Adherence to heart rate training zones in an exercise training program in adults with coronary artery disease

Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and relationship between trained intensity and functional capacity. Methods: Retrospective study led with medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50 ­60% of heart rate reserve, increasing monthly to 70 ­80% by the third month. Spearman's test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (Borg­RPE). Adherence was classified as 'below' when HRTZ was not achieved in any phase of the program, 'intermediate' when HR was within the HRTZ for one or two months, and 'above' when HR was at or higher than HRTZ two months. Improvement was tested with t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. Trained intensity did not go below 8.6% of the prescribed minimal threshold of HRTZ. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or Borg­RPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume incardiovascular rehabilitation programs.

Effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus: a systematic review and meta-analysis.

Purpose: To assess the effects of exercise training parameters on cardiorespiratory fitness of individuals with type 2 diabetes mellitus (T2DM). Methods: This systematic review was registered on PROSPERO (CRD42020210470). Searches were performed on PubMed, PEDro EMBASE, MEDLINE (Ovid), LILACS, PsycINFO, SCIELO, CINAHL, and Cochrane Library. The primary outcome was cardiorespiratory fitness, defined as maximal oxygen uptake (VO2max) during a maximal or submaximal exercise test. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled using a random effects model and expressed as mean difference (MD) and 95% confidence interval (95%CI). Heterogeneity (I2) was assessed using Cochran's Q test. The risk of bias and quality of evidence was assessed using the Cochrane risk of bias tool and GRADE. Results: Twenty-two studies comparing exercise and control groups were included. The risk of bias indicated some concerns in most studies, and the quality of evidence was rated very low. Interventions with moderate (MD = 1.91, 95%CI = .58 to 3.34) and progressive exercise intensity (MD = 2.70, 95%CI = 2.43 to 2.96) and volume (MD = 1.72, 95%CI = .59 to 2.85) showed greater improvements in VO2max. Conclusions: Protocols that progressively increased exercise training parameters improved the cardiorespiratory fitness response. Progressive exercise might be more suitable for individuals with T2DM. Our conclusion may be limited due to the very low quality of evidence. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01205-5.

Maintenance of Physical Activity Behavior by Individuals with Prediabetes and Diabetes during the COVID-19 Pandemic after Completing an Exercise Intervention in Brazil.

This cross-sectional study evaluated the perception of individuals with prediabetes/diabetes about their living conditions during the COVID-19 pandemic to identify the facilitators, barriers, and reasons to remain physically active at home and adhere to recommended exercise. It included individuals with prediabetes/diabetes who had completed an exercise intervention, which started on-site and moved to a remote home-based regime due to the COVID-19 pandemic and were advised to keep exercising at home. The outcomes were assessed by a bespoke questionnaire that was developed by the research team, the Brazilian Portuguese adapted version of the Exercise Adherence Rating scale, and the Motives for Physical Activity Measure-Revised scale. Of 15 participants (8 female, 58 ± 11 years), most reported positive perceptions about their living conditions and few difficulties maintaining some physical activity at home. However, only 53.8% of them adhered to the recommended exercise. Time flexibility, no need for commuting, and a sense of autonomy were the main facilitators of home exercise, while a lack of adequate space was the main barrier. The descending order of median scores that were obtained in each reason for physical activity was fitness, enjoyment, competence, social, and appearance. Individuals with prediabetes/diabetes maintained some physical activity during the pandemic, mainly motivated by health concerns.

Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial.

BACKGROUND: The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM: To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN: Single-blind randomized control trial. SETTING: A university hospital. POPULATION: Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS: The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS: 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS: CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT: Home-CR can contribute to overcome participants' barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.

Assessment of V̇o2peak and Exercise Capacity After Stroke: A Validity Study of the Human Activity Profile Questionnaire.

OBJECTIVE: To investigate the concurrent validity of the Human Activity Profile (HAP) in individuals after stroke to provide the peak oxygen uptake (V̇o2peak) and the construct validity of the HAP to assess exercise capacity, and to provide equations based on the HAP outcomes to estimate the distance covered in the Incremental Shuttle Walking Test (ISWT). DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Individuals (N=57) aged 54±11 years who have experienced stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Agreement between the V̇o2peak provided by the HAP (lifestyle energy consumption [LEC] outcome, in mL/kg-1/min-1) and the criterion standard measure of the V̇o2peak (mL/kg-1/min-1), obtained through the symptom-limited Cardiopulmonary Exercise Test (CPET). Correlation between the HAP outcomes (LEC, maximum activity score [MAS], and adjusted activity score [AAS]) and the construct measure: the distance covered (in meters) in the ISWT. An equation to estimate the distance covered in the ISWT was determined. RESULTS: High magnitude agreement was found between the V̇o2peak, in mL/kg-1/min-1, obtained by the symptom-limited CPET and the value of V̇o2peak, in mL/kg-1/min-1, provided by the HAP (LEC) (intraclass correlation coefficient, 0.75; P<.001). Low to moderate magnitude correlations were found between the distance covered in the ISWT and the HAP (LEC/MAS/AAS) (0.34≤ρ≤0.58). The equation to estimate the distance covered in the ISWT explained 31% of the variability of the ISWT (ISWTestimated, -361.91+(9.646xAAS)). CONCLUSION: The HAP questionnaire is a clinically applicable way to provide a valid value of V̇o2peak (in mL/kg-1/min-1) and to assess the exercise capacity of individuals after stroke. Furthermore, an equation to estimate the distance covered in the submaximal field exercise test (ISWT) based on the result of the AAS (in points) was provided.

Acute effects of expiratory positive airway pressure on exercise tolerance in patients with COPD.

OBJECTIVE: To evaluate the acute effects of expiratory positive airway pressure (EPAP) on exercise tolerance, dyspnea, leg discomfort, and breathing pattern in patients with COPD. METHODS: Fifteen patients with COPD were assessed with the following three different protocols: EPAP of 7.5 cmH2O used during a constant cycle ergometer exercise test (Protocol-1); EPAP of 7.5 cmH2O used for 15 minutes before the test (Protocol-2); and a sham system without pressure used for 15 minutes before the test (Protocol-3). Dyspnea and leg discomfort were assessed using Borg scale, whereas breathing pattern by optoelectronic plethysmography. Statistical analyses were performed using generalized estimating equations and Bonferroni tests (α = 5%), considering the protocols (1, 2, and 3) and moment (resting and the end of exercise). RESULTS: Exercise tolerance was lower in protocol 1: 108 ± 45 seconds compared to protocols 2: 187 ± 99 seconds (p= .011) and 3: 183 ± 101 seconds (p= .021). No difference was observed between protocols 2 and 3 (p> .999). Dyspnea in protocol 1: 7.0 ± 2.08 was higher than protocols 2: 4.10 ± 2.45 (p= .001) and 3: 3.90 ± 2.21 (p< .001), but no differences were observed between protocols 2 and 3 (p> .999). No significant difference was observed for leg discomfort among the protocols (p= .137). There were no statistically significant differences for most variables of breathing pattern among the protocols. CONCLUSION: A reduction on exercise tolerance and an increase in dyspnea were found with EPAP of 7.5 cm H2O during a constant cycle ergometer exercise test in patients with COPD.

Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study / Valores normativos e equação de referência para o teste do degrau de seis minutos para avaliar a capacidade funcional de exercício: um estudo multicêntrico

ABSTRACT Objective: To establish normative values and a reference equation for the number of steps climbed during the six-minute step test (6MST) in healthy adults, and to assess the reliability of the test and of the equation. Methods: This was a multicenter cross-sectional study involving 468 healthy volunteers (age range: 18-79 years) recruited from the general community in six research laboratories across different regions of Brazil, which is a country with continental dimensions. The 6MST was performed twice (30-min interval), and clinical, demographic, and functional variables were evaluated. An independent sample of 24 volunteers was evaluated to test the reference equation a posteriori. Results: The number of steps had excellent test-retest reliability (intraclass correlation coefficient = 0.96 [95%CI: 0.95-0.97]), and the mean number of steps was 175 ± 45, the number being 14% greater in males than in females. The best performance on the test was correlated with age (r = −0.60), sex (r = 0.28), weight (r = 0.13), height (r = 0.41), BMI (r = −0.22), waist circumference (r = −0.22), thigh circumference (r = 0.15), FVC (r = 0.54), and physical activity level (r = 0.17; p < 0.05 for all). In the regression analysis, age, sex, height, and weight explained 42% of the variability of the 6MST. Normative values were established for the 6MST according to age and sex. There was no difference between the 6MST values from the independent sample and its predicted values (157 ± 29 steps vs. 161 ± 25 steps; p = 0.47; 97% of predicted values). Conclusions: The normative values and the reference equation for the 6MST in this study seem adequate to accurately predict the physical functional performance in adults in Brazil.

RESUMO Objetivo: Estabelecer valores normativos e uma equação de referência para o número de degraus subidos no teste do degrau de seis minutos (TD6) em adultos saudáveis, bem como avaliar a confiabilidade do teste e da equação. Métodos: Estudo transversal multicêntrico com 468 voluntários saudáveis (faixa etária: 18-79 anos) recrutados na comunidade geral em seis laboratórios de pesquisa em diferentes regiões do Brasil, um país de dimensões continentais. O TD6 foi realizado duas vezes (com 30 min de intervalo entre uma e outra), e foram avaliadas variáveis clínicas, demográficas e funcionais. Uma amostra independente composta por 24 voluntários foi avaliada para testar a equação de referência a posteriori. Resultados: O número de degraus subidos apresentou excelente confiabilidade teste-reteste [coeficiente de correlação intraclasse = 0,96 (IC95%: 0,95-0,97)], e a média de degraus subidos foi de 175 ± 45, sendo 14% maior no sexo masculino. O melhor desempenho no teste correlacionou-se com as seguintes variáveis: idade (r = −0,60), sexo (r = 0,28), peso (r = 0,13), estatura (r = 0,41), IMC (r = −0,22), circunferência da cintura (r = −0,22), circunferência da coxa (r = 0,15), CVF (r = 0,54) e nível de atividade física (r = 0,17; p < 0,05 para todos). Na análise de regressão, idade, sexo, estatura e peso explicaram 42% da variabilidade do TD6. Foram estabelecidos valores normativos para o TD6 de acordo com a idade e o sexo. Não houve diferença entre os valores do TD6 na amostra independente e os valores previstos (157 ± 29 vs. 161 ± 25 degraus subidos; p = 0,47; 97% dos valores previstos). Conclusões: Os valores normativos e a equação de referência para o TD6 neste estudo parecem adequados para predizer com precisão o desempenho físico funcional em adultos no Brasil.

Behavior change interventions in patients with type 2 diabetes: a systematic review of the effects on self-management and A1c.

PURPOSE: This study aimed to identify the characteristics of interventions employed to promote behavior change in people with type 2 diabetes mellitus (T2DM) and their impact on disease self-management and glycated hemoglobin (A1c). METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to guide the protocol development for this systematic review. Randomized controlled clinical trials which compared behavior change interventions to controls in adults with T2DM and investigated disease self-management and glycated hemoglobin (A1c) measured by validated methods were eligible for this study. The risk of bias and quality of evidence was assessed respectively by Cochrane's tool and grading of recommendations, assessment, development, and evaluation (GRADE). RESULTS: A total of 27 studies were included involving 4464 participants. Behavior change was mainly promoted by education sessions on diabetes care delivered face-to-face, monthly, or every other month, lasting more than 60 min, involving blood glucose monitoring, healthy eating, exercise, and medication. Four studies showed significant improvement in both disease self-management and A1c. The risk of bias was classified as high in most studies. A meta-analysis could not be performed for A1c and self-management due to the high differences in intervention parameters (delivery mode, number, duration, and frequency) and self-management assessments. CONCLUSION: Low evidence of improvement in disease self-management and A1c considering only validated assessment methods were found for behavior change interventions, mainly promoted by education sessions on diabetes care. The quality of studies and probably the differences in intervention protocols contributed to this finding. PROSPERO NUMBER: CRD42020161162.

Brazilian Portuguese version of the Mediterranean diet scale: Translation procedures and measurement properties.

BACKGROUND AND AIM: The Mediterranean Diet Scale (MDS) is a questionnaire with characteristics which can contribute to the multidimensional assessment of patients with diabetes mellitus (DM) by the multidisciplinary team, as well as to evaluate the effect of specific educational and nutritional interventions. The aim of this study was to translate and perform a cross-cultural adaptation of a Canadian MDS and analyze the measurement properties of the Brazilian Portuguese version of the Mediterranean Diet Scale (MDS-Brazil) in individuals with DM in Brazil. METHODS: This was a cross-sectional study. The analyzed measurement properties were the internal consistency, floor and ceiling effects, reproducibility, and construct validity. The inclusion criteria were diagnosis of DM type 1 or type 2, literate, outpatients, and without eating restrictions. RESULTS: Of the 160 volunteers included in this study, 30 participated in pretesting, and another 130 (57.7% women, 74.6% DM type 2, 56.55 ± 14.88 years) agreed to participate in the evaluation stage of the measurement properties. All items were cross-culturally adapted. A factor analysis (KMO = 0.555 and X² = 137.22; p < 0.001) extracted five factors, with no floor or ceiling effects, Cronbach's alpha = 0.42, and reproducibility ICC = 0.75. CONCLUSIONS: The cross-cultural adaptation was performed maintaining the equivalences. The MDS-Brazil measurement properties showed substantial reproducibility, low internal consistency, and fair correlations of construct validity in patients with DM.

Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A Global Comparison.

BACKGROUND: This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. METHODS: In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. RESULTS: ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). CONCLUSION: In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.

A qualitative study of patient's perceptions of two cardiac rehabilitation models.

BACKGROUND: Understanding patients' perceptions about rehabilitation can guide healthcare administrators on modifications of program elements, which can ultimately improve cardiac rehabilitation (CR) use, adherence of heart-health behaviors, and improvements in clinical outcomes. OBJECTIVE: To examine the perception of patients about their participation in CR. METHODS: Qualitative study using semi-structured interviews, performed in a public CR center in Brazil. Twenty-eight patients were interviewed 2-years following participation in two CR models: exercise-based and comprehensive CR. RESULTS: Themes identified included: knowledge acquisition, improvement in functionality, and psychosocial well-being. It appeared that the perceived benefits of CR participation were overall positive and similar between the two models; however, those in the comprehensive CR identified additional subthemes: self-care need and knowledge transfer. CONCLUSIONS: This study suggested that patients from two different CR models perceived in the long term that the CR participation positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions seemed to be associated with improved participants' perception about CR, which could contribute to long-term maintenance of heart-health behavior and better outcomes.

Effects of detraining on cardiorespiratory fitness of individuals with chronic stroke.

BACKGROUND: Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known. OBJECTIVE: To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VO2peak) of individuals after stroke, who participated in aerobic training. METHODS: A cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VO2peak increase >1.3 ml.kg-1.min-1 from before to immediately after the training) or non-gain group (VO2peak change ≤1.3 ml.kg-1.min-1). Cardiorespiratory fitness (VO2peak), obtained by the cardiopulmonary exercise test was assessed one and 6 months after the end of the training (short- and long-term detraining, respectively), or collected retrospectively from patient chart (before and after the training). RESULTS: There was found a significant interaction effect (time*group) for VO2peak (F= 6.108;p < 0,001). Higher values in the VO2peak observed in the gain group with the aerobic training (F = 25.86; p< .001) were significantly reduced with short-term detraining, reaching values similar to that observed before the training and to that of the non-gain group (F = 14.81;p= .001). Both groups had similar VO2peak values within long-term detraining (F = 2.70;p= .12), with no significant differences from the values observed before the training and after short-term detraining (0.11 ≤ p≤ 1.00). CONCLUSIONS: Detraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life.

Resistance training prevents the reduction of insulin-mediated vasodilation in the mesenteric artery of dexamethasone-treated rats.

This study evaluated whether resistance training (RT) could prevent glucocorticoid-induced vascular changes. Wistar rats were divided into groups: control (CO), dexamethasone (DEX), and Dexamethasone+RT (DEX+RT). On the eighth week, dexamethasone was administered in the DEX and DEX+RT groups. Thereafter, the animals were sacrificed and blood samples were used to assess the lipid profile, glucose and insulin. Vascular reactivity to insulin and phenylephrine (Phe) were evaluated. The DEX+RT group presented an improvement in the lipid profile, fasting glucose, and insulin levels compared to the DEX group. In addition, vasodilation was reduced in the DEX group compared to the CO group, and was increased in the DEX+RT group. After inhibition of phosphatidylinositol 3-kinase, DEX group showed contraction, in which it was in the DEX + RT group. When nitric oxide synthase (NOS) participation was evaluated, the DEX group presented a contraction compared to the CO group, with no contractile effect in the DEX+RT group. Moreover, vasoconstriction caused by NOS inhibition was abolished by BQ123 (endothelin receptor antagonist). In respect Phe response, there was an increase in tension in the DEX group compared to the CO group, being reduced in the DEX+RT group. The results suggest that RT prevented damage to vascular reactivity.

Comprehensive Cardiac Rehabilitation Effectiveness in a Middle-Income Setting: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: The impact of comprehensive cardiac rehabilitation (CCR) in Latin America is not well known. Herein, the pre-specified tertiary outcomes of a cardiac rehabilitation (CR) trial are reported: disease-related knowledge, depressive symptoms, and heart-health behaviors (exercise, diet, and smoking). METHODS: This was a single-blinded, single-center (Brazil) randomized trial with three parallel arms: CCR (exercise + education) versus exercise-only CR versus wait-list control. Eligible patients were randomized in blocks of four with 1:1:1 concealed allocation. The CR program was 6 mo long. Participants randomized to exercise-only CR received 36 exercise classes; the CCR group also received 24 educational sessions, including a workbook. All outcomes were assessed at pre-test and 6-mo later (blinded). Analysis of covariance was performed by intention-to-treat (ITT) and per-protocol (PP). RESULTS: A total of 115 (89%) patients were randomized; 93 (81%) were retained. There were significant improvements in knowledge with CCR (ITT [51.2 ± 11.9 pre and 60.8 ± 13.2 post] and PP; P < .01), with significantly greater knowledge with CCR versus control (ITT mean difference [MD] = 9.5, 95% CI, 2.3-16.8) and CCR vs exercise-only CR at post-test (ITT MD = 6.8, 95% CI, 0.3-14.0). There were also significant improvements in self-reported exercise with CCR (ITT [13.7 ± 15.8 pre and 32.1 ± 2 5.7 post] and PP; P < .001), with significantly greater exercise with CCR versus control at post-test (ITT MD = 7.6, 95% CI, 3.8-11.4). Also, there were significant improvements in diet with CCR (PP: 3.4 ± 7.5 pre and 8.0 ± 7.0 post; P < .05). CONCLUSIONS: In this first-ever randomized trial of CR for coronary artery disease in Latin America, the benefits of CCR have been supported.

Physical Rehabilitation Needs in the BRICS Nations from 1990 to 2017: Cross-National Analyses Using Data from the Global Burden of Disease Study.

Background: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation; all p < 0.01). Musculoskeletal & pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%); India had both absolute and relative growths of pediatric rehabilitation needs (p < 0.01); China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p < 0.01; r2 = 0.97); Brazil had a both absolute and relative growth of needs coming from musculoskeletal & pain conditions (p < 0.01); and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources.

Effects of aerobic training on physical activity in people with stroke: A randomized controlled trial.

BACKGROUND: Individuals with stroke have low physical activity levels and spend high amount of time in low-energy expenditure activities. OBJECTIVE: To investigate the effects of aerobic treadmill training on physical activity levels and time spent in low-energy expenditure activities (primary outcomes), as well as on cardiorespiratory fitness, endurance, depression, mobility, quality of life and participation (secondary outcomes) after stroke. METHODS: A randomized controlled trial, with 22 adults with chronic stroke was performed. Experimental group: aerobic treadmill training at 60-80% of heart rate reserve. CONTROL GROUP: outdoor-overground walking below 40% of heart rate reserve. Both groups: three 40 min sessions/week over 12 weeks. Outcomes were measured at baseline, post-training, and 16-week follow-up. RESULTS: No changes in the primary outcomes were found for any of the groups. The experimental group showed greater improvements in quality of life at 16-week follow-up (13 points;95% CI:3.5-23). Both groups improved depression (2.2 points;95% CI:0.01-4.3), endurance (Six-minute walk test:31 m;95% CI:5.6-57, Incremental shuttle-walk test:55 m;95% CI:3.8-107), and mobility (0.12 m/s;95% CI:0.02-0.2). CONCLUSION: Aerobic treadmill training improved quality of life. Aerobic treadmill training or outdoor-overground walking improved depression, endurance and mobility. Further studies are needed to clarify the effects of aerobic training on physical activity levels and time spent in low-energy expenditure activities after stroke.

Comparação das respostas fisiológicas do incremental shuttle walk test e do Glittre-ADL test: instrumentos complementares para avaliação da capacidade funcional / Comparación de las respuestas fisiológicas de incremental shuttle walk test y de Glittre-ADL test: instrumentos complementarios para evaluar la capacidad funcional / Comparison of the physiological responses of the Incremental Shuttle Walk test and Glittre-ADL test: complementary instruments for the evaluation of functional capacity

RESUMO O objetivo deste estudo foi avaliar e comparar respostas metabólicas, cardiovasculares e ventilatórias do incremental shuttle walk test (ISWT) e do Glittre activities of daily living test (Glittre-ADL test). Trata-se de um estudo transversal, realizado com indivíduos saudáveis. A capacidade funcional (CF) foi avaliada pela distância percorrida e consumo de oxigênio pico (VO2pico) no ISWT e pelo tempo gasto e VO2 no Glittre-ADL test. Trinta indivíduos percorreram 656,67 (IC95%:608,8-704,5) metros no ISWT e executaram o Glittre-ADL test em 2,4 (IC95%:2,2-2,6) minutos. O VO2 pico do ISWT foi 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p<0,001) no estado estável (EE) do Glittre-ADL test. As correlações entre distância percorrida no ISWT e o tempo gasto no Glittre-ADL test, o VO2pico do ISWT e o VO2 no EE do Glittre-ADL test e a FC no pico do ISWT e no EE do Glittre-ADL test foram de moderada a alta magnitude. O Glittre-ADL test apresenta menores respostas metabólicas, cardiovasculares e ventilatórias se comparado ao ISWT.

RESUMEN El presente estudio tuvo el objetivo de evaluar y comparar las respuestas metabólicas, cardiovasculares y ventilatorias de incremental shuttle walk test (ISWT) y de Glittre activities of daily living test (Glittre-ADL test). Es un estudio transversal realizado con individuos sanos. La capacidad funcional (CF) se evaluó utilizando la distancia recorrida y consumo máximo de oxígeno (VO2máx) en el ISWT y el tiempo empleado y VO2 en el Glittre-ADL test. Treinta individuos caminaron 656,67 (IC95%:608,8-704,5) metros en el ISWT y realizaron el Glittre-ADL test en 2,4 (IC95%:2,2-2,6) minutos. El VO2 máx del ISWT fue de 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p<0,001) en el estado estable (EE) del Glittre-ADL test. Las correlaciones entre la distancia recorrida en el ISWT y el tiempo empleado en el Glittre-ADL test, el VO2máx del ISWT y el VO2 en el EE de Glittre-ADL test y la FC en el máximo del ISWT y en el EE de Glittre-ADL test fueron de moderada a alta magnitud. El Glittre-ADL test presenta respuestas metabólicas, cardiovasculares y ventilatorias más bajas en comparación con el ISWT.

ABSTRACT The aim of the study was to assess and compare the cardiovascular, ventilatory and metabolic responses of the Incremental Shuttle Walk test (ISWT) and Glittre Activities of Daily Living test (Glittre-ADL test). This is a cross-sectional study with individuals. The functional capacity (FC) was evaluated by distance and peak oxygen consumption (VO2peak) in the ISWT and time spent and VO2 in Glittre-ADL test. Thirty individuals went through 656.67 (CI95%:608.8-704.5) meters at the ISWT and performed the Glittre-ADL test in 2.4 (CI95%:2.2-2.6) minutes. The peak VO2 of the ISWT was 27.8 (CI95%25.6-29.9) vs. 22.2 (CI95%20.5-24.1) mL×kg−1×min−1 (p<0.001) in the steady state (SS) of the Glittre-ADL test. Correlations between distance traveled in the ISWT and the time spent in Glittre-ADL test, VO2 peak of ISWT and VO2 in SS of Glittre-ADL test and HR at the ISWT peak and at the Glittre-ADL test SS were moderate to high magnitude. The Glittre-ADL test has lower metabolic, cardiovascular and ventilatory responses compared to ISWT, despite correlations between variables.

Cardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries.

BACKGROUND: Brazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described. OBJECTIVE: This study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs). METHODS: In this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N=249 programmes). RESULTS: Cardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0% programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n=16, 53.3%), but in 11 programmes (36.7%) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70% of programmes. Programmes had a team of 3.8±1.9 staff (versus 5.9±2.8 in other upper-MICs, p<0.05), offering 4.0±1.6/10 core components (versus 6.0±1.5 in other upper-MICs, p<0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25-75=29-65) vs. 32 sessions/patient (Q25-75=15-40) in other upper-MICs (p<0.01). CONCLUSION: Brazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.

Influence of posture, sex, and age on breathing pattern and chest wall motion in healthy subjects.

OBJECTIVE: We evaluated the effects of posture, sex, and age on breathing pattern and chest wall motion during quiet breathing in healthy participants. METHODS: Eighty-three participants aged 42.72 (SD=21.74) years presenting normal pulmonary function were evaluated by optoelectronic plethysmography in the seated, inclined (with 45° of trunk inclination), and supine positions. This method allowed to assess the chest wall in a three dimensional way considering the chest wall as three compartments: pulmonary rib cage, abdominal rib cage and abdomen. RESULTS: Posture influenced all variables of breathing pattern and chest wall motion, except respiratory rate and duty cycle. Chest wall tidal volume and minute ventilation were reduced (p<0.05) in both sexes from seated to inclined and from seated to supine positions, mainly in males. Moreover, moving from seated to supine position significantly increased the percentage contribution of the abdomen to the tidal volume in both sexes (p<0.0001). Regarding sex, women showed higher contribution of thoracic compartment compared to men (p=0.008). Aging provided reductions on rib cage contributions to tidal volume that were compensated by increases of abdomen contributions (p<0.0001). In addition, increases in end-inspiratory and end-expiratory volumes over the years were observed. CONCLUSION: The degree of contribution of chest wall compartments is dependent on posture, sex, and age. Therefore, verticalization increases expansion of pulmonary rib cage as well as horizontalization increases abdominal displacement. Women presented higher thoracic contribution to tidal volume than men. Aging reduces rib cage contributions to tidal volume that were compensated by increases of abdomen contributions.

Efficacy of interventions aimed at improving physical activity in individuals with stroke: a systematic review.

Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature.Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales.Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity.Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.