Effects of cardiopulmonary rehabilitation in exercise tolerance time and oxygen kinetics in ischemic heart disease

Introdução: A reabilitação cardiopulmonar e metabólica (RCPM) é uma importante estratégia no tratamento da insuficiência cardíaca isquêmica. Entretanto, os seus principais mecanismos de melhora e as correlações com aumento na capacidade de exercício e menos sintomas ainda não estão totalmente esclarecidos. Objetivos: Investigar os efeitos de um programa multidisciplinar de RCPM sobre o tempo de tolerância ao esforço (TLim) e a resposta da fase rápida (fase II) da cinética do consumo de oxigênio (variável relacionada ao desempenho oxidativo muscular) em cardiopatas isquêmicos. Adicionalmente, avaliar as variáveis cardiovasculares, ventilatórias e metabólicas nos TCPE máximo (TRIM) e de endurance (TSCC), além da composição corporal pela bioimpedância elétrica, fração de ejeção (FE) e qualidade de vida. Métodos: Cento e seis pacientes com cardiopatia isquêmica encaminhados ao PRCPM foram submetidos ao TRIM em esteira rolante e, após intervalo de 1 a 7 dias, ao TSCC, com 80% da carga atingida no TRIM. Trinta e sete (37) pacientes foram excluídos, 31 por adesão 35kg.m-2 e 3 com FE 35kg.m-2 and 3 with EF <35%. After 12 weeks of CPMR, 69 patients underwent the same tests and analyzed the effects on TLim. Results: The patients had an evident reduction in functional limitation and 95.6% became Class I (pre-CPMR was 62.3%), 4.3% class II (31.8% before intervention) and no longer in class III (5.8% previously), after the intervention of the CPMR. They had significant improvement in performance when effort on both Max and End protocols, however, the increase in exercise tolerance time was nearly 3 times higher in End. Among the various systems assessed by CPET, peripheral component showed the most significant improvement, especially the increase in the phase II kinetics V\'O2, reducing the time constant (tau) ? (p <0.001) and so parallel the mean response time (p <0.001), which also includes the phase III. There was a reduction of ischemic effort indices as well as the significant arrhythmogenic density by 37%. There was significant improvement in all domains of quality of life (p <0.001) and modest, but with statistical significance, in body composition by bioelectrical impedance with increasing lean mass and decreasing fat mass after training and also the EF. The quality of life was correlated with the phase II kinetics V\'O2 (tau), both physical and mental domains. In multiple regression analysis, the physical summary post CPMR had as predictors phase II kinetics V\'O2 and EF. Conclusions: The CPMR has resulted in important physiological benefits and quality of life for patients with ischemic heart disease with predominant NYHA I and II. The quality of life was associated with obtaining more rapid response kinetics V\'O2, reflecting the improvement in muscle oxidative metabolism. Regular physical training promoted retardation in the threshold of myocardial ischemia and reduced arrhythmogenic density. The End, when compared to Max, detected gains of greater magnitude after CPMR as Tlim, and provided the measurement of new indices in the evaluation of responses to the intervention of physical training as the kinetics of V\'O

El magisterio español : Revista General de la Enseñanza: Epoca 4ª Año LVIII Número 6848 - 1924 Febrero 09

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 200