Evaluación de la seguridad de la test de marcha de 6 minutos en pacientes en el pre-transplante cardiaco

FUNDAMENTO: O teste de caminhada dos 6 minutos (TC6) tem sido utilizado como forma de avaliação da capacidade funcional, estadiamento clínico e prognóstico cardiovascular. A segurança e o impacto metabólico são pouco descritos na literatura, principalmente em pacientes com insuficiência cardíaca grave, com indicação clínica para transplante cardiovascular. OBJETIVO: Avaliar a ocorrência de arritmias e alterações cardiovasculares durante o TC6. Correlacionar o desempenho no TC6 com o estadiamento clínico e prognóstico cardiovascular. MÉTODOS: Doze pacientes, sendo 10 masculinos, com idade de 52 ± 8 anos, foram submetidos à avaliação inicial. Realizaram o TC6 com monitoramento eletrocardiográfico por telemetria, sinais vitais e lactato. Foram acompanhados por 12 meses. RESULTADOS: Os pacientes percorreram 399,4 ± 122,5 (D, m), atingindo um esforço percebido (EP) de 14,3 ± 1,5 e variação de 34% na freqüência cardíaca basal. Dois pacientes apresentaram arritmia de maior gravidade pré-TC6 e não pioraram ante o esforço, quatro tiveram elevação significativa nos níveis de lactato sangüíneo (>5 mmol/dl), e três interromperam o exame. A distância percorrida evidenciou correlação com a fração de ejeção (%) e classificação funcional (NYHA). Após 12 meses de seguimento, três pacientes foram a óbito, e reinternaram-se sete por descompensação cardíaca. A relação (D/EP) e freqüência cardíaca de recuperação no segundo minuto (FCR2, bpm) foram inferiores no grupo-óbito. CONCLUSÃO: O comportamento clínico e eletrocardiográfico sugere que o método é seguro, mas pode ser considerado de alta intensidade para alguns pacientes com insuficiência cardíaca grave. Variáveis relacionadas ao desempenho no TC6 podem estar associadas com a mortalidade no seguimento de um ano. _______________________________________________________________________________________________________________ ABSTRACTBackground: The 6-minute walk test (6WT) has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation.Objective: To evaluate the occurrence of arrhythmias and cardiovascular changes during 6WT. To correlate 6WT performance with clinical staging and cardiovascular prognosis.Methods: Twelve patients, 10 of whom males, aged 52 ± 8 years were evaluated at baseline. 6WT was performed with telemetry electrocardiography, vital signs and lactate monitoring. The patients were followed-up for 12 months.Results: The patients walked 399.4±122.5 (D, m), reaching a perceived exertion (PE) of 14.3±1.5 and a 34% baseline heart rate variation. Two patients presented more severe pre-6WT arrhythmia which did not worsen with the exercice, four patients presented a significant increase of blood lactate levels (>5 mmol/dl), and three interrupted the test. The distance walked correlated with the ejection fraction (%) and functional class (NYHA). After 12-month follow-up, three patients died and seven were rehospitalized for cardiac decompensation. The D/PE ratio and 2-minute heart rate recovery (HRR2, bpm) were lower in the death group.Conclusion: The clinical and electrocardiographic behaviors suggest that the method is safe, but it may be considered too strenuous for some patients with severe heart failure. Variables related to 6WT performance may be associated with the one-year follow-up mortality. _______________________________________________________________________________________________________________ RESUMENFUNDAMENTO: El test de marcha de 6 minutos (TM6m) ha sido utilizado como forma de evaluación de la capacidad funcional, del estadiamiento clínico y el pronóstico cardiovascular. La seguridad y el impacto metabólico son poco descritos en la literatura, principalmente en pacientes con insuficiencia cardiaca severa e indicación clínica para transplante cardiovascular Objetivo: Evaluar la ocurrencia de arritmias y alteraciones cardiovasculares durante el TM6m. Correlacionar el desempeño en el TM6m con el estadiamiento clínico y el pronóstico cardiovascular. MÉTODOS: Un total de 12 pacientes, 10 varones, con edad de 52 ± 8 años, fueron sometidos a evaluación inicial. Realizaron el TM6m con monitoreo electrocardiográfico por telemetría, señales vitales y lactato. Se siguieron a los individuos por 12 meses. RESULTADOS: Los pacientes recorrieron 399,4 ± 122,5 (D, m), alcanzando un esfuerzo percibido (EP) de 14,3 ± 1,5 y variación del 34% en la frecuencia cardiaca basal. Dos pacientes presentaron arritmia de mayor severidad pre-TM6m y no mostraron empeoramiento ante el esfuerzo; cuatro tuvieron elevación significativa en los niveles de lactato sanguíneo (>5 mmol/dl), y tres interrumpieron el examen. La distancia recorrida evidenció correlación con la fracción de eyección (%) y la clasificación funcional (NYHA). Tras 12 meses de seguimiento, tres pacientes murieron, y siete se reinternaron por descompensación cardiaca. La relación (D/EP) y frecuencia cardiaca de recuperación en el segundo minuto (FCR2, lpm) fueron inferiores en el grupo óbito. CONCLUSIÓN: El comportamiento clínico y electrocardiográfico sugiere que el método es seguro, pero se puede considerarlo de alta intensidad para algunos pacientes con insuficiencia cardiaca severa. Variables relacionadas al desempeño en el TM6m pueden estar asociadas con la mortalidad en el seguimiento de un año

Anthropometric and musculoskeletal assessment of patients with Marfan syndrome

CONTEXTUALIZAÇÃO: A Síndrome de Marfan (SM) é uma doença autossômica dominante do tecido conjuntivo que envolve os sistemas ocular, cardiovascular e musculoesquelético, causada por mutações no gene da fibrilina1, gerando flacidez nos ligamentos articulares, favorecendo a hipermobilidade articular e redução na contenção do crescimento ósseo. OBJETIVOS: Avaliar as medidas antropométricas, alterações musculoesqueléticas e a frequência do tratamento fisioterapêutico nos pacientes com SM. MÉTODOS: Participaram deste estudo 26 pacientes, sendo 17 do gênero feminino, com idade de 13,23±2,77 anos, massa corpórea de 51,5±24-68 Kg, altura de 1,70±1,40-1,81 m e envergadura de 1,73±0,12 cm, e nove do gênero masculino, com idade de 14,44±2,18, massa corpórea de 61,0±42-72 Kg, altura de 1,83±1,66-1,97 m e envergadura de 1,93±0,13. Foram obtidas medidas antropométricas, alterações ME de forma padronizada, sendo o pectus e a escoliose, por avaliação radiológica, e a angulação (â) da curva escoliótica, pelo método de Cobb; a aracnodactilia, pelo sinal do polegar e teste de Walker-Murdoch, e a dolicostenomelia, pela envergadura em relação à altura. Os pacientes responderam a um questionário quanto à participação em tratamento de fisioterapia. RESULTADOS: Quando comparados com a estimativa brasileira, a massa corpórea e a altura apresentaram valores maiores no gênero feminino (p=0,001 e p<0,0005) e masculino (p=0,019 e p=0,0001). Das alterações musculoesqueléticas, encontrou-se pectus em 3 (11%), pectus e escoliose em 19 (73%), dolicostenomelia em 11 (42%) e aracnodactilia em 21(80%). Onze (42%) pacientes com SM já haviam realizado tratamento de fisioterapia. CONCLUSÕES: As alterações antropométricas e musculoesqueléticas estão presentes na SM, e o tratamento fisioterapêutico é pouco frequente. ________________________________________________________________________________________________ ABSTRACTBACKGROUND: Marfan syndrome (MS) is an autosomic dominant condition of the connective tissue that involves the ocular, cardiovascular and musculoskeletal systems. MS is caused by mutations in the fibrillin-1 gene, leading to joint ligaments flaccidity, joint hypermobility and an overgrowth of the long bones. OBJECTIVES: The aim of the present study was to assess anthropometry, musculoskeletal alterations and the prevalence of physical therapy treatments among patients with MS. METHODS: Twenty-six patients were included in this study [17 females (age: 13.23±2.77 years; body mass 51.5±24-68 Kg; height 1.70±1.40-1.81 m; arm span: 1.73±0.12 m) and 9 males (age: 14.44±2.18; body mass: 61.0±42-72 Kg; height: 1.83±1.66-1.97 m; arm span: 1.93±0.13 m)]. Anthropometric measurements and musculoskeletal abnormalities were determined in a standardized fashion: pectus and scoliosis were assessed through radiography and angulation (â) of the scoliosis curve using the Cobb method; arachnodactyly was assessed through the thumb sign and Walker-Murdoch test and dolichostenomelia was assessed by arm span in relation to height. Patients also responded to a questionnaire addressing participation in physical therapy. RESULTS: In comparison to values estimated for the Brazilian population, mass and height were greater among the patients with MS (females: p=0.001 e p<0.0005 e males p=0.019 e p=0.0001, respectively). The following musculoskeletal abnormalities were found: pectus in 3 patients (11%), pectus and scoliosis in 19 (73%), dolichostenomelia in 11 (42%) and arachnodactyly in 21 (80%). Eleven patients (42%) with MS had previously undergone physical therapy. CONCLUSIONS: Patients with MS exhibit altered musculoskeleto and anthropometry and have infrequent physical therapy treatment

Evaluación de la seguridad de la test de marcha de 6 minutos en pacientes en el pre-transplante cardiaco

BACKGROUND: The 6-minute walk test (6WT) has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation. OBJECTIVE: To evaluate the occurrence of arrhythmias and cardiovascular changes during 6WT. To correlate 6WT performance with clinical staging and cardiovascular prognosis. METHODS: Twelve patients, 10 of whom males, aged 52 ± 8 years were evaluated at baseline. 6WT was performed with telemetry electrocardiography, vital signs and lactate monitoring. The patients were followed-up for 12 months. RESULTS: The patients walked 399.4±122.5 (D, m), reaching a perceived exertion (PE) of 14.3±1.5 and a 34% baseline heart rate variation. Two patients presented more severe pre-6WT arrhythmia which did not worsen with the exercice, four patients presented a significant increase of blood lactate levels (>5 mmol/dl), and three interrupted the test. The distance walked correlated with the ejection fraction (%) and functional class (NYHA). After 12-month follow-up, three patients died and seven were rehospitalized for cardiac decompensation. The D/PE ratio and 2-minute heart rate recovery (HRR2, bpm) were lower in the death group. CONCLUSION: The clinical and electrocardiographic behaviors suggest that the method is safe, but it may be considered too strenuous for some patients with severe heart failure. Variables related to 6WT performance may be associated with the one-year follow-up mortality.FUNDAMENTO: El test de marcha de 6 minutos (TM6m) ha sido utilizado como forma de evaluación de la capacidad funcional, del estadiamiento clínico y el pronóstico cardiovascular. La seguridad y el impacto metabólico son poco descritos en la literatura, principalmente en pacientes con insuficiencia cardiaca severa e indicación clínica para transplante cardiovascular Objetivo: Evaluar la ocurrencia de arritmias y alteraciones cardiovasculares durante el TM6m. Correlacionar el desempeño en el TM6m con el estadiamiento clínico y el pronóstico cardiovascular. MÉTODOS: Un total de 12 pacientes, 10 varones, con edad de 52 ± 8 años, fueron sometidos a evaluación inicial. Realizaron el TM6m con monitoreo electrocardiográfico por telemetría, señales vitales y lactato. Se siguieron a los individuos por 12 meses. RESULTADOS: Los pacientes recorrieron 399,4 ± 122,5 (D, m), alcanzando un esfuerzo percibido (EP) de 14,3 ± 1,5 y variación del 34% en la frecuencia cardiaca basal. Dos pacientes presentaron arritmia de mayor severidad pre-TM6m y no mostraron empeoramiento ante el esfuerzo; cuatro tuvieron elevación significativa en los niveles de lactato sanguíneo (>5 mmol/dl), y tres interrumpieron el examen. La distancia recorrida evidenció correlación con la fracción de eyección (%) y la clasificación funcional (NYHA). Tras 12 meses de seguimiento, tres pacientes murieron, y siete se reinternaron por descompensación cardiaca. La relación (D/EP) y frecuencia cardiaca de recuperación en el segundo minuto (FCR2, lpm) fueron inferiores en el grupo óbito. CONCLUSIÓN: El comportamiento clínico y electrocardiográfico sugiere que el método es seguro, pero se puede considerarlo de alta intensidad para algunos pacientes con insuficiencia cardiaca severa. Variables relacionadas al desempeño en el TM6m pueden estar asociadas con la mortalidad en el seguimiento de un año.FUNDAMENTO: O teste de caminhada dos 6 minutos (TC6) tem sido utilizado como forma de avaliação da capacidade funcional, estadiamento clínico e prognóstico cardiovascular. A segurança e o impacto metabólico são pouco descritos na literatura, principalmente em pacientes com insuficiência cardíaca grave, com indicação clínica para transplante cardiovascular. OBJETIVO: Avaliar a ocorrência de arritmias e alterações cardiovasculares durante o TC6. Correlacionar o desempenho no TC6 com o estadiamento clínico e prognóstico cardiovascular. MÉTODOS: Doze pacientes, sendo 10 masculinos, com idade de 52 ± 8 anos, foram submetidos à avaliação inicial. Realizaram o TC6 com monitoramento eletrocardiográfico por telemetria, sinais vitais e lactato. Foram acompanhados por 12 meses. RESULTADOS: Os pacientes percorreram 399,4 ± 122,5 (D, m), atingindo um esforço percebido (EP) de 14,3 ± 1,5 e variação de 34% na freqüência cardíaca basal. Dois pacientes apresentaram arritmia de maior gravidade pré-TC6 e não pioraram ante o esforço, quatro tiveram elevação significativa nos níveis de lactato sangüíneo (>5 mmol/dl), e três interromperam o exame. A distância percorrida evidenciou correlação com a fração de ejeção (%) e classificação funcional (NYHA). Após 12 meses de seguimento, três pacientes foram a óbito, e reinternaram-se sete por descompensação cardíaca. A relação (D/EP) e freqüência cardíaca de recuperação no segundo minuto (FCR2, bpm) foram inferiores no grupo-óbito. CONCLUSÃO: O comportamento clínico e eletrocardiográfico sugere que o método é seguro, mas pode ser considerado de alta intensidade para alguns pacientes com insuficiência cardíaca grave. Variáveis relacionadas ao desempenho no TC6 podem estar associadas com a mortalidade no seguimento de um ano.Universidade Federal de São Paulo (UNIFESP) Universidade de São PauloUNIFESP, Universidade de São PauloSciEL

Effects of blood flow restriction therapy in patients with knee osteoarthritis: protocol for an overview of systematic reviews

BackgroundOsteoarthritis (OA) is the most common and prevalent musculoskeletal disease associated with population aging, negatively impacting function and quality of life. A consequence of knee OA is quadriceps muscle weakness. Musculoskeletal rehabilitation using low load exercises, associated with Blood Flow Restriction (BFR) may be a useful alternative to high load exercises when those cannot be tolerated. Several systematic reviews have reported inconclusive results due to discrepancies in study findings, heterogeneity of results, evaluated time points, and research questions explored.ObjectiveTo perform an overview of systematic reviews with meta-analyses, synthesizing the most recent evidence on the effects of muscle strength training with BFR for knee OA.MethodologySystematic reviews that include primary controlled and randomized clinical trials will be considered for inclusion. Articles will be considered only if they present a clear and reproducible methodological structure, and when they clearly demonstrate that a critical analysis of the evidence was carried out using instrumented analysis. Narrative reviews, other types of review, overviews of systematic reviews, and diagnostic, prognostic and economic evaluation studies will be excluded. Studies must include adults aged 40 years and older with a diagnosis of knee OA. Two authors will perform an electronic search with guidance from an experienced librarian. The following databases will be searched: PubMed via MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host, Web of Science, and the gray literature. The search strategy used in the databases will follow the acronym PICOS (population, intervention, comparison, outcome, and study design). Screening (i.e., titles and abstracts) of studies identified by the search strategy will be selected using Rayyan (http://rayyan.qcri.org). The quality assessment will be performed using the “Assessment of Multiple Systematic Reviews” (AMSTAR-2) tool.Systematic Review RegistrationPROSPERO, CRD42022367209

Diacutaneous fibrolysis versus passive stretching after articular immobilisation : muscle recovery and extracellular matrix remodelling

Introduction Atrophy and muscle shortening due to articular immobilisation are common problems in musculoskeletal rehabilitation. Muscle stretching mechanical stimuli might be considered as the golden standard procedure to improve muscle flexibility in rehabilitation. Muscle stretching generates mechanotransduction, potentiating specific gene expression and promotes sarcomerogenesis and extracellular matrix remodelling on shortened and atrophied muscles. Hypothesis Diacutaneous fibrolysis, like stretching, uses an external force to stress connective and muscle tissues mechanically to treat muscle shortening; thus, it is widely used in clinical practice even if there is no evidence to support it. Considering this subject, we have hypothesised that diacutaneous fibrolysis can generate mechanotransduction, affecting muscle hypertrophy and extracellular matrix remodelling after immobilisation. Evaluation of hypothesis We have designed a laboratory experimental study with a sample of 50 rats. The sample was randomly divided into five groups: Control group (n = 10) with non–immobilised rats; 3–week immobilisation group (n = 10); 3–week immobilisation/3–week non–immobilisation group (n = 10);3–week immobilisation/3–week stretching group (n = 10); and 3–week immobilisation/3–week diacutaneous fibrolysis group (n = 10). All rats had their left tibiotarsal joint immobilised in maximum plantar flexion with the orthotics for 3 consecutive weeks. After the immobilisation period, the intervention groups received their respective intervention on their left triceps suralis for 3 weeks. Dependent variables of the study were sarcomere analysis, polymerase chain reaction, connective tissue density, collagen birefringence and matrix metalloproteinases. Statistical analysis was performed using analysis of variance and Duncan post hoc test was applied for differences between groups. For all calculations, a 5% (p < 0.05) significance level was established. Conclusion If the hypothesis is confirmed, the present study might provide evidence to support the use of this physical therapy resource widely used to treat muscle dysfunctions

Cardio-respiratory responses of the 6-minute walk test in patients with refractory heart failure during the preoperative period for heart transplant surgery

Background: The six-minute walk test (6MWT) has been used to assess functional capacity, clinical status and prognosis. There are a very few descriptions in the literature on the safety and metabolic impact of the test, especially in patients with severe heart failure, awaiting cardiac transplantation. Objective: The aim of the present study was to assess the cardiovascular responses and correlate the performance on the 6MWT with clinical status. Method: From 15 initial candidates, twelve patients (10 males) aged 52 ± 8 years were submitted to a comprehensive clinical evaluation. The patients performed the 6MWT with electrocardiographic and perceived exertion monitoring in addition to determination of blood lactate concentration. Patients were followed up for 12 months. Results: The patients walked 399.4±122.5 meters, reaching a perceived exertion (PE) of 14.3±1.5 and an increase of 34% in resting heart rate. Two patients exhibited a greater severity of arrhythmia prior to the 6MWT, which did not increase during exertion. Four patients exhibited a significant increase in blood lactate levels (>5 mmol/dL) and three interrupted the test prematurely. The distance walked (D) revealed a correlation with the ejection fraction (%) and functional classification (NYHA). After 12 months of follow up, three patients died and seven were re-hospitalized due to heart failure decompensation. Conclusion: Clinical and electrocardiographic behavior suggests that the 6MWT is safe, but may be considered of high intensity for some patients with severe heart failure. Variables related to the performance on the 6MWT may be associated to worsening clinical status in this population

Pocket Rehab - mHealth-based rehabilitation program for patients with cardiovascular disease as a prevention and treatment strategy for COVID-19 victims : an international multicentric collaborative study

Pacientes com doença cardiovascular e fatores de risco para doença cardiovascular (DCV) têm sido afetados com mais frequência e mais gravemente pelo novo coronavírus. Isso agravou o cenário anterior de subutilização dos programas de reabilitação cardiovascular (RCV) antes da pandemia, exigindo alternativas otimizadas de RCV, como por exemplo aquelas baseadas em aplicativos móveis (mHeath), não apenas por gerar benefícios bem estabelecidos, mas agora também para manter esses pacientes clinicamente estáveis, diminuindo a chance de eventos cardiovasculares e risco de contaminação naqueles não infectados pelo vírus, bem como tratando dos sobreviventes da COVID-19, tendo em vista as disfunções adicionais que tem sido descritas nos sistemas respiratório, cardiovascular e muscular. Serão realizados dois estudos: o estudo 1, qualitativo, de concordância e reprodutibilidade. Criação aplicativo baseado em tecnologia móvel (mHealth), para dar suporte a um programa otimizado (capaz de avaliar após COVID-19) de reabilitação cardiovascular (RCV) em ambiente domiciliar, desenvolvido pela Universidade do Luxemburgo (Centro 4), integrando instrumentos reconhecidos internacionalmente, como o EXPERT Tool, Hasselt University (Centro 3) e PACERProject, University of Miami (Centro 2). O aplicativo será testado e avaliado por profissionais de saúde nos dois centros colaboradores do estudo (Centro 2 e Centro 3) e na instituição executora - Universidade de Brasília (Centro 1)

Spirometric and cardiovascular evaluation in patients with Marfan syndrome

Background: Marfan syndrome (MS) is a dominant autosomal connective tissue disease that impacts multiple systems, such as the musculoskeletal, ocular, cardiovascular, pulmonary, tegumentary and neurological. This mutation may produces impairment in the connective tissue which causes modifications in the vascular viscoelastic properties, tegumentary elasticity, bone calcification matrix and pulmonary parenchyma. Purpose: To evaluate pulmonary function test (PFT) in patients with MS and relate it to clinical evaluation aspects, especially possible thoracic cage abnormalities (TCA), and the occurrence of cardiac arrhythmias during the spirometric exam (SE). Method: From a sample of 75 subjects, we evaluate 46 MS patients, 29 female and aged 20±0,51 years, who was underwent clinical, anthropometric, echocardiographic, radiographic and PF evaluation; 51 subjects (33 with MS) had their electrocardiography information evaluated during PFT. These individuals were matched and compared to a healthy control group (CG). Results: Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) in the patients with MS were significantly lower in comparison to the CG (p=0.012 and p=0.0006) and predicted values (p=0.04 and p=0.003). Subgroup analysis based on TCA revealed differences between patients with MS with two combined abnormalities (pectus + scoliosis) in comparison to both the CG (p=0.012 and p=0.002) and patients without abnormalities (p=0.05 and p=0.006). Some aspects from clinical evaluation (Arm span to height ratio,m and axillary to xiphoid perimetry ratio,cm), cardiovascular behavior (Left ventricular mass Index-LVMI, g/m2 and Aortic Diameter- Ao,mm) and PF (FEV1/FVC%) has demonstrated a moderate correlation. There were no differences regarding the occurrence of arrhythmia during exertion on the SE. Conclusion: PF is reduced in patients with MS, and deformities in the thoracic cage appear to contribute to this reduction. Some aspects clinical, cardiovascular and PF are associated in MS. Despite the apparent structural alterations in the cardiovascular system in this young population, exertion during the spirometric exam appears to be safe in relation to electrocardiography modifications.Introdução: A Síndrome de Marfan (SM) é uma doença autossômica dominante do tecido conjuntivo (TC) que envolve diversos sistemas tais como, sistema músculo-esquelético, ocular, cardiovascular, pulmonar, tegumentar e neurológico. Estas mutações que causam a SM podem produzir modificações no TC, que causa alteração nas propriedades viscoelásticas do sistema cardiovascular, elasticidade da pele, matriz para calcificação óssea e parênquima pulmonar. Objetivos: Avaliar a função pulmonar (FP) de pacientes com a SM, relacionar com os aspectos da avaliação clínica, especialmente as possíveis alterações de caixa torácica (ACT) e identificar as manifestações do sistema cardiovascular durante o exame espirométrico (EE). Métodos: De uma amostra inicial de 75 sujeitos, foram avaliados 46 pacientes com SM, sendo 29 do sexo feminino, idade média 20±8 anos, submetidos à avaliação clínica, antropométrica, ecocardiográfica, radiográfica e função pulmonar; 51 sujeitos (33 com SM) foram monitorizados pelo eletrocardiograma (ECG) durante o teste de FP. Estes indivíduos foram pareados e comparados a um grupo controle compostos por indivíduos saudáveis. Resultados: A capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1) dos pacientes com SM foram significativamente menores quando comparado com o GC (p=0.012 e 0.0006) e quando comparado com o previsto (p=0.04 e 0.003). Nos subgrupos baseados nas ACT observamos diferenças entre pacientes com SM com duas ACT combinadas (pectus + escoliose) quando comparados com o GC (p=0.012 e 0.002) e nos pacientes sem ACT (p=0.05 e 0.06). Alguns aspectos da avaliação clínica (relação envergadura/altura e relação da cirtometria axilar/xifóide), comportamento cardiovascular (Índice de massa do ventrículo esquerdo-IMVE, g/m2 e diâmetro da Aorta – Ao, mm) e FP (VEF1/CVF,%) apresentaram correlação moderada. Não foi observada diferença na análise de arritmia durante o esforço para o EE. Conclusões: A FP encontrou-se reduzida nos pacientes com SM e a presença de deformidades da caixa torácica parece contribuir com esta redução. Alguns aspectos clínicos, cardiovasculares e FP estão associados na SM. Apesar das alterações aparentes na estrutura do sistema cardiovascular desta população jovem, o esforço durante a avaliação da função pulmonar parece ser seguro em relação às alterações no ECG.TEDEBV UNIFESP: Teses e dissertaçõe

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

From previous systematic reviews and meta-analyses, there is consensus about the positive effect of exercise training on exercise capacity for systolic heart failure (HF); however, the effect on actual prognostic markers such as NTproBNP and minute ventilation/carbon dioxide production (VE/VCO2) slope has not been evaluated. The primary aim of the proposed study is to determine the effect of aerobic exercise training (AEX) on the VE/VCO2 slope and NTproBNP. The following databases (up to February 30, 2013) were searched with no language limitations: CENTRAL (The Cochrane Library 2013, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), and Physiotherapy Evidence Database (PEDro) (from January 1929). We screened reference lists of articles and also conducted an extensive hand search of the literature. Randomized controlled trials of exercise-based interventions with 2-month follow-up or longer compared to usual medical care or placebo were included. The study population comprised adults aged between 18 and 65 years, with evidence of chronic systolic heart failure (LVEF  300 pg/ml). Two review authors independently extracted data on study design, participants, interventions, and outcomes. We assessed the risk of bias using PEDro scale. We calculated mean differences (MD) or standardized mean differences between intervention and control groups for outcomes with sufficient data; for other outcomes, we described findings from individual studies. Eight studies involving a total of 408 participants met the inclusion criteria across the NTproBNP (5 studies with 191 patients) and VE/VCO2 slope (4 studies with 217 patients). Aerobic exercise significantly improved NTproBNP by a MD of −817.75 [95 % confidence interval (CI) −929.31 to −706.19]. Mean differences across VE/VCO2 slope were −6.55 (95 % CI −7.24 to −5.87). Those patients’ characteristics and exercise were similar (frequency = 3–5 times/week; duration = 20–50 min/day; intensity = 60–80 % of VO2 peak) on the included studies. Moreover, the risk of bias across all studies was homogeneous (PEDro scale = 7–8 points). However, based on the statistical analysis, the heterogeneity among the studies was still high, which is related to the variable characteristics of the studies. Aerobic exercise may be effective at improving NTproBNP and the VE/VCO2 slope in systolic HF patients, but these effects are limited to a specific HF population meeting specific inclusion criterion in a limited number of studies. Future randomized controlled studies including diastolic and HF overleap with pulmonary diseases are needed to better understand the exact influence of AEX

Exercise intensity domains determined by heart rate at the ventilatory thresholds in patients with cardiovascular disease: new insights and comparisons to cardiovascular rehabilitation prescription recommendations

Objectives To compare the elicited exercise responses at ventilatory thresholds (VTs: VT1 and VT2) identified by cardiopulmonary exercise testing (CPET) in patients with cardiovascular disease (CVD) with the guideline-directed exercise intensity domains; to propose equations to predict heart rate (HR) at VTs; and to compare the accuracy of prescription methods.Methods A cross-sectional study was performed with 972 maximal treadmill CPET on patients with CVD. First, VTs were identified and compared with guideline-directed exercise intensity domains. Second, multivariate linear regression analyses were performed to generate prediction equations for HR at VTs. Finally, the accuracy of prescription methods was assessed by the mean absolute percentage error (MAPE).Results Significant dispersions of individual responses were found for VTs, with the same relative intensity of exercise corresponding to different guideline-directed exercise intensity domains. A mathematical error inherent to methods based on percentages of peak effort was identified, which may help to explain the dispersions. Tailored multivariable equations yielded r2 of 0.726 for VT1 and 0.901 for VT2. MAPE for the novel VT1 equation was 6.0%, lower than that for guideline-based prescription methods (9.5 to 23.8%). MAPE for the novel VT2 equation was 4.3%, lower than guideline-based methods (5.8%–19.3%).Conclusion The guideline-based exercise intensity domains for cardiovascular rehabilitation revealed inconsistencies and heterogeneity, which limits the currently used methods. New multivariable equations for patients with CVD were developed and demonstrated better accuracy, indicating that this methodology may be a valid alternative when CPET is unavailable