Effects of Inspiratory Muscle Training Using an Electronic Device on Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial

Abstract Background Cardiac surgery causes pathophysiological changes that favor the occurrence of pulmonary and functional complications. Objective To investigate the effects of inspiratory muscle training (IMT) with an electronic device on patients undergoing cardiac surgery. Methods A randomized controlled trial was conducted with 30 adult patients undergoing elective cardiac surgery. A control group (CG) received conventional physical therapy care, and an intervention group (IG) received IMT using the POWERbreathe K5® electronic device. Two daily sessions of physical therapy were performed at the intensive care unit and one daily session at the ward until the sixth postoperative day. The following variables were measured preoperatively and on the sixth postoperative day, in both groups: inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow. Data distribution was evaluated by the Shapiro-Wilk test. Analysis of variance was used, and the results were considered statistically significant when p < 0.05. Results Maximal inspiratory pressure (71.7 ± 17.1 cmH2O vs 63.3 ± 21.3 cmH2O; p = 0.11], S-index (52.61 ± 18.61 vs 51.08 ± 20.71), and peak inspiratory flow [(2.94 ± 1.09 vs 2.79 ± 1.26)] were maintained in the IG but had a significant reduction in the CG. Conclusion IMT performed with an electronic device was effective at maintaining inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow when compared to conventional physical therapy. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Evidências científicas sobre Fisioterapia e funcionalidade em pacientes com COVID-19 adulto e pediátrico / Evidence-based Physiotherapy and Functionality in adult and pediatric patients with COVID-19

Introdução: O corona vírus (2019-nCoV OU HCOV-19 ou CoV2), emergiu na China como a principal causa de pneumonia viral (COVID-19, Doença do Coronavírus 19). Objetivo: Avaliar evidências científicas sobre Fisioterapia e Funcionalidade em pacientes com COVID-19 adulto e pediátrico. Métodos: Trata-se de uma revisão de literatura do tipo integrativa utilizando a bases de dados do MedLine/PubMed, bioblioteca da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Physiotherapy Evidence Database (PEDRo).Resultados:Os pacientes com COVID-19 apresentam sinais de deficiência respiratória com hipoxemia, com baixo impacto em crianças estas evoluem sem sintomas ou com quadro de baixa gravidade. além de observar impacto na restrição da participação. a fisioterapia atua na oxigenioterapia e ventilação dos pacientes.Conclusão: A COVID-19 causa alterações na função pulmonar com formação de deficiência respiratória hipoxêmica e de complacência, com repercussões cardiovasculares que leva a necessidade da fisioterapia no desfecho desta pandemia, seja por meio da oxigenioterapia e/ou do suporte ventilatório (invasivo e não-invasivo).(AU)

Introduction: The corona virus (2019-nCoV OR HCOV-19 or CoV2), has emerged in China as the main cause of viral pneumonia (COVID-19, Coronavirus Disease-19). Aim: To provide evidence-based Physiotherapy and functionality in patients with adult and pediatric COVID-19. Methods: This is an integrative literature review using the MedLine / PubMed databases, library of Latin American and Caribbean Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDRo). Results: Part of the patients with covid 19 show signs of respiratory deficiency with hypoxemia, with low severity in children. Impaired functionality is also expected. Conclusion: COVID-19 causes low pulmonary compliance and important changes in lung function with hypoxemia and cardiovascular repercussions. These changes lead to the need for Physiotherapy and the management of oxygen therapy and ventilatory support (invasive and non-invasive) for these patients.

Comparação da força e resistência dos músculos inspiratórios entre ativos e sedentários / Comparison of the strength and resistance of inspirational muscles between assets and sedentary

Introdução: A prática regular de atividade física está associada com melhora do estado de saúde, aumento da capacidade funcional, aumento da força muscular e redução da mortalidade por doenças cardíacas. Apesar dos benefícios de a prática regular de exercício físico estarem consolidados na literatura, as adaptações na força e resistência dos músculos inspiratórios são controversas. Objetivo: Testar a hipótese que não há diferença da força e resistência dos músculos inspiratórios entre indivíduos ativos e sedentários. Métodos:Estudo observacional de corte transversal. Avaliou-se indivíduos entre 18 e 30 anos, ambos os sexos e saudáveis. Os voluntários foram divididos em ativos e sedentários de acordo a classificação da American College of Sports Medicine (ACMS). Os indivíduos tiveram a força máxima dos músculos inspiratórios (FMI) determinada através do dispositivo POWERbreathe® K5 inspiratory muscle trainer, que intula esta variável como Sindex. A resistência dos músculos inspiratórios foi avaliada través de um teste incremental. Para comparação das médias foi aplicada o teste t de student para distribuição simétrica, p< 0,05. O estudo foi aprovado pelo comitê de ética em pesquisa com CAAE : 37781014.4.0000.5544. Resultados: Foram avaliados 92 indivíduos, destes 55 (60%) foram classificados como ativos e 57 (62%) do sexo masculino. Ao realizar a comparação do Sindex entre ativos e sedentários (128±26; 119±24 cmH2O; p=0,85) e da exaustão no teste incremental (6516% e 6016%;p=0,095), respctivamente. Conclusão: Os indivíduos ativos não apresentam músculos inspiratórios mais fortes e resistentes quando comparados com sedentários. [AU]

Introduction: The regular practice of physical activity is associated with improved health status, increased functional capacity, increased muscle strength and reduced mortality from heart disease. Although the benefits of regular exercise are well established in the literature, adaptations in inspiratory muscle strength and endurance are controversial. Objective: To test the hypothesis that there is no difference in the strength and resistance of the inspiratory muscles between active and sedentary individuals. Methods: Cross-sectional observational study. It was evaluated individuals between 18 and 30 years old, both sexes and healthy. The volunteers were divided into active and sedentary according to the classification of the American College of Sports Medicine (ACMS). Individuals had maximal inspiratory muscle strength (IMS) determined through the POWERbreathe® K5 inspiratory muscle trainer, which injects this variable as Sindex. The inspiratory muscle strength was evaluated through an incremental test. For the comparison of the means the student's t-test was applied for symmetrical distribution, p <0.05. The study was approved by the research ethics committee with CAAE: 37781014.4.0000.5544. Results: A total of 92 individuals were evaluated. Of these, 55 (60%) were classified as active and 57 (62%) were male. When comparing Sindex between active and sedentary (128 ± 26/119 ± 24 cmH2O, p = 0.85) and exhaustion in the incremental test (63.2 ± 16.1%. p = 0.095), respectively. Conclusion: Active individuals do not present stronger and stronger inspiratory muscles when compared to sedentary ones. [AU]

Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery

Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results: 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Alterações fisiológicas da caminhada e tempo de internamento no pós-operatório de cirurgia cardíaca / Physiological changes from walking and time of stay after heart surgery

Fundamentos: Nas últimas décadas a fisioterapia vem se destacando no manejo de pacientes submetidos à cirurgiacardíaca, e a deambulação é um tipo de exercício bem tolerado pelos pacientes.Objetivos: Avaliar as alterações fisiológicas da caminhada e verificar a correlação com o tempo de internamentohospitalar no pós de cirurgia cardíaca (CC).Métodos: Realizado ensaio clínico transversal, quantitativo e observacional. Foram selecionados 30 pacientes.Avaliadas as variáveis hemodinâmicas: frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólica (PAD)e duplo-produto (DP); e respiratórias: frequência respiratória (FR) e saturação periférica de oxigênio (SpO2), umminuto antes de andar e imediatamente após o término da caminhada.Resultados: Constatou-se elevação na: PAS 112,0±11,9 mmHg para 118,2±19,1 mmHg (p=0,06); FC final 94,1±17,6 bpmpara 81,7±14,6 bpm (p=0,00); DP 9166,0±2041,6 para 11230,7±3441,3 (p=0,00); e PAD 74,0±18,7 mmHg para77,3±11,7 mmHg (p=0,27). Já a FR 19,4±4,4 ipm para 24,0±4,4 ipm (p=0,00); e a SpO2 95,3±2,4% para 94,9±3,2%(p=0,53). Observou-se também correlação significativa entre a variação da FC, do DP e da PAS pós-exercício.Conclusões: A caminhada gerou efeitos hemodinâmicos sobre a FC e o DP e alteração da FR. A FC, o DP e a PASpós apresentaram relação direta com o tempo de permanência hospitalar.

Background: In the past decades, physical therapy has been outstanding in the management of patients undergoing heart surgeryand walking is a type of exercise well tolerated by patients.Objectives: To evaluate the physiological changes from walking and the correlation with hospital stay after heart surgery (HS).Methods: Cross-sectional quantitative observational clinical trial has been conducted. Thirty 30 patients were selected. The followinghemodynamic variables have been evaluated: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) anddouble product (DP); as well as the following respiratory variables: respiratory rate (RR), peripheral oxygen saturation (PO2S), oneminute before walking and immediately after the end of the walk.Results: The following rates were increased: SBP 112.0±11.9 mmHg to 118.2±19.1 mmHg (p=0.06); end HR 94.1±17.6 bpm to81.7±14.6 bpm (p=0.00); DP 9166.0±2041.6 to 11230.7±3441.3 (p=0.00); and DBP 74.0±18.7 mmHg to 77.3±11.7 mmHg (p=0.27).RR increased from 19.4±4.4 ipm to 24.0±4.4 ipm (p=0.00); and PO2S 95.3±2.4% to 94.9±3.2% (p=0.53). There was also a significantcorrelation between the variation of HR, DP and SBP after exercise.Conclusions: Walking generated hemodynamic effects over HR, DP, and changes in RR. HR, DP and SBP after heart surgery hada direct relationship with the length of hospital stay.

Influência da deambulação precoce no tempo de internação hospitalar no pós-operatório de cirurgia cardíaca / Influence of early ambulation in postoperative hospitalization following cardiac surgery

Fundamentos: Apesar do avanço tecnológico que visa a prolongar a qualidade de vida de pacientes submetidos acirurgia cardíaca, esse procedimento ainda é considerado de alta complexidade. A deambulação precoce é uma alternativa para melhorar a capacidade pulmonar, o condicionamento cardiovascular e o aumento do desempenho funcional. Objetivos: Avaliar o impacto da deambulação precoce sobre o tempo de internação na Unidade de Terapia Intensiva (UTI) e hospitalar em pacientes submetidos a cirurgia cardíaca. Métodos: Estudo transversal, realizado com 49 pacientes submetidos à cirurgia cardíaca e admitidos na UTI, no período de outubro de 2014 a abril de 2015. Os pacientes foram estratificados em dois grupos: com e semdeambulação precoce. Deambulação precoce definida como o ato de caminhar até o terceiro dia de internação na UTI. Análise estatística realizada para verificar a existência de modificações no tempo de permanência hospitalare UTI entre os dois grupos de deambulação.Resultados: Foram estudados 49 pacientes, dos quais 55,1% homens, média de idade 55,2±13,9 anos, internados na UTI em decorrência de cirurgia cardíaca no período do estudo. Não se observou correlação estatística entre o ato de deambular precocemente com o tempo de permanência na UTI cardíaca (3,0±1,5 dias vs. 2,8±1,1 dias, p=0,819) e hospitalar (5,4±3,3 dias vs. 5,3±2,6 dias, p=0,903).Conclusão: A deambulação precoce não se associou a um menor tempo de permanência na UTI ou hospitalar.

Background: Despite the technological advances aimed to extend the quality of life of patients undergoing cardiac surgery, such procedure is still deemed a highly complex intervention. Early ambulation is an alternative to improve lung capacity, cardiovascular fitness and increased functional performance. Objective: Assess the impact of early ambulation on the length of stay in intensive care unit (ICU) and in hospital, for patients undergoing cardiac surgery. Methods: Cross-sectional study of 49 patients undergoing cardiac surgery and admitted to the ICU from October 2014 to April 2015. Patients were stratified into two groups: with and without early ambulation. Early ambulation is the act of walking up to the third day of ICU admission. Statistical analysis performed to check for changes in the length of stay in ICU and in hospital between the two groups of ambulation. Results: The study observed 49 patients (55.1% men) with mean age of 55.2±13.9 years, admitted to the ICU due to cardiac surgery carried out during the study period. No statistical correlation was found between early ambulation and the length of stay in cardiac ICU (3.0±1.5 days vs. 2.8±1.1 days, p=0.819) and in hospital (5.4±3.3 days vs. 5.3±2.6 days, p=0.903).Conclusion: Early ambulation is not related to a shorter length of stay in ICU or in hospital.

Efeitos dos exercícios funcionais e neuromusculares no tempo de internação e controle pressórico de pacientes hospitalizados / Effects of functional and neuromuscular exercises in hospitalization time and pressure control of hospitalized patients

INTRODUÇÃO: Exercícios funcionais e neuromusculares são importantes ferramentas em centros de reabilitação, porém são pouco explorados em protocolos hospitalares. OBJETIVO: Verificar se exercícios funcionais e neuromusculares são mais eficazes na redução do tempo de internamento e controle da pressão arterial (PA) dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina. MÉTODOS: Foram incluídos pacientes hospitalizados por enfermidades não cardiológicas e sem hipertensão arterial sistêmica, sendo estes randomizados para grupo controle (GC), que realizou exercícios respiratórios, exercícios ativo-livres para membros superiores/ inferiores e caminhada no corredor, ou grupo de reabilitação funcional (GRF), submetido a exercícios neuromusculares para membros superiores/inferiores, cicloergômetro e treino de subir/descer degraus. Ambos os grupos receberam intervenção 2x/dia. A PA foi aferida na admissão, durante o internamento e na alta hospitalar. O tratamento estatístico foi realizado adotando-se intervalo de confiança de 95% e nível de significância de 5%. RESULTADOS: Avaliados 42 voluntários, dos quais 26 atenderam aos critérios de elegibilidade. Porém, seis foram excluídos, quatro por permanência hospitalar inferior a três dias e dois por não completarem o protocolo de tratamento. A média de idade no GC foi de 72±11 versus 73±8 no GRF. Não houve diferenças estatísticas da PA na admissão. Evidenciou-se redução da PA apenas no GRF durante o internamento (p<0,01), assim como na alta hospitalar (p<0,01). O GC apresentou maior tempo (dias) de internação 7,2±1,8 versus 5,5±1,3 do GRF (p<0,05). CONCLUSÃO: Exercícios funcionais e neuromusculares parecem mais eficazes na redução do tempo de internamento e controle da PA dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina.

INTRODUCTION: Functional and neuromuscular exercises are important tools in rehabilitation centers, however they are little explored in hospital protocols. OBJECTIVE: To determine whether functional and neuromuscular exercises are more effective in reducing hospital stay and controlling blood pressure (BP) of hospitalized individuals than routine hospital physiotherapy. METHODS: Hospitalized patients for non-cardiac illnesses and without hypertension were included, which were randomized to the control group (CG), who performed breathing exercises, active-free exercises for upper/lower limbs and walk in the hallway, or to functional rehabilitation group (FRG), which underwent neuromuscular exercises for upper/lower limbs, cycle ergometer and up/down stairs training. Both groups received intervention 2x/day. BP was measured at admission, during hospitalization and at discharge. Statistical analysis was performed by adopting a confidence interval of 95% and a 5% significance level. RESULTS: Forty-two volunteers were evaluated, of which 26 met the eligibility criteria. However, six were excluded, four due to hospital stay less than three days and two for not completing the treatment protocol. The average age in the CG was 72±11 versus 73±8 in the FRG. There were no statistical differences in BP levels at admission. There was a reduction in the BP only in the FRG during hospitalization (p<0.01) and at discharge (p<0.01). The CG presented longer time (days) of hospitalization - 7.2±1.8 versus 5.5±1.3 of the FRG (p<0.05). CONCLUSION: Functional and neuromuscular exercises seem more effective in reducing the length of hospital stay and blood pressure control, of hospitalized individuals that routine hospital physiotherapy.