , Humanos , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Desempenho Físico Funcional , Pontuação de Propensão , Encaminhamento e Consulta , Espanha
11.
Nutr Metab Cardiovasc Dis ; 31(4): 1247-1256, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33549445

RESUMO

BACKGROUND AND AIMS: This study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults. METHODS AND RESULTS: After a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HRmean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HRmean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05). CONCLUSION: Despite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03212391 (July 11, 2017).


Assuntos
Exercício Físico , Obesidade/terapia , Caminhada , Adiposidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Tolerância ao Exercício , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Força Muscular , Obesidade/diagnóstico , Obesidade/fisiopatologia , Cooperação do Paciente , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
12.
Medicine (Baltimore) ; 100(6): e24564, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578552

RESUMO

BACKGROUND: Among discharged COVID-19 patients, the health-related quality of life is poor, and patients suffer from significant physical and psychological impairment. This study was designed to investigate the effects of Liuzijue exercise on the rehabilitation of COVID-19 patients. METHODS: Thirty three eligible patients with COVID-19 were enrolled in the study after discharge. All the participants practiced Liuzijue exercise once per day for 20 minutes over 4 weeks. Data were collected at baseline and the end of the intervention. Primary outcomes involved functional capacity and secondary outcomes involved quality of life. RESULTS: The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and diaphragm movement in deep breathing (DM-DB) of patients increased significantly after 4 weeks of intervention. The dyspnea was also alleviated and exercise capacity was significantly improved. In terms of quality of life, physical functioning and role-physical scores were significantly increased. Moreover, Liuzijue could significantly alleviate the depression and anxiety status of the patients. CONCLUSION: Liuzijue exercise is a viable alternative home exercise program that produced better functional capacity and quality of life in discharged patients with COVID-19. These findings also showed the necessity of rehabilitation intervention for cured COVID-19 patients.


Assuntos
/reabilitação , Qigong/métodos , Adulto , /psicologia , Diafragma/fisiopatologia , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Mecânica Respiratória
15.
Artigo em Chinês | MEDLINE | ID: mdl-33535338

RESUMO

Objective: To explore the role of chronic disease self-management program (CDSMP) in promoting pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD) . Methods: In June 2017 and December 2018, 380 COPD patients were selected from the health management center of Qilu Hospital of Shandong University during the same period. They were randomly divided into the experimental group and the control group. At the end of the study, 17 cases were lost to follow-up and 5 cases were withdrawn from the study. Finally, 175 and 183 patients in the experimental group and the control group completed the study. The experimental group was treated with CDSMP for 6 months, while the control group was not intervened. Lung function and blood gas analysis results, lung rehabilitation related indicators and SF-36 scores were compared between the two groups before and after intervention. The measurement data were expressed by Mean±SD, and the comparison between the two groups was performed by t test. The count data were expressed by frequency and constituent ratio (%) . Chi square test or rank sum test was used for comparison between groups. Results: After CDSMP intervention, compared with the control group, the 6MWD, weekly moderate intensity exercise time, weekly moderate intensity exercise frequency and self exercise efficacy score of the experimental group were significantly increased, and the single exercise duration was longer, the difference was statistically significant (P<0.05) . The physiological function score, general health score, physical energy score, mental health score and total score of the experimental group were higher, and the differences were statistically significant (P<0.05) . Conclusion: CDSMP may have a certain effect in promoting lung rehabilitation in COPD patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Autogestão , Doença Crônica , Tolerância ao Exercício , Humanos , Qualidade de Vida , Resultado do Tratamento
16.
JAMA ; 325(6): 542-551, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560320

RESUMO

Importance: Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects. Objective: To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF. Design, Setting, and Participants: Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded. Interventions: Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise). Main Outcomes and Measures: Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months. Results: Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs -0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs -0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, -0.4 [95% CI, -1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%). Conclusions and Relevance: Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF. Trial Registration: ClinicalTrials.gov Identifier: NCT02078947.


Assuntos
Terapia por Exercício/métodos , Exercício Físico , Insuficiência Cardíaca/metabolismo , Treinamento Intervalado de Alta Intensidade , Consumo de Oxigênio , Idoso , Medicina Baseada em Evidências , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Volume Sistólico
17.
Artigo em Russo | MEDLINE | ID: mdl-33605132

RESUMO

The use of pulmonary rehabilitation reduces symptoms, improves life quality and exercise tolerance. The article presents indications for physical training, their characteristics and assessment of their effectiveness in the rehabilitation of patients with chronic lung diseases. It was noted that the execution of exercise tests (a monitoring with a progressive load increase on a bicycle ergometer or treadmill, a test with a constant load, a 6-minute walk test, a shuttle test with an increasing load and a shuttle test with a constant load) is appropriate for physical training before rehabilitation course. Physical endurance training programs are an essential component of pulmonary rehabilitation. Strength training, flexibility training and upper limb exercises give a good additional effect. To assess the effectiveness after rehabilitation programs, it is advisable to perform tests with physical activity. To assess the effectiveness of rehabilitation, the constant load exercise test and the constant load shuttle test are more sensitive to changes than the increasing load tests.


Assuntos
Teste de Esforço , Doença Pulmonar Obstrutiva Crônica , Exercício Físico , Terapia por Exercício , Tolerância ao Exercício , Humanos , Qualidade de Vida
18.
J Stroke Cerebrovasc Dis ; 30(4): 105628, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33508728

RESUMO

OBJECTIVES: To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger. MATERIALS AND METHOD: In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression. RESULTS: This study included 101 patients, with mean age (SD) 55.5 (11.4) years, NIHSS median (Q1, Q3) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke. CONCLUSION: We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.


Assuntos
Tolerância ao Exercício , Exercício Físico , Saúde Mental , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , /psicologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Prognóstico , Recuperação de Função Fisiológica , Fatores de Risco , Licença Médica , Inquéritos e Questionários , Fatores de Tempo
19.
J Thorac Cardiovasc Surg ; 161(3): 822-832.e6, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33451846

RESUMO

OBJECTIVES: To (1) measure 4 physiologic metrics before esophagectomy, (2) use these in an index to predict composite postoperative outcome after esophagectomy, and (3) compare predictive accuracy of this index to that of the Fried Frailty Index and Modified Frailty Index. METHODS: Grip strength (kilograms), 30-second chair sit-stands (number), 6-minute walk distance (meters), and normalized psoas muscle area (cm2/m) were measured for 77 consenting patients from January 1, 2018, to April 1, 2019. Imbalanced random forest classification estimated probability of a composite postoperative outcome, which included mortality, respiratory complications, anastomotic leak, delirium, length of stay ≥14 days, discharge to nursing facility, and readmission. G-mean error was used to compare predictive accuracy among indexes. RESULTS: Median grip strength was 38 kg (25th-75th percentiles, 31-44), number of sit-stands 11 (10-14), psoas muscle area to height ratio 6.9 cm2/m (6.0-8.2), and 6-minute walk distance 407 m (368-451). There was generally weak correlation between these metrics, with the highest between 30-second sit-stands and 6-minute walk distance (r = 0.57). Age, degree of patient-reported exhaustion, and the 4 objective metrics comprised the Esophageal Vitality Index, which had a lower G-mean error of 32% (31-33) than the Fried Frailty Index, 37% (37-38), and the Modified Frailty Index, 48% (47-48). CONCLUSIONS: The Esophageal Vitality Index, an objective, simple assessment consisting of grip strength, 30-second chair sit-stands, 6-minute walk, and psoas muscle area to height ratio outperformed commonly used frailty indexes in predicting postesophagectomy mortality and morbidity. The index provides a robust picture of patients' fitness for surgery beyond the qualitative "eyeball" test.


Assuntos
Técnicas de Apoio para a Decisão , Esofagectomia , Fragilidade/diagnóstico , Indicadores Básicos de Saúde , Idoso , Composição Corporal , Tomada de Decisão Clínica , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Tolerância ao Exercício , Feminino , Fragilidade/complicações , Fragilidade/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiopatologia , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Teste de Caminhada , Caminhada
20.
Artigo em Inglês | MEDLINE | ID: mdl-33451086

RESUMO

This study was aimed to: (1) investigate the effects of physiological functions of sprint interval training (SIT) on the aerobic capacity of elite badminton players; and (2) explore the potential mechanisms of oxygen uptake, transport and recovery within the process. Thirty-two elite badminton players volunteered to participate and were randomly divided into experimental (Male-SIT and Female-SIT group) and control groups (Male-CON and Female-CON) within each gender. During a total of eight weeks, SIT group performed three times of SIT training per week, including two power bike trainings and one multi-ball training, while the CON group undertook two Fartlek runs and one regular multi-ball training. The distance of YO-YO IR2 test (which evaluates player's ability to recover between high intensity intermittent exercises) for Male-SIT and Female-SIT groups increased from 1083.0 ± 205.8 m to 1217.5 ± 190.5 m, and from 725 ± 132.9 m to 840 ± 126.5 m (p < 0.05), respectively, which were significantly higher than both CON groups (p < 0.05). For the Male-SIT group, the ventilatory anaerobic threshold and ventilatory anaerobic threshold in percentage of VO2max significantly increased from 3088.4 ± 450.9 mL/min to 3665.3 ± 263.5 mL/min (p < 0.05),and from 74 ± 10% to 85 ± 3% (p < 0.05) after the intervention, and the increases were significantly higher than the Male-CON group (p < 0.05); for the Female-SIT group, the ventilatory anaerobic threshold and ventilatory anaerobic threshold in percentage of VO2max were significantly elevated from 1940.1 ± 112.8 mL/min to 2176.9 ± 78.6 mL/min, and from 75 ± 4% to 82 ± 4% (p < 0.05) after the intervention, which also were significantly higher than those of the Female-CON group (p < 0.05). Finally, the lactate clearance rate was raised from 13 ± 3% to 21 ± 4% (p < 0.05) and from 21 ± 5% to 27 ± 4% for both Male-SIT and Female-SIT groups when compared to the pre-test, and this increase was significantly higher than the control groups (p < 0.05). As a training method, SIT could substantially improve maximum aerobic capacity and aerobic recovery ability by improving the oxygen uptake and delivery, thus enhancing their rapid repeated sprinting ability.


Assuntos
Treinamento Intervalado de Alta Intensidade , Esportes com Raquete , Limiar Anaeróbio , Tolerância ao Exercício , Feminino , Humanos , Ácido Láctico , Masculino
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