Predictive value of invasive mechanical ventilation parameters for mortality in COVID-19 related ARDS: a retrospective cohort study.

The 2019 coronavirus (COVID-19) can generate acute respiratory distress syndrome (ARDS), requiring advanced management within the Intensive Care Unit (ICU) using invasive mechanical ventilation (IMV However, managing this phenomenon has seen learning and improvements through direct experience. Therefore, this study aims were to describe the assessment of the different IMV variables in patients with post-COVID-19 hospitalized in the ICU and their relation with mortality. Observational and retrospective study. The sample was divided into two, the surviving group (SG) and the non-surviving group (NSG). Clinical data were extracted from the electronic clinical file and the respiratory therapist record sheet. The following information was obtained: Patient medical history: gender, age, co-morbidities, arterial gases, days on IMV, and IMV parameters. Out of a total of 101 patients, the total mortality was 32%. There was a significant decrease in respiratory rate (RR) (29.12 ± 4.24-26.78 ± 3.59, p = 0.006), Driving pressure (DP) (11.33 ± 2.39-9.67 ± 1.84, p = 0.002), Ventilatory rate (VR) (2.26 ± 0.66-1.89 ± 0.45, p = 0.001) and a significant rise in Static compliance (Cest) (35.49 ± 8.64-41.45 ± 9.62, p = 0.003) and relation between Arterial oxygen pressure/Inspirated oxygen fraction (PaO2/FiO2) (201.5 ± 53.98- 227.8 ± 52.11, p = 0.008) after 72 h of IMV, within the NSG compared to the SG. Apart from these points, multi-morbidity (HR = 3.208, p = 0.010) and DP (HR = 1.228, p = 0.030) and VR variables (HR = 2.267, p = 0.027) had more death probabilities. The results of this study indicate that there was a significant increase in RR, DP, VR, and CO2 and a significant drop in Cest and PaO2/FiO2 among the NSG compared with the SG. Apart from this, the DP and VR variables, multi-morbidity and being male. have more possibility of death.

Comparison of distance covered, physiological cost, and perceived exertion in four six-minute walk test protocols.

Objective: There is evidence that indicates that the Walked Distance (WD) in the 6-Minute Walk Test (6MWT) would be sensitive to the type of track and encouragement. The aim of study was compared the impact of track type and verbal encouragement provided in the 6MWT on WD, physiological cost, perceived exertion, and gait efficiency in healthy young adults unfamiliar with the test. Method: WD, heart rate, subjective sensation of dyspnea (SSD), and fatigue (SSF) were measured in four 6MWT protocols: i) 30 m linear track and protocolized encouragement (LT + PE), ii) 30 m linear track and constant encouragement (LT + CE), iii) 81 m elliptical track and protocolized encouragement (ET + PE), and iv) 81 m elliptical track and constant encouragement (ET + CE). In addition, the Gait Efficiency Index (GIE) associated with physiological cost, dyspnea and fatigue was calculated and compared between the different protocols. Results: The WD was significantly higher in the ET + CE protocol. The percentage of the heart rate reserve used (%HRRu) at minute 6 was higher in the ET + CE protocol. The SSD and SSD had difference in startup time between the protocols. The GEI was higher in %HRRu, SSD, and SSF for the ET + CE protocol. Conclusion: The ET + CE protocol showed a significant increase in WD during the 6MWT in healthy young adults. Although it obtained the highest physiological cost, it did not present perceptual differences when entering cardiopulmonary assessment windows relevant to a more efficient test for the participant. It is advisable to discuss, based on the findings, the fundamental objective of the 6MWT and national and international recommendations to achieve a result as close as possible to the real maximal effort.

Effects of a pulmonary rehabilitation program on pulmonary function, exercise performance, and quality of life in patients with severe COVID-19.

BACKGROUND: Severe coronavirus 2019 disease (COVID-19) causes acute hypoxemic respiratory failure requiring invasive mechanical ventilation (IMV). Once these symptoms are resolved, patients can present systemic deterioration. OBJECTIVE: The two objectives of this study were as follows: to describe the results of a pulmonary rehabilitation program (PRP), which is divided into three groups with different numbers of sessions (12, 24, and 36), and to associate the variables of pulmonary function, exercise performance, and functionality with the number of sessions and functional improvement. DESIGN: Prospective, observational study. METHODS: PRP consisted of aerobic + strength + flexibility exercises under the supervision and individualized into 12, 24, or 36 sessions (12s, 24s, and 36s), depending on the evolution of each patient. At the beginning of the study and immediately after the intervention, forced vital capacity (FVC), maximal inspiratory pressure, 6-minute walk test (6MWT), sit-to-stand test (STS), maximal handgrip strength (HGS), Fatigue Assessment Scale, Post-COVID-19 Functional Status (PCFS), and health-related quality of life (HRQoL) were measured. RESULTS: The proposed PRP demonstrated a positive effect on pulmonary function, exercise performance, and HRQoL, regardless of the number of sessions. A higher score on the PCFS and more days on IMV were associated with the increased likelihood of needing more sessions, whereas more meters on the 6MWT in the initial evaluation was associated with a reduced likelihood of needing more sessions. Finally, more repetitions on the STS and less distance covered on the initial 6MWT were associated with a greater improvement in exercise performance evaluated with the 6MWT. CONCLUSION: Supervised and individualized PRP for patients with severe post-COVID-19 improves pulmonary function, exercise performance, functionality, and quality of life. Functionality, distance covered on the 6MWT, and the days on IMV are central to the scheduling of the number of sessions for these patients.

A pulmonary rehabilitation program is an effective strategy to improve forced vital capacity, muscle strength, and functional exercise capacity similarly in adults and older people with post-severe COVID-19 who required mechanical ventilation.

BACKGROUND: It is internationally known that our population is aging. At the same time, some patients with COVID-19, due to their symptoms, required mechanical ventilation (MV) and subsequent pulmonary rehabilitation (PR). This study aimed to compare the effects of a multimodal PR program "ADULT" versus "OLDER" people with COVID-19 who were on MV. METHODS: The intervention consisted of an 8-week hybrid PR program (2x week). Forced vital capacity (FVC) was measured at the beginning and end of PR, upper and lower limb strength was obtained through hand grip strength (HGS) and the sit-to-stand test (STST), respectively, and functional exercise capacity was measured with the 6-minute walking test (6MWT). RESULTS: The main results were an increase in the FVC in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.27), an increase in HGS in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.52), in the same way, the number of repetitions on the STST increased in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.55). Finally, the distance covered on the 6MWT increased in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.65). CONCLUSIONS: The PR program is an effective strategy to improve FVC, muscle strength, and functional exercise capacity similarly in adults and older people with post severe COVID-19 who required MV.

Composición Corporal y Capacidad Física en Pacientes con COVID-19 Hospitalizados en una Unidad de Cuidados Intensivos

Las unidades de cuidados intensivos (UCI) y agudos han sido los contenedores del avance de la pandemia por COVID-19. Sin embargo, la estadía prolongada en esta unidad puede repercutir sobre la composición corporal (CC) y la capacidad derealizar ejercicio de los pacientes. El objetivo de esta investigación fue determinar si existe relación entre composición corporal (CC) y la prueba de caminata en 6 minutos (PC6m). Se reclutaron 17 personas (8 mujeres y 9 hombres). Se tomaron las siguientes medidas: PC6m, se consideró su distancia recorrida (DRPC6m) y su velocidad (VelPC6m). Las variables de CC medidas fueron índice de masa corporal (IMC), masa grasa (MG), masa libre de grasa (MLG) y masa magra (MM). La DRPC6m sólo mostró relación significativa con la MM corporal (MMC). Por otra parte, la VelPC6m tuvo una relación significativa con la MMC. Además de esto, la MLG del miembro inferior derecho y la MLG del miembro inferior izquierdo mostraron una relación con la VelPC6m (r=0,422; p=0,041 y r=0,417; p=0,025, respectivamente). También la MM del miembro inferior derecho y la MM del miembro inferior izquierdo se relacionaron significativamente con la VelPC6m (r=0,422; p=0,030 y r=0,420; p=0,042). En conclusión, existe relación entre composición corporal y VelPC6m. Esto permitiría aproximarse de manera rápida al nivel de funcionalidad con la que ingresa un paciente a un programa de rehabilitación.

SUMMARY: The intensive care units (ICU) and acute care units have been the containers for the advance of the COVID-19 pandemic. However, prolonged stay in this unit can impact patients' body composition (WC) and ability to exercise. This research aimed to determine if there is a relationship between body composition (BC) and the 6-minute walk test (6mWT). 17 people were recruited (8 women and 9 men). The following measurements were taken: 6mWT, its distance traveled (6mWTDT) and its speed (6mWTS) were considered. The WC variables measured were body mass index (BMI), fat mass (FM), fat-free mass (FFM), and lean mass (LM). 6mWTDT only showed a significant relationship with body LM (BLM). On the other hand, 6mWTS had a significant relationship with BLM. In addition to this, the FFM of the right lower limb and the FFM of the left lower limb showed a relationship with 6mWTS (r=0.422; p=0.041 and r=0.417; p=0.025, respectively). Also, the LM of the right lower limb and the LM of the left lower limb were significantly related to the 6mWTS (r=0.422; p=0.030 and r=0.420; p=0.042). In conclusion, there is a relationship between body composition and 6mWTS. This would allow us to quickly approach the level of functionality with which a patient enters a rehabilitation program.

Retrospective Analysis of the Ventilatory Workload Kinetic Index during Stability and Crisis in Patients with Asthma and COPD in a Monitored Program.

To assess ventilatory evolution through the Ventilatory Workload Kinetic Index (VWKI) in patients with asthma and chronic obstructive pulmonary disease (COPD) during stability and exacerbation. Retrospective analysis. Conducted at the Padre Alberto Hurtado Hospital, Santiago, Chile. Ten patients with asthma and fifty-five with COPD participated. Sixty-five clinical records were reviewed. The VWKI in stability and exacerbation of these patients was extracted. When analyzing the baseline with the peak in both asthma and COPD, there was a significant increase in the VWKI. Similarly, the loads, translations, and supports significantly increased from the baseline to the peak. However, in the loads, there were no changes in airway resistance for asthma or in cough for COPD. Likewise, the supports for asthma and COPD showed no changes in the O2. The VWKI determined ventilatory issues in outpatients and made locating the greatest compromise in loads, translations, or supports possible.

Confiabilidad Inter-evaluador en la Medición del Grosor Muscular y el Ángulo de Penación a través de la Evaluación Ecográfica: Estudio entre un Experto y un Kinesiólogo en Formación / Inter-Evaluator Reliability in Measurement of Muscle Thickness and Penance Angle through Ultrasound Evaluation: Comparison Study between an Expert and a Physical Therapist in Training

Existen diversas formas de evaluar el músculo esquelético. Una herramienta que ha ganado relevancia es la evaluación ecográfica. Esta, permite medir el grosor muscular (GM) y el ángulo de penación (AP). Por otra parte, en la formación inicial de los Kinesiólogos es importante realizar el ejercicio de la confiabilidad en la medición en relación al experto. un procedimiento diagnóstico. Así, el objetivo de este estudio es determinar la confiabilidad inter-evaluador en la medición del GM y el AP, a través de la evaluación ecográfica, entre un experto y un kinesiólogo en formación. La capacitación contó de tres fases; el ciclo teórico, el ciclo práctico y el proceso de confiabilidad. Para este último, se realizaron 10 pruebas para cada una de las mediciones GM 1, GM 2 y GM 3 y de AP. La confiabilidad inter-evaluador en la medición de GM es buena a excelente en los tres intentos GM1 (ICC=0,81; p=0,001), GM2 (ICC=0,86; p<0,001), GM3 (ICC=0,88;<0,001). Por su parte, la confiabilidad del AP fue pobre a regular (ICC=0,21; p=0,143. Las conclusiones de esta investigación indican que existe una excelente confiabilidad inter evaluador en la medición de GM. No así, en la medición de AP, por lo que se sugiere incrementar las horas prácticas en el proceso de aprendizaje de esta medida.

SUMMARY: Skeletal muscle can be assessed in a number of different ways. Consequently, ultrasound evaluation has become a relevant diagnostic tool. This procedure allows measuring muscle thickness (MT) and pennation angle (PA). Furthermore, during the initial training of physical therapists it is important in a diagnostic procedure, to exercise reliability in measurement in comparison to the expert. Therefore, the objective of this study is to determine the inter-rater reliability in the measurement of MT and PA, through ultrasound evaluation, between an expert and a physical therapist in training. This training was comprised of three phases: The theoretical cycle, the practical cycle and the reliability process. For the latter, ten different tests were performed for each of the MT 1, MT 2 and MT 3 and PA measurements. Inter-rater reliability in the MT measurement was good to excellent in the three attempts MT1 (ICC=0.81; p=0.001), MT2 (ICC=0.86; p<0.001), MT3 (ICC=0. 88;<0.001). On the other hand, reliability of the PA was poor to fair (ICC=0.21; p=0.143. In conclusion, this research indicates that there is excellent inter-rater reliability in the measurement of MT. This does not however apply to the measurement of PA. It is therefore suggested that practical hours during the learning process of this measure be increased.

Submandibular Skinfold Thickness Cut-off Values in Relation to Body Mass Index and Percentage Body Fat Among Chilean Adolescents.

The present study evaluates submandibular skinfold (SMS) cutoff values to estimate excess weight for BMI and percentage body fat (%BF) among Chilean adolescents. The results show an optimal area under the cutoff curve value of 83% among girls and 91% in boys to estimate SMS concerning %BF and BMI. The SMS cutoff value estimating obesity by %BF was 10 mm among girls and 9 mm among boys, 10 mm among girls, and 7 mm among boys by BMI. Our results showed that SMS is significantly associated with anthropometric parameters for obesity.

Impacto de un Programa de Recuperación Funcional en Músculos Ventilatorios y Apendiculares en Pacientes Post-ventilación Mecánica por COVID-19 / Impact of a Functional Recovery Program on Ventilatory and Appendicular Muscles in Patients Post-mechanical Ventilation for COVID-19

Los pacientes con COVID-19 subsidiarios de ventilación mecánica (VM), evolucionan con consecuencias funcionales en la musculatura ventilatoria y apendicular que no necesariamente se abordan de manera diferenciada. El objetivo de esta investigación fue evaluar el impacto de un programa de recuperación funcional en estos pacientes y determinar si las intervenciones afectan de manera diferenciada a las funciones ventilatorias y musculatura apendicular, utilizando pruebas de bajo costo. Se evaluaron 47 pacientes con COVID-19 que estuvieron en VM. Posterior a una espirometría basal se les realizó; presión inspiratoria máxima (PIMáx), fuerza de prensión palmar (FPP), prueba de pararse y sentarse (PPS) y Prueba de caminata en 6 minutos (PC6m), antes y después del plan de intervención. Este programa incluyó ejercicios aeróbicos y de fuerza supervisados por dos sesiones semanales de 60 minutos durante 3 meses. Después del programa, se observaron mejoras significativas en la capacidad vital forzada (CVF), el volumen espiratorio en el primer segundo (VEF1) y la PIMáx. Se encontraron relaciones significativas entre estas mediciones y la distancia recorrida de la PC6m, la FPP y la PPS. En conclusión, el programa de recuperación funcional en pacientes con COVID-19 que requirieron VM, beneficia tanto la función ventilatoria como la fuerza muscular apendicular. Las pruebas de fuerza muscular apendicular pueden ser útiles para evaluar la recuperación ya que pueden entregar información diferenciada de sus rendimientos. Por último, se necesita más investigación para comprender mejor la respuesta de estos pacientes a la rehabilitación.

SUMMARY: Patients with COVID-19 requiring mechanical ventilation (MV) evolve with functional consequences in the ventilatory and appendicular muscles that are not necessarily addressed in a differentiated manner. The objective of this research was to evaluate the impact of a functional recovery program in these patients and determine if the interventions differentially affect ventilatory functions and appendicular muscles, using low- cost tests. 47 patients with COVID-19 who were on MV were evaluated. After a baseline spirometry, they were performed; maximum inspiratory pressure (MIP), handgrip strength (HGS), sit to stand test (STST) and 6-minute walk test (6MWT), before and after the intervention plan. This program included supervised aerobic and strength exercises for two weekly 60-minute sessions for 3 months. After the program, significant improvements were observed in forced vital capacity (FVC), expiratory volume in the first second (FEV1) and MIP. Significant relationships were found between these measurements and the distance traveled of the 6MWT, the HGS and the STST. In conclusion, the functional recovery program in patients with COVID-19 who required MV benefits both ventilatory function and appendicular muscle strength. Appendicular muscle strength tests can be useful to evaluate recovery since they can provide differentiated information about your performances. Finally, more research is needed to better understand the response of these patients to rehabilitation.

Asociación entre la Arquitectura Muscular y el Índice de Calidad Muscular en Adultos Sedentarios / Association Between Muscle Architecture and Muscle Quality Index in Sedentary Adults

La evaluación de la calidad y la arquitectura muscular son importantes para comprender y cuantificar los cambios musculares asociados con el envejecimiento y el estilo de vida sedentario, además nos facilita información de la capacidad del músculo para generar fuerza, potencia o funcionalidad. los objetivos del estudio fueron (I) determinar la asociación entre los parámetros de la arquitectura muscular y el índice de calidad muscular (MQI) y (II) determinar la asociación entre los parámetros de la arquitectura muscular y la potencia media relativa del sit to stand test (STS). Únicamente el grosor muscular (MT) mostró una asociación moderada con el MQI (r = 0,545). En contraste, tanto la longitud del fascículo (FL) como el ángulo de penación (PA) exhibieron asociaciones "muy bajas", las cuales no resultaron significativas con el MQI. Al examinar la relación de los parámetros de la arquitectura muscular con la potencia media relativa de STS, MT presentó una asociación "moderada" (r = 0,444). Sin embargo, tanto FL como PA mostraron asociaciones "muy bajas" y "bajas", respectivamente, con la potencia media relativa al STS. En conclusión, estos hallazgos refuerzan la idea de que MT puede ser un indicador relevante de la calidad muscular y la capacidad de generar potencia en la prueba de STS. Específicamente, se observó que un aumento en MT estaba asociado con una mejora en MQI y la potencia media relativa de STS.

SUMMARY: Assessment of muscle quality and architecture is important for understanding and quantifying muscle changes associated with aging and a sedentary lifestyle and provides information on the muscle's ability to generate strength, power, or function. The aims of the study were (I) to determine the association between muscle architecture parameters and muscle quality index (MQI) and (II) to determine the association between muscle architecture parameters and mean relative power in the sit-to-stand test (STS). Only muscle thickness (MT) showed a moderate association with MQI (r = 0.545). In contrast, both fascicle length (FL) and penile angle (PA) exhibited "very low" associations, which were not significant with the MQI. When examining the relationship between muscle architecture parameters and mean relative STS power, MT presented a "moderate" association (r = 0.444). However, both LF and PA showed "very low" and "low" associations, respectively, with a mean power relative to STS. In conclusion, these findings reinforce the idea that MT may be a relevant indicator of muscle quality and ability to generate power in the STS test. Specifically, an increase in MT was associated with an improvement in MQI and mean power relative to STS.

Influence of probe position in the measurement of muscle thickness and its association with lean mass: an ultrasound study / Influencia de la posición de la sonda en la medición del grosor muscular y su asociación con la masa magra: un estudio ecográfico

SUMMARY: Skeletal muscles play a fundamental role in people's lives and their evaluation provides significant information on health. Different tools have been used to evaluate muscle mass, and the evaluation of muscle thickness (MT) using ultrasound has been included as an alternative, which can be performed with the probe in different positions; however, these could present differences. The objectives of this study were to determine whether there are differences in the measurement of MT in the vastus lateralis (VL) muscle using the probe in the longitudinal or transverse position, and to determine its association with the lean mass of the lower limbs. The results indicated no significant differences between MT measurements with the probe in the longitudinal and transverse positions (p =0.084). However, when associating these measurements with lower limb lean mass, it was found that transverse measurements had a strong association (r =0.547; p < 0.001), while longitudinal measurements had a moderate association (r =0.351; p =0.007). This suggests that measurements with the probe positioned transversely to measure the MT would be the best option. Therefore, it could be useful as an indicator of lower limb lean mass in the absence of tools, such as bioelectrical bioimpedance or magnetic nuclear resonance.

El músculo esquelético cumple un rol fundamental en la vida de las personas, y su evaluación entrega mucha información de la salud. Se han utilizado diferentes herramientas para evaluar la masa muscular, y el último tiempo se ha incluido la evaluación del grosor muscular (MT) a través de la ecografía como una alternativa para estimarla, las cuales se pueden realizar con la sonda en distintas posiciones, sin embargo, estas podrían presentar diferencias. Los objetivos del estudio fueron determinar si existen diferencias en la medición de MT en el músculo vasto lateral (VL) utilizando la sonda en posición longitudinal o transversal y determinar su asociación con la masa magra de los miembros inferiores. Los resultados indican que no existen diferencias significativas entre las mediciones de MT con la sonda en posición longitudinal y transversal (valor p: 0.084). Sin embargo, al asociar estas mediciones con la masa magra de los miembros inferiores, se encontró que las mediciones transversales poseen una asociación fuerte (r: 0.547; valor p < 0.001), mientras que las mediciones longitudinales presentan una asociación moderada (r: 0.351; valor p: 0.007). Esto sugiere que las mediciones con la sonda posicionada transversal para medir MT serían la mejor opción. Por lo tanto, podría ser de utilidad como un indicador de masa magra de los miembros inferiores en caso de no contar con herramientas como la bioimpedancia bioeléctrica o resonancia nuclear magnética.

Respiratory muscles: structure, function and relationship with the ACE gene: a brief morphofunctional communication / Músculos respiratorios: estructura, función y relación con el gen de la ECA: una breve comunicación morfofuncional

SUMMARY: Pulmonary ventilation is a mechanical process in which the respiratory muscles act in coordination to maintain the oxygenation of the organism. Any alteration in the performance of these muscles may reduce the effectiveness of the process. The respiratory muscles differ from the other skeletal muscles in the vital support that they provide through rhythmiccontractions. The structure and energy system of the muscles are specially adapted to perform this function. The composition of the respiratory muscles is exceptional; they are small, and present an abundant capillary network, endowing them with a high aerobic level and resistance to fatigue. Coordinated regulation of the local renin-angiotensin system provides proper blood flow and energy supply in the myofibrils of the skeletal muscle tissue. Specifically, this performance will depend to a large extent on blood flow and glucose consumption, regulated by the renin-angiotensin system. The angiotensin converting enzyme is responsible for degrading kinins, which finally regulate muscle bioenergy and glucose between the blood vessel and the skeletal muscle. The objective of this review is to describe the structure of the respiratory muscles and their association with the angiotensin converting enzyme gene.

La ventilación pulmonar es un proceso mecánico en el que los músculos respiratorios actúan coordinadamente para mantener la oxigenación en el organismo. Así, cualquier alteración en el desempeño de estos músculos puede reducir la efectividad del proceso. Los músculos respiratorios se diferencian de otros músculos esqueléticos, debido al apoyo vital que brindan a través de sus contracciones rítmicas. La estructura y el sistema energético de estos músculos están especialmente adaptados para realizar esta función. La composición de los músculos respiratorios es especial; son pequeñas y presentan una abundante red capilar, lo que les otorga un alto nivel aeróbico y resistencia a la fatiga. La regulación coordinada del sistema renina-angiotensina local, proporciona un adecuado flujo sanguíneo y suministro de energía a las miofibrillas del músculo esquelético. En concreto, este rendimiento dependerá en gran medida del flujo sanguíneo y del consumo de glucosa, regulado por el sistema renina-angiotensina. Aquí, la enzima convertidora de angiotensina es responsable de degradar las kininas, que finalmente regulan la bioenergía muscular y la glucosa entre el vaso sanguíneo y el músculo esquelético. El objetivo de esta breve comunicación es describir la estructura de los músculos respiratorios y su asociación con el gen de la enzima convertidora de angiotensina.

Use of the speed achieved on the 6MWT for programming aerobic training in patients recovering from severe COVID-19: an observational study.

INTRODUCTION: Patients who suffered severe COVID-19 need pulmonary rehabilitation. Training may be prescribed objectively based on the maximum speed in the six-minute walk test. The objective of this study was to determine the effects of a personalized pulmonary rehabilitation program based on the six-minute walk test speed for post-COVID-19 patients. METHODS: Observational quasi-experimental study. The pulmonary rehabilitation program consisted of 8 weeks of training, twice a week for 60 minutes per session of supervised exercise. Additionally, the patients carried out home respiratory training. Patients were evaluated by exercise test, spirometry and the Fatigue Assessment Scale before and after the eight-week pulmonary rehabilitation program. RESULTS: After the pulmonary rehabilitation program, forced vital capacity increased from 2.47 ± 0.60 to 3.06 ± 0.77 L (p < .001) and the six-minute walk test result increased from 363.50 ± 88.87 to 480.9 ± 59.25 m (p < .001). In fatigue perception, a significant decrease was observed, from 24.92 ± 7.01 to 19.10 ± 7.07 points (p < .01). Isotime evaluation of the Incremental Test and the Continuous Test showed a significant reduction in heart rate, dyspnoea and fatigue. CONCLUSION: The eight-week personalized pulmonary rehabilitation program prescribed on the basis of the six-minute walk test speed improved respiratory function, fatigue perception and the six-minute walk test result in post-COVID-19 patients.KEY MESSAGESCOVID-19 is a multisystem disease with common complications affecting the respiratory, cardiac and musculoskeletal systems.The 6MWT speed-based training plan allowed for increased speed and incline during the eight-week RP program.Aerobic, strength and flexibility training reduced HR, dyspnoea and fatigue in severe post-COVID-19 patients.

El término kinesiología, sus implicancias en la forma profesional y en el fondo disciplinar. Segunda parte: los matices en su desarrollo / The term kinesiology, its implications in the professional practice and disciplinary background. Second part: the nuances in its the development

Los matices que ha generado el término Kinesiología en el desarrollo disciplinar han podido justificar una importante cantidad de acciones profesionales que van desde la educación física, pasando por la investigación de laboratorio, cinética, cinemática del deporte y función ventilatoria, para culminar otorgando asistencias en el extremo de la disfunción y la inmovilidad concomitante al término de la gran mayoría de las enfermedades. Así la Kinesiología ha sido el soporte argumentativo para profesores, entrenadores, científicos y terapeutas que trabajan con el movimiento humano. No exentas de contribuir al objeto de estudio se encuentran las humanidades y las ciencias sociales que parten en la antropología y se consolidan en la biopolítica de organizaciones gremiales con carácter universal para fijar lineamientos de control. Ante la importante magnitud del campo de conocimientos acumulados, es posible sostener la evidente oportunidad de generar condiciones favorables que se encarguen de reflexionar otras soluciones inspiradas en la trascendencia de la funcionalidad y el movimiento. El denominador común de estos alcances comienza cuando la funcionalidad pasa a ser la meta epistemológica de los paradigmas al servicio del movimiento humano. En este contexto, el objetivo de esta investigación fue analizar el término Kinesiología en el contexto de los matices disciplinares para recomponer sus implicancias y determinar su posibilidad de sobrevida.

SUMMARY: The nuances that the term Kinesiology has generated in disciplinary development have upheld a significant number of professional actions, ranging from physical education to laboratory research, kinetics, sport kinematics and ventilator function. Such actions have ultimately assisted in the extreme dysfunction and immobility concomitant at the end of a vast majority of diseases. Therefore, Kinesiology has been the argumentative support for teachers, coaches, scientists and therapists working with human movement. Humanities and social sciences that commence with anthropology and are consolidated in the bio politics of global union organizations to establish control guidelines are also an important contribution to its study. Given the vast amount of knowledge in this field, there is an opportunity to generate favorable conditions that reflect on further solutions inspired by the transcendence of functionality and movement. When reflecting on these achievements, the common denominator is when functionality becomes the epistemological goal ofthe paradigms at the service of human movement. In this context, the objective of this research was to analyze the term Kinesiology in the context of disciplinary nuances to recompose its implications and to determine if it can survive as a discipline.

[Maximum isometric force of the quadriceps and hamstrings and functionality after total knee arthroplasty]. / Fuerza isométrica máxima de cuádriceps e isquiotibiales y funcionalidad luego de la artroplastia total de rodilla.

Gonarthrosis is a highly prevalent disease in older adults. The objective of this research was to identify changes in quadriceps muscle strength and their impact on the functionality of total knee replacement (TKA) operated patients undergoing kinesitherapy at Hospital El Carmen de Maipú (HEC). All TKA operated patients were measured, pre and post intervention, maximum isometric strength (MIF), Time Up and Go, Standing and sitting test, Unipodal support and the WOMAC scale. The operated and contralateral MIF is higher in flexion and extension when comparing both genders (p < 0.0001; p < 0.0001, respectively). In the up and go and the standing and sitting test, performance was significantly higher for males than for females (p = 0.001; p = 0.007, respectively). In the WOMAC, there were significant differences before and after the intervention in men and women (p < 0.0001; p < 0.0001, respectively). Patients with a body mass index (BMI) > 30 kg/m2 are 3 times less likely [OR = -3.498; CI (0.062-1.067)] to receive treatment in a period of less than 50 days. On the other hand, injuries to the non-dominant (left) knee have a 4 times greater chance of stay in treatment in less than 50 days [(OR = 2.71; CI (1.000-16.252)]. There was an increase in MIF of the knee treated post-intervention, in both genders. Functionality increased in men and women, after the intervention.

La gonartrosis es una enfermedad de alta prevalencia en adultos mayores. El objetivo de esta investigación fue identificar los cambios en la fuerza muscular del cuádriceps y su efecto en la funcionalidad de los pacientes operados de artroplastia total de rodilla (ATR) sometidos a kinesiterapia en el Hospital El Carmen de Maipú (HEC). A todos los operados de ATR se les midió, pre y post intervención, fuerza isométrica máxima (FIM), Time Up and Go, test de pararse y sentarse, apoyo unipodal y la escala WOMAC. La FIM de la rodilla operada y la no operada, es mayor en flexión y extensión al comparar ambos géneros (p < 0.0001; p < 0.0001, respectivamente). En el up and go y la prueba pararse y sentarse el rendimiento fue significativamente superior para el género masculino en relación al femenino (p = 0.001; p = 0.007, respectivamente). En el WOMAC, existieron diferencias significativas pre y post intervención en hombres y mujeres (p < 0.0001; p < 0.0001, respectivamente). Los pacientes con un índice de masa corporal (IMC) > 30 kg/m2 tienen 3 veces menos posibilidades [OR = -3.498; IC (0.062-1.067)] de permanecer en tratamiento en un plazo menor a 50 días. Por otra parte, las lesiones en la rodilla no dominante (izquierda) tiene 4 veces más posibilidades de tratamiento inferior a 50 días [(OR = 2.71; IC (1.000-16.252)]. Existió un aumento de la FIM de la rodilla tratada post intervención, en ambos géneros. La funcionalidad aumentó en hombres y mujeres, posterior a la intervención.

Physical therapy protocols to attenuate skeletal muscle atrophy in critically ill patients: narrative review / Protocolos de terapia física para atenuar la atrofia del músculo esquelético en pacientes críticos: revisión narrativa

SUMMARY: To describe the physical therapy protocols used in critically ill patients to attenuate skeletal muscle atrophy. We conducted a search in PubMed and Embase from inception to November 2020. Observational or experimental studies published in English or Spanish that evaluated the effect of physical therapy protocols on the attenuation of skeletal muscle atrophy in critically ill patients through muscle strength or mass measurement were considered eligible. Studies were only included if they reported a detailed description of the dosing of the interventions. Seventeen studies met the eligibility criteria. We included randomised clinical trials (n = 16) and observational studies (n = 1). The total population of the included studies was 872 critically ill patients. The studies aimed to evaluate the reliability, safety or effectiveness of neuromuscular electrical stimulation (n = 10) protocols, early mobilisation (n = 3), ergometer training (n = 2), transfers in tilt table (n = 1), and blood flow restriction (n = 1). Physical therapy protocols are part of the critically ill patient's integral management. Strategies such as passive mobilisation, in-bed and out-of-bed transfers, gait training, ergometer training, and neuromuscular electrical stimulation substantially impact critically ill patients' prognoses and quality of life after hospital discharge.

RESUMEN: Describir los protocolos de terapia física usados en pacientes críticos para atenuar la atrofia muscular esquelética. Realizamos una búsqueda en PubMed y Embase desde el inicio hasta noviembre de 2020. Se consideraron los estudios observacionales o experimentales publicados en inglés o español que evaluaron el efecto de los protocolos de terapia física en la atenuación de la atrofia del músculo esquelético en pacientes críticos a través de la medición de la fuerza o la masa muscular. Los estudios solo se incluyeron si informaron una descripción detallada de la dosificación de las intervenciones. Diecisiete estudios cumplieron los criterios de elegibilidad. Se incluyeron ensayos clínicos aleatorizados (n = 16) y estudios observacionales (n = 1). La población total de los estudios incluidos fue de 872 pacientes en estado crítico. Los estudios tuvieron como objetivo evaluar la confiabilidad, seguridad o efectividad de los protocolos de estimulación eléctrica neuromuscular (n = 10), movilización temprana (n = 3), entrenamiento con ergómetro (n = 2), transferencias en mesa basculante (n = 1) y restricción del flujo sanguíneo (n = 1). Los protocolos de terapia física forman parte del manejo integral del paciente crítico. Es- trategias como la movilización pasiva, los traslados dentro y fuera de la cama, el entrenamiento de la marcha, el entrenamiento con ergómetro y la estimulación eléctrica neuromuscular tienen un impacto sustancial en el pronóstico y la calidad de vida de los pacientes críticos después del alta hospitalaria.

Fuerza isométrica máxima de cuádriceps e isquiotibiales y funcionalidad luego de la artroplastia total de rodilla / Maximum isometric force of the quadriceps and hamstrings and functionality after total knee arthroplasty

Resumen La gonartrosis es una enfermedad de alta prevalencia en adultos mayores. El objetivo de esta investigación fue identificar los cambios en la fuerza muscular del cuádriceps y su efecto en la funcionalidad de los pacientes operados de artroplastia total de rodilla (ATR) sometidos a kinesiterapia en el Hospital El Carmen de Maipú (HEC). A todos los operados de ATR se les midió, pre y post intervención, fuerza isométrica máxima (FIM), Time Up and Go, test de pararse y sentarse, apoyo unipodal y la escala WOMAC. La FIM de la rodilla operada y la no operada, es mayor en flexión y extensión al comparar ambos géneros (p < 0.0001; p < 0.0001, respectivamente). En el up and go y la prueba pararse y sentarse el rendimiento fue significativamente superior para el género masculino en relación al femenino (p = 0.001; p = 0.007, respectivamente). En el WO MAC, existieron diferencias significativas pre y post intervención en hombres y mujeres (p < 0.0001; p < 0.0001, respectivamente). Los pacientes con un índice de masa corporal (IMC) > 30 kg/m2 tienen 3 veces menos posi bilidades [OR = -3.498; IC (0.062-1.067)] de permanecer en tratamiento en un plazo menor a 50 días. Por otra parte, las lesiones en la rodilla no dominante (izquierda) tiene 4 veces más posibilidades de tratamiento inferior a 50 días [(OR = 2.71; IC (1.000-16.252)]. Existió un aumento de la FIM de la rodilla tratada post intervención, en ambos géneros. La funcionalidad aumentó en hombres y mujeres, posterior a la intervención.

Abstract Gonarthrosis is a highly prevalent disease in older adults. The objective of this re search was to identify changes in quadriceps muscle strength and their impact on the functionality of total knee replacement (TKA) operated patients undergoing kinesitherapy at Hospital El Carmen de Maipú (HEC). All TKA operated patients were measured, pre and post intervention, maximum isometric strength (MIF), Time Up and Go, Standing and sitting test, Unipodal support and the WOMAC scale. The operated and contralateral MIF is higher in flexion and extension when comparing both genders (p < 0.0001; p < 0.0001, respectively). In the up and go and the standing and sitting test, performance was significantly higher for males than for females (p = 0.001; p = 0.007, respectively). In the WOMAC, there were significant differences before and after the intervention in men and women (p < 0.0001; p < 0.0001, respectively). Patients with a body mass index (BMI) > 30 kg/m2 are 3 times less likely [OR = -3.498; CI (0.062-1.067)] to receive treatment in a period of less than 50 days. On the other hand, injuries to the non-dominant (left) knee have a 4 times greater chance of stay in treatment in less than 50 days [(OR = 2.71; CI (1.000-16.252)]. There was an increase in MIF of the knee treated post-intervention, in both genders. Functionality increased in men and women, after the intervention.

Eight Weeks of Supervised Pulmonary Rehabilitation Are Effective in Improving Resting Heart Rate and Heart Rate Recovery in Severe COVID-19 Patient Survivors of Mechanical Ventilation.

Background and Objectives: Patients who survive severe COVID-19 require significant pulmonary rehabilitation. Heart rate (HR) has been used as a safety variable in the evaluation of the results of interventions in patients undergoing pulmonary rehabilitation. The aim of this research was to analyse HR during a pulmonary rehabilitation program in post-severe COVID-19 patients who survived mechanical ventilation (MV). The study includes the initial and final evaluations and aerobic training sessions. Materials and Methods: Twenty patients (58 ± 13 years, 11 men) were trained for 8 weeks. A 6-minute walk test (6 MWT) was performed and, subsequently, a supervised and individualised training plan was created. Resting heart rate (RHR), heart rate recovery (HRR), heart rate at minute 6 (HR6 min) and the product of HR6 min and systolic blood pressure (HR6 minxSBP) were measured at 6 MWT. In addition, HR was measured at each training session. Results: After 8 weeks of pulmonary rehabilitation, patients decreased their RHR from 81.95 ± 9.36 to 73.60 ± 9.82 beats/min (p < 0.001) and significantly increased their HRR from 12.45 ± 10.22 to 20.55 ± 7.33 beats/min (p = 0.005). HR6 min presented a significant relationship with walking speed and walked distance after the pulmonary rehabilitation period (r = 0.555, p = 0.011 and r = 0.613, p = 0.011, respectively). HR6 minxSBP presented a significant relationship with walking speed and walked distance after training (r = 0.538, p = 0.014 and r = 0.568, p = 0.008, respectively). In the pulmonary rehabilitation sessions, a significant decrease in HR was observed at minutes 1, 6 and 15 (p < 0.05) between sessions 1 and 6 and at minute 1 between sessions 1 and 12. Conclusions: Eight weeks of individualised and supervised pulmonary rehabilitation were effective in improving RHR and HRR in COVID-19 patients surviving MV. HR is an easily accessible indicator that could help to monitor the evaluation and development of a pulmonary rehabilitation program in COVID-19 patients who survived MV.

Physical therapy protocols to attenuate skeletal muscle atrophy in critically ill patients: narrative review / Protocolos de terapia física para atenuar la atrofia del músculo esquelético en pacientes críticos: revisión narrativa

To describe the physical therapy protocols used in critically ill patients to attenuate skeletal muscle atrophy. We conducted a search in PubMed and Embase from inception to November 2020. Observational or experimental studies published in English or Spanish that evaluated the effect of physical therapy protocols on the attenuation of skeletal muscle atrophy in critically ill patients through muscle strength or mass measurement were considered eligible. Studies were only included if they reported a detailed description of the dosing of the interventions. Seventeen studies met the eligibility criteria. We included randomised clinical trials (n =16) and observational studies (n = 1). The total population of the included studies was 872 critically ill patients. The studies aimed to evaluate the reliability, safety or effectiveness of neuromuscular electrical stimulation (n = 10) protocols, early mobilisation (n = 3), ergometer training (n = 2), transfers in tilt table (n = 1), and blood flow restriction (n = 1). Physical therapy protocols are part of the critically ill patient's integral management. Strategies such as passive mobilisation, in-bed and out-of-bed transfers, gait training, ergometer training, and neuromuscular electrical stimulation substantially impact critically ill patients' prognoses and quality of life after hospital discharge.