Sarcopenia, frailty, and elective surgery outcomes in the elderly: an observational study with 125 patients (the SAFESOE study).

Background: Sarcopenia is a syndrome characterized by loss of muscle mass, strength and function. Frailty, a state of vulnerability with diminished reserves. The measurement of perioperative risk does not include the assessment of these variables, as little is known about how these conditions impact each other. Methods: Observational study with a cross-sectional and a prospective cohort component. Elderly people over 60 years of age, able to walk and to independently perform activities of daily living were consecutively recruited in the preoperative period of non-emergency surgical procedures. Frailty was measured by the modified frailty index (mFI-11). Sarcopenia was measured by: (1) thickness and echogenicity on ultrasound; (2) handgrip strength on dynamometry and (3) gait speed. Data obtained from eight muscle groups were submitted to Principal Component Analysis. Postoperative complications were measured using the Clavien-Dindo scale. Follow-up was performed for 1 year to record readmissions and deaths. Results: Between February and May 2019, 125 elderly people were recruited, median age of 71 years (IQR 65-77), 12% of whom were frail. Frailty was associated with older age, use of multiple medicines, presence of multimorbidity and greater surgical risk according to the American Society of Anesthesiologists (ASA) scale, in addition to lower gait speeds and lower handgrip strength. Frailty was also independently associated with smaller measurements of muscle thickness but not with echogenicity, and with longer hospital and Intensive care unit (ICU) stays. Prevalence of sarcopenia was 14% when considering at least two criteria: low walking speed and low handgrip strength. For muscle thickness, lower values were associated with female gender, older age, frailty, lower gait speeds and lower muscle strength, higher proportion of postoperative complications and higher occurrence of death. For echogenicity, higher values were related to the same factors as those of lower muscle thickness, except for postoperative complications. Lower gait speeds and lower handgrip strength were both associated with higher proportions of postoperative complications, and longer hospital stays. A higher mortality rate was observed in those with lower gait speeds. Conclusion: Sarcopenia was associated with frailty in all its domains. Unfavorable surgical outcomes were also associated with these two conditions.

[Repercussions of the COVID-19 pandemic on health services for people with disabilities: report from rehabilitation professionals]. / Repercussões da pandemia de COVID-19 nos serviços de saúde para pessoas com deficiência: relato dos profissionais de reabilitação.

Several healthcare processes, including rehabilitation, require prompt initiation and cannot be interrupted. Therefore, these processes underwent important adaptations during the COVID-19 pandemic. However, it is not fully known how healthcare facilities adapted their strategies and what the results were. This study investigated how rehabilitation services were affected during the pandemic and what strategies were employed to maintain the provided services. From June 2020 to February 2021, 17 semi-structured interviews were conducted with healthcare professionals working in rehabilitation services from the Brazilian Unified National Health System (SUS), who work at one of the three levels of care, in the municipalities of Santos and São Paulo, state of São Paulo, Brazil. The interviews were recorded, transcribed, and analyzed via content analysis. The professionals reported organizational changes in their services, with the initial interruption of appointments and, subsequently, the adoption of new sanitary protocols and the gradual return to in-person and/or remote appointments. Working conditions were directly impacted, as there was a need for staffing, training, increased workloads, as well as physical and mental exhaustion among professionals. The pandemic caused a series of changes in healthcare services, some of which were interrupted due to the suspension of numerous services and appointments. Some in-person appointments were maintained exclusively for patients who presented a risk of short-term deterioration. Preventive sanitary measures and strategies for continuity of care were adopted.

Diversos processos que permeiam a assistência à saúde, incluindo a reabilitação, precisam de brevidade para ser iniciados ou não podem ser interrompidos. Sendo assim, estes passaram por importantes adaptações durante a pandemia de COVID-19. Porém, não se sabe ao certo como os equipamentos de saúde adaptaram suas estratégias e quais foram os resultados. O estudo investigou como os atendimentos em reabilitação foram afetados durante a pandemia e quais foram as estratégias para a manutenção dos serviços prestados. Entre junho de 2020 e fevereiro de 2021, realizaram-se 17 entrevistas semiestruturadas com profissionais de saúde da área da reabilitação do Sistema Único de Saúde (SUS), que atuam em um dos três níveis de atenção, nas cidades de Santos e São Paulo, Estado de São Paulo, Brasil. Os discursos foram gravados, transcritos e analisados por meio da análise de conteúdo. Os profissionais relataram mudanças organizacionais em seus serviços, com a interrupção inicial dos atendimentos e, posteriormente, com a adoção de novos protocolos sanitários e o retorno gradativo dos atendimentos presenciais e/ou a distância. As condições de trabalho foram diretamente impactadas, pois houve necessidade de dimensionamento, capacitação, ampliação de carga horária, além da sobrecarga de trabalho e do esgotamento físico e mental dos profissionais. A pandemia determinou uma série de mudanças nos serviços de saúde, por vezes descontínuas, com a suspensão de inúmeros serviços e atendimentos. Alguns atendimentos presenciais foram mantidos, apenas para os pacientes que apresentavam risco de agravo em curto prazo. Medidas sanitárias preventivas e estratégias de continuidade dos atendimentos foram adotadas.

Diversos procesos que impregnan la asistencia a la salud, incluida la rehabilitación, deben iniciarse con prontitud o no pueden interrumpirse. Por lo que estos sufrieron importantes adaptaciones durante la pandemia de COVID-19. Sin embargo, no se sabe con certeza cómo las instalaciones de salud adaptaron sus estrategias y cuáles fueron los resultados. El estudio investigó cómo se vieron afectados los servicios de rehabilitación durante la pandemia y cuáles fueron las estrategias para mantener los servicios prestados. Entre junio del 2020 y febrero del 2021, se realizaron 17 entrevistas semiestructuradas con profesionales de la salud del área de rehabilitación del Sistema Único de Salud (SUS), que actúan en uno de los tres niveles de atención, en las ciudades de Santos y São Paulo, estado de São Paulo, Brasil. Los discursos se grabaron, se transcribieron y se analizaron mediante análisis de contenido. Los profesionales relataron cambios organizacionales en sus servicios, con la interrupción inicial de la atención y, posteriormente, con la adopción de nuevos protocolos sanitarios y el regreso gradual de la atención presencial o a distancia. Las condiciones de trabajo se vieron directamente afectadas, ya que fue necesario el dimensionamiento, la capacitación, la ampliación de la carga horaria, además de la sobrecarga de trabajo y del agotamiento físico y mental de los profesionales. La pandemia determinó una serie de cambios en los servicios de salud, en ocasiones discontinuos, con la suspensión de numerosos servicios y atenciones. Se mantuvieron algunas atenciones presenciales, solo para los pacientes con riesgo de agravamiento a corto plazo. Se adoptaron medidas sanitarias preventivas y estrategias de continuidad de las atenciones.

Repercussões da pandemia de COVID-19 nos serviços de saúde para pessoas com deficiência: relato dos profissionais de reabilitação / Repercussions of the COVID-19 pandemic on health services for people with disabilities: report from rehabilitation professionals / Repercusiones de la pandemia de COVID-19 en los servicios de salud para personas con discapacidad: relato de los profesionales de la rehabilitación

Resumo: Diversos processos que permeiam a assistência à saúde, incluindo a reabilitação, precisam de brevidade para ser iniciados ou não podem ser interrompidos. Sendo assim, estes passaram por importantes adaptações durante a pandemia de COVID-19. Porém, não se sabe ao certo como os equipamentos de saúde adaptaram suas estratégias e quais foram os resultados. O estudo investigou como os atendimentos em reabilitação foram afetados durante a pandemia e quais foram as estratégias para a manutenção dos serviços prestados. Entre junho de 2020 e fevereiro de 2021, realizaram-se 17 entrevistas semiestruturadas com profissionais de saúde da área da reabilitação do Sistema Único de Saúde (SUS), que atuam em um dos três níveis de atenção, nas cidades de Santos e São Paulo, Estado de São Paulo, Brasil. Os discursos foram gravados, transcritos e analisados por meio da análise de conteúdo. Os profissionais relataram mudanças organizacionais em seus serviços, com a interrupção inicial dos atendimentos e, posteriormente, com a adoção de novos protocolos sanitários e o retorno gradativo dos atendimentos presenciais e/ou a distância. As condições de trabalho foram diretamente impactadas, pois houve necessidade de dimensionamento, capacitação, ampliação de carga horária, além da sobrecarga de trabalho e do esgotamento físico e mental dos profissionais. A pandemia determinou uma série de mudanças nos serviços de saúde, por vezes descontínuas, com a suspensão de inúmeros serviços e atendimentos. Alguns atendimentos presenciais foram mantidos, apenas para os pacientes que apresentavam risco de agravo em curto prazo. Medidas sanitárias preventivas e estratégias de continuidade dos atendimentos foram adotadas.

Abstract: Several healthcare processes, including rehabilitation, require prompt initiation and cannot be interrupted. Therefore, these processes underwent important adaptations during the COVID-19 pandemic. However, it is not fully known how healthcare facilities adapted their strategies and what the results were. This study investigated how rehabilitation services were affected during the pandemic and what strategies were employed to maintain the provided services. From June 2020 to February 2021, 17 semi-structured interviews were conducted with healthcare professionals working in rehabilitation services from the Brazilian Unified National Health System (SUS), who work at one of the three levels of care, in the municipalities of Santos and São Paulo, state of São Paulo, Brazil. The interviews were recorded, transcribed, and analyzed via content analysis. The professionals reported organizational changes in their services, with the initial interruption of appointments and, subsequently, the adoption of new sanitary protocols and the gradual return to in-person and/or remote appointments. Working conditions were directly impacted, as there was a need for staffing, training, increased workloads, as well as physical and mental exhaustion among professionals. The pandemic caused a series of changes in healthcare services, some of which were interrupted due to the suspension of numerous services and appointments. Some in-person appointments were maintained exclusively for patients who presented a risk of short-term deterioration. Preventive sanitary measures and strategies for continuity of care were adopted.

Resumen: Diversos procesos que impregnan la asistencia a la salud, incluida la rehabilitación, deben iniciarse con prontitud o no pueden interrumpirse. Por lo que estos sufrieron importantes adaptaciones durante la pandemia de COVID-19. Sin embargo, no se sabe con certeza cómo las instalaciones de salud adaptaron sus estrategias y cuáles fueron los resultados. El estudio investigó cómo se vieron afectados los servicios de rehabilitación durante la pandemia y cuáles fueron las estrategias para mantener los servicios prestados. Entre junio del 2020 y febrero del 2021, se realizaron 17 entrevistas semiestructuradas con profesionales de la salud del área de rehabilitación del Sistema Único de Salud (SUS), que actúan en uno de los tres niveles de atención, en las ciudades de Santos y São Paulo, estado de São Paulo, Brasil. Los discursos se grabaron, se transcribieron y se analizaron mediante análisis de contenido. Los profesionales relataron cambios organizacionales en sus servicios, con la interrupción inicial de la atención y, posteriormente, con la adopción de nuevos protocolos sanitarios y el regreso gradual de la atención presencial o a distancia. Las condiciones de trabajo se vieron directamente afectadas, ya que fue necesario el dimensionamiento, la capacitación, la ampliación de la carga horaria, además de la sobrecarga de trabajo y del agotamiento físico y mental de los profesionales. La pandemia determinó una serie de cambios en los servicios de salud, en ocasiones discontinuos, con la suspensión de numerosos servicios y atenciones. Se mantuvieron algunas atenciones presenciales, solo para los pacientes con riesgo de agravamiento a corto plazo. Se adoptaron medidas sanitarias preventivas y estrategias de continuidad de las atenciones.

Establishing a Cancer Rehabilitation Service in a Middle-Income Country: an Experience from Brazil.

Purpose of Review: Our aim is to provide a historical review of the implementation of a cancer rehabilitation center in Brazil, active since 2008. We expect this data to support the implementation of other centers both in Brazil and worldwide. Recent Findings: Cancer rehabilitation delivery is fragmented and punctuated in most cases, and cancer rehabilitation centers are rare. Data on how to establish rehabilitation centers could facilitate the implementation of new centers. We provide data on what was our strategy for hiring, establishing treatment protocols, barriers, and facilitators. We also provide figures on the number of each rehabilitation specialist, as well as the general standard operating procedures of our rehabilitation center, among other features. Summary: Establishing cancer rehabilitation centers in a middle-income country is feasible. We expect that our experience may facilitate the establishment of new cancer rehabilitation services and the improvement of current ones.

Efficacy of neuromuscular electrical stimulation with combined low and high frequencies on body composition, peripheral muscle function and exercise tolerance in patients with chronic kidney disease undergoing haemodialysis: a protocol for a randomised, double-blind clinical trial.

INTRODUCTION: Neuromuscular electrical stimulation (NMES) as an adjunctive strategy to increase isolated muscular strength or endurance has been widely investigated in patients with chronic kidney disease (CKD) undergoing haemodialysis (HD). However, the efficacy of combined low and high frequencies, to improve both muscular strength and endurance, is unknown. This trial aims to evaluate the efficacy of this combined NMES strategy in this population. METHODS AND ANALYSIS: This is a randomised controlled trial with blinded assessments and analysis. A total of 56 patients with CKD undergoing HD will be recruited and randomised to an NMES protocol. The evaluations will be performed on three different days at baseline and after 24 sessions of follow-up. Assessments will include the background, insulin-like growth factor, lactate measurement, malnutrition and inflammation score evaluation, an electrical bioimpedance examination, global muscular evaluation by means of the Medical Research Council scale, handgrip strength evaluation, muscular isokinetic evaluation of lower limbs, 6 min step test performance and quality of life (QoL) questionnaire with emphasis on physical function. The patients will be allocated in one of the following four groups: 1) combined low and high frequencies; 2) low frequency; 3) high frequency; and 4) sham stimulation with minimal intensity to generate only sensory perception (with no visible contraction). In all groups, the intensity throughout the session will be the highest tolerated by patient (except for control group). The primary endpoint is the change of peripheral muscle function (muscular strength and endurance). The secondary endpoints will be the changes of body composition; muscle trophism; exercise tolerance; QoL; and nutritional, inflammatory, and metabolic markers. The findings of this study are expected to provide valuable knowledge on how to optimise the NMES intervention, with improvements in both muscle strength and endurance. ETHICS AND DISSEMINATION: This protocol has been approved by the Ethics Committee on Research with Humans of Hospital Sírio-Libanês (approval no. 24337707). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03779126.

Facilitadores do acesso da pessoa com deficiência aos serviços de saúde: revisão de escopo / Facilitators of persons with disabilities' access to health services: a scope review

Objetivo: Este estudo tem como objetivo analisar as evidências científicas globais e locais relativas aos facilitadores que promovem o acesso de pessoas com deficiência aos serviços de saúde. Métodos: Realizou-se uma revisão de escopo, estabelecendo-se a pergunta norteadora: "Quais são os principais facilitadores que as pessoas com deficiência encontram no acesso a serviços de saúde?" O levantamento dos artigos foi realizado em julho de 2019, em seis bases de dados de literatura científica. Dos 1.155 documentos identificados nas buscas, após seleção por título e resumo, foram lidas 170 publicações na íntegra e incluídas 76 revisões da literatura, que foram categorizadas conforme referencial teórico. Resultados: A revisão elenca os facilitadores identificados por prestadores de serviços e por pessoas com deficiência e os seus familiares e/ou cuidadores, em todos os níveis de complexidade dos cuidados de saúde. Os facilitadores foram categorizados pelas diferentes dimensões do acesso e da Lei Brasileira de Inclusão. Os principais facilitadores identificados, tanto pelos usuários dos serviços quanto pelos prestadores de serviço, incluem a disponibilidade de programas de promoção à saúde, profissionais capacitados, informações sobre os serviços prestados, orientação em cuidados de saúde, serviços de cuidados específicos de reabilitação e suporte social. Conclusões: Evidenciamos que faltam estudos nacionais sobre esta temática e que os facilitadores para o acesso aos serviços de saúde para as pessoas com deficiência precisam ser mais profundamente abordados na literatura cientifica como um todo. O melhor entendimento desta realidade é de grande valia para o incremento de políticas públicas e implementação de estratégias voltadas à promoção do acesso aos serviços de saúde.

Objective: This study aims to analyze global and local scientific evidence regarding the facilitators that promote the access of people with disabilities to health services. Methods: A scope review was carried out, establishing the guiding question: "What are the main facilitators that people with disabilities find in accessing health services?" The search was carried out in July 2019, in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and 76 literature reviews were included, which were categorized according to the theoretical framework. Results: The review lists the facilitators identified by service providers and people with disabilities and their family members and/or caregivers, at all levels of healthcare. The facilitators were categorized by the different dimensions of access and the Brazilian Inclusion Law. Key facilitators identified by both service users and service providers include the availability of health promotion programs, trained professionals, information about services provided, healthcare guidance, specific rehabilitation care services, and social support. Conclusions: There is a lack of national studies on this topic and the facilitators of persons with disabilities' access to health services need to be more deeply addressed in the literature. A better understanding of this reality would be of great value for improving public policies and implementing strategies aimed at promoting access to health services.

Barriers to the access of people with disabilities to health services: a scoping review.

OBJECTIVE: To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS: A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS: The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS: It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.

Acupuncture for Climacteric-Like Symptoms in Breast Cancer Improves Sleep, Mental and Emotional Health: A Randomized Trial.

Objective: Breast cancer is the most prevalent malignant neoplasm in women. Optimal treatment frequently includes a hormonal-blockage phase maintained for 5-10 years. Pharmacologic agents used for this blockage induce many climacteric-like symptoms, which often exact a heavy toll on patients' quality of life. Acupuncture has had promising results for treating climacteric-like symptoms induced by hormonal blockage, but there is no evidence of efficacy for controlling hot flashes. Materials and Methods: This trial used acupuncture to treat the climacteric-like symptoms of patients with breast cancer, focusing on the mental, physical, and genitourinary symptoms and sleep disturbances, to determine the influence of acupuncture treatment. The randomized placebo-controlled trial, at a university-based cancer center, with blinded data collectors, compared an Acupuncture group (A), a Sham-Acupuncture group (S), and a Wait-List Control group (C). The patients were receiving tamoxifen. Group A had 10 weekly sessions of manual Acupuncture; Group S had 10 weekly sessions of Sham Acupuncture; and Group C spent 10 weeks on a Wait-List. The main outcome measures were the Beck Depression Inventory-II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Menopause Rating Scale (MRS). Results: Primary analysis revealed differences among the groups' improvements in scores for the 3 questionnaires (P < 0.001), The A group had significant improvements on the BDI-II (P < 0.001), PSQI (P < 0.002), and MRS (P < 0.004) compared to the S group in a post hoc analysis. Conclusions: Acupuncture improved sleep, and mental and emotional distress symptoms induced by hormonal blockage in patients with breast cancer. Clinical Trial: This trial was registered at CAAE as trial #: 37758414.8.0000.0065.

Acupuncture for chemotherapy-induced peripheral neuropathy: a randomised controlled pilot study.

Chemotherapy-induced peripheral neuropathy (CIPN) can cause loss of independence and poor quality of life (QoL) due to severe disabilities, but in spite of its importance there is still a lack of data for the management of CIPN. Acupuncture has showed promising results and may be a cost-effective option for the treatment. OBJECTIVES: To evaluate the effect of acupuncture treatment on neurological symptoms of CIPN and QoL of oncological patients. METHODS: We performed a clinical, single-centre, randomised and controlled pilot study that involved 33 adult patients with cancer and CIPN randomised into two groups (control and acupuncture treated with 10 sessions, two times per week). Both groups were subjected to a complete physical examination and clinical assessment with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Scale V.2.0, FIM Scale, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) Scale and Visual Analogue Scale for pain before and 5 weeks after treatment. RESULTS: There were no adverse events, and we found statistical differences in groups in physical (p=0.03) and function (p=0.04) domains of EORTC QLQ-C30 when comparing control and acupuncture groups. About NCI CTCAE Scale and neuropathy sensory symptoms, we found better results in acupuncture group, comparing pretreatment and post-treatment analyses (p=0.01). In control group, we have no differences after 5 weeks (p=0.11). CONCLUSION: Although these results suggest an interesting effect of acupuncture on this patient population, the clinical significance has remained unclear. Given the tendency towards benefit and the lack of adverse effects, the authors recommend a follow-up acupuncture trial using higher follow-up time and better sample size. TRIAL REGISTRATION NUMBER: NCT02309164.

Barriers to the access of people with disabilities to health services: a scoping review / Barreiras ao acesso das pessoas com deficiência aos serviços de saúde: uma revisão de escopo

ABSTRACT OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.

RESUMO OBJETIVO Analisar as evidências científicas relativas às barreiras para o acesso de pessoas com deficiência aos serviços de saúde. MÉTODOS Realizou-se uma revisão de escopo estabelecendo-se a perguntanorteadora: "Quais são as principais barreiras que as pessoas com deficiência enfrentam no acesso a serviços de saúde?" O levantamento dos artigos foi realizado em julho de 2019, em seis bases de dados de literatura científica. Dos 1.155 documentos identificados nas buscas, após seleção por título e resumo, foram lidas na íntegra 170 publicações e, após leitura, 96 artigos foram incluídos e categorizados conforme referencial teórico. RESULTADOS As principais barreiras indicadas pelos usuários do serviço foram: comunicação falha entre profissionais e paciente/cuidador; limitações financeiras; questões atitudinais/comportamentais; oferta de serviços escassa; barreiras organizacionais e de transporte. As principais barreiras apresentadas pelos prestadores de serviços foram: falta de treinamento/capacitação aos profissionais; falha do sistema de saúde; barreiras físicas; falta de recursos/tecnologia e barreiras de idioma. CONCLUSÕES Ficou evidente que as pessoas com deficiência enfrentam diversas barreiras ao tentarem acesso aos serviços de saúde de que necessitam e que usuários e profissionais de saúde têm visões distintas e complementares sobre as dificuldades.

The influence of a supervised group exercise intervention combined with active lifestyle recommendations on breast cancer survivors' health, physical functioning, and quality of life indices: study protocol for a randomized and controlled trial.

BACKGROUND: Most cancer patients, under active treatment or not, are sedentary, despite increasing scientific and clinical understanding of the benefits of exercise and physical activity, such as improving quality of life, limiting disease symptoms, decreasing cancer recurrence, and increasing overall survival. Studies have shown that both supervised exercise and unsupervised physical activity programs have low adherence and limited long-term benefits among cancer survivors. Therefore, interventions focused on increasing physical activity levels have clinical and psychological relevance. The present study will examine the feasibility and efficacy of an intervention that combines supervised group exercise with active lifestyle recommendations, analyzing its clinical, psychological, physiological, functional, and immunological effects in breast cancer survivors. METHODS: Women aged 35-75 years who have completed chemotherapy, radiotherapy, and surgery for breast cancer will be recruited from the Cancer Institute of the State of Sao Paulo (ICESP) and take part in a 16-week, parallel-group, randomized, and controlled trial. They will receive a booklet with recommendations for achieving a physically active lifestyle by increasing overall daily movement and undertaking at least 150 min/week of structured exercise. Then, they will be randomized into two groups: the supervised group will take part in two canoeing group exercise sessions every week, and the unsupervised group will increase their overall physical activity level by any means, such as active commuting, daily activities, or home-based exercise. Primary outcome includes aerobic capacity. Secondary outcomes are physical activity, physical functioning, self-reported quality of life, fatigue, presence of lymphedema, body composition, immune function, adherence to physical activity guidelines, and perceptions of self-image. DISCUSSION: Results should contribute to advance knowledge on the impact of a supervised group exercise intervention to improve aspects related to health, physical functioning, and quality of life in female breast cancer survivors. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials Number: RBR-3fw9xf. Retrospectively Registered on 27 December 2018. Items from the World Health Organization Trial Registration Data Set can be accessed on http://www.ensaiosclinicos.gov.br/rg/RBR-3fw9xf/ .

Corrigendum: Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study.

[This corrects the article DOI: 10.3389/fphys.2021.624169.].

Bleeding frequency during physiotherapy in thrombocytopenic patients undergoing hematopoietic stem cell transplantation.

BACKGROUND: During hematopoietic stem cell transplantation (HSCT) the patients perform activities of low and moderate intensity because have reduced hematological lineages, leaving them susceptible to hemorrhagic events. The objective of this study was to describe the frequency of bleeding events, severity, and possible association with physical exercise in thrombocytopenic patients. METHODS: A retrospective study with seventy-seven HSCT patients hospitalised, that had a platelet count ≤ 50,000 /µL and received physical exercise during physiotherapy intervention. RESULTS: Regarding bleeding events, only six were related to physical exercise, and bleeding events occurred more frequently at platelet levels ≤ 10,000 /µL. The most frequent bleeding event was epistaxis, considered of low severity, and with the moderate possibility of being related to physical exercise; followed by extremity hematoma, considered of medium severity and highly related to physical exercise. In this study, there was no occurrence of bleeding events considered of high severity. CONCLUSION: Bleeding frequency in supervised physical exercise during physiotherapy in adults with thrombocytopenia undergoing HSCT is minor and relatively rare but occurs more frequently in patients with platelet count ≤10,000 /µL. These results encourage the maintenance of physical activity in this population who is at high risk of developing immobility-related complications.

Skeletal Muscle Wasting and Function Impairment in Intensive Care Patients With Severe COVID-19.

Background: Intensive care patients commonly develop muscle wasting and functional impairment. However, the role of severe COVID-19 in the magnitude of muscle wasting and functionality in the acute critical disease is unknown. Objective: To perform a prospective characterization to evaluate the skeletal muscle mass and functional performance in intensive care patients with severe COVID-19. Methods: Thirty-two critically ill patients (93.8% male; age: 64.1 ± 12.6 years) with the diagnosis of the severe COVID-19 were prospectively recruited within 24 to 72 h following intensive care unit (ICU) admission, from April 2020 to October 2020, at Hospital Sírio-Libanês in Brazil. Patients were recruited if older than 18 years old, diagnosis of severe COVID-19 confirmed by RT-PCR, ICU stay and absence of limb amputation. Muscle wasting was determined through an ultrasound measurement of the rectus femoris cross-sectional area, the thickness of the anterior compartment of the quadriceps muscle (rectus femoris and vastus intermedius), and echogenicity. The peripheral muscle strength was assessed with a handgrip test. The functionality parameter was determined through the ICU mobility scale (IMS) and the International Classification of Functioning, Disability and Health (ICF). All evaluations were performed on days 1 and 10. Results: There were significant reductions in the rectus femoris cross-section area (-30.1% [95% IC, -26.0% to -34.1%]; P < 0.05), thickness of the anterior compartment of the quadriceps muscle (-18.6% [95% IC, -14.6% to 22.5%]; P < 0.05) and handgrip strength (-22.3% [95% IC, 4.7% to 39.9%]; P < 0.05) from days 1 to 10. Patients showed increased mobility (0 [0-5] vs 4.5 [0-8]; P < 0.05), improvement in respiratory function (3 [3-3] vs 2 [1-3]; P < 0.05) and structure respiratory system (3 [3-3] vs 2 [1-3]; P < 0.05), but none of the patients returned to normal levels. Conclusion: In intensive care patients with severe COVID-19, muscle wasting and decreased muscle strength occurred early and rapidly during 10 days of ICU stay with improved mobility and respiratory functions, although they remained below normal levels. These findings may provide insights into skeletal muscle wasting and function in patients with severe COVID-19.

Relationship of phase angle and peak torque of knee extensors with the performance in six-minute step test in haemodialysis patients.

BACKGROUND: Chronic kidney disease is a systemic disease affecting not only renal function, but also endocrine, cardiovascular, and skeletal muscle systems, with broad impact on functionality. Therefore, the assessment of body composition, peripheral muscle function, and exercise tolerance is also of great importance in this population. In addition, the development of reliable strategies that use feasible tools in clinical practice is of great importance in the functional diagnosis, clinical management and prescription of physical activity. OBJECTIVE: To assess the relationship between phase angle and peak torque of knee extensors with the performance in six-minute step test of patients with chronic kidney disease undergoing haemodialysis. METHODS: Observational and cross-sectional study at Haemodialysis Centre of Sírio-Libanês Hospital. The evaluations took place 3 days before the haemodialysis sessions. On the first day, patients underwent anthropometric evaluation and biochemical tests (lactate, urea, creatinine, albumin, ferritin and growth factor similar to insulin type 1 [IGF1]). On the second day, performed electrical bioimpedance and exercise tolerance assessed using the six-minute step test. On the last day, the evaluation of knee extensor muscles strength using isokinetic dynamometry was performed. RESULTS: Eighteen subjects were included, with a mean age of 62.3 ± 17.6 years. A positive linear correlation was observed between the phase angle, derived from the electrical bioimpedance, and the performance in six-minute step test in these patients. It was also possible to observe a linear correlation between phase angle and IGF1, handgrip strength, peak torque of knee extensors and quality of life questionnaire. The peak torque of knee extensors also presented a linear correlation with IGF1, the performance in six-minute step test and mal-nutrition and inflammation score. CONCLUSION: Phase angle and peak torque of knee extensors were correlated with the performance in six-minute step test. Therefore, the phase angle seems to be an important marker of reduced peripheral muscle function and exercise tolerance in haemodialysis patients.

Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Increased exercise and physical activity levels are recommended throughout cancer therapy and survivorship. Nonetheless, the COVID-19 pandemic and consequent social distancing are likely to cause a decline in physical activity. Objective: to evaluate the level of unsupervised physical activity of breast cancer survivors during the COVID-19 pandemic, and the factors associated with difficulties in engaging and maintaining recommended physical activity levels. Methods: This is a cross-sectional epidemiological study with a sample of 37 breast cancer survivors. They participated in a canoeing training program (project Remama) at the University of São Paulo before the COVID-19 pandemic. Socioeconomic aspects, engagement in physical activity, motivation, and potential exposure to COVID-19 were investigated through an online survey, administered in September of 2020. Results: During the pandemic, participants increased their body weight (5 ± 3.4 kg); 90% reported decreasing physical activity levels associated with increased sedentary time. Twenty-one (58%) participants exhibited some COVID-19-related symptoms, most used public transportation (59%), or returned to work during the period of a high incidence of COVID-19. The only factor associated with perceived difficulty in engaging in physical activities was having had more than three cancer treatments (RR: 2.14; 95% CI: 1.07-4.27). Conclusion: The COVID-19 pandemic led to a group of previously active breast cancer survivors to decrease their physical activity, gain weight, and have sedentary behavior. Specific tailored-care interventions are needed to prevent these occurrences, as overweight and physical inactivity may impose an additional risk for breast cancer recurrence and a severe course of COVID-19 in cancer patients.

Dynamic hyperinflation induced by the 6-minute pegboard and ring test in hospitalized patients with exacerbated COPD.

BACKGROUND: The six-minute pegboard and ring test (6-PBRT) has been used to evaluate functional capacity of the upper limbs in stable chronic obstructive pulmonary disease (COPD) patients. To the best of our knowledge, no studies have evaluated dynamic hyperinflation (DH) during exercise with upper limbs in the hospital setting. The aim of this study was to evaluate physiological responses and DH induced by 6-PBRT in hospitalized patients with acute exacerbation of COPD (AECOPD). METHODS: A cross-sectional study was conducted in a tertiary hospital enrolling patients who were hospitalized due to AECOPD. All included participants underwent an evaluation of lung function and 6-PBRT when they reached minimum clinical criteria. Ventilatory and hemodynamics parameters were monitored during 6-PBRT and until 6 minutes of rest after the test. Symptoms of dyspnea and upper limb fatigue were also measured. RESULTS: Eighteen patients (71.3±5.1 years) with a mean FEV1 of 43.2±18.3% were included in the study (11 females). Prevalence of DH after 6-PBRT was 50% (considering the drop of 150 ml or 10% of inspiratory capacity, immediately after the end of the test). There was a significant increase in respiratory rate, minute volume, dyspnea, and upper limb fatigue after the end of 6-PBRT (p<0.05). Dyspnea recovered more precociously than the perception of fatigue, being reestablished within four minutes of rest. An increase in heart rate, systolic and diastolic blood pressures was also induced by 6-PBRT (p<0.05), requiring 6 minutes of recovery to return to baseline. No adverse events were observed during 6-PBRT. We concluded that 6-PBRT induces physiological changes during its execution, at safe levels, requiring a maximum of 6 minutes for recovery. Finally, the test proved to be safe and applicable for patients hospitalized due to AECOPD.

Physiotherapy Care of Patients with Coronavirus Disease 2019 (COVID-19) - A Brazilian Experience.

Some patients with coronavirus disease (COVID-19) present with severe acute respiratory syndrome, which causes multiple organ dysfunction, besides dysfunction of the respiratory system, that requires invasive procedures. On the basis of the opinions of front-line experts and a review of the relevant literature on several topics, we proposed clinical practice recommendations on the following aspects for physiotherapists facing challenges in treating patients and containing virus spread: 1. personal protective equipment, 2. conventional chest physiotherapy, 3. exercise and early mobilization, 4. oxygen therapy, 5. nebulizer treatment, 6. non-invasive ventilation and high-flow nasal oxygen, 7. endotracheal intubation, 8. protective mechanical ventilation, 9. management of mechanical ventilation in severe and refractory cases of hypoxemia, 10. prone positioning, 11. cuff pressure, 12. tube and nasotracheal suction, 13. humidifier use for ventilated patients, 14. methods of weaning ventilated patients and extubation, and 15. equipment and hand hygiene. These recommendations can serve as clinical practice guidelines for physiotherapists. This article details the development of guidelines on these aspects for physiotherapy of patients with COVID-19.