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1.
Int Heart J ; 60(6): 1366-1372, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735775

RESUMO

The Kihon Checklist (KCL) is a reliable tool for determining frailty status in the elderly. However, there is no information in the literature about the relationship between frailty status and exercise capacity. Here, we examined the associations between cardiopulmonary exercise testing parameters and frailty status in elderly patients with stable heart failure (HF).Ninety-two elderly patients with stable HF were evaluated using cardiopulmonary exercise testing and the KCL. A KCL score of 0-3 was classified as robust, 4-7 as pre-frail, and ≥ 8 as frail.Mean age, peak VO2, and KCL score were 81.7 years, 13.2 mL/kg/minute, and 10.7, respectively. KCL score was significantly correlated with peak VO2 (r = -0.527, P < 0.001) and peak work rate (r = -0.632, P < 0.001). In patients with frailty (n = 63), the peak work rate (WR) was significantly lower than it was in patients without frailty (n = 29; 39.9 versus 69.5 W, respectively; P < 0.001). Multivariate analysis revealed that peak WR and peak systolic blood pressure were significant, independent predictors of frailty (ß = -0.108 and -0.045, respectively). In a diagnostic performance plot analysis, a cutoff value for peak WR of 51.9 W was the best predictor of frailty.Frailty status was significantly associated with peak WR and peak systolic blood pressure in elderly patients with stable HF. Therefore, cardiopulmonary exercise testing may be useful for assessing frailty status in this patient population.


Assuntos
Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Lista de Checagem , Teste de Esforço , Feminino , Fragilidade/complicações , Insuficiência Cardíaca/complicações , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Valor Preditivo dos Testes
2.
Arq Gastroenterol ; 56(3): 252-255, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633720

RESUMO

BACKGROUND: Fatigue is highly prevalent in end stage liver disease, the studies about its association with exercise capacity in cirrhotic patients before liver are scarse. OBJECTIVE: In this study, we evaluated fatigue in 95 in end stage liver disease patients awaiting transplantation, compared to healthy volunteers, and tested the association between exercise capacity and fatigue. METHODS: Cross-sectional study of patients with chronic liver disease treated at a referral center in Fortaleza, Brazil. Fatigue was quantified with the Fatigue Severity Scale. The patients were submitted to the 6-min walk test, the 6-min step test, the Hospital Anxiety and Depression Scale, C-reative protein measurement and hematocrit count, measurement of dyspnea among other tests. Fatigue data were obtained from healthy individuals for comparison with patients. RESULTS: The mean age of patients was 45.9±12.3 years, and 53.7% were male. Fatigue, anxiety and depression levels were higher among end stage liver disease patients than among controls. A negative correlation was observed between 6 min step test and Fatigue Severity Scale score (r= -0.2; P=0.02) and between hematocrit count and Fatigue Severity Scale score (r= -0.24; P=0.002). Dyspnea on the Borg scale and fatigue were positively correlated (r=31; P=0.002). In the multivariate analysis, low 6-min step test values and high levels of dyspnea were associated with fatigue. CONCLUSION: Fatigue was more prevalent and severe in end stage liver disease patients than in healthy controls. Low 6MST values and high levels of dyspnea were associated with fatigue in this scenario.


Assuntos
Doença Hepática Terminal/psicologia , Tolerância ao Exercício/fisiologia , Fadiga/psicologia , Transplante de Fígado/psicologia , Adulto , Transtornos de Ansiedade/psicologia , Estudos Transversais , Transtorno Depressivo/psicologia , Doença Hepática Terminal/fisiopatologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Listas de Espera
4.
J Sports Med Phys Fitness ; 59(9): 1513-1525, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31610639

RESUMO

INTRODUCTION: Physical fitness is a performance factor that is characterized by its ability to be assessed using closed tests. Among the existing tests today, there are no data on which are the most optimal ones for the sport for which they are applied. Tests of a generic nature are widely used regardless of the sample of players or the sport to which is being referred as they allow to compare the performance among athletes. In spite of this, it is necessary to identify and develop specific tests of physical fitness for each sport. Thus, the main purpose of this review on physical fitness in basketball players was to identify and group the different tests described in the literature up until November 2018. EVIDENCE ACQUISITION: A literature search was conducted in the different data base to systematically ascertain the most commonly used tests for assessing physical fitness in basketball players. A total of 40 articles were selected, after passing the selection and exclusion criteria. EVIDENCE SYNTHESIS: Finally, they were classified according to the tests assessed in each document. The capacities more frequently studied in literature are jump (N.=21) aerobic capacity (N.=17) and anaerobic capacity (N.=16). On the contrary, the least common evaluated capacities are speed and agility (N.=14). CONCLUSIONS: The results and discussion showed that few specific tests are used to assess this quality in athletes. The analyzed bibliography reveals the lack of design and use of specific tests to highlight the qualities involved in the targeted sport.


Assuntos
Basquetebol/fisiologia , Aptidão Física/fisiologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Masculino
5.
J Sports Med Phys Fitness ; 59(9): 1526-1535, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31610640

RESUMO

BACKGROUND: Body composition may affect the potential for success in sports. For this reason, our study aimed to determine the impact of body composition on the level of aerobic and anaerobic capacity in competitive rowers. METHODS: The study involved 48 males aged 20±2 years. Body composition was analysed using electrical bioimpedance. Maximum aerobic capacity (VO2max) and average anaerobic power (AP) were determined using an incremental cycling test until exhaustion and a standard Wingate Anaerobic Test (WAT), respectively. RESULTS: The optimal ranges of body components with respect to the level of anaerobic and aerobic capacity at preparatory period for highly trained rowers aged 17-23 years, with body mass 67.5-104.7 kg, were 86-88% for fat free mass (FFM), 63-65% for total body water (TBW) and 11-13% for fat mass (FM). Regression analyses showed that BM and FFM significantly contributed to the prediction of VO2max and AP. The increase in FFM and BM by 1 kg resulted in the change of VO2max by +0.161 l.min-1 and -0.057 l.min-1, and AP by +5.51 W and +4.74 W, respectively. CONCLUSIONS: Body composition is closely related to the level of aerobic and anaerobic capacity in rowers, and we suggest that its regulation can serve as an effective tool to improve physical performance. The regression models we developed seem to be promising for estimating the changes in physical capacity based on body composition modifications, however, their accuracy should be verified in an experimental study.


Assuntos
Composição Corporal/fisiologia , Tolerância ao Exercício/fisiologia , Esportes Aquáticos/fisiologia , Adolescente , Adulto , Estudos Transversais , Humanos , Masculino , Adulto Jovem
7.
Sports Health ; 11(6): 492-497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486715

RESUMO

BACKGROUND: The Buffalo Concussion Treadmill Test (BCTT) is a graded exertion test for assessing exercise tolerance after concussion, but its utility is limited for certain populations. HYPOTHESIS: We developed the Buffalo Concussion Bike Test (BCBT) and tested its comparability with the BCTT. We hypothesize that heart rate (HR) at symptom exacerbation on the BCBT will be equivalent to the BCTT. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Adolescents with acute concussion (AC) (n = 20; mean age, 15.9 ± 1.1 years; 60% male) presenting to a concussion clinic within 10 days of injury and age- and sex-matched healthy controls (n = 20; mean age, 15.9 ± 1.1 years; 60% male) performed the BCTT at first visit and returned within 3 days to perform the BCBT. Test duration, HR, symptom severity (measured using a visual analog scale), and exertion (measured using the Borg Rating of Perceived Exertion) were collected during each test. RESULTS: Adolescents with AC who were exercise intolerant on the BCTT were also intolerant on the BCBT, with symptom exacerbation occurring at a mean 8.1 ± 2.8 minutes on the BCTT versus 14.6 ± 6.0 minutes on the BCBT (P < 0.01). Two 1-sided t tests showed that the HR at symptom exacerbation in AC patients (137 ± 28 bpm on BCTT vs 135 ± 25 bpm on BCBT; 95% CI, <0.01-0.03) and at voluntary exhaustion for controls (175 ± 13 bpm on BCTT vs 175 ± 13 bpm on BCBT; 95% CI, 0.03-0.03) on each test were statistically equivalent. CONCLUSION: The HR at symptom exacerbation on BCBT is equivalent to the BCTT for the assessment of exercise tolerance after concussion in adolescents. CLINICAL RELEVANCE: The BCBT can be used in patients with limited mobility or for research interventions that require limited participant motion.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Teste de Esforço/métodos , Adolescente , Estudos de Casos e Controles , Tolerância ao Exercício/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino
8.
Braz J Med Biol Res ; 52(9): e8402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482976

RESUMO

Cardiopulmonary fitness assessment is a valuable resource to obtain quantitative indicators of an individual's physical performance. The cardiopulmonary exercise test (CPX), considered the gold standard test for this evaluation, is costly and difficult to be accessed by the general population. In order to make this evaluation more accessible, and to better reflect the performance of daily life activities, alternative tests were proposed. Morbidly obese patients present limitations that impair physical performance assessment and could benefit from a test of shorter duration, provided it is validated. This observational study aimed to validate the two-minute step test (2MST) as a tool to evaluate functional capacity (FC) in obese with comorbidities and morbidly obese patients, compared the 2MST with CPX as a measure of physical performance, and developed a predictive equation to estimate peak oxygen uptake (VO2) in the 2MST. The CPX and the 2MST were performed and metabolic and ventilatory parameters were recorded in 31 obese individuals (BMI>35 kg/m2). Pearson correlation and multiple linear regression analyses were performed to evaluate the peak VO2 best predictors. Bland-Altman analysis was performed to assess the agreement between the two methods. Peak VO2 measured by CPX and 2MST showed a strong correlation (r=0.70, P<0.001) and there was a moderate correlation between peak VO2 of the 2MST and the number of up-and-down step cycles (UDS) (r=0.55; P=0.01). The reference equation obtained was: VO2 (mL·kg-1·min-1) = 13.341 + 0.138 × total UDS - (0.183 × BMI), with an estimated standard error of 1.3 mL·kg-1·min-1. The 2MST is a viable, practical, and easily accessible test for FC. UDS and BMI can predict peak VO2 satisfactorily.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Tolerância ao Exercício/fisiologia , Frequência Cardíaca/fisiologia , Obesidade/fisiopatologia , Consumo de Oxigênio/fisiologia , Teste de Caminhada/métodos , Adolescente , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Fatores de Tempo , Adulto Jovem
9.
Mayo Clin Proc ; 94(9): 1718-1730, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31486378

RESUMO

OBJECTIVE: To examine the effect of high-intensity interval training (HIIT) on body fat mass and distribution in patients with myocardial infarction (MI) who underwent cardiac rehabilitation (CR). PATIENTS AND METHODS: We retrospectively screened 391 consecutive patients with MI enrolled in CR between September 1, 2015, and February 28, 2018. We included 120 patients who completed 36 CR sessions and underwent pretest-posttest dual-energy x-ray absorptiometry; 90 engaged in HIIT, and 30 engaged in moderate-intensity continuous training (MICT). High-intensity interval training included 4 to 8 alternating intervals of high- (30-60 seconds at a rating of perceived exertion [RPE] of 15-17 [Borg scale range, 6-20]) and low-intensity (1-5 minutes at RPE <14), and MICT performed for 20 to 45 minutes of exercise at an RPE of 12 to 14. Body weight, fat mass, and lean mass were measured via dual-energy x-ray absorptiometry with lipid profile measured via clinical procedures. RESULTS: The HIIT and MICT groups were similar in age (67 vs 67 years), sex (26.7% [24 of 90 patients in the HIIT group] vs 26.7% [8 of 30 in the MICT group), and body mass index (30.3 vs 29.5 kg/m2) at baseline. The HIIT group had greater reductions in body fat percentage (P<.001), fat mass (P<.001), abdominal fat percentage (P<.001), waist circumference (P=.01), total cholesterol (P=.002), low-density lipoprotein cholesterol (P<.001), and triglycerides (P=.006). Improvements in total body mass and body mass index were not different across groups. After matching exercise duration, exercise intensity, and energy expenditure, HIIT-induced improvements in total fat mass (P=.02), body fat percentage (P=.01), and abdominal fat percentage (P=.02) persisted. CONCLUSION: Our data suggest that supervised HIIT results in significant reductions in total fat mass (P<.001) and abdominal fat percentage (P<.001) and improved lipid profile in patients with MI who undergo CR.


Assuntos
Índice de Massa Corporal , Tolerância ao Exercício/fisiologia , Treinamento Intervalado de Alta Intensidade/métodos , Infarto do Miocárdio/reabilitação , Consumo de Oxigênio , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do Tratamento
10.
Mayo Clin Proc ; 94(12): 2415-2426, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31477320

RESUMO

OBJECTIVE: To examine the effects of interval walking training (IWT) on the estimated peak aerobic capacity (eV˙O2peak) and lifestyle-related disease (LSD) score while focusing on exercise intensity and volume in middle-aged and older people. PARTICIPANTS AND METHODS: Men and women (N=679; mean age, 65±7 SD years) completed 5-month IWT. Participants were instructed to repeat 5 or more sets of fast and slow walking for 3 minutes each at 70% or more and 40% eV˙O2peak for walking, respectively, per day for 4 or more d/wk. This study was conducted from April 1, 2005, through February 29, 2008. RESULTS: Interval walking training increased eV˙O2peak by 14% and decreased LSD score by 17% on average (P<.001). During 5-month IWT, fast and slow walking times were 88±65 SD and 100±86 min/wk, respectively, but varied among participants. We divided participants into approximately 10 bins for 6 minutes each of fast and slow walking times per week up to 60 min/wk, and above this time, approximately 8 bins for 30 or 60 minutes each of fast and slow walking up to the maximal time. We found that both eV˙O2peak and LSD score improved as fast walking time per week increased up to 50 min/wk (R2=0.94; P<.001 for eV˙O2peak; R2=0.51; P=.03 for LSDS) but plateaued above this time. In contrast, improvement in neither eV˙O2peak nor LSDS was positively correlated with slow or total walking time per week. Multiple regression analyses confirmed that fast walking time per week was the major determinant of improvements in eV˙O2peak (P<.001) and LSD score (P=.001). CONCLUSION: High-intensity walking time during IWT is a key factor to increase eV˙O2peak and decrease LSD score in middle-aged and older people.


Assuntos
Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Tolerância ao Exercício/fisiologia , Treinamento Intervalado de Alta Intensidade , Hipertensão/epidemiologia , Aptidão Física/fisiologia , Idoso , Diabetes Mellitus/fisiopatologia , Dislipidemias/fisiopatologia , Feminino , Humanos , Hipertensão/fisiopatologia , Incidência , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Caminhada/fisiologia
11.
Tuberk Toraks ; 67(2): 83-91, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414638

RESUMO

Introduction: The goals of chronic obstructive pulmonary disease (COPD) treatment are to relieve dyspnea, increase exercise capacity, and improve quality of life. The relation of exercise capacity, dyspnea level, and quality of life with long-term mortality is unclear. Aim of the study was to assess the effect of exercise capacity, dyspnea level and quality of life on long-term mortality risk in patients with COPD. Materials and Methods: Dyspnea level was assessed using the modified Medical Research Council (mMRC), Borg and Baseline Dyspnea Index (BDI) and Body Obstruction Dyspnea Exercise (BODE), health-related quality of life with St. George's Respiratory Questionnaire, and exercise capacity with the 6-minute walking test (6MWT) and cardiopulmonary exercise test. At the end of 8-year follow-up period, the relation between these tests and mortality was examined. Result: A total of 42 patients with stable COPD were included in the study. Sixteen patients died during the approximately 8-year follow-up period. Univariate analysis revealed that VO2 peak [HR: 1.845; CI: (1.336-2.55); p<0.001], BODE index [HR: 0.787; CI: (0.703-0.880); p<0.001], and SGRQ [HR: 1.073; CI: (1.028-1.119); p= 0.001] were significantly correlated to mortality risk. Multivariate Cox regression analysis revealed VO2 peak [HR: 1.031; CI: (0.683-1.120); p= 0.01] as the single significant predictor of mortality. VO2 peak less than 22.5 had a sensitivity of 82%, specificity of 80%, and area under the curve of 0.142 [95% CI: (0.027-0.257); p< 0.001] for mortality risk with ROC analysis. Conclusions: Cardiopulmonary disturbances during maximal exercise may be an important indicator of mortality risk.


Assuntos
Dispneia/fisiopatologia , Tolerância ao Exercício/fisiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Idoso , Análise de Variância , Exercício , Teste de Esforço , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia , Curva ROC , Sensibilidade e Especificidade , Inquéritos e Questionários
12.
Expert Rev Med Devices ; 16(9): 787-798, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31453716

RESUMO

Introduction: Left ventricular assist device (LVAD) implantation has become a well-established treatment option for patients with end stage heart failure (HF) who are refractory to medical therapy. While LVADs implantation does effectively improve hemodynamic performance many patients still possess peripheral pathological adaptations often present in end-stage HF. Therefore, increased attention has been placed on investigating the effects of exercise training for patients with LVADs to improve clinical outcomes. However, the available evidence on exercise training for patients with LVADs is limited. Areas covered: The purpose of this narrative review is to summarize: 1) The evolution of LVAD technology and usage; 2) The physiological responses to exercise in patients with LVADs; 3) The available evidence regarding exercise training; 4) Potential strategies to implement exercise training programs for this patient population. Expert opinion: The available evidence for exercise training to improve physical function and clinical outcomes for patients with LVADs is promising but limited. Future research is needed to further elucidate the ideal exercise training parameters, method of delivery for exercise training, and unique barriers and facilitators to exercise training for patients receiving LVAD implantation.


Assuntos
Tolerância ao Exercício/fisiologia , Ventrículos do Coração/fisiopatologia , Coração Auxiliar , Débito Cardíaco , Exercício/fisiologia , Humanos , Respiração
13.
Diabetes Res Clin Pract ; 155: 107813, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31408665

RESUMO

AIMS: To assess cardiac autonomic control and its association with submaximal exercise measured using the 6-minute walk test (6MWT) in subjects with type-2 diabetes mellitus (DM2). METHODS: Cardiac autonomic control was assessed using Ewing's tests and heart rate variability (HRV) in DM2 volunteers (DG, n = 22) and sex-, age- and body mass index-matched non-diabetic controls (CG, n = 22) before, during and after 6MWT. RESULTS: Before the 6MWT, DG presented lower HRV represented by reduced SDNN [median 28.9 ms2 (IQR:18.6-35.4) vs. 45.1 (IQR:39.2-62.67), p < 0.001] and Total Power [median 785 ms2 (IQR:256-1264) vs. 1757 ms2 (IQR:1006-2912), p = 0.004]. Exercise capacity was reduced in DG [maximal predicted distance (%) = 88.4 ±â€¯6.4 vs. 95.2 ±â€¯11.0%, p = 0.018]. DG demonstrated lower global HRV during recovery and lower parasympathetic drive, represented by reduced RMSSD, during all phases of the 6MWT. Moreover, supine HR (r = -0.32), HR orthostatism (ρ = -0.40), SDNN pre-6MWT (ρ = 0.39), TP pre-6MWT (ρ = 0.38), Valsalva ratio (ρ = 0.39) and 30:15 ratio (ρ = 0.38) were all correlated with maximal walked distance. CONCLUSIONS: DM2 subjects presented abnormal HRV during and after submaximal exercise. Furthermore, autonomic control impairment in orthostatism, represented by lower global HRV (SDNN, Total power) and lower Ewing's indexes (Valsalva and 30:15 ratios), was associated with lower exercise capacity.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Gait Posture ; 74: 60-65, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31470225

RESUMO

BACKGROUND: Abnormalities of spatiotemporal gait parameters are frequently observed in chronic obstructive pulmonary disease (COPD). However, associations of gait parameters with clinical outcomes and their implementation into clinical practice have not been established. RESEARCH QUESTION: To investigate gait abnormalities and their association with clinical outcomes of COPD. METHODS: This study included 34 male outpatients with COPD and 16 community-dwelling healthy men aged ≥65 years. The subjects underwent a ten-metre walk test wearing an accelerometer. Data on gait speed, step length, cadence, walk ratio, acceleration magnitude, and standard deviation of step time (step time SD) were collected. Forced expiratory volume in 1-second, modified Medical Research Council dyspnoea score, six-minute walk distance (6MWD), quadriceps muscle strength (QMVC), and physical activity (daily steps and time spent in moderate to vigorous physical activity per day) were measured in the COPD group as clinical outcomes of COPD. We tested group differences in gait parameters, associations between gait parameters and COPD clinical outcomes, and predictive capability of gait parameters for reductions in 6MWD, QMVC, and daily steps in COPD. RESULTS: All gait parameters except walk ratio deteriorated in COPD. Step time SD and gait speed were significant independent predictors of 6MWD in COPD (B=-0.440, p = 0.001, B = 0.339, p = 0.007, respectively). Step length was a significant independent predictor of QMVC (B=-0.609, p < 0.001) and daily steps (B=-0.453, p = 0.006). Step length was a significant predictor of muscle weakness and physical inactivity, and step time SD was significant in predicting poor 6MWD in COPD. SIGNIFICANCE: Significant associations between gait abnormalities measured by an accelerometer and deficits in extra-pulmonary features of COPD were observed. An accelerometer-based gait analysis could be an alternative approach to assessing gait abnormalities and screening of functional decline in COPD.


Assuntos
Marcha/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Tolerância ao Exercício/fisiologia , Volume Expiratório Forçado , Análise da Marcha/métodos , Humanos , Masculino , Força Muscular/fisiologia , Músculo Quadríceps/fisiopatologia , Comportamento Sedentário , Velocidade de Caminhada
15.
Braz J Med Biol Res ; 52(8): e8513, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365695

RESUMO

Phenotypic differences have been described between patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and SSc-associated pulmonary hypertension, including performance differences in the 6-min walk test (6MWT). Moreover, the correlations between the 6MWT and traditional pulmonary function tests (PFTs) are weak, indicating the need to search for new parameters that explain exercise performance. Thus, our objective was to evaluate the impact of ventilation distribution heterogeneity assessed by the nitrogen single-breath washout (N2SBW) test and peripheral muscle dysfunction on the exercise capacity in patients with SSc-ILD and limited involvement of the pulmonary parenchyma. In this cross-sectional study, 20 women with SSc-ILD and 20 matched controls underwent PFTs (including spirometry, diffusing capacity for carbon monoxide (DLco), and the N2SBW test) and performed the 6MWT and knee isometric dynamometry. The 6-min walking distance (6MWD, % predicted) was strongly correlated with the phase III slope of the single-breath nitrogen washout (phase III slopeN2SBW) (r=-0.753, P<0.0001) and reasonably correlated with the forced vital capacity (FVC) (r=0.466, P=0.008) and DLco (r=0.398, P=0.011). The peripheral oxygen saturation (SpO2) during exercise was not significantly correlated with any of the pulmonary or muscle function parameters. The phase III slopeN2SBW was the only predictive variable for the 6MWD, whereas quadriceps strength and FVC/DLco were predictive variables for SpO2. Ventilation distribution heterogeneity is one factor that contributes to a lower 6MWD in SSc-ILD patients. In addition, muscle dysfunction and abnormal lung diffusion at least partly explain the decreased SpO2 of these patients.


Assuntos
Tolerância ao Exercício/fisiologia , Hipertensão Pulmonar/fisiopatologia , Doenças Pulmonares Intersticiais/fisiopatologia , Pulmão/fisiologia , Testes de Função Respiratória/métodos , Escleroderma Sistêmico/complicações , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/etiologia , Medidas de Volume Pulmonar/métodos , Pessoa de Meia-Idade , Ventilação Pulmonar , Doença de Raynaud/complicações , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia , Teste de Caminhada/métodos
16.
Med Sci Monit ; 25: 5159-5169, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31296834

RESUMO

BACKGROUND Respiratory therapy is an integral part of treatment of cardiac patients. The aim of this study was to evaluate the effect of addition of inspiratory muscle training (IMT) to second-stage cardiac rehabilitation on exercise tolerance and function of lower extremities in patients following myocardial infarction (MI). MATERIAL AND METHODS This study included 90 patients (mean age 65 years) with MI who took part in the second stage of an 8-week cycle of cardiac rehabilitation (CR). They were divided into 3 groups: group I underwent CR and IMT, group II only underwent CR, and group III only underwent IMT. Groups I and II were allocated randomly according sealed opaque envelopes. The third group consisted of patients who could not participate in standard rehabilitation for various reasons. Before and after the 8-week program, participants were assessed for maximal inspiratory and expiratory pressure (PImax and PEmax) values, exercise tolerance, and knee muscle strength. RESULTS In groups I and II, a significant increase in the PImax parameters and exercise tolerance parameters (MET) were observed. Group I had increased PEmax parameters. In group III, the same changes in the parameter values that reflect respiratory muscle function were observed. All of the examined strength parameters of the knee joint muscles demonstrated improvement in all of the investigated groups, but the biggest differences were observed in group I. CONCLUSIONS Use of IMT in the ambulatory rehabilitation program of MI patients resulted in improved rehabilitation efficacy, leading to a significant improvement in physical condition.


Assuntos
Terapia por Exercício/métodos , Tolerância ao Exercício/fisiologia , Infarto do Miocárdio/terapia , Idoso , Idoso de 80 Anos ou mais , Exercícios Respiratórios/métodos , Exercício/fisiologia , Teste de Esforço , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Modalidades de Fisioterapia , Músculos Respiratórios/fisiopatologia , Terapia Respiratória/métodos
17.
Life Sci ; 232: 116629, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31276687

RESUMO

AIMS: To investigate the effects of moderate aerobic physical training on cardiac function and morphology as well as on the levels of glial cell-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) of animals infected with the Y strain of Trypanosoma cruzi. MAIN METHODS: Twenty-eight male C57BL/6 mice were distributed into 4 groups: sedentary control (SC), trained control (TC), sedentary infected (CHC) and trained infected (CHT). The infection was performed by intraperitoneal injection of trypomastigote forms and the animals were adapted to treadmill in the week before the beginning of the training protocol, initiated 45 days post infection. Maximal exercise test (TEM) was performed at the baseline as well as at the end of the 4th, 8th and 12th weeks of training. At the end of the 12th week, all animals were evaluated for cardiac morphology and function by echocardiography. KEY FINDINGS: CHC group showed a larger area of right ventricle (RVA), increased end-systolic volume and reduction in ejection fraction (EF), stroke volume (SV), cardiac output (CO) and fractional area change (FAC). The training reduced the RVA and improved the FAC of chagasic animals. GDNF level was higher in TC and CHC groups compared to SC in heart and BDNF levels were higher in CHC compared to SC in heart and serum. SIGNIFICANCE: Physical training ameliorated the cardiac function of infected animals and promoted adjusts in BDNF and GDNF levels. These findings evidenced these neurotrophins as possible biomarkers of cardiac function responsive to exercise stimulus.


Assuntos
Tolerância ao Exercício/fisiologia , Condicionamento Físico Animal/métodos , Condicionamento Físico Animal/fisiologia , Animais , Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/análise , Fator Neurotrófico Derivado do Encéfalo/fisiologia , Débito Cardíaco , Doença de Chagas/metabolismo , Modelos Animais de Doenças , Ecocardiografia , Teste de Esforço , Fator Neurotrófico Derivado de Linhagem de Célula Glial/análise , Fator Neurotrófico Derivado de Linhagem de Célula Glial/fisiologia , Coração/fisiologia , Testes de Função Cardíaca , Ventrículos do Coração/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fator de Crescimento Neural/análise , Fator de Crescimento Neural/fisiologia , Fatores de Crescimento Neural/metabolismo , Fatores de Crescimento Neural/fisiologia , Volume Sistólico/fisiologia , Trypanosoma cruzi/patogenicidade
18.
Respir Res ; 20(1): 141, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286970

RESUMO

There is increasing focus on understanding the nature of chronic obstructive pulmonary disease (COPD) during the earlier stages. Mild COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 or the now-withdrawn GOLD stage 0) represents an early stage of COPD that may progress to more severe disease. This review summarises the disease burden of patients with mild COPD and discusses the evidence for treatment intervention in this subgroup.Overall, patients with mild COPD suffer a substantial disease burden that includes persistent or potentially debilitating symptoms, increased risk of exacerbations, increased healthcare utilisation, reduced exercise tolerance and physical activity, and a higher rate of lung function decline versus controls. However, the evidence for treatment efficacy in these patients is limited due to their frequent exclusion from clinical trials. Careful assessment of disease burden and the rate of disease progression in individual patients, rather than a reliance on spirometry data, may identify patients who could benefit from earlier treatment intervention.


Assuntos
Tolerância ao Exercício/efeitos dos fármacos , Volume Expiratório Forçado/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Corticosteroides/farmacologia , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/farmacologia , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Tolerância ao Exercício/fisiologia , Volume Expiratório Forçado/fisiologia , Humanos , Antagonistas Muscarínicos/farmacologia , Antagonistas Muscarínicos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Resultado do Tratamento
19.
Cardiol Young ; 29(6): 800-807, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159904

RESUMO

BACKGROUND: Tricuspid valve regurgitation is an inherent part of Ebstein's anomaly, yet whether the severity of the regurgitation further impairs exercise capacity and contributes to long-term morbidity on top of the lesion severity per se is unknown. METHODS: To evaluate for this potential effect, we included 30 patients with Ebstein's anomaly who did not undergo any form of surgical interventions and had a cardiopulmonary exercise test and echocardiographic studies in this retrospective analysis. Echocardiographic studies and cardiopulmonary exercise tests were critically reviewed for lesion severity grade, tricuspid regurgitation degree, and exercise parameters. Cardiac-related hospitalisations were recorded from computerised medical records and during clinic visits. RESULTS: Fourteen patients (47%) had moderate and 8 (27%) had severe regurgitation. Patients with ≥ moderate regurgitation exhibited significantly lower exercise capacity (median % predicted maximal oxygen consumption, 62 versus 79%, p = 0.03) and venilatory efficiency at exercise. When stratifying exercise results by regurgitation degree, a stepwise decrease in oxygen consumption and ventilatory efficiency with increasing regurgitation severity was observed, regardless of the anatomic lesion severity. During a median follow-up of 4.6 years, > moderate tricuspid regurgitation was associated with significantly lower cumulative probability of freedom from cardiac hospitalisations. CONCLUSIONS: We report that among non-operated Ebstein's anomaly patients, greater tricuspid regurgitation severity was associated with worse exercise capacity and with overall higher probability of cardiac-related hospitalisations independent from the underlying lesion severity.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Anomalia de Ebstein/complicações , Tolerância ao Exercício/fisiologia , Hospitalização/tendências , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Anomalia de Ebstein/diagnóstico , Ecocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/fisiopatologia , Função Ventricular Direita/fisiologia , Adulto Jovem
20.
Expert Rev Cardiovasc Ther ; 17(6): 413-426, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31161825

RESUMO

Introduction: Reference values for cardiopulmonary exercise testing (CPET) parameters provide the comparative basis for answering important questions concerning the normalcy of exercise responses in patients, and significantly impacts the clinical decision-making process. Areas covered: The aim of this study was to provide an updated systematic review of the literature on reference values for CPET parameters in healthy subjects across the life span. A systematic search in MEDLINE, Embase, and PEDro databases were performed for articles describing reference values for CPET published between March 2014 and February 2019. Expert opinion: Compared to the review published in 2014, more data have been published in the last five years compared to the 35 years before. However, there is still a lot of progress to be made. Quality can be further improved by performing a power analysis, a good quality assurance of equipment and methodologies, and by validating the developed reference equation in an independent (sub)sample. Methodological quality of future studies can be further improved by measuring and reporting the level of physical activity, by reporting values for different racial groups within a cohort as well as by the exclusion of smokers in the sample studied. Normal reference ranges should be well defined in consensus statements.


Assuntos
Teste de Esforço/métodos , Exercício/fisiologia , Tolerância ao Exercício/fisiologia , Voluntários Saudáveis , Humanos , Valores de Referência
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