RELAÇÃO ENTRE O CONSUMO DE ÁLCOOL E A QUALIDADE DO SONO COM O RISCO CARDIOVASCULAR EM JOVENS SAUDÁVEIS

Introdução: O consumo excessivo de bebida alcoólica (BA) é um sério problema de saúde que está associado ao desalinhamento do sono, da função cardiovascular e aumento da mortalidade. Objetivo: Avaliar relação entre BA e qualidade do sono (QS) com o risco cardiovascular em jovens saudáveis. Métodos: Recorte transversal da pesquisa “Binge drinking and cardiovascular health in young adults” da Universidade de Illinois de Chicago. Recrutados 48 sujeitos que, após avaliação clínica, foram estratificados conforme o consumo de álcool em 03 grupos: “Bebedores Abstinentes” (AB; n=11); “Bebedores Moderados” (BM; n=17); “Bebedores Compulsivos” (BC; n=18). QS foi avaliada pelo Questionário de Pittsburgh e classificada em Boa ou Ruim. O risco cardiovascular foi avaliado pela Velocidade da Onda de Pulso (VOP) e Pressão de Pulso Central (PPcentral) por tonometria de aplanação e um transdutor de alta fidelidade de tensão de calibre. Os resultados foram analisados no programa SPSS-24 e considerado significativo p≤0,05. Resultados: A PPcentral foi mais elevada no BC, comparado ao BM (33,0±5,3 vs 28,9±3,5, p=0,034), a VOP apresentou tendência a elevação em BC (5,1±0,5) e BM (5,1±0,6) comparado aos AB (4,6±0,5). QS (escore total e componentes) foi semelhante entre os grupos. Apenas sujeitos com QS Ruim: BC (n=11) apresentou maior PPcentral comparado ao BM (n=10) (34,5±5,8 vs 29,2±3,9, p=0,046). BA correlacionou-se com os distúrbios do sono (r=0,310, p=0,036) e a PPcentral (r=0,336, p=0,012). Conclusão: Jovens adultos BC apresentam mais elevada PPcentral e tendem a maior rigidez arterial pela VOP. Distúrbios do sono e PPcentral estão relacionados ao consumo de BA

Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety

Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients

Neuromuscular electrical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support userandomized controlled trial

Objective: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. Design: A randomized controlled study. Subjects: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. Intervention: Patients were randomized into two groups: control group subject to the usual care (n=35)neuromuscular electrical stimulation group (n=35) received daily training sessions to both lower extremities for around two weeks. Main measures: The baseline 6-minute walk test to determine functional capacity was performed 24hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. Results: After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n=25 and neuromuscular electrical stimulation group, n=24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (29334.78m vs. 265.8 +/- 48.53m, P<0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 +/- 1.72 mu g/kg/min vs. 3.86 +/- 1.61 mu g/kg/min, P=0.001, respectively). Conclusion: A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.Univ Fed Sao Paulo, Sao Paulo Hosp, Cardiol & Cardiovasc Surg Discipline, Rua Napoleao de Barros,715,3 Andar, BR-04024002 Sao Paulo, BrazilUniv Fed Sao Carlos, Cardiopulm Physiotherapy Lab, Sao Carlos, BrazilUniv Illinois, Coll Appl Hlth Sci, Dept Phys Therapy, Chicago, IL USAUniv Fed Sao Paulo, Physiotherapy Sch, Dept Human Mot Sci, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Hosp, Cardiol & Cardiovasc Surg Discipline, Rua Napoleao de Barros,715,3 Andar, BR-04024002 Sao Paulo, BrazilWeb of Scienc

RESPOSTA FRACTAL DA VARIABILIDADE DA FREQUÊNCIA CARDÍACA NO TESTE DO DEGRAU DE 6 MINUTOS EM PACIENTES COM DOENÇA PULMONAR OBSTRUTIVA CRÔNICA

Introdução: Pacientes DPOC apresentam alterações na variabilidade da frequência cardíaca (VFC) podendo ser avaliados pelos índices Alpha1 (α1) e Alpha2 (α2) de propriedade fractal. Objetivo: Avaliar a resposta da VFC pela análise não linear frente ao teste do degrau de 6 minutos (TD6m) em pacientes DPOC. Métodos: Estudo transversal, incluiu 11 pacientes DPOC de moderado a muito grave sem arritmia cardíaca. A FC foi registrada com cardiofrequencímetro Polar® durante o repouso (rep=5 minutos) e recuperação (rec=5 minutos pós-teste). Os dados foram analisados no software Kubios-2.2. Para determinar a retomada vagal calculou-se delta de variação entre a FC_pico subtraindo a FC_recuperação no 1º minuto pós_teste (FCRec=FC_pico - FC_recuperada). No TD6m utilizou-se um degrau de 20cm de altura e os pacientes foram orientados a descer e subir o maior número de degraus em cadência livre. Os resultados foram analisados no SPSS-23.0, considerando significativo p≤0,05. Resultados: Os pacientes subiram 80,2±19,6 degraus no TD6m. Nenhuma diferença entre repouso e recuperação para α1 (p=0,117) e α2 (p=0,199). Identificamos diferenças na FC_repouso para FC_pico do TD6m (rep=78,9±10,5 vs pico=109,0±13,9 bpm,

Efeitos da Pressão Positiva Expiratória sobre a capacidade de exercício em sujeitos acometidos por Doença Pulmonar Obstrutiva Crônica

A Doença Pulmonar Obstrutiva Crônica (DPOC) leva a repercussões cardíacas e intolerância ao exercício. A pressão positiva expiratória nas vias aéreas (EPAP) aumenta a saturação de oxigênio (SpO2) e reduz o trabalho respiratório. O objetivo foi avaliar o EPAP na tolerância ao exercício em pacientes com DPOC. Estudo cruzado randomizado, avaliou-se 19 pacientes com DPOC através do teste de caminhada de seis minutos (TC6m): sem EPAP (G1) e com EPAP (G2). Variáveis analisadas no repouso, durante o TC6m e recuperação pós teste: SpO2, frequência respiratória (FR), frequência cardíaca (FC), BORG-esforço (BORG-e), BORG-dispneia (BORG-d), pressão arterial sistólica e diastólica e duplo produto (DP). Utilizou-se análise de variância para estimar a diferença dentro dos grupos e teste t de Student para a diferença entre os grupos. Dentro e em ambos os grupos: durante o TC6m verificou-se aumento da FC, do BORG-d, do DP e redução da SpO2 que se recuperou pós teste. Somente G2 recuperou a FC pós teste. Diferenças significativas foram observadas entre os grupos: no repouso para a SpO2 e FR; na recuperação pós TC6m para a FR. O EPAP de 5cmH2O, causa efeito positivo na SpO2 e FR de repouso e proporciona atenuada melhora na recuperação da FC e SpO2 pós TC6m

Correlation between autonomous function and left ventricular performance after acute myocardial infarction

Reduced ejection fraction (EF), possibly induced/mediated by autonomic abnormal activation, is one of the most powerful predictors of adverse outcome after acute myocardial infarction (MI). A deep understanding of the correlation between the autonomous functionality and the left ventricular performance in these patients is therefore of paramount importance. The autonomous function is reflected in the cardiac activity and, specifically, in the heart rate variability (HRV) signal. Given the cardiac activity nonlinearity, growing interest is being manifested towards nonlinear methods of analysis, which might provide more significant information than the traditional linear approaches

Correlation between autonomous function and left ventricular performance after acute myocardial infarction

Reduced ejection fraction (EF), possibly induced/mediated by autonomic abnormal activation, is one of the most powerful predictors of adverse outcome after acute myocardial infarction (MI). A deep understanding of the correlation between the autonomous functionality and the left ventricular performance in these patients is therefore of paramount importance. The autonomous function is reflected in the cardiac activity and, specifically, in the heart rate variability (HRV) signal. Given the cardiac activity nonlinearity, growing interest is being manifested towards nonlinear methods of analysis, which might provide more significant information than the traditional linear approaches. The aim of the present study was to investigate if non-linear HRV metrics change between MI patients with preserved EF (pEF) and MI patients with reduced EF (rEF). Data were acquired in the context of the cardioRisk project. Ten MI patients with rEF and six MI patients with pEF, admitted to Intensive Cardiac Care after a first acute MI episode, were studied. The ECG was acquired during a Holter recording and the tachogram was extracted. Sample entropy (SE) and Lempel-Ziv Complexity (LZC 1 and LZC 2) metrics were computed on five hour long tachogram portions. A significant correlation was found between LZC indices and EF in the whole population; SE, LZC 1 and LZC 2 were significantly higher in patients with pEF. Our results indicate that lower complexity characterizes the HRV of MI patients with rEF. Complexity reduction might be due to a simplification of regulatory mechanisms, which might explain why MI patients with rEF are at higher risk for subsequent non-fatal and fatal events

Inductive plethysmography potential as a surrogate for ventilatory measurements during rest and moderate physical exercise

Background: Portable respiratory inductive plethysmography (RIP) systems have been validated for ventilatory assessment during resting conditions and during incremental treadmill exercise. However, in clinical settings and during field-based exercise, intensity is usually constant and submaximal. A demonstration of the ability of RIP to detect respiratory measurements accurately during constant intensity conditions would promote and validate the routine use of portable RIP devices as an alternative to ergospirometry (ES), the current gold standard technique for ventilatory measures. Objective: To investigate the agreement between respiratory variables recorded by a portable RIP device and by ES during rest and constant intensity exercise. Method: Tidal volume (VT), respiratory rate (RR) and minute ventilation (VE) were concurrently acquired by portable RIP and ES in seven healthy male volunteers during standing rest position and constant intensity treadmill exercise. Results: Significant agreement was found between RIP and ES acquisitions during the standing rest position and constant intensity treadmill exercise for RR and during the standing rest position for VE. Conclusion: Our results suggest that portable RIP devices might represent a suitable alternative to ES during rest and during constant submaximal exercise

Funcionalidade da família dos pacientes com Doença Pulmonar Obstrutiva Crônica

La enfermedad pulmonar obstructiva crónica (EPOC) es muy limitante, tanto en aspectos físicos como socioemocionales, causando dificultades significativas en la vida diaria de los pacientes. Además de afectar a los pacientes, la EPOC también influye en la vida de los familiares y amigos cercanos, ya que de ellos proviene la red de apoyo que los pacientes necesitan. El objetivo de este artículo es evaluar la funcionalidad de la familia en la vida cotidiana de lospacientes afectados por EPOC. Se trata de un estudio transversal que evaluó la funcionalidad familiar de pacientes con EPOC en diferentes etapas de la  enfermedad y que realizan un Programa de Rehabilitación Cardiaca (PRC). Se utilizó el instrumento APGAR familiar, que es un acrónimo caracterizado por A =  Adaptation/Adaptación), P = (Partnership/Compañerismo), G = (Grow/Desarrollo), A = (Affection/Afectividad), R = (Resolve/Capacidad de resolución), compuesto por 5 preguntas evaluadas en “siempre”, “a veces” y “nunca”, que combinadas resultan en “disfunción familiar severa”, “disfunción familiar moderada” y “buena funcionalidad familiar”. Se evaluaron 21 pacientes con EPOC [sexo masculino (n=11; 52,3%); edad media 66,3±10 años], con una estadificación que varía de moderada a muy grave. A través del APGAR familiar identificamos 2  pacientes con severa disfunción familiar; 2 pacientes con disfunción familiar moderada; 17 pacientes con buena funcionalidad familiar. De los que relataron disfunción familiar severa y moderada, los acrónimos más comprometidos fueron “compañerismo”, “afectividad” y “desarrollo”. El grado de obstrucción de las vías se asoció moderada y positivamente con la funcionalidad de la familia (r=0,697; p=0,004). Los pacientes con EPOC que participaron en el PCR presentaron una buena funcionalidad familiar en su vida diaria y la gravedad de la enfermedad se asoció a esta funcionalidad. Los pacientes que presentaron mayor disfunción familiar relataron falta de “compañerismo”, “afectividad” y “desarrollo” .A doença pulmonar obstrutiva crônica (DPOC) é altamente limitante, tanto nos aspectos físicos, quanto socioemocionais, causando dificuldades significativas no cotidiano dos pacientes. Além de afetar os pacientes, a DPOC também influência na vida dos familiares eamigos próximos, pois deles vem a rede de apoio de que os pacientes necessitam. O objetivo deste artigo é avaliar a funcionalidade da família no cotidiano de pacientes acometidos por DPOC. É um estudo transversal que avaliou a funcionalidade de família de pacientes com DPOC em diferentes estágios da doença e que realizam Programa Reabilitação  Cardiorrespiratória (PRC). Utilizou-se o instrumento APGAR de Família, sendo este, um acrônimo caracterizado por A = (Adaptation/Adaptação), P = (Partnership/Companheirismo),G = (Grow/Desenvolvimento), A = (Affection/Afetividade), R = (Resolve/Capacidade resolutiva), composto por 5 questões avaliadas em “sempre”, “algumas vezes” e “nunca”, o que somados resultam em “elevada disfunção familiar”, moderada disfunção familiar” e “boa funcionalidade familiar”. Foram avaliados 21 pacientes DPOC [sexo masculino (n=11; 52,3%); idade média 66,3±10 anos], com estadiamento entre moderado a muito severo. Através doAPGAR da Família identificamos 2 pacientes com elevada disfunção familiar; 2 pacientes com moderada disfunção familiar; 17 pacientes com boa funcionalidade familiar. Dos que relataram elevada e moderada disfunção familiar, os acrômios mais comprometidos foram “companheirismo”, “afetividade” e “desenvolvimentos”. O grau de obstrução das vias áreas associou-se moderada e positivamente com a funcionalidade da família (r = 0,697; p = 0,004). Pacientes com DPOC participantes do PRC apresentaram boa funcionalidade familiar no seu cotidiano e a gravidade da doença esteve associada a esta funcionalidade. Pacientesque apresentaram maior disfunção familiar relataram falta de “companheirismo”,  afetividade” e “desenvolvimentos”.Chronic Obstructive Pulmonary Disease (COPD) is highly limiting, both  physically and socioemotionally, causing significant difficulties in the daily lives of patients. In addition, COPD also influences the lives of family andfriends, because theirs who come to the support network that patient need. Objective: To evaluate the family functionality in the daily life of COPD patients. Methods: This cross-sectionalstudy evaluated the family functionality in COPD patients with different stages of disease and underwent Cardiorespiratory Rehabilitation Program (CRP). The Family APGAR instrument was used and it is an acronym characterized by A = (Adaptation / Adaptation), P = (Partnership / Companionship), G = (Grow / Development), A = (Affection / Affectivity), R = (Resolve / Resolving capacity), composed of 5 questions assessed in “always”, “sometimes” and “never”, which together result in “high family dysfunction”, moderate family dysfunction “and” good family functionality”. We evaluated 21 COPD patients [male gender (n = 11; 52.3%); mean age 66.3 ± 10 years], status  disease between moderate to very severe. Through of the Family APGARwe identified 2 patients with high  family dysfunction; 2 patients with moderate family dysfunction; 17  patients with good family functionality. Among those who reported high and moderate family dysfunction, the most compromised acromia’s were “companionship”, “affection” and “developments”. The degree of airway obstruction was moderately and positively associated with family functionality (r = 0.697; p = 0.004). Patients with COPD who participated in CRP had good family functionality in their daily lives and the severity ofthe disease was associated with this functionality. Patients with high family dysfunction reported lack of  “companionship”, “affection” and“developments”