The Use of Cardiac Autonomic Responses to Aerobic Exercise in Elderly Stroke Patients: Functional Rehabilitation as a Public Health Policy.

BACKGROUND AND PURPOSE: The development of public policies must be guided by full knowledge of the health-disease process of the population. Aerobic exercises are recommended for rehabilitation in stroke patients, and have been shown to improve heart rate variability (HRV). Our aim was to compare the cardiac autonomic modulation of elderly stroke patients with that of healthy elderly people during and after an acute bout of aerobic exercise. METHODS: A total of 60 elderly people participated in the study (30 in the control group, mean age of 67 ± 4 years; 30 in the stroke group, mean age of 69 ± 3 years). HRV was analyzed in rest-10 min of rest in supine position; exercise-the 30 min of peak exercise; and recovery-30 min in supine position post-exercise. RESULTS: Taking rest and exercises together, for SDNN, RMSSD, pNN50, RRTri, and TINN, there was no difference between the stroke and control groups (p = 0.062; p = 0.601; p = 0.166; p = 0.224, and p = 0.059, respectively). The HF (ms2) was higher and the LF/HF ratio was lower for the stroke group than the control group (p < 0.001 and p = 0.007, respectively). The SD2 was lower for the stroke group than for the control group (p = 0.041). CONCLUSION: Stroke patients present reduced variability at rest, sympathetic predominance during exercise, and do not return to baseline after the 30 min of recovery, with similar responses found in the healthy elderly group.

Correlation between timed up and go, usual gait speed and dizziness handicap inventory in elderly with vestibular disorders: a retrospective and analytical study.

BACKGROUND: This study was done to verify the associations between the usual gait speed (UGS), the Timed Up and Go test (TUG), and the perception of disability in elderly vestibular patients and to identify factors associated with TUG results. METHODS: This was a descriptive, analytical, and retrospective study that used data from the clinical records of vestibular patients aged 65 years or older at a rehabilitation service in Buenos Aires, Argentina. The records were examined for the following information: sex, age, type of vestibular disorder, dizziness handicap inventory (DHI) score and performance in the TUG and UGS tests before treatment. Pearson's or Spearman's correlation coefficient was used depending on the distribution of data. Age and the DHI were factored into multiple linear regression models in order to model the tests. A Receiver Operating Characteristic (ROC) curve was used to analyze the predictive power of age, the DHI total, and the UGS for the sample's TUG results. The level of significance was 5%. RESULTS: We evaluated 118 clinical records, of which 26 were excluded due to incomplete information, leaving data from 92 vestibular patients (73 females; 78.3 ± 5.8 years old). Unilateral vestibular hypofunction and Benign Paroxysmal Positional Vertigo presented the highest prevalence. The total score and the DHI domains showed a significant association with the TUG and UGS values. The age-adjusted DHI had a low predictive power for these same values. CONCLUSIONS: The total score and DHI domains have a significant association with the TUG and UGS values for elderly adults with vestibular disorders. The age-adjusted DHI has a low predictive power for TUG and UGS values.

Patient-Reported and Performance Outcomes Significantly Improved in Elderly Patients with Vestibular Impairment following Rehabilitation: A Retrospective Study.

OBJECTIVE: To describe the results of a vestibular rehabilitation (VR) program in the timed up and go (TUG), gait speed (GS), and dizziness handicap inventory (DHI) scores for elderly vestibular patients in a developing country. METHODS: Descriptive study with retrospective data collected from the clinical records of vestibular patients. The following information was recorded: sex, age, type of vestibular disorder, DHI score, and performance in TUG and GS, before and after participation in a VR program taking place from January 1 to August 30, 2017. The VR program consisted of 10 twice weekly sessions in the clinic and daily exercises at the patient's home. We used Student's t-test for paired and Wilcoxon's test according to the data distribution. The level of significance was 5%. RESULTS: Data from 57 patients (49 females; 78 ± 5.8 years old) were used. There were statistically significant differences in TUG (12.52 versus 11.56), GS (0.81 versus 0.90 m/s), DHI total handicap (46 versus 24), physical (14 versus 8), emotional (14 versus 6), and functional (18 versus 12) domains. CONCLUSION: The functional outcome measures reported, including TUG, gait speed, and DHI, reflect statistically significant improvements in elderly patients after vestibular rehabilitation; the DHI improvements are clinically relevant.

Cardiac autonomic modulation of children with Down syndrome.

The aim of this study is to analyze the autonomic modulation in children with Down syndrome (DS). The study was conducted with a convenience sample of children with DS and without heart disease, from the Genetics Clinic of the Hospital Infantil Darcy Vargas and APAE São Paulo, São Paulo, SP, Brazil. The control group was matched for sex and age. The analysis of autonomic modulation was performed using the indices of heart rate variability (HRV). The children remained in the supine position with spontaneous breathing for 20 min. Heart rate was recorded beat-to-beat. HRV analysis was performed in time and frequency domain. For data analysis, we used Student's t test: unpaired and Mann-Whitney. It was considered statistically significant at p < 0.05. From 75 children with DS, 50 were excluded, a total of 25 children [16 boys, 8.6 (1.4) years] participated in this study, and the control group also consisted of 25 children [16 boys, 9.0 (1.2) years] without the syndrome. The BMI of the volunteers with DS was higher than the controls [19.1 (2.9) vs. 15.8 (1.2), p < 0.0001]. There were differences between groups in the indices in frequency domain: LFms(2) [1242.1 (788.25) vs. 786.44 (481.90), p = 0.040], LFun [69.104 (11.247) vs. 57.348 (11.683), p = 0.0004], HFun [30.896 (11.247) vs. 42.520 (11.634), p = 0.0004] and LF/HF [2.594 (1.104) vs. 1.579 (0.9982), p = 0.0004]. No differences were observed in time domain indices. The results indicate increased indices representing the sympathetic branch of the autonomic nervous system and those that indicate the overall modulation in children with DS.

Prevalence of burnout syndrome in clinical nurses at a hospital of excellence.

BACKGROUND: Burnout syndrome can be defined as long-term work stress resulting from the interaction between constant emotional pressure associated with intense interpersonal involvement for long periods of time and personal characteristics. We investigated the prevalence/propensity of Burnout syndrome in clinical nurses, and the factors related to Burnout syndrome-associated such as socio-demographic characteristics, work load, social and family life, leisure activities, extra work activities, physical activities, and work-related health problems. METHOD: We conducted a cross-sectional, quantitative, prospective epidemiological study with 188 surgical clinic nurses. We used the Maslach Burnout Inventory (MBI), which is a socio-demographic questionnaire and the most widely used instrument to assess Burnout syndrome (three basic dimensions: emotional exhaustion, despersonalization and professional underachievement). The socio-demographic profile questionnaire wascomposed of questions regarding identification, training, time at work, work characteristics and personal circumstances. RESULTS: The prevalence of Burnout syndrome was higher (10.1%) and 55, 4% of subjects had a propensity to develop this syndrome. The analysis of the socio-demographic profile of the nurse sample studied showed that most nurses were childless married women, over 35 years of age, working the day shift for 36 hours weekly on average, with 2-6 years of post-graduation experience, and without extra employments. Factors such as marital status, work load, emotion and work related stress aggravated the onset of the syndrome. CONCLUSION: The prevalence and propensity of Burnout syndrome were high. Some factors identified can be useful for the adoption of preventive actions in order to decrease the prevalence of the clinical nurses Burnout syndrome.

Analysis of cardiac autonomic modulation of children with attention deficit hyperactivity disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is characterized by decreased attention span, impulsiveness, and hyperactivity. Autonomic nervous system imbalance was previously described in this population. We aim to compare the autonomic function of children with ADHD and controls by analyzing heart rate variability (HRV). METHODS: Children rested in supine position with spontaneous breathing for 20 minutes. Heart rate was recorded beat by beat. HRV analysis was performed in the time and frequency domains and Poincaré plot. RESULTS: Twenty-eight children with ADHD (22 boys, aged 9.964 years) and 28 controls (15 boys, age 9.857 years) participated in this study. It was determined that the mean and standard deviation of indexes which indicate parasympathetic activity is higher in children with ADHD than in children without the disorder: high frequency in normalized units, 46.182 (14.159) versus 40.632 (12.247); root mean square of successive differences, 41.821 (17.834) versus 38.150 (18.357); differences between adjacent normal-to-normal intervals greater than 50 milliseconds, 199.75 (144.00) versus 127.46 (102.21) (P<0.05); percentage of differences between adjacent normal-to-normal intervals greater than 50 milliseconds, 23.957 (17.316) versus 16.211 (13.215); standard deviation of instantaneous beat-to-beat interval, 29.586 (12.622) versus 26.989 (12.983). CONCLUSION: Comparison of the autonomic function by analyzing HRV suggests an increase in the activity of the parasympathetic autonomic nervous systems in children with ADHD in relation to the control group.

Heart rate variability in stroke patients submitted to an acute bout of aerobic exercise.

Stroke has been associated with cardiac autonomic impairment due to damage in central nervous system. Dysfunction in heart rate variability (HRV) may reflect dysfunction of the autonomic nervous system. Aerobic training has been used in the rehabilitation procedure of patients, due to improvement of aerobic function and other beneficial effects as increased recruitment of motor units, favoring the development of muscle fibers. The purpose of this study was to evaluate the cardiac autonomic modulation in patients with stroke before, during, and after an acute bout of aerobic exercise. The heart rate of 38 stroke patients was recorded using a heart rate (HR) monitor and the data were used to assess cardiac autonomic modulation through HRV analysis. The patients were in supine position and remained at resting condition (R) for 10 min before starting the experiment. Afterwards, they were submitted to walking exercise (E) on a treadmill until achieve 50-70% of maximum heart rate. After 30 min of aerobic exercise, the subjects were advised to remain in supine position for additional 30 min in order to record the HR during the recovery (RC) period. The recordings were divided in three periods: RC1, immediately after the end of exercise bout, RC2, between 12 and 17 min of recovery, and RC3, at the final 5 min of recovery. A significant decrease was observed during exercise in the MeanRR index (577.3±92 vs. 861.1+109), RRtri (5.1±2 vs. 9.1±3), high frequency component (11.2±4 vs. 167±135 ms) and SD1 (5.7±2 vs. 16.9±7 ms) compared to resting values. The SDNN index reduced during E (27.6±19) and RC1 (29.9±11), RC2 (27.9±9) and RC3 (32.4±13) compared to resting values (42.4±19). The low frequency component increased during E (545±82), but decreased during RC1 (166.3±129), RC2 (206.9±152), and RC3 (249.5±236) compared to R levels (394.6±315). These findings suggest that stroke patients showed a reduced HRV during and at least 30 min after exercise, due to an autonomic imbalance reflected by increased indexes that represent the sympathetic nervous system.

Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients.

BACKGROUND: Decreased heart rate variability (HRV) is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. METHODS: We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD) and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences]) and frequency domains ultra-low frequency (ULF) ≤ 0,003 Hz, very low frequency (VLF) 0,003 - 0,04 Hz, low frequency (LF) (0.04-0.15 Hz), and high frequency (HF) (0.15-0.40 Hz) as well as the ratio between LF and HF components (LF/HF). In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (-ApEn), α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC). The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. RESULTS: Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms2, RMSSD ≤ 23.9 ms, ApEn ≤-0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. CONCLUSION: We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment.

Evaluation of movements of lower limbs in non-professional ballet dancers: hip abduction and flexion.

BACKGROUND: The literature indicated that the majority of professional ballet dancers present static and active dynamic range of motion difference between left and right lower limbs, however, no previous study focused this difference in non-professional ballet dancers. In this study we aimed to evaluate active movements of the hip in non-professional classical dancers. METHODS: We evaluated 10 non professional ballet dancers (16-23 years old). We measured the active range of motion and flexibility through Well Banks. We compared active range of motion between left and right sides (hip flexion and abduction) and performed correlation between active movements and flexibility. RESULTS: There was a small difference between the right and left sides of the hip in relation to the movements of flexion and abduction, which suggest the dominant side of the subjects, however, there was no statistical significance. Bank of Wells test revealed statistical difference only between the 1st and the 3rd measurement. There was no correlation between the movements of the hip (abduction and flexion, right and left sides) with the three test measurements of the bank of Wells. CONCLUSION: There is no imbalance between the sides of the hip with respect to active abduction and flexion movements in non-professional ballet dancers.

Sudden cardiac death athletes: a systematic review.

Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords "sudden death, athletes and mortality". The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD.

Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns.

BACKGROUND: Little is known with respect to the metabolic response and the requirements of infected newborns. Moreover, the nutritional needs and particularly the energy metabolism of newborns with sepsis are controversial matter. In this investigation we aimed to evaluate the rest energy expenditure (REE) of newborns with bacterial sepsis during the acute and the recovery phases. METHODS: We studied nineteen neonates (27.3 +/- 17.2 days old) with bacterial sepsis during the acute phase and recovery of their illness. REE was determined by indirect calorimetry and VO2 and VCO2 measured by gas chromatography. RESULTS: REE significantly increased from 49.4 +/- 13.1 kcal/kg/day during the acute to 68.3 +/- 10.9 kcal/kg/day during recovery phase of sepsis (P < 0.01). Similarly, VO2 (7.4 +/- 1.9 vs 10 +/- 1.5 ml/kg/min) and VCO2 (5.1 +/- 1.7 vs 7.4 +/- 1.5 ml/kg/min) were also increased during the course of the disease (P < 0.01). CONCLUSION: REE was increased during recovery compared to the sepsis phase. REE of septic newborns should be calculated on individualized basis, bearing in mind their metabolic capabilities.