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ABSTRACT Introduction: Heart rate control by the autonomic nervous system (ANS) is impaired in heart transplant (HT) recipients, leading to increased resting heart rate, metabolic demand, and fatigue, which can impair their quality of life (QoL). In this study, we hypothesized the association of hemodynamics and autonomic function as predictors of QoL in HT recipients. Methods: This is a cross-sectional study conducted with HT recipients aged ≥ 18 years at ambulatorial accompaniment. Blood pressure was used for hemodynamics assessment, and heart rate variability (HRV) was used for ANS assessment. QoL was assessed by the 36-item Short Form Health Survey. The significance level was set as P≤0.05. Results: Twenty-two volunteers were included in the study. Systolic blood pressure (SBP) and double product (DP) were significantly negatively associated with the physical functioning domain of QoL. DP, the number of consecutive normal RR interval differences > 50 ms (NN50), and the percentage of normal RR intervals that differed by > 50 ms from the adjacent interval (PNN50) exhibited negative association with the physical role domain. NN50 and PNN50 were significantly associated with bodily pain, social functioning, and emotional role domains. SBP was negatively associated with the vitality domain. Considering general and mental health domains, no variable demonstrated significant association. DP, NN50, and PNN50 were negatively associated with the total score of QoL. Conclusion: This study demonstrated DP and HRV as predictors of QoL in HT recipients. These innovative results can become a relevant therapeutic target for improving QoL in HT recipients prior to its deterioration.
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INTRODUCTION: Previous studies describe an imbalance of the autonomic nervous system in Chagas' disease causing increased sympathetic activity, which could influence the genesis of hypertension. However, patients undergoing regular physical exercise could counteract this condition, considering that exercise causes physiological responses through autonomic and hemodynamic changes that positively affect the cardiovascular system. This study aimed to evaluate the effects of an exercise program on blood pressure in hypertensive patients with chronic Chagas' heart disease. METHODS: We recruited 17 patients to a 24-week regular exercise program and used ambulatory blood pressure monitoring before and after training. We determined the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) from the beginning to the end of the study. RESULTS: The blood pressures were evaluated in general and during periods of wakefulness and sleep, respectively: SBP (p = 0.34; 0.23; 0.85), DBP (p = 0.46; 0.44; 0.94) and MBP (p = 0.41; 0.30; 0.97). CONCLUSIONS: There was no statistically significant change in blood pressure after the 24-week exercise program; however, we concluded that physical training is safe for patients with chronic Chagas' disease, with no incidence of increase in blood pressure.
INTRODUÇÃO: Estudos prévios descrevem um desequilíbrio do sistema nervoso autônomo na doença de Chagas causando maior atividade simpática, o que poderia influenciar na gênese da hipertensão arterial. No entanto, pacientes submetidos a exercícios físicos regulares poderiam contrapor esta condição, visto que o exercício provoca respostas fisiológicas através de adaptações autonômicas e hemodinâmicas que influenciam positivamente o sistema cardiovascular. O presente estudo se propõe a avaliar os efeitos da reabilitação cardíaca sobre a pressão arterial em pacientes hipertensos com cardiopatia chagásica crônica. MÉTODOS: Foram recrutados 17 pacientes submetidos a um programa regular de exercícios durante 24 semanas, sendo utilizado monitorização ambulatorial da pressão arterial (MAPA) antes e após o treinamento. Foi descrita a diferença da pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão arterial média (PAM) do início ao fim estudo. RESULTADOS: As pressões foram avaliadas de forma geral e nos períodos de vigília e sono, respectivamente: PAS (p=0,34; 0,23; 0,85), PAD (p=0,46; 0,44; 0,94) e PAM (p=0,41; 0,30; 0,97). CONCLUSÕES: Não houve diferença estatisticamente significativa na variação da pressão arterial após o período de reabilitação cardíaca de 24 semanas, no entanto, evidenciamos que o treinamento físico é seguro em pacientes com cardiopatia chagásica crônica, não ocorrendo aumento da pressão arterial.
Subject(s)
Adult , Aged , Humans , Middle Aged , Blood Pressure/physiology , Chagas Cardiomyopathy/rehabilitation , Exercise Therapy/methods , Hypertension/prevention & control , Blood Pressure Monitoring, Ambulatory , Chronic Disease , Hypertension/physiopathology , Prospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Despite all efforts to restrict its transmission, Chagas' disease remains a severe public health problem in Latin America, affecting 8-12 million individuals. Chronic Chagas' heart disease, the chief factor in the high mortality rate associated with the illness, affects more than half a million Brazilians. Its evolution may result in severe heart failure associated with loss of functional capacity and quality of life, with important social and medical/labor consequences. Many studies have shown the beneficial effect of regular exercise on cardiac patients, but few of them have focused on chronic Chagas' heart disease. METHODS: This study evaluated the effects of an exercise program on the functional capacity of patients with chronic Chagas' disease who were treated in outpatient clinics at the Evandro Chagas Institute of Clinical Research and the National Institute of Cardiology, Rio de Janeiro, Brazil. The exercises were performed 3 times a week for 1 h (30 min of aerobic activity and 30 min of resistance exercises and extension) over 6 months in 2010. Functional capacity was evaluated by comparing the direct measurement of the O2 uptake volume (VO2) obtained by a cardiopulmonary exercise test before and after the program (p < 0.05). RESULTS: Eighteen patients (13 females) were followed, with minimum and maximum ages of 30 and 72 years, respectively. We observed an average increase of VO2peak > 10% (p = 0.01949). CONCLUSIONS: The results suggest a statistically significant improvement in functional capacity with regular exercise of the right intensity.
INTRODUÇÃO: Mesmo com todos os esforços para interrupção de sua transmissão, a doença de Chagas permanece como grave problema de saúde pública na América Latina, onde atinge entre 8 e 12 milhões de indivíduos. A cardiopatia chagásica crônica, principal responsável pela elevada morbimortalidade da doença, chega a acometer mais de meio milhão de brasileiros. Sua evolução atinge estágios graves de insuficiência cardíaca com perda de capacidade funcional e qualidade de vida, com grande impacto social e médico-trabalhista. Muitos estudos demonstram o resultado benéfico da prática regular de exercícios em cardiopatas, porém, há escassez de investigações em cardiopatia chagásica. MÉTODOS: O presente estudo avaliou efeitos de um programa de exercícios sobre a capacidade funcional de dezoito pacientes (13 mulheres) com cardiopatia chagásica crônica, com idade entre 30 e 72 anos, atendidos nos ambulatórios do Instituto de Pesquisa Clínica Evandro Chagas e do Instituto Nacional de Cardiologia, na cidade do Rio de Janeiro. Os exercícios foram executados 3 vezes por semana, durante 1 hora (30 minutos de atividade aeróbica e 30 minutos de exercícios contra-resistência e alongamentos), ao longo de 6 meses, no ano de 2010. A avaliação da capacidade funcional foi realizada pela comparação da medida direta do VO2 obtido pelo Teste de Exercício Cardiopulmonar, antes e depois do programa. Para análise estatística foram utilizados testes T de Student pareado e de Wilcoxon. RESULTADOS: Os resultados mostram aumento médio do VO2pico acima de 10%(p=0,01949). CONCLUSÕES: Os resultados sugerem melhora significativa da capacidade funcional com prática regular de exercícios na população amostral.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Chagas Cardiomyopathy/rehabilitation , Exercise Therapy/methods , Oxygen Consumption/physiology , Chronic Disease , Exercise TestABSTRACT
Fundamentos: Existem estudos que demonstram a melhora da qualidade de vida em pacientes com diversas cardiopatias, quando submetidos a um programa regular de exercícios. Contudo, há carência de estudos na população com cardiopatia chagásica crônica. Objetivo: Avaliar a qualidade de vida em pacientes com cardiopatia chagásica crônica antes e após um programa regular de exercícios. Métodos: Trata-se de um estudo prospectivo de intervenção, do tipo antes e depois realizado por 24 semanas em 24 pacientes. A avaliação da qualidade de vida foi feita antes, com 3 meses e após 6 meses de treinamento, através da aplicação do questionário de Minnesota (Minnesota Living with Heart Failure Questionnaire), validado no Brasil. Resultados: Comparando o escore de Minnesota antes e após o programa de exercícios houve diferença estatística (p = 0,002105). Houve diferença estatística quando comparado o escore de Minnesota antes e durante o programa de exercícios (p = 0,001816) e não houve diferença estatística quando comparado o escore de Minnesota durante e após o programa de exercícios (p = 0,7807). Conclusão: Conclui-se que a aplicação de um programa regular de exercícios promove melhora da qualidade de vida em pacientes com cardiopatia chagásica crônica.
Background: Several studies show improved quality of life in patients with various heart diseases, when subjected to a regular exercise program. However, few studies address patients with chronic Chagas cardiomyopathy.Objective: To assess the quality of life in patients with chronic Chagas cardiomyopathy before and after a regular exercise program.Methods: Prospective intervention study, with a before and after design, was conducted for 24 weeks, in 24 patients. The quality of life assessment was made before the adoption of a regular exercise program, within 3 months of program, and after 6 months of program, through the application of the Minnesota questionnaire (Minnesota Living with Heart Failure Questionnaire), validated in Brazil.Results: Statistical difference was found when comparing the Minnesota score before and after the exercise program (p = 0.002105). Statistical difference was found when comparing the score before and during the exercise program (p = 0.001816). No statistical difference was found when comparing the score during and after the exercise program (p = 0.7807).Conclusion: This study concludes that the application of a regular exercise program promotes improved quality of life in patients with chronic Chagas cardiomyopathy.