Eficácia do exergaming na aderência a reabilitação cardíaca fase II: um protocolo de ensaio clínico randomizado / Effectiveness of exergaming on the phase II cardiac rehabilitation adherence: a randomized clinical trial protocol

Introdução: O exergaming, dado o seu perfil lúdico, pode tornar a Reabilitação Cardíaca (RC) mais atrativa. Assim, questiona-se se o exergaming pode reduzir a evasão dos pacientes à RC. Objetivo: Analisar a eficácia do exergaming na aderência à RC fase dois. Métodos: Ensaio clínico randomizado, incluindo pacientes com doenças cardíacas, de ambos os sexos, maiores de 18 anos, admitidos na RC fase dois; excluídos os com contraindicações a essa intervenção. Os participantes serão alocados em dois grupos, com 30 indivíduos cada: grupo intervenção, que realizará o exergaming no Nintendo Wii; grupo controle, realizará exercício em esteira. A intervenção de ambos os grupos será de intensidade moderada, 30 minutos por sessão, três vezes por semana, por 12 semanas. A aderência à RC será identificada através da porcentagem do comparecimento às sessões. Resultados: As variáveis dos grupos serão comparadas por meio do Teste T de Student ou MannWhitney. O teste do qui-quadrado será utilizado para comparação das variáveis categóricas, quando inadequado, o exato de Fischer. Nível de significância será 5%. Conclusão: Esta investigação auxiliará na elucidação da eficácia do exergame na adesão à RC fase dois e quanto a outros desfechos secundários, como a melhora da capacidade de exercício.

Effect of high-intensity interval training on aerobic capacity and heart rate control of heart transplant recipients: a systematic review with meta-analysis

Abstract Introduction: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. High-intensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderate-intensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. Methods: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Meta-analysis was performed using the random-effects, generic inverse variance method. Results: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. Conclusion: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

Evidências científicas sobre Fisioterapia e funcionalidade em pacientes com COVID-19 adulto e pediátrico / Evidence-based Physiotherapy and Functionality in adult and pediatric patients with COVID-19

Introdução: O corona vírus (2019-nCoV OU HCOV-19 ou CoV2), emergiu na China como a principal causa de pneumonia viral (COVID-19, Doença do Coronavírus 19). Objetivo: Avaliar evidências científicas sobre Fisioterapia e Funcionalidade em pacientes com COVID-19 adulto e pediátrico. Métodos: Trata-se de uma revisão de literatura do tipo integrativa utilizando a bases de dados do MedLine/PubMed, bioblioteca da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Physiotherapy Evidence Database (PEDRo).Resultados:Os pacientes com COVID-19 apresentam sinais de deficiência respiratória com hipoxemia, com baixo impacto em crianças estas evoluem sem sintomas ou com quadro de baixa gravidade. além de observar impacto na restrição da participação. a fisioterapia atua na oxigenioterapia e ventilação dos pacientes.Conclusão: A COVID-19 causa alterações na função pulmonar com formação de deficiência respiratória hipoxêmica e de complacência, com repercussões cardiovasculares que leva a necessidade da fisioterapia no desfecho desta pandemia, seja por meio da oxigenioterapia e/ou do suporte ventilatório (invasivo e não-invasivo).(AU)

Introduction: The corona virus (2019-nCoV OR HCOV-19 or CoV2), has emerged in China as the main cause of viral pneumonia (COVID-19, Coronavirus Disease-19). Aim: To provide evidence-based Physiotherapy and functionality in patients with adult and pediatric COVID-19. Methods: This is an integrative literature review using the MedLine / PubMed databases, library of Latin American and Caribbean Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDRo). Results: Part of the patients with covid 19 show signs of respiratory deficiency with hypoxemia, with low severity in children. Impaired functionality is also expected. Conclusion: COVID-19 causes low pulmonary compliance and important changes in lung function with hypoxemia and cardiovascular repercussions. These changes lead to the need for Physiotherapy and the management of oxygen therapy and ventilatory support (invasive and non-invasive) for these patients.

Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial

Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery

Evaluation of cardiac autonomic modulation using symbolic dynamics after cardiac transplantation

Abstract Objective: To characterize the behavior of cardiac autonomic modulation in individuals with different times after orthotopic heart transplantation (HTx) using symbolic dynamics analysis. Methods: Sixty patients were evaluated after HTx. We recorded their instantaneous R-R intervals (RRi) by cardiac monitor Polar® RS800CX™ (Polar Electro Oy, Kempele, Finland) for 10 minutes. The same sequence of RRi with 256 consecutive beats was used to perform spectral analysis and symbolic dynamics analysis. We used hierarchical clustering to form groups. One-way analysis of variance (ANOVA) (with Holm-Sidak method) or one-way Kruskal-Wallis test (with Dunn´s post-hoc test) was used to analyze the difference between groups. Linear correlation analysis between variables was performed using Pearson's or Spearman's tests. P-value < 0.05 was considered statistically significant. Results: The 0V% index increased, the 2UV% index and the normalized complexity index decreased with an increase of HTx postoperative time. There were a negative correlation between complexity indexes and 0V% and a positive correlation between complexity indexes and 2UV%. Conclusion: Symbolic dynamics indexes were able to show a specific cardiac autonomic modulation pattern for HTx recipients with different postoperative times.

Physical activity level and performance in the six-minute walk test of children and adolescents with sickle cell anemia

ABSTRACT Background: To establish determinants of maximum walking distance in the 6-minute walk test of children and adolescents with sickle cell anemia, and to compare the performance in this test with physical activity level between patients and healthy controls. Methods: A cross-sectional study was performed in which the participants answered the Physical Activity Questionnaire for Older Children and Adolescents, and completed the 6-minute walk test. Main results: Fifty-seven patients and 58 controls were studied. By univariate analysis of the patients, age (p < 0.0001) and indirect bilirubin (p = 0.008) were associated with maximum walking distance in the 6-minute walk test. In multivariate analysis, age was positively associated (p < 0.0001; beta: 0.75), while body mass index was inversely associated with distance walked (p = 0.047; beta: -0.32). This yields the following equation: maximum distance walked = 487.7 (age × 18.3) - (12 × body mass index) meters. Patients reported a lower physical activity level however there was no significant difference in the distance walked in six minutes between patients (500.6 ± 88.7 m) and controls (536.3 ± 94 m). Conclusion: The determinants for the 6-minute walk test in children and adolescents with sickle cell anemia were age and body mass index. There was no significant difference in the 6-minute walk test but patients with sickle cell anemia had a lower physical activity level compared to healthy controls.

Reference values for the six-minute walk test in healthy children and adolescents: a systematic review

Abstract Objective: The aim of the study is to compare the available reference values and the six-minute walk test equations in healthy children/adolescents. Our systematic review was planned and performed in accordance with the PRISMA guidelines. We included all studies that established reference values for the six-minute walk test in healthy children/adolescents. Methods: To perform this review, a research was performed in PubMed, EMBASE (via SCOPUS) and Cochrane (LILACS), Bibliographic Index Spanish in Health Sciences, Organization Collection Pan-American Health Organization, Publications of the World Health Organization and Scientific Electronic Library Online (SciELO) via Virtual Health Library until June 2015 without language restriction. Results: The initial research identified 276 abstracts. Twelve studies met the inclusion criteria and were fully reviewed and approved by both reviewers. None of the selected studies presented sample size calculation. Most of the studies recruited children and adolescents from school. Six studies reported the use of random samples. Most studies used a corridor of 30 meters. All studies followed the American Thoracic Society guidelines to perform the six-minute walk test. The walked distance ranged 159 meters among the studies. Of the 12 included studies, 7 (58%) reported descriptive data and 6 (50%) established reference equation for the walked distance in the six-minute walk test. Conclusion: The reference value for the six-minute walk test in children and adolescents ranged substantially from studies in different countries. A reference equation was not provided in all studies, but the ones available took into account well established variables in the context of exercise performance, such as height, heart rate, age and weight. Countries that did not established reference values for the six-minute walk test should be encouraged to do because it would help their clinicians and researchers have a more precise interpretation of the test.

Avaliação do estilo de vida de pacientes com infarto agudo do miocárdio admitidos em uma unidade coronariana / Lifestyle assessment of patients with acute myocardial of admitted in a coronary unit

OBJETIVO: Descrever o estilo de vida de pacientes admitidos em uma unidade coronariana com diagnóstico de infarto agudo do miocárdio. MÉTODOS: Estudo de corte transversal, observacional, realizado entre março e junho de 2012, em um hospital da cidade de Juazeiro (BA). O questionário utilizado foi o FANTASTIC, que é uma ferramenta validada internacionalmente, inclusive no Brasil. O questionário foi aplicado aos pacientes durante os primeiros dias de internação na unidade fechada, e os dados secundários foram coletados nos prontuários. RESULTADOS: Responderam ao questionário 57 pacientes, sendo 63,2% do sexo masculino, com idade média 61,3±10,9 anos e índice de massa corporal médio de 27,0±4,4kg/m2. A média de pontuação pelo questionário foi de 57,2±7,2, e 63,2% apresentaram um "bom" estilo de vida pela classificação previamente padronizada. As mulheres apresentaram um escore de estilo de vida melhor do que os homens (61,1±5,1 pontos versus 55,0±7,3 pontos; p=0,001). Houve menor pontuação nos domínios nutrição, atividade física e tabagismo. CONCLUSÃO: Os pacientes com infarto agudo do miocárdio apresentaram um escore "bom" pelo questionário FANTASTIC. Alguns domínios, no entanto, mostram valores baixos, como atividade física, nutrição e tabagismo.

OBJECTIVE: To describe the lifestyle of patients admitted to a coronary care unit with acute myocardial infarction. METHODS: Observational cohort study, conducted between March and June, 2012, in a hospital of Juazeiro (BA), Brazil. The questionnaire used was FANTASTIC, that is an internationally validated tool, including Brazil. This was administered to patients during the first days in the coronary care unit and the secondary data were collected from the medical records. RESULTS: Fifty-seven patients answered the questionnaire, 63.2% male, mean age 61.3±10.9 years and mean body mass index of 27.0±4.4kg/m2 . Mean score of the questionnaire was 57.2±7.2; and 63.2% had a "good" lifestyle by previously standardized classification. Women had a better lifestyle score than men (61.1±5.1 points versus 55.0±7.3 points; p=0.001) There were lower scores in the areas nutrition, physical activity and smoking questionnaire. CONCLUSION: Acute myocardial infarction patients had a "good" score in the FANTASTIC questionnaire. Some domains, however, were undesirably low: physical activity, nutrition and smoking.

Aplicação da classificação internacional de funcionalidade, incapacidade e saúde em Unidade de Terapia Intensiva Cardiotorácica / Application of the international classification of functioning, disability and health in Cardiothoracic Intensive Care Unit

Objetivos: Codificar, através da Classificação Internacional de Funcionalidade (CIF), o estado de saúde dos pacientes internados em Unidade de Terapia Intensiva (UTI) cardiotorácica e comparar a codificação da mobilidade destes na admissão e na alta da unidade. Métodos: Foi realizado um estudo observacional longitudinal descritivo, na UTI Cardiotorácica adulta, no segundo dia de internação e no dia da alta. Os dados foram coletados por meio de uma ficha de internação e de um checklist cardiológico da CIF. Resultados: Amostra composta por 43 pacientes, idade média de 50,58 ± 17,24 anos, com internação média de 3,42 ± 4,24 dias. Na codificação relacionada a transferência e locomoção, feita na avaliação e alta, observou-se resultados estatisticamente significantes (p < 0,001) para todas as variáveis analisadas. Conclusão: A CIF demonstrou grande capacidade de padronizar a linguagem entre os profissionais na UTI além de quantificar a evolução dos pacientes. (AU)

Objectives: To codify, using the International Classification of Functioning (ICF), the health status of patients hospitalized in the Cardiothoracic Intensive Care Unit (ICU) and compare the encoding of these mobility at admission and at discharge from the unit. Methods: A descriptive longitudinal study was performed in adult Cardiothoracic ICU on the second day of admission and day of discharge. Data were collected through a hospitalization form and a cardiology checklist of CIF. Results: A sample of 43 patients, 50.58 ± 17.24 years old, with an average hospital stay of 3.42 ± 4.24 days. We noticed that, in coding related to transfer and locomotion, made in the assessment and discharge, there was a statistically significant result (p < 0.001) for all variables. Conclusion: The ICF has shown great ability to standardize the language among professionals in the ICU as well as quantify the evolution of intensive care unit patients.(AU)

Effects of One Resistance Exercise Session on Vascular Smooth Muscle of Hypertensive Rats / Efeitos de uma Sessão de Exercício Resistido sobre o Músculo Liso Vascular de Ratos Hipertensos

AbstractBackground:Hypertension is a public health problem and increases the incidence of cardiovascular diseases.Objective:To evaluate the effects of a resistance exercise session on the contractile and relaxing mechanisms of vascular smooth muscle in mesenteric arteries of NG-nitro L-arginine methyl ester (L-NAME)-induced hypertensive rats.Methods:Wistar rats were divided into three groups: control (C), hypertensive (H), and exercised hypertensive (EH). Hypertension was induced by administration of 20 mg/kg of L-NAME for 7 days prior to experimental protocols. The resistance exercise protocol consisted of 10 sets of 10 repetitions and intensity of 40% of one repetition maximum. The reactivity of vascular smooth muscle was evaluated by concentration‑response curves to phenylephrine (PHEN), potassium chloride (KCl) and sodium nitroprusside (SNP).Results:Rats treated with L-NAME showed an increase (p < 0.001) in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) compared to the initial period of induction. No difference in PHEN sensitivity was observed between groups H and EH. Acute resistance exercise reduced (p < 0.001) the contractile response induced by KCl at concentrations of 40 and 60 mM in group EH. Greater (p < 0.01) smooth muscle sensitivity to NPS was observed in group EH as compared to group H.Conclusion:One resistance exercise session reduces the contractile response induced by KCl in addition to increasing the sensitivity of smooth muscle to NO in mesenteric arteries of hypertensive rats.

ResumoFundamento:A hipertensão é um problema de saúde pública e faz aumentar a incidência das doenças cardiovasculares.Objetivo:Avaliar os efeitos de uma sessão de exercício resistido sobre os mecanismos contráteis e relaxantes do músculo liso vascular em artéria mesentérica de ratos hipertensos induzidos por L-NAME.Métodos:Ratos Wistar foram divididos em três grupos: Controle (C), Hipertenso (H) e Hipertenso Exercitado (HE). A hipertensão foi induzida pela administração de 20 mg/kg de NG-nitro L-arginina metil éster (L-NAME) durante sete dias antes dos protocolos experimentais. O protocolo de exercício resistido consistiu em dez séries de dez repetições e intensidade de 40% de uma repetição máxima. A reatividade do músculo liso vascular foi avaliada através de curvas concentração-resposta para a fenilefrina (FEN), cloreto de potássio (KCl) e nitroprussiato de sódio (NPS).Resultados:Os ratos tratados com L-NAME apresentaram aumento (p < 0,001) da Pressão Arterial Sistólica (PAS), da Pressão Arterial Diastólica (PAD) e da Pressão Arterial Média (PAM) quando comparados ao período inicial da indução. Não foi observada diferença na sensibilidade da FEN entre os grupos H e HE. O exercício resistido agudo reduziu (p < 0,001) a resposta contrátil induzida pelo KCl nas concentrações de 40 e 60 mM do grupo HE quando comparado ao grupo H. Foi observado maior (p < 0,01) sensibilidade do músculo liso ao NPS no grupo HE quando comparado ao grupo H.Conclusão:Uma sessão de exercício resistido reduz as respostas contráteis induzidas pelo KCl, além de aumentar a sensibilidade do músculo liso ao NO em artéria mesentérica de ratos hipertensos.

Determinants of peak VO2 in heart transplant recipients / Determinantes do pico de VO2 em transplantados cardíacos

Objective: To establish the determinants of the peak VO2 in heart transplant recipients. Methods: Patient's assessment was performed in two consecutive days. In the first day, patients performed the heart rate variability assessment followed by a cardiopulmonary exercise test. In the second day, patients performed a resting echocardiography. Heart transplant recipients were eligible if they were in a stable condition and without any evidence of tissue rejection diagnosed by endomyocardial biopsy. Patients with pacemaker, noncardiovascular functional limitations such as osteoarthritis and chronic obstructive pulmonary disease were excluded from this study. Results: Sixty patients (68% male, 48 years and 64 months following heart transplantation) were assessed. Multivariate analysis selected the following variables: receptor's gender (P=0.001), receptor age (P=0.049), receptor Body Mass Index (P=0.005), heart rate reserve (P <0.0001), left atrium diameter (P=0.016). Multivariate analysis showed r=0.77 and r2=0.6 with P <0.001. Equation: peakVO2=32.851 - 3.708 (receptor gender) - 0.067 (receptor age) - 0.318 (receptor BMI) + 0.145 (heart rate reserve) - 0.111 (left atrium diameter). Conclusion: The determinants of the peak VO2 in heart transplant recipients were: receptor sex, age, Body Mass Index, heart rate reserve and left atrium diameter. Heart rate reserve was the unique variable positively associated with peak VO2. This data suggest the importance of the sympathetic reinnervation in peak VO2 in heart transplant recipients. .

Objetivo: Estabelecer os determinantes do VO2 pico em transplantados de coração. Métodos: Avaliação do paciente foi realizada em dois dias consecutivos. No primeiro dia, os pacientes realizaram a avaliação da variabilidade da frequência cardíaca seguida de um teste de esforço cardiopulmonar. No segundo dia, os pacientes realizaram ecocardiografia de repouso. Os transplantados foram elegíveis se estivessem em uma condição estável e sem qualquer evidência de rejeição diagnosticada por biópsia endomiocárdica. Pacientes com marca-passo, limitações funcionais não cardiovasculares, tais como osteoartrite e doença pulmonar obstrutiva crônica foram excluídos deste estudo. Resultados: Sessenta pacientes (68% do sexo masculino, 48 anos e 64 meses após o transplante cardíaco) foram avaliados. A análise multivariada selecionou as seguintes variáveis: sexo (P=0,001), idade (P=0,049), Índice de Massa Corporal (P=0,005), frequência cardíaca de reserva (P <0,0001), diâmetro do átrio esquerdo (P=0,016), variáveis do receptor. A análise multivariada mostrou r=0,77 e r2=0,6, com P <0,001. Equação: VO2=32,851 - 3,708 (sexo receptor) - 0,067 (idade receptor) - 0,318 (IMC receptor) + 0,145 (frequência cardíaca de reserva) - 0,111 (diâmetro de átrio esquerdo). Conclusão: Os determinantes do pico de VO2 em transplantados de coração foram: sexo receptor, idade, Índice de Massa Corporal, frequência cardíaca de reserva e diâmetro do átrio esquerdo. A frequência cardíaca de reserva foi a única variável positivamente associada com o pico de VO2. Estes dados sugerem a importância da reinervação simpática no pico de VO2 em transplantados de coração. .

Effects of Yoga in Patients with Chronic Heart Failure: A Meta-Analysis / Prática de Yoga em Pacientes com Insuficiência Cardíaca Crônica: Uma Meta-análise

The use of yoga as an effective cardiac rehabilitation in patients with chronic heart failure (CHF) remains controversial. We performed a meta-analysis to examine the effects of yoga on exercise capacity and health-related quality of life (HRQOL) in patients with CHF. Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials, Excerpta Medica database, LILACS, Physiotherapy Evidence Database, The Scientific Electronic Library Online, and Cumulative Index to Nursing and Allied Health (from the earliest date available to December 2013) for randomized controlled trials (RCTs) examining the effects of yoga versus exercise and/or of yoga versus control on exercise capacity (peakVO2) and quality-of-life (HRQOL) in CHF. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Two studies met the selection criteria (total: 30 yoga and 29 control patients). The results suggested that yoga compared with control had a positive impact on peak VO2 and HRQOL. Peak VO2, WMD (3.87 95% CI: 1.95 to 5.80), and global HRQOL standardized mean differences (-12.46 95% CI: -22.49 to -2.43) improved in the yoga group compared to the control group. Yoga enhances peak VO2 and HRQOL in patients with CHF and could be considered for inclusion in cardiac rehabilitation programs. Larger RCTs are required to further investigate the effects of yoga in patients with CHF.

A eficácia da prática de yoga na reabilitação cardíaca em pacientes com insuficiência cardíaca crônica (ICC) permanece controversa. Uma meta-análise foi realizada para verificar os efeitos do Yoga sobre a capacidade de exercício e qualidade de vida relacionada à saúde (QVRS) em pacientes com ICC. Material e métodos: As bases MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, CINAHL (da data mais antiga disponível a dezembro de 2013) foram pesquisadas para a identificação de ensaios clínicos randomizados (ECRs) que investigaram os efeitos do Yoga (em relação ao grupo praticante de exercícios físicos e/ou grupo controle) sobre a capacidade de exercício (VO2 pico) e qualidade de vida relacionada à saúde (QVRS) em pacientes com ICC. Dois avaliadores selecionaram os ensaios clínicos de forma independente. Diferenças médias ponderadas (DMPs) e intervalos de confiança de 95% (IC 95%) foram calculados, e a heterogeneidade foi avaliada através do teste I2. Dois ensaios clínicos atenderam os critérios de elegibilidade, perfazendo um grupo amostral com 30 pacientes praticantes de Yoga e 29 pacientes controle. Os resultados sugerem que o Yoga teve um impacto positivo sobre o VO2 pico e QVRS em comparação com o grupo controle. O grupo praticante de Yoga apresentou um aumento no VO2 pico e na diferença média ponderada (IC 95% 3,87: 1,95-5,80) e aumento na diferença média padronizada na QVRS (IC 95% -12,46: -22,49 a -2,43) em comparação ao grupo controle. A prática de Yoga aumenta o VO2 pico e QVRS em pacientes com ICC e poderá ser incluída em programas de reabilitação cardíaca. ECRs mais abrangentes são necessários para elucidar os efeitos do Yoga em pacientes com ICC.

Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study / Avaliação da força muscular periférica de pacientes submetidos à cirurgia cardíaca eletiva: estudo longitudinal

Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results: Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion: The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline. .

Introdução: A força muscular periférica tem sido pouco explorada na literatura atual no contexto da reabilitação cardiovascular. Objetivo: Avaliar a força muscular periférica de pacientes submetidos à cirurgia cardíaca eletiva. Métodos: Trata-se de um estudo observacional e longitudinal. A força muscular periférica foi mensurada por meio de dinamometria isométrica de MMII (extensores e flexores de joelho) em três momentos distintos: pré-operatório (M1), dia da alta da unidade de terapia intensiva (M2) e dia da alta hospitalar (M3). Os participantes receberam atendimento fisioterapêutico pré e pós-operatório durante os dias do internamento, nos períodos matutino e vespertino. Resultados: Foram avaliados 22 pacientes. Os valores de força muscular periférica de extensores de joelho pré-operatórios encontrados foram cerca de 50% menores do que os preditos para a população saudável. Ao comparar a força muscular prévia (M1), com os demais momentos de avaliação, encontrou-se em M2 queda de 29% para o movimento de extensão do joelho e 25% para o movimento de flexão de joelho e queda de 10% para o movimento de extensão do joelho e 13% para o movimento de flexão de joelho em M3 ao comparar com M1. Conclusão: Os valores de força muscular periférica prévia dos pacientes do estudo foram menores do que o predito para a população saudável com a mesma faixa etária. Após o evento cirúrgico, essa redução é ainda mais notável, sendo reestabelecida até o momento da alta hospitalar a valores próximos ao basal. .

Tumores cardíacos em criança: análise retrospectiva / Heart neoplasms in children: retrospective analysis

FUNDAMENTO: Avanço dos métodos não invasivos de imagem proporcionou o aumento no número de diagnóstico de tumores cardíacos. Apesar disso, a literatura apresenta poucos trabalhos envolvendo tumores cardíacos primários em crianças. OBJETIVO: Avaliar retrospectivamente casos de tumores cardíacos primários em crianças, considerando manifestações clínicas iniciais, exames utilizados para o diagnóstico, indicação cirúrgica, tipos histopatológicos encontrados e evolução pós-operatória imediata. MÉTODOS: O estudo foi retrospectivo, baseado na avaliação de prontuários no período de 1983 a 2011. Incluímos somente casos que foram orientados para tratamento cirúrgico no período. Avaliaram-se a idade na admissão, o diagnóstico pré-natal, a história familial, os sintomas iniciais e os resultados de exames realizados. Foram coletados, ainda, a data e indicação de cirurgia, os achados intraoperatórios, o resultado do exame histopatológico, assim como as complicações imediatas no pós-operatório. RESULTADOS: Dos 18 pacientes estudados, as manifestações clínicas mais encontradas foram dispneia e sopro cardíaco (7 e 6 pacientes, respectivamente); o método de complemento diagnóstico mais usado foi o ecocardiograma (18 pacientes); a obstrução cavitária ou do trato de entrada ou saída ventricular foi a principal indicação de cirurgia (12 casos); o perfil histológico mais encontrado foi rabdomioma (7 pacientes); a maioria dos pacientes apresentou boa evolução clínica. CONCLUSÃO: Neste estudo o diagnóstico por imagem foi basicamente ecocardiográfico, com boa correlação com os achados intraoperatórios. Os achados histopatológicos foram concordantes com a literatura, com o rabdomioma apresentando-se como o tumor mais comum em crianças. A evolução após tratamento cirúrgico mostrou-se favorável na maior parte dos casos.

BACKGROUND: The advancement of noninvasive imaging methods has resulted in the increase in diagnosis of heart neoplasms. However, the literature has few studies involving primary cardiac neoplasms in children. OBJECTIVE: To retrospectively review cases of primary heart neoplasms in children, considering the initial clinical manifestations, diagnostic tests used, surgical indication, histopathological types and immediate postoperative course. METHODS: The retrospective study was based on the assessment of medical records from 1983 to 2011. Only cases that were referred for surgical treatment during that period were included. Age at admission, prenatal diagnosis, family history, initial symptoms and the results of performed tests were assessed. Moreover, the date and indication of the surgery, intraoperative findings, the result of the histopathological analysis, as well as the immediate postoperative complications were recorded. RESULTS: Of the 18 patients studied, the most frequent clinical manifestations were dyspnea and heart murmur (7 and 6 patients, respectively); the most often used adjunct diagnostic method was echocardiography (18 patients); cavitary obstruction or ventricular inflow or outflow tract obstruction was the main indication for surgery (12 cases); the most common histological profile was rhabdomyoma (7 patients) and most patients showed good clinical outcome. CONCLUSIONS: In this study, imaging diagnosis was basically attained through echocardiography, with good correlation with intraoperative findings. Histopathological findings were consistent with the literature, with rhabdomyoma being the most common neoplasm in children. The evolution after surgical treatment was favorable in most cases.

A systematic review of the effects of different types of therapeutic exercise on physiologic and functional measurements in patients with HIV/AIDS

Several studies have reported the benefits of exercise training for adults with HIV, although there is no consensus regarding the most efficient modalities. The aim of this study was to determine the effects of different types of exercise on physiologic and functional measurements in patients with HIV using a systematic strategy for searching randomized controlled trials. The sources used in this review were the Cochrane Library, EMBASE, MEDLINE, and PEDro from 1950 to August 2012. We selected randomized controlled trials examining the effects of exercise on body composition, muscle strength, aerobic capacity, and/or quality of life in adults with HIV. Two independent reviewers screened the abstracts using the Cochrane Collaboration's protocol. The PEDro score was used to evaluate methodological quality. In total, 29 studies fulfilled the inclusion criteria. Individual studies suggested that exercise training contributed to improvement of physiologic and functional parameters, but that the gains were specific to the type of exercise performed. Resistance exercise training improved outcomes related to body composition and muscle strength, with little impact on quality of life. Aerobic exercise training improved body composition and aerobic capacity. Concurrent training produced significant gains in all outcomes evaluated, although moderate intensity and a long duration were necessary. We concluded that exercise training was shown to be a safe and beneficial intervention in the treatment of patients with HIV.

Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial

OBJECTIVE: To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD: This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS: There was a greater reduction in systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Group B (2.3% and 7.3%), and Group C (3.9% and 4.9%, respectively). Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS: The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.

MicroRNAs: um novo paradigma no tratamento e diagnóstico da insuficiência cardíaca? / MicroRNAs: a new paradigm in the treatment and diagnosis of Heart failure? / MicroRNAs: ¿un nuevo paradigma en el tratamiento y diagnóstico de la insuficiencia cardíaca?

MicroRNAs (miRNAs) são um grupo recém-descoberto de pequenos RNAs, não codificantes, que representam uma das áreas mais estimulantes da ciência médica moderna por modularem uma enorme e complexa rede regulatória da expressão dos genes.Recentemente, linhas de evidências sugerem que os miRNAs desempenham um papel crucial na patogênese da insuficiência cardíaca. Alguns miRNAs altamente expressos no coração como o miR-1, miR-133 e miR-208 estão fortemente associados ao desenvolvimento da hipertrofia cardíaca, enquanto o exato papel de miR-21 no sistema cardiovascular permanece controverso. Os níveis séricos de miRNAs circulantes como o miR-423-5p estão sendo avaliados como potenciais biomarcadores no diagnóstico e prognóstico da insuficiência cardíaca.Por outro lado, a manipulação dos níveis de miRNAs usando técnicas como os mimetizadores de miRNAs (miRmimics) e miRNAs antagônicos(antagomiRs) está tornando cada vez mais evidente o enorme potencial dos miRNAs como promissoras estratégias terapêutica sna insuficiência cardíaca.

MicroRNAs (miRNAs) are a group of newly discovered small RNAs, non-coding, which represent one of the most exciting areas of modern medical science as they modulate a huge and complex regulatory network of gene expression. Lines of evidence have recently suggested that miRNAs play a key role in the pathogenesis of heart failure. Some miRNAs highly expressed in the heart, such as miR-1, miR-133 and miR-208, are strongly associated with the development of cardiac hypertrophy, while the exact role of miR-21 in the cardiovascular system remains controversial. Serum levels of circulating miRNAs such as miR-423-5p are being evaluated as potential biomarkers in the diagnosis and prognosis of heart failure. On the other hand, the manipulation of levels of miRNAs using techniques such as mimicking the miRNAs (miRmimics) and antagonistic miRNAs (antagomiRs) is making increasingly evident the enormous potential of miRNAs as promising therapeutic strategies in heart failure.

MicroRNAs(miRNAs) son un grupo recién descubierto de pequeños RNAs, no codificantes, que representan una de las áreas más estimulantes de la ciencia médica moderna por modular en una enorme y compleja red regulatoria de la expresión de los genes. Recientemente, líneas de evidencias sugieren que los miRNAs desempeñan un papel crucial en la patogénesis de la insuficiencia cardíaca. Algunos miRNAs altamente expresados en el corazón como el miR-1, miR-133 y miR-208 están fuertemente asociados al desarrollo de la hipertrofia cardíaca, mientras que el exacto papel de miR-21 en el sistema cardiovascular permanece controvertido. Los niveles séricos de miRNAs circulantes como el miR-423-5p están siendo evaluados como potenciales biomarcadores en el diagnóstico y pronóstico de la insuficiencia cardíaca. Por otro lado, la manipulación de los niveles de miRNAs usando técnicas como los mimetizadores de miRNAs (miRmimics) y miRNAs antagónicos (antagomiRs) está volviendo cada vez más evidente el enorme potencial de los miRNAs como promisorias estrategias terapéuticas en la insuficiencia cardíaca.