RESUMO
OBJECTIVE: To evaluate heart rate variability during an inspiratory muscle endurance protocol at three different load levels [30%, 60% and 80% of maximal inspiratory pressure], in patients who had previously undergone coronary artery bypass grafting. METHODS: Nineteen late postoperative myocardial revascularization patients participating in a cardiovascular rehabilitation program were studied. Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was applied for four minutes each, in random order. Heart rate and RR intervals were recorded and heart rate variability was analyzed by time (RMSSD-the mean of the standard deviations for all R-R intervals, and RMSM-root-mean square differences of successive R-R intervals) and frequency domains indices (high and low frequency) in normalized units. ANOVA for repeated measurements was used to compare heart rate variability indices and Student t-test was used to compare the maximal inspiratory pressure and maximal expiratory pressure values. RESULTS: Heart rate increased during performance of maximal respiratory pressures maneuvers, and the maximal inspiratory pressure and maximal expiratory pressure mean values were significantly lower than predicted values (P <0.05). RMSSD increased significantly at 80% in relation to rest and 30% of maximal inspiratory pressure and RMSM decreased at 30% and 60% of maximal inspiratory pressure in relation to rest (P <0.05). Additionally, there was significant and progressive decrease in low frequency and increase in high frequency at 30%, 60% and 80% of maximal inspiratory pressure in relation to the resting condition. CONCLUSION: These results suggest that respiratory muscle training at high intensities can promote greater parasympathetic activity and it may confer important benefits during a rehabilitation program in post-coronary artery bypass grafting.
Assuntos
Exercícios Respiratórios/métodos , Ponte de Artéria Coronária/reabilitação , Frequência Cardíaca/fisiologia , Inalação/fisiologia , Exercícios de Alongamento Muscular/métodos , Músculos Respiratórios/fisiopatologia , Idoso , Análise de Variância , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Valores de Referência , Testes de Função Respiratória , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
Abstract Background: Numerous studies show the benefits of exercise training after myocardial infarction (MI). Nevertheless, the effects on function and remodeling are still controversial. Objectives: To evaluate, in patients after (MI), the effects of aerobic exercise of moderate intensity on ventricular remodeling by cardiac magnetic resonance imaging (CMR). Methods: 26 male patients, 52.9 ± 7.9 years, after a first MI, were assigned to groups: trained group (TG), 18; and control group (CG), 8. The TG performed supervised aerobic exercise on treadmill twice a week, and unsupervised sessions on 2 additional days per week, for at least 3 months. Laboratory tests, anthropometric measurements, resting heart rate (HR), exercise test, and CMR were conducted at baseline and follow-up. Results: The TG showed a 10.8% reduction in fasting blood glucose (p = 0.01), and a 7.3-bpm reduction in resting HR in both sitting and supine positions (p < 0.0001). There was an increase in oxygen uptake only in the TG (35.4 ± 8.1 to 49.1 ± 9.6 mL/kg/min, p < 0.0001). There was a statistically significant decrease in the TG left ventricular mass (LVmass) (128.7 ± 38.9 to 117.2 ± 27.2 g, p = 0.0032). There were no statistically significant changes in the values of left ventricular end-diastolic volume (LVEDV) and ejection fraction in the groups. The LVmass/EDV ratio demonstrated a statistically significant positive remodeling in the TG (p = 0.015). Conclusions: Aerobic exercise of moderate intensity improved physical capacity and other cardiovascular variables. A positive remodeling was identified in the TG, where a left ventricular diastolic dimension increase was associated with LVmass reduction.
Resumo Fundamento: Vários estudos mostraram os benefícios da prática de exercício após infarto do miocárdio (IM). No entanto, os efeitos na função e no remodelamento são controversos. Objetivos: Avaliar os efeitos do exercício aeróbio de intensidade moderada no remodelamento ventricular em pacientes após IM através de ressonância magnética cardíaca (RMC). Métodos: 26 pacientes do sexo masculino (52,9 ± 7,9 anos), após um primeiro IM, foram designados para dois grupos: grupo treinado (GT), 18; e grupo controle (GC), 8. O GT realizou exercício aeróbio supervisionado em esteira duas vezes por semana, e não supervisionado em 2 dias adicionais por semana, por no mínimo 3 meses. Exames laboratoriais, medidas antropométricas, frequência cardíaca (FC) de repouso, teste de esforço e RMC foram realizados na condição basal e no seguimento. Resultados: O GT apresentou redução de 10,8% na glicemia de jejum (p = 0,01), e de 7,3 bpm na FC de repouso nas posições sentada e supina (p < 0,0001). Houve aumento no consumo de oxigênio apenas no GT (de 35,4 ± 8,1 para 49,1 ± 9,6 ml/kg/min, p < 0,0001) e diminuição estatisticamente significativa na massa ventricular esquerda (MVE) no GT (de 128,7 ± 38,9 para 117,2 ± 27,2 g, p = 0,0032). Não houve alterações estatisticamente significativas no volume diastólico final ventricular esquerdo (VDFVE) nem na fração de ejeção nos grupos. A relação MVE/VDFVE demonstrou remodelamento positivo estatisticamente significativo no GT (p = 0,015). Conclusões: Observou-se remodelamento positivo no GT, onde o aumento da dimensão diastólica ventricular esquerda associou-se com redução da MVE. O exercício aeróbio de intensidade moderada melhorou a capacidade física e outras variáveis cardiovasculares.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Exercício Físico/fisiologia , Remodelação Ventricular/fisiologia , Terapia por Exercício/métodos , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/reabilitação , Valores de Referência , Volume Sistólico/fisiologia , Fatores de Tempo , Triglicerídeos/sangue , Imageamento por Ressonância Magnética , Índice de Massa Corporal , Reprodutibilidade dos Testes , Função Ventricular Esquerda/fisiologia , Resultado do Tratamento , Estatísticas não Paramétricas , Teste de Esforço , Frequência Cardíaca/fisiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Infarto do Miocárdio/diagnóstico por imagemRESUMO
BACKGROUND: Numerous studies show the benefits of exercise training after myocardial infarction (MI). Nevertheless, the effects on function and remodeling are still controversial. OBJECTIVES: To evaluate, in patients after (MI), the effects of aerobic exercise of moderate intensity on ventricular remodeling by cardiac magnetic resonance imaging (CMR). METHODS: 26 male patients, 52.9 ± 7.9 years, after a first MI, were assigned to groups: trained group (TG), 18; and control group (CG), 8. The TG performed supervised aerobic exercise on treadmill twice a week, and unsupervised sessions on 2 additional days per week, for at least 3 months. Laboratory tests, anthropometric measurements, resting heart rate (HR), exercise test, and CMR were conducted at baseline and follow-up. RESULTS: The TG showed a 10.8% reduction in fasting blood glucose (p = 0.01), and a 7.3-bpm reduction in resting HR in both sitting and supine positions (p < 0.0001). There was an increase in oxygen uptake only in the TG (35.4 ± 8.1 to 49.1 ± 9.6 mL/kg/min, p < 0.0001). There was a statistically significant decrease in the TG left ventricular mass (LVmass) (128.7 ± 38.9 to 117.2 ± 27.2 g, p = 0.0032). There were no statistically significant changes in the values of left ventricular end-diastolic volume (LVEDV) and ejection fraction in the groups. The LVmass/EDV ratio demonstrated a statistically significant positive remodeling in the TG (p = 0.015). CONCLUSIONS: Aerobic exercise of moderate intensity improved physical capacity and other cardiovascular variables. A positive remodeling was identified in the TG, where a left ventricular diastolic dimension increase was associated with LVmass reduction.
Assuntos
Terapia por Exercício/métodos , Exercício Físico/fisiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/reabilitação , Remodelação Ventricular/fisiologia , Adulto , Índice de Massa Corporal , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Teste de Esforço , Frequência Cardíaca/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Valores de Referência , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Fatores de Tempo , Resultado do Tratamento , Triglicerídeos/sangue , Função Ventricular Esquerda/fisiologiaRESUMO
Abstract Objective: To evaluate heart rate variability during an inspiratory muscle endurance protocol at three different load levels [30%, 60% and 80% of maximal inspiratory pressure], in patients who had previously undergone coronary artery bypass grafting. Methods: Nineteen late postoperative myocardial revascularization patients participating in a cardiovascular rehabilitation program were studied. Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was applied for four minutes each, in random order. Heart rate and RR intervals were recorded and heart rate variability was analyzed by time (RMSSD-the mean of the standard deviations for all R-R intervals, and RMSM-root-mean square differences of successive R-R intervals) and frequency domains indices (high and low frequency) in normalized units. ANOVA for repeated measurements was used to compare heart rate variability indices and Student t-test was used to compare the maximal inspiratory pressure and maximal expiratory pressure values. Results: Heart rate increased during performance of maximal respiratory pressures maneuvers, and the maximal inspiratory pressure and maximal expiratory pressure mean values were significantly lower than predicted values (P <0.05). RMSSD increased significantly at 80% in relation to rest and 30% of maximal inspiratory pressure and RMSM decreased at 30% and 60% of maximal inspiratory pressure in relation to rest (P <0.05). Additionally, there was significant and progressive decrease in low frequency and increase in high frequency at 30%, 60% and 80% of maximal inspiratory pressure in relation to the resting condition. Conclusion: These results suggest that respiratory muscle training at high intensities can promote greater parasympathetic activity and it may confer important benefits during a rehabilitation program in post-coronary artery bypass grafting.
Assuntos
Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Exercícios Respiratórios/métodos , Ponte de Artéria Coronária/reabilitação , Frequência Cardíaca/fisiologia , Inalação/fisiologia , Exercícios de Alongamento Muscular/métodos , Músculos Respiratórios/fisiopatologia , Análise de Variância , Força Muscular/fisiologia , Valores de Referência , Testes de Função Respiratória , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
The purpose of this study was to evaluate the influence of a home-based walking program on erectile function and the relation between functional capacity and erectile dysfunction (ED) in patients with recent myocardial infarctions. Patients with acute myocardial infarctions deemed to be at low cardiovascular risk were randomized into 2 groups: (1) a home-based walking group (n = 41), instructed to participate in a progressive outdoor walking program, and (2) a control group (n = 45), receiving usual care. Functional capacity was determined by the 6-minute walk test and evaluation of sexual function by the International Index of Erectile Function questionnaire; the 2 tests were performed at hospital discharge and 30 days later. In the overall cohort, 84% of patients reported previous ED at hospital discharge. After 30 days, ED had increased by 9% in the control group in relation to baseline (p = 0.08). However, the home-based walking group had a significant decrease of 71% in reported ED (p <0.0001). The 6-minute walk distance was statistically significant higher in the home-based walking group compared with the control group (p = 0.01). There was a significant negative correlation between 6-minute walk distance and ED 30 days after hospital discharge (r = -0.71, p <0.01). In conclusion, an unsupervised home-based progressive walking program led to significant improvements in functional capacity in men at low cardiovascular risk after recent acute myocardial infarctions. In addition, this intervention demonstrated a link between functional capacity and exercise training and erectile function improvement.
Assuntos
Disfunção Erétil/terapia , Terapia por Exercício , Infarto do Miocárdio/reabilitação , Autocuidado , Caminhada , Adulto , Idoso , Estudos de Coortes , Deambulação Precoce , Disfunção Erétil/complicações , Tolerância ao Exercício , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this study was to evaluate the influence of an early cardiac rehabilitation (CR) program on health-related quality of life (HRQL) and functional capacity in patients who recently experienced an acute myocardial infarction (AMI). This program was initiated in the inpatient setting and was followed by an unsupervised outpatient intervention. METHODS: After the same inpatient care plan, low-risk patients who experienced an AMI were randomized into 2 groups: (1) a control group (CG) (n = 43) entailing usual care and (2) an intervention group (IG) (n = 45) entailing outpatient (unsupervised) CR primarily centered on a progressive walking program. Initially, all patients underwent a supervised exercise program with early mobilization beginning 12 hours after an AMI. On hospital discharge, all patients were classified according to cardiovascular risk. Quality of life was evaluated by the MacNew Heart Disease HRQL questionnaire 30 days after discharge. Functional capacity was determined by a 6-minute walk test (6MWT) distance on the day of inpatient discharge as well as 30 days afterward. RESULTS: The HRQL global score was higher in the IG compared with the CG 30 days after discharge (P < 0.001); physical and emotional domain scores were both significantly higher in the IG (P < 0.001). Furthermore, the IG showed a greater 6MWT distance compared with the CG (P < 0.001). CONCLUSIONS: A CR program based on early progressive exercises, initiated by supervised inpatient training and followed by an unsupervised outpatient program, improved HRQL and functional capacity in patients at low cardiovascular risk who recently experienced an AMI.
Assuntos
Terapia por Exercício , Pacientes Internados , Infarto do Miocárdio/reabilitação , Pacientes Ambulatoriais , Qualidade de Vida , Caminhada , Adolescente , Adulto , Idoso , Terapia por Exercício/métodos , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , Cooperação do Paciente , Intervenção Coronária Percutânea , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
FUNDAMENTO: A insuficiência cardíaca crônica (IC) é uma síndrome complexa caracterizada pela redução do débito cardíaco em relação às necessidades metabólicas do organismo, bem como alterações metabólicas e do eixo neuro-hormonal. Sintomas como fadiga muscular e dispneia são notórios e os testes de esforço são amplamente utilizados para a avaliação da capacidade funcional, prognóstico e eficácia das intervenções terapêuticas nessa síndrome. OBJETIVO: Avaliar a reprodutibilidade do teste de caminhada de seis minutos (TC6') em pacientes com IC e correlacionar a magnitude das variáveis atingidas no pico do esforço do TC6' com as de um teste cardiopulmonar (TCP). MÉTODOS: Foram estudados 16 pacientes (12 homens e 4 mulheres) com diagnóstico de IC CF I-II (NYHA). Os voluntários foram submetidos a dois testes TC6' (TC6'1 e TC6'2) com intervalo de 30 minutos entre eles; posteriormente realizaram um TCP máximo. RESULTADOS: Todas as variáveis obtidas nos dois TC6' mostraram-se significantes, com altas correlações: distância percorrida (DP) (r = 0,93; p < 0,0001), frequência cardíaca (FC) (r = 0,89; p < 0,0001), consumo de oxigênio (VO2) (r = 0,93; p < 0,0001) e escala de percepção de esforço (r = 0,85; p < 0,0001). Por sua vez, todas as variáveis analisadas no TC6' mostraram correlações moderadas e significantes com as variáveis obtidas no TCP, a saber: FC pico (r = 0,66; p = 0,005); VO2 (r = 0,57; p = 0,02) e VO2 no TCP e DP no TC6'2 (r = 0,70; p = 0,002). CONCLUSÃO: O TC6' foi reprodutível nesse grupo de pacientes com IC (NYHA - I-II) e se correlacionou com o TCP. Sendo assim, apresenta-se como ferramenta de avaliação fidedigna, constituindo-se numa alternativa adequada, segura e de baixo custo para a prescrição de exercícios físicos aeróbicos em pacientes com IC.
BACKGROUND: Chronic heart failure (HF) is a syndrome characterized by reduced cardiac output in relation to the metabolic needs of the organism, as well as metabolic and neurohormonal axis abnormalities. Symptoms such as fatigue and dyspnoea are notorious and stress tests are widely used to assess functional capacity, prognosis and effectiveness of therapeutic interventions in this syndrome. OBJECTIVE: To evaluate the reproducibility of the six-minute walk test (6MW) in patients with HF and correlate the magnitude of the variables reached at peak exercise of the 6MWT with a cardiopulmonary exercise test (CPET). METHODS: We studied 16 patients (12 men and 4 women) diagnosed with HF FC I-II (NYHA). The volunteers underwent two 6MWT (6MWT'1 and 6MWT'2) with 30-minute interval between them; then, they underwent a maximum CPET. RESULTS: All variables obtained in the two 6MWT' proved to be significant with high correlations: distance walked (DW) (r = 0.93, p < 0.0001), heart rate (HR) (r = 0.89, p < 0.0001), oxygen consumption (VO2) (r = 0.93, p < 0.0001) and scale of perceived exertion (r = 0.85, p < 0.0001). In turn, all variables analyzed in the 6MWT' showed significant and moderate correlations with the variables obtained from the CPET, namely: peak HR (r = 0.66; p = 0.005); VO2 (r = 0.57; p = 0.02) and VO2 in the CPET and DT in the 6MWT'2 (r = 0.70; p = 0.002). CONCLUSION: The 6MWT was reproducible in this group of patients with HF (NYHA - I-II) and correlated with the CPET. Therefore, it is a tool for reliable evaluation, and a suitable, safe and low-cost alternative for the prescription of aerobic exercise in patients with HF.
FUNDAMENTO: La insuficiencia cardíaca crónica (IC), es un síndrome complejo que se caracteriza por la reducción del débito cardíaco con relación a las necesidades metabólicas del organismo, como también por las alteraciones metabólicas y del eje neuro hormonal. Los síntomas como el cansancio muscular y la disnea son notables y los test de esfuerzo son ampliamente utilizados para la evaluación de la capacidad funcional, pronóstico y eficacia de las intervenciones terapéuticas en ese síndrome. OBJETIVO: Evaluar la reproductibilidad del test de esfuerzo de seis minutos (TE6') en pacientes con IC y correlacionar la magnitud de las variables alcanzadas en el pico del esfuerzo del TE6' con las de un test cardiopulmonar (TECP). MÉTODOS: Se estudiaron 16 pacientes (12 hombres y 4 mujeres) con un diagnóstico de IC CF I-II (NYHA). Los voluntarios se sometieron a dos test TE6' (TC6'1 y TC6'2), con un intervalo de 30 minutos entre ellos. Posteriormente realizaron un TECP máximo. RESULTADOS: Todas las variables obtenidas en los dos TE6' fueron significativas, y con altas correlaciones: distancia recorrida (DR) (r = 0,93; p < 0,0001), frecuencia cardíaca (FC) (r = 0,89; p < 0,0001), consumo de oxígeno (VO2) (r = 0,93; p < 0,0001) y escala de percepción de esfuerzo (r = 0,85; p < 0,0001). A su vez, todas las variables analizadas en el TE6' mostraron correlaciones moderadas y significativas con las variables obtenidas en el TECP, a saber: FC pico (r = 0,66; p = 0,005); VO2 (r = 0,57; p = 0,02) y VO2 en el TECP y DR en el TE6'2 (r = 0,70; p = 0,002). CONCLUSIÓN: El TE6' se pudo reproducir en ese grupo de pacientes con IC (NYHA - I-II) y se correlacionó con el TECP. Por lo tanto, se presenta como una herramienta de evaluación fidedigna y constituye una alternativa adecuada, segura y de bajo coste para la prescripción de ejercicios físicos aeróbicos en pacientes con IC.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Teste de Esforço , Insuficiência Cardíaca/fisiopatologia , Tolerância ao Exercício/fisiologia , Consumo de Oxigênio/fisiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo , Caminhada/fisiologiaRESUMO
BACKGROUND: Chronic heart failure (HF) is a syndrome characterized by reduced cardiac output in relation to the metabolic needs of the organism, as well as metabolic and neurohormonal axis abnormalities. Symptoms such as fatigue and dyspnoea are notorious and stress tests are widely used to assess functional capacity, prognosis and effectiveness of therapeutic interventions in this syndrome. OBJECTIVE: To evaluate the reproducibility of the six-minute walk test (6MW) in patients with HF and correlate the magnitude of the variables reached at peak exercise of the 6MWT with a cardiopulmonary exercise test (CPET). METHODS: We studied 16 patients (12 men and 4 women) diagnosed with HF FC I-II (NYHA). The volunteers underwent two 6MWT (6MWT'1 and 6MWT'2) with 30-minute interval between them; then, they underwent a maximum CPET. RESULTS: All variables obtained in the two 6MWT' proved to be significant with high correlations: distance walked (DW) (r = 0.93, p < 0.0001), heart rate (HR) (r = 0.89, p < 0.0001), oxygen consumption (VO2) (r = 0.93, p < 0.0001) and scale of perceived exertion (r = 0.85, p < 0.0001). In turn, all variables analyzed in the 6MWT' showed significant and moderate correlations with the variables obtained from the CPET, namely: peak HR (r = 0.66; p = 0.005); VO2 (r = 0.57; p = 0.02) and VO2 in the CPET and DT in the 6MWT'2 (r = 0.70; p = 0.002). CONCLUSION: The 6MWT was reproducible in this group of patients with HF (NYHA - I-II) and correlated with the CPET. Therefore, it is a tool for reliable evaluation, and a suitable, safe and low-cost alternative for the prescription of aerobic exercise in patients with HF.
Assuntos
Teste de Esforço , Insuficiência Cardíaca/fisiopatologia , Idoso , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo , Caminhada/fisiologiaRESUMO
OBJECTIVE: To evaluate the acute effect of physiotherapy (deep breathing exercises and walking) on heart rate variability in patients hospitalised with chronic heart failure (CHF). DESIGN: Ten males with CHF (57â±â7 years) and 10 healthy controls (59â±â9 years) were included. Heart rate and RR intervals were recorded in the following conditions: supine, seated, during deep breathing exercises and during and after walking. Heart rate variability was analysed by linear and non-linear methods (α2, Mean HR, rMSSD, SDNN and ApEn). RESULTS: Patients presented significantly lower SDNN (12.4â±â4 versus 26â±â8 ms), rMSSD (18.2â±â16.2 versus 25â±â19.5 ms) and ApEn (9.9â±â10 versus 16.68â±â22.6) during the walking compared to controls (pâ<â0.05). In addition, mean HR was significantly higher during and after walking for patients with CHF compared to controls (103â±â8 versus 80â±â2 bpm and 90â±â9 versus 68â±â2 bpm, respectively). Patients with CHF demonstrated a significant reduction of α2 during deep breathing (0.78â±â0.1) when compared to the seated position (1.08â±â0.1) and walking (1.15â±â0.2, pâ<â0.05). Additionally, rMSSD index increased during deep breathing when compared to walking in both groups. CONCLUSION: Deep breathing exercises and walking are safe and promote beneficial effects on heart rate variability in patients hospitalised for CHF.
Assuntos
Insuficiência Cardíaca/reabilitação , Frequência Cardíaca/fisiologia , Consumo de Oxigênio/fisiologia , Respiração , Caminhada , Idoso , Antropometria , Sistema Nervoso Autônomo/fisiologia , Determinação da Pressão Arterial , Estudos de Casos e Controles , Doença Crônica , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Mecânica Respiratória , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
A função neuro-regulatória do coração tem sidoinvestigada por meio da variabilidade da frequência cardíaca (VFC)em pacientes com insufi ciência cardíaca crônica (ICC), entretanto,pouco é sabido sobre as repostas fi siológicas e da VFC nestes pacientesem ambiente hospitalar (fase I). Objetivo: Avaliar as respostasfi siológicas e da VFC durante uma sessão de fi sioterapia na fase I emum paciente com ICC. Métodos: Foi avaliado um homem (54 anos),após estabilidade clínica do quadro de descompensação. O registroda frequência cardíaca (FC) foi realizado nas condições supina esentada, exercícios respiratórios (ER), deambulação e recuperação.A VFC foi analisada nos domínios do tempo e da frequência. Resultados:Foi observado aumento das respostas fi siológicas e reduçãoda VFC frente a deambulação e aumento durante os exercíciosrespiratórios. No entanto, na mudança postural houve aumento daatividade parassimpática. Conclusão: Uma sessão de fi sioterapia podeproduzir respostas fi siológicas e ajustes na modulação autonômicada FC neste paciente com ICC...
The neuro-regulatory cardiac autonomic functionhas been investigated by heart rate variability (HRV) in patients withchronic heart failure (CHF); however, little is known about the physiologicand HRV responses during one session of physical therapyin phase I in CHF patients. Objective: To evaluate the physiologicand HRV responses during one session of physical therapy in phaseI in CHF patient. Methods: one man (54 years) after clinical stabilityof CHF decompensation was evaluated. Th e heart rate records wereperformed in the following conditions: supine and seated position,respiratory exercises, walking and recovery. Th e HRV was analyzedin time and frequency domains. Results: We observed an increase ofphysiologic responses and a reduction of HRV during walking andan increase of HRV during respiratory exercise. However, an increaseof parasympathetic activity after postural change was noticed.Conclusion: A session of physical therapy may produce physiologicresponses and autonomic modulation of heart rate adjustments inthis patient with CHF...
Assuntos
Humanos , Especialidade de Fisioterapia , Insuficiência Cardíaca , ReabilitaçãoRESUMO
Modelo do estudo: Retrospectivo. Objetivos do estudo: Avaliar o efeito do treinamento físico aeróbico nas variáveis cardiovasculares em pacientes coronariopatas participantes do Programa de Reabilitação Cardiovascular. Metodologia: Foram incluídos pacientes portadores de coronariopatia estável e foram avaliadas as variáveis cardiovasculares de testes ergométricos seriados, realizados antes e após um período mínimo de 12 semanas de treinamento físico aeróbico em um Programa de Reabilitação Cardiovascular, de fevereiro de 2002 a julho de 2005. Resultados: Documentou-se incremento significativo (p < 0,0001) do consumo de oxigênio pico(VO2 pico) após a reabilitação cardiovascular (30,1 ± 9,5 versus 35,5 ± 8,8 ml/kg/min). Este delta do VO2 pico apresentou correlação negativa com a capacidade física inicial, com maiores ganhos nos pacientes com menores valores iniciais de VO2 pico. Não foram observadas diferenças significativas na pressão arterial sistólica e no duplo produto pico, e uma diferença de pequena magnitude foi observada na freqüência cardíaca pico. A melhora no limiar isquêmico do miocárdio, avaliada pelo consumo de oxigênio na positivação, foi ainda mais expressiva, com incremento de 7,4 ml/kg/min (p < 0,0001) (21,0 ± 6,9 versus 28,4 ± 8,2 ml/kg/min). Conclusões: A reabilitação cardiovascular melhorou a capacidade física e o limiar isquêmico de pacientes participantes do Programa de Reabilitação Cardiovascular. O benefício na capacidade física foi maior nos pacientes com menores valores iniciais de consumo de oxigênio pico.
Study model: Retrospective. Study objectives: Evaluate the effect of aerobic physical training in cardiovascular variables in patients with coronary artery disease participants of a Cardiovascular Rehabilitation Program. Methods: Patients with stable coronary artery disease were included and were analyzed the cardiovascular variables of exercise testing, carried out before and after a minimum period of 12 weeks of aerobic physical training in a Cardiovascular Rehabilitation Program, from February 2002 to July 2005. Results: A significant increment (p <0.0001) of maximal oxygen consumption (VO2 max) was observed after the cardiovascular rehabilitation (30.1 ± 9.5 versus 35.5 ± 8.8 ml/kg/min). The difference of the VO2 max had negative correlation with the initial physical capacity, with greater benefits in patients with smaller initial values of VO2 max. Significant differences were not observed in maximal systolic blood pressure and double product, and a small difference was observed in maximal heart rate. The improvement in ischemic threshold was more pronounced, with an increment of 7.4 ml/kg/min in oxygen consumption, with statistical significance (p < 0.0001) (21.0 ± 6.9 versus 28.4 ± 8.2 ml/kg/min). Conclusions: The cardiovascular rehabilitation improved physical capacity and ischemic thresholdin patients participants of a Cardiovascular Rehabilitation Program. The benefit in physical capacity was greater in patients with smaller initial values of maximal oxygen consumption.