Metabolic and cardiac autonomic effects of high-intensity resistance training protocol in Wistar rats.

The aim of this study was to assess the effects of metabolic and autonomic nervous control on high-intensity resistance training (HRT) as determined by pancreatic glucose sensitivity (GS), insulin sensitivity (IS), blood lactate ([La]), and heart rate variability (HRV) in rats. Thirty male, albino Wistar rats (292 ± 20 g) were divided into 3 groups: sedentary control (SC), low-resistance training (LRT), and HRT. The animals in the HRT group were submitted to a high-resistance protocol with a progressively increasing load relative to body weight until exhaustion, whereas the LRT group performed the same exercise regimen with no load progression. The program was conducted 3 times per week for 8 weeks. The [La], parameters related to the functionality of pancreatic tissue, and HRV were measured. There was a significant increase in peak [La] only in the HRT group, but there was a reduction in [La] when corrected to the maximal load in both trained groups (LRT and HRT, p < 0.05). Both trained groups exhibited an increase in IS; however, compared with SC and LRT, HRT demonstrated a significantly higher GS posttraining (p < 0.05). With respect to HRV, the low-frequency (LF) band, in milliseconds squared, reduced in both trained groups, but the high-frequency band, in milliseconds squared and nu, increased, and the LF in nu, decreased only in the HRT group (p < 0.05). The HRT protocol produced significant and beneficial metabolic and cardiac autonomic adaptations. These results provide evidence for the positive benefits of HRT in counteracting metabolic and cardiovascular dysfunction.

Gastric Volvulus: A Multidisciplinary Approach and Conservative Treatment.

Gastric volvulus can be defined as an abnormal rotation of the stomach. It can be both an emergency and a chronic intermittent problem. Being such a rare clinical entity and a difficult condition to diagnose, it is commonly diagnosed at the time of surgery or even at autopsy. We present the case of an 82-year-old independent female with a past medical history of hiatal hernia, who came to the emergency department with hematemesis and severe epigastric pain. An abdominal CT scan revealed an organoaxial stomach volvulus within the intrathoracic cavity. After initial treatment with gastric decompression, IV fluids and proton pump inhibitors, the patient was informed that the surgical intervention would be the only definitive curative treatment for her condition and denied the procedure. She was then discharged after clinical and analytical improvement. She was offered a conservative treatment and follow up by the internal medicine team. After a few months, the patient reported moderate improvement of her symptoms and less episodes of epigastric pain. She was pleased with the conservative management and denied any surgical or invasive procedures. A proximity contact was established with the family doctor, which she maintains. This case report is proof that rare entities can happen to patients presenting common symptoms and better resolutions come from multidisciplinary approaches.

Pé torto congênito: método de Ponseti e sua aplicabilidade pelo fisioterapeuta / Congenital clubfoot: Ponseti method and its applicability by the physiotherapist

O pé torto congênito é uma das deformidades mais frequentes de membro inferior que, por sua complexidade com relação às alterações anatômicas, é alvo de dúvidas e divergência de opinião dos profissionais da área quanto ao tratamento mais eficaz. No entanto, o método mais utilizado atualmente e que vem apresentando resultados positivos é o de Ponseti. O objetivo deste trabalho é analisar a eficácia do método de Ponseti e sua aplicabilidade pelo fisioterapeuta. Tratou-se de pesquisa do tipo revisão, com abordagem qualitativa por meio de consulta a publicações das bases de dados Scielo, Lilacs, Medline e Bireme, preferencialmente dos últimos dez anos, e a coleta de dados no mês de outubro de 2016. Foram encontradas 248 publicações e, após análise, foram selecionados 23 artigos para a pesquisa, distribuídas em duas categorias: Eficácia do método Ponseti e Eficácia das técnicas fisioterapêuticas. Diante do exposto, percebese que o método de Ponseti tem se mostrado o mais eficaz no tratamento do pé torto congênito, e suas técnicas são compatíveis com as utilizadas por fisioterapeutas, sendo possível sua aplicabilidade por este profissional, com exceção da tenotomia do calcâneo. Portanto, este trabalho abre espaço para novas pesquisas que corroborem esta temática. (AU)

The congenital club foot is one of the most frequent lower limb deformities that, due to its complexity in relation to anatomical changes, is the subject of doubts and divergence of opinion of professionals in the area regarding the most effective treatment. However, the method most used currently and that has presented positive results is that of Ponseti. The aim of this study was to analyze the effectiveness of the Ponseti method and its applicability by the physiotherapist. This research was a literature review, with a qualitative approach, through consultation of publications of Scielo, Lilacs, Medline and Bireme databases, preferably in the last ten years, and data collection in October 2016. We found 248 publications and after analysis, 23 articles were selected for the research, distributed in two categories: Efficacy of the Ponseti method and Efficacy of physiotherapeutic techniques. The Ponseti method has been shown to be the most effective in the treatment of congenital clubfoot, and its techniques are like those used by physiotherapists, being possible its applicability by this professional, except for tenotomy of the calcaneus. Therefore, this work opens space for new research that corroborates this theme. (AU)

Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State.

OBJECTIVES: To evaluate respiratory muscle strength (RMS) in a sample composed exclusively of healthy sedentary individuals and to compare with predicted values, to investigate the relationship between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and age, weight and height, and propose predictive equations of MIP and MEP for this population. METHODS: Subjects were 140 healthy and sedentary individuals: 70 males (55+/-20 years) and 70 females (54+/-21 years), separated into groups according to age. The RMS was obtained with an aneroid vacuum manometer (+/-300 cmH2O). RESULTS: There was a significant reduction in RMS with increasing age (ANOVA one-way, p<0.05). Moreover, the RMS values decreased significantly from age 40 compared to the predicted values (Student t test, p<0.05). There were also significant correlations of RMS with age, weight and height (Pearson correlation, p<0.05). The predictive equations using linear regression for maximal respiratory pressures according to sex showed that age in males and females and weight in females influenced the prediction of the MIP and MEP values. CONCLUSIONS: Our results showed that age and anthropometric characteristics influence RMS values. In addition, the RMS values were lower compared to the predicted values from age 40 because the sample was composed exclusively of sedentary individuals. In this context, we propose equations to predict the MIP and MEP values exclusively for healthy, sedentary individuals from 20 to 89 years of age.

Autonomic control of heart rate in patients with chronic cardiorespiratory disease and in healthy participants at rest and during a respiratory sinus arrhythmia maneuver.

OBJECTIVE: To evaluate the autonomic modulation of heart rate (HR) at rest in the supine position and during a respiratory sinus arrhythmia maneuver (M-RSA) among participants with chronic obstructive pulmonary disease (COPD) or with chronic heart failure (CHF). METHODS: Twenty-eight men were divided into three groups: ten with COPD, aged 69+/-9 years; nine with CHF, aged 62+/-8 years; and nine healthy participants aged 64+/-5 years (controls). At rest, the R-R interval of the electrocardiographic signal was obtained in the following situations: 1) 15 min in the supine position; and 2) 4 min during M-RSA in the supine position. The data were analyzed in the time domain (RMSSD and SDNN indices) and the frequency domain (LFab and HFab). During M-RSA, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (IE) were calculated. RESULTS: The main findings showed that the CHF patients presented lower RMSSD (12.2+/-2.6 vs. 20.4+/-6.5), LFab (99.2+/-72.7 vs. 305.3+/-208.9) and HFab (53.4+/-29.9 vs. 178.9+/-113.1), compared with the controls. The LFab band was significantly lower in the COPD group than in the controls (133.8+/-145.5 vs. 305.3+/-208.9). Additionally, both CHF patients and COPD patients showed lower E/I ratios (1.1+/-0.06 vs. 1.2+/-0.1 and 1.1+/-0.03 vs. 1.2+/-0.1) and IE values (7.0+/-3.5 vs. 12.7+/-0.1 and 4.9+/-1.6 vs. 12.7+/-0.1), respectively, compared with the controls during M-RSA. CONCLUSION: The results from this study suggest that both COPD and CHF have a negative impact on the autonomic control of heart rate. Article registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number: ACTRN12609000467235.

Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease.

BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD) on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69+/-9 years; FEV(1)/FVC 59+/-12% and FEV(1) 41+/-11% predicted) and nine age-matched healthy volunteers (64+/-5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (DeltaIE) (r = 0.60, p<0.01) were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.

Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State / Pressões respiratórias máximas em indivíduos saudáveis sedentários de 20 a 89 anos da região central do Estado de São Paulo

OBJECTIVES: To evaluate respiratory muscle strength (RMS) in a sample composed exclusively of healthy sedentary individuals and to compare with predicted values, to investigate the relationship between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and age, weight and height, and propose predictive equations of MIP and MEP for this population. METHODS: Subjects were 140 healthy and sedentary individuals: 70 males (55±20 years) and 70 females (54±21 years), separated into groups according to age. The RMS was obtained with an aneroid vacuum manometer (±300 cmH2O). RESULTS: There was a significant reduction in RMS with increasing age (ANOVA one-way, p<0.05). Moreover, the RMS values decreased significantly from age 40 compared to the predicted values (Student t test, p<0.05). There were also significant correlations of RMS with age, weight and height (Pearson correlation, p<0.05). The predictive equations using linear regression for maximal respiratory pressures according to sex showed that age in males and females and weight in females influenced the prediction of the MIP and MEP values. CONCLUSIONS: Our results showed that age and anthropometric characteristics influence RMS values. In addition, the RMS values were lower compared to the predicted values from age 40 because the sample was composed exclusively of sedentary individuals. In this context, we propose equations to predict the MIP and MEP values exclusively for healthy, sedentary individuals from 20 to 89 years of age.

Objetivos: Avaliar a força muscular respiratória (FMR) em uma amostra composta apenas por indivíduos sedentários saudáveis e comparar com os valores preditos; correlacionar os valores de pressão inspiratória máxima (PImáx) e expiratória máxima (PEmáx) com a idade, peso e altura, e propor equações preditivas de PImáx e PEmáx para essa população. Métodos: Foram selecionados 140 indivíduos saudáveis e sedentários, sendo 70 homens (55±20 anos) e 70 mulheres (54±21 anos) que foram separados em grupos de acordo com a idade. A FMR foi obtida por meio de um manovacuômetro aneroide (±300 cmH2O). RESULTADOS: Foi verificada redução significativa da FMR com o avançar da idade (ANOVA one-way, p<0,05). Além disso, os valores de FMR foram significativamente menores em relação aos valores preditos a partir dos 40 anos (Teste t de Student, p<0,05). Também foram observadas correlações significativas da FMR com a idade, peso e altura (correlação de Pearson, p<0,05). Quando realizadas as equações preditivas por meio de regressão linear para as pressões respiratórias máximas em cada gênero, verificou-se que a idade em ambos os sexos e o peso para as mulheres exerceram influência na predição dos valores de PImáx e PEmáx. Conclusões: Os resultados mostraram que a idade e as características antropométricas exercem influência nos valores de FMR. Os valores de FMR foram menores em relação aos valores preditos devido ao fato de a amostra ser composta exclusivamente por sujeitos sedentários. Neste contexto, propõem-se equações para predizer os valores de PImáx e PEmáx exclusivamente para indivíduos saudáveis sedentários de 20 a 89 anos.

Controle autonômico da frequência cardíaca de pacientes com doenças cardiorrespiratórias crônicas e indivíduos saudáveis em repouso e durante a manobra de acentuação da arritmia sinusal respiratória / Autonomic control of heart rate in patients with chronic cardiorespiratory disease and in healthy participants at rest and during a respiratory sinus arrhythmia maneuver

OBJETIVO: Avaliar a modulação autonômica da frequência cardíaca (FC) em repouso, na postura supina e durante a manobra de acentuação da arritmia sinusal respiratória (M-ASR) de pacientes com doença pulmonar obstrutiva crônica (DPOC) ou com insuficiência cardíaca crônica (ICC). MÉTODOS: Vinte e oito homens foram subdivididos em três grupos: 10 com DPOC (GD) e 69±9 anos; 9 com ICC (GI) e 62±8 anos; e 9 saudáveis (GC) com 64±5 anos. Em repouso, os intervalos R-R a partir do sinal eletrocardiográfico foram obtidos nas seguintes situações: 1) 15 minutos na posição supina e 2) 4 minutos durante M-ASR na posição supina. Os dados foram analisados nos domínios do tempo (índices RMSSD e SDNN) e da frequência. Durante M-ASR, foram calculadas a razão expiração/inspiração (E/I) e a diferença inspiração/expiração (∆IE). RESULTADOS: Os principais achados mostraram que os pacientes com ICC apresentaram menores valores de RMSSD (12,2±2,6 vs 20,4±6,5), BFab (99,2±72,7 vs 305,3±208,9) e AFun (53,4±29,9 vs 178,9±113,1) quando comparados ao controle. Além disso, a banda de BFab foi significantemente reduzida no grupo DPOC quando comparado ao controle (133,8±145,5 vs 305,3±208,9). Adicionalmente, pacientes com ICC e DPOC mostraram menor razão E/I (1,1±0,06 vs 1,2±0,1 e 1,1±0,03 vs 1,2±0,1) e ∆IE (7,0±3,5 vs 12,7±0,1 e 4,9±1,6 vs 12,7±0,1), respectivamente, comparados ao GC durante a M-ASR. CONCLUSÃO: Os resultados deste estudo sugerem que tanto a DPOC como a ICC produzem impacto negativo sobre o controle autonômico da FC.

OBJECTIVE: To evaluate the autonomic modulation of heart rate (HR) at rest in the supine position and during a respiratory sinus arrhythmia maneuver (M-RSA) among participants with chronic obstructive pulmonary disease (COPD) or with chronic heart failure (CHF). METHODS: Twenty-eight men were divided into three groups: ten with COPD, aged 69±9 years; nine with CHF, aged 62±8 years; and nine healthy participants aged 64±5 years (controls). At rest, the R-R interval of the electrocardiographic signal was obtained in the following situations: 1) 15 min in the supine position; and 2) 4 min during M-RSA in the supine position. The data were analyzed in the time domain (RMSSD and SDNN indices) and the frequency domain (LFab and HFab). During M-RSA, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (∆IE) were calculated. RESULTS: The main findings showed that the CHF patients presented lower RMSSD (12.2±2.6 vs. 20.4±6.5), LFab (99.2±72.7 vs. 305.3±208.9) and HFab (53.4±29.9 vs. 178.9±113.1), compared with the controls. The LFab band was significantly lower in the COPD group than in the controls (133.8±145.5 vs. 305.3±208.9). Additionally, both CHF patients and COPD patients showed lower E/I ratios (1.1±0.06 vs. 1.2±0.1 and 1.1±0.03 vs. 1.2±0.1) and ∆IE values (7.0±3.5 vs. 12.7±0.1 and 4.9±1.6 vs. 12.7±0.1), respectively, compared with the controls during M-RSA. CONCLUSION: The results from this study suggest that both COPD and CHF have a negative impact on the autonomic control of heart rate.

Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease

BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD) on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69±9 years; FEV1/FVC 59±12 percent and FEV1 41±11 percent predicted) and nine age-matched healthy volunteers (64±5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (ΔIE) (r = 0.60, p<0.01) were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.

Efeitos do treinamento de força sobre a função pancreática e a sensibilidade tecidual à insulina em ratos / Strength training on the pancreatic function and tissue sensitivity to insulin in rats

Estudos têm demonstrado que o exercício aeróbio promove elevação na sensibilidade tecidual à insulina (SI) e na tolerância à glicose (TG), porém a análise de tais variáveis após treinamento de força (TF) tem sido pouco explorada. Assim, o objetivo deste estudo foi avaliar os efeitos do TF sobre a TG e SI em ratos. Foram estudados 20 ratos Wistar, pareados por peso e aleatoriamente distribuídos em 2 grupos: G1 ? Sham e G2 ? TF. Todos os animais foram submetidos a 3 dias de adaptação e, subsequentemente, treinados com cargas progressivas por 3 vezes por semana, durante 8 semanas numa escada de madeira. Para avaliar SI e TG foram realizadas coletas de sangue e avaliada a cinética da glicemia pelo teste de tolerância à insulina (% de decaimento da curva; B) e o teste de tolerância à glicose (área sob a curva; AC), antes da adaptação e após o 24º dia de treinamento. A análise estatística foi realizada pelo teste t de Student pareado e não-pareado, sendo o p ? 0,05. Apenas G2 mostrou significativo aumento no B após treinamento, sendo que o delta do B entre os grupos mostrou diferenças significativas (p ? 0,05), com maiores valores no G2. Em contraste, AC não apresentou alteração significativa entre os grupos nem entre os deltas (p > 0,05). O TF promoveu benefícios adaptativos na sensibilidade tecidual à insulina, sugerindo que o TF pode ser um recurso interessante durante programas de fisioterapia cardiovascular em doenças crônicas.

Experimental studies have demonstrated that aerobic exercise promotes an increase of tissue insulin sensitivity (IS) and glucose tolerance (GT), however the analysis of such variables after strength training (ST) have been little explored. So the objective of this issue was to investigate the effects of ST on GT and IS in rats submitted to strength training (ST). We studied 20 male Wistar rats, paired by weight and randomly assigned to one of two groups: G1? training without load (Sham) and G2 ? strength training (ST). All animals were submitted to 3 days of adaptation and subsequently were trained with progressive loads 3 times a week for 8 weeks, in a wooden stair of height-1,1m and inclination-80º with a rest area on the top. To measure the IS and GT were collected blood samples and evaluated glycemic kinetic by insulin tolerance tests (% of decay-B) and glucose tolerance tests (area under the curve-AC), before the adaptation and after the 24th day of training. Statistical Analysis was performed by Kolmogorov-Smirnov test and paired and unpaired Student t-tests, with p?0.05. Only G2 showed significant increase in B after training and the delta of B showed significant differences (p?0.05) with higher values in G2. In contrast, the AC did not change between groups or deltas (p>0.05). The ST promoted beneficial adaptations in the tissue sensitivity to insulin, suggest that ST can be an interesting resource during cardiovascular physiotherapy programs in chronic diseases.

Indice de impacto dos resíduos sólidos urbanos na saúde pública (IIRSP): metodologia e aplicação / Impact index of solid wastes management systems on public health (IIRSP): methodology and application

A redução do número de enfermidades produzidas, direta ou indiretamente, pelos resíduos sólidos depende de uma coleta eficiente e de uma adequada disposição final. Com as informações obtidas da aplicação de um questionário enviado aos municípios sul rio-grandenses divididos em sete regiões homogêneas, foram desenvolvidos indicadores e, por meio de procedimentos estatísticos não paramétricos, estruturados oito índices (índices específicos) que formaram um índice geral de controle de qualidade dos serviços de limpeza urbana. O artigo apresenta um sumário e um exemplo da metodologia utilizada para a criação do índice de Impacto dos Resíduos Sólidos Urbanos na Saúde Pública (IIRSP), o qual mais diretamente espelha a relação Resíduos sólidos-homem-saúde pública.