Brazilian Cardiovascular Rehabilitation Guideline - 2020

Non-Invasive Ventilatory Support as a Tool to Improve Exercise Tolerance in Patients With Heart Failure: A Systematic Review With Meta-Analysis

BACKGROUND AND PURPOSE

Heart failure (HF) is a complex syndrome that impacts persons' daily activities and adherence to exercise programs. Non-Invasive ventilation (NIV) reduces respiratory load and improves cardiac function, potentially serving as an important adjunct in its treatment. These effects can be enhanced with a cardiac rehabilitation program, improving dyspnea and functionality. This study aimed to evaluate the effects of NIV during exercise on functional performance outcomes, dyspnea, QL, hemodynamics, and respiratory function.

METHODS

A systematic review followed by meta-analysis was conducted. Searches were performed in PubMed, CENTRAL, Embase, LILACS, SciELO, and CINAHL.

ELIGIBILITY CRITERIA

Randomized clinical trials of patients over 18 years of age with HF, compared to a control group, were included with the objective of improving exercise tolerance. The studies were categorized as short-term effects of NIV and those implementing an exercise program.

RESULTS

Seven studies were included in the qualitative review and five in the meta-analysis. Only two studies presented a low risk of bias. The analyzed outcomes were the 6-min walk test (6MWT), dyspnea, SpO2, heart rate (HR), systolic, and diastolic arterial pressure (SAP and DAP, respectively), maximal inspiratory and expiratory muscle strength (MIP and MEP, respectively), forced expiratory volume in one second (FEV1), and quality of life (QL).

DISCUSSION

There was a significant difference in favor of the NIV group compared to the control group in both modalities in relation to the 6MWT, with a mean difference (MD) 41.72 (CI 95% 2.15, 81.29) meters in the exercise program and MD 68.61 (CI 95% 5.69, 131.54) meters in short-term effect studies. There were also favorable results in the outcomes of dyspnea and FEV1 in the NIV group (p < 0.01). There were no statistically significant differences in the outcomes peripheral oxygen saturation (p = 0.11), systolic (p = 0.76) and diastolic blood pressure (p = 0.93), heart rate (p = 0.19), MIP (p = 0.49), MEP (p = 0.22) and QL (p = 0.13).

TRAIL REGISTRATION

PROSPERO CRD42022367746.

Cardiovascular Telerehabilitation: An Alternative for Greater Availability of Cardiovascular and Metabolic Rehabilitation in Brazil

Central Illustration: Cardiac Telerehabilitation - An alternative for patients with difficulty attending rehabilitation centers.

M-health with cardiac rehabilitation improves functional capacity: A systematic review with meta-analysis

BACKGROUND AND OBJECTIVE

In this systematic review and meta-analysis, we compared the effectiveness of the combined m-health and a cardiac rehabilitation program (CRP) and of CRP alone on functional capacity, adherence to CRP, and management of cardiovascular risk factors in cardiac patients.

METHODS

Medline, EMBASE, Central, PEDro, and SPORTDiscus were searched, from inception until July 2020, for randomized controlled trials (RCTs) comparing the m-health with CRP combination with CRP alone for adults with heart disease. The PEDro scale and GRADE approach was used to assess methodological and overall quality, respectively. Pooled estimates were calculated using a random-effects model to obtain the mean difference (MD) or standardized mean difference (SMD), and their respective 95 % confidence intervals (95 %CIs).

RESULTS

Twenty-two RCTs were eligible. The median risk-of-bias was 6.5/10. CRP with the m-Health intervention was more effective than CRP alone in improving VO2peak (MD: 1.02 95 %CI 0.50 -1.54) at short-term, and at medium-term follow-up (MD: 0.97, 95 %CI: 0.04 - 1.90. Similarly, CRP and m-Health were superior to CRP alone in increasing self-reported physical activity at short-term (SMD: 0.98, 95 %CI: 0.65 - 1.32] but not at medium-term follow-up (SMD: 0.18, 95 %CI:0.01 to 0.36). Furthermore, supervision of CRP with the m-Health intervention at short-term follow-up and M-Health and semi-supervised CRP - medium-term were more effective in improving VO2peak respectively (MD: 1.01, 95 %CI: 0.38‒1.64), (MD: 1.49, 95 %CI: 0.09, 2.89), and self-reported physical activity than supervised CRP at short-term (SMD: 0.98, 95 %CI: 0.65‒1.32) medium-term follow-ups (MD: 0.29 95 %CI: 0.12, 0.45].

CONCLUSION

Our review found high-quality evidence that m-health interventions combined with CRP was more effective than CRP alone in improving cardiorespiratory fitness, at the short and medium terms follow-up.

Development of evidence-based standards for inpatient physiotherapy services: a systematic review and content analysis of clinical practice guidelines

OBJECTIVE

Performance standards are critical to service design and quality improvement. There are no published standards defining the care inpatients should receive from physiotherapists in Aotearoa New Zealand. This study aims to explore the potential of using clinical practice guidelines (CPGs) to develop a set of evidence-based standards for physiotherapy in inpatient settings.

DESIGN

A systematic review and content analysis of CPGs.

DATA SOURCES

Scholarly databases (Web of Science, CINAHL and Scopus, PEDro) and grey literature (guideline databases - NICE, SIGN, ECRI guideline trust, Guidelines International Network (GIN)) were searched between July and September 2021.

ELIGIBILITY CRITERIA

CPGs related to conditions and treatments common to physiotherapy in a secondary care setting were included. Mental health conditions, paediatrics, COVID-19 and conditions common to tertiary care were excluded.

DATA EXTRACTION AND SYNTHESIS

A pragmatic approach was taken to group guidelines aligned with common physiotherapy services and select only the most recent and comprehensive guidelines for final analysis. The quality of CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II). Data from guideline recommendations of relevance to inpatient physiotherapy were grouped into themes. Summative 'statements' were drafted to represent the content of each theme; these were given a confidence rating based on the number of supporting guidelines and the strength or grade of evidence awarded by the guideline group.

RESULTS

The recommendations of 32 CPGs yielded 27 statements.

CONCLUSION

Twenty-seven statements represent a distillation of the best evidence-based practice recommendations from CPGs in inpatient physiotherapy. Statements of physiotherapy dosage (frequency, intensity and duration) are not available for many areas of practice; researchers and CPG groups should consider the importance of these data for service commissioning.  .

Assessment of detraining through a six-minute walk test in patients with heart disease

BACKGROUND

Detraining can partially or completely reduce training-induced metabolic adaptations. However, the duration for which the rehabilitation effects persist after detraining, especially in patients with heart disease, remains unclear.

OBJECTIVES

To evaluate the principle of reversibility/detraining in patients with heart disease via the 6-minute walk test (6MWT) after a period of rest.

DESIGN AND SETTING

A retrospective cohort study developed at the Rehabilitation Center of the Universidade Federal do Triângulo Mineiro in Uberaba/MG, Brazil.

METHODS

This clinical, retrospective longitudinal study involved 20 patients with heart disease who underwent 5 months of supervised cardiac rehabilitation (CR). The mean age of participants was 64.05 ± 9.25 years. The initial rehabilitation was followed by an interruption period and rehabilitation for another 5 months. Functional capacity was assessed using the 6MWT.

RESULTS

In the specific analysis of the distance covered, values of P = 0.03 and P = 0.01 were obtained on comparing post-training (669.64 ± 58.80 meters) with post-detraining (640.82 ± 101.23 meters) and post-detraining with post-retraining (650.82 ± 96.28 meters), respectively. No significant difference was observed for the comparison between training and retraining (P = 0.83).

CONCLUSION

Cardiovascular rehabilitation positively stimulates functional capacity, whereas detraining significantly reduces it. The 6MWT is effective in measuring changes in physical capacity.

Validation of a Wearable Sensor Prototype for Measuring Heart Rate to Prescribe Physical Activity: Cross-Sectional Exploratory Study

BACKGROUND

Wearable sensors are rapidly evolving, particularly in health care, due to their ability to facilitate continuous or on-demand physiological monitoring.

OBJECTIVE

This study aimed to design and validate a wearable sensor prototype incorporating photoplethysmography (PPG) and long-range wide area network technology for heart rate (HR) measurement during a functional test.

METHODS

We conducted a transversal exploratory study involving 20 healthy participants aged between 20 and 30 years without contraindications for physical exercise. Initially, our laboratory developed a pulse wearable sensor prototype for HR monitoring. Following this, the participants were instructed to perform the Incremental Shuttle Walk Test while wearing the Polar H10 HR chest strap sensor (the reference for HR measurement) and the wearable sensor. This test allowed for real-time comparison of HR responses between the 2 devices. Agreement between these measurements was determined using the intraclass correlation coefficient (ICC3.1) and Lin concordance correlation coefficient. The mean absolute percentage error was calculated to evaluate reliability or validity. Cohen d was used to calculate the agreement's effect size.

RESULTS

The mean differences between the Polar H10 and the wearable sensor during the test were -2.6 (95% CI -3.5 to -1.8) for rest HR, -4.1 (95% CI -5.3 to -3) for maximum HR, -2.4 (95% CI -3.5 to -1.4) for mean test HR, and -2.5 (95% CI -3.6 to -1.5) for mean recovery HR. The mean absolute percentage errors were -3% for rest HR, -2.2% for maximum HR, -1.8% for mean test HR, and -1.6% for recovery HR. Excellent agreement was observed between the Polar H10 and the wearable sensor for rest HR (ICC3.1=0.96), mean test HR (ICC3.1=0.92), and mean recovery HR (ICC3.1=0.96). The agreement for maximum HR (ICC3.1=0.78) was considered good. By the Lin concordance correlation coefficient, the agreement was found to be substantial for rest HR (rc=0.96) and recovery HR (rc=0.96), moderate for mean test HR (rc=0.92), and poor for maximum HR (rc=0.78). The power of agreement between the Polar H10 and the wearable sensor prototype was large for baseline HR (Cohen d=0.97), maximum HR (Cohen d=1.18), and mean recovery HR (Cohen d=0.8) and medium for mean test HR (Cohen d= 0.76).

CONCLUSIONS

The pulse-wearable sensor prototype tested in this study proves to be a valid tool for monitoring HR at rest, during functional tests, and during recovery compared with the Polar H10 reference device used in the laboratory setting.

Association Between SARC-F and Clinical Outcomes in Older Adults With Cardiovascular Diseases Admitted to the Emergency Room: A Longitudinal Study

INTRODUCTION

Sarcopenia can be more significant and severe in the presence of cardiovascular diseases. In hospitalized older adults with acute cardiac disease, assessing strength parameters, muscle mass, and physical performance is difficult largely because of bed rest restrictions. In this context, simple questionnaire to rapidly diagnose sarcopenia (SARC-F) emerges as a feasible screening tool to identify sarcopenia in an emergency room setting.

OBJECTIVES

Assess the association between SARC-F, length of stay, mechanical ventilation, and in-hospital mortality in older adults with cardiovascular diseases admitted to the ER.

METHODOLOGY

An observational longitudinal study with 160 Brazilian older adults with cardiovascular diseases admitted to the hospital following an ER visit. The risk of sarcopenia was assessed by the SARC-F tool (independent variable). Length of stay, use of mechanical ventilation, and in-hospital mortality were the dependent variables, collected via an electronic medical chart. Data were analyzed by simple and multiple linear and logistic regression.

RESULTS

SARC-F explained 62% of length of stay, adjusted for the confounding variables age, male sex, and use of continuous medication, mechanical ventilation, and corticosteroids. Risk of sarcopenia was also associated with mechanical ventilation during hospitalization (odds ratio = 1.398; 95% CI, 1.018-1.919). SARC-F was not related to mortality.

CONCLUSION

Older adults with cardiovascular diseases hospitalized at greater risk of sarcopenia were more likely to need invasive mechanical ventilation and more prone to prolonged hospital stays.

Accurate prediction equations for ventilatory thresholds in cardiometabolic disease when gas exchange analysis is unavailable: development and validation

AIMS

To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains.

METHODS AND RESULTS

Cross-sectional study involving 2868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8-21.3%, VT2: 5.1-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines.

CONCLUSION

Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.

Development and validation of a mobile application prototype for postoperative cardiac surgery

OBJECTIVES

to develop and validate the content, appearance, and semantics of a prototype application for monitoring patients in the postoperative period of cardiac surgery.

METHODS

this is a technological development study based on Contextualized Instructional Design. The content and appearance evaluation was conducted by a committee of specialists, and semantic validation was carried out by patients from a cardiac surgery outpatient clinic.

RESULTS

the application prototype consisted of 43 screens, validated by 17 health specialists, with content validity ratio and appearance validity index results of 0.86 and 0.99, respectively. For semantic validation, 10 patients participated in data collection, with a total content validity index of 0.978.

CONCLUSIONS

the prototype of the "VivaCor PósOp" application demonstrated evidence of content, appearance, and semantic validity, with the potential to stimulate self-care in patients in the postoperative period of cardiac surgery.

Association of sedentary behavior and physical activity with occurrence of signs and symptoms in participants of a cardiac rehabilitation program

Sedentary behavior (SB) is associated with health impairments, while physical activity (PA) has been a protective factor. It is unclear whether SB and PA are associated with occurrence of signs and/or symptoms (SS) during cardiac rehabilitation program (CRP) exercise sessions. The objective was to evaluate the association between SB and PA with occurrence of SS. Was included 48 patients from a CRP program (64.7 ± 10.4 years-old). Daily time and % of time of SB and weekly time in moderate-to-vigorous-intensity [MVPA], % of MVPA time, steps/day, and steps/minute were accelerometer-measured. Patients were followed-up during 24 CRP sessions, for accompaniment of SS. Age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, obesity) were covariates. Log-transformed values of SB, MVPA and steps/day were also analyzed. As results, 43.7% (n = 21) of participants presented occurrence of signs, 62.5% (n = 30) presented occurrence of symptoms, and 81.2% (n = 39) present occurrence of SS. In fully adjusted model, % of time in MVPA (β: -0.449,p = 0.045) and steps/minute (β: -0.244,p = 0.026) were inversely associated with occurrence of symptoms. No association was observed between SB and PA and occurrence of signs. The occurrence of symptoms and SS among CRP participants was directly associated with SB and inversely associated with variables of PA.

Translation, Cultural Adaptation of the Portuguese Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-P) Scale and Assessment of Its' Measurement Properties

BACKGROUND/OBJECTIVES

Access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to identify key factors influencing CR referral in a Latin American context for the first time.

METHODS

The PACRR was translated into Brazilian Portuguese through a rigorous process involving independent translation, back-translation, and expert panel review to ensure face, content, and cross-cultural validity. A total of 44 Brazilian physicians completed the questionnaire, allowing for an assessment of internal consistency, criterion validity, and convergent validity.

RESULTS

The findings confirmed the face, content, and cultural validity of the 20 translated items, with a mean item clarity rating of 4.8/5. The final version included 17 of the original 19 PACRR-P items, with a Cronbach's alpha of 0.73. Referral rates were significantly associated with over one-third of the PACRR-P items, preliminarily supporting the scale's criterion validity, while correlations with the ReCaRe scores further supported its convergent validity. The most prominent barriers to referral were a lack of familiarity with CR site locations, absence of a standard referral form, and lack of automatic referral processes.

CONCLUSIONS

The PACRR's validity and reliability among Portuguese-speaking providers are preliminarily supported.

Brazilian Guideline for Exercise Testing in Children and Adolescents - 2024

CLASSES OF RECOMMENDATION

LEVELS OF EVIDENCE

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Cardiac Rehabilitation to Inpatient Heart Transplant-HRN4HTx Intervention Protocol

Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients' functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials-NCT06552390.

Preliminary Effects of a Structured Educational Program in Cardiac Patients at Different Stages of Enrollment in Cardiovascular Rehabilitation

This quasi-experimental study investigated the preliminary effects of a structured education intervention in a pooled sample of cardiovascular rehabilitation (CR) patients in Brazil. Recently enrolled (RE) and long-term enrolled (LTE) patients attended 12 weekly education sessions in addition to three weekly exercise sessions. Patients completed surveys assessing disease-related knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was assessed by the 6-minutes walking test. All outcomes were assessed at pre-,post-CR, and 6-months follow-up. Bonferroni correction was applied. In total, 69 (69.7%) patients completed all three assessments. There were significant improvements in knowledge pre-to post-test in both subgroups (p < 0.001), and in functional capacity (p ≤ 0.001) and food intake (p ≤ 0.001) pre-to post-test in the RE subgroup. Post-test knowledge was correlated to physical activity, functional capacity and health literacy. This preliminary study suggests the importance of structured education for CR patients. A larger study using a randomized controlled design is needed to determine efficacy.

Effect of an exercise-based cardiac rehabilitation program on quality of life of patients with chronic Chagas cardiomyopathy: results from the PEACH randomized clinical trial

To investigate the effect of an exercise-based cardiac rehabilitation program on the quality of life (QoL) of patients with chronic Chagas cardiomyopathy (CCC). PEACH study was a single-center, superiority randomized clinical trial of exercise training versus no exercise (control). The sample comprised Chagas disease patients with CCC, left ventricular ejection fraction < 45%, without or with HF symptoms (CCC stages B2 or C, respectively). QoL was assessed at baseline, after three months, and at the end of six months of follow-up using the SF-36 questionnaire. Patients randomized for the exercise group (n = 15) performed exercise training (aerobic, strength and stretching exercises) for 60 min, three times a week, during six months. Patients in the control group (n = 15) were not provided with a formal exercise prescription. Both groups received identical nutritional and pharmaceutical counseling during the study. Longitudinal analysis of the effects of exercise training on QoL, considering the interaction term (group × time) to estimate the rate of changes between groups in the outcomes (represented as beta coefficient), was performed using linear mixed models. Models were fitted adjusting for each respective baseline QoL value. There were significant improvements in physical functioning (β =  + 10.7; p = 0.02), role limitations due to physical problems (β =  + 25.0; p = 0.01), and social functioning (β =  + 19.2; p < 0.01) scales during the first three months in the exercise compared to the control group. No significant differences were observed between groups after six months. Exercise-based cardiac rehabilitation provided short-term improvements in the physical and mental aspects of QoL of patients with CCC.Trial registration: ClinicalTrials.gov Identifier: NCT02517632; August 7, 2015.

Some types of exercise interventions are more effective than others in people with coronary heart disease: systematic review and network meta-analysis

QUESTION

What are the effects of different types of exercise treatments on oxygen consumption, quality of life and mortality in people with coronary heart disease?

DESIGN

Systematic review with network meta-analysis of randomised controlled trials.

PARTICIPANTS

Adults with coronary heart disease.

INTERVENTION

Exercise interventions including aerobic (continuous or high-intensity interval) training, resistance training, respiratory muscle exercises, water-based exercises, yoga, Tai chi, Qigong exercises and a combination of different types of exercise.

OUTCOME MEASURES

Oxygen consumption, quality of life and mortality.

RESULTS

This review included 178 randomised controlled trials with 19,143 participants. Several exercise interventions improved peak oxygen consumption (mL/kg/min): high-intensity interval training (MD 4.5, 95% CI 3.7 to 5.4); combined water-based exercises and moderate-intensity continuous training (MD 3.7, 95% CI 1.3 to 6.0); combined aerobic and resistance exercise (MD 3.4, 95% CI 2.5 to 4.3); water-based exercises (MD 3.4, 95% CI 0.6 to 6.2); combined respiratory muscle training and aerobic exercise (MD 3.2, 95% CI 0.6 to 5.8); Tai chi (MD 3.0, 95% CI 1.0 to 5.0); moderate-intensity continuous training (MD 3.0, 95% CI 2.3 to 3.6); high-intensity continuous training (MD 2.7, 95% CI 1.6 to 3.8); and resistance training (MD 2.2, 95% CI 0.6 to 3.7). Quality of life was improved by yoga (SMD 1.5, 95% CI 0.5 to 2.4), combined aerobic and resistance exercise (SMD 1.2, 95% CI 0.6 to 1.7), moderate-intensity continuous training (SMD 1.1, 95% CI 0.6 to 1.6) and high-intensity interval training (SMD 0.9, 95% CI 0.1 to 1.6). All-cause mortality was reduced by continuous aerobic exercise (RR 0.67, 95% CI 0.53 to 0.86) and combined aerobic and resistance exercise (RR 0.58, 95% CI 0.36 to 0.94). Continuous aerobic exercise also reduced cardiovascular mortality (RR 0.56, 95% CI 0.42 to 0.74).

CONCLUSION

People with coronary heart disease may use a range of exercise modalities to improve oxygen consumption, quality of life and mortality.

REGISTRATION

PROSPERO CRD42022344545.

Long-term effects of virtual reality-based therapy in cardiovascular rehabilitation: A longitudinal study

BACKGROUND

In Cardiovascular Rehabilitation (CR), patient adherence to the maintenance phase is a major challenge. Virtual reality-based therapy (VRBT) promotes acute hemodynamic and autonomic repercussions similar to traditional rehabilitation and can increase patient adherence to the program. However, it is unknown whether the combination of VRBT to a traditional CR manages to maintain or even improve clinical and autonomic variables in long term.

OBJECTIVE

To analyze whether VRBT combination in a traditional CR can maintain or improve clinical and autonomic variables in cardiac patients in the maintenance phase of these programs.

METHODS

Twenty-six volunteers (62.04 ± 12.22 years) were evaluated, who underwent an initial assessment and two other assessments (in the sixth and 12th week) of the following outcomes: systolic and diastolic blood pressure, respiratory rate, pulse saturation of oxygen, heart rate, perceived exertion, and cardiac autonomic modulation, using linear and non-linear heart rate variability methods.

RESULTS

Except for the apparent lack of clinical significance observed in Shannon Entropy, LF (nu), and HF (nu), the combination of VRBT as routine in a traditional program did not cause significant changes in the analyzed variables.

CONCLUSION

combination of VRBT was able to maintain the chronic hemodynamic and autonomic repercussions caused by traditional CR.

Comparison of home-based rehabilitation and a centre-based exercise in terms of functional capacity, muscle oxygenation and quality of life in people with peripheral arterial disease: a protocol for a randomised controlled trial

INTRODUCTION

Peripheral arterial disease (PAD) is increasingly prevalent, and supervised physical exercise programmes are recommended as the first-line treatment. However, these programmes are underused. Alternative delivery models may be able to expand treatment coverage. The objective of this study was to compare a home-based exercise programme (HBEP) and a centre-based exercise (CBE) in terms of their effects on functional capacity, peripheral muscle oxygenation and quality of life in individuals with PAD.

METHODS AND ANALYSIS

This single-blind, parallel randomised clinical trial will consist of two groups: HBEP and CBE. A qualitative analysis will be carried out to investigate acceptability and satisfaction. The primary outcome will be functional capacity, assessed by the incremental shuttle walk test. Secondary outcomes will include functional capacity, assessed by a treadmill walking test; peripheral muscle oxygenation and quality of life; and self-reported functional impairment, risk factors, morbidity, level of physical activity, adherence, acceptability and satisfaction. The intervention protocols will consist of 12 weeks of intermittent walking until claudication symptoms, three times a week. Participants randomly assigned to the CBE group will participate in supervised face-to-face sessions. The HBEP group will perform exercises at home with remote supervision, monitored by a pedometer and heart rate monitor, and subjective perception of effort during each session will be recorded by participants in a training diary; follow-up will be conducted by telephone calls. Statistical analyses will follow the intention-to-treat principle. Participants allocated to the HBEP group will be interviewed about their experience of remote treatment using a qualitative approach.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Universidade Federal de Minas Gerais. The results will be disseminated in a peer-reviewed journal and presented at international congresses. This research has the potential to improve the care of people with PAD because if home-based rehabilitation demonstrates effectiveness, it could be considered an alternative or support resource to the usual centre-based treatment models, expanding access, coverage and participation in vascular physiotherapy TRIAL REGISTRATION: https://ensaiosclinicos.gov.br/rg/RBR-97vy9n7 on 14 April 2022.

Self-efficacy measurement instruments for individuals with coronary artery disease: A systematic review

INTRODUCTION

Over the past decade, there has been a heightened interest in evaluating self-efficacy among patients with coronary artery disease (CAD). A significant number of instruments have been developed and validated, yet the need remains to assess the quality of their studies and their properties.

OBJECTIVES

To evaluate the measurement properties and link the content extracted from self-efficacy instrument items for individuals with CAD to the International Classification of Functioning, Disability, and Health (ICF).

METHODOLOGY

The study was conducted following the Cochrane systematic review guidelines and COnsensus norms for Selection of health Measuring INstruments (COSMIN), registered under CRD42021262613. The search was carried out on MEDLINE (Ovid), Web of Science, EMBASE, and PsycINFO, including studies involving the development and validation of self-efficacy instruments for individuals with CAD, without language or date restrictions. Data extraction was performed in May 2022 and updated in January 2023 and all the steps of this review were carried out by two different collaborators and reviewed by a third when there were divergences. Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) recommended by COSMIN was used to determine the quality of evidence as high, moderate, low, or very low. Instrument categorization was carried out per COSMIN recommendations, according to the construct of interest and study population into three categories (A, B, or C).

RESULTS

A total of 21 studies from 12 instruments were identified. The best-rated instruments received a recommendation of B, which means, additional validation studies are needed. Barnason Efficacy Expectation Scale (BEES) showed high-quality evidence for structural, construct, criterion, and internal consistency validity; Cardiac Self-Efficacy Scale (CSES) demonstrated high quality for content, structural, cross-cultural validity, and internal consistency; Self-efficacy for Appropriate Medication Use (SEAMS) achieved a high level for structural, criterion, and internal consistency validity; Cardiovascular Management Self-Efficacy Scale exhibited high-level validity for structural, criterion, construct, and internal consistency. The CSES showed content linkage with all domains of the ICF, as well as the highest number of linkages with the categories.

CONCLUSIONS

Instruments with a B-level recommendation hold potential for use. More studies assessing measurement properties are needed to reinforce or improve these recommendations. The CSES stands out as the most comprehensive instrument concerning the ICF.

A Systematic Review of Clinical Practice Guidelines and Consensus Statements for Cardiac Rehabilitation Delivery: Consensus, Divergence, and Important Knowledge Gaps

BACKGROUND

After 2020, clinical practice recommendations have been released to inform cardiac rehabilitation (CR) programs of best practices for post-COVID programming. The objective of this systematic review was to identify and summarize recommendations from clinical practice guidelines (CPGs) and consensus statements for CR delivery postpandemic.

METHODS

Five databases (March 2020 through April 2023), grey literature and Web sites of CR international associations were searched. Inclusion criteria were local, national, and international association-endorsed CPGs, and/or position, expert, and scientific statements related to CR delivery (program models, program elements, and core components). Two researchers independently screened the citations for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE) II was used for quality assessment. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guidelines.

RESULTS

Overall, 4890 records were identified; 4 CPGs, 9 position/scientific statements, and 6 expert/Delphi consensus papers were included. All guidelines/statements included information related to program delivery models, with 95% endorsing the use of virtual, hybrid, home-based, and telerehabilitation, especially during the pandemic. Outside of the context of COVID-19, program components including referral, CR indications, CR contraindications, timing, and structure were included in the 4 CPGs and 2 of 15 statements. Recommendations related to CR core components were primarily focused on exercise, with no changes since before the pandemic except for COVID-19 considerations for safety. One guideline was specific to women, and 1 scientific statement to heart failure with preserved ejection fraction.

CONCLUSIONS

Although 19 documents were identified, CR delivery in low resource settings and for culturally and linguistically diverse populations require attention. Additionally, few recommendations on nutrition, psychosocial counselling, and patient education were reported.

Which Components of The International Classification of Functioning, Disability and Health (ICF) are Covered by Cardiac Rehabilitation Assessment Tools among Individuals with Heart Failure?

BACKGROUND

The therapeutic assessment of functioning in cardiac rehabilitation from the perspective of the International Classification of Functioning, Disability and Health (ICF) can provide a biopsychosocial approach to health care. However, it is unclear which components are reflected in the instruments used for cardiac rehabilitation in individuals with heart failure (HF).

OBJECTIVES

To investigate which ICF components (body function, structures, activities, participation, environmental factors, and personal factors) are represented in the assessment instruments used in individuals with HF and to identify the most appropriate instrument to use based on the inclusion of these factors.

METHODS

Forty-four clinical trials included in an updated Cochrane systematic review that investigated the effects of exercise-based cardiac rehabilitation in patients with HF were reviewed. The instruments were analyzed to extract significant concepts linked to the ICF codes.

RESULTS

A total of 12 outcomes and 40 instruments were identified. The concepts were linked to 2466 codes in the following ICF components: body functions (41.8%), activities (29.7%), participation (8.4%), environmental factors (3.8%), personal factors (1.3%), and body structures (1.0%); other concepts (13.9%) were classified as not covered by ICF. None of the instruments presented concepts linked to all ICF components. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), however, demonstrated comprehensive coverage of the ICF components, with the exception of body structure.

CONCLUSIONS

Body function was the most frequently detected ICF component. Individual instruments did not provide a comprehensive perspective on the functioning level of individuals with HF. The MLHFQ provided the greatest coverage of ICF components.

Construction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study

OBJECTIVE

to construct and validate an educational booklet for self-care of patients in the postoperative period of cardiac surgery.

METHODS

methodological study, including bibliographic survey, construction of the booklet and validation with judges and the target audience. For validation with judges, the Health Educational Content Validation Instrument was used, and with the target audience, an instrument was used with questions related to organization, writing style, appearance and motivation. To analyze the judges' answers, the content validation index was used.

RESULTS

the booklet was prepared with 14 topics. The content validation index among the eight judges was 1 and the concordance index among the ten patients was above 80%. The final version of the material was made available in printed format.

CONCLUSION

the educational booklet was developed and validated by judges and the target audience, serving as an educational support tool for self-care of patients in the postoperative period of cardiac surgery.

Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test

BACKGROUND

Central Illustration : Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test CPET: cardiopulmonary exercise test; TUG: timed up and go test; VO2peak: peak oxygen consumption.

BACKGROUND

The use of the timed up and go (TUG) test to assess cardiorespiratory fitness in patients with heart disease has not been well defined in the literature.

OBJECTIVES

Test the association between TUG and peak oxygen consumption (VO2peak), construct an equation based on TUG to predict VO2peak, and determine a cutoff point to estimate VO2peak ≥ 20 mL/kg/min.

METHODS

This cross-sectional study included 201 patients with coronary artery disease or heart failure, between 36 and 92 years of age, who underwent TUG and cardiopulmonary exercise test. Correlation, ROC curve, multiple linear regression, and Bland-Altman analyses were performed. The significance level was set at p < 0.05.

RESULTS

The mean age of the total sample was 67 ± 13 years, and 70% of participants were male. The mean VO2peak was 17 ± 6 mL/kg/min, and the mean TUG time was 7 ± 2.5 seconds. The correlation between VO2peak and TUG was r = -0.54 (p < 0.001), and R2 was 0.30. The following equation was developed based on TUG: V O 2 peak = 33.553 + ( - 0.149 × age ) + ( - 0.738 × TUG ) + ( - 2.870 × sex ) ; a value of 0 was assigned to the male sex and 1 to the female sex (adjusted R: 0.41; adjusted R2: 0.40). The VO2peak estimated by the equation was 18.81 ± 3.2 mL/kg/min, and the VO2peak determined by cardiopulmonary exercise test was 18.18 ± 5.9 mL/kg/min (p > 0.05). The best cutoff point in the TUG for VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds (area under the curve: 0.80; 95% confidence interval: 0.74 to 0.86).

CONCLUSIONS

TUG and VO2peak showed a significant association. A prediction equation for VO2peak was developed and validated internally with good performance. The cutoff point in the TUG to predict VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds.

Effects of exercise on platelet reactivity after myocardial infarction: a randomized clinical trial

Exercise training (ET) can lower platelet reactivity in patients with cardiovascular risk factors. However, the effects of ET on platelet reactivity in higher-risk patients is unknown. The aim of this study was to evaluate the effects of ET on platelet reactivity in patients with recent myocardial infarction (MI). Ninety patients were randomly assigned 1 month post-MI to the intervention (patients submitted to a supervised ET program) or control group. All patients were on dual antiplatelet therapy (DAPT). Platelet reactivity by VerifyNow-P2Y12 (measured by P2Y12 reaction units - PRUs) test was determined at baseline and at the end of 14 ± 2 weeks of follow-up at rest (primary endpoint), and multiplate electrode aggregometry (MEA) adenosine diphosphate (ADP) and aspirin (ASPI) tests were performed immediately before and after the maximal cardiopulmonary exercise test (CPET) at the same time points (secondary endpoints). Sixty-five patients (mean age 58.9 ± 10 years; 73.8% men; 60% ST elevation MI) completed follow-up (control group, n = 31; intervention group, n = 34). At the end of the follow-up, the mean platelet reactivity was 172.8 ± 68.9 PRUs and 166.9 ± 65.1 PRUs for the control and intervention groups, respectively (p = .72). Platelet reactivity was significantly increased after the CPET compared to rest at the beginning and at the end of the 14-week follow-up (among the intervention groups) by the MEA-ADP and MEA-ASPI tests (p < .01 for all analyses). In post-MI patients on DAPT, 14 weeks of supervised ET did not reduce platelet reactivity. Moreover, platelet reactivity was increased after high-intensity exercise (ClinicalTrials.gov: NCT02958657; https://clinicaltrials.gov/ct2/show/NCT02958657).

Melatonin supplementation enhances pulmonary rehabilitation outcomes in COPD: a randomized, double-blind, placebo-controlled study

Melatonin (MLT), the main product of the pineal gland, is involved in muscle tissue repair and regeneration, besides several other important physiologic functions. In COPD, MLT administration can improve lung oxidative stress and sleep quality, but its potential effects on the outcomes of pulmonary rehabilitation (PR) have not been previously investigated. A randomized controlled trial was undertaken to test the hypothesis that a combined approach of rehabilitative exercise training and MLT supplementation could maximize functional performance, health status and quality of life in patients with COPD. Thirty-nine individuals with COPD referred to a supervised PR program at the Federal University of Ceara, Brazil, were randomized to receive MLT (3 mg/day; n = 18) or placebo (n = 21). Exercise capacity (6-min walk test - 6MWT), health status (COPD assessment test), and quality of life (airways questionnaire 20) were investigated as primary outcomes. No differences were observed at baseline in demographic, anthropometric and clinical characteristics between MLT and placebo groups. At the end of PR, superiority of the MLT group was demonstrated in improvement in the distance covered in the 6MWT (71 ± 26 vs. 25 ± 36 m; p < 0.01), health status (-11 ± 6 vs. -3 ± 5; p < 0.01), and quality of life (-6.9 ± 3.0 vs. -1.9 ± 2.4; p < 0.01), compared to the placebo group. In conclusion, MLT supplementation during the course of 12 weeks of PR can improve functional capacity, health status and quality of life in patients with COPD. These findings may have significant implications for the management of this condition.

Perceived dyspnea and experience of hospitalized patients with acute decompensated heart failure undergoing an early MObilization protocol with immersive Virtual rEality: MOVE study protocol for a parallel superiority randomized clinical trial

BACKGROUND

Immersive virtual reality (VR) is an innovative strategy for inpatient rehabilitation programs. Using immersive VR in early mobilization protocols has not yet been investigated in the setting of hospitalized patients with acute decompensated heart failure (ADHF), especially to improve perceived dyspnea, a common symptom of heart failure (HF).

METHODS

This is a single-center parallel superiority randomized clinical trial. The study will be conducted at a public teaching hospital in Brazil from January 2023 to January 2024. The sample will include adult patients with ADHF hospitalized for at least 24 h, randomly assigned in a 1:1 ratio to the control (standard early mobilization protocol conducted in the intensive care unit (ICU)) or intervention group (the same standard early mobilization protocol but associated with immersive VR). The primary outcome will be assessing perceived dyspnea, and the secondary outcome will be assessing patient experience.

DISCUSSION

Using immersive VR in early mobilization protocols in the ICU is expected to improve perceived dyspnea in patients with ADHF as well as patient experience regarding care. This study has the potential to increase patient adherence to early mobilization protocols in the setting of ADHF as well as to promote a positive patient experience. Filling this gap could promote the rational incorporation of technologies in health care.

TRIAL REGISTRATION

This study protocol is in its first version.

CLINICALTRIALS

gov NCT05596292. Registered on 1 December 2022.

Aerobic Exercise Prescription in Cardiac Rehabilitation Based on Heart Rate from Talk Test Stages and 6-Minute Walk Test

BACKGROUND

Although the Talk Test (TT) is a reliable and low-cost test, its use for aerobic exercise prescription is still limited.

OBJECTIVE

To analyze the heart rate (HR) in the stages of the TT and at the peak of the 6-minute walk test (6MWT) as a parameter to prescribe aerobic exercise compared with HR at the first and second ventilatory thresholds (VT1 and VT2) of cardiopulmonary exercise test (CPET).

METHODS

Individuals with cardiovascular disease attended three assessment days: 1) anamnesis and CPET; 2) 6MWT; and 3) TT. One-way repeated measures ANOVA or Friedman's test were used to compare HR at VT1 and VT2 with HR at TT stages: last positive (TT+), first equivocal (TT±), and negative (TT-), and at the peak of the 6MWT. Pearson's or Spearman's test assessed correlations between HR at VTs, TT stages, and 6MWT. Statistical significance was set at 5%.

RESULTS

The study included 22 cardiac patients (13 men, 61 ± 8 years). HR at VT1 was similar to HR at TT+ (p = 0.987) and TT± (p = 0.154), and moderately correlated with TT+ (r = 0.479, p = 0.024). HR at VT2 was similar to TT- (p = 0.383), with a strong correlation (r = 0.757, p < 0.001). HR at the peak of the 6MWT was significantly different from HR at TT+, TT±, and VT1 (p = 0.001, p = 0.005, and p < 0.001, respectively) but similar to TT- (p = 0.68).

CONCLUSIONS

HR at TT+ and TT- reflect HR at VT1 and VT2, respectively, differently from 6MWT, which was similar only to VT2. TT may be an objective test to assist aerobic exercise prescription in cardiac rehabilitation.

Whole-body vibration exercise in the management of cardiovascular diseases: A systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are an important public health problem, representing about 45% of deaths in the world. Its management is linked to medications, changes in lifestyle, and physical exercise, with the whole-body vibration exercises (WBV) being a promising therapeutic resource. This study aims to investigate the effects of WBV in isolation or associated with other types of exercises in the management of CVDs.

METHODS

A systematic review following the PRISMA guidelines and registered on the PROSPERO platform was carried out. The search took place in the databases PubMed, Cochrane, PEDro, Lilacs, and Science Direct, from the beginning of the databases until January 2021. Descriptors related to WBV and CVD were used. The selected studies were assessed for quality, risk of bias, and level of evidence.

RESULTS

In all, 84 studies were identified, and of these, three were included. The intervention protocols used were analyzed, in addition to the effects of WBV on hemodynamic, cardiovascular, vascular/arterial, and muscle parameters.

CONCLUSION

The use of different WBV protocols, in isolation, in the improvement of the parameters mentioned above in individuals with CVD is plausible, with significant responses acutely or chronically and can be considered as a safe and effective training resource.

In the Cardiac Rehabilitation Era, is There a "No-Option" Refractory Angina Patient?: A Case Report

Exercise-based cardiac rehabilitation, an effective and safe adjuvant treatment recommended to patients with coronary artery disease, is scarcely applied to patients with refractory angina (RA) due to difficulties related to safety, trainning prescription and their clinical management. This case report presents an instance of a "no-option" patient with RA, who was included in a 12-week exercise program, in sessions consisted of 40 minutes of treadmill aerobic exercise, three times a week, and intensity prescribed between ischemic/angina threshold and ventilatory threshold 1, obtained in the cardiopulmonary exercise test; mild to moderate angina was allowed during training. Furthermore, 15 minutes of moderate-intensity resistance training (large group muscle exercises, two sets of 8 to 12 repetitions) was performed. At the end of the protocol, the patient presented an important improvement in functional performance (VO 2 peak 17.0 ml/kg/min to 27.3 ml/kg/min), angina threshold (HR 68 bpm to 95 bpm), and intensity chest pain (levels 7 to 5) with no clinical adverse events during the period. Exercise-based cardiac rehabilitation was safe, even in the occurrence of angina/ischemia during training, according to tolerability to symptoms and other warning clinical signs.

Exercise intensity domains determined by heart rate at the ventilatory thresholds in patients with cardiovascular disease: new insights and comparisons to cardiovascular rehabilitation prescription recommendations

Objectives

To compare the elicited exercise responses at ventilatory thresholds (VTs: VT1 and VT2) identified by cardiopulmonary exercise testing (CPET) in patients with cardiovascular disease (CVD) with the guideline-directed exercise intensity domains; to propose equations to predict heart rate (HR) at VTs; and to compare the accuracy of prescription methods.

Methods

A cross-sectional study was performed with 972 maximal treadmill CPET on patients with CVD. First, VTs were identified and compared with guideline-directed exercise intensity domains. Second, multivariate linear regression analyses were performed to generate prediction equations for HR at VTs. Finally, the accuracy of prescription methods was assessed by the mean absolute percentage error (MAPE).

Results

Significant dispersions of individual responses were found for VTs, with the same relative intensity of exercise corresponding to different guideline-directed exercise intensity domains. A mathematical error inherent to methods based on percentages of peak effort was identified, which may help to explain the dispersions. Tailored multivariable equations yielded r2 of 0.726 for VT1 and 0.901 for VT2. MAPE for the novel VT1 equation was 6.0%, lower than that for guideline-based prescription methods (9.5 to 23.8%). MAPE for the novel VT2 equation was 4.3%, lower than guideline-based methods (5.8%-19.3%).

Conclusion

The guideline-based exercise intensity domains for cardiovascular rehabilitation revealed inconsistencies and heterogeneity, which limits the currently used methods. New multivariable equations for patients with CVD were developed and demonstrated better accuracy, indicating that this methodology may be a valid alternative when CPET is unavailable.

Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.

Physiotherapeutic Approaches in the Rehabilitation of Patients After Severe Acute Respiratory Syndrome Coronavirus 2: A Scoping Review of In-Hospital Until Outpatient Phase

OBJECTIVES

This scoping review aimed to identify studies that address the use of physical therapy in the rehabilitation of adult and elderly patients after SARS-CoV-2 infection.

METHODS

This scoping review was based on Joanna Briggs Institute methodology: participant (P), represented by adult and elderly patients after SARS-CoV-2; concept (C), main physical therapy interventions; and context (C), recovery period after SARS-CoV-2 (in-hospital or outpatient phase). The following information sources were used: MEDLINE/PubMed, Cochrane Library, PEDro, Scopus, CINAHL, Web of Science, Science Direct, and Springer. The search was conducted between December 2019 and November 2021. Rayyan (Qatar Computing Research Institute, QCRI) was used for study selection process and analysis.

RESULTS

A total of 7,568 studies were identified; 11 were included in this review. The most frequent physical therapy interventions were those associated with pulmonary, cardiac, musculoskeletal, neurological, and digestive rehabilitation in adult and elderly patients after SARS-CoV-2. Physiotherapy interventions included aerobic exercises, respiratory muscle training, muscle strength training, breathing exercises, early mobilization, balance training, bronchial hygiene maneuvers, body positioning management, flexibility training, cognitive training, neuromuscular electrical stimulation, and trunk exercises.

CONCLUSION

Our study demonstrated the growing utility of therapeutic interventions, mainly in improving quality of life, as well as body functions after pulmonary, cardiac, neurological, digestive, and musculoskeletal rehabilitation in patients after SARS-CoV-2.

Spirituality, Functional Gain, and Quality of Life in Cardiovascular Rehabilitation

BACKGROUND

Religiosity and spirituality have been associated with higher recovery rates, greater adherence to treatments, and better levels of quality of life in patients with heart disease.

OBJECTIVES

To evaluate the association between spirituality, functional gain, and improved quality of life in patients in a cardiovascular rehabilitation program.

METHODS

This prospective cohort study evaluated the association between functional and quality of life gains during a cardiovascular rehabilitation program and a religiosity/spirituality index based on a validated scale. Depression, anxiety, and stress symptoms were screened for control purposes. P values < 0.05 were considered significant for all analyses.

RESULTS

The study followed 57 patients (66 ± 12 years old; 71.7% male; 76% with coronary artery disease). The Spearman correlation coefficient did not show any associations between increases in functional capacity and organizational (rs = 0.110; p = 0.421), non-organizational (rs = -0.007; p = 0.421), or intrinsic (rs = -0.083; p = 0.543) religiosity. Furthermore, no associations were detected between the results of a quality of life score and organizational (rs = 0.22; p = 0.871), non-organizational (rs = 0.191; p = 0.159), or intrinsic (rs = 0.108; p = 0.429) religiosity.

CONCLUSION

No association was detected between functional and quality of life gains and organizational, non-organizational, or intrinsic religiosity in this sample of patients undergoing cardiovascular rehabilitation.

Impact of COVID-19's on Cardiovascular Rehabilitation Programs in Brazil: An Online Survey-Based Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic had an impact on cardiovascular rehabilitation (CR) programs in Brazil.

OBJECTIVES

To describe the characteristics of CR programs in Brazil, the impacts of the first epidemiological wave of COVID-19 (first 60 days) on the programs and present the initiatives used to overcome the impacts.

METHOD

This cross-sectional and retrospective study utilized a specific online survey. Participants were coordinators of CR programs. Variables were presented by Brazilian geographic region and as the following categories: demographic, clinical and operational characteristics. The significance level for statistical analysis was set at 5%.

RESULTS

Fifty-nine CR programs were responsible for 5,349 patients, of which only 1,817 were post-acute cardiovascular events, which corresponded to 1.99% of hospitalized patients in the month prior to the survey (n=91,231). The greatest impact was the suspension of on-site activities, which occurred similarly in areas with the highest and the lowest rates of COVID-19 in the period. Forty-five programs (75%) were shortly interrupted, while three (5%) were ended. All 42 programs that already used remote rehabilitation strategies noticed a substantial increase in activities, based primarily on the use of media and video calling. Only three (5%) considered safe to see patients during the first 60 days.

CONCLUSIONS

There was a reduction in the number of CR programs with the COVID-19 pandemic. Telerehabilitation activities increased during the first two months of the COVID-19 pandemic, but this was not enough to overcome the reduction in CR program activities across Brazil.

Comparative effects of a cardiovascular rehabilitation program on functional capacity in patients with chronic chagasic cardiomyopathy with or without heart failure

PURPOSE

The aim of the present study was to evaluate the effects of cardiovascular rehabilitation (CR) on functional capacity of patients with chronic chagasic cardiomyopathy (CCC) and to compare the responses between CCC patients without and with heart failure (HF).

MATERIALS AND METHODS

A longitudinal observational retrospective study was carried out including 36 patients with CCC without HF (stage B2 [n = 7]) and with HF (stage C [n = 29]), who participated in a CR program. Functional capacity was assessed by a maximal progressive cardiopulmonary exercise test performed on a treadmill. The longitudinal effects of the CR on functional capacity were determined by linear mixed models that included an interaction term to evaluate the differential responses between patients without and with HF.

RESULTS

Significant improvements in peak oxygen consumption, resting heart rate and blood pressure, and maximum pulmonary ventilation were observed for the overall study sample, with no apparent differential effects according to the presence of HF.

CONCLUSIONS

CR significantly improved functional capacity of patients with CCC. The responses to CR appear to be similar among patients without and with HF, reinforcing the need for its inclusion as a standard treatment strategy of CCC.Implications for rehabilitationExercise-based cardiovascular rehabilitation (CR) is a safe strategy that improves functional capacity, cardiac function, and quality of life in patients with several cardiovascular diseases, and recent studies also suggested a potential beneficial effect of CR in chronic chagasic cardiomyopathy (CCC).In this observational study, CR seems to equally improve exercise capacity, resting heart rate, resting blood pressure, and maximum pulmonary ventilation in patients with CCC without (stage B2) and with heart failure (stage C).Cardiovascular rehabilitation should be included as a standard treatment strategy for patients with CCC, regardless the severity of cardiomyopathy.

Effects of High Intensity Interval Training versus Sprint Interval Training on Cardiac Autonomic Modulation in Healthy Women

BACKGROUND

For the prevention of cardiovascular diseases, the practice of physical exercises is an effective strategy in improving or maintaining cardiorespiratory health; however, a lack of time is a barrier to access and interval training appears as possible facilitator. This study aims to compare the effects of two interval training protocols on cardiac autonomic modulation in healthy women.

METHODS

we conducted a randomized clinical trial with 43 women with a mean age of 29.96 ± 6.25 years, allocated into two groups; high-intensity interval training (HIIT) consisting of four four-minute high-intensity sprints interspersed with three minutes of active recovery and the Sprint interval training (SIT) with four 30-s sprints all-out, interspersed with four minutes of recovery (active or passive).

RESULTS

the HIIT group presented better results for the patterns without variation (0V) variables (p = 0.022); Shannon entropy (p = 0.004) Conditional Entropy (p = 0.025). However, there was a significant group effect for some variables, Oxygen Volume (VO2) (p = 0.004), Square root of the mean quadratic differences between the adjacent normal R-R intervals (p = 0.002) and standard deviation of all normal R-R intervals recorded in a time interval (p = 0.003), demonstrating an improvement independent of the protocol.

CONCLUSION

we conclude that eight weeks of interval training were able to produce positive effects on cardiac autonomic modulation in healthy women, with better results for HIIT in this population.

Self-efficacy instruments for individuals with coronary artery disease: a systematic review protocol

INTRODUCTION

Self-efficacy is associated with management of diseases, psychological well-being, improved quality of life and rehabilitation adherence. Several instruments related to behaviour or specific disease (eg, coronary artery disease (CAD)) assess self-efficacy. The evaluation of cardiac self-efficacy in individuals with CAD will support healthcare professionals to improve self-efficacy via interventions; therefore, a suitable instrument is crucial. This systematic review aims to assess measurement properties, methodological quality and content of outcome measures of cardiac self-efficacy instruments for individuals with CAD.

METHODS AND ANALYSIS

The study has been developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and Consensus Norms for Selection of Health Measuring Instruments (COSMIN). The following databases will be searched: MEDLINE (Ovid), Web of Science, EMBASE and PsycINFO. Studies assessing measurement properties of cardiac self-efficacy instruments for individuals with CAD will be included. No date or language restrictions will be applied to the search. Two independent authors will be responsible for assessing the eligibility of studies. Methodological quality of studies will be assessed using the COSMIN RoB Checklist, and the Grading of Recommendations, Assessment, Development and Assessment will be used to assess the quality of each study. Two authors will independently evaluate the content of instruments and link this to the International Classification of Functioning, Disability and Health.

ETHICS AND DISSEMINATION

This study does not require ethics committee approval since it is based on previously published data. Evidence from this systematic review will be disseminated through publication in peer-reviewed journals and presentation at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42021262613.

Application and Measurement Properties of the Talk Test in Cardiopulmonary Patients: A Systematic Review

Background

The talk test (TT) evaluates the exercise intensity by measuring speech comfort level during aerobic exercise. There are several application protocols available to assess individuals with cardiopulmonary diseases. However, the measurement properties of the TT were not systematically reviewed yet.

Methods

A systematic review was developed, registered (CRD420181068930), and reported according to PRISMA Statement. Randomized clinical trials, cross-sectional studies, or series cases were identified through multiple databases and were selected if they presented concomitant speech provocation and an exercise test. Included studies were evaluated based on methodological quality (adapted New Castle-Ottawa Scale), descriptive quality (STROBE Statement), and risk of bias (COSMIN bias risk scale).

Results

Ten studies were included. Seven studies presented moderate to high quality and the majority presented good scores according to the STROBE statement. Four hundred and fourteen subjects performed the TT, the majority being patients with coronary artery disease. The test validity was supported by the included studies. Talk Test reliability was considered satisfactory, although only one study presented an adequate reliability analysis. The studies found a correlation between the last positive stage of the TT with the first ventilatory threshold. Workload, oxygen uptake, and heart rate in the last positive stage of the TT were not different from the same parameters related to the first ventilatory threshold.

Conclusions

The evidence indicates that the TT is suitable as an alternative tool for the assessment and prescription of exercise in individuals with cardiovascular diseases. The stage when the individual is still able to speak comfortably is suggested as the intensity for aerobic exercise prescription. As there is still no well-defined and fully explored TT protocol, caution is required when interpreting the TT results.

Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study

OBJECTIVES

The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC).

METHODS

Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO_2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by β coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0).

RESULTS

The intervention group presented higher costs with healthcare visits (β = +3317.3; p < 0.001), hospitalisation (β = +2810.4; p = 0.02) and total cost (β = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (β = +2455.8; p < 0.001) and total cost (β = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg^-1  min^-1 of VO_2peak .

CONCLUSIONS

The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.