A case management strategy to reduce falls in older people with a history of falls: A randomized controlled trial.

The present study aimed to determine whether a remotely delivered intervention, based on an individual case management, can reduce falls and their consequences in community-dwelling older people with a history of multiple falls. In this randomized controlled trial, 32 participants were randomized to the intervention group, which comprised a 16-week case management program involving a multidimensional assessment, targeted interventions according to the identified fall risk factors, and development of individualized care plans. The intervention was performed by trained gerontologists, under weekly supervision of professionals with experience in falls. The control group (n = 30) received usual care. Falls were monitored over 12 months with monthly falls calendars and telephone calls. Remotely delivered case management presented an 82 % uptake of recommendations. There was a trend toward a reduced fall incidence in the intervention vs control group, with lower fall, fall injury and fracture rates in the intervention group compared with the control group at both the 16-week and 12-month time-points, with the difference statistically significant for injurious fall rates at 12 months - IRR=0.18 (95 % CI = 0.04 to 0.74).

User and family satisfaction with nursing homes: a systematic review.

BACKGROUND: Implementation of person-directed care planning is a challenge for nursing home services. User satisfaction is indispensable to implement it. OBJECTIVE: The aim of this study was to address user and family satisfaction with nursing homes and the scales used and to identify the determinants of satisfaction with this service. METHODS: A systematic review was conducted, and the Cochrane Library, PubMed, Scopus, Web of Science and CINAHL databases were searched between December 2019 and April 2020. Studies involving assessment of user or family satisfaction with nursing homes and users ≥65 years old or their families were included in this review. The methodological quality of the included studies was assessed by the Joanna Briggs Institute reviewer's manual. RESULTS: Eight articles were included based on the eligibility criteria, from a total of 2378 records found in the electronic search. All studies presented a cross-sectional design, and the total sample of this review was 57 214 older people. Most of the studies included showed positive overall satisfaction with nursing homes. There was no consensus about the best scale to assess satisfaction because of the huge variety of tools among studies. The most common determinants of satisfaction among studies were quality of life (mental and physical components), anxiety and social and health factors. CONCLUSION: The findings of our review may contribute to a better view of satisfaction with nursing homes experienced by users and families and to an improvement of care in these institutions.

Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery--a randomised controlled trial.

OBJECTIVE: Coronary artery bypass grafting (CABG) is accompanied by severe impairment of cardiac autonomous regulation (CAR). This study aimed to determine whether a short-term physiotherapy exercise protocol post-CABG, during inpatient cardiac rehabilitation (CR), might improve CAR. DESIGN: Seventy-four patients eligible for CABG were recruited and randomised into physiotherapy exercise group (EG) or physiotherapy usual care group (UCG). EG patients underwent a short-term supervised inpatient physiotherapy exercise protocol consisting of an early mobilisation with progressive exercises plus usual care (respiratory exercises). UCG only received respiratory exercises. Forty-seven patients (24 EG and 23 UGC) completed the study. Outcome measures of CAR included linear and non-linear measures of heart rate variability (HRV) assessed before discharge. RESULTS: By hospital discharge, EG presented significantly higher parasympathetic HRV values [rMSSD, high frequency (HF), SD1)], global power (STD RR, SD2), non-linear HRV indexes [detrended fluctuation analysis (DFA)alpha1, DFAalpha2, approximate entropy (ApEn)] and mean RR compared to UCG (p<0.05). Conversely, higher values of mean HR, low frequency (LF) (sympathetic activity) and the LF/HF (global sympatho-vagal balance) were found in the UCG. CONCLUSIONS: A short-term supervised physiotherapy exercise protocol during inpatient CR improves CAR at the time of discharge. Thus, exercise-based inpatient CR might be an effective non-pharmacological tool to improve autonomic cardiac tone in patient's post-CABG.

Noninvasive ventilation acutely modifies heart rate variability in chronic obstructive pulmonary disease patients.

OBJECTIVE: The purpose of present study was to evaluate the acute effects of bi-level positive airway pressure (BiPAP) on heart rate variability (HRV) of stable chronic obstructive pulmonary disease patients (COPD). METHODS: Nineteen males with COPD (69+/-8 years and with forced expiratory volume in 1s <50% of predicted) and eight healthy sedentary age-matched (69 years) males in the control group (CG) were evaluated during two conditions of controlled respiratory rate: spontaneous breathing (SB) and BiPAP (inspiratory and expiratory levels between 12-14 cmH(2)O and 4-6 cmH(2)O, respectively). Peripheral oxygen saturation (SpO(2)), end-tidal of carbon dioxide (ETCO(2)), systolic blood pressure (SBP) and R-R interval were obtained. HRV was analyzed by time (RMSSD and SDNN index) and frequency domains (high frequency - HF, low frequency - LF and HF/LF ratio). RESULTS: Significant reduction of ETCO(2) and SBP in both groups and increase of SpO(2) in COPD group was observed during BiPAP ventilation (p<0.05). During spontaneous breathing, patients with COPD presented lower values of LF, LF/HF and higher values of HF when compared to CG (p<0.05). However, HF was significantly reduced and LF increased during BiPAP ventilation (58+/-19-48+/-15 and 41+/-19-52+/-15 un, respectively) in COPD group. Significant correlations between delta BiPAP-SB (Delta) ETCO(2) and DeltaHF were found (r=0.89). CONCLUSIONS: Sympathetic and parasympathetic neural control of heart rate is altered in COPD patients and that BiPAP acutely improves ventilation, enhances sympathetic response and decreases vagal tonus. The improvement of ventilation caused by BiPAP was associated with reduced cardiac vagal activity in stable moderate-to-severe COPD patients.

Are cardiovascular and metabolic responses to field walking tests interchangeable and obesity-dependent?

PURPOSE: To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals. METHOD: Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20-45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland-Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables. RESULTS: There was an agreement between CPX and both the 6MWT [oxygen uptake (VO2 mL kg(-1) min(-1)) = 6.9 (CI: 5.7-8.1), and heart rate (bpm) = 37.0 (CI: 33.3-40.7)] and ISWT [VO2 (mL kg(-1) min(-1)) = 6.1 (CI: 4.9-7.3), and heart rate (bpm) = 36.2 (CI: 32.1-40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO2 ( r = 0.70); dyspnoea (r = 0.80); and leg fatigue (r = 0.70). CONCLUSIONS: 6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited. Implications for Rehabilitation Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk. Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing. Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

Continuous Positive Airway Pressure During Exercise Improves Walking Time in Patients Undergoing Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: Continuous positive airway pressure (CPAP) has been used as an effective support to decrease the negative pulmonary effects of coronary artery bypass graft (CABG) surgery. However, it is unknown whether CPAP can positively influence patients undergoing CABG during exercise. This study evaluated the effectiveness of CPAP on the first day of ambulation after CABG in patients undergoing inpatient cardiac rehabilitation (CR). METHODS: Fifty-four patients after CABG surgery were randomly assigned to receive either inpatient CR and CPAP (CPG) or standard CR without CPAP (CG). Cardiac rehabilitation included walking and CPAP pressures were set between 10 to 12 cmH2O. Participants were assessed on the first day of walking at rest and during walking. Outcome measures included breathing pattern variables, exercise time in seconds (ETs), dyspnea/leg effort ratings, and peripheral oxygen saturation (SpO2). RESULTS: Twenty-seven patients (13 CPG vs 14 CG) completed the study. Compared with walking without noninvasive ventilation assistance, CPAP increased ETs by 43.4 seconds (P = .040) during walking, promoted better thoracoabdominal coordination, increased ventilation during walking by 12.5 L/min (P = .001), increased SpO2 values at the end of walking by 2.6% (P = .016), and reduced dyspnea ratings by 1 point (P = .008). CONCLUSIONS: Continuous positive airway pressure can positively influence exercise tolerance, ventilatory function, and breathing pattern in response to a single bout of exercise after CABG.

Recovery of linear and nonlinear heart rate dynamics after coronary artery bypass grafting surgery.

BACKGROUND: Conventional coronary artery bypass grafting (C-CABG) and off-pump CABG (OPCAB) surgery may produce different patients' outcomes, including the extent of cardiac autonomic (CA) imbalance. The beneficial effects of an exercise-based inpatient programme on heart rate variability (HRV) for C-CABG patients have already been demonstrated by our group. However, there are no studies about the impact of a cardiac rehabilitation (CR) on HRV behaviour after OPCAB. The aim of this study is to compare the influence of both operative techniques on HRV pattern following CR in the postoperative (PO) period. METHODS: Cardiac autonomic function was evaluated by HRV indices pre- and post-CR in patients undergoing C-CABG (n = 15) and OPCAB (n = 13). All patients participated in a short-term (approximately 5 days) supervised CR programme of early mobilization, consisting of progressive exercises, from active-assistive movements at PO day 1 to climbing flights of stairs at PO day 5. RESULTS: Both groups demonstrated a reduction in HRV following surgery. The CR programme promoted improvements in HRV indices at discharge for both groups. The OPCAB group presented with higher HRV values at discharge, compared to the C-CABG group, indicating a better recovery of CA function. CONCLUSION: Our data suggest that patients submitted to OPCAB and an inpatient CR programme present with greater improvement in CA function compared to C-CABG.

Is applying the same exercise-based inpatient program to normal and reduced left ventricular function patients the best strategy after coronary surgery? A focus on autonomic cardiac response.

PURPOSE: To assess whether the same exercise-based inpatient program applied to patients with normal and reduced left ventricular function (LVF) evokes a similar cardiac autonomic response after coronary artery bypass graft (CABG). METHOD: Forty-four patients post-CABG, subgrouped according to normal LVF [LVFN: n = 23; left ventricular ejection fraction (LVEF) ≥ 55%] and reduced LVF (LVFR: n = 21; LVEF 35-54%), were included. All initiated the exercise protocol on post-operative day 1 (PO1), following a whole progressive program until discharge. Cardiac autonomic response was assessed by the indices of heart rate variability (HRV) at rest and during exercise (extremity range of motion and ambulation). RESULTS: During ambulation, lower values of HRV indices were found in the LVFR group compared with the LVFN group [standard deviation of all RR (STDRR; 6.1 ± 2.7 versus 8.9 ± 4.7 ms), baseline width of the RR histogram (TINN; 30.6 ± 14.8 versus 45.8 ± 24.9 ms), SD2 (14.8 ± 8.0 versus 21.3 ± 9.0 ms), Shannon entropy (3.6 ± 0.5 versus 3.9 ± 0.4) and correlation dimension (0.08 ± 0.2 versus 0.2 ± 0.2)]. Also, when comparing the ambulation to rest change, lower values were observed in the LVFR group for linear (STDRR, TINN, RR TRI, rMSSD) and non-linear (SD2 and correlation dimension) HRV indices (p < 0.05). On PO1, we observed only intra-group differences between rest and exercise (extremity range of motion), for mean intervals between heart beats and heart rate. CONCLUSION: For patients with LVFN, the same inpatient exercise protocol triggered a more attenuated autonomic response compared with patients with LVFR. These findings have implications as to how exercise should be prescribed according to LVF in the early stages following recovery from CABG. Implications for Rehabilitation Exercise-based inpatient program, performed by post-CABG patients who have normal left ventricular function, triggered a more attenuated cardiac autonomic response compared with patients with reduced left ventricular function. Volume of the inpatient exercises should be prescribed according to the left ventricular function in the early stages following recovery from CABG.

Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients.

INTRODUCTION: Upper limb exercises are frequently used in respiratory physiotherapy, with UL elevation and controlled inspiratory timing. However, the use of expiration during upper limb elevation appears to be a strategy that could minimize the action of accessory muscles in patients with chronic obstructive pulmonary disease. In this context, little is known about the synchrony of upper limb (UL) movements associated with breathing. The aim of this study was to investigate the respiratory pattern of chronic obstructive pulmonary disease patients during different UL exercises associated with respiratory exercises. METHODS: Fifteen chronic obstructive pulmonary disease patients participated in this study. Respiratory pattern analysis by inductance plethysmography was performed during four types of upper limb exercises, two shoulder flexion-extension (one associated with inspiratory time during the concentric phase and the other associated with expiratory time) and two shoulder abduction-adduction (same timing as above). Statistical analysis was performed by the Kolmogorov-Smirnov test and ANOVA with Tukey tests (p< 0.05). RESULTS: The thoracoabdominal coordination measurements increased in the two exercises using both inspiration during shoulder flexion (PhRIB: 172%; PhREB: 131%; PhRTB: 142% and PhAng: 238%) as well as in shoulder horizontal abduction (PhRIB: 145%; PhREB: 109%; PhRTB: 130% and PhAng: 229%), differing from the exercises with expiration at the time of shoulder flexion and horizontal abduction. CONCLUSION: The exercises performed with inverted respiratory time produced less asynchrony and can be used as important strategies during physical exercise programs in these patients.

Left-ventricular function and autonomic cardiac adaptations after short-term inpatient cardiac rehabilitation: a prospective clinical trial.

OBJECTIVE: Cardiac rehabilitation is associated with cardiac autonomic and physiological benefits. However, it is unclear whether baseline left ventricular function (LVF) impacts on training-induced cardiac autonomic adaptations. The aim of this study was to assess the cardiac autonomic adaptations in patients with varying left ventricular function profiles undergoing coronary artery bypass grafting and cardiac rehabilitation. DESIGN: Assessor-blinded prospective trial. PATIENTS: Forty-four patients undergoing coronary artery bypass grafting, divided into normal LVFN (≥ 55%, n = 23) or reduced LVFR (35-54%, n = 21) were evaluated. METHOD: Cardiac autonomic function was evaluated by heart rate variability indexes obtained both pre- and post-cardiac rehabilitation. All patients participated in a short-term (approximately 5 days) supervised inpatient physiotherapy program. RESULTS: There were differences in heart rate variability indexes, correlation dimension and SD2 according to time and group (e.g. interaction time (effect of cardiac rehabilitation) vs group (LVFN vs LVFR), p = 0.04). Simple main effects analysis showed that the LVFR group benefited to a greater degree from cardiac rehabilitation compared with the LVFN group. Heart rate variability indexes increased significantly in the former group compared with the latter. CONCLUSION: Among post-coronary artery bypass grafting patients engaged in short-term inpatient rehabilitation, those with reduced left ventricular function are most likely to have better cardiac autonomic adaptations to exercise-based rehabilitation.

Acute application of bilevel positive airway pressure influences the cardiac autonomic nervous system.

INTRODUCTION: Noninvasive positive pressure has been used to treat several diseases. However, the physiological response of the cardiac autonomic system during bilevel positive airway pressure (Bilevel) remains unclear. OBJECTIVE: The aim of this study was to evaluate the heart rate variability (HRV) during Bilevel in young healthy subjects. METHODS: Twenty men underwent 10-minute R-R interval recordings during sham ventilation (SV), Bilevel of 8-15 cmH(2)O and Bilevel of 13-20 cmH(2)O. The HRV was analyzed by means of the parallel R-R interval (mean R-Ri), the standard deviation of all R-Ri (SDNN), the root mean square of the squares of the differences between successive R-Ri (rMSSD), the number of successive R-Ri pairs that differ by more than 50 milliseconds (NN50), the percentage of successive R-Ri that differ by more than 50 milliseconds (pNN50), the low frequency (LF), the high frequency (HF) and SD1 and SD2. Additionally, physiological variables, including blood pressure, breathing frequency and end tidal CO(2), were collected. Repeated-measures ANOVA and Pearson correlation were used to assess the differences between the three studied conditions and the relationships between the delta of Bilevel at 13-20 cmH(2)O and sham ventilation of the HRV indexes and the physiological variables, respectively. RESULTS: The R-Ri mean, rMSSD, NN50, pNN50 and SD1 were reduced during Bilevel of 13-20 cmH(2)O as compared to SV. An R-Ri mean reduction was also observed in Bilevel of 13-20 cmH(2)O compared to 8-15 cmH(2)O. Both the R-Ri mean and HF were reduced during Bilevel of 8-15 cmH(2)O as compared to SV, while the LF increased during application of Bilevel of 8-15 cmH(2)O as compared to SV. The delta (between Bilevel at 13-20 cmH(2)O and sham ventilation) of ETCO(2) correlated positively with LF, HF, the LF/HF ratio, SDNN, rMSSD and SD1. Acute application of Bilevel was able to alter the cardiac autonomic nervous system, resulting in a reduction in parasympathetic activity and an increase in sympathetic activity and higher level of positive pressure can cause a greater influence on the cardiovascular and respiratory system.

Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients

INTRODUCTION: Upper limb exercises are frequently used in respiratory physiotherapy, with UL elevation and controlled inspiratory timing. However, the use of expiration during upper limb elevation appears to be a strategy that could minimize the action of accessory muscles in patients with chronic obstructive pulmonary disease. In this context, little is known about the synchrony of upper limb (UL) movements associated with breathing. The aim of this study was to investigate the respiratory pattern of chronic obstructive pulmonary disease patients during different UL exercises associated with respiratory exercises. METHODS: Fifteen chronic obstructive pulmonary disease patients participated in this study. Respiratory pattern analysis by inductance plethysmography was performed during four types of upper limb exercises, two shoulder flexion-extension (one associated with inspiratory time during the concentric phase and the other associated with expiratory time) and two shoulder abduction-adduction (same timing as above). Statistical analysis was performed by the Kolmogorov-Smirnov test and ANOVA with Tukey tests (p< 0.05). RESULTS: The thoracoabdominal coordination measurements increased in the two exercises using both inspiration during shoulder flexion (PhRIB: 172 percent; PhREB: 131 percent; PhRTB: 142 percent and PhAng: 238 percent) as well as in shoulder horizontal abduction (PhRIB: 145 percent; PhREB: 109 percent; PhRTB: 130 percent and PhAng: 229 percent), differing from the exercises with expiration at the time of shoulder flexion and horizontal abduction. CONCLUSION: The exercises performed with inverted respiratory time produced less asynchrony and can be used as important strategies during physical exercise programs in these patients.

Acute application of bilevel positive airway pressure influences the cardiac autonomic nervous system

INTRODUCTION: Noninvasive positive pressure has been used to treat several diseases. However, the physiological response of the cardiac autonomic system during bilevel positive airway pressure (Bilevel) remains unclear. OBJECTIVE: The aim of this study was to evaluate the heart rate variability (HRV) during Bilevel in young healthy subjects. METHODS: Twenty men underwent 10-minute R-R interval recordings during sham ventilation (SV), Bilevel of 8-15 cmH2O and Bilevel of 13-20 cmH2O. The HRV was analyzed by means of the parallel R-R interval (mean R-Ri), the standard deviation of all R-Ri (SDNN), the root mean square of the squares of the differences between successive R-Ri (rMSSD), the number of successive R-Ri pairs that differ by more than 50 milliseconds (NN50), the percentage of successive R-Ri that differ by more than 50 milliseconds (pNN50), the low frequency (LF), the high frequency (HF) and SD1 and SD2. Additionally, physiological variables, including blood pressure, breathing frequency and end tidal CO2, were collected. Repeated-measures ANOVA and Pearson correlation were used to assess the differences between the three studied conditions and the relationships between the delta of Bilevel at 13-20 cmH2O and sham ventilation of the HRV indexes and the physiological variables, respectively. RESULTS: The R-Ri mean, rMSSD, NN50, pNN50 and SD1 were reduced during Bilevel of 13-20 cmH2O as compared to SV. An R-Ri mean reduction was also observed in Bilevel of 13-20 cmH2O compared to 8-15 cmH2O. Both the R-Ri mean and HF were reduced during Bilevel of 8-15 cmH2O as compared to SV, while the LF increased during application of Bilevel of 8-15 cmH2O as compared to SV. The delta (between Bilevel at 13-20 cmH2O and sham ventilation) of ETCO2 correlated positively with LF, HF, the LF/HF ratio, SDNN, rMSSD and SD1. Acute application of Bilevel was able to alter the cardiac autonomic nervous system, resulting in a reduction in parasympathetic...