El puntaje de Framingham ayudaría en la estratificación del riesgo de pacientes con ergometría positiva y SPECT normal / The Framingham score could help in risk stratification of patients with positive ergometry and normal SPECT

Antecedentes. El valor pronóstico de una ergometría positiva en el contexto de imágenes tomográficas de perfusión miocárdica de estrés y reposo (SPECT) normales no está bien establecido. Objetivos. Documentar la incidencia de infarto, muerte y revascularización coronaria en pacientes con una ergometría positiva de riesgo intermedio e imágenes de perfusión SPECT normales, y explorar el potencial valor del puntaje de riesgo de Framingham en la estratificación pronóstica de estos pacientes. Métodos. Cohorte retrospectiva integrada por pacientes que habían presentado síntomas o hallazgos electrocardiográficos compatibles con enfermedad arterial coronaria durante la prueba de esfuerzo, con criterios de riesgo intermedio en la puntuación de Duke y perfusión miocárdica SPECT normal. Fueron identificados a partir de la base de datos del laboratorio de cardiología nuclear del Instituto de Cardiología y Cirugía Cardiovascular de la ciudad de Posadas, Argentina. Resultados. Fueron elegibles 217 pacientes. El seguimiento fue de 3 1,5 años. La sobrevida libre de eventos (muerte,infarto de miocardio no fatal, angioplastia coronaria o cirugía de bypass de arteria coronaria) a uno, tres y cinco años fue significativamente menor (Log-rank test, p= 0,001) en el grupo con puntaje de Framingham alto o muy alto (77, 71y 59 %, respectivamente) que en el grupo de puntaje bajo o intermedio (89, 87 y 83 %). Tomando como referencia a los pacientes con riesgo bajo en el puntaje de Framingham, luego de ajustar por edad, sexo y puntaje de Duke, los pacientes categorizados en los estratos alto y muy alto riesgo del puntaje de Framingham presentaron una incidencia del evento combinado cercana al triple (hazard ratio [HR] 2,81; intervalo de confianza [IC] del 95 % 0,91 a 8,72; p= 0,07 y HR 3,61;IC 95 % 1,23 a 10,56; p= 0,019 respectivamente). Conclusiones. La estimación de riesgo con el puntaje de Framingham sería de ayuda en la estratificación pronóstica de los pacientes con ergometría positiva y SPECT normal. (AU)

Background. The prognostic value of positive exercise testing with normal SPECT myocardial perfusion imaging is not well established. Objectives. To document the incidence of infarction, death, and coronary revascularization in patients with a positive intermediate-risk exercise test and normal SPECT perfusion images and to explore the potential value of the Framingham Risk Score in the prognostic stratification of these patients. Methods. A retrospective cohort comprised patients who presented symptoms or electrocardiographic findings compatible with coronary artery disease during the stress test, with intermediate risk criteria in the Duke score and normal SPECT myocardial perfusion. They were identified from the database of the nuclear cardiology laboratory of the Instituto de Cardiología y Cirugía Cardiovascular of Posadas, Argentina. Results. 217 patients were eligible. Follow-up was 3 1.5 years. Event-free survival (death, non-fatal myocardial infarction, coronary angioplasty, or coronary artery bypass surgery) at one, three, and five years was significantly lower (Log-ranktest, p: 0.001) in the group with a score of Framingham high or very high (77, 71 and 59 %, respectively) than in the lowor intermediate score group (89, 87 and 83 %). Taking as reference the low-risk patients in the Framingham score, after adjusting for age, sex, and Duke score, the patients categorized in the high-risk and very high-risk strata showed about three times higher incidence of the combined event (hazard ratio [HR] 2.81; 95 % confidence interval [CI] 0.91 to 8.72;p=0.07 and HR 3.61; 95 % CI 1.23 to 10.56; p=0.019 respectively). Conclusions. Risk estimation with the Framingham score would be helpful in the prognostic stratification of patients with positive exercise testing and normal SPECT. (AU)

El dilema clínico frente a los pacientes con ergometría positiva y prueba de perfusión miocárdica con SPECT normal / The clinical dilemma facing patients with positive stress test and normal SPECT myocardial perfusion imaging

La evaluación de la perfusión miocárdica con SPECT combina una prueba de esfuerzo (ergometría o estrés farmacológico) junto a imágenes de perfusión con radioisótopos. Este estudio es útil para establecer el diagnóstico de enfermedad arterial coronaria, estratificar el riesgo de infarto y tomar decisiones terapéuticas. Un resultado normal aporta un alto valor predictivo negativo, es decir, una muy baja probabilidad de que el paciente presente eventos cardiovasculares. El hallazgo de signos de isquemia en la ergometría podría poner en jaque el valor predictivo negativo de una perfusión normal. En presencia de este resultado, el paso siguiente es evaluar los predictores de riesgo en la ergometría, el riesgo propio del paciente en función de los antecedentes clínicos y el puntaje cálcico coronario, cuando este se encuentra disponible. Ante la presencia concomitante de otros marcadores de riesgo se sugiere completar la evaluación con un estudio anatómico.El uso de nuevas tecnologías podría mejorar la precisión en la predicción de eventos. (AU)

Assessment of myocardial perfusion with SPECT combines a stress test (ergometry or pharmacological stress) with radioisotope perfusion imaging. This test is helpful to diagnose coronary artery disease, stratify the risk of heart attack, and make therapeutic decisions. A normal result provides a high negative predictive value; therefore, the probability of cardiovascular events is very low. Signs of ischemia on an ergometry could jeopardize the negative predictive value of normal perfusion. In this clinical setting, the next step is to evaluate the risk predictors in the stress test, the individual risk based on the clinical history, and the coronary calcium score when available. Given the simultaneous presence of other risk markers,completing the evaluation with an anatomical study is suggested. The use of new technologies could improve the accuracy of event prediction. (AU)

Experiencia en un programa de rehabilitación cardíaca extrahospitalario usando cardiotacómetros: seguridad y eficacia / Experience in an outpatient cardiac rehabilitation program using cardiotachometers: safety and effectiveness / Experiência em programa de reabilitação cardíaca extra-hospitalar com uso de cardiotacômetros: segurança e eficácia

Introducción: El ejercicio físico, integrando la rehabilitación cardíaca (RC), tiene un efecto positivo demostrado en el pronóstico de los pacientes con enfermedad cardiovascular, optimizando el rendimiento cardíaco en términos de capacidad funcional. Mediante los programas de RC se pretende obtener los máximos beneficios clínicos del ejercicio físico con un mínimo riesgo para el paciente. Objetivos: Evaluar la seguridad y eficacia de un programa de RC extrahospitalario en pacientes de todos los niveles de riesgo, monitorizando con cardiotacómetros (instrumento de pulsera que detecta frecuencia cardíaca y permite programar alarmas) a pacientes de moderado y alto riesgo, con base en la ausencia de complicaciones cardíacas graves y la mejoría funcional de los participantes. Material y métodos: Estudio de cohorte retrospectiva, sometida a un plan de RC durante 12 semanas en el período comprendido entre enero de 2014 y marzo de 2020. Se evaluaron parámetros clínicos y funcionales al inicio y al final del plan de rehabilitación, controlando la tolerancia al esfuerzo, la presión arterial y la frecuencia cardíaca mediante el uso de cardiotacómetros. Resultados: Se incluyeron 181 pacientes, con edad promedio de 58,7 ± 9,7 años, 87,8% del sexo masculino, mayoritariamente portadores de cardiopatía isquémica (90,1%). Según la clasificación de la Asociación Americana de Rehabilitación Cardiovascular y Pulmonar, 54 pacientes (29,8%) eran de alto riesgo, 29 (16,0%) de moderado riesgo y 98 (54,1%) de bajo riesgo. En más de 10.000 horas de actividad física realizadas, un paciente requirió el implante de un marcapaso definitivo por bloqueo auriculoventricular completo, sin observarse otras complicaciones graves. Se obtuvo una mejoría significativa (p = 0,001) de la capacidad funcional, que aumentó de 7,34 ± 2,68 a 10,20 ± 2,35 METs (incremento relativo individual promedio 28,1%). Conclusiones: La RC es un tratamiento seguro y efectivo en los pacientes cardiópatas, aún en aquellos de moderado y alto riesgo. El uso de cardiotacómetros permite una adecuada monitorización del ejercicio y una oportuna detección de complicaciones.

Introduction: physical exercise, integrating cardiac rehabilitation (CR), has a proven positive effect on the prognosis of patients with cardiovascular disease, optimizing cardiac performance in terms of functional capacity. CR programs aim to obtain maximum clinical benefits with minimal risks to the patient. Objectives: assess the safety and efficacy of a cardiotachometer-monitored out-of-hospital CR program in high- and moderate-risk patients, based on the absence of major cardiac complications and improvement in participant's functional capacity. Materials and methods: retrospective cohort study, submitted to a CR plan for 12 weeks in the period between January 2014 and March 2020. Clinical and functional parameters were evaluated at the beginning and at the end of the rehabilitation plan, controlling effort tolerance, blood pressure and heart rate using cardiotachometers. Results: 181 patients were included, aged 58.7 ± 9.7 years and 87.8% female, of whom 90% were carriers of ischemic heart disease. According to the classification of the American Association of Cardiovascular and Pulmonary Rehabilitation, the patients were distributed as follows: 54 (29.8%) at high risk, 29 (16.0%) at intermediate risk, and 98 (54.1%) low risk. In more than ten thousand hours of physical activity performed, one patient required implantation of a permanent pacemaker due to complete atrioventricular block. A significant improvement (p = 0.001) of the functional capacity, from 7.34 ± 2.68 to 10.2 ± 2.35 (mean relative improvement: 28.1%.) was obtained. Conclusions: the CR is a safe and effective procedure for cardiac patients, even in moderate or high-risk subjects. The use of cardiotachometers allows adequate exercise monitoring and timely detection of complications.

Introdução: o exercício físico, integrando a reabilitação cardíaca (RC), tem comprovado efeito positivo no prognóstico de pacientes com doença cardiovascular, otimizando o desempenho cardíaco em termos de capacidade funcional. Os programas de RC visam obter o máximo de benefícios clínicos com riscos mínimos para o paciente. Objetivos: avaliar a segurança e eficácia de um programa de RC fora do hospital monitorado por cardiotacômetro em pacientes de alto e moderado risco, com base na ausência de complicações cardíacas maiores e na melhora da capacidade funcional dos participantes. Materiais e métodos: trata-se de um estudo descritivo, de um plano de RC de 12 semanas, em um período entre janeiro de 2014 a março de 2020. Os parâmetros clínicos e funcionais foram avaliados no início e no final do plano de reabilitação, a tolerância ao esforço, pressão arterial e frequência cardíaca utilizando cardiotacômetros. Resultados: foram incluídos 181 pacientes, com média de idade de 58,7 ± 9,7 anos e 87,8% do sexo masculino, dos quais 90% eram portadores de cardiopatia isquêmica. De acordo com a classificação da Associação Americana de Reabilitação Cardiovascular e Pulmonar, os pacientes foram distribuídos da seguinte forma: 54 (29,8%) de alto risco, 29 (16,0%) de risco intermediário e 98 (54,1%) de baixo risco. Em mais de dez mil horas de atividade física realizada, um paciente necessitou de implante de marcapasso definitivo por bloqueio atrioventricular total. A avaliação final mostrou melhora significativa (p = 0,001) na capacidade funcional medida em METs; este passou de 7,34 ± 2,68 para 10,2 ± 2,35 (melhora relativa média: 28,1%). Conclusões: este trabalho demonstra que a RC é um tratamento seguro e eficaz para pacientes com doenças cardíacas, mesmo em indivíduos de risco moderado e alto. O uso de cardiotacômetros permite o monitoramento adequado do exercício e a detecção oportuna de complicações.

Ergometría en el entrenamiento de alto rendimiento cubano / Ergometry in cuban high performance training

Introducción: El Centro de Investigaciones del Deporte Cubano, en estrecha relación con el Instituto de Medicina Deportiva, ha realizado en el Área de control cardiorrespiratorio numerosas pruebas funcionales a los deportistas de alto rendimiento. Como parte del control médico a los deportistas, se han ejecutado pruebas ergométricas cardiopulmonares en el laboratorio, con la novedad de ajustarse los protocolos a las necesidades especiales del atleta en función de su modalidad deportiva. Objetivos: Fundamentar la importancia de la ergometría cardiovascular para el entrenamiento deportivo y rediseñar protocolos de ergometría deportiva acordes a las especificidades de la modalidad atlética. Métodos: Se realizó un estudio descriptivo, longitudinal, en el periodo entre noviembre de 2019 y febrero de 2020. Muestra selectiva intencional, todos los deportistas de los equipos nacionales en cada modalidad: judo, boxeo y luchas (libre y grecorromana). Resultados: Se rediseñaron los protocolos de ergometría sobre la base de los convencionales estandarizados en medicina deportiva, para judo, boxeo y lucha. Se obtuvieron parámetros óptimos (frecuencia cardíaca, volumen máximo de oxígeno y equivalente metabólico) para cada modalidad deportiva. Conclusiones: Las pruebas ergoespirométricas constituyen una herramienta científica útil en la medicina deportiva. Rediseñar protocolos ergométricos permite una mejor valoración funcional del atleta y proporciona un adecuado soporte científico al entrenamiento individual. La ergometría cardiopulmonar es un instrumento disponible para evaluar, recuperar y mejorar las capacidades funcionales y deportivas de los atletas de alto rendimiento, especialmente en la etapa pos-COVID-19(AU)

Introduction: The Cuban Sports Research Center, in close relationship with the Institute of Sports Medicine, has carried out numerous functional tests on high-performance athletes for cardiorespiratory monitoring. As part of the medical control of athletes, cardiopulmonary ergometric tests have been carried out in the laboratory, with the novelty of adjusting the protocols to the special needs of the athlete depending on their sports modality. Objectives: To demonstrate the importance of cardiovascular exercise testing for sports training and to redesign sports exercise testing protocols according to the specificities of the athletic modality. Methods: A descriptive, longitudinal study was carried out from November 2019 to February 2020. Intentional selective sample, all the athletes of the national teams in each modality such as judo, boxing and wrestling. Results: The ergometry protocols were redesigned based on the conventional standardized in sports medicine, for judo, boxing and wrestling. Optimal parameters, as heart rate, maximum oxygen volume and metabolic equivalent, were obtained for each sports modality. Conclusions: Ergospirometric tests are a useful scientific tool in sports medicine. Redesigning ergometric protocols allows better functional assessment of the athletes and provides adequate scientific support for individual training. Cardiopulmonary ergometry is an instrument available to evaluate, recover and improve the functional and sports capacities of high-performance athletes, especially in the post-COVID-19 stage(AU)

Ergometría cardiovascular en la cultura física y el deporte / Cardiovascular ergometry in sports and physical culture

Introducción: La cultura física y el deporte tienen una gran importancia en el fortalecimiento de la salud humana y en la prevención de los procesos de enfermedad y envejecimiento. Dentro de las herramientas científico-tecnológicas utilizadas desde las ciencias aplicadas, la ergometría es uno de los instrumentos fundamentales en el campo médico deportivo. Puede ser empleada en la planificación del entrenamiento deportivo e igualmente, en el diagnóstico y la recuperación de la salud en los individuos enfermos, así como en el mantenimiento del bienestar físico en la persona sana, de cualquier grupo de edad. Objetivo: Fundamentar la importancia de la ergometría cardiovascular en apoyo a la cultura física y el deporte. Métodos: Se realizó una revisión de literatura científica y trabajos investigativos relacionados con los temas de cultura física y deporte en relación con la ergometría. Se revisaron los trabajos publicados actualmente en Medline con la interfaz PubMed. Desarrollo: La ergometría cardiovascular permite valorar indicadores fiables antes de iniciar toda práctica deportiva. Esto garantiza la implementación de planes de entrenamiento dirigidos sobre bases científicas y evidencia la elevación del rendimiento deportivo, de la calidad de vida y la salud. Conclusiones: La ergometría es una herramienta científico-tecnológica que permite avalar un inicio y mantenimiento eficaz del entrenamiento deportivo individualizado. Es necesaria para la implementación de un correcto programa de ejercicios físicos, que tiene como objetivos promover salud y mejorar los componentes de la aptitud física relacionados con la salud y la rehabilitación(AU)

Introduction: Physical culture and sports are of great importance in strengthening human health and in preventing disease and aging processes. Within the scientific-technological tools used by applied sciences, ergometry is one of the fundamental instruments in the sports medical field. It can be used in the planning of sports training and also in the diagnosis and recovery of health in sick individuals, as well as in the maintenance of physical well-being in the healthy person, of any age group. Objective: To prove the importance of cardiovascular ergometry in support of physical culture and sports. Methods: A review of scientific literature and research works related to the topics of physical culture and sports as to exercise testing was carried out. Articles currently published in Medline with the PubMed interface were reviewed. Findings: Cardiovascular ergometry allows to assess reliable indicators before starting any sports practice. This guarantees the implementation of specific training plans founded on scientific bases, which evidences the rise of sports performance, quality of life and health. Conclusions: Ergometry is a scientific-technological tool that allows to guarantee an effective start and maintenance of individualized sports training. It is necessary for the implementation of correct physical exercise programs, which aims to promote health and improve the components of physical fitness related to health and rehabilitation(AU)

Consideraciones médicas entorno a la reincorporación deportiva después de la COVID-19 / Medical considerations around sports resuming after COVID-19

RESUMEN Introducción: El 11 de marzo de 2020 se declaró por la Organización Mundial de la Salud (OMS) a la enfermedad causada por el coronavirus SARS-COV-2, la COVID-19, como pandemia global. Tanto en Cuba como en el mundo los gobiernos han dictado medidas para proteger la salud de sus habitantes. La alta capacidad de transmisión del germen y su elevada morbi-mortalidad ha tenido como consecuencia profundas afectaciones en todos los ámbitos de la sociedad, y el deporte no ha escapado de esta realidad. Objetivos: Definir los niveles de riesgo de contagio según deporte; elaborar recomendaciones generales de prevención respecto a la reincorporación deportiva en la etapa post COVID-19 y establecer las medidas para la realización de las pruebas ergométricas cardiovasculares a los deportistas. Métodos: Se realizó una revisión de literatura científica y trabajos investigativos relacionados con los temas de la ergometría en el contexto deportivo y la reincorporación de los atletas en la etapa después del COVID-19. Desarrollo: Se elaboraron las medidas en cuanto a acciones a seguir para evitar, tras la reanudación de la práctica deportiva, los contagios entre deportistas y personal que le acompaña, tanto en entrenamiento como en pruebas funcionales cardiorrespiratorias. Conclusiones: La reincorporación al entrenamiento deportivo y la realización de las pruebas cardiopulmonares deben cumplir con las recomendaciones entorno a la reanudación de la actividad atlética, donde será la prioridad minimizar los contagios por virus SARS-COV-2 y reducir la incidencia de las lesiones en los deportistas sometidos a un largo período de aislamiento.

ABSTRACT Introduction: On March 11, 2020, the disease caused by SARS-COV-2 coronavirus, COVID-19, was declared a global pandemic by the World Health Organization (WHO). Both in Cuba and in the world, governments have issued measures to protect the health of its inhabitants. The high transmission capacity of the germ and its high morbidity and mortality have had profound effects on all areas of society, and sport has not escaped this reality. Objectives: Define the levels of contagion risk according to sport; to develop general prevention recommendations regarding sports reincorporation in the post-COVID-19 stage and to establish measures for performing cardiovascular ergometric tests on athletes. Methods: A review of scientific literature and research papers was carried out on exercise testing in the sports context and the returning of athletes in the post-COVID-19 stage. Findings: Measures were drawn up in terms of actions to follow for avoiding contagion between athletes and accompanying personnel, after resuming sports practice, both in training and in cardiorespiratory functional tests. Conclusions: The return to sports training and the performance of cardiopulmonary tests must comply with the recommendations regarding the resumption of athletic activity, where it will be the priority to minimize infections by SARS-COV-2 virus and to reduce the incidence of injuries in athletes subjected to a long period of distancing.

Ecoestresse físico na cardiomiopatia hipertrófica: como, quando e por quê? / Exercise stress echocardiography in hypertrophic cardiomyopathy: how, when and why?

Resumo Historicamente, o papel do ecocardiograma de estresse físico no manejo da cardiomiopatia hipertrófica tem sido negligenciado na prática clínica, de acordo com a análise das diretrizes do American College of Cardiology/ American Heart Association de 2002, que recomendavam cautela no uso dessa metodologia, em portadores de cardiomiopatia hipertrófica, devido ao risco de possível ocorrência tanto de arritmia cardíaca, como de colapso hemodinâmico no esforço. Atualmente, o estresse físico na cardiomiopatia hipertrófica integra a avaliação rotineira de pacientes sintomáticos com ou sem gradiente da via de saída do ventrículo esquerdo < 50 mmHg, em repouso. Para este grupo, é um método seguro e confiável para medir o gradiente da via de saída do ventrículo esquerdo durante o esforço e sólido diferenciador de pacientes com cardiomiopatia hipertrófica não obstrutivos (gradiente ausente, tanto em repouso quanto no esforço) daqueles com gradientes lábeis (gradiente ausente no repouso e presente no esforço). Portanto, na avaliação da cardiomiopatia hipertrófica, o estresse físico é igualmente útil na quantificação do grau de regurgitação mitral, nas alterações da contratilidade segmentar do ventrículo esquerdo e na avaliação da função diastólica do ventrículo esquerdo, diante do esforço, sendo capaz de predizer o futuro desenvolvimento de sintomas de insuficiência cardíaca. O método é também importante na determinação das diferentes estratégias de tratamento para cada paciente, desde a miomectomia cirúrgica ou a ablação septal alcoólica, para aqueles com gradiente lábil, com sintomas limitantes e refratários ao tratamento medicamentoso versus transplante cardíaco para aqueles sem gradiente.(AU)

Uso de teorias e metodologias para atuação com grupos na atenção básica / Use of theories and methodologies for group work in primary care / Uso de teorías y metodologías para la actuación con grupos en la atención básica

As práticas em grupo representam significativa parcela da assistência na atenção básica por meio das políticas de educação em saúde. Há uma diversidade de dispositivos para atuação em grupo e, portanto, cabe ao profissional no processo de trabalho da equipe, a escolha do referencial e da metodologia utilizada nessas práticas. Esta pesquisa pretendeu identificar a compreensão de profissionais da estratégia de saúde da família sobre a prática com grupos na atenção básica. Este artigo compõe uma pesquisa-ação de abordagem qualitativa, realizada com 39 profissionais de diversas categorias atuantes em equipes de saúde do município de Blumenau (SC). Para a produção de dados foram realizados oito grupos focais gravados em áudio e transcritos para posterior análise de conteúdo embasada nos processos grupais de Enrique Pichon-Rivière e pressupostos da ergologia de Ives Schwartz. A maioria dos profissionais demonstraram dificuldades em sugerir teorias, técnicas ou metodologias de trabalho com grupos. A minoria reconheceu o termo 'grupo operativo', contudo nenhum associou ao teórico Pichon-Rivière. As metodologias tradicionais foram referidas como as mais utilizadas, porém a pesquisa constituiu um espaço de debate das normas e práticas grupais dos profissionais. Foi concluído a necessidade de capacitação para desenvolver trabalhos com grupos diante do pouco conhecimento teórico, metodológico e vivencial.

Group practices are a significant part of primary care, enacted via health education policies. Given the wide diversity of devices for group work, it is up to the professional responsible for the work process to choose the framework and methodology to be used in these group practices. This study investigates the professionals' perception of the Family Health Strategy regarding group practices in primary care. A qualitative action research was conducted with 39 professionals from several categories working in health teams in the city of Blumenau, Santa Catarina, Brazil. Data were collected by means of eight focal groups, audio recorded and transcribed for later content analysis based on Enrique Pichon-Rivière's group processes and Ives Schwartz's ergology assumptions. Most professionals had difficulties in suggesting theories, techniques, or methodologies for working with groups. Few of them recognized the term 'operative group,' but none associated it with psychiatrist Pichon-Rivière. Traditional methodologies were referred to as being widely used, but the research constituted a space for debating the norms and group practices of the professionals. Given the little theoretical, methodological, and experience knowledge evidenced, the text points to a need for training to develop group practices.

Las prácticas grupales representan significativa parte de la asistencia en la atención básica a través de las políticas de educación en salud. Existe una diversidad de dispositivos para actuación en grupo, por lo tanto, le corresponde al profesional en el proceso de trabajo del equipo elegir el referencial y la metodología que serán utilizados en esas prácticas grupales. Esta investigación pretendió identificar la comprensión de profesionales de la Estrategia Salud Familiar sobre la práctica con grupos en la atención básica. Este artículo forma parte de una investigación-acción de abordaje cualitativo, realizada con 39 profesionales de diversas categorías actuantes en equipos de salud del municipio de Blumenau, Santa Catarina (Brasil). Para la producción de datos se realizaron ocho grupos focales grabados en audio y transcritos, para posterior análisis de contenido basado en los procesos grupales de Enrique Pichon-Rivière y presupuestos de la ergología de Ives Schwartz. La mayoría de los profesionales demuestran dificultades en apuntar teorías, técnicas o metodologías de trabajo con grupos. La minoría reconoció el término 'grupo operativo', pero ninguno estuvo asociado al teórico Pichon-Rivière. Las metodologías tradicionales fueron las más utilizadas, sin embargo, la investigación constituyó un espacio de debate de las normas y prácticas grupales de los profesionales. Se concluyó la necesidad de capacitación para desarrollar trabajos con grupos frente al poco conocimiento teórico, metodológico y vivencial.

Proposal of accuracy analysis of indoor tracking systems in basketball / Proposta de análise de precisão de sistemas de rastreamento interno em basquetebol

ABSTRACT The development of tracking technology caused a exponentially grow-up of research into this topic. The use of standardized methodologies is useful to contrast data of different studies. On the other hand, a low-cost reference system is needed. For this reason, the main aim of the present research is the description of a specific protocol to accuracy assessment of tracking location in indoor conditions in basketball. It can resume in three steps with detailed and easily procedures in the method section. The accuracy analysis method presented can report the centimeter of accuracy in each coordinate that the tracking system measure. A standardized protocol to evaluate the location on indoor conditions in basketball will provide to the sport science professionals a useful tool to analyze the accuracy and reliability of all tracking system, being the results can compare both within and between-court.

RESUMO O desenvolvimento da tecnologia de rastreamento causou um crescimento exponencial das pesquisas sobre esse tópico. O uso de metodologias padronizadas é útil para contrastar dados de diferentes estudos. Por outro lado, é necessário um sistema de referência de baixo custo. Por este motivo, o principal objetivo da presente pesquisa é a descrição de um protocolo específico para avaliação da acurácia do rastreamento de localização em condições internas no basquete. Pode retomar em três etapas com procedimentos detalhados e fáceis na seção do método. O método de análise de precisão apresentado pode relatar o centímetro de precisão em cada coordenada medida pelo sistema de rastreamento. Um protocolo padronizado para avaliar a localização em condições internas no basquetebol fornecerá aos profissionais de ciências do esporte uma ferramenta útil para analisar a precisão e a confiabilidade de todo o sistema de rastreamento, sendo que os resultados podem ser comparados dentro e entre as quadras.

The validity of Keiser-M3 stationary bicycle with standard ergometer for physiological measurements associated with maximum effort

Abstract Aim: This study aims to investigate the concordance between two cycle ergometers for variables measured in the test of maximum incremental effort. Methods: This correlation study enrolled 15 inactive women (19,2 ± 4,0 years old). At random, the participants performed two maximal effort incremental tests (MEIT), using cycle ergometers (Keiser-M3 and Ergo-167) on different days with a minimum interval of 72 hours. The test had stages of two minutes, and two-step increments were carried out at the end of each stage. Lactate concentration ([LAC]), and rated perceived exertion (RPE) were collected, in addition to monitoring oxygen uptake (VO2) and heart rate (HR). The Paired t-test was carried out to compare physiologic variables, Lin's test was used for correlation, and Bland Altman was used to measuring concordances among variables. Results: The correlations between physiologic parameters were considered strong for HR on the anaerobic threshold (Keiser M3 = 146 ± 14 bpm; Ergo-167 = 149 ± 9 bpm; r = 0.762), greater blood lactate value (Keiser M3 = 9,97 ± 2,51 mmol/L; Ergo-167 = 9.71 ± 2.56 mmol/L; r = 0.820), VO2max (Keiser M3 = 38,37 ± 6,97 mL/kg/min; Ergo-167 = 36.06 ± 8.4 mL/kg/min; r = 0,806) and HRmax (Keiser M3 = 186 ± 53 bpm; Ergo-167 = 188 ± 11 bpm; r = 0.716). Conclusion: The results show the feasibility of using the cycle ergometer Keiser, model M3, to perform the maximal effort incremental test, whereas there was high concordance in the physiologic responses in both ergometers for inactive women.

Evaluation of two models of saddles on the back of Arabian horses through thermography / Avaliação de dois modelos de selas sobre o dorso de cavalos Árabes com o emprego da termografia

Dorsopathies are common causes of decreased performance in athletic horses of various modalities, and inadequate or poorly adjusted saddles can lead to the onset of injuries and low back pain. The present study, searching to find the most appropriate saddle, evaluated the pressure determined from the panels of two saddle models most commonly used in endurance Arab horse on the thoracolumbar region. For the study, six Arabian geldings were used, weighing 390 ± 4.2 and 2.1 ± age 8 years, conditioned to endurance races, and two saddle models, English and Western. The horses were submitted to the work riding on a sandy lane by the same experienced rider who weighed 76 kg. Thermography was performed before and after each exercise session. The obtained data were analyzed through Student's paired t-test at 5% of significance. After exercise, there was a mean temperature difference between the contact areas of the right and left of the sweepers of two saddles compared, with the English saddle showing higher temperatures. Therefore, the Western saddle model, which has wider panels, despite not being a preferred model of endure riders, has proved to be more suitable for Arabian horse work.(AU)

As dorsopatias são causas comuns de diminuição de desempenho em cavalos atletas de várias modalidades e a sela inadequada ou mal ajustada pode levar ao aparecimento de lesões e dor lombar. O presente trabalho avaliou a pressão que os suadores dos dois modelos de sela mais comumente utilizados em cavalos Árabes de enduro exercem sobre a região toracolombar desses animais de modo a sugerir o uso do que fosse mais adequado. Foram utilizados seis cavalos da raça Árabe, machos castrados, com peso de 390 ± 4,2 e idade 8 ± 2,1 anos, condicionados para as provas enduro de velocidade livre e dois modelos de sela, a Inglesa e a Western. Os cavalos foram submetidos ao trabalho montado em pista de areia pelo mesmo cavaleiro, experiente, que pesou 76 kg. Foi realizada a termografia antes e depois das sessões de exercício. Os dados obtidos foram analisados através de teste T pareado de Student a 5% de significância. Houve diferença de temperatura média, após o exercício, entre as áreas de contato dos suadores direito e esquerdo da sela Inglesa e da sela Western, quando comparados, sendo que a sela Inglesa apresentou maiores temperaturas. Portanto, o modelo de sela Western, que possui suadores largos, embora não seja o modelo de preferência dos cavaleiros de enduro, mostrou-se mais adequado para o trabalho de cavalos Árabes.(AU)

Is a short-stage protocol during an incremental exercise test reliable for heart rate variability threshold analysis?

Aim: Heart rate variability threshold (HRVT) is a valid method to determine parasympathetic depression during an incremental exercise test (IET). However, HRVT is usually assessed using the last 60s of each 180s stage of an IET, resulting in longer and demotivating tests. This study aimed to evaluate the agreement of HRVT analysis adopting the first and second minute of R-R interval (iRR) segment comparatively to a standard third-minute segment obtained at each 3-min stage on IET. Methods: Seventeen young male subjects (22.2 ± 3.1 years; 23.4 ± 2.3 kg/m2) underwent IET on a cycle ergometer. HRVT was considered the load corresponding to the point of stabilization of the SD1 index (HRVTV), or the first load with SD1 value < 3ms (HRVT<3), both assessed by the 1st (HRVT1V, HRVT1<3), 2nd (HRVT2V, HRVT2<3) and standard 3rd (HRVT3V, HRVT3<3) 60s iRR segment analyzed at each stage of IET. Agreement and reliability were assessed by the Bland-Altman analysis and the intraclass correlation coefficient (ICC), respectively. Results: High reliability and non-significant bias were observed considering HRVT1V vs HRVT3V (ICC = 0.92; p = 0.18) or HRVT2V vs HRVT3V (ICC = 0.94; p = 0.99). However, lower reliability was observed for HRVT1<3 vs HRVT3<3 (ICC = 0.79; p = 0.75) and for HRVT2<3 vs HRVT3<3 (ICC = 0.91; p = 0.33). Conclusion: HRVT can be similarly assessed by the 1st, 2nd or 3rd 60 seconds iRR segment, mainly when assessed by a visual method.(AU)

Riesgo de hipertensión arterial en individuos hiperreactivos cardiovasculares / Risk of high blood pressure in hyperreactive cardiovascular individuals

Resumen Objetivo Determinar el riesgo de padecer hipertensión arterial en individuos normotensos con hiperreactividad cardiovascular, identificados mediante la ergometría isométrica. Material y métodos Se desarrolló un estudio de cohorte, de cinco años de evolución, con un total de 419 personas; de ellas, 215 normorreactivos cardiovasculares y 204 hiperreactivos cardiovasculares. Se determinó el riesgo relativo que tienen los individuos hiperreactivos cardiovasculares de ser hipertensos y el peso de la hiperreactividad cardiovascular en la aparición de hipertensión arterial; se fijó un nivel de significación estadística de p igual 0.05. Resultados La frecuencia de nuevos hipertensos en la cohorte de hiperreactivos cardiovasculares respecto a los normorreactivos cardiovasculares fue dos veces superior (RR: 2.23 IC95% 1.42;3.51). La hiperreactividad cardiovascular fue la variable de mayor influencia. Conclusiones Los individuos normotensos hiperreactivos cardiovasculares tienen mayor riesgo de hipertensión arterial que los normotensos normorreactivos cardiovasculares.

Abstract Objective To determine the risk of high blood pressure in cardiovascular hyperreactive individuals identified by the isometric hand-held weight test. Materials and methods A prospective cohort study was conducted for 5 years, including a total of 419 individuals. Of them, 215 were normoreactive and 204 hyperreactive. The relative risk of hypertension in the hyperreactive individuals and the contribution of cardiovascular hyperreactivity to the development of high blood pressure were determined. The significance level was 0.05. Results The frequency of new hypertension cases after five years was twice as high in the cohort of hyperreactive subjects compared to the cohort of normoreactive subjects (RR 2.23, 95%CI 1.42, 3.51). The cardiovascular hyperreactivity was the most important variable for predicting of the high blood pressure (OR: 2.73; 95%CI 1.59, 4.54). Conclusions Cardiovascular hyperreactive individuals have a higher risk of high blood pressure than normorreactive individuals.

The Role of Tiotropium+Olodaterol Dual Bronchodilator Therapy in the Management of Chronic Obstructive Pulmonary Disease / 결핵

Bronchodilator therapy is central to the management of chronic obstructive pulmonary disease and are recommended as the preferred treatment by the Global Obstructive Lung Disease Initiative (GOLD). Long acting anti-muscarinics (LAMA) and long acting β₂ agonists (LABA) are both more effective than regular short-acting drugs but many patients remain symptomatic despite monotherapy with these drugs. Combination therapy with LAMA and LABA increases the therapeutic benefit while minimizing dose-dependent side effects of long-acting bronchodilator therapy. The TOviTO programme has investigated the benefits of treatment with a combination of tiotropium and olodaterol administered via a single inhaler. Tiotropium+olodaterol 5/5 µg significantly improved forced expiratory volume in 1 second (FEV₁) area under the curve from 0 to 3 hours, trough FEV₁ health status and breathlessness versus the mono-components and placebo. Tiotropium+olodaterol 5/5 µg also increased endurance time and reduced dynamic hyperinflation during constant work rate cycle ergometry. On the basis of these and other studies the 2017 GOLD report recommends escalating to dual bronchodilator therapy in patients in groups B and C if they remain symptomatic or continue to have exacerbations and as initial therapy for patients in group D.

Upper extremity temporospatial parameters and kinematics of Filipino track and field paralympians during wheelchair Propulsion: An analysis using a Kinect-based markerless motion analysis system

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The potential of a low-cost, novel Kinect?-based markerless motion analysis system as a tool to measure temporospatial parameters, joint and muscle kinematics, and hand trajectory patterns during the propulsion and recovery phase of wheelchair propulsion (WCP) was determined.</p><p style="text-align: justify;"><strong>METHODS:</strong>Twenty (20) adult male track and field paralympians,(mean age = 36 ± 8.47) propelled themselves on a wheelchair ergometer system while their upper extremity motion was recorded by two Kinect? cameras and processed.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The temporospatial parameters, joint kinematics, and hand trajectory patterns during the propulsion and recovery phase of each participant's WCP cycle were determined and averaged. Average cycle time was 1.45s ± 0.19, average cadence was 0.70 cycles/s ± 0.09, and average speed was 0.76m/s ± 0.32. Average shoulder flexion was 30.99° ± 28.38, average elbow flexion was 24.23° ± 12.25, and average wrist flexion was 12.82° ± 26.78. Eighty five percent (85%) of the participants used a semicircular hand trajectory pattern.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The low-cost, novel Kinect?-based markerless motion analysis system had the potential to obtain measurable values during independent wheelchair propu

A cycle ergometer exercise program improves exercise capacity and inspiratory muscle function in hospitalized patients awaiting heart transplantation: a pilot study

Abstract Objective: The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods: Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results: Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P =0.08 and P =0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P <0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P =0.22 and P <0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P <0.01). Conclusion: Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support.

Alternative Physical Therapy Protocol Using a Cycle Ergometer During Hospital Rehabilitation of Coronary Artery Bypass Grafting: a Clinical Trial

ABSTRACT OBJECTIVE: To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting. METHODS: A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention. RESULTS: Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2vs. 249.7; P=0.06). CONCLUSION: There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings.

Abordagem e tratamento da estenose aórtica assintomática / Evaluation and treatment of asymptomatic aortic stenosis

A estenose aórtica degenerativa representa atualmente a valvopatia mais frequente nos países desenvolvidos, com prevalência de 3% a 5% na população acima dos 75 anos de idade. Do ponto de vista epidemiológico, o Brasil apresenta distribuição bimodal da prevalência de estenose aórtica, aco- metendo idosos (etiologia calcifica/degenerativa) e faixas etárias mais jovens, devido, sobretudo, à febre reumática e alterações congênitas (valvas bicúspides). Clinicamente, a estenose aórtica caracteriza-se por sintomas de insufici- ência cardíaca esquerda associados à dor torácica anginosa e síncope. Atualmente, observamos um crescente interesse no manejo da estenose aórtica degenerativa sem sintomas. A análise do perfil dos portadores de estenose aórtica assin- tomáticos revela grande heterogeneidade clínica. Diversos estudos descrevem preditores de mau prognóstico para estes pacientes, os quais devem ser levados em conta na estratificação de risco e definição do momento ideal para a intervenção cirúrgica.

Degenerative aortic stenosis is currently the most common valvular heart disease in developed countries, with prevalence ranging from 3 to 5% in the population above 75 years of age. From an epiderniological perspective, Brazil has a classical bi- modal distribution of the prevalence of aortic stenosis, affecting both elderly (calcification/degenerative etiology) and younger age groups, especially due to rheumatic fever and congenital abnormalities (bicuspid valves). Clinically, aortic stenosis is characterized by symptoms of left heart failure associated with anginal chest pain and syncope. Currently, we could observe an increasing interest in the management of degenerative aor- tic stenosis without symptoms. The analysis of the profile of asymptomatic aortic stenosis shows great clinical heterogeneity. Several studies describe predictors of poor prognosis for these patients, which should be taken into account in risk stratification and definition of the optimal time for surgical intervention.