RESUMO

Among the most prevalent multimorbidities that accompany the aging process, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) stand out, representing the main causes of hospital admissions in the world. The prevalence of COPD coexistence in patients with CHF is higher than in control subjects, given the common risk factors associated with a complex process of chronic diseases developing in the aging process. COPD-CHF coexistence confers a marked negative impact on mechanical-ventilatory, cardiocirculatory, autonomic, gas exchange, muscular, ventilatory, and cerebral blood flow, further impairing the reduced exercise capacity and health status of either condition alone. In this context, integrated approach to the cardiopulmonary based on pharmacological optimization and non-pharmacological treatment (i.e., exercise-based cardiopulmonary and metabolic rehabilitation) can be emphatically encouraged by health professionals as they are safe and well-tolerated, reducing hospital readmissions, morbidity, and mortality. This review aims to explore aerobic exercise, the cornerstone of cardiopulmonary and metabolic rehabilitation, resistance and inspiratory muscle training and exercise-based rehabilitation delivery models in patients with COPD-CHF multimorbidities across the continuum of the disease. In addition, the review address the importance of adjuncts to enhance exercise capacity in these patients, which may be used to optimize the gains obtained in these programs.

RESUMO

BACKGROUND: Endothelial function assessment may provide important insights into the cardiovascular function and long-term effects of exercise training. Many studies have investigated the possible negative effects on cardiovascular function due to extreme athletic performance, leading to undesirable effects. The purposes of this study were to investigate the acute effects of maximal intensity exercise on endothelium-dependent vasodilation, and to understand the patterns of flow-mediated dilation (FMD) change following maximal exercise in elite female athletes with a high-volume training history. METHODS: Twenty-six elite female soccer players (mean age, 22±4 years; BMI, 21±2 kg/m2; VO2max, 41±4 mL/kg/min) were evaluated. Brachial artery FMD was determined using high-resolution ultrasound at rest, and after 15 and 60 min of maximal cardiopulmonary exercise (CPX) testing on a treadmill. Flow velocity was measured at baseline and during reactive hyperemia at the same periods. RESULTS: Rest FMD was 12.4±5.5%. Peak diameter in response to reactive hyperemia was augmented after 15 min of CPX (3.5±0.4 vs. 3.6±0.4 mm, P<0.05), returning to resting values after 60 min. However, %FMD did not change among time periods. There were two characteristic patterns of FMD response following CPX. Compared to FMD at rest, half of the subjects responded with an increased FMD following maximum exercise (10.5±6.1 vs. 17.8±7.5%, P<0.05). The other subjects demonstrated a reduced FMD response following maximum exercise (14.2±4.3 vs. 10.9±3.2%, P<0.01). CONCLUSIONS: These results indicate that elite female soccer players presented robust brachial artery FMD at rest, with a heterogeneous FMD response to acute exercise with a 50% FMD improvement rate.

Assuntos

RESUMO

BACKGROUND: The evaluation of thoracoabdominal mobility is a tool extensively used in the physiotherapy practice in different populations. Photogrammetry may be a simple tool to analyse thoracoabdominal mobility; however, it is unclear whether this assessment can be a reliable method. AIM: To test the reliability intra-examinator by photogrammetry in asthmatic patients and in health controls. METHODS: Twenty-six asthmatic patients (29 ± 9 years) and 14 healthy matched controls (27 ± 8 years) were assessed by thoracoabdominal mobility. Photographs during rest, during inspiration and expiration maximum were used to calculate latero-lateral and antero-posterior diameters of the thorax (at axillary and xiphoid levels) and umbilical by markers positioned in osseous structures. An evaluator obtained the same measurements in an 8-day interval. RESULTS: We found a moderate reliability for axillary, xiphoid and umbilical mobility (average intraclass correlation coefficient [ICC] respectively [0.68, 0.55 and 0.73]) for asthmatic group. In addition, for control group, we found a moderate reliability for axillary mobility (average ICC respectively [0.68] and a good reliability for xiphoid and umbilical mobility) (average ICC 0.81 and 0.70). Bland-Altman plots showed goods limit of agreement in photos 1 and 2 in both groups. CONCLUSION: The photogrammetric analysis of thoracoabdominal mobility presented itself as a reliable method and may be used in clinical practice in asthmatic patients and in controls.

Assuntos