Muscle oxygenation of the quadriceps and gastrocnemius during maximal aerobic effort / Oxigenación muscular de cuádriceps y gastrocnemio durante el esfuerzo aeróbico máximo / Oxigenação muscular de quadríceps e gastrocnêmio durante o esforço aeróbico máximo

ABSTRACT Introduction: Near infrared spectroscopy (NIRS) is a non-invasive technique that is used in the assessment of tissue oxygenation and the monitoring of physical activity. Objective: To determine the influence of sexual, anthropometric and ergospirometric factors on muscle oxygenation of the quadriceps and gastrocnemius, obtained by NIRS during a stress test. Methods: Twenty healthy subjects participated in this study (10 women). Two Humon Hex® devices were placed on the dominant side of the quadriceps and gastrocnemius muscles to measure muscle oxygen saturation (SmO2). The stress test was performed on a treadmill with electrocardiographic control and measurement of oxygen consumption. SmO2 was obtained at rest and after maximum effort during the stress test. In addition, the height, weight, skinfold and waist contour were measured. Bioimpedance was used to obtain the percentages of fat mass and muscle mass, which were used to calculate the relative fat mass (RFM). Results: The SmO2 of both muscles at rest is higher in males than in females. At maximum effort, the SmO2 of the quadriceps is similar in both groups. The SmO2 of both muscles is positively related to height, body mass, percentage of mass muscle and waist contour, and negatively with percentage of mass fat, RFM and skinfold thickness. The negative correlation between fat percentage and oxygen saturation is more evident in females. It was observed that the variables that quantify maximum effort are not related to the SmO2 values, except for the correlation between HR max and SmO2 of the gastrocnemius muscle in males. Conclusion: The SmO2 of recreational athletes is influenced by the location of the device and the fat mass of the subjects. The biggest differences between the sexes are in the gastrocnemius muscle. Level of Evidence II; Diagnostic Studies - Investigating a Diagnostic Test .

RESUMEN Introducción: La espectroscopia de infrarrojo cercano (NIRS) es una técnica no invasiva usada en la evaluación de la oxigenación tisular y en la monitorización de la actividad física. Objetivos: Determinar la influencia de factores sexuales, antropométricos y ergoespirométricos sobre la oxigenación muscular de cuádriceps y del gastrocnemio, obtenidos por NIRS durante un test de esfuerzo. Métodos: Participaron en este estudio 20 individuos saludables (10 mujeres). Se colocaron dos dispositivos Humon Hex® en el lado dominante de los músculos cuádriceps y gastrocnemio para medir la saturación de oxígeno muscular (SmO2). El test de esfuerzo fue realizado en una cinta ergométrica con control electrocardiográfico y medición del consumo de oxígeno. La SmO2 fue obtenida en reposo y después de esfuerzo máximo durante el test. Además, fueron medidos altura, peso, pliegues cutáneos y contorno de la cintura. Fue usada bioimpedancia para obtener los porcentuales de masa grasa y masa muscular, que fueron usados para calcular la masa grasa relativa (MGR). Resultados: La SmO2 de ambos músculos en reposo es mayor en hombres que en mujeres. En el esfuerzo máximo la SmO2 del cuádriceps es semejante en los dos grupos. La SmO2 de ambos músculos es positivamente relacionada con altura, masa corporal, porcentual de masa muscular y contorno de la cintura y negativamente relacionada con el porcentaje de masa grasa, MGR y espesor de los pliegues cutáneos. La correlación negativa entre el porcentual de grasa y la saturación de oxígeno es más evidente en las mujeres. Se observó que variables que cuantifican el esfuerzo máximo no está relacionadas con los valores SmO2, excepto por la correlación entre FCmáx y SmO2 del músculo gastrocnemio en sexo masculino. Conclusión: La SmO2 de los atletas recreativos es influenciada por la localización del dispositivo y por la masa grasa de los individuos. Las mayores diferencias entre los sexos están en el músculo gastrocnemio. Nivel de Evidencia II; Estudios diagnósticos - Investigación de un examen para diagnóstico .

RESUMO Introdução: A espectroscopia de infravermelho próximo (NIRS) é uma técnica não invasiva usada na avaliação da oxigenação tecidual e no monitoramento da atividade física. Objetivos: Determinar a influência de fatores sexuais, antropométricos e ergoespirométricos sobre a oxigenação muscular do quadríceps e do gastrocnêmio obtidos por NIRS durante um teste de esforço. Métodos: Participaram deste estudo 20 indivíduos saudáveis (10 mulheres). Dois dispositivos Humon Hex® foram colocados no lado dominante dos músculos quadríceps e gastrocnêmio para medir a saturação de oxigênio muscular (SmO2). O teste de esforço foi realizado em uma esteira com controle eletrocardiográfico e mensuração do consumo de oxigênio. A SmO2foi obtida em repouso e depois de esforço máximo durante o teste. Além disso, foram medidos estatura, peso, dobras cutâneas e contorno da cintura. A bioimpedância foi usada para obter os percentuais de massa gorda e massa muscular, que foram usados para calcular a massa gorda relativa (MGR). Resultados: A SmO2de ambos os músculos em repouso é maior em homens do que em mulheres. No esforço máximo, a SmO2do quadríceps é semelhante nos dois os grupos. A SmO2de ambos os músculos é positivamente relacionada com estatura, massa corporal, percentual de massa muscular e contorno da cintura e negativamente relacionada com a porcentagem de massa gorda, MGR e espessura das dobras cutâneas. A correlação negativa entre o percentual de gordura e a saturação de oxigênio é mais evidente nas mulheres. Observou-se que variáveis que quantificam o esforço máximo não estão relacionadas com os valores SmO2, exceto pela correlação entre FCmáx e SmO2do músculo gastrocnêmio no sexo masculino. Conclusão: A SmO2dos atletas recreativos é influenciada pela localização do dispositivo e pela massa gorda dos indivíduos. As maiores diferenças entre os sexos estão no músculo gastrocnêmio. Nível de Evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico .

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

Effect of an interdisciplinary intervention with motivational approach on exercise capacity in obese adolescents: a randomized controlled clinical trial / Efeito de intervenção interdisciplinar com abordagem motivacional na capacidade de exercício em adolescentes obesos: ensaio clínico controlado randomizado

ABSTRACT Objective To evaluate the effect of an interdisciplinary intervention with a motivational approach on exercise capacity and usual physical activity levels in overweight and obese adolescents. Methods This is a randomized, controlled clinical trial with single blinding of subjects. Adolescents aged 15 to 18 years with overweight and obesity (body mass index ≥ 85 percentile) were included. The adolescents were randomized into two groups: interdisciplinary intervention or control − traditional approach aiming at lifestyle modifications. The initial evaluations were carried out, including the cardiopulmonary exercise test and the physical activity level measurement by using the International Physical Activity Questionnaire and a pedometer. The evaluations were performed in two moments: time zero (time of inclusion in the study) and after 3 months (end of intervention). There were 12 sessions with weekly meetings. Results A total of 37 participants were included, 19 in the Intervention Group. There were no significant differences in the baseline demographic, anthropometric and physical activity characteristics between groups, with mean age of 17.3±1.0 years in the Control Group, and 16.8±0.9 years in the Intervention Group (p=0.14). The motivational intervention did not cause significant differences (p>0.05) in the comparison of the variables of exercise capacity and usual physical activity (questionnaire and pedometer) between groups. Conclusion The intervention with a motivational approach did not alter exercise capacity and levels of usual physical activity in overweight and obese adolescents. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.

RESUMO Objetivo Avaliar o efeito de uma intervenção interdisciplinar com abordagem motivacional na capacidade de exercício e no nível de atividade física habitual em adolescentes com sobrepeso e obesidade. Métodos Trata-se de ensaio clínico controlado, randomizado, com cegamento único dos indivíduos. Foram incluídos adolescentes com idade entre 15 e 18 anos, com sobrepeso e obesidade (índice de massa corporal ≥ percentil 85). Os adolescentes foram randomizados em dois grupos: intervenção interdisciplinar motivacional ou controle − abordagem tradicional, visando à modificação do estilo de vida. Foram realizadas as avaliações iniciais incluindo o teste de exercício cardiopulmonar e a aferição do nível de atividade física por meio do International Physical Activity Questionnaire e do pedômetro. As avaliações foram realizadas em dois momentos, no tempo zero (inclusão no estudo) e após 3 meses (término da intervenção). Foram realizadas 12 sessões com encontros semanais. Resultados Foram incluídos 37 participantes, sendo 19 no Grupo Intervenção. Não houve diferenças significativas nos dados basais de características demográficas, antropométricas e de atividade física entre os grupos, e a média de idade foi de 17,3±1,0 anos no Grupo Controle e 16,8±0,9 anos no Intervenção (p=0,14). A intervenção motivacional não provocou diferenças significativas (p>0,05) na comparação das variáveis de capacidade de exercício e atividade física habitual (questionário e pedômetro) entre os grupos. Conclusão A intervenção com abordagem motivacional não alterou a capacidade de exercício e os níveis de atividade física habitual em adolescentes com sobrepeso e obesidade. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.

Construct validity and reproducibility of the six-minute step test in subjects with obstructive sleep apnea treated with continuous positive airway pressure / Validação de constructo e reprodutibilidade do teste de degrau de seis minutos em indivíduos com apneia obstrutiva do sono tratados com pressão positiva contínua nas vias aéreas

ABSTRACT Objective: To evaluate the construct validity and reproducibility of the six-minute step test (6MST) in individuals with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Methods: We evaluated 48 volunteers diagnosed with OSA and treated with CPAP for at least two months. The volunteers underwent the six-minute walk test (6MWT) and the 6MST, in random order and on different days, with an interval of, at most, seven days between the two tests. Results: A moderate positive correlation was found between the distance walked on the 6MWT and the number of steps climbed on the 6MST (r = 0.520; p < 0.001). There was no significant difference between the two 6MSTs in terms of the number of steps climbed (121.7 ± 27.1 vs. 123.6 ± 26.7). Reproducibility for performance on the 6MST and for cardiovascular variables was considered excellent (intraclass correlation coefficient > 0.8). Regarding cardiovascular responses, the 6MST produced higher values than did the 6MWT for HR at six minutes, percent predicted maximum HR, and leg fatigue at six minutes, as well as for systolic blood pressure at six minutes and at one minute of recovery. Conclusions: The 6MST is valid and reproducible, producing greater cardiovascular stress than does the 6MWT. However, the 6MST is also characterized as a submaximal test for the assessment of exercise tolerance in individuals with OSA treated with CPAP.

RESUMO Objetivo: Avaliar a validade do constructo e a reprodutibilidade do teste de degrau de seis minutos (TD6) em indivíduos com apneia obstrutiva do sono (AOS) tratados com continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas). Métodos: Foram avaliados 48 voluntários com diagnóstico de AOS e tratados com CPAP há, no mínimo, dois meses. Os voluntários foram submetidos ao teste de caminhada de seis minutos (TC6) e ao TD6, em ordem aleatória e em dias diferentes, com um intervalo de, no máximo, sete dias entre os dois testes. Resultados: Foi observada uma correlação positiva moderada entre a distância percorrida no TC6 e o número de subidas no TD6, (r = 0,520; p < 0,001). Não foram encontradas diferenças significativas no número de subidas entre os dois TD6 (121,7 ± 27,1 vs. 123,6 ± 26,7 degraus). A reprodutibilidade para o desempenho no TD6 e para as variáveis cardiovasculares foi considerada excelente (coeficiente de correlação intraclasse > 0,8). Com relação às respostas cardiovasculares, quando comparado ao TC6, o TD6 apresentou maiores valores em relação a FC no sexto minuto, percentual do predito da FC máxima, fadiga de membros inferiores no sexto minuto e pressão arterial sistólica no sexto minuto e no primeiro minuto da fase de recuperação. Conclusões: O TD6 é válido, reprodutível e causa maior estresse cardiovascular quando comparado ao TC6. No entanto, o TD6 também se caracteriza como um teste submáximo para a avaliação da tolerância ao esforço em indivíduos com AOS tratados com CPAP.

Influência da reabilitação pulmonar no paciente com Doença Pulmonar Obstrutiva Crônica fenótipo exacerbador / Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype

RESUMO Objetivo Verificar se existem diferenças em pacientes com doença pulmonar obstrutiva crônica (DPOC) fenótipos exacerbador e não exacerbador submetidos a um programa de reabilitação pulmonar (PRP). Métodos Estudo retrospectivo de vida real que incluiu pacientes com DPOC da rede pública de atendimento ambulatorial em nível de atenção primária, que completaram o PRP, com duração de 12 semanas, três vezes por semana. Todos foram avaliados antes e depois do PRP, por meio do teste de caminhada dos seis minutos (TC6min), índice de dispneia (mMRC), qualidade de vida e índice BODE. Resultados Dos 151 pacientes analisados, a média de idade foi 65,0 ± 8,1 anos e a média VEF1% do predito foi de 39,8 ± 15,9. O gênero predominante foi o masculino (66,9%). Desses pacientes, 31 (20,5%) eram fenótipo exacerbador. Houve melhora significativa na média da distância percorrida no TC6min em ambos os grupos, sendo a maior mudança observada no grupo exacerbador [mΔ(IC95%): 84,9 (57,1-112,6) vs. 48,6 (37-60,2); p = 0,018]. Redução significativa da dispneia pela escala mMRC ocorreu em ambos os grupos, sendo de maior intensidade no grupo exacerbador [mΔ(IC95%): -0,8 (-1,11 a 0,51) vs. -1,6 (-2,20 a -1,13); p = 0,006]. Melhora no índice BODE ocorreu em ambos os grupos, mas a variação média também foi significativamente maior no grupo exacerbador [mΔ(IC95%): -1,44 (-2,17 a -0,70); p = 0,045]. Conclusão Os pacientes com DPOC fenótipo exacerbador apresentaram maior magnitude de resposta ao PRP (36 metros) quando comparados ao não exacerbador, independentemente da gravidade da obstrução do fluxo aéreo, impactando a melhora no prognóstico medido pelo índice BODE.

ABSTRACT Objective To verify if there are differences in Chronic Obstructive Pulmonary Disease (COPD) patient exacerbator and non-exacerbator phenotypes undergoing a Pulmonary Rehabilitation Program (PRP). Methods A real life retrospective study included outpatients with COPD from public primary care who completed a 12-weeks PRP, three times a week. All were assessed before and after PRP using the six-minute walk test (6MWT), the modified Medical Research Council (mMRC) dyspnea index, quality of life and Body-mass Index, airflow Obstruction, Dyspnea and Exercise (BODE index). Results A total of 151 patients were analyzed and mean age was 65.0 ± 8.1 years and mean Forced Expiratory Volume (FEV) 1% of predicted was 39.8 ± 15.9. The predominant gender was male (66.9%). Of these patients 31 (20.5%) were exacerbator phenotype There was a significant improvement in the mean distance in the 6MWT in both groups, with the largest change observed in the exacerbator group [mΔ (95% CI): 84.9 (57.1-112.6) vs. 48.6 (37-60.2) p= 0.018]. Significant reduction in dyspnea on the mMRC scale occurred in both groups, with the highest intensity in the exacerbator group [mΔ (95% CI): - 0.8 (-1.11 to 0.51) vs. -1.6 (-2.20 to -1.13) p = 0.006]. Improvement in the BODE index occurred in both groups, but the mean variation was also significantly greater in the exacerbator group [mΔ (95% CI): -1.44 (-2.17 to -0.70) p= 0.045]. Conclusion Patients with COPD exacerbator phenotype had a greater magnitude of response to PRP (36 meters) when compared to non-exacerbator phenotype regardless the severity of airflow obstruction, also showing improvement in prognosis measured by the BODE index.

Qual o melhor protocolo e ponto de corte no teste 4-metre gait speed para discriminar capacidade de exercício na Doença Pulmonar Obstrutiva Crônica? / Which is the best protocol and cut-off point in the 4-metre gait speed test to discriminate exercise capacity in COPD?

RESUMO Objetivo Verificar o poder discriminativo e o ponto de corte de diferentes protocolos do teste 4-metre gait speed (4MGS) para identificar capacidade de exercício preservada ou reduzida no teste de caminhada de 6 minutos (TC6min) em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC); comparar os protocolos do 4MGS; e comparar as características dos indivíduos de acordo com o melhor ponto de corte encontrado. Métodos Foram avaliados 56 pacientes com DPOC. Todos os pacientes foram submetidos à avaliação das características antropométricas, função pulmonar (espirometria) e capacidade funcional de exercício (TC6min e 4 protocolos do 4MGS). No teste 4MGS, os pacientes foram instruídos a caminhar em velocidade usual e máxima em percursos de 4 metros (4MGS 4m - usual e máximo) e 8 metros (4MGS 8m - usual e máximo). Resultados Somente o protocolo 4MGS 4m-máximo foi capaz de identificar capacidade de exercício preservada no TC6min (AUC=0,70) com correlação moderada entre os testes (r=0,52; P<0,0001). O ponto de corte encontrado no 4MGS 4m-máximo foi de 1,27 m/s. Os pacientes com capacidade de exercício preservada (4MGS 4m-máximo ≥1,27m/s) atingiram maior distância percorrida no TC6min em %predito (91±2 vs 76±3; P<0,0001). Nas outras comparações envolvendo gênero, IMC, VEF1%pred e índice GOLD não ocorreram diferenças significantes entre os grupos. Além disso, a concordância de indivíduos classificados com capacidade de exercício preservada e reduzida no TC6min e no 4MGS 4m-máximo foi significante (P=0,008). Conclusão O teste 4MGS 4m-máximo pode ser utilizado para discriminar capacidade de exercício preservada em pacientes com DPOC, e se correlaciona com o TC6min.

ABSTRACT Objective To determine the discriminative capacity and cut-off point of different 4-metre gait speed test (4MGS) protocols in identifying preserved or reduced exercise capacity using the six-minute walk test (6MWT) in patients with Chronic Obstructive Pulmonary Disease (COPD); also, to compare 4MGS protocols and characteristics of individuals according to the best cut-off point. Methods We evaluated fifty-six patients with COPD, all of which were submitted to the assessment of anthropometric characteristics, pulmonary function (spirometry) and functional exercise capacity (6MWT and four protocols of the 4MGS). In the 4MGS test, patients were instructed to walk at normal pace and at maximum speed in a 4 meters course (4MGS 4m - usual pace and at maximum) and 8 meters course (4MGS 8m - usual pace and at maximum). Results Only the 4MGS 4m-maximum protocol was able to identify preserved exercise capacity in the 6MWT (AUC=0.70) with moderate correlation between them (r=0.52; P=0<0.0001). The cut-off point found in the 4MGS 4m-maximum was 1.27 m/s. Patients with preserved exercise capacity (4MGS 4m-maximum ≥1.27m/s) walker greater distances on the 6MWT in %pred (91±2 vs 76±3; P<0.0001). In the other comparisons involving gender, BMI, FEV1% pred and GOLD index there were no significant differences between the groups. In addition, the agreement of individuals classified as preserved and reduced exercise capacity in the 6MWT and 4MGS 4m-maximum was significant (P = 0.008). Conclusion The 4MGS 4m-maximum test can be used to discriminate preserved exercise capacity in patients with COPD and correlates with the 6MWT.

Effects of high- and moderate-intensity exercise on central hemodynamic and oxygen uptake recovery kinetics in CHF-COPD overlap

The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.

Associação da fadiga com capacidade do exercício em pacientes hepatopatas crônicos candidatos a transplante hepático / Association between fatigue and exercise capacity in patients with chronic liver disease awaiting liver transplantation

ABSTRACT BACKGROUND: Fatigue is highly prevalent in end stage liver disease, the studies about its association with exercise capacity in cirrhotic patients before liver are scarse. OBJECTIVE: In this study, we evaluated fatigue in 95 in end stage liver disease patients awaiting transplantation, compared to healthy volunteers, and tested the association between exercise capacity and fatigue. METHODS: Cross-sectional study of patients with chronic liver disease treated at a referral center in Fortaleza, Brazil. Fatigue was quantified with the Fatigue Severity Scale. The patients were submitted to the 6-min walk test, the 6-min step test, the Hospital Anxiety and Depression Scale, C-reative protein measurement and hematocrit count, measurement of dyspnea among other tests. Fatigue data were obtained from healthy individuals for comparison with patients. RESULTS: The mean age of patients was 45.9±12.3 years, and 53.7% were male. Fatigue, anxiety and depression levels were higher among end stage liver disease patients than among controls. A negative correlation was observed between 6 min step test and Fatigue Severity Scale score (r= -0.2; P=0.02) and between hematocrit count and Fatigue Severity Scale score (r= -0.24; P=0.002). Dyspnea on the Borg scale and fatigue were positively correlated (r=31; P=0.002). In the multivariate analysis, low 6-min step test values and high levels of dyspnea were associated with fatigue. CONCLUSION: Fatigue was more prevalent and severe in end stage liver disease patients than in healthy controls. Low 6MST values and high levels of dyspnea were associated with fatigue in this scenario.

RESUMO CONTEXTO: A fadiga é uma queixa comum em indivíduos com doença hepática crônica candidatos a transplante hepático. Estudos sobre sua associação com capacidade do exercício são escassos. OBJETIVO: Avaliar a fadiga de pacientes com hepatopia crônica candidatos a transplante hepático comparando com um grupo de indivíduos saudáveis. Avaliar a associação da fadiga com capacidade de exercício. MÉTODOS: Este é um estudo transversal com pacientes hepatopatas crônicos num centro de referência em Fortaleza, Brasil. Foi utilizado o questionário de gravidade da fadiga. Os pacientes realizaram o teste da caminhada dos 6 min, teste do degrau 6 min, foi aplicada a escala de ansiedade e depressão, foram dosados proteína C reativa e hematócrito. RESULTADO: A idade média dos pacientes foi de 45,9±12,3 anos, sendo que 53,7% eram homens. Os níveis de fadiga e ansiedade e depressão eram maiores entre os pacientes hepatopatas crônicos quando comparados ao grupo controle. Uma correlação inversa foi observada entre fadiga e o teste do degrau (r= -0,2; P=0,02) também entre hematócrito e fadiga (r= -0,24; P=0,002). Houve uma correlação positiva entre dispneia, através da escala de Borg, e fadiga (r=31; P=0,002). Na análise multivariada um baixo desempenho no teste do degrau e um nível maior de dispneia mostraram uma associação com fadiga. CONCLUSÃO: A fadiga é mais frequente entre os pacientes hepatopatas crônicos quando comparados ao grupo controle. O baixo desempenho na capacidade de exercício e uma queixa maior de dispneia apresentaram uma associação com fadiga nestes pacientes.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea

ABSTRACT Objective: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). Subjects and methods: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). Results: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. Conclusion: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Non Electrocardiographic alterations in exercise testing in asymptomatic women. Associations with cardiovascular risk factors

OBJECTIVES: To estimate the prevalence of exercise testing alterations in middle-aged women without symptoms of heart disease and to verify the associations of functional capacity and heart rate behavior during and after exercise with cardiovascular risk factors. METHODS: A cross-sectional study was conducted with 509 asymptomatic women aged between 46 and 65 years who underwent clinical evaluations and exercise testing (Bruce protocol). The heart rate behavior was evaluated by the maximal predicted heart rate achieved, chronotropic index and recovery heart rate. RESULTS: The mean age was 56.4±4.8 years, and 13.4% of the patients had a Framingham risk score above 10%. In the exercise treadmill testing, 58.0% presented one or more of the following alterations (listed in order of ascending prevalence): symptoms (angina, dyspnea, and dizziness), ST-segment depression, arrhythmia, reduction in recovery heart rate of ≤12 bpm at 1 minute, altered maximal predicted heart rate achieved, abnormal blood pressure, functional capacity deficiency, and altered chronotropic index. In the multivariate analysis, the following associations (odds ratio) were observed for these alterations: chronotropic index was associated with obesity (2.08) and smoking (4.47); maximal predicted heart rate achieved was associated with smoking (6.45); reduction in the recovery heart rate at 1 minute was associated with age (1.09) and obesity (2.78); functional capacity was associated with age (0.92), an overweight status (2.29) and obesity (6.51). CONCLUSIONS: More than half of middle-aged women without cardiovascular symptoms present alterations in one or more exercise testing parameters. Alterations in the functional capacity or heart rate behavior, as verified by exercise testing, are associated with age, smoking, an overweight status and obesity.

Ventilation distribution as a contributor to the functional exercise capacity in patients with systemic sclerosis-associated interstitial lung disease without pulmonary hypertension

Phenotypic differences have been described between patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and SSc-associated pulmonary hypertension, including performance differences in the 6-min walk test (6MWT). Moreover, the correlations between the 6MWT and traditional pulmonary function tests (PFTs) are weak, indicating the need to search for new parameters that explain exercise performance. Thus, our objective was to evaluate the impact of ventilation distribution heterogeneity assessed by the nitrogen single-breath washout (N2SBW) test and peripheral muscle dysfunction on the exercise capacity in patients with SSc-ILD and limited involvement of the pulmonary parenchyma. In this cross-sectional study, 20 women with SSc-ILD and 20 matched controls underwent PFTs (including spirometry, diffusing capacity for carbon monoxide (DLco), and the N2SBW test) and performed the 6MWT and knee isometric dynamometry. The 6-min walking distance (6MWD, % predicted) was strongly correlated with the phase III slope of the single-breath nitrogen washout (phase III slopeN2SBW) (r=−0.753, P<0.0001) and reasonably correlated with the forced vital capacity (FVC) (r=0.466, P=0.008) and DLco (r=0.398, P=0.011). The peripheral oxygen saturation (SpO2) during exercise was not significantly correlated with any of the pulmonary or muscle function parameters. The phase III slopeN2SBW was the only predictive variable for the 6MWD, whereas quadriceps strength and FVC/DLco were predictive variables for SpO2. Ventilation distribution heterogeneity is one factor that contributes to a lower 6MWD in SSc-ILD patients. In addition, muscle dysfunction and abnormal lung diffusion at least partly explain the decreased SpO2 of these patients.

Validation of the two-minute step test in obese with comorbibities and morbidly obese patients

Cardiopulmonary fitness assessment is a valuable resource to obtain quantitative indicators of an individual's physical performance. The cardiopulmonary exercise test (CPX), considered the gold standard test for this evaluation, is costly and difficult to be accessed by the general population. In order to make this evaluation more accessible, and to better reflect the performance of daily life activities, alternative tests were proposed. Morbidly obese patients present limitations that impair physical performance assessment and could benefit from a test of shorter duration, provided it is validated. This observational study aimed to validate the two-minute step test (2MST) as a tool to evaluate functional capacity (FC) in obese with comorbidities and morbidly obese patients, compared the 2MST with CPX as a measure of physical performance, and developed a predictive equation to estimate peak oxygen uptake (VO2) in the 2MST. The CPX and the 2MST were performed and metabolic and ventilatory parameters were recorded in 31 obese individuals (BMI>35 kg/m2). Pearson correlation and multiple linear regression analyses were performed to evaluate the peak VO2 best predictors. Bland-Altman analysis was performed to assess the agreement between the two methods. Peak VO2 measured by CPX and 2MST showed a strong correlation (r=0.70, P<0.001) and there was a moderate correlation between peak VO2 of the 2MST and the number of up-and-down step cycles (UDS) (r=0.55; P=0.01). The reference equation obtained was: VO2 (mL·kg-1·min-1) = 13.341 + 0.138 × total UDS - (0.183 × BMI), with an estimated standard error of 1.3 mL·kg-1·min-1. The 2MST is a viable, practical, and easily accessible test for FC. UDS and BMI can predict peak VO2 satisfactorily.

Dysfunctional breathing: what do we know? / Disfunção respiratória: o que sabemos?

ABSTRACT Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or "air hunger", DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.

RESUMO A disfunção respiratória (DR) é um quadro respiratório caracterizado por padrões respiratórios irregulares que ocorrem na ausência de doenças concomitantes ou secundariamente a doenças cardiopulmonares. Embora o principal sintoma seja frequentemente dispneia ou "fome por ar", a DR também está associada a sintomas não respiratórios, como vertigem e palpitações. A DR pode ser identificada em todas as idades. Sua prevalência entre adultos na atenção primária no Reino Unido é de aproximadamente 9,5%. Além disso, entre indivíduos com asma, um diagnóstico positivo de DR é encontrado em um terço das mulheres e um quinto dos homens. Embora a DR tenha sido investigada por décadas, ela permanece pouco compreendida devido a uma escassez de ensaios clínicos de alta qualidade e de variáveis de desfecho validadas especificamente para essa população. Assim, a DR é frequentemente subdiagnosticada ou diagnosticada incorretamente, devido à similaridade de seus sintomas associados (dispneia, taquicardia e vertigem) aos de outras doenças cardiopulmonares comuns, como DPOC e asma. As altas taxas de diagnóstico incorreto de DR sugerem que os profissionais de saúde não entendam completamente esse quadro e possam, portanto, não fornecer aos pacientes um tratamento adequado. Dada à natureza multifatorial e psicofisiológica da DR, uma avaliação holística e multidimensional parece ser a maneira mais apropriada de melhorar a compreensão e a precisão do diagnóstico. A presente revisão foi desenvolvida como um meio de resumir as evidências disponíveis sobre DB, bem como de melhorar a compreensão do quadro por pesquisadores e profissionais.

Echocardiographic Assessment of Ventricular Function in Young Patients with Asthma / Avaliação Ecocardiográfica da Função Ventricular em Pacientes Jovens com Asma

Abstract Background: Despite significant advances in understanding the pathophysiology and management of asthma, some of systemic effects of asthma are still not well defined. Objectives: To compare heart function, baseline physical activity level, and functional exercise capacity in young patients with mild-to-moderate asthma and healthy controls. Methods: Eighteen healthy (12.67 ± 0.39 years) and 20 asthmatics (12.0 ± 0.38 years) patients were enrolled in the study. Echocardiography parameters were evaluated using conventional and tissue Doppler imaging (TDI). Results: Although pulmonary acceleration time (PAT) and pulmonary artery systolic pressure (PASP) were within normal limits, these parameters differed significantly between the control and asthmatic groups. PAT was lower (p < 0.0001) and PASP (p < 0.0002) was higher in the asthma group (114.3 ± 3.70 ms and 25.40 ± 0.54 mmHg) than the control group (135.30 ± 2.28 ms and 22.22 ± 0.40 mmHg). The asthmatic group had significantly lower early diastolic myocardial velocity (E', p = 0.0047) and lower E' to late (E'/A', p = 0.0017) (13.75 ± 0.53 cm/s and 1.70 ± 0.09, respectively) compared with control group (15.71 ± 0.34 cm/s and 2.12 ± 0.08, respectively) at tricuspid valve. In the lateral mitral valve tissue Doppler, the asthmatic group had lower E' compared with control group (p = 0.0466; 13.27 ± 0.43 cm/s and 14.32 ± 0.25 cm/s, respectively), but there was no statistic difference in the E'/A' ratio (p = 0.1161). Right isovolumetric relaxation time was higher (p = 0.0007) in asthmatic (57.15 ± 0.97 ms) than the control group (52.28 ± 0.87 ms), reflecting global myocardial dysfunction. The right and left myocardial performance indexes were significantly higher in the asthmatic (0.43 ± 0.01 and 0.37 ± 0.01, respectively) compared with control group (0.40 ± 0.01 and 0.34 ± 0.01, respectively) (p = 0.0383 and p = 0.0059, respectively). Physical activity level, and distance travelled on the six-minute walk test were similar in both groups. Conclusion: Changes in echocardiographic parameters, evaluated by conventional and TDI, were observed in mild-to-moderate asthma patients even with normal functional exercise capacity and baseline physical activity level. Our results suggest that the echocardiogram may be useful for the early detection and evoluation of asthma-induced cardiac changes.

Resumo Fundamento: Apesar de avanços significativos no entendimento da fisiopatologia e manejo da asma, alguns efeitos sistêmicos da asma ainda não são bem definidos. Objetivos: Comparar a função cardíaca, o nível de atividade física basal, e a capacidade funcional de pacientes jovens com asma leve a moderada com controles saudáveis. Métodos: Dezoito voluntários saudáveis (12,67 ± 0,39 anos) e 20 pacientes asmáticos (12,0 ± 0,38 anos) foram incluídos no estudo. Os parâmetros de ecocardiografia foram avaliados pelo exame de ecocardiogragia com Doppler convencional e tecidual (EDT). Resultados: Apesar de o tempo de aceleração pulmonar (TAP) e da pressão arterial sistólica pulmonar (PASP) encontrarem-se dentro da faixa de normalidade, esses parâmetros foram significativamente diferentes entre o grupo controle e o grupo asmático. O TAP foi menor (p < 0,0001) e a PASP maior (p < 0,0002) no grupo de indivíduos asmáticos (114,3 ± 3,70 ms e 25,40 ± 0,54 mmHg) que o grupo controle (135,30 ± 2,28 ms e 22,22 ± 0,40 mmHg). O grupo asmático apresentou velocidade diastólica inicial do miocárdio (E', p = 0,0047) e relação entre E' e velocidade tardia mais baixas (E'/A', p = 0,0017) (13,75 ± 0,53 cm/s e 1,70 ± 0,09, respectivamente) em comparação ao grupo controle (15,71 ± 0,34 cm/s e 2,12 ± 0,08, respectivamente) na valva tricúspide. No exame Doppler tecidual do anel mitral lateral, o grupo asmático apresentou menor E' em comparação ao grupo controle (p = 0,0466; 13,27 ± 0,43 cm/s e 14,32 ± 0,25 cm/s, respectivamente), mas não houve diferença estatística na razão E'/A' (p = 0,1161). O tempo de relaxamento isovolumétrico foi maior no grupo de pacientes asmáticos (57,15 ± 0,97 ms) que no grupo controle (52,28 ± 0,87 ms) (p = 0,0007), refletindo uma disfunção global do miocárdio. O índice de performance miocárdica direito e esquerdo foi significativamente maior no grupo asmático (0,43 ± 0,01 e 0,37 ± 0,01, respectivamente) que no grupo controle (0,40 ± 0,01 e 0,34 ± 0,01, respectivamente) (p = 0,0383 e p = 0,0059 respectivamente). O nível de atividade física e a distância percorrida no teste de caminhada de seis minutos foram similares entre os grupos. Conclusão: Mudanças nos parâmetros ecocardiográficos, avaliados pela ecocardiografia convencional e pela EDT foram observadas em pacientes com asma moderada a grave com capacidade funcional e nível de atividade física basal normais. Nossos resultados sugerem que o ecocardiograma pode ser útil para a detecção precoce e a evolução de alterações cardíacas induzidas pela asma. (Arq Bras Cardiol. 2018; 110(3):231-239)

Nitrogen single-breath washout test for evaluating exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease

Pulmonary function tests (PFTs) traditionally used in clinical practice do not accurately predict exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess whether the nitrogen single-breath washout (N2SBW) test explains exercise intolerance and poor quality of life in stable COPD patients. This cross-sectional study included 31 patients with COPD subjected to PFTs (including the N2SBW test) and a cardiopulmonary exercise test (CPET). Patients were also evaluated using the following questionnaires: the COPD assessment test (CAT), the 36-Item Short Form Health Survey (SF36) and St. George's Respiratory Questionnaire (SGRQ). Peak oxygen uptake (peak VO2) was negatively correlated with the phase III slope of the N2SBW (SIIIN2) (r=-0.681, P<0.0001) and positively correlated with forced expiratory volume in one second (FEV1; r=0.441, P=0.013). Breathing reserve was negatively correlated with SIIIN2, closing volume/vital capacity, and residual volume (RV) (r=-0.799, P<0.0001; r=-0.471, P=0.007; r=-0.401, P=0.025, respectively) and positively correlated with FEV1, forced vital capacity (FVC) and FEV1/FVC (r=0.721; P<0.0001; r=0.592, P=0.0004; r=0.670, P<0.0001, respectively). SIIIN2 and CAT were independently predictive of VO2 and breathing reserve at peak exercise. RV, FVC, and FEV1 were independently predictive of the SF36-physical component summary, SF36-mental component summary, and breathing reserve, respectively. The SGRQ did not present any independent variables that could explain the model. In stable COPD patients, inhomogeneity of ventilation explains a large degree of exercise intolerance assessed by CPETs and, to a lesser extent, poor quality of life.

Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica / Tools for physical activity assessment in chronic obstructive pulmonary disease

The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice.

Effects of simple long-term respiratory care strategies in older men with COPD / Efeitos de estratégias de longo prazo simples de cuidados respiratórios em homens idosos com DPOC

ABSTRACT Objective: To evaluate a 24-month supervised, community-based maintenance exercise program after 3 months of pulmonary rehabilitation (PR) in comparison with a 27-month physical activity counseling program, in terms of the effects on maximal muscle strength, muscle power output, and exercise capacity, in individuals with COPD. Methods: Sixty-three men with moderate-to-severe COPD were recruited from two previous studies. Of those 63 participants, 31 were offered 3 months of PR followed by a 24-month supervised maintenance exercise program (24MME group) and 32 were offered a 27-month physical activity counseling program (27MPAC group). Measurements at 3 months and at the end of the study period included maximal strength of the upper and lower limbs, power output of the lower limbs, six-minute walk distance (6MWD), and quality of life. Results: At 27 months, the improvements in maximal strength of the upper and lower limbs were greater in the 24MME group than in the 27MPAC group (37.6 ± 28.3% and 28.4 ± 13.3%, respectively, vs. 8.8 ± 16% and 13.6 ± 16.4%, respectively; p < 0.05), as was the improvement in power output of the lower limbs (24.6 ± 18.4% vs. −2.3 ± 28.5%; p < 0.01). The increase in the 6MWD after 3 months was also greater in the 24MME group than in the 27MPAC group (33.2 ± 36.6 m vs. 2.9 ± 34.7 m; p < 0.05), although there were no differences between the two groups in terms of the Δ6MWD at 27 months (vs. baseline). Conclusions: A supervised, community-based maintenance program is a successful long-term strategy to preserve the benefits of PR on peripheral muscle function and exercise capacity in individuals with COPD. However, physical activity counseling can maintain maximal muscle strength and exercise capacity in such individuals.

RESUMO Objetivo: Avaliar um programa comunitário supervisionado de 24 meses de exercícios de manutenção precedido de 3 meses de reabilitação pulmonar (RP) em comparação com um programa de 27 meses de aconselhamento de atividade física, quanto aos efeitos na força muscular máxima, potência muscular e capacidade de exercício em indivíduos com DPOC. Métodos: Foram recrutados 63 homens com DPOC moderada a grave de dois estudos anteriores. A 31 desses 63 participantes foram oferecidos 3 meses de RP seguidos de um programa supervisionado de 24 meses de exercícios de manutenção (grupo 24MEM), e a 32, um programa de 27 meses de aconselhamento de atividade física (grupo 27MAAF). Medidas realizadas aos 3 meses e ao final do período estudado incluíram força máxima dos membros superiores e inferiores, potência dos membros inferiores, distância percorrida no teste de caminhada de seis minutos (DTC6) e qualidade de vida. Resultados: Aos 27 meses, a melhora da força máxima dos membros superiores e inferiores foi maior no grupo 24MEM que no grupo 27MAAF (37,6 ± 28,3% e 28,4 ± 13,3%, respectivamente, vs. 8,8 ± 16% e 13,6 ± 16,4%, respectivamente; p < 0,05), e houve melhora da potência dos membros inferiores (24,6 ± 18,4% vs. −2,3 ± 28,5%; p < 0,01). O aumento da DTC6 após 3 meses também foi maior no grupo 24MEM que no grupo 27MAAF (33,2 ± 36,6 m vs. 2,9 ± 34,7 m; p < 0,05), mas não houve diferenças entre os grupos quanto a ΔDTC6 aos 27 meses (vs. basal). Conclusões: Um programa comunitário supervisionado de manutenção é uma estratégia de longo prazo bem sucedida para preservar os benefícios da RP na função muscular periférica e capacidade de exercício em indivíduos com DPOC. No entanto, o aconselhamento de atividade física consegue manter a força muscular máxima e a capacidade de exercício nesses indivíduos.

Um protocolo mais simples de eletroestimulação neuromuscular periférica melhora a capacidade funcional de pacientes com insuficiência cardíaca grave / A simpler and shorter neuromuscular electrical stimulation protocol improves functional status and modulates inflammatory profile in patients with end-stage congestive heart failure

Fundamento: Estimulação elétrica neuromuscular (EENM) utilizando protocolo de estimulação por 5 dias/semana durante 8 semanas tem sido usada como opção de tratamento para pacientes com insuficiência cardíaca congestiva (ICC) incapazes de tolerar exercícios aeróbicos. Objetivo: Nós avaliamos o impacto de um protocolo de EENM mais curto, utilizando uma corrente russa (CR) sobre a capacidade funcional, qualidade de vida (QV) e perfil inflamatório de pacientes com ICC em estágio final. Métodos: Vinte e oito pacientes com ICC grave (53 ± 11 anos) foram randomizados em grupo tratamento (EENM) e grupo placebo. O grupo EENM foi submetido a tratamento com CR aplicada por 50 minutos no quadríceps, bilateralmente, duas vezes por semana, por 7 semanas. No grupo EENM a estimulação foi aplicada promovendo contração muscular visível e para o grupo placebo a aplicação da corrente não promoveu contração muscular. A distância no teste de caminhada de 6 minutos (TC6) e a pontuação de QV pelo Questionário Minnesota Living with Cardiac Insufficiency foram avaliadas antes, imediatamente após e um mês após a conclusão do protocolo aplicado. Os leucócitos periféricos foram obtidos para medir os níveis de expressão gênica de citocinas inflamatórias. Resultados : O grupo EENM apresentou aumento na distância percorrida no TC6 (324 ± 117 vs 445 ± 100 m; p = 0,02) e QV (64 ± 22 versus 45 ± 17; p < 0,01) imediatamente após o programa de tratamento, mas não um mês após a conclusão do protocolo. Assim como, o aumento nos níveis de expressão de IL-1 ß , IL-6 e IL-8 após a conclusão do protocolo. Conclusão: O uso da EENM aplicada duas vezes por semana melhora a qualidade de vida e a capacidade funcional de pacientes com IC grave. Esta melhora clínica foi acompanhada pelo aumento da expressão gênica de algumas citocinas nos leucócitos periféricos. Este protocolo mais curto de EENM é capaz de produzir efeitos clínicos benéficos semelhantes a protocolos mais intensos e longos, bem como modular a resposta inflamatória. Este protocolo pode ser uma boa alternativa para pacientes com ICC grave e limitações na adesão ao protocolo

Background: Neuromuscular electrical stimulation (NMES) using a stimulation wave for 5 days/week over 8 weeks has been used as a treatment option for congestive heart failure (CHF) patients who are unable to tolerate aerobic exercise. Objective: We assessed the impact of a shorter NMES protocol using a Russian stimulation wave on the functional status, quality of life (QoL) and inflammatory profile of end-stage CHF patients. Methods: Twenty-eight patients with end-stage CHF (53 ± 11 years) were randomized to the NMES or control group. Treatment was an NMES training program with Russian stimulation wave, applied for 50 minutes to both quadriceps femoral muscles twice weekly over seven weeks. The stimulation intensity was chosen to elicit muscle contractions in the NMES group and current input up to sensory threshold in the control group. Distance in the 6-minute walk test (6MWD) and QoL score by the Minnesota Living with Heart Failure Questionnaire were evaluated before, immediately after and one month after NMES protocol completion. Peripheral leukocytes were obtained to measure the gene expression levels of inflammatory cytokines. Results: The NMES group showed increases in the 6MWD (324 ± 117 vs. 445 ± 100 m; p = 0.02) and QoL score (64 ± 22 vs. 45 ± 17; p < 0.01) immediately but not 1 month after protocol completion, as well as increased gene expression levels of IL-1ß, IL-6 and IL-8 after protocol completion. Conclusion: Using a shorter and fewer sessions NMES protocol improved the QoL score and functional class of severe CHF patients, and modulated the gene expression levels of some cytokines. This protocol might be a good alternative for patients with severe CHF and limitations in protocol adherence

Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis / Capacidade Funcional na Cardiopatia Congênita: Revisão Sistemática e Metanálise

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.

Efectos de un entrenamiento intervalado de alta intensidad en la capacidad aeróbica de adolescentes / Effects of a high intensity interval training on the aerobic capacity of adolescents

Background: If aerobic capacity is stimulated early in life, maximal oxygen consumption during adulthood is assured. Aim: To analyze the effects of a high intensity interval training (HIIT) in adolescents on the maximal oxygen consumption (VO2max) measured using the 20-m shuttle run test (20mSRT). Material and Methods: Twenty eight teenagers aged 13 ± 0.6 years were divided in two groups of 14 subjects each. One group was to a 16 sessions of HIIT interval training based on their individual maximal aerobic speed and the other continued with their usual exercise done at school. At baseline and the end of the intervention VO2max was measured using the 20mSTR. Results: At the end of the intervention, the trained teenagers significantly improved their VO2max and the time spent in the 20mSTR. Conclusions: A HIIT program based on the individual maximal aerobic speed improves VO2max in adolescents.