ABSTRACT
ABSTRACT Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2max (−5.84 mL.kg−1.min−1, 95% CI −6.93, −4.76 mL.kg−1.min−1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (−93.30 meters, 95% CI −141.2, −45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.
ABSTRACT
Abstract Background: Children and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing. Objective: To evaluate the functional capacity of children and adolescents with congenital heart disease (CHD) with systematic review and meta-analyses. Methods: The review included observational studies, data from the first evaluation of randomized clinical trials or observational follow-up periods after clinical trials which evaluated functional capacity by cardiopulmonary exercise test, stress testing, six-minute walk test or step test, in children and adolescents with CHD, aged between six and 18 years, and comparisons with healthy controls in the same age group. The quantitative assessment was performed by meta-analysis, by comparing the maximal oxygen consumption (VO2max) of children and adolescents with CHD and respective control groups. Results: Twenty-five of 2.683 studies identified in the search met the inclusion criteria. The VO2max measurement showed that patients with CHD have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group. The meta-analysis of the data of maximum heart rate (HR) reached during cardiopulmonary test and stress testing, retrieved from 18 studies, showed a HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group. Conclusion: Children and adolescents with CHD have lower VO2max and HR compared to controls.
Resumo Fundamento: Crianças e adolescentes com cardiopatia congênita frequentemente apresentam alterações na sua capacidade de exercício que pode ser avaliada através de vários testes funcionais. Objetivo: Avaliar a capacidade funcional de crianças e adolescentes com cardiopatias congênitas (CC) através de revisão sistemática e metanálise. Métodos: A revisão incluiu estudos observacionais, dados da primeira avaliação de ensaios clínicos randomizados ou acompanhamento após ensaios clínicos que avaliaram a capacidade funcional através teste de exercício cardiopulmonar, teste ergométrico, teste de caminhada de seis minutos ou teste do degrau em crianças e adolescentes. Foram incluídos indivíduos com CC, idade entre seis e 18 anos e seus controles saudáveis. A avaliação quantitativa foi realizada por metanálise, comparando o consumo máximo de oxigênio (VO2max) entre crianças e adolescentes com CC e seus pares saudáveis. Resultados: Vinte e cinco dos 2.683 estudos identificados na pesquisa atenderam aos critérios de inclusão. A medida do VO2máx mostrou que os pacientes com CC apresentaram uma diminuição de 9,31 ml/Kg/min (IC 95%: -12,48 a -6,13; I2, 94,3%, P para heterogeneidade < 0,001) em comparação ao grupo controle. A metanálise dos dados de frequência cardíaca máxima (FCM) alcançada durante o teste de exercício cardiopulmonar e teste ergométrico, avaliado por 18 estudos, mostrou um valor de -15,14 bpm (IC 95%: -20,97 a -9,31; I2; 94,3%, P para heterogeneidade < 0,001) em comparação ao grupo controle. Conclusão: Crianças e adolescentes com CC apresentam menor VO2máx e FCM em relação a controles saudáveis.
Subject(s)
Humans , Child , Adolescent , Exercise/physiology , Exercise Tolerance/physiology , Exercise Test , Heart Defects, Congenital/physiopathology , Oxygen Consumption/physiology , Heart Rate/physiologyABSTRACT
Fundamentos: A insuficiência cardíaca é uma doença multissistêmica que inclui disfunção autonômica. Objetivo: Avaliar os efeitos agudos da Estimulação Elétrica Funcional (EEF) e do Treinamento Muscular Inspiratório (TMI) sobre o controle autonômico, a função endotelial e os níveis de citocinas inflamatórias em pacientes portadores de IC. Métodos: Estudo randomizado cruzado que incluiu 12 pacientes submetidos a três intervenções randomizadas: EEF, TMI, e EEF + TMI, com intervalo de 1 semana entre as sessões. O TMI foi realizado durante 15 minutos, com 30% da pressão inspiratória máxima. A EEF foi realizada nos músculos vasto lateral e vasto medial, a uma frequência de 20Hz durante 30 minutos. O controle autonômico foi medido através de monitorização de pressão batimento por batimento (Finapres); a função endotelial, através da técnica de dilatação mediada por fluxo (DMF); e os níveis de citocinas inflamatórias foram medidos antes e depois de cada sessão. Resultados: O controle autonômico após EEF diminuiu em termos de BF/AF (p=0,01) e BFn.u (p=0,03), e aumentou em termos de RR médio (p=0,005). Observou-se um aumento do RR médio após o TMI (p=0,005) e após EEF+TMI (p=0,02). Não houve diferenças na DMF e na concentração de lactato sérico. Quanto às citocinas, a EEF promoveu uma redução nos níveis de TNF-α (pré versus pós 24 horas, p = 0,05). O TMI resultou em níveis aumentados de IL-10 (pré versus 24 horas pós, p=0,05) e em níveis diminuídos de TNF-α (1 hora pós versus 24 horas pós, p = 0,03). Não houve diferenças quando as duas intervenções foram associadas. Conclusão: EEF, TMI, e EEF + TMI alteraram o controle autonômico, mas não a função endotelial. A EEF e o TMI isoladamente alteraram os níveis de citocinas inflamatórias. Ensaios Clínicos: NCT01325597
Background: Heart Failure is a multisystem disorder, which includes autonomic dysfunction. Objective: To evaluate the acute effects of Functional Electrical Stimulation (FES) and Inspiratory Muscle Training (IMT) on autonomic control, endothelial function and inflammatory cytokine levels in patients with HF. Methods: Randomized crossover trial including 12 patients undergoing three randomized interventions: FES, IMT, and FES+IMT, with a 1-week interval between sessions. IMT was performed for 15 minutes with 30% of the maximal inspiratory pressure. FES was performed in the vastus lateralis and vastus medialis muscles, at 20Hz for 30 minutes. The autonomic control was measured using beat-to-beat blood pressure monitoring (Finapres); the endothelial function, using the flow-mediated dilation technique (FMD); and inflammatory cytokine levels were assessed before and after the sessions. Results: Autonomic control after FES decreased regarding LF/HF (p=0.01) and LFn.u (p=0.03), and increased regarding mean RR (p=0.005). Increased mean RR was observed after IMT (p=0.005) and after FES+IMT (p=0.02). No differences were found in FMD and blood lactate concentration. As regards the cytokines, FES led to a decrease in TNF-α levels (pre vs. 24 hours post, p = 0.05). IMT resulted in increased IL-10 levels (pre vs. 24 hours post, p=0.05) and decreased TNF-α levels (1 hour post vs. 24 hours post, p = 0.03). No difference was observed when the two interventions were associated. Conclusion: FES, IMT, and FES+IMT changed the autonomic control without changing the endothelial function. FES and IMT separately changed inflammatory cytokine levels. Clinical Trials: NCT01325597