Influência da ventilação não invasiva por meio do BiPAP® sobre a tolerância ao exercício físico e força muscular respiratória em pacientes com doença pulmonar obstrutiva crônica (DPOC)

This study aimed to assess the effect of BiPAP®, by nasal mask, on exercise tolerance and respiratory muscle strength in patients with a clinical and spirometric diagnosis of moderate/severe COPD (FEV1 < 60% of predicted). Ten patients of 59.4±8.9 years old, with FEV1/FVCEl objetivo de esto estudio fue evaluar el efecto del BiPAP®, por medio de la máscara nasal, sobre la tolerancia al ejercicio físico y el desempeño muscular respiratorio en pacientes con diagnosis clínico y espirométrico de EPOC moderada/grave (VEF1 < 60% del previsible). Con VEF1/CVFO objetivo deste estudo foi avaliar o efeito do BiPAP®, através de máscara nasal, na tolerância ao exercício físico e no desempenho muscular respiratório em pacientes com diagnóstico clínico e espirométrico de DPOC, moderado/grave (VEF1 < 60% do previsto). Com VEF1/CV

Determination of anaerobic threshold through heart rate and near infrared spectroscopy in elderly healthy men

BACKGROUND:Aging leads to low functional capacity and this can be reversed by safe and adequate exercise prescription. OBJECTIVE:The aim of this study was to identify the anaerobic threshold (AT) obtained from the V-slope method as well as visual inspection of oxyhemoglobin ( O2Hb) and deoxyhemoglobin (HHb) curves and compare findings with the heteroscedastic (HS) method applied to carbon dioxide production ( CO2), heart rate (HR), and HHb data in healthy elderly men. A secondary aim was to assess the degree of agreement between methods for AT determination. METHOD:Fourteen healthy men (61.4±6.3 years) underwent cardiopulmonary exercise testing (CPX) on a cycle ergometer until physical exhaustion. Biological signals collected during CPX included: ventilatory and metabolic variables; spectroscopy quasi-infrared rays - NIRS; and HR through a cardio-frequency meter. RESULTS:We observed temporal equivalence and similar values of power (W), absolute oxygen consumption (O2 - mL/min), relative O2 ( mL.Kg - 1.min -1), and HR at AT by the detection methods performed. In addition, by the Bland-Altman plot, HR confirmed good agreement between the methods with biases between -1.3 and 3.5 beats per minute. CONCLUSIONS:(i) all detection methods were sensitive in identifying AT, including the HS applied to HR and (ii) the methods showed a good correlation in the identification of AT. Thus, these results support HR as valid and readily available parameter in determining AT in healthy elderly men.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal do Rio de Janeiro School of Medicine Physical Therapy DepartmentUniversidade Federal de São Paulo (UNIFESP) Department of MedicineUniversity of Illinois College of Applied Health Sciences Physical Therapy DepartmentUniversidade Federal de Sao Carlos Physical Therapy Department Nucleus of Research in Physical ExerciseUNIFESP, Department of MedicineSciEL

Heart rate responses during isometric exercises in patients undergoing a phase III cardiac rehabilitation program

CONTEXTUALIZAÇÃO: A magnitude das respostas cardiovasculares depende dos componentes estático e dinâmico bem como da duração e intensidade da contração realizada. OBJETIVO: Avaliar as respostas da frequência cardíaca (FC) frente a diferentes percentuais de contração isométrica em 12 pacientes (63±11,6 anos; média±dp) com doença da artéria coronária e/ou fatores de risco para ela, participantes de um programa de reabilitação cardíaca fase III. MÉTODOS: A variação da frequência cardíaca (&#916;FC) foi avaliada durante as contrações voluntárias máximas (CVM; 5" e 10" de duração) e submáximas (CVSM; 30 e 60% da CVM-5, até exaustão muscular) de preensão palmar, utilizando-se um dinamômetro (hand grip). Adicionalmente, o RMSSD dos iR-R em ms (índice representante da modulação vagal cardíaca) foi calculado em repouso (pré-contração) nos últimos 30 segundos da CVSM e na recuperação (pós-contração). RESULTADOS: A &#916;FC apresentou maiores valores em CVM-10 vs CVM-5 (17±5,5 vs 12±4,2 bpm, p<0,05) e no CVSM-60 vs CVSM-30 (19±5,8 vs 15±5,1 bpm, p<0,05). No entanto, os resultados para CVM-10 mostraram &#916;FC similar quando comparados aos resultados obtidos para CVSM (p&gt;0,05). RMSSD de repouso reduziu-se (p<0,05) durante a CVSM-30 (30%=29,9±17,1 vs 12,9±8,5ms) e CVSM-60 (60%=25,8±18,2 vs 9,96±4,2 ms), mas retornou aos valores basais quando a contração foi interrompida. CONCLUSÕES: Em pacientes com doença da artéria coronária e/ou fatores de risco para ela, a contração isométrica de baixa intensidade mantida por longos períodos de tempo apresenta os mesmos efeitos sobre as respostas da FC, quando comparada à contração isométrica de alta ou máxima intensidade, porém de breve duração.BACKGROUND: The magnitude of cardiovascular responses is dependent on the static and dynamic components as well as the duration and intensity of the contraction performed. OBJECTIVE: To evaluate the heart rate responses to different percentages of isometric contractions in 12 patients (63±11.6 years) with coronary artery disease and/or risk factors for coronary artery disease that were participating in a phase III cardiac rehabilitation program. METHODS: Heart rate variation (&#916;HR) was evaluated during maximum (MVC, five and ten seconds in duration) and submaximal (SMVC, 30 and 60% of MVC-5, until muscle exhaustion) voluntary contraction, using a handgrip dynamometer. Additionally, the representative index of cardiac vagal modulation (RMSSD index) was calculated at rest (pre-contraction), at the final 30 seconds of SMVC and during recovery (post-contraction). RESULTS: &#916;HR showed higher values in MVC-10 versus MVC-5 (17±5.5 vs 12±4.2 bpm, p<0.05) and the SMVC-60 vs SMVC-30 (19±5.8 vs 15±5.1 bpm, p<0.05). However, results for CVM-10 showed similar &#916;HR compared to results for CVSM (p&gt; 0.05). RICVM at rest decreased (p<0.05) during SMVC-30 (30% = 27.9±17.1 vs 12.9±8.5 ms) and SMVC-60 (60% =25.8±18.2 vs 9.96±4.2 ms), but returned to the baseline values when the contraction was interrupted. CONCLUSIONS: In patients with coronary artery disease and/or risk factors for coronary heart disease, low intensity isometric contraction, maintained over long periods of time, presents the same effect on the responses of HR, compared to a high intensity or maximal isometric contraction of briefly duration.Conselho Nacional de Pesquisa e Desenvolvimento Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

O impacto da ventilação não-invasiva no treinamento físico em pacientes com doença pulmonar obstrutiva crônica moderada a grave

OBJECTIVE: To evaluate the influence of physical training with or without noninvasive ventilation at 2 levels of pressure in the airways (BiPAP®) in patients with chronic obstructive pulmonary disease. METHODS: Eighteen patients with FEV1 = 34 ± 8% of predicted values, mean age of 68 ± 9 years were randomly distributed into 2 groups, one group performing physical training on a treadmill and the other group performing physical training associated with BiPAP® (physical training+B), for 30 minutes, 3 times a week for 12 weeks. The training velocity was based on a test of cardiopulmonary force performed pre- and postintervention, which registered the values for heart rate, systolic blood pressure, diastolic blood pressure, peripheral oxygen saturation, blood lactate, sensation of dyspnea, respiratory muscle strength, and analysis of gases expired such as oxygen consumption and the production of carbon dioxide. RESULTS: For both groups, there was a significant improvement in dyspnea and peripheral oxygen saturation at identical levels of physical exercise, in distance walked during the physical training, and in respiratory muscle strength (P < 0.05). Only the physical training+B group had a significant improvement in heart rate, systolic blood pressure, and oxygen consumption after training (P < 0.05). Significant reductions of blood lactate were observed at identical levels of exercise in physical training+B when compared to isolated physical training (from 1.3 ± 0.7 mMol/L versus 2.5 ± 0.9 mMol/L, (P < 0.05), respectively). CONCLUSION: Physical training associated with BiPAP® enhanced the oxidative muscular capacity and could be an adjunctive recourse for physical rehabilitation in patients with chronic obstructive pulmonary disease.OBJETIVO: Avaliar a influência do treinamento físico, com e sem ventilação não invasiva com dois níveis de pressão nas vias aéreas (BiPAP®), em pacientes com doença pulmonar obstrutiva crônica. MÉTODOS: Dezoito pacientes com VEF1=34±8% do previsto, idade média de 68±9 anos, foram randomicamente distribuídos em dois grupos, um grupo realizando treinamento físico em esteira e outro grupo realizando treinamento físico associado ao BiPAP® (treinamento físico+B), durante 30 minutos, 3 vezes por semana, por 12 semanas. A velocidade do treinamento foi baseada no teste cardiopulmonar realizado pré e pós-intervenção, com registro dos valores de freqüência cardíaca, pressão arterial sistólica, pressão arterial diastólica, saturação periférica de oxigênio, lactato sanguíneo, sensação de dispnéia, força muscular respiratória e análise de gases expirados como consumo de oxigênio, produção de dióxido de carbono. RESULTADOS: Em ambos os grupos houve melhora significativa na dispnéia e saturação periférica de oxigênio no mesmo nível de esforço, na distância percorrida no teste cardiopulmonar e na força muscular respiratória (

Comparative evaluation of functional capacity, quality of life and quality of sleep in elderly submitted to cardiopulmonary and neuro-orthopedic physiotherapy

Poster presented at the 4th International Congress of CiiEM - Health, Well-being and Ageing in the XXI Century. 2-5 June 2019, Campus Egas Moniz, Monte de Caparica, Portugal.N/

Microvascular oxygen delivery-to-utilization mismatch at the onset of heavy-intensity exercise in optimally treated patients with CHF

Sperandio PA, Borghi-Silva A, Barroco A, Nery LE, Almeida DR, Neder JA. Microvascular oxygen delivery-to-utilization mismatch at the onset of heavy-intensity exercise in optimally treated patients with CHF. Am J Physiol Heart Circ Physiol 297: H1720-H1728, 2009. First published September 4, 2009; doi:10.1152/ajpheart.00596.2009.-Impaired muscle blood flow at the onset of heavy-intensity exercise may transiently reduce microvascular O(2) pressure and decrease the rate of O(2) transfer from capillary to mitochondria in chronic heart failure (CHF). However, advances in the pharmacological treatment of CHF (e. g., angiotensin-converting enzyme inhibitors and third-generation beta-blockers) may have improved microvascular O(2) delivery to an extent that intramyocyte metabolic inertia might become the main locus of limitation of O(2) uptake ((V)over dot(O2)) kinetics. We assessed the rate of change of pulmonary (V)over dot(O2) ((V)over dot(O2p)), (estimated) fractional O(2) extraction in the vastus lateralis (similar to Delta[deoxy-Hb + Mb] by near-infrared spectroscopy), and cardiac output ((Q)over dot(T)) during high-intensity exercise performed to the limit of tolerance (Tlim) in 10 optimally treated sedentary patients (ejection fraction = 29 +/- 8%) and 11 controls. Sluggish (V)over dot(O2p) and (Q)over dot(T) kinetics in patients were significantly related to lower Tlim values (P < 0.05). the dynamics of Delta[deoxy-Hb + Mb], however, were faster in patients than controls [mean response time (MRT) = 15.9 +/- 2.0 s vs. 19.0 +/- 2.9 s; P < 0.05] with a subsequent response overshoot being found only in patients (7/10). Moreover, tau(V)over dot(O2)/MRT-[deoxy-Hb + Mb] ratio was greater in patients (4.69 +/- 1.42 s vs. 2.25 +/- 0.77 s; P < 0.05) and related to (Q)over dot(T) kinetics and Tlim (R = 0.89 and -0.78, respectively; P < 0.01). We conclude that despite the advances in the pharmacological treatment of CHF, disturbances in central and peripheral circulatory adjustments still play a prominent role in limiting (V)over dot(O2p) kinetics and tolerance to heavy-intensity exercise in nontrained patients.Fed Univ São Paulo UNIFESP, Dept Med, Div Resp Med, Pulm Funct & Clin Exercise Physiol Unit SEFICE, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, São Paulo, BrazilFed Univ Sao Carlos UFSCar, Nucleus Res Phys Exercise, Cardiopulm Lab, Sao Carlos, SP, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Resp Med, Pulm Funct & Clin Exercise Physiol Unit SEFICE, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, São Paulo, BrazilWeb of Scienc

Determining anaerobic threshold through heart rate variability in patients with COPD during cycloergometer exercise

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is characterized by structural alterations of lung parenchyma resulting in systemic manifestations. These patients may have marked change in cardiac autonomic control. In this context, studies investigating heart rate variability (HRV) in patients with COPD during physical exercise cycloergometers have been little explored. OBJECTIVE: To determine the anaerobic threshold through HRV in order to establish parameters of evaluation and prescription of exercise intensity in these patients on a cycloergometer. MATERIALS AND METHODS: Eight male patients diagnosed with COPD, mean age 69.5 ± 7.6 years were studied. Heart rate was analyzed at rest and at different intensities of exercise. The test was performed on a cycloergometer and consisted of a warm-up period of four minutes at a minimum power. Steps were performed with initial power of 4W, with increments of 5 in 5W, until the patient reached the anaerobic threshold. RESULTS: Patients that presented higher values of FEV1 showed greater powers during the cycloergometer. Additionally, there was significant reduction in HRV during exercise compared to rest sitting p < 0.05. CONCLUSION: Patients had a severe physical deconditioning reaffirmed the impossibility determined by the anaerobic threshold of 50% of the sample.INTRODUÇÃO: A Doença Pulmonar Obstrutiva Crônica (DPOC) é caracterizada por alterações estruturais do parênquima pulmonar, acarretando manifestações sistêmicas. Além disso, esses pacientes podem apresentar marcada alteração do controle autonômico cardíaco. Nesse contexto, estudos investigando a variabilidade da frequência cardíaca (VFC) em pacientes com DPOC durante a realização de exercício físico em cicloergometro têm sido pouco explorados. OBJETIVO: Determinar o limiar anaeróbio por meio da VFC com o propósito de estabelecer parâmetros de avaliação e prescrição da intensidade de exercício desses pacientes em cicloergômetro. MATERIAIS E MÉTODOS: Foram avaliados oito pacientes do sexo masculino com diagnóstico de DPOC com idade média de 69,5 ± 7,6 anos. A frequência cardíaca foi analisada no repouso e em diferentes intensidades do exercício. O teste foi realizado em um cicloergômetro e consistiu em um período de aquecimento de quatro minutos em uma potência mínima. Foram, também, realizados degraus com potência inicial de 4W, com acréscimos de 5 em 5W, até que o paciente atingisse o limiar anaeróbio. RESULTADOS: Os pacientes que apresentaram maiores valores de VEF1 apresentaram maiores potências no cicloergômetro. Houve redução significativa da VFC durante o exercício físico se comparado ao repouso sentado p < 0,05. CONCLUSÃO: Os pacientes estudados apresentaram um severo descondicionamento físico reafirmado pela impossibilidade determinada pelo LA de 50% da amostra.Universidade Federal de São Carlos Departamento de Fisioterapia Núcleo de Pesquisa em Exercício FísicoUniversidade Federal de São Carlos Fisioterapia CardiovascularUniversidade Federal de São Paulo (UNIFESP) MedicinaUniversidade Federal de São Carlos GeriatriaUniversidade de Federal de São Carlos FisioterapiaUNIFESP, MedicinaSciEL

Exercise training in group 2 pulmonary hypertension: which intensity and what modality

Pulmonary hypertension (PH) due to left-sided heart disease (LSHD) is a common and disconcerting occurrence. For example, both heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) often lead to PH as a consequence of a chronic elevation in left atrial filling pressure. A wealth of literature demonstrates the value of exercise training (ET) in patients with LSHD, which is particularly robust in patients with HFrEF and growing in patients with HFpEF. While the effects of ET have not been specifically explored in the LSHD–PH phenotype (i.e., composite pathophysiologic characteristics of patients in this advanced disease state), the overall body of evidence supports clinical application in this subgroup. Moderate intensity aerobic ET significantly improves peak oxygen consumption, quality of life and prognosis in patients with HF. Resistance ET significantly improves muscle strength and endurance in patients with HF, which further enhance functional capacity. When warranted, inspiratory muscle training and neuromuscular electrical stimulation are becoming recognized as important components of a comprehensive rehabilitation program. This review will provide a detailed account of ET programing considerations in patients with LSHD with a particular focus on those concomitantly diagnosed with PH

Association of Oscillatory Ventilation during Cardiopulmonary Test to Clinical and Functional Variables of Chronic Heart Failure Patients

Objective: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. Methods: Forty-six male patients (age: 53.1 +/- 13.6 years oldleft ventricular ejection fraction [LVEF]: 30 +/- 8%) with heart failure were recruited to perform a maximal CET and to correlate the CET responses with clinical variables. The EOV was obtained according to Leite et al. criteria and VE/VCO2 > 34 and peak VO2 34 and peak VO2 34 to patients who just had one of these responses either. Conclusion: The present study showed that there was an incidence of patients with EOV and lower peak VO2 and higher VE/VCO2 slope values, but they showed no difference on other prognostic variables. As well, there was no influence of the presence of EOV on other parameters of CET in this population, suggesting that this variable may be an independent marker of worst prognosis in HF patients.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ)Univ Fed Rio de Janeiro, Fac Med, Res Grp Cardioresp Rehabil GECARE, Rio de Janeiro, RJ, BrazilUniv Fed Rio de Janeiro, Fac Med, Dept Phys Therapy, Rio de Janeiro, RJ, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Med, Resp Div,Pulm Funct & Clin Exercise Physiol Unit, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Physiotherapy, Resp Div, Sao Paulo, BrazilUniv Fed Sao Carlos UFSCAR, Dept Phys Therapy, Lab Cardiopulm Phys Therapy LACAP, Sao Carlos, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Med, Resp Div,Pulm Funct & Clin Exercise Physiol Unit, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Physiotherapy, Resp Div, Sao Paulo, BrazilWeb of Scienc