Home-based Virtual Reality Exercise Program During the Maintenance Stage of Cardiac Rehabilitation: A Randomized Controlled Trial

Abstract Background: Home-based virtual reality technology may become an alternative to cardiac rehabilitation. Objectives: To evaluate the effects of a specific, home-based exercise program, performed either through a virtual reality (Kinect) or a conventional format (booklet) in the maintenance stage of cardiac rehabilitation for six months on functional muscle strength of the lower limbs, physical activity and exercise tolerance. Methodology: This is a randomized clinical trial (ClinicalTrials.gov — NCT02753829) with individuals with coronary artery disease from a hospital in Porto, Portugal, randomly allocated to an experimental group "1" (EG1; n = 11), submitted to a virtual reality exercise program (Kinect); an experimental group "2" (EG2; n = 11), submitted to an exercise program described in a booklet (conventional format); or a control group (CG) (n=11), submitted to routine care. Parameters of functional muscle strength of the lower limbs (sit-to-stand test), physical activity (accelerometer) and exercise tolerance (stress test) were assessed and compared between the groups. Descriptive and inferential statistics were applied, with 95% with a significance level of 0.05. Results: Significant improvements in functional muscle strength of the lower limbs were observed in EG1 compared to EG2, at three months (19.5 ± 7.7 versus 11.9 ± 4.7, p = 0.042), and at six months (23.0 ± 7.7 versus 14.6 ± 4.6, p = 0.027) of intervention. Conclusions: The program did not demonstrate superior results, in relation to the control group and among the different formats, in physical activity and effort tolerance. In relation to the functional muscle strength of the lower limbs, the virtual reality format showed significantly better results when compared to the conventional format only.

Núcleo de Apoio à Saúde da Família e os desafios para a saúde mental na atenção básica / Family Health Support Center and the challenges for mental health in primary health care

Resumo Este estudo teve como objetivo analisar artigos científicos publicados na área da saúde, investigando os principais desafios para o trabalho dos Núcleos de Apoio à Saúde da Família (NASFs), considerando a relação saúde mental-atenção básica. Como método, realizou-se revisão sistemática nas bases de dados entre os anos de 2013 e 2018 das pesquisas com campo empírico que se dedicaram a estudar a atuação dos NASFs no eixo de saúde mental na Região Sudeste do Brasil. Foram encontrados 21 artigos, dos quais três foram escolhidos a partir dos critérios de inclusão para análise e discussão de resultados. Conclui-se que entre os principais desafios do NASF na relação saúde mental-atenção básica, há: 1) predominância de um modelo biomédico em detrimento de um modo de trabalhar pautado no coletivo; 2) dificuldade em compreender e realizar o apoio matricial; e 3) isolamento e baixo grau de comunicação entre equipes, o que cria barreiras para o exercício da interdisciplinaridade.

ABSTRACT This study aimed to analyze scientific articles published in the health area, investigating the main challenges for the work of the Family Health Support Centers (NASFs), considering the relation between mental health and primary health care. As a method, we did a systematic review in the databases between the years of 2013 and 2018 of empirical researches dedicated to study the performance of NASFs in the mental health axis in the Southeastern Region of Brazil. As a result, we found 21 articles, and three met the inclusion criteria for analysis and discussion of results. We concluded that among the main challenges of the NASF in mental health-primary health care there are: 1) Predominance of biomedical model in detriment of a way of working based on the collective; 2) Difficulty in understanding and performing matrix support; and 3) Isolation and low degree of communication between teams which creates barriers to the exercise of interdisciplinarity.