Continuous Aerobic Training and High Intensity Interval Training Increase Exercise Tolerance in Heart Failure Patients: A Retrospective Study

Abstract Background: Conventional aerobic training is the first choice in cardiac rehabilitation for patients with chronic heart failure (CHF). However, high-intensity interval training (HIIT) may be an alternative, although it has little evidence. Objectives: To evaluate the effect of continuous aerobic training (CAT) or HIIT on exercise tolerance in CHF patients. Methods: Retrospective study with 30 patients, of both genders, members of a 10-week CAT or HIIT program. The control group (CON) consisted of patients who did not participate voluntarily in the program. Peak oxygen uptake (VO2peak), thresholds (LV1 and LV2), and ventilatory efficiency in the production of dioxide (VE/VCO2 slope), oxygen uptake efficiency (OUES), and VO2 recovery kinetics were analyzed. A two-way or repeated measures ANOVA was used, followed by Fisher's post-hoc test (p<0.05). Results: After 10 weeks of training, the CAT group increased the treadmill speed at LV1 (p=0.040), while the HIIT increased both the speed (p=0.030) and incline of the treadmill (p<0.001) for VO2peak and LV2, as well as the total time of the cardiopulmonary test. The VE/VCO2 slope was lower than that predicted for CAT (p=0.003) and HIIT (p=0.008). There was no change in VO2peak, recovery of heart rate (HR), and VO2, VE/VCO2, and OUES in both groups. Conclusions: After 10 weeks, both CAT and HIIT increased the tolerance to physical exercise. However, HIIT showed improvement in more parameters, differently from CAT.

Analysis of Cardiovascular Disease Risk Factors in Women.

AIM: Study the cardiovascular risk factors in a feminine population vulnerable to cardiovascular events particularly to evaluate the principal factors or possible confounding variables. METHODS: This is a cross-sectional descriptive study. Were analysed all the female patients from the Cardiovascular Rehabilitation Institute of Sports Medicine of Caxias do Sul who had the complete information on cardiovascular disease history, comorbidities and habits and who knew the complete gynaecological history by a phone interview. RESULTS: A group of 91 patients were analysed. About the comorbidities and habits, 45.2% of these patients presented some tobacco load, 82.4% are hypertensive, 61.5% are dyslipidemic, 25.3% are diabetic and the BMI average was 29.27 (overweight). Between the patients who undergone a hysterectomy and had an episode of the acute coronary syndrome (10 patients), 70% had the event after the procedure. Between the post-menopause women with at least one episode of the acute coronary syndrome, 80.5% (33 patients) had the first event after the menopause. CONCLUSION: We found multiple lifetime risk factors that predisposed the women of the sample to have cardiovascular disease. Between the women with specific to women risk factors and without, the prevalence of cardiovascular disease was very similar. This information supports the idea that these are just confounding factors of CVD and the principals involved are the genetic factors and habits. For this reason, the focus of CVD prevention and treatment should be directed towards these aspects.

Phototherapy for Improvement of Performance and Exercise Recovery: Comparison of 3 Commercially Available Devices.

CONTEXT: Recent studies suggest the prophylactic use of low-powered laser/light has ergogenic effects on athletic performance and postactivity recovery. Manufacturers of high-powered lasers/light devices claim that these can produce the same clinical benefits with increased power and decreased irradiation time; however, research with high-powered lasers is lacking. OBJECTIVE: To evaluate the magnitude of observed phototherapeutic effects with 3 commercially available devices. DESIGN: Randomized double-blind placebo-controlled study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Forty healthy untrained male participants. INTERVENTION(S): Participants were randomized into 4 groups: placebo, high-powered continuous laser/light, low-powered continuous laser/light, or low-powered pulsed laser/light (comprising both lasers and light-emitting diodes). A single dose of 180 J or placebo was applied to the quadriceps. MAIN OUTCOME MEASURE(S): Maximum voluntary contraction, delayed-onset muscle soreness (DOMS), and creatine kinase (CK) activity from baseline to 96 hours after the eccentric exercise protocol. RESULTS: Maximum voluntary contraction was maintained in the low-powered pulsed laser/light group compared with placebo and high-powered continuous laser/light groups in all time points (P < .05). Low-powered pulsed laser/light demonstrated less DOMS than all groups at all time points (P < .05). High-powered continuous laser/light did not demonstrate any positive effects on maximum voluntary contraction, CK activity, or DOMS compared with any group at any time point. Creatine kinase activity was decreased in low-powered pulsed laser/light compared with placebo (P < .05) and high-powered continuous laser/light (P < .05) at all time points. High-powered continuous laser/light resulted in increased CK activity compared with placebo from 1 to 24 hours (P < .05). CONCLUSIONS: Low-powered pulsed laser/light demonstrated better results than either low-powered continuous laser/light or high-powered continuous laser/light in all outcome measures when compared with placebo. The increase in CK activity using the high-powered continuous laser/light compared with placebo warrants further research to investigate its effect on other factors related to muscle damage.

Does photobiomodulation therapy is better than cryotherapy in muscle recovery after a high-intensity exercise? A randomized, double-blind, placebo-controlled clinical trial.

This study aimed to determine the effectiveness of photobiomodulation therapy (PBMT) and cryotherapy, in isolated and combined forms, as muscle recovery techniques after muscle fatigue-inducing protocol. Forty volunteers were randomly divided into five groups: a placebo group (PG); a PBMT group (PBMT); a cryotherapy group (CG); a cryotherapy-PBMT group (CPG); and a PBMT-cryotherapy group (PCG). All subjects performed four sessions at 24-h intervals, during which they submitted to isometric assessment (MVC) and blood collection in the pre-exercise period, and 5 and 60 min post-exercise, while the muscle fatigue induction protocol occurred after the pre-exercise collections. In the remaining sessions performed 24, 48, and 72 h later, only blood collections and MVCs were performed. A single treatment with PBMT and/or cryotherapy was applied after only 2 min of completing the post-5-min MVC test at the first session. In the intragroup comparison, it was found that exercise led to a significant decrease (p < 0.05) in the production of MVC in all groups. Comparing the results of MVCs between groups, we observed significant increases in the MVC capacity of the PBMT, CPG, and PCG volunteers in comparison with both PG and CG (p < 0.05). We observed a significant decrease in the concentrations of the biochemical markers of oxidative damage (TBARS and PC) in all groups and muscle damage (creatine kinase-CK) in the PBMT, PCG, and CPG compared with the PG (p < 0.01). The clinical impact of these findings is clear because they demonstrate that the use of phototherapy is more effective than the use of cryotherapy for muscle recovery, additionally cryotherapy decreases PBMT efficacy.

Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs.

AIM: This paper aims to assess the dropout rate in different age groups through the example of the large cardiac rehabilitation centre affiliated with the Institute of Sports Medicine, University of Caxias do Sul. MATERIAL AND METHODS: A historic cohort study comprising the following groups: Non-Old < 65 (n = 141); Young-Old 65-74 (n = 128); and Middle-Old 75-84 years old (n = 57). The exercise program lasted 48 sessions and dropout was defined as attendance of 50% of sessions or less. Logistic binominal regression was performed to assess the risk of dropout. For all analyses, a two-tailed P value of < 0.05 was used. RESULTS: The total dropout rate was 38.6%. The Young-Old and Middle-Old groups showed lower dropouts compared to Non-Old patients (p = 0.01). Young-Old has 96% less risk for dropout compared to Non-Old group (adjusted odds ratios = 1.96 [1.16-3.29]). Furthermore, patients underwent the Coronary Artery Bypass Graft showed a lower rate of dropout (p = 0.001). The absence of CABG involved three times more risk of dropout (p = 0.001). CONCLUSION: The Non-Old and the Middle-Old patients showed higher dropout rates compared to Young-Old. To ensure the best possible rehabilitation and to improve patients´ participation in CR, these programs should be adjusted to the needs of patients in terms of their age.

Pre-Exercise Infrared Low-Level Laser Therapy (810 nm) in Skeletal Muscle Performance and Postexercise Recovery in Humans, What Is the Optimal Dose? A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

AIM: This study aimed to evaluate the medium-term effects of low-level laser therapy (LLLT or photobiomodulation) in postexercise skeletal muscle recovery and performance enhancement and to identify the optimal dose of 810 nm LLLT. MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled trial was performed, with voluntary participation of 28 high-level soccer athletes. We analyzed maximum voluntary contraction (MVC), delayed onset muscle soreness (DOMS), creatine kinase (CK) activity, and interleukin-6 (IL-6) expression. The assessments were performed before exercise protocols, after 1 min, and 1, 24, 48, 72, and 96 h after the end of eccentric exercise protocol used to induce fatigue. LLLT was applied before eccentric exercise protocol with a cluster with five diodes, and dose of 10, 30, or 50 J (200 mW and 810 nm) in six sites of quadriceps. RESULTS: LLLT increased (p < 0.05) MVC from immediately after exercise to 24 h with 50 J dose, and from 24 to 96 h with 10 J dose. Both 10 J then 50 J dose decreased (p < 0.05) CK and IL-6 with better results in favor of 50 J dose. However, LLLT had no effect in decreasing DOMS. No differences (p > 0.05) were found for 30 J dose in any of the outcomes measured. CONCLUSIONS: Pre-exercise LLLT, mainly with 50 J dose, significantly increases performance and improves biochemical markers related to skeletal muscle damage and inflammation.

Change in Profile of Entrants in a Brazilian Large Cardiovascular Rehabilitation Service.

BACKGROUND: There are references regarding physical activity and cardiovascular disease since the nineteenth century. New evidences support that cardiac rehabilitation is closely related to therapeutic success after major coronary events. Although the benefits of cardiac rehabilitation programs are well established, referencing and enrolment in such services remain low. AIM: The aim of this paper is to describe the profile changes throughout the years in a large cardiac rehabilitation service in Brazil. MATERIAL AND METHODS: This is a retrospective analysis of medical records of all patients referred to cardiac rehabilitation service of the Institute of Sports Medicine, University of Caxias do Sul from March 2003 to July 2014. Data collection was carried out using SPSS software and the statistical analysis with Student's t-test, ANOVA test and chi square test. RESULTS: It has seen a substantial increase of patients, mostly routed via universal health system, also an increase of post-myocardial infarction patients and ex-smokers. Also, it was seen few patients in the 7th and 8th life decades, and men were in majority since the beginning. CONCLUSION: An increase in the number of patients referred by universal health system occurred because there is a governmental interest in this type of program. About tobacco, hospitalizations appear to be influential in the decision of abandonment. There was a substantial increase of patients with more severe disease which is in accordance with the latest guidelines of Cardiovascular and Metabolic Rehabilitation.

What is the best treatment to decrease pro-inflammatory cytokine release in acute skeletal muscle injury induced by trauma in rats: low-level laser therapy, diclofenac, or cryotherapy?

Currently, treatment of muscle injuries represents a challenge in clinical practice. In acute phase, the most employed therapies are cryotherapy and nonsteroidal anti-inflammatory drugs. In the last years, low-level laser therapy (LLLT) has becoming a promising therapeutic agent; however, its effects are not fully known. The aim of this study was to analyze the effects of sodium diclofenac (topical application), cryotherapy, and LLLT on pro-inflammatory cytokine levels after a controlled model of muscle injury. For such, we performed a single trauma in tibialis anterior muscle of rats. After 1 h, animals were treated with sodium diclofenac (11.6 mg/g of solution), cryotherapy (20 min), or LLLT (904 nm; superpulsed; 700 Hz; 60 mW mean output power; 1.67 W/cm(2); 1, 3, 6 or 9 J; 17, 50, 100 or 150 s). Assessment of interleukin-1ß and interleukin-6 (IL-1ß and IL-6) and tumor necrosis factor-alpha (TNF-α) levels was performed at 6 h after trauma employing enzyme-linked immunosorbent assay method. LLLT with 1 J dose significantly decreased (p < 0.05) IL-1ß, IL-6, and TNF-α levels compared to non-treated injured group as well as diclofenac and cryotherapy groups. On the other hand, treatment with diclofenac and cryotherapy does not decrease pro-inflammatory cytokine levels compared to the non-treated injured group. Therefore, we can conclude that 904 nm LLLT with 1 J dose has better effects than topical application of diclofenac or cryotherapy in acute inflammatory phase after muscle trauma.

Influência do exercício físico na qualidade de vida de mulheres na pós-menopausa: um estudo caso-controle / The influence of exercise in the quality of life of postmenopausal women a case control study

Avaliar a influência de atividade física na qualidade de vida e sintomasreferidos por um grupo de mulheres pós-menopáusicas. Metodologia: estudo casocontroleenvolvendo de 197 mulheres na pós- menopausa com idade entre 50-65anos: 132 sedentárias e 65 praticantes de exercícios físicos aeróbicos deintensidade leve a moderada. A qualidade de vida e a sintomatologia climatéricaforam avaliadas pela Menopause Rating Scale (MRS). Na análise estatística,procedeu-se à análise multivariada por regressão linear múltipla. Resultados: Ogrupo fisicamente apresentou índices de qualidade de vida significativamentemelhores em todos os domínios do instrumento MRS: sintomas sômato-vegetativos(p<0,01), sintomas psicológicos (p<0,01) e geniturinários e sexuais (p<0,01);63,6% do grupo sedentário e 33,4% do fisicamente ativo referiram sintomas deintensidade moderada a severa. A capacidade cardiorrespiratória se mostroutambém significativamente maior entre as mulheres fisicamente ativas (26,5±7,0ml/Kg/min and 20,2±7,8 ml/kg/min, respectivamente). Através da análisemultivariada, mostraram-se fatores preditores da qualidade de vida no presenteestudo, a confirmação de atividade física regular (p<0,01) e a renda familiar percapita (p<0,01), de modo que as mulheres fisicamente ativas ou com melhorrenda tenderam a referir menor sintomatologia climatérica e melhor qualidadede vida. Conclusões: No presente estudo, a atividade física regular de intensidadeleve a moderada e a renda familiar per capita influenciaram positivamente aqualidade de vida e a intensidade da sintomatologia climatérica

Equilíbrio postural de canoístas profissionais / Postural balance of professional canoeing

O equilíbrio corporal relaciona-se diretamente com a postura corporal. O equilíbrio corporal do ser humano depende das informações oriundas do labirinto, da visão, da somatocepção, que são receptores sensoriais periféricos relacionados com a orientação espacial. Este estudo teve como objetivo, a comparação de parâmetros estabilométricos em teste de longa duração de um grupo de canoístas profissionais do sexo feminino na postura ortostática. O grupo de participantes foi constituído por nove atletas da Seleção Brasileira Feminina de Canoagem Velocidade, divididas em dois grupos: veteranas e cadetes. O sistema de aquisição dos dados foi através de uma plataforma de força AccuSway Plus, com o software Balance Clinic. As atletas permaneceram sobre a plataforma por 31 minutos em posição ortostática, com os pés descalços e unidos, braços ao longo do corpo e com os olhos abertos. As atletas veteranas apresentaram melhor controle postural e menor desconforto durante o teste do que as atletas cadetes.

The body balance is directly related to body posture. The balance of the human body depends on information from the labyrinth, the vision of somatocepção, peripheral sensory receptors that are related to orientation espacial. This study aims to compare the parameters stabilometric in long-term test of a group of canoístas professional female in orthostatic posture. The group of participants consisted of nine athletes from the Brazilian National Team for Women's Canoe speed, divided into two groups, veterans and cadets. The system of data acquisition was through a platform of strength AccuSway Plus, with the Balance Clinic software. The players remained on the platform for 31 minutes in a standing position, and with bare feet together, arms along the body and with eyes open. The veteran athletes showed better postural control and less discomfort during the test than the athletes cadets.