Effect of six-week core strengthening exercises on inspiratory muscle strength and functional capacity in patients with chronic kidney disease undergoing haemodialysis

This study aims to evaluate the effect of core strengthening exercises on inspiratory muscle strength and functional capacity in patients with CKD undergoing Haemodialysis. The study included 10 patients with CKD undergoing hemodialysis according to the eligibility criteria. All patients performed core strengthening exercises for 6 weeks (2 times/week). The outcome measures are assessed before and after the intervention using inspiratory muscle strength and functional capacity. We found significant improvements in inspiratory muscle strength (p=0.150) and functional capacity (p=0.004) after the core strengthening exercises. At the end of the result, we concluded that the core strengthening exercise program improves the inspiratory muscle strength and functional capacity in patients with CKD undergoing Haemodialysis.

Association between prosthesis use to the physical functioning and quality of life among adult unilateral lower limb amputees: An analytical cross-sectional study / Health Sciences Journal

Introduction@#A prosthesis is an artificial assistive device designed to replace a missing body part (e.g., limb), secondary to a disease, injury or congenital deformities. Prostheses are often used to restore functional capacity while improving the quality of life (QoL). @*Methods@#An analytical cross-sectional study was conducted among adults aged 19 to 64 years who were permanent residents in Luzon who had undergone unilateral lower leg amputation. This epidemiologic study employed the Modified Barthel Index for activities of daily living (ADLs), the Frenchay Activities Index for instrumental activities of daily living (IADLs), and the WHOQOL-BREF for QoL. Descriptive and analytical statistics of the responses of the Lower Limb Amputees (LLA) were done. Prevalence odds ratio (POR) was calculated, and statistical significance was determined.@*Results@#Among 165 LLA respondents, only 47.88% used prostheses. Unilateral LLA who exhibited greater independence in ADLs (POR=19.22), more actively performed IADLs (POR=5.51), and had good QoL (POR=3.83) were more likely to have been using prosthesis. All these findings were statistically significant. @*Conclusion@#This study revealed a statistically significant association between prosthesis use to the physical functioning and QoL among adult unilateral LLAs. It showed that prosthetic use was likely linked with improved performance in ADLs and IADLs, and better QoL compared to those without.

Efeitos de um programa de reabilitação sobre capacidade física de pacientes pós-infecção por SARS-CoV-2: um estudo retrospectivo / Effects of a rehabilitation program on the physical capacity of patients after SARS-Cov-2 infection: a retrospective study

Objetivo: avaliar o efeito de um programa de reabilitação sobre a capacidade física de pacientes integrantes de um programa de reabilitação pós-infecção por SARS-CoV-2. Métodos: estudo observacional de incidência retrospectiva, com amostra de prontuários de pacientes >18 anos, participantes do programa de reabilitação pós-COVID-19 no Centro de Reabilitação da PUCRS. Foram extraídos dados demográficos, antropométricos e de testes funcionais, incluindo o teste da caminhada dos seis minutos (TC6) e o teste de sentar e levantar (TSL), antes e depois do programa. O programa foi composto por treinamento aeróbico e re-sistido, duas vezes por semana, totalizando 16 sessões. O treinamento aeróbico foi conduzido na esteira com duração de 30 minutos, sendo avaliada frequência cardíaca, saturação, pressão arterial e escala de Borg (dispneia e cansaço em membros inferiores). O treino resistido foi realizado após o teste de repetição máxima (1RM) com a carga variando entre 50-80% de 1RM, durante 30 minutos. Resultados: foram incluídos 13 pacientes, com média de idade de 51,0±16,4 anos. Ao comparar os resultados pré e pós-reabilitação, encontramos diferenças significativas na distância percorrida no TC6, sendo de 480,5±91,3 metros pré e 722,1±235,9 metros após a intervenção (p<0,001), bem como no percentual do previsto, sendo 87,5±18,8 pré e 130,7±43,5 após (p=0,001). Além disso, ao analisar o TSL, verificou-se uma redução significativa no tempo, de 12,3±4,7 segundos pré-programa para 8,8±2,2 após (p=0,005). Conclusão: o programa de reabilitação apresentou impacto positivo na capaci-dade física de pacientes que integraram o programa de reabilitação pós-infecção por SARS-CoV-2

Objective: to evaluate the effect of a rehabilitation program on the physical capacity of patients participating in a rehabilitation program after SARS-CoV-2 infection. Methods: retrospective incidence observational study, with a sample of medical records of patients >18 years old, participants in the post-covid-19 rehabilitation program at the PUCRS Rehabilitation Center. Demographic, anthropometric and functional test data: six-minute walk test (TC6) and sit-to-stand teste (TSL) were extracted pre and post program. The program consisted of aerobic and resistance training, twice a week, totaling 16 sessions. Aerobic training was performed on a treadmill lasting 30 minutes, with heart rate, saturation, blood pressure and Borg (dyspnea and fatigue in the lower limbs) being evaluated. Resistance training was performed after the maximum repetition test (1RM) with a load ranging from 50-80% of 1RM, for 30 minutes. Results: 13 patients were included, with a mean age of 51.0±16.4 years. When comparing the pre and post rehabilitation results, we found significant differences in the distance covered in the TC6, being 480.5±91.3 meters before and 722.1±235.9 meters after the inter-vention (p<0.001) and in the percentage of predicted, being 87.5±18.8 pre and 130.7±43.5 post (p=0.001). Fur-themore, when analyzing the TSL, we found a significant reduction in time of 12.3±4.7 seconds pre-program and 8.8±2.2 post (p=0.005). Conclusion: the rehabilitation program had a positive impact on the physical capacity of patients who parti-cipated in the rehabilitation program after SARS-CoV-2 infection

Advanced glycation end products consumption and the decline of functional capacity in patients with Parkinson's disease: Cross-sectional study

Abstract Introduction Advanced Glycation End-Products (AGEs) are a diverse group of highly reactive molecules that play a vital role in the development of neurodegenerative disorders, such as Parkinson's Disease (PD), leading to a decline in functional and cognitive capacity. The objective of this study was to assess the intake and quantification of AGEs in individuals with PD and to correlate them with their functional and cognitive abilities. Methods This was a cross-sectional study involving 20 PD patients and 20 non-PD individuals as the Control group (C). The autofluorescence reader was used to evaluate skin AGEs, while food recall was used to quantify AGEs consumed for three different days. The Montreal Cognitive Assessment, Short Physical Performance Battery, and handgrip tests were used. PD patients demonstrated greater impairment in functional capacity compared to the control group. Results Dominant Handgrip (p = 0.02) and motor performance, in the sit and stand test (p = 0.01) and Short Physical Performance Battery (SPPB) (p = 0.01) were inferior in PD patients than the control group. Although PD patients tended to consume less AGEs than the control group, AGE intake was negatively correlated with handgrip strength in individuals with PD (r = -0.59; p < 0.05). Conclusion PD patients had lower strength and functional capacity, suggesting that the effects of AGEs might be exacerbated during chronic diseases like Parkinson's.

A pilot observational study to identify reference values for the 6-minute walk test in Brazilian people with hypertension / Um estudo observacional piloto para identificar valores de referência para o teste de caminhada de 6 minutos em hipertensos brasileiros

Abstract Introduction Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global popu-lation. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by mul-tiple linear regression analysis. Results The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46-59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.

Resumo Introdução A hipertensão arterial sistêmica (HAS) é respon-sável por 9,5 milhões de mortes na população mundial. Con-dições do estilo de vida, incluindo a inatividade física, são importantes fatores de risco modificáveis no desenvolvimento da HAS. Desse modo, o exercício físico tem se mostrado eficaz no controle da HAS e, antes da prescrição, o teste de caminhada de seis minutos (TC6) tem sido comumente utilizado para ava-liar a capacidade física. Objetivo Propor valores de referência para o teste de TC6 em brasileiros com HAS. Métodos Realizou-se um estudo observacional transversal com 302 hipertensos (62,61 + 10,93 anos) admitidos em um programa de reabilitação cardíaca. Os participantes foram divididos em diferentes quartis de idade e submetidos ao TC6. Os dados de distância percorrida foram comparados entre os quartis e ajustados por análise de regressão linear múltipla. Resultados Os hipertensos caminharam 388,07 + 115,03 m durante o TC6. Não encontrou-se diferença significativa entre os gêneros. No entanto, quando comparados os quartis de idade, para a faixa etária de 46 a 59 anos, as mulheres caminharam menos do que os homens. As comparações intragrupo mostraram que a distância percorrida no TC6 diminuiu com o aumento da idade, tanto em homens quanto em mulheres. Conclusão O presente estudo fornece valores de referência para o TC6, tanto para homens quanto para mulheres brasileiras de diferentes faixas etárias. Esses dados podem ser um parâmetro importante para futuros estudos clínicos, estratégias de prevenção e intervenção clínica.

Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. Methods: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. Results: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. Conclusion: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

Food consumption, physical activity and aerobic capacity in systemic lupus erythematosus patients with high cardiovascular risk

Abstract Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune and multisystemic rheumatic disease. Patients with SLE have decreased functional and aerobic capacity, as well as increased prevalence of Cardiovascular Diseases (CVD), which are the primary causes of morbimortality in this condition. Dietary intake and physical activity are well-known modifiable cardiovascular risk factors. The aim of this study is to describe food consumption, sedentary behavior, physical activity level, and functional and aerobic capacity in a sample of SLE patients with high cardiovascular risk. This was a cross-sectional study in which patients were assessed for (i) Demographic, anthropometric, and disease-related parameters; (ii) Food consumption; (iii) Physical activity level and sedentary behavior; (iv) Functional and aerobic capacity. Patients averaged 41.7 ± 9 years, and most were classified as overweight/obese (87%). Average macronutrient intake was within recommendations; however, fiber (16 ± 9g) and calcium (391 ± 217 mg) intakes were below, and sodium intake (2.9 ± 1.3 mg) was above recommendations. Besides, food consumption assessed by the Nova system showed a predominance of unprocessed foods (43.8 ± 14.0%TEI), although ultraprocessed food intake (20.0 ± 13.9%TEI) was slightly higher than that seen in the Brazilian population. Patients also exhibited high sedentary behavior (8.2 ± 2.2h) and only eighteen participants reached the minimum recommended amount of moderate-to-vigorous physical activity. Overall, patients had a low functional and aerobic capacity compared to the general population. Data from this study may help design dedicated clinical trials aiming to investigate the effects of lifestyle intervention to mitigate CVD in SLE.

Capacidade funcional e qualidade de vida de adultos e idosos com feridas crônicas / Functional capacity and quality of life of adults and elderly people with wounds

Introdução: As feridas crônicas afetam a população em geral e comprometem negativamente a qualidade de vida e geram impactos biopsicossociais. Objetivo: Analisar a associação entre a capacidade funcional e a qualidade de vida de adultos e idosos com feridas crônicas. Métodos: Estudo transversal com 135 acometidas por feridas crônicas cadastradas nos serviços de atenção primária à saúde de um município de Minas Gerais, Brasil. Para a coleta de dados realizada no período de 2017 a 2018, utilizaram-se os instrumentos i) Cardiff Wound Impact Schedule que foi traduzido, adaptado culturalmente e validado para a língua portuguesa do Brasil; ii) Índice de Katz e iii) questionário sociodemográfico com informações sobre o perfil de saúde/doença e características das feridas. Resultados: Houve predomínio de participantes do sexo feminino (59,3%), com idade acima de 60 anos (70,4%) e até 4 anos de estudo (72,6%). No questionário Cardiff Wound Impact Schedule, o domínio com menor pontuação foi o de bem-estar (média 45,6 ± 18,2). Na avaliação da funcionalidade realizada por meio do Índice de Katz, destaca-se que 30 (22,2%) pessoas foram consideradas dependentes para tomar banho e 33 (24,4%) necessitavam de ajuda para se locomover. Houve associação estatisticamente significativa entre as seguintes variáveis independentes do Índice de Katz e do Cardiff Wound Impact Schedule para "vida social" e "banho", "vida social" e "vestir-se", "vida social" e "higiene pessoal", "vida social" e "locomoção", "vida social" e "alimentação", "sintomas físicos e vida diária" e "vestir-se", "bem-estar" e "continência". Conclusão: A incapacidade funcional está associada à diminuição da qualidade de vida de adultos e idosos com feridas crônicas (AU).

Introdução: As feridas crônicas afetam a população em geral e comprometem negativamente a qualidade de vida e geram impactos biopsicossociais. Objetivo: Analisar a associação entre a capacidade funcional e a qualidade de vida de adultos e idosos com feridas crônicas. Métodos: Estudo transversal com 135 acometidas por feridas crôni-cas cadastradas nos serviços de atenção primária à saúde de um município de Minas Gerais, Brasil. Para a coleta de dados realizada no período de 2017 a 2018, utilizaram-se os instrumentos i) Cardiff Wound Impact Schedule que foi traduzido, adaptado culturalmente e validado para a língua portuguesa do Brasil; ii) Índice de Katz e iii) questio-nário sociodemográfico com informações sobre o perfil de saúde/doença e características das feridas. Resultados: Houve predomínio de participantes do sexo feminino (59,3%), com idade acima de 60 anos (70,4%) e até 4 anos de estudo (72,6%). No questionário Cardiff Wound Impact Schedule, o domínio com menor pontuação foi o de bem-estar (média 45,6 ± 18,2). Na avaliação da funcionalidade realizada por meio do Índice de Katz, destaca-se que 30 (22,2%) pessoas foram consideradas dependentes para tomar banho e 33 (24,4%) necessitavam de ajuda para se locomover. Houve associação estatisticamente significativa entre as seguintes variáveis independentes do Índice de Katz e do Cardiff Wound Impact Schedule para "vida social" e "banho", "vida social" e "vestir-se", "vida social" e "higiene pessoal", "vida social" e "locomoção", "vida social" e "alimentação", "sintomas físicos e vida diária" e "vestir-se", "bem-estar" e "continência". Conclusão: A incapacidade funcional está associada à diminuição da qualidade de vida de adultos e idosos com feridas crônicas (AU).

Correlation Between Kinesiophobia and Functional Capacity In Phase II Coronary Artery By pass Graft Patients

Background: Coronary Artery Bypass Graft surgery (CABG) remains the most performed cardiac surgery worldwide. Fear of movement (Kinesiophobia) after cardiac surgery is associated with physical activity and non-adherence to cardiac rehabilitation. It is observed that functional capacity is significantly reduced after cardiac surgery. Long term Kinesiophobia leads to avoidance behaviours and hampers the physical levels and leads to deconditioning.The aim of the study was to find out the Correlation between Kinesiophobia and Functional Capacity in Phase II Coronary Artery Bypass Graft patients.Subjects and Methods: 50 CABG patients in Phase II were included in the study. The Tampa Scale of Kinesiophobia- Short Version Heart (TSK-SV Heart) and Six Minute Walk Test were done in the CVTS-OPD. The Spearman rho correlation was done to find a correlation between Kinesiophobia and Functional CapacityResults and Observations: It was observed that there was no correlation between TSK-SV Heart score (Kinesiophobia) and percent predicted value of 6MWT (Functional Capacity) with r = 0.099 and p value= 0.494. However, the mean of the total TSK-SV Heart score was 41.1 ± 4.743 which was high and 88% of the population reported high Kinesiophobia (score> 37).conclusion: The results of the study showed no correlation but patients did report high Kinesiophobia and thus it should not be underestimated during cardiac rehabilitation. The possible reasons for high Kinesiophobia could be lack of awareness about the safety and level of physical activity, over-protective care givers, lack of attendance to cardiac rehabilitation post discharge, anxiety, and depression.

Intervención integral de salud para mejorar el control de la diabetes mellitus tipo II

Introducción: La diabetes mellitus es una enfermedad caracterizada por un aumento sostenido de las cifras de glucemia. Las manifestaciones clínicas y complicaciones de la enfermedad generan discapacidad funcional y afectación de la percepción calidad de vida. El control de la glucemia es fundamental para mejorar el estado de salud de los pacientes. Objetivo: Implementar una intervención de salud integral en pacientes con diagnóstico de DM tipo II residentes en el cantón Riobamba. Métodos: Se realizó una investigación aplicada, con diseño cuasiexperimental, descriptivo y longitudinal. El universo estuvo constituido por 256 pacientes con diagnóstico de diabetes mellitus tipo II, de los cuales 155 formaron parte de la muestra del estudio. Se analizaron, al inicio y final de la intervención, el control glucémico, estado nutricional, circunferencia de la cintura y nivel de conocimiento; así como las características generales al inicio del estudio. Se utilizó la prueba de rangos con signos de Wilcoxon para identificar si la intervención generó cambios en las variables de estudio comparando los resultados antes y después de la intervención. Resultados: Promedio de edad de 63,28 años, predominio de pacientes femeninas (69,68 %) y sin comorbilidades asociadas (66,45 %). Al inicio del estudio predominó el nivel de conocimiento bajo (60,00 %), control glucémico admisible (34,19 %) y circunferencia de la cintura con riesgo elevado en hombres (37,96 %) y mujeres (38,30 %). Después de terminado el estudio predominó el nivel medio de conocimiento (38,71%), los pacientes con normopeso (57,4 2%), control glucémico adecuado (34,84 %). Conclusiones: la intervención aplicada generó cambios positivos en las variables estudiadas.

Introduction: Diabetes mellitus is a disease characterized by a sustained increase in blood glucose levels. The clinical manifestations and complications of the disease generate functional disability and affect the perception of quality of life. Glycemic control is essential to improve the health status of patients. Objective: To implement a comprehensive health intervention in patients diagnosed with type II DM residing in the Riobamba canton. Methods: Applied research was carried out, with a quasi-experimental, descriptive and longitudinal design. The universe consisted of 256 patients diagnosed with type II diabetes mellitus, of which 155 were part of the study sample. Glycemic control, nutritional status, waist circumference and level of knowledge were analyzed at the beginning and end of the intervention; as well as the general characteristics at the beginning of the study. The Wilcoxon signed rank test was used to identify whether the intervention generated changes in the study variables by comparing the results before and after the intervention. Results: Average age of 63.28 years, predominance of female patients (69.68 %) and no associated comorbidities (66.45 %). At the beginning of the study, the low level of knowledge (60.00 %), admissible glycemic control (34.19%) and waist circumference with high risk prevailed in men (37.96 %) and women (38.30 %). . After completing the study, the average level of knowledge (38.71 %), patients with normal weight (57.42 %), adequate glycemic control (34.84 %) predominated. Conclusions: the applied intervention generated positive changes in the variables studied.

El diagnóstico precoz de las enfermedades reumáticas, necesidades reales

Introducción: Las enfermedades reumáticas son conceptualizadas como un grupo de afecciones que generan grados variables de discapacidad funcional y disminución de la percepción de calidad de vida relacionada con la salud. Su diagnóstico precoz resulta vital para minimizar el riesgo de aparición de complicaciones y deformidades articulares. Objetivo: Identificar el nivel de conocimiento sobre los elementos básicos del diagnóstico de enfermedades reumáticas en médicos del primer nivel de atención de salud. Métodos: Se realizó una investigación básica, no experimental, descriptiva y transversal. El universo estuvo constituido por 428 médicos generales que laboran en el primer nivel de atención de salud de la zona 3 en Ecuador. La muestra quedó conformada por 204 profesionales. Se aplicó un modelo de recolección de información que permitió identificar características generales y nivel de conocimiento sobre elementos básicos del diagnóstico de las enfermedades reumáticas. Resultados: Promedio de edad de 28,39 años, predominio de médicos femeninas (63,24 %), entre 4 y 6 años de graduados (35,78 %) y haber recibido capacitaciones sobre los elementos básicos del diagnóstico de las enfermedades reumáticas (98,04 %). El nivel de conocimiento predominante sobre este tema fue el bajo (89,70 %). Conclusiones: El nivel de conocimiento sobre elementos básicos del diagnóstico de enfermedades reumáticas en médicos del primer nivel de atención de salud es bajo.

Introduction: Rheumatic diseases are conceptualized as a group of conditions that generate variable degrees of functional disability and decreased perception of health-related quality of life. Its early diagnosis is vital to minimize the risk of complications and joint deformities. Objective: To identify the level of knowledge about the basic elements of the diagnosis of rheumatic diseases in doctors of the first level of health care. Methods: A basic, non-experimental, descriptive and cross-sectional investigation was carried out. The universe consisted of 428 general practitioners who work in the first level of health care in zone 3 in Ecuador. The sample was made up of 204 professionals. An information collection model was applied that allowed the identification of general characteristics and level of knowledge about basic elements of the diagnosis of rheumatic diseases. Results: Average age of 28.39 years, predominance of female doctors (63.24 %), between 4 and 6 years of graduation (35.78 %) and having received training on the basic elements of diagnosis of rheumatic diseases (98.04 %). The predominant level of knowledge on this topic was low (89.70 %). Conclusions: The level of knowledge about basic elements of the diagnosis of rheumatic diseases in doctors of the first level of health care is low.

Análisis de la capacidad funcional cardiorrespiratoria en pacientes entre 30 y 60 años post COVID-19

Introducción: La COVID-19 genera afectación durante el proceso de la enfermedad en el aparato respiratorio y cardiovascular; sin embargo, se desconoce si esta afectación desaparece con la resolución del proceso inflamatorio o se mantienen en forma de secuela con el de cursar del tiempo. Objetivo: Analizar la capacidad funcional cardiorrespiratoria en pacientes entre 30 y 60 años post COVID-19. Métodos: Se realizó una investigación básica, no experimental, descriptiva y transversal que incluyó 328 pacientes, de los cuales 178 formaron parte de la muestra. Se analizaron características generales, la capacidad funcional respiratoria y cardiovascular. Resultados: Promedio de edad de 53,48 años con predominio de pacientes femeninas (55,62 %). El 33,15 % de los pacientes refirió una comorbilidad asociada. El 15,73 % de los pacientes presentaba bradicardia y el 8,99 % taquicardia. En el 42,70 % de los casos se identificó enfermedad hipertensiva. Las manifestaciones respiratorias estuvieron dadas por la presencia de disnea y porcentaje elevado de pacientes con taquipnea y trastornos de la saturación de oxígeno. Conclusiones: Después de transcurridos 6 meses de la presencia de COVID-19 un elevado porcentaje de pacientes presentaban manifestaciones cardiorrespiratorias que afectaban la capacidad funcional de ambos aparatos.

Introduction: COVID-19 affects the respiratory and cardiovascular systems during the disease process; however, it is unknown if this affectation disappears with the resolution of the inflammatory process or if it remains in the form of a sequel over time. Objective: To analyze the cardiorespiratory functional capacity in patients between 30 and 60 years old post COVID-19. Methods: A basic, non-experimental, descriptive and cross-sectional investigation was carried out that included 328 patients, of which 178 were part of the sample. General characteristics, respiratory and cardiovascular functional capacity were analyzed. Results: Average age of 53,48 years with a predominance of female patients (55.62 %). 33.15 % of the patients reported an associated comorbidity. 15.73 % of the patients presented bradycardia and 8.99 % tachycardia. Hypertensive disease was identified in 42.70 % of the cases. The respiratory manifestations were given by the presence of dyspnea and a high percentage of patients with tachypnea and oxygen saturation disorders. Conclusions: After 6 months of the presence of COVID-19, a high percentage of patients presented cardiorespiratory manifestations that affected the functional capacity of both devices.

La atención primaria de salud como piedra angular del control de las enfermedades reumáticas

Las enfermedades reumáticas constituyen uno de los grupos de enfermedades que con mayor frecuencia se presentan en el primer nivel de atención de salud. Dentro de sus características más distintivas destacan la generación de distintos grados de discapacidad funcional y la afectación a la percepción de calidad de vida relacionada con la salud. El diagnóstico precoz y el tratamiento oportuno constituyen las herramientas que se orientan al mejor control de la enfermedad; sin embargo, para lograrlo se necesita aumentar el nivel de preparación y competencia profesional del equipo de salud que labora en el primer nivel de atención. El objetivo de esta investigación es exponer, desde el punto de vista de la formación médica, los mecanismos que pueden formar parte de herramientas de superación profesional en el primer nivel de atención en base al reconocimiento de los elementos que permiten el diagnóstico de las enfermedades reumáticas y la correcta orientación diagnóstica. Se realiza un breve bosquejo de los elementos que deben ser incluidos tanto en la educación médica de pregrado como de posgrado. Se concluye que el abordaje de las enfermedades reumáticas debe constituir una práctica de superación permanente, como alternativa viable a disminuir la discapacidad funcional y aumentar la percepción de calidad de vida relacionada con la salud de estos pacientes.

Rheumatic diseases constitute one of the groups of diseases that most frequently occur in the first level of health care. Among its most distinctive characteristics, the generation of different degrees of functional disability and the affectation of the perception of health-related quality of life stand out. Early diagnosis and timely treatment are the tools that are aimed at better control of the disease; however, to achieve this, it is necessary to increase the level of preparation and professional competence of the health team that works at the first level of care. The objective of this research is to expose, from the point of view of medical training, the mechanisms that can be part of professional improvement tools in the first level of care based on the recognition of the elements that allow the diagnosis of rheumatic diseases. and the correct diagnostic orientation. A brief outline of the elements that should be included in both undergraduate and postgraduate medical education is made. It is concluded that the approach to rheumatic diseases should constitute a permanent improvement practice, as a viable alternative to reduce functional disability and increase the perception of quality of life related to the health of these patients.

Interpretation of the international expert consensus guideline on exercise management for older adults / 中华老年医学杂志

Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiopulmonary fitness in older adults and may eventually lead to reduced capabilities to conduct daily activities and independent living.Exercise plays an important role in maintaining physical function and mental health, preventing and treating chronic diseases, reducing mortality, and improving the quality of life in older people.In 2021, the International Conference of Frailty and Sarcopenia Research(ICFSR)proposed international expert consensus guidelines on exercise recommendations for older people.It mainly introduces two aging phenotypes and six recommended exercise modalities and discusses the effects of exercise on maintaining physical health and preventing common chronic diseases and geriatric syndromes.It aims to provide suggestions for older adults to maintain physical fitness and prevent disease progression and disability via exercise.We intend to interpret the important contents of the guidelines to provide a reference for exercise research and practical applications in the elderly in China.

Two Cases of Elderly Heart Failure Patients who Improved Pulmonary Congestion and Maintained Functional Capacity with Tokishakuyakusan / 日本東洋医学雑誌

We report two cases of older heart failure (HF) patients who improved pulmonary congestion and maintained functional capacity with tokishakuyakusan. Case 1 was an 83-year-old woman who previously treated with percutaneous coronary intervention for angina and had multiple comorbidities such as chronic kidney disease and rheumatoid arthritis. Despite of multiple medications including 3 kinds of diuretics, general fatigue that interferes with her daily life, marked pulmonary congestion, and leg edema remained. After prescription of tokishakuyakusan, urine volume increased rapidly and HF symptoms were alleviated so that 2 diuretics were successfully discontinued. Case 2 was an 88-year-old man with chronic atrial fibrillation and severe mitral regurgitation with worsening dyspnea on effort, paroxysmal nocturnal dyspnea, and leg edema. Tokishakuyakusan was effective for improving these HF symptoms and he returned to normal life without additional HF treatment. For elderly HF patients, tokishakuyakusan is considered to be effective to improve blood deficiency/stasis pattern and fluid retention, which enables these patients to make their daily life without being disturbed by severe HF symptoms.

Prediction equation of peak oxygen uptake for the modified shuttle test in healthy adolescents / Equação de predição do consumo máximo de oxigênio para o shuttle test modificado em adolescentes saudáveis / Ecuación de predicción del consumo máximo de oxígeno para el shuttle test modificado en adolescentes sanos

ABSTRACT Given the gap in the literature regarding the peak of oxygen consumption (VO2peak) for adolescents of both sexes, this study aimed to propose an equation to predict the VO2peak in healthy adolescents using the Modified Shuttle Test (MST). This is a cross-sectional study with 84 healthy adolescents between 12 and 18 years old, female and male. The MST is an external paced test, in which the speed increases at each minute. Two MST were performed with at least 30 minutes of rest between them. The test with the longest walked distance was considered for analysis. VO2 was directly monitored by an open circuit spirometry. Mean age was 14.67±1.82 and the walked distance was 864.86±263.48m. Variables included in the prediction equation were walked distance and sex, explaining the VO2peak variability of 53% during MST performance. The prediction equation for VO2peak with the MST was: predicted VO2peak=18.274+(0.18×Distance Walked, meters)+(7.733×Sex); R2=0.53 and p<0.0001 (sex: 0 for girls, 1 for boys). This MST equation, proposed to predict VO2peak in healthy adolescents of both sexes, can be used as a reference to assess exercise capacity in healthy adolescents and to investigate cardiopulmonary function in adolescents with reduced functional capacity.

RESUMO Dada a lacuna na literatura quanto à equação de predição do pico de consumo de oxigênio (VO2) para adolescentes de ambos os sexos, o objetivo deste estudo é propor uma equação para predizer o VO2pico em adolescentes saudáveis utilizando o shuttle test modificado (MST). Trata-se de um estudo transversal realizado com 84 adolescentes saudáveis entre 12 e 18 anos, do sexo feminino e masculino. O MST é um teste de campo ditado por um sinal sonoro que indica o aumento da velocidade a cada minuto. Dois MSTs foram realizados com pelo menos 30 minutos de descanso entre eles. O teste com a maior distância percorrida foi o considerado para análise. O VO2 foi monitorado diretamente por uma espirometria de circuito aberto. A média de idade foi de 14,67±1,82 anos, e a de distância percorrida foi de 864,86±263,48m. As variáveis incluídas na equação de predição foram distância percorrida e sexo, que explicaram 53% da variabilidade do VO2pico durante a realização do MST. A equação de referência para o VO2pico previsto com o MST foi VO2pico predito=18,274+(0,18×Distância percorrida, em metros)+(7,733×Sexo); R2=0,53 e p<0,0001 (sexo: 0 para meninas, 1 para meninos). A equação do MST proposta para predizer o VO2pico em adolescentes saudáveis de ambos os sexos pode ser usada como referência para avaliar a capacidade de exercício em adolescentes saudáveis e investigar a função cardiopulmonar em adolescentes com capacidade funcional reduzida.

RESUMEN Dada una laguna en la literatura con respecto a la ecuación para predecir el consumo máximo de oxígeno (VO2) en adolescentes de ambos sexos, el objetivo de este estudio es proponer una ecuación para predecir el VO2máximo en adolescentes sanos usando el shuttle test modificado (MST). Se trata de un estudio transversal, realizado con 84 adolescentes sanos con edades entre 12 y 18 años, de ambos sexos. El MST es una prueba de campo dictada por una señal sonora que indica el aumento de velocidad cada minuto. Se realizaron dos MST con al menos 30 minutos de descanso entre ellos. Para el análisis se consideró la prueba con mayor distancia recorrida. El monitoreo del VO2 fue realizado directamente por espirometría de circuito abierto. La edad media fue de 14,67±1,82 años; y la distancia recorrida, de 864,86±263,48m. Las variables incluidas en la ecuación de predicción fueron la distancia recorrida y el sexo, que explicaron el 53% de la variabilidad del VO2máximo durante la realización del MST. La ecuación de referencia para el VO2máximo predicho con el MST fue VO2máximo previsto=18,274+(0,18×Distancia recorrida, en metros)+(7,733×Sexo); R2=0,53 y p<0,0001 (sexo: 0 para chicas, 1 para chicos). La ecuación MST propuesta para predecir el VO2máximo en adolescentes sanos de ambos sexos puede utilizarse como una referencia para evaluar la capacidad de ejercicio en adolescentes sanos y para investigar la función cardiopulmonar en adolescentes con capacidad funcional reducida.

Early Six-Minute Walk Test May Predict Midterm Outcomes Following Coronary Artery Bypass Grafting

ABSTRACT Objective: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6MWD, considering the preoperative baseline as 100%. Methods: A prospective cohort of patients undergoing elective CABG were included. The percentage fall in 6MWD was assessed by the difference between preoperative and postoperative day (POD) five. Clinical outcomes were evaluated three months after hospital discharge. Results: There was a significant decrease in 6MWD on POD5 compared with preoperative baseline values (percentage fall of 32.5±16.5%, P<0.0001). Linear regression analysis showed an independent association of the percentage fall of 6MWD with cardiopulmonary bypass (CPB) and preoperative inspiratory muscle strength. Receiver operating characteristic curve analysis revealed that the best cutoff value of percentage fall in 6MWD to predict poorer clinical outcomes at three months was 34.6% (area under the curve = 0.82, sensitivity = 78.95%, specificity = 76.19%, P=0.0001). Conclusion: This study indicates that a cutoff value of 34.6% in percentage fall of 6MWD on POD5 was able to predict poorer clinical outcomes at three months of follow-up after CABG. Use of CPB and preoperative inspiratory muscle strength were independent predictors of percentage fall of 6MWD in the postoperative period. These findings further support the clinical application of 6MWD and propose an inpatient preventive strategy to guide clinical management over time.

Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial

Abstract Objective This study aims to evaluate the effect of functional versus resistance exercise training on the functional capacity and quality of life of psoriatic arthritis patients. Methods Forty-one psoriatic arthritis patients (18 to 65 years old) were randomized into two groups: functional training group and resistance exercise group. The functional training group underwent functional exercises with elastic band and the functional training group underwent machine resistance exercise twice a week for 12 weeks. Outcome measures were: The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S) for functional capacity and functional status, one-repetition maximum test for muscle strength, the Short Form 36 health survey questionnaire (SF-36) for quality of life, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Score 28 (DAS-28) for disease activity. Analyzes were performed by a blinded evaluator at baseline (T0), six (T6) and twelve (T12) weeks after the beginning of the exercise. Results At baseline, the groups were homogeneous in the clinical and demographic characteristics. There was a statistical intra-group improvement for both groups in the BASFI, BASDAI, HAQ-s, and DAS-28. In the quality-of-life assessment, both groups showed statistical intra-group improvements for all domains except the "emotional aspect" domain in the resistance exercise group. In the muscle strength, there was a statistical improvement for all exercises in both groups, except for the "alternate biceps (bilateral)" exercise. Conclusion Functional training and resistance exercise are similarly effective in improving functional capacity, functional status, disease activity, general quality of life, and muscle strength in patients with psoriatic arthritis. Trial Registration ClinicalTrials.gov: NCT04304326. Registered 11 March 2020, https://clinicaltrials.gov/ct2/show/NCT04304326?term=NCT04304326&draw=2&rank=1.

Effects of a physiotherapeutic protocol in cardiorespiratory, muscle strength, aerobic capacity and quality of life after hematopoietic stem cell transplantation

Abstract Objective To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT). Methods From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow "Peak Flow", 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments. Results 29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1-9). A decreasing in the right and left dynamometry (p ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation. Conclusion Cardiorespiratory rehabilitation can preserve functional capacity and quality of life.

Discapacidad funcional en pacientes con fibromialgia en un hospital en Lima, Perú

Introducción: La fibromialgia es un trastorno reumatológico caracterizado por dolor generalizado de localización imprecisa que afecta principalmente a mujeres. Se asocia a fatiga, ansiedad, depresión y la capacidad funcional de estos pacientes se ve afectada por la coexistencia de dichos trastornos. Métodos: Serie de casos de corte transversal con uso de datos secundarios de 126 pacientes con fibromialgia que acudieron a consultorio externo del servicio de reumatología de un hospital en Lima durante febrero de 2020. Se buscó determinar la frecuencia de discapacidad funcional y explorar factores asociados en pacientes con diagnóstico de fibromialgia con o sin depresión. La capacidad funcional y la presencia de síntomas depresivos fueron medidas mediante uso de escalas validadas. Se realizó un análisis multivariado de regresión logística múltiple para valorar si la depresión es un factor de riego independiente de discapacidad. Resultados: La edad tuvo una mediana de 53,5 (RIQ: 46-60) años y 122 participantes eran mujeres, además 42 (33,33%) pacientes presentaban depresión y 76 (60,32%) presentaban discapacidad funcional. En el análisis multivariado, se encontró que la depresión es un factor de riesgo independiente de discapacidad funcional luego de ajustar a diabetes, presencia de 3 o más comorbilidades, intensidad de fatiga y síntomas asociados [OR de 3.09 (1.24 - 7.70); p: 0.015]. Conclusiones: La depresión es un factor independiente para discapacidad funcional en pacientes con fibromialgia.

Background: Fibromyalgia is a rheumatological disorder characterized by generalized pain of imprecise localization that mainly affects women. It is associated with fatigue, anxiety, depression, and functional capacity is greatly affected by the coexistence of these disorders. Methods: It is a series of cross-sectional cases, using secondary data from 126 patients with fibromyalgia who attended the outpatient clinic of a hospital at Lima at the rheumatology service during February 2020. We try to determine the frequency of functional disability and explore associated factors in patients diagnosed with fibromyalgia with or without depression. Functional capacity and the presence of depressive symptoms were measure by validated scales. A multivariate multiple logistic regression analysis was performed to assess whether depression is an independent risk factor for disability. Results: The age had a median of 53.5 (IQR: 46-60) years, 122 participants were women. In addition, 42 (33.33%) patients had depression and 76 (60.32%) patients had functional disability. In the multivariate analysis, it was found that depression is an independent risk factor for functional disability after adjusting for diabetes, presence of 3 or more comorbidities, intensity of fatigue and associated symptoms [OR 3.09 (1.24 - 7.70); p: 0.015]. Conclusions: Depression is an independent factor for functional incapacity in patients with fibromyalgia.