Combining functional exercises with exercise training in COPD: a randomized controlled trial.

INTRODUCTION: Increasing physical activity in daily life (PADL) in chronic obstructive pulmonary disease (COPD), mainly in short-term training programs, is still a challenge. The combination of functional exercises with aerobic and resistance training may be a strategy to improve PADL and limitations in activities of daily living (ADL) in COPD. OBJECTIVE: To evaluated the short- and medium-term effects of the combination of functional exercises with aerobic and resistance training. METHODS: Seventy-six patients were randomized into (1) functional training group who performed resistance and aerobic and functional exercises; (2) conventional training group (CTG) who performed resistance and aerobic exercise; or (3) usual care group who performed respiratory physiotherapy. Patients were evaluated for PADL (activity monitor), ADL limitations (London Chest Activity of Daily Living scale [LCADL]), functional exercise capacity (6-minute walk test [6MWT]), and peripheral muscle strength before and after eight weeks. Medium-term effects were evaluated 12 weeks after the training. RESULTS: There were no changes or differences between groups in PADL and in 6MWT post-intervention and 12 weeks post-training. Only CTG showed a reduction in the total score on LCADL scale after the intervention and increase at follow-up (score: 20 ± 8; 17 ± 6; 19 ± 8, pre-intervention, post-intervention, and 12 weeks post-training, respectively, p = 0.001), without differences between groups (p = 0.375). There were increases in the muscle strength of knee flexors (p = 0.016) and extensors (p < 0.001) after the intervention only in CTG. CONCLUSIONS: Combined aerobic and resistance training with functional exercises failed to improve PADL and ADL limitations in COPD. Eight weeks of conventional training improved ADL. This, however, was not superior to the results from the other groups and was not sustained at medium-term 12 weeks post-training.

Relationship of the Aggregation of Cardiovascular Risk Factors in the Parasympathetic Modulation of Young People with Type 1 Diabetes.

Background and objectives: In healthy individuals, autonomic alterations are associated with the aggregation of cardiovascular risk factors. However, in individuals with type 1 diabetes, who are known to present autonomic alterations, mainly characterized by a reduction in parasympathetic modulation, these associations have not yet been investigated. We assess whether the aggregation of cardiovascular risk factors influences parasympathetic indices of heart rate variability in young people with type 1 diabetes. Materials and methods: This cross-sectional study included 39 individuals with type 1 diabetes (22.54 ± 4.31), evaluated in relation to the risk factors: blood pressure, fat percentage, and resting heart rate. For heart rate variability analysis, heart rate was recorded beat-to-beat using a cardio frequency meter (PolarS810i) for 30 min with the volunteers in dorsal decubitus. The parasympathetic heart rate variability indices were calculated: rMSSD, pNN50, high frequency (HF) n.u (normalized units), SD1, 2LV, and 2ULV. Data collection was carried out in 2014 and analyzed in 2017. Results: Individuals with two aggregate risk factors present a reduction in the values of the indices that reflect parasympathetic autonomic modulation compared to individuals without the risk factors analyzed, regardless of sex and age. Conclusion: In young people with type 1 diabetes, the aggregation of cardiovascular risk factors is associated with parasympathetic autonomic impairment.

Effects of massage as a recuperative technique on autonomic modulation of heart rate and cardiorespiratory parameters: a study protocol for a randomized clinical trial.

BACKGROUND: Recuperative techniques have been used to anticipate and potentiate recovery. The massage is one of the most widely used in sports. Among the ways to demonstrate the recovery of the organism is the resumption of autonomic modulation of heart rate, which can be analyzed in situations that cause disturbances in the behavior of the cardiovascular system with the objective of verifying the responsiveness of the autonomic nervous system (ANS). Recovery can be assessed through heart rate variability (HRV) which analyzes the oscillations in consecutive heartbeats, thus allowing an important non-invasive alternative for the study of modulation of the ANS. The objective of the study will be to measure the effects of massage as a recuperative technique on the autonomic modulation of heart rate and cardiorespiratory parameters at different moments of application. METHODS: This is a randomized, cross-over clinical trial. Forty men aged 18 to 30 years, healthy and physically active according to the International Physical Activity Questionnaire will participate in the study. Participants will be randomized into groups, which will perform the five interventions of the study at randomized moments, one intervention per session: Intervention 1: control; Intervention 2: participants will receive the massage protocol; Intervention 3: performance of the stress protocol; Intervention 4: participants will perform the stress protocol and immediately after receive the massage; Intervention 5: participants will perform the stress protocol and 1 h after conclusion of the protocol will receive the massage. The sessions will occur with an interval of 1 week between them and, due to the technique used, blinding participants and therapists is not possible. The primary outcome measure is HRV that will be measured 2 h after the conclusion of each intervention, and secondary outcome measures, which include heart rate, respiratory rate, blood pressure, oxygen saturation, and individual touch perception, will be measured at specific moments in the course of each intervention. DISCUSSION: The implementation and use of this standardized protocol should provide important and reliable information regarding the use of massage in post-exercise recovery, with the identification of its effects on the ANS and the best timing and form of massage application. The data obtained in the present study will provide subsidies for the best management of application of the technique in sports clinical practice, considering periods of training and, mainly, of competitions. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03094676 . Pre-results. 12 March 2018.

Application of Heart Rate Variability in Diagnosis and Prognosis of Individuals with Diabetes Mellitus: Systematic Review.

BACKGROUND: The use of heart rate variability as a tool capable of discriminating individuals with diabetes mellitus is still little explored, as its use has been limited to comparing those with and without the disease. Thus, the purpose of this study was to verify the use of heart rate variability as a tool for diagnostic and prognostic evaluation in person with diabetes and to identify whether there are cutoff points generated from the use of this tool in these individuals. METHODS: A search was conducted in the electronic databases MEDLINE, Cochrane Library, Web of Science, EMBASE, and LILACS starting from the oldest records until January 2015, by means of descriptors related to the target condition, evaluated tool, and evaluation method. All the studies were evaluated for methodological quality using the QUADAS-2 instrument. RESULTS: Eight studies were selected. In general, the studies showed that the heart rate variability is useful to discriminate cardiac autonomic neuropathy in person with diabetes, and the sample entropy, SD1/SD2 indices, SDANN, HF, and slope of TFC have better discriminatory power to detect autonomic dysfunction, with sensitivity and specificity values ranging from 72% to 100% and 71% to 97%, respectively. CONCLUSION: Although there are methodological differences in indices used, in general, this tool demonstrated good sensitivity and specificity and can be used as an additional and/or complementary tool to the conventional autonomic tests, in order to obtain safer and more effective diagnostic, collaborating for better risk stratification conditions of these patients.

Qualificação da dor em trabalhadoras de uma malharia no sul do Brasil / Qualification of pain in women workers of a textile factory in the south of Brazil / Cualificación del dolor de trabajadoras de una tienda de mallas del sur de Brasil

OBJETIVO: Analisar e qualificar a dor em mulheres de uma malharia do sul do Brasil. MÉTODOS: Estudo transversal, descritivo, com abordagem quantitativa, em que foram entrevistadas 15 trabalhadoras em um único dia de maio de 2012. As avaliações para qualificação e análise da dor aconteceram por meio de três questionários: multidimensional adaptado, inventário para dor de Wisconsin (análise da dor) e o questionário de McGill (qualificação). Para análise dos dados, foi realizada a estatística descritiva, com o calculo da média, desvio padrão, percentual e números absolutos. RESULTADOS: As participantes apresentavam média de idade de 33,4 (±14,9) anos e trabalhavam 9 horas diárias. Referente à postura dolorosa no posto de trabalho, observou-se maior queixa em ombros abduzidos e cotovelos flexionados (n=7, 46,6%). Os locais anatômicos dolorosos mais frequentes foram ombros (n=8, 22,2%), coluna cervical (n=7, 19,4%) e cotovelos (n=7, 19,4%). A análise da dor pelo inventário de Wisconsin, classificada por meio da Escala Visual Analógica de Dor (EVA), demonstrou interferência moderada no trabalho, sono, humor, apreciação da vida e na atividade geral. De acordo com o questionário de McGill, houve destaque para o nível sensorial, com maior frequência para dor latejante (n=10, 50%), agulhada (n=4, 20%) e formigamento (n=4, 20%). CONCLUSÃO: A amostra apresentou alta frequência de dor nos ombros, cotovelos, coluna cervical e sintomatologia dolorosa considerada moderada na maioria dos itens avaliados, o que pode levar a uma interferência importante nas atividades laborais e do cotidiano

OBJECTIVE: To analyze and qualify pain in women workers of a textile factory in the south of Brazil. METHODS: Cross-sectional descriptive study, with quantitative approach, in which 15 women workers were interviewed on a single day in May 2012. The assessments for pain qualification and analysis were performed by means of three instruments: multidimensional adapted questionnaire, Wisconsin Pain inventory (pain analysis) and McGill Pain questionnaire (qualification). For data analysis, descriptive statistics was employed, by calculating the average, standard deviation, percentage and absolute numbers. RESULTS: The participants' mean age was 33.4 (± 14.9) and they worked 9 hours a day. As for the painful posture in the workplace, the major complaint regarded abducted shoulders and flexed elbows (n=7, 46.6%). The most commonly painful anatomic sites were shoulders (n=8, 22.2%), cervical spine (n=7, 19.4%) and elbows (n=7, 19.4%). Pain analysis through the Wisconsin inventory, classified by the Visual Analogue Pain Scale (VAS), demonstrated moderate interference with work, sleep, mood, enjoyment of life and general activity. According to McGill questionnaire, the sensory level stood out, with highest frequencies to throbbing pain (n=10, 50%), needled (n=4, 20%) and tingling pain (n=4, 20%). CONCLUSION: The sample showed high frequency of pain in shoulders, elbows and cervical spine, in addition to painful symptomatology regarded moderate in most of the evaluated items, which might lead to significant interference with the labor activities and daily life

OBJETIVO: Analizar y cualificar el dolor de mujeres de una tienda de mallas del sur de Brasil. MÉTODOS: Estudio transversal y descriptivo de abordaje cuantitativo en el cual se entrevistaron 15 trabajadoras en un único día del mes de mayo de 2012. Las evaluaciones para la cualificación y el análisis del dolor se dieron a través de tres cuestionarios: el multidimensional adaptado, el inventario para el dolor de Wisconsin (análisis del dolor) y el cuestionario de McGill (cualificación). Para el análisis de los datos se realizó la estadística descriptiva con el cálculo de la media, la desviación típica, el porcentual y los valores absolutos. RESULTADOS: Las participantes presentaron la media de edad de 33,4 (±14,9) años y 9 horas al día de trabajo. Respecto la postura de dolor en el sector de trabajo, se observó más quejas en los hombros en abducción y los codos en flexión (n=7, 46,6%). Los puntos anatómicos de dolor más frecuentes fueron los hombros (n=8, 22,2%), la columna cervical (n=7, 19,4%) y los codos (n=7, 19,4%). El análisis del dolor a través del inventario de Wisconsin clasificado por la Escala Visual Analógica de Dolor (EVA) ha demostrado interferencia moderada con el trabajo, el sueño, el humor, la apreciación de la vida y la actividad general. Según el cuestionario de McGill hubo importancia para el nível sensorial con más frecuencia para el dolor latigante (n=10, 50%), en agujada (n=4, 20%) y hormigueo (n=4, 20%). CONCLUSIÓN: La muestra presentó elevada frecuencia para el dolor en los hombros, los codos, la columna cervical y sintomatología de dolor moderada para la mayoría de ítems evaluados lo que puede llevar a una interferencia importante en las actividades laborales y del cotidiano