Effects of exercise training on smoking-induced cardiopulmonary diseases. A review of the physiological mechanisms / Efectos del entrenamiento físico en la enfermedad cardiopulmonar inducida por el tabaquismo: revisión de los mecanismos fisiológicos

OBJECTIVE: Cigarette smoking triggers a plethora of biological mechanisms that promote the development of cardiovascular and respiratory diseases. Some preclinical studies have shown that exercise training could be effective in blunting oxidative stress and inflammatory response induced by cigarette smoking. Therefore, we aim to analyze the effect of exercise training on pulmonary and cardiovascular system in experimental models of cigarette smoking. METHODS: A systematic search was performed in order to identify studies addressed to evaluate the effects of exercise training on pulmonary and/or cardiovascular damage induced by cigarette smoking in animal models. RESULTS: fourteen articles were identified, all of them performed in rats or mice. Running and swimming were the only training methods and whole-body smoke exposition was the most prevalent smoking protocol used in the studies. CONCLUSION: The studies support the hypothesis that exercise training performed before, concurrently or after smoking can blunt or even revert the oxidative stress and inflammatory response in animals exposed to cigarette smoke, which could contribute to recovering its cardiovascular and respiratory function

OBJETIVO: El tabaquismo desencadena diversos mecanismos biológicos que producen el desarrollo de enfermedades cardiovasculares y pulmonares. Algunos estudios preclínicos han demostrado que el entrenamiento físico puede ser eficaz en la reducción del estrés oxidativo y de la respuesta inflamatoria inducida por el tabaquismo. Por tanto, nuestro objetivo ha sido analizar el efecto del entrenamiento físico en los sistemas pulmonar y cardiovascular en modelos experimentales de tabaquismo. MÉTODO: Se realizo una búsqueda sistemática para localizar estudios orientados al análisis de los efectos del entrenamiento físico sobre los daños pulmonares y/o cardiovasculares inducidos por el tabaquismo en modelos animales. RESULTADOS: Se identificaron catorce estudios, todos realizados en ratas o ratones. Correr o nadar fueron los únicos métodos de entrenamiento y la exposición de cuerpo entero al humo del tabaco fue el protocolo de tabaquismo mas frecuentemente usado en los estudios. CONCLUSIÓN: Los estudios sustentan la hipótesis de que el entrenamiento físico realizado antes, durante o después del tabaquismo, puede reducir o incluso revertir, el estrés oxidativo y la respuesta inflamatoria en animales expuestos al humo del tabaco, lo que podría contribuir en la recuperación de la función cardiovascular y respiratoria

What do patients really know about cardiopulmonary rehabilitation: a cross-sectional survey study.

BACKGROUND: Although it is known that cardiopulmonary rehabilitation (CPR) reduces mortality and morbidity, it is not widely implemented as is in Turkey. One factor might be lack of demand since the levels of knowledge and awareness among patients who are eligible for CPR seem to be insufficient. AIM: It is aimed to investigate the level of awareness and knowledge of CPR among patients with cardiopulmonary problems. DESIGN: Cross-sectional survey study. SETTING: Outpatient. METHODS: Knowledge regarding CPR was assessed by questionnaires given to 690 patients recruited in seven university hospitals and six training and research hospitals in which either comprehensive or limited CPR services are available. POPULATION: Patients who have cardiopulmonary problems RESULTS: Of the patients, 34.7% were given information on CPR by healthcare staff, and 25.3% reported that their source of information was physicians. Although 49.9% of the patients knew that they needed to exercise for their cardiac/pulmonary problems, only 23.4% and 32.1% of those were aware that fast walking and climbing stairs, respectively, would not pose a risk to their cardiac/pulmonary health. The majority of the patients believed that activities of daily living, which comprise the most important component of exercise-based CPR, were harmful for their cardiopulmonary health. We found that 31.1% of the patients exercised regularly. During their stay at the hospital, certain kinds of exercises were suggested to 62.7% of the patients, and 34.7% of these patients performed various exercises. Of the patients who were given detailed information on cardiopulmonary rehabilitation, 69% stated that they would be willing to participate in a similar program. CONCLUSION: Although nearly half of the patients stated that they needed CR, it was observed that the ratio of patients who had true knowledge of CPR was low among patients. It is imperative to furnish patients with information on CPR, both in the field of PMR and throughout Turkey, and to put more effort into running those services effectively. Furthermore, we should make an effort to increase the level of liaison between patients and physicians and other healthcare professionals who participate in the treatment of cardiac/pulmonary patients.

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Material del carro de reanimación cardiopulmonar pediátrica / Material for the pediatric resuscitation trolley

La parada cardiorrespiratoria y por tanto la necesidad de realizar una reanimación cardiopulmonar se puede presentar en cualquier lugar, tanto en el medio extrahospitalario como intrahospitalario. Por ese motivo, todos los centros sanitarios tanto hospitalarios, como de atención primaria y los servicios de emergencias extrahospitalarias, deben estar preparados para realizar una reanimación cardiopulmonar pediátrica y el tratamiento de otras urgencias vitales. Para ello, deben disponer de los medios materiales adecuados. El carro de parada o mesa de reanimación constituye un elemento asistencial indispensable en todo centro sanitario. El material que debe contener el carro de parada puede variar dependiendo del tipo de centro sanitario y el tipo de reanimación (p. ej., la reanimación neonatal). Debe existir al menos un carro en cada centro de atención primaria, unidad de cuidados intensivos pediátricos, servicio de urgencias, servicio de emergencias extrahospitalarias y planta de pediatría. El carro debe estar en un lugar fácilmente accesible y en él se debe colocar sólo el material imprescindible para las emergencias vitales. Deben existir los tamaños de cada instrumental necesarios para tratar a niños de cualquier edad, y el número suficiente de recambios de cada instrumento y medicación que puedan precisarse durante una reanimación. El material debe ser revisado periódicamente y todo el personal médico, de enfermería y auxiliar deberá conocer el contenido y la disposición del material y medicación del carro

Cardiorespiratory arrest and the need for cardiopulmonary resuscitation can occur anywhere, both in the out-of-hospital and in-hospital settings. Therefore, all healthcare centers (hospitals, primary care facilities, out-of-hospital emergency services) must be prepared to initiate life support procedures in children and to treat other life-threatening emergencies. To achieve this objective, adequate material including a full crash cart or resuscitation trolley is essential and must be available in all healthcare centers. Specific items contained in the trolley can vary according to the characteristics of the facility and the most probable type of resuscitation needed (for example, neonatal resuscitation). At least one resuscitation trolley must be available in primary care centers, pediatric intensive care units, emergency departments, out-of-hospital emergency services, and pediatric wards. The trolley must be located in an easily accessible site and must contain only indispensable material. It is essential to include instruments in several sizes, covering children of all ages, as well as enough spare instruments and medications that could be required during resuscitation. The material must be checked periodically and all the staff (physicians, nurses, and auxiliary personnel) must be familiar with the trolley's contents and the location of all material and drugs

Laboratorio de evaluación del ejercicio cardiopulmonar en rehabilitación / Assessment laboratory of cardiopulmonary exercise in rehabilitation

Los programas de entrenamiento físico son parte fundamental del tratamiento de los pacientes con enfermedades respiratorias crónicas, así como en los afectados de patología cardíaca. Los efectos beneficiosos del ejercicio controlado se producen tanto física como psicológicamente, contribuyendo a mejorar la calidad de vida. Para determinar el entrenamiento de forma personalizada deben realizarse previamente una serie de estudios basados en la fisiología cardiorrespiratoria del ejercicio: historia clínica, exploración física, estudios básicos como analítica, radiografía de tórax, electrocardiograma, exploración funcional respiratoria, gasometría arterial basal, etc. Completaremos el estudio con la evaluación de parámetros más específicos, como disnea o capacidad de esfuerzo. La mayoría de los pacientes que acuden a estos programas presentan disnea al esfuerzo y/o intolerancia al ejercicio, por lo que consideramos imprescindible analizar la disnea y la capacidad de ejercicio tanto desde el punto de vista cardiológico como respiratorio. En la clínica se dispone de una serie de pruebas sencillas, como el test de marcha o las escaleras, y más complejas como la ergometría, que se describen y analizan. Resulta fundamental la percepción de la limitación por parte del propio paciente para la realización de actividades de la vida diaria, así como la calidad de vida como resultado final del entrenamiento. Se evalúan mediante cuestionarios validados a la lengua de la población a la que se aplica, por lo que en las unidades específicas debe existir personal entrenado en la aplicación de estas escalas. Estos conocimientos permitirán una prescripción individualizada y más eficaz del ejercicio

The physical training programs are a fundamental part of the treatment of patients with chronic respiratory diseases and in the affects of heart disease. Beneficial effects of controlled exercise occur both on the physical and psychological level, contributing to improve quality of life. To determine personalized training, a series of studies based on cardiorespiratory physiology of exercise should be done: clinical history, physical examination, basic studies such as analysis, chest X-ray, electrocardiogram, functional respiratory examination, baseline arterial blood gases, etc. We will complete the study with the assessment of more specific parameters, such as dyspnea or exercise capacity. Most of the patients who come to these programs have dyspnea on exercise and/or intolerance to exercise, so that we consider it is essential to assess dyspnea and exercise capacity from the cardiological and respiratory point of view. In the clinical setting, there is a series of simple tests, such as walking test, or stairs and more complex ones such as ergometer, that are described and analyzed. Perception of the limitation by the patient is fundamental to perform daily life activities and to quality of life as a final result of training. They are evaluated by questionnaires validated to the language of the population in which they are used. Thus, there should be staff trained in the application of these scales in the specific units. This knowledge will allow us to make an individualized and more effective prescription of exercise

Optimization and mechanism of step-leap respiration exercise in treating of cor pulmonale.

The interaction between cardiovascular system and the respiratory system is complicated and may be used for the rehabilitation of the cor pulmonale disease. To study the effects of different breathing mode on the cardiac and pulmonary systems, a mathematical model is established based on the previous work. Using this model, computer simulation experiments are carried out for searching an optimal respiration mode in treating of cor pulmonale disease. Results indicate that the step-leap respiration mode could provide a better assistant to the rehabilitation of the cor pulmonale patients in the sense of increasing coronary flow, reducing pulmonary arterial pressure and reducing the working load for the right heart. This result is also proven by the clinical experiments. This work may suggest that a proper directed respiration exercise can be used in the treatment of cor pulmonale disease.