RESUMO

A reabilitação cardiovascular (RCV) é um componente essencial do tratamento não farmacológico para cardiopatas, utilizada para modificar fatores de risco cardiovascular e melhorar a tolerância ao exercício físico. Relatar o caso de um paciente com cardiomiopatia isquêmica, submetido à cirurgia de revascularização do miocárdio e inserido em um programa de RCV, descrevendo as mudanças em seu desempenho físico e qualidade de vida ao longo de três anos de acompanhamento. Um paciente de 68 anos, após a revascularização do miocárdio e participação na RCV, apresentou uma melhora significativa na capacidade cardiorrespiratória. Isso foi evidenciado pelo aumento da distância percorrida no Teste de Caminhada de Seis Minutos (TC6M) (de 490 ± 70 para 846 ± 8 metros) e pela redução na média das frequências cardíacas basais (de 70 ± 8 para 52 ± 2 batimentos por minuto), além da diminuição da dose de betabloqueadores. A análise dos resultados do TC6M e do questionário SF-36 revelou melhorias no desempenho físico e uma boa qualidade de vida, respectivamente. Os resultados ressaltam a importância da RCV como parte integrante do tratamento para pacientes com doença isquêmica do coração, demonstrando a redução da carga farmacológica e a melhoria na capacidade cardiorrespiratória.

Cardiovascular rehabilitation (CR) is an essential component of non-pharmacological treatment for heart disease patients, used to modify cardiovascular risk factors and improve exercise tolerance. This report presents the case of a patient with ischemic cardiomyopathy who underwent coronary artery bypass surgery and participated in a CR program, describing the changes in their physical performance and quality of life over three years of follow-up. A 68-year-old patient, following coronary artery bypass surgery and participation in CR, showed significant improvement in cardiorespiratory capacity. This was evidenced by an increase in the distance covered during the Six-Minute Walk Test (6MWT) (from 490 ± 70 to 846 ± 8 meters) and a reduction in the average resting heart rate (from 70 ± 8 to 52 ± 2 beats per minute), along with a decrease in the dose of beta-blockers. The analysis of 6MWT results and the SF 36 questionnaire revealed improvements in physical performance and good quality of life, respectively. The results highlight the importance of CR as an integral part of treatment for patients with ischemic heart disease, demonstrating a reduction in pharmacological load and an improvement in cardiorespiratory capacity.

RESUMO

ABSTRACT Introduction: The Pilates method (PM) combines slow-deep breathing with strengthening and stretching exercises. However, it has been proposed as a method of physical conditioning for several decades and only recently aroused academic/scientific interest, with few reports of the effects of this intervention in hypertensive patients. Objective: to compare PM to aerobic training (AT) effects on hypertensive subjects' blood pressure (BP), functional capacity and autonomic balance. Methods: Twenty-four hypertensive subjects were randomly allocated into two groups: ATG performed three 40 min sessions/week, moderate intensity (40-70% of reserve HR), and PMG performed two 60 min sessions/week; both during the same eight weeks period. Blood pressure (casual and for 24 hours), 6-minute walking test (6-MWT) and autonomic balance were evaluated before and after intervention. Results: There was a reduction on systolic BP (SBP, p=0.007), diastolic (p=0.032) and mean blood pressure (MBP, p=0.016), measured on 24h, on PMG. There was also a 24h SBP reduction on ATG (p=0.021). The PMG had a greater reduction on 24h SBP (-3.4 mmHg, 95% CI -6.6 to -0.2) and MBP (-3.3 mmHg, 95% CI -6.3 to -0.3) than the ATG. ATG held a longer distance in 6-MWT. Casual BP and autonomic balance had no difference. Conclusion: This PM protocol was superior to AT on BP monitored for 24 hours in hypertensive subjects, but AT was better for functional capacity. The eight weeks of training were not enough to change the autonomic balance. Level of Evidence: I; High-quality randomized clinical trial with or without statistically significant difference, but with narrow confidence intervals.

RESUMEN Introducción: el método Pilates (MP) combina la respiración lenta-profunda con ejercicios de fortalecimiento y estiramiento. Aunque se ha propuesto como un método de acondicionamiento físico durante varias décadas, solo recientemente despertó interés académico/científico, con pocos reportes de los efectos de esta intervención en pacientes hipertensos. Objetivo: comparar los efectos del MP con el entrenamiento aeróbico (EA) sobre la presión arterial (PA), la capacidad funcional y el equilibrio autónomo en sujetos hipertensos. Métodos: Veinticuatro sujetos hipertensos fueron asignados aleatoriamente en dos grupos: GEA realizó tres sesiones de 40 min/semana, intensidad moderada (40-70% de la FC de reserva), y GMP realizó dos sesiones de 60 min/semana; ambos durante el mismo período de 8 semanas. La presión arterial (casual y durante 24 horas), la prueba de marcha de 6 minutos y el equilibrio autonómico se evaluaron antes y después de la intervención. Resultados: Hubo una reducción de la PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) y presión arterial media (PAM, p = 0,016), medida a las 24 h, en GMP. También hubo una reducción de PAS en 24 h en GEA (p = 0,021). El GMP tuvo una mayor reducción en la PAS de 24 h (-3,4 mmHg, CI del 95%: -6,6 a -0,2) y la PAM (-3,3 mmHg, CI del 95%: -6,3 a -0,3) que la GEA. GEA mantuvo una mayor distancia en la prueba de marcha de 6 minutos. La PA casual y el equilibrio autónomo no tuvieron diferencias. Conclusión: Este protocolo de MP fue superior al EA en la PA monitoreada durante 24 horas en sujetos hipertensos, pero el EA fue mejor para la capacidad funcional. Las ocho semanas de entrenamiento no fueron suficientes para cambiar el equilibrio autonómico. Nivel de Evidencia: I; Estudio clínico aleatorizado de alta calidad con o sin diferencia estadísticamente significativa, pero con intervalos de confianza estrechos.

RESUMO Introdução: O método Pilates (MP) combina respiração lenta e profunda com exercícios de fortalecimento e alongamento. Embora tenha sido proposto como método de condicionamento físico por várias décadas, só recentemente despertou-se o interesse acadêmico/científico, com poucos relatos dos efeitos dessa intervenção em hipertensos. Objetivos: comparar os efeitos do MP com o treinamento aeróbio (TA) sobre a pressão arterial (PA), capacidade funcional e equilíbrio autonômico em hipertensos. Métodos: Vinte e quatro hipertensos foram alocados aleatoriamente em dois grupos: O grupo GTA realizou três sessões de 40 min/semana, intensidade moderada (40-70% da FC de reserva), e o grupo GMP, que realizou duas sessões de 60 min/semana; ambos durante o mesmo período de 8 semanas. A pressão arterial (casual e após 24 horas), o teste de caminhada de 6 minutos (TC6) e o equilíbrio autonômico foram avaliados antes e depois da intervenção. Resultados: Houve redução da PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) e da pressão arterial média (PAM, p = 0,016), medida em 24h, sem GMP. Também houve redução da PAS em 24h no GTA (p = 0,021). O GMP teve uma redução maior em 24h PAS (-3,4 mmHg, IC 95% -6,6 a -0,2) e PAM (-3,3 mmHg, IC 95% -6,3 a -0,3) do que o GTA. O GTA manteve uma maior distância no TC6. A PA casual e o equilíbrio autonômico não apresentaram diferenças estatísticas. Conclusão: Este protocolo de MP foi superior ao TA na PA monitorada por 24 horas em hipertensos, porém o TA foi superior para a capacidade funcional. As oito semanas de treinamento não foram suficientes para alterar o equilíbrio autonômico. Nível de Evidência: 1; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significativa, mas com intervalos de confiança estreitos.

RESUMO

Abstract Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

resumen está disponible en el texto completo

RESUMO

La COVID-19 representa una emergencia internacional por los crecientes números de contagiados y fallecidos a nivel mundial. Los pacientes recuperados pueden sufrir afectaciones y secuelas respiratorias, cardiacas y neurológicas, lo que afecta su calidad de vida. El objetivo de este artículo consistió en reconstruir los protocolos de rehabilitación y fisioterapia respiratoria, cardiovascular, neurológica y neuromuscular para pacientes afectados por COVID-19, a partir de evidencias científicas reportadas. Para ello, se realizó una revisión bibliográfica en las principales bases de datos internacionales (PubMed, SciELO, Google Académico, ente otras). Para la búsqueda se utilizaron las palabras claves: COVID-19, síndrome de distrés respiratorio agudo, fisioterapia, rehabilitación respiratoria, Rehabilitación cardiovascular, rehabilitación neuromuscular y neurológica, en inglés y en español. Estos protocolos atribuyen mejorías significativas de las secuelas y en la calidad de vida de los pacientes. Se recomiendan ejercicios de fisioterapia respiratoria en posición decúbito-prono, entrenamiento de músculos inspiratorios, ejercicios aeróbicos y entrenamiento moderado de fuerza muscular. Los resultados de la aplicación de estos protocolos son satisfactorios en la recuperación de los pacientes.

A COVID-19 representa uma emergência internacional devido ao número crescente de pessoas infectadas e falecidas em todo o mundo. Os pacientes recuperados podem sofrer efeitos e sequelas respiratórias, cardíacas e neurológicas, o que afeta sua qualidade de vida. O objetivo deste artigo foi reconstruir os protocolos de reabilitação respiratória, cardiovascular, neurológica e neuromuscular e de fisioterapia para pacientes afetados pela COVID-19, com base em evidências científicas relatadas. Para tanto, foi realizada uma revisão bibliográfica nas principais bases de dados internacionais (PubMed, SciELO, Google Scholar, entre outras). As palavras-chave foram utilizadas para a busca: COVID-19, síndrome do desconforto respiratório agudo, fisioterapia, reabilitação respiratória, reabilitação cardiovascular, reabilitação neuromuscular e neurológica, nos idiomas inglês e espanhol. Esses protocolos atribuem melhorias significativas nas sequelas e na qualidade de vida dos pacientes. São recomendados exercícios de fisioterapia respiratória em posição prona, treinamento muscular inspiratório, exercícios aeróbicos e treinamento moderado de força muscular. Os resultados da aplicação desses protocolos são satisfatórios na recuperação dos pacientes.

The COVID-19 represents an international emergency due to the increasing numbers of infected and deceased people worldwide. Recovered patients may suffer respiratory, cardiac and neurological effects and sequelae, which affects their quality of life. The objective of this article was to reconstruct the respiratory, cardiovascular, neurological and neuromuscular rehabilitation and physiotherapy protocols for patients affected by COVID-19, based on reported scientific evidence. For it, a bibliographic review was carried out in the main international databases (PubMed, sciELO, Google Scholar, among others). The key words were used for the search: COVID-19, acute respiratory distress syndrome, physiotherapy, respiratory rehabilitation, cardiovascular rehabilitation, neuromuscular and neurological rehabilitation, in English and Spanish. These protocols attribute significant improvements in sequelae and in the quality of life of patients. Respiratory physiotherapy exercises in the prone position, inspiratory muscle training, aerobic exercises and moderate muscle strength training are recommended. The results of the application of these protocols are satisfactory in the recovery of patients.

RESUMO

Introduction: In Mexico, cardiac rehabilitation (CR) as an interdisciplinary intervention with therapeutic impact in patients with heart disease is growing. There is the need to know actual conditions of CR in our country. Objectives: The objective of this National Registry is to follow-up those existing and new CR units in Mexico through the comparison between the two previous registries, RENAPREC-2009 and RENAPREC II-2015 studies. This is a descriptive study focused on diverse CR activities such as assistance training, and certification of health professionals, barriers, reference, population attended, interdisciplinarity, permanence over time, growth prospects, regulations, post-pandemic condition, integrative characteristics, and scientific research. Results: Data were collected from 45 CR centers in the 32 states, 75.5% are private practice units, 67% are new, 33% were part of RENAPREC II-2015, and 17 have continued since 2009. With a better distribution of CR units along the territory, the median reference of candidates for CR programs is 9% with a significant reduction into tiempo of enrollment to Phase II admission (19 ± 11 days). Regarding to previous registries, the coverance of Phases I, II, and III is 71%, 100%, and 93%, respectively; and a coverance increases in evaluation, risk stratification, and prescription, more comprehensive attendance and prevention strategies. Conclusions: CR in Mexico has grown in the past 7 years. Even there is still low reference and heterogeneity in specific processes, there are strengths such as interdisciplinarity, scientific professionalization of specialists, national diversification, and an official society that are consolidated over time.

Introducción: En México, la Rehabilitación Cardíaca (RC) como intervención interdisciplinaria con impacto terapéutico en paciente con cardiopatía está en crecimiento. Existe la necesidad de conocer las condiciones actuales de la RC en nuestro país. Objetivo: El objetivo de este Registro es dar seguimiento comparativo de las unidades nuevas y existentes entre los registros anteriores, RENAPREC-2009 y RENAPREC II-2015. Se trata de un estudio descriptivo centrado en diversas actividades de la RC: formación asistencial y certificación de sus profesionales, barreras, referencia, población atendida, interdisciplinariedad, permanencia en el tiempo, perspectivas de crecimiento, normativa, condición pospandemia, características integradoras e investigación. Resultados: Se recolectaron datos de 45 centros en los 32 estados, 67% son nuevos 75.5% son de práctica privada, 33% fueron parte de RENAPREC II-2015 y 17 desde 2009. Con una mejor distribución de las unidades de RC a lo largo del territorio, la mediana de referencia de pacientes candidatos a RC es ahora del 9% con reducción significativa del tiempo de admisión a Fase II (19 ± 11 días). Respecto a registros anteriores las coberturas de las Fases I, II y III son del 71%, 100% y 93%, respectivamente; con un aumento de la cobertura en evaluación, estratificación de riesgo y prescripción, atención más integral y estrategias de prevención. Conclusiones: La RC en México ha crecido en los últimos 7 años. Si bien aún existe baja referencia y heterogeneidad en procesos específicos, existen fortalezas como la interdisciplinariedad, la profesionalización científica de los especialistas, la diversificación nacional y una sociedad oficial que se consolida en el tiempo.

RESUMO

Cardiovascular diseases represent the leading cause of death worldwide. Thus, cardiovascular rehabilitation programs are crucial to mitigate the deaths caused by this condition each year, mainly in patients with coronary artery disease. COVID-19 was not only a challenge in this area but also an opportunity to open remote or hybrid versions of these programs, potentially reducing the number of patients who leave rehabilitation programs due to geographical/time barriers. This paper presents a method for building a cardiovascular rehabilitation prediction model using retrospective and prospective data with different features using stacked machine learning, transfer feature learning, and the joint distribution adaptation tool to address this problem. We illustrate the method over a Chilean rehabilitation center, where the prediction performance results obtained for 10-fold cross-validation achieved error levels with an NMSE of 0.03±0.013 and an R2 of 63±19%, where the best-achieved performance was an error level with a normalized mean squared error of 0.008 and an R2 up to 92%. The results are encouraging for remote cardiovascular rehabilitation programs because these models could support the prioritization of remote patients needing more help to succeed in the current rehabilitation phase.

RESUMO

Background: To describe the average effects and the interindividual variability after a comprehensive outpatient cardiovascular rehabilitation (CCR) program using concurrent exercise training prescribed according to cardiovascular risk stratification on cardiorespiratory fitness (CRF), anthropometric/body composition, quality of life and emotional health in patients of four cardiovascular disease profiles. Methods: CRF, anthropometric/body composition, quality of life, and emotional health were measured before and after a CCR and analyzed in heart valve surgery (HVS), heart failure with reduced ejection fraction (HFrEF), post-acute myocardial infarction (post-AMI), and in coronary artery disease (CAD) patients. Twenty, twenty-four, and thirty-two exercise sessions were prescribed according to mild, moderate, and severe baseline cardiovascular risk, respectively. In addition to concurrent exercise training, nutritional counseling, psychological support, and lifestyle education programs were performed. Results: The main outcomes by delta changes comparisons (Δ) revealed no significant differences at anthropometric/body composition as ΔBody fat decreases (HVS Δ−1.1, HFrEF Δ−1.0, post-AMI Δ−1.4, CAD Δ−1.2 kg) and ΔSkeletal muscle mass increases (HVS Δ+1.4, HFrEF Δ+0.8, post-AMI Δ+0.9, CAD Δ+0.9 kg), and CRF performance as ΔVO2peak increases (HVS Δ+4.3, HFrEF Δ+4.8, post-AMI Δ+4.1, CAD Δ+5.1 mL/kg/min) outcomes among HVS, HFrEF, post-AMI, and CAD (p > 0.05). Secondary outcomes showed significant pre-post delta changes in METs (HVS Δ+1.8, HFrEF Δ+0.7, post-AMI Δ+1.4, CAD Δ+1.4), and maximal O2pulse (HVS Δ+3.1, post-AMI Δ+2.1, CAD Δ+1.9). In addition, quality of life had a significant improvement in physical functioning (HVS Δ+17.0, HFrEF Δ+12.1, post-AMI Δ+9.8, CAD Δ+11.2), physical role (HVS Δ+28.4, HFrEF Δ+26.8, post-AMI Δ+25.6, CAD Δ+25.3), vitality (HVS Δ+18.4, HFrEF Δ+14.3, post-AMI Δ+14.2, CAD Δ+10.6) and social functioning (HVS Δ+20.4, HFrEF Δ+25.3, post-AMI Δ+20.4, CAD Δ+14.8) in all cardiovascular disease. For anxiety (HVS Δ−3.6, HFrEF Δ−2.3, post-AMI Δ−3.0, CAD Δ−3.1) and depression (HVS Δ−2.8, HFrEF Δ−3.4, post-AMI Δ−3.2, CAD Δ−2.3) significant changes were also observed. Conclusions: A CCR program that prescribes the number of exercise sessions using a cardiovascular risk stratification improves CRF, QoL, and emotional health, and the average results show a wide interindividual variability (~25% of non-responders) in this sample of four CVD profile of patients.

Assuntos

RESUMO

RESUMEN La diabetes mellitus tipo 2 se asocia a un incremento del riesgo de mortalidad por enfermedad cardiovascular y es una afección frecuente dentro de los pacientes con enfermedad cardiovascular establecida. El tratamiento adecuado permite mejorar la calidad de vida del paciente y disminuir la morbilidad y la mortalidad por esta y otras causas. La rehabilitación cardiovascular ha demostrado ser una terapéutica eficaz y beneficiosa en los pacientes con diabetes mellitus tipo 2. Por eso, se revisaron 70 referencias bibliográficas con el objetivo de describir elementos importantes sobre su tratamiento, que incluye estrategias farmacológicas, no farmacológicas y la rehabilitación cardiovascular.

ABSTACT Type 2 diabetes mellitus is associated with an increased risk of mortality from cardiovascular disease and it is a common condition within patients with established cardiovascular disease. Appropriate treatment can improve the patient's quality of life and decrease morbidity and mortality from this and other causes. Cardiovascular rehabilitation has been shown to be an effective and beneficial therapy in patients with type 2 diabetes mellitus. For this reason, 70 bibliographic references were reviewed with the aim of describing important elements of its treatment, which includes pharmacological and non-pharmacological strategies and cardiovascular rehabilitation.

RESUMO

Physical training can increase peak oxygen uptake (VO2peak) in people who have suffered acute myocardial infarction (AMI). However, there is still a gap in the literature in relation to the effectiveness of different types of interventions. Therefore, the aim of the present study was to evaluate the effects of different physical training modalities on VO2peak in post-AMI patients. The following databases were used: PubMed (MEDLINE), Cochrane Library, Scopus, and Pedro. Studies that evaluated aerobic exercise, strength exercise, or combined exercise were included. Six studies met eligibility criteria. Aerobic exercise increased VO2peak by 6.07 ml.kg-1.min-1 when compared to the control group (CG) (p = 0.013). The comparison between combined exercise and control group detected a difference of 1.84 ml.kg-1.min-1, but this was not significant (p = 0.312). We therefore conclude that aerobic exercise is the only modality that is effective for increasing VO2peak compared to a control group.

RESUMO

| INTRODUÇÃO: As repercussões cardiorrespiratórias da cirurgia cardíaca podem ser avaliadas por teste submáximo. OBJETIVO: comparar as respostas cardiorrespiratórias do teste de sentar e levantar em um minuto (TSL1) nos indivíduos, entre o momento pré e pós de cirurgia cardíaca. MÉTODOS: Estudo de caráter transversal e analítico, incluiu 45 indivíduos de ambos os sexos, estáveis hemodinamicamente, com fração de ejeção maior que 45%, que foram submetidos à cirurgia de revascularização do miocárdio no Instituto do Coração de um Hospital do interior do estado do Rio Grande do Sul, entre 2018 e 2019. As variáveis de desfechos foram coletadas no repouso e ao final do teste, um dia antes da cirurgia e no pós-operatório: pressão arterial sistólica e diastólica (PAS e PAD em mmHg), frequência cardíaca (FC bpm), frequência respiratória (FR rpm), saturação periférica de oxigênio (SpO2 %), fadiga de membros inferiores (Fmm 0-10) e dispneia (Di 0-10), número de repetições e interrupções do teste. Foi utilizado o programa R para o tratamento dos dados, para avaliar a normalidade foi aplicado o teste de Shapiro Wilk, a comparação dos grupos pelo teste não paramétrico de Wilcoxon. RESULTADOS: A maioria do sexo masculino (71%) e média de idade foi de 61± 9 anos. No pré-operatório, ocorreu aumento entre o repouso e o final do teste, PAS, FC, FR, Fmm e Di (p<0,05). No pós-operatório, houve aumento entre o repouso e o final do teste, para FC, FR, Fmm e Di (P<0,05), contudo, sem elevação da PAS. Ao comparar as variáveis entre os momentos pré e pós, observamos maiores valores da FC, FR e número de interrupções na condição pós (p<0,05), bem como menores valores para a PAS, SpO2 e número de repetições (p<0,05) para essa condição. CONCLUSÃO: Os dados desta pesquisa comprovam que o TSL1 realizado no pré-operatório de cirurgia cardíaca, assim como entre o 4° ou 5° dia de pós-cirurgia cardíaca, é seguro e eficaz, representado pela ausência das repercussões cardiorrespiratórias que comprometessem ou agravassem o quadro clínico do paciente. O TSL1 foi capaz de induzir respostas cardiorrespiratórias fisiológicas no pré-operatório; contudo, na condição pós acarretou respostas cardiorrespiratórias mais elevadas no repouso e atenuada resposta em exercício em comparação ao pré-operatório.

INTRODUCTION: The cardiorespiratory repercussions of heart surgery can be assessed through submaximal testing. OBJECTIVE: Compare cardiorespiratory responses to the one-minute sit-and-stand test in individuals pre- and post-heart surgery. METHODS: An analytical, cross-sectional study was conducted involving 45 hemodynamically stable male and female patients with an ejection fraction greater than 45% submitted to coronary artery bypass surgery at a cardiology service of a hospital in the interior of the state of REDACTED between 2018 and 2019. The following variables were collected at rest and the end of the test one day before surgery and postoperatively: systolic and diastolic blood pressure (SBP and DBP, mmHg), heart rate (HR, bpm), respiratory rate (RR, rpm), peripheral saturation oxygen (SpO2, %), lower limb fatigue (LLF, 0-10), dyspnea (0-10), number of test repetitions and number of interruptions. The R program was used to process the data. The Shapiro-Wilk test was used for the determination of normality. The groups were compared using the non-parametric Wilcoxon test. RESULTS: Most participants were male (71%), and the mean age was 61±9 years. In the preoperative period, statistically significant increases (p≤0.05) were found for SBP, HR, RR, LLF, and dyspnea between resting values and the end of the test. Significant increases (p≤0.05) were found in the postoperative period for HR, RR, LLF, and dyspnea between rest and the end of the test, with no increase in SBP. Comparing the preoperative and postoperative evaluations variables, higher HR, RR, the number of interruptions and lower SBP, SpO2, and the number of repetitions were found after surgery (p≤0.05). CONCLUSION: The one-minute sit-to-stand test induced physiological cardiorespiratory responses in the preoperative evaluation. However, higher cardiorespiratory responses at rest and an attenuated response to exercise were found in the postoperative evaluation compared to the preoperative evaluation.

Assuntos

RESUMO

Introducción: Por lo general los pacientes con antecedentes de cardiopatía isquémica no quieren renunciar a una actividad física o deportiva; por otra parte, es indudable que pueden beneficiarse de un plan de ejercicio físico que promueva una mejor calidad de vida. Objetivo: Evaluar la capacidad funcional de pacientes con cardiopatía isquémica rehabilitados con terapia física, según el trazado ergométrico. Métodos: Se realizó un estudio descriptivo longitudinal y prospectivo en el Servicio de Terapia Física y Rehabilitación del Hospital General Docente Dr. Juan Bruno Zayas de Santiago de Cuba durante el bienio 2017-2019, de 41 pacientes que habían padecido un infarto agudo de miocardio y fueron incluidos en un programa de rehabilitación cardiovascular. Para determinar la capacidad funcional se comparó el nivel de riesgo cardiovascular y la clase funcional, antes y después de aplicado el programa de ejercicios físicos. Resultados: Se logró modificar la respuesta a la prueba ergométrica en 87,8 % después de aplicado el programa de rehabilitación, en tanto el estado cardiovascular, según el nivel de riesgo de los pacientes, fue modificado en 68,2 % hacia el bajo riesgo y la capacidad funcional mostró una mejoría en 82,9 %. Conclusiones: La aplicación de un programa de rehabilitación cardíaca resultó útil en la mayoría de los pacientes, pues se obtuvo una mejoría significativa de los parámetros cardiovasculares evaluados, lo que apuntó a un restablecimiento de la calidad de vida y de la tolerancia al esfuerzo.

Introduction: Patients with a history of ischemic cardiopathy generally don´t want to abandon a physical or sport activity; on the other side, they can undoubtedly obtain benefits from a physical exercise plan which brings a better life quality. Objective: To evaluate he functional capacity of patients with ischemic cardiopathy who have been rehabilitated with physical therapy, according to the ergometric trace. Method: A descriptive, longitudinal and prospective study was carried out in the Physical Therapy and Rehabilitation Service from Dr. Juan Bruno Zayas Teaching in Santiago de Cuba during the biennium 2007-2019, in 41 patients who had suffered from a myocardial infarction and were included in a cardiovascular rehabilitation program. To determine the functional capacity, the cardiovascular risk level was compared to the functional class before and after the physical exercise. Results: It was achieved to modify the ergometric response in 87.8 % after applying the rehabilitation program, while the cardiovascular state according to the risk level of the patients was modified in 68.2 % towards the low risk and the functional capacity showed an improvement of 82.9 %. Conclusions: The implementation of a cardiac rehabilitation program was useful in most of the patients, and a significant improvement of the evaluated cardiovascular parameters was obtained, what pointed at a reestablishment of the life quality and of tolerance to efforts.

Assuntos

RESUMO

RESUMEN La diabetes mellitus tipo 2 constituye una de las enfermedades crónicas con mayor prevalencia a nivel mundial y se asocia a múltiples factores de riesgo cardiovascular y a un incremento del riesgo de mortalidad por enfermedad cardiovascular. Se revisaron 58 referencias bibliográficas con el objetivo de describir elementos importantes para la estratificación del riesgo cardiovascular y en el tratamiento de algunos factores de riesgo en los pacientes con esta enfermedad.

ABSTRACT Type 2 diabetes mellitus is one of the most prevalent chronic diseases worldwide. It is associated with a number of cardiovascular risk factors and an increased risk of mortality due to cardiovascular disease. We reviewed 58 bibliographic references in an attempt to describe important elements for cardiovascular risk stratification and management of some risk factors in patients with type 2 diabetes mellitus.

RESUMO

RESUMEN Introducción: La coexistencia de la enfermedad arterial periférica en pacientes con síndrome coronario agudo afecta la calidad de vida relacionada con la salud; la rehabilitación cardiovascular es una herramienta eficaz para el tratamiento de ambas enfermedades. Objetivo: Evaluar la calidad de vida relacionada con la salud según el cuestionario EQ-5D, antes y después de la rehabilitación. Método: Se estudiaron 484 pacientes egresados de la sala de cuidados coronarios con diagnóstico de síndrome coronario agudo, a los que se les realizó el diagnóstico de enfermedad arterial periférica mediante índice tobillo-brazo después del ejercicio y se incorporaron a la rehabilitación cardiovascular, en el período comprendido del 1 de marzo de 2011 al 30 de febrero de 2018. Se evaluó su calidad de vida mediante el cuestionario EQ-5D, antes y después de la rehabilitación. Se utilizó el coeficiente de correlación de Pearson para variables cuantitativas, y la prueba no paramétrica de Wilcoxon para contrastar la hipótesis de igualdad entre dos medianas poblacionales en variables ordinales y de intervalo. Resultados: Las dimensiones evaluadas mediante el cuestionario de calidad de vida EQ-5D reflejan una correlación positiva entre la distancia caminada sin dolor y el tiempo de ejercicio, con los resultados de la escala EQ-5D como expresión de los beneficios de la rehabilitación. Conclusiones: La rehabilitación cardiovascular mejoró la calidad de vida de los pacientes con enfermedad arterial periférica y síndrome coronario agudo.

ABSTRACT Introduction: The coexistence of peripheral artery disease in patients with acute coronary syndrome affects health-related quality of life. Cardiac rehabilitation is an effective tool for the treatment of both diseases. Objective: To assess health-related quality of life according to the EQ-5D questionnaire before and after rehabilitation. Methods: A total of 484 patients discharged from the coronary care unit with a diagnosis of acute coronary syndrome were studied. They were diagnosed with peripheral artery disease by ankle-brachial index test and started cardiac rehabilitation from March the 1st, 2011 to February the 30th, 2018. Their quality of life was assessed using the EQ-5D questionnaire before and after rehabilitation. The Pearson correlation coefficient was employed for quantitative variables and the Wilcoxon nonparametric test was utilized to contrast the hypothesis of equality between two population medians in ordinal and interval variables. Results: The dimensions assessed by the EQ-5D quality of life questionnaire show a positive correlation between pain-free walking distance and exercise time with the results of the EQ-5D score, thus demonstrating the benefits of rehabilitation. Conclusions: Cardiac rehabilitation improved the quality of life of patients with peripheral artery disease and acute coronary syndrome.

RESUMO

RESUMEN Introducción: La rehabilitación cardiovascular es una reconocida estrategia de prevención secundaria para el tratamiento de numerosas cardiopatías. Es una herramienta multicomponente donde se incluyen la educación en un estilo de vida saludable, control de los factores de riesgo, asesoramiento en aspectos psicosociales y la prescripción supervisada del ejercicio físico. Numerosos ensayos clínicos, revisiones sistemáticas y metaanálisis han demostrado su eficacia y seguridad. Sin embargo, sigue siendo una herramienta subutilizada. Existen datos descriptivos de cómo se lleva a cabo la rehabilitación cardiovascular y las características de los centros que la implementan de varios países europeos y de Norteamérica. A nivel sudamericano en su conjunto, contamos con datos reportados en el año 2014 y otros provenientes de Brasil, Colombia y Uruguay. Pero existen escasos datos provenientes de nuestro país, por ello el objetivo de este estudio se centró en conocer la situación actual de los programas de rehabilitación cardiovascular en Argentina. Material y métodos: Se trata de un estudio descriptivo, realizado por medio de un cuestionario virtual que evalúa la estructura y características de los programas de rehabilitación de nuestro país y las potenciales barreras para una rehabilitación eficiente. Resultados: Respondieron 72 centros. Los principales resultados muestran gran concentración de centros en áreas urbanas (69,23% en el AMBA), predominancia de centros privados (66,67%) inclusión de pacientes con patologías cardiovasculares denominadas como clásicas (enfermedad coronaria, insuficiencia cardíaca, posoperatorios valvulares, enfermedad vascular periférica, postrasplante cardíaco y poscolocación de dispositivos), y predominancia de centros con estrategia centrada en el ejercicio. La principal dificultad a la hora de la inclusión de pacientes a los centros es la escasa referencia de los candidatos. Conclusiones: Los datos de esta encuesta permiten hacer un diagnóstico de situación, y pueden ser el punto de partida para estrategias de mejora, que permitan implementar estándares de calidad y en un futuro establecer programas de acreditación de centros.

ABSTRACT Background: Cardiac rehabilitation is a well-known strategy for secondary prevention in several heart diseases and includes a set of strategies based on education of a healthy lifestyle, management of cardiovascular risk factors, psychosocial counseling, and prescription of supervised physical exercise. Several clinical trials, systematic reviews and meta-analyses have documented its efficacy and safety. Nevertheless, cardiac rehabilitation remains underused. There is information available describing the current status of cardiac rehabilitation and the characteristics of centers in some European countries and North America. There are pooled data from South America in 2014, along with reports from Brazil, Colombia, and Uruguay, but there are few data from our country. Therefore, the aim of this study was to determine the current status of cardiac rehabilitation programs in Argentina. Methods: We conducted a descriptive study using a virtual questionnaire to evaluate the structure and characteristics of rehabilitation programs in our country and the potential barriers to achieve efficient rehabilitation. Results: Seventy-two centers responded. The main results show a high concentration of centers in urban areas (69.23% in AMBA), predominance of private centers (66.67%), inclusion of patients with the so-called classic cardiovascular diseases (coronary artery disease, heart failure, postoperative heart valve surgery, peripheral vascular disease, and after cardiac transplantation and device implantation), and a majority of centers with an exercise-centered strategy. The main difficulty for the inclusion of patients in the centers was poor referral of candidates. Conclusions: The data from this survey allows for a diagnosis of the situation and can be the starting point for developing improvement strategies to implement quality standards and future accreditation programs for the centers.

RESUMO

Resumo O treinamento físico é capaz de aumentar o consumo de oxigênio de pico em indivíduos que sofreram infarto agudo do miocárdio. No entanto, em relação à eficácia de diferentes tipos de intervenções ainda há uma lacuna na literatura. O objetivo do presente estudo foi avaliar os efeitos de diferentes modalidades de treinamento físico no consumo de oxigênio de pico de pacientes pós-infarto agudo do miocárdio. Foram utilizadas as seguintes bases de dados: PubMed (MEDLINE), Cochrane Library, Scopus e PEDro. Foram incluídos estudos que avaliassem exercícios aeróbicos, de força ou combinados. Seis estudos preencheram elegibilidade. O exercício aeróbico aumentou 6,07 mL.kg-1.min-1 quando comparado ao grupo controle (p = 0,013). Na comparação entre exercício combinado e grupo controle, foi observada uma diferença de 1,84 mL.kg-1.min-1, no entanto, sem significância (p = 0,312). Portanto, concluímos que o exercício aeróbico é a única modalidade que apresenta eficácia para aumentar o consumo de oxigênio de pico em comparação a um grupo controle.

Abstract Physical training can increase peak oxygen uptake (VO2peak) in people who have suffered acute myocardial infarction (AMI). However, there is still a gap in the literature in relation to the effectiveness of different types of interventions. Therefore, the aim of the present study was to evaluate the effects of different physical training modalities on VO2peak in post-AMI patients. The following databases were used: PubMed (MEDLINE), Cochrane Library, Scopus, and Pedro. Studies that evaluated aerobic exercise, strength exercise, or combined exercise were included. Six studies met eligibility criteria. Aerobic exercise increased VO2peak by 6.07 ml.kg-1.min-1 when compared to the control group (CG) (p = 0.013). The comparison between combined exercise and control group detected a difference of 1.84 ml.kg-1.min-1, but this was not significant (p = 0.312). We therefore conclude that aerobic exercise is the only modality that is effective for increasing VO2peak compared to a control group.

Assuntos

RESUMO

ABSTRACT Objectives: to describe a medium-range nursing theory for the cardiovascular rehabilitation process. Methods: theoretical development study, addressing the elaboration of medium-range theory, based on Roy's Adaptation Model, which combined theoretical deduction with induction strategies, based on literature review and concept analysis. Results: the Medium-Range Theory for Nursing in Cardiovascular Rehabilitation presents eleven concepts and respective definitions, organized in relationships that represent elements, through modeling and image representation. Theoretical assumptions and propositions are presented. Final Considerations: the theory presented aims to contribute to the description of the cardiovascular rehabilitation process from the perspective of the adaptation of the person, family and groups, as well as to impact the nursing care implemented to patients in the process. The procedures advanced from conceptualization to operationalization, through the production of theoretical propositions that will guide future theoretical testing.

RESUMEN Objetivos: describir una teoría de enfermería de rango medio para el proceso de rehabilitación cardiovascular. Métodos: se trata de un estudio de desarrollo teórico, volcado hacia la elaboración de la teoría de rango medio y basado en el Modelo de Adaptación de Roy que combinó estrategias de inducción y deducción teórica, desde la revisión de la literatura y el análisis del concepto. Resultados: la Teoría de Rango Medio para la Enfermería en Rehabilitación Cardiovascular presenta once conceptos y sus respectivas definiciones, organizados en relaciones que representan elementos, a través de la modelización y la representación pictórica. Se exponen supuestos y propuestas teóricas. Consideraciones Finales: la teoría presentada tiene como intuito contribuir con la descripción del proceso de rehabilitación cardiovascular desde la perspectiva de la adaptación de la persona, la familia y los grupos para causar impacto en los cuidados de enfermería implementados a los pacientes durante el proceso. Los procedimientos avanzaron desde la conceptualización hasta la operacionalización, pasando por la producción de proposiciones teóricas que guiarán las futuras pruebas.

RESUMO Objetivos: descrever uma teoria de enfermagem de médio alcance para o processo de reabilitação cardiovascular. Métodos: estudo de desenvolvimento teórico, orientado para elaboração de teoria de médio alcance, a partir do Modelo de Adaptação de Roy, que combinou estratégias de dedução teórica com indução, a partir de revisão da literatura e análise de conceito. Resultados: a Teoria de Médio Alcance para Enfermagem em Reabilitação Cardiovascular apresenta onze conceitos e respectivas definições, organizados em relações que representam elementos, por meio de modelagem e representação pictórica. Pressupostos e proposições teóricas são apresentadas. Considerações Finais: a teoria apresentada tem como finalidade contribuir para descrição do processo de reabilitação cardiovascular, na perspectiva da adaptação da pessoa, família e grupos, bem como, consequentemente, impactar no cuidado de enfermagem implementado a pacientes no processo. Os procedimentos avançaram da conceitualização até a operacionalização, pela produção de proposições teóricas que guiarão a futura testagem teórica.

RESUMO

ABSTRACT Objectives: to describe a medium-range nursing theory for the cardiovascular rehabilitation process. Methods: theoretical development study, addressing the elaboration of medium-range theory, based on Roy's Adaptation Model, which combined theoretical deduction with induction strategies, based on literature review and concept analysis. Results: the Medium-Range Theory for Nursing in Cardiovascular Rehabilitation presents eleven concepts and respective definitions, organized in relationships that represent elements, through modeling and image representation. Theoretical assumptions and propositions are presented. Final Considerations: the theory presented aims to contribute to the description of the cardiovascular rehabilitation process from the perspective of the adaptation of the person, family and groups, as well as to impact the nursing care implemented to patients in the process. The procedures advanced from conceptualization to operationalization, through the production of theoretical propositions that will guide future theoretical testing.

RESUMEN Objetivos: describir una teoría de enfermería de rango medio para el proceso de rehabilitación cardiovascular. Métodos: se trata de un estudio de desarrollo teórico, volcado hacia la elaboración de la teoría de rango medio y basado en el Modelo de Adaptación de Roy que combinó estrategias de inducción y deducción teórica, desde la revisión de la literatura y el análisis del concepto. Resultados: la Teoría de Rango Medio para la Enfermería en Rehabilitación Cardiovascular presenta once conceptos y sus respectivas definiciones, organizados en relaciones que representan elementos, a través de la modelización y la representación pictórica. Se exponen supuestos y propuestas teóricas. Consideraciones Finales: la teoría presentada tiene como intuito contribuir con la descripción del proceso de rehabilitación cardiovascular desde la perspectiva de la adaptación de la persona, la familia y los grupos para causar impacto en los cuidados de enfermería implementados a los pacientes durante el proceso. Los procedimientos avanzaron desde la conceptualización hasta la operacionalización, pasando por la producción de proposiciones teóricas que guiarán las futuras pruebas.

RESUMO Objetivos: descrever uma teoria de enfermagem de médio alcance para o processo de reabilitação cardiovascular. Métodos: estudo de desenvolvimento teórico, orientado para elaboração de teoria de médio alcance, a partir do Modelo de Adaptação de Roy, que combinou estratégias de dedução teórica com indução, a partir de revisão da literatura e análise de conceito. Resultados: a Teoria de Médio Alcance para Enfermagem em Reabilitação Cardiovascular apresenta onze conceitos e respectivas definições, organizados em relações que representam elementos, por meio de modelagem e representação pictórica. Pressupostos e proposições teóricas são apresentadas. Considerações Finais: a teoria apresentada tem como finalidade contribuir para descrição do processo de reabilitação cardiovascular, na perspectiva da adaptação da pessoa, família e grupos, bem como, consequentemente, impactar no cuidado de enfermagem implementado a pacientes no processo. Os procedimentos avançaram da conceitualização até a operacionalização, pela produção de proposições teóricas que guiarão a futura testagem teórica.

RESUMO

Cardiovascular diseases (CVD) and frailty syndrome are major problems for successful aging. These conditions share many biological aspects, symptoms and adverse effects. Aerobic capacity and muscle strength, that are important characteristics for independence in daily activity, are markedly reduced in older adults with CVD and frailty. There are evidence and recommendations of physical activity and exercises to prevent, treat and manage these conditions. However, the exact dose-response (type, intensity and duration) of exercises is still uncertain for these population. A good physical exercise program should consider the aging physiologic alterations, the vulnerability of the frail syndrome, and the functional-structural changes of CVD. Therefore, a multicomponent program with aerobic and strength training is desirable to improve these conditions. For long term results it is important to older adults with these conditions to change lifestyle and be more active during daily living to reduce sedentary behavior. Being frail with CVD it is not a contraindication for older adults to be engaged in physical activities.

Assuntos

RESUMO

RESUMEN Introducción: La rehabilitación cardiovascular es beneficiosa en múltiples situaciones clínicas. En pacientes que son tratados mediante intervencionismo coronario es necesario seguir profundizando su estudio. Objetivos: Determinar los efectos de la rehabilitación cardiovascular en pacientes con infarto agudo de miocardio con elevación del segmento ST a quienes se les realizó intervencionismo coronario percutáneo. Método: Estudio cuasi-experimental en 30 pacientes con infarto agudo de miocardio con elevación del ST después de ser tratados con angioplastia coronaria y que se atendieron en el Servicio de Rehabilitación Cardiovascular del Hospital Universitario Celestino Hernández Robau, en el período de septiembre de 2016 a marzo de 2018. Se recolectaron datos clínicos y epidemiológicos, y se analizaron variables ergométricas y ecocardiográficas al inicio y luego de 12 semanas de realizar un programa de rehabilitación cardiovascular. Resultados: Existió un efecto positivo en la frecuencia cardíaca en reposo (66±11 vs. 61±11 latidos/minuto; p=0,008), el tiempo de ejercicio (8,3±2,5 vs. 10,2±2,0 minutos; p<0,0001) y del máximo consumo de oxígeno (24,2±5,0 vs. 27,6±4,9 ml/kg/min; p<0,0001). Existió mejoría de la fracción de eyección y reducción del diámetro del ventrículo izquierdo en diástole, pero sin diferencia estadística significativa. Conclusiones: Existió mejoría en los parámetros ergométricos y ecocardiográficos luego del programa de rehabilitación cardiovascular, que fue más beneficioso en pacientes con hipertensión arterial, hábito de fumar e intervencionismo coronario percutáneo de dos arterias.

ABSTRACT Introduction: Cardiovascular rehabilitation is beneficial in multiple clinical situations. In patients who are treated through percutaneous coronary intervention it is necessary to continue deepening its study. Objectives: To determine the effects of cardiovascular rehabilitation in patients with ST-segment elevation acute myocardial infarction who underwent percutaneous coronary intervention. Method: Quasi-experimental study in 30 patients with ST-segment elevation acute myocardial infarction after being treated with coronary angioplasty, and who were attended at the Department of Cardiovascular Rehabilitation of the Hospital Universitario Celestino Hernández Robau, in the period from September 2016 to March 2018. Clinical and epidemiological data were collected, and ergometric and echocardiographic variables were analyzed before and after 12 weeks of developing a cardiovascular rehabilitation program. Results: There was a positive effect on heart rate at rest (66±11 vs. 61±11 beats/minute; p=0.008), exercise time (8.3±2.5 vs. 10.2±2.0 minutes; p <0.0001) and maximum oxygen consumption (24.2±5.0 vs. 27.6±4.9 ml/kg/min; p<0.0001). There was improvement of the ejection fraction and reduction of the diameter of the left ventricle in diastole left ventricular end diastolic diameter, but without significant statistical difference. Conclusions: There was improvement in the ergometric and echocardiographic parameters after the cardiovascular rehabilitation program, which was more beneficial in patients with high blood pressure, smoking habit and percutaneous coronary intervention of two arteries.

Assuntos