Effects of physical exercise on the autonomic nervous system in patients with coronary artery disease: a systematic review

BACKGROUND

Imbalance in autonomic modulation can occur after a cardiac event, which can lead to deleterious consequences. Exercise has proven to be a therapy which affects this modulation and can be assessed through heart rate variability (HRV).

AREAS COVERED

The objective of this systematic review was to investigate the effects of physical exercise on heart rate variability in individuals with coronary artery disease (CAD). The PubMed, PEDro, Scielo, Lilacs and Cochrane databases were systematically searched, for articles which performed supervised exercises in phase II of cardiac rehabilitation in patients with CAD.

EXPERT OPINION

Given the differences between studies on interventions and population characteristics, it is difficult to justify similarities or divergences in terms of results. In addition to the variation in sample size, intervention duration, carrying out an additional program at home, and patients with different clinical presentations, it can be inferred that responses to exercise may vary for certain types/clinical profile of individuals with CAD. Thus, it is necessary to carry out more studies with greater methodological rigor, greater standardization of the variables studied and the evaluation forms, in order to increase the veracity of the results and the consequent clinical relevance and therapeutic application.

Knowledge of physiotherapists working in adult ICU on contraindications to mobilization

Abstract Introduction: Mobilization is an effective therapy to combat the deleterious effects of immobility, but not all patients are in a condition to be moved; thus, knowledge about contraindication criteria is fundamental. Objective: To evaluate the knowledge of physiotherapists working in adult ICUs on contraindications to the mobilization of critical patients. Method: This was a cross-sectional study in which a survey was applied to physiotherapists working in an adult ICU in the city of Recife. Results: Out of the 36 criteria presented, only five were considered contraindication criteria. Clinical parameters were those that obtained higher frequency for not being considered criteria for contraindication, nor were there observed differences in the relation between the time of working in the ICU. Conclusion: Most physiotherapists did not consider the criteria presented as contraindications to mobilization, so that professional training in mobilization practices and the creation of protocols are necessary.

Effects of noninvasive ventilation on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis: randomized controlled trial

BACKGROUND

Dyspnea and exercise intolerance are the symptoms that most affect the quality of life of children and adolescents with respiratory disorders resulting from cystic fibrosis (CF).

OBJECTIVE

To evaluate the effect of noninvasive ventilation (NIV) on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis patients.

METHOD

Crossover clinical trial, randomized, controlled and open with 13 children and adolescents with CF, aged 7-16 years, with pulmonary impairment (NTC01987271). The patients performed a treadmill walking test (TWT) during 6 min, with and without NIV on a BiLEVEL mode, an interval of 24-48 h between tests. Before and after each test, patients were assessed by spirometry and optoelectronic plethysmography.

RESULTS

Walking distance in TWT with NIV was significantly higher that without ventilatory support (mean ± sd: 0.41 ± 0.08 vs. 0.39 ± 0.85 km, p = 0.039). TWT with NIV increase forced expiratory volume on 1 s (FEV1; p = 0.036), tidal volume (Vt; p = 0.005), minute ventilation (MV; p = 0.013), pulmonary rib cage volume (Vrcp; p = 0.011), and decrease the abdominal volume (Vab; p = 0.013) after test. There was a significant reduction in oxygen saturation (p = 0.018) and permanent increase in respiratory rate after 5 min (p = 0.021) after the end test without NIV.

CONCLUSION

During the walking test on the treadmill, the NIV change thoracoabdominal kinematics and lung function in order to optimized ventilation and tissue oxygenation, with improvement of walk distance. Consequently, NIV is an effective tool to increase functional capacity in children and adolescents with cystic fibrosis.

Influência dos corticosteroides inalatórios nas pressões respiratórias máximas de crianças escolares asmáticas

INTRODUÇÃO: O corticosteroide inalatório (CI) é o principal medicamento utilizado no tratamento profilático e de manutencão da asma. Graças à superdosagem ou ao uso prolongado dos CIs podem surgir efeitos colaterais como a redução do crescimento ósseo, supressão adrenal e miopatia. OBJETIVOS: Avaliar a influência dos corticosteroides inalatórios nas pressões inspiratórias (PImax) e expiratórias (PEmax) máximas de crianças escolares asmáticas. MATERIAIS E MÉTODOS: Estudo transversal, observacional, que incluiu 60 crianças entre 6 e 12 anos de idade divididas em três grupos: controle (CG), asma (GA) e crianças com asma que faziam uso de CI por pelo menos três meses (GA+CI). As avaliações das pressões respiratórias foram realizadas em três dias diferentes com intervalo de 12 dias entre elas. RESULTADOS: A média ± DP da PImax no terceiro dia foi - (65,4 ± 21,9), - (74,9 ± 19,5) e - (80,7 ± 21,5) cmH2O para os grupos GA, GA+CI e GC, respectivamente. A PImax foi menor no GA em relação ao GC (p < 0,05). A média ± DP da PEmax no terceiro dia foi 52,7 ± 14,8; 61,7 ± 17,4; e 75,6 ± 18,4 cmH2O para os grupos GA, GA+CI e GC, respectivamente. A PEmax foi maior no GC em relação ao GA (p < 0,05). A PEmax foi maior no GC em relação ao GA+CI (p < 0,05). CONCLUSÕES: Os resultados sugerem que os CIs promovem maior controle da hiperinsuflação pulmonar com aumento da PImax nas crianças com asma, porém promovem também redução da PEmax, provavelmente em razão do efeito do CI sobre as fibras musculares tipo II.