RESUMO
El ejercicio físico puede ser una herramienta importante para el manejo de personas con enfermedades psiquiátricas, puesto que un notable número de estudios longitudinales y transversales ha demostrado que el mismo se constituye en una estrategia preventiva y en un enfoque adyuvante del tratamiento de los trastornos mentales. En ese sentido, se ha evidenciado que las formas más efectivas de ejercicio físico son los ejercicios aeróbicos (tales como caminar, trotar, andar en bicicleta, nadar, entre otros) y los de fortalecimiento. El objetivo de este artículo es presentar una actualización general acerca del ejercicio físico como tratamiento adyuvante de los trastornos mentales. Esta es una revisión narrativa, no sistemática, centrada en literatura primaria seleccionada de una búsqueda en PubMed, SciELO y LILACS. Los términos clave que se utilizaron fueron los siguientes: "ejercicio físico y salud mental", "fisioterapia y salud mental", "ejercicio físico y trastornos mentales" y "ejercicio físico y psiquiatría". Se complementaron estos artículos con libros y capítulos de libros, resaltando hallazgos duplicados. Todos los miembros del equipo de investigación participaron en la revisión de la literatura. Aunque existen excelentes estudios y revisiones que analizan detalladamente el papel del ejercicio físico en el tratamiento específico de algunos trastornos mentales, se consideró que se necesitaba una revisión más general para brindar orientación a médicos psiquiatras y a fisioterapeutas en este campo de integración de la salud física y mental.
Physical exercise can be an important part of the management of people with psychiatric illnesses, since a considerable number of longitudinal and cross-sectional studies has shown that it constitutes a preventive strategy and an adjuvant approach to the treatment of mental disorders. In that sense, it has been demonstrated that the most effective forms of physical exercise are aerobic exercises (such as walking, jogging, cycling, swimming, among others) and strengthening. The aim of this article is to present a general update about physical exercise as an adjuvant treatment of mental disorders. This is a narrative review, not systematic, focused on primary literature selected from a search in PubMed, SciELO and LILACS. The key terms used were: "physical exercise and mental health", "physiotherapy and mental health", "physical exercise and mental disorders" and "physical exercise and psychiatry." These articles were supplemented with books and book chapters, highlighting duplicate findings. All members of the research team participated in the review of the literature. Although there are excellent studies and reviews that analyze in detail the role of physical exercise in the specific treatment of some mental disorders, it was considered that a more general revision was needed to provide guidance to psychiatrists and physiotherapists in this field of integration of physical and mental health.
RESUMO
OBJECTIVE: Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti-Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Single-cohort, prospective observational study. SETTING: Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico. PATIENTS: A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied. PRIMARY OUTCOME: Mortality. METHODS: Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart. RESULTS: Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status. CONCLUSION: These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.